Comprehensive evaluation of broad‐beam transmission of patient supports from three fluoroscopy‐guided interventional systems

DeLorenzo, Matthew C.; Yang, Kai; Li, Xinhua; Liu, Bob

doi:10.1002/mp.12803

Cited by 10 publications

(10 citation statements)

References 12 publications

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“…Although this was corrected using

B_{PMMA}^{st}

, human patients are comprised of soft tissue, bone, and air, and a more thorough investigation of the scattering properties of these materials would be helpful to estimate skin dose more accurately. Another limitation was the use of a single support pad for both systems; previous work has shown a relationship between TTF and support pad thickness . Vendors typically quote the equivalent aluminum thickness (mm Al Eq.)…”

Section: Discussionmentioning

confidence: 99%

“…The energy spectrum incident on the patient skin for under‐table exposures would therefore differ from those oriented in the lateral direction. DeLorenzo et al showed that the patient support attenuates the x‐ray beam and becomes a source of forward scatter, and some combinations of table and pad can reduce the transmission of air kerma to 60% of its original value . With the presence of the patient support in mind, we hypothesize that PSD calculations would benefit from measuring BSF and TTF simultaneously to produce a single value for x‐ray beam orientations that intercept the patient support.…”

Section: Introductionmentioning

confidence: 96%

“…Two interventional fluoroscopic x‐ray systems were used in this study: the General Electric (GE) Innova 2100 with Omega V table, and the Siemens Artis Zee with Siemens Tabletop Narrow (CARD) table. Nominal values for attenuation and measured dimensions for these tables are provided in previous work . The support pad is by Burlington Medical (model MA‐09‐3979, Newport News, VA, USA) and is made of 100% high resilient polyurethane foam.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of skin dose calculation factors in interventional fluoroscopy

DeLorenzo

Goode

2019

J Applied Clin Med Phys

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PurposeThe purpose of this study was to measure fluoroscopic dose calculation factors for modern fluoroscopy‐guided interventional (FGI) systems, and to fit to analytical functions for peak skin dose (PSD) calculation.MethodsTable transmission factor (TTF), backscatter factor (BSF), and a newly termed kerma correction factor (KCF) were measured for two interventional fluoroscopy systems. For each setup, air kerma rates were measured using a small ionization chamber in fluoroscopic service mode while selecting kVp, copper (Cu) filter thickness, incident angle, and x‐ray field size at the assumed patient skin locations. Angle dependency on KCF was measured on the GE system at isocenter for angles of 0, 15, 30, and 40 degrees, using a range of kVp, Cu filters, and one field size. An analytical equation was created to fit the data to facilitate PSD calculation.ResultsFor the GE system, oblique incidence measurements show KCF decreased by about 2%, 8%, and 13% for incident angles of 15, 30, and 40°, respectively, relative to KCF at 0 degree. The GE and Siemens systems' KCFs ranged from 0.89 to 1.45, and 0.64 to 1.44, respectively. The KCFs increased with a power of field size, and generally increased with kVp and Cu filter. The average percentage difference between TTF × BSF × f and KCF was 16% at normal incidence. The KCF data were successfully fitted to function of angle, field size, kVp, and Cu filter thickness using seven parameters, with an average R‐squared value of 0.98 and maximum percentage difference of 6.0%.ConclusionsThis study evaluated scatter factors for two fluoroscopy systems, and dependencies on angle, kVp, Cu filter, and field size, with emphasis on under table beam orientations. Analytical fitting of the data with exposure parameters may facilitate PSD calculations, and more accurately determine the potential for radiation‐induced skin injury.

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“…Although this was corrected using

B_{PMMA}^{st}

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Evaluation of skin dose calculation factors in interventional fluoroscopy

DeLorenzo

Goode

2019

J Applied Clin Med Phys

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“…The effect of the patient table and the mattress on the x‐ray beam transmission is taken into account by using

italicTAF

which depends on beam quality, field size, and C‐arm angulation. DeLorenzo et al 33 . found that

italicTAF

values at 0° for table plus pad ranged from 0.59 to 0.89 for three different fluoroscopy systems.…”

Section: Methodsmentioning

confidence: 99%

Vendor‐independent skin dose mapping application for interventional radiology and cardiology

