Two measures of fluoroscopic image quality-high-contrast video spatial resolution and low-contrast video resolution-were assessed in 64 interventional cardiology catheterization laboratories. The results of high-contrast spatial resolution testing indicate variable levels of performance with median values of 1.5, 2.0, and 2.5 line pairs/mm at the three levels of magnification. The results of the low-contrast video resolution testing indicate clinically relevant limitations in performance. This was particularly true when testing was performed in a dynamic mode under simulated large patient conditions. Under these conditions, 50% of systems failed to detect a wire of diameter 0.017". In addition, limited system dynamic range was identified in a substantial fraction of laboratories and may contribute to these important variations in performance. Taken together, these findings serve to characterize overall system performance in the current era of interventional cardiology and reaffirm the continued need for image quality assessment programs.