Interventional and fluoroscopic imaging procedures for pediatric patients are becoming more prevalent because of the less-invasive nature of these procedures compared to alternatives such as surgery. Flat-panel X-ray detectors (FPD) for fluoroscopy are a new technology alternative to the image intensifier/TV (II/TV) digital system that has been in use for more than two decades. Two major FPD technologies have been implemented, based on indirect conversion of X-rays to light (using an X-ray scintillator) and then to proportional charge (using a photodiode), or direct conversion of X-rays into charge (using a semiconductor material) for signal acquisition and digitization. These detectors have proved very successful for high-exposure interventional procedures but lack the image quality of the II/TV system at the lowest exposure levels common in fluoroscopy. The benefits for FPD image quality include lack of geometric distortion, little or no veiling glare, a uniform response across the field-of-view, and improved ergonomics with better patient access. Better detective quantum efficiency indicates the possibility of reducing the patient dose in accordance with ALARA principles. However, first-generation FPD devices have been implemented with less than adequate acquisition flexibility (e.g., lack of tableside controls/information, inability to easily change protocols) and the presence of residual signals from previous exposures, and additional cost of equipment and long-term maintenance have been serious impediments to purchase and implementation. Technological advances of second generation and future hybrid FPD systems should solve many current issues. The answer to the question "how much better are they?" is "significantly better", and they are certainly worth consideration for replacement or new implementation of an imaging suite for pediatric fluoroscopy.