Krajinović

Kržanović

Ciraj-Bjelac

2021

J Applied Clin Med Phys

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Purpose The purpose of this paper is to present and validate an originally developed application SkinCare used for skin dose mapping in interventional procedures, which are associated with relatively high radiation doses to the patient’s skin and possible skin reactions. Methods SkinCare is an application tool for generating skin dose maps following interventional radiology and cardiology procedures using the realistic 3D patient models. Skin dose is calculated using data from Digital Imaging and Communications in Medicine (DICOM) Radiation Dose Structured Reports (RDSRs). SkinCare validation was performed by using the data from the Siemens Artis Zee Biplane fluoroscopy system and conducting “Acceptance and quality control protocols for skin dose calculating software solutions in interventional cardiology” developed and tested in the frame of the VERIDIC project. XR‐RV3 Gafchromic films were used as dosimeters to compare peak skin doses (PSDs) and dose maps obtained through measurements and calculations. DICOM RDSRs from four fluoroscopy systems of different vendors (Canon, GE, Philips, and Siemens) were used for the development of the SkinCare and for the comparison of skin dose maps generated using SkinCare to skin dose maps generated by different commercial software tools (Dose Tracking System (DTS) from Canon, RadimetricsTM from Bayer and RDM from MEDSQUARE). The same RDSRs generated during a cardiology clinical procedure (percutaneous coronary intervention—PCI) were used for comparison. Results Validation performed using VERIDIC's protocols for skin dose calculation software showed that PSD calculated by SkinCare is within 17% and 16% accuracy compared to measurements using XR‐RV3 Gafchromic films for fundamental irradiation setups and simplified clinical procedures, respectively. Good visual agreement between dose maps generated by SkinCare and DTS, RadimetricsTM and RDM was obtained. Conclusions SkinCare is proved to be very convenient solution that can be used for monitoring delivered dose following interventional procedures.

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“…The data obtained should be corrected for the attenuation of the couch to get a more accurate estimation of the dose to the investigated phantom. Transmission factors for the couch of several angiographic devices was measured as reported in DeLorenzo et al 10 .…”

Section: Methodsmentioning

confidence: 99%

DNA damage in lens epithelial cells exposed to occupationally-relevant X-ray doses and role in cataract formation

Udroiu

Sgura

Chendi

et al. 2020

Sci Rep

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The current framework of radiological protection of occupational exposed medical workers reduced the eye-lens equivalent dose limit from 150 to 20 mSv per year requiring an accurate dosimetric evaluation and an increase understanding of radiation induced effects on Lens cells considering the typical scenario of occupational exposed medical operators. Indeed, it is widely accepted that genomic damage of Lens epithelial cells (LEC) is a key mechanism of cataractogenesis. However, the relationship between apoptosis and cataractogenesis is still controversial. In this study biological and physical data are combined to improve the understanding of radiation induced effects on LEC. To characterize the occupational exposure of medical workers during angiographic procedures an INNOVA 4100 (General Electric Healthcare) equipment was used (scenario A). Additional experiments were conducted using a research tube (scenario B). For both scenarios, the frequencies of binucleated cells, micronuclei, p21-positive cells were assessed with different doses and dose rates. A Monte-Carlo study was conducted using a model for the photon generation with the X-ray tubes and with the Petri dishes considering the two different scenarios (A and B) to reproduce the experimental conditions and validate the irradiation setups to the cells. The simulation results have been tallied using the Monte Carlo code MCNP6. The spectral characteristics of the different X-ray beams have been estimated. All irradiated samples showed frequencies of micronuclei and p21-positive cells higher than the unirradiated controls. Differences in frequencies increased with the delivered dose measured with Gafchromic films XR-RV3. The spectrum incident on eye lens and Petri, as estimated with MCNP6, was in good agreement in the scenario A (confirming the experimental setup), while the mean energy spectrum was higher in the scenario B. Nevertheless, the response of LEC seemed mainly related to the measured absorbed dose. No effects on viability were detected. Our results support the hypothesis that apoptosis is not responsible for cataract induced by low doses of X-ray (i.e. 25 mGy) while the induction of transient p21 may interfere with the disassembly of the nuclear envelop in differentiating LEC, leading to cataract formation. Further studies are needed to better clarify the relationship we suggested between DNA damage, transient p21 induction and the inability of LEC enucleation.

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Comprehensive evaluation of broad‐beam transmission of patient supports from three fluoroscopy‐guided interventional systems

Cited by 10 publications

References 12 publications

Evaluation of skin dose calculation factors in interventional fluoroscopy

Evaluation of skin dose calculation factors in interventional fluoroscopy

Vendor‐independent skin dose mapping application for interventional radiology and cardiology

DNA damage in lens epithelial cells exposed to occupationally-relevant X-ray doses and role in cataract formation

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