Measuring Skin Dose With Radiochromic Dosimetry Film in the Cardiac Catheterization Laboratory

Giles, Edwin R.; Murphy, Paul H.

doi:10.1097/00004032-200206000-00017

Cited by 63 publications

(42 citation statements)

References 10 publications

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“…The performance claimed by the manufacturer may be overestimated, however (i.e. doses below 0.2 Gy may be less reliable [9,24]). Indeed, when the X-ray beam projection is far away from the vertical position (LOA 90 u , for instance, or close to it), the primary beam cannot intercept the film.…”

Section: Discussionmentioning

confidence: 99%

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Journy

Sinno‐Tellier²,

Maccia³

et al. 2012

BJR

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Objective: The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods: We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results: The mean MSD and DAP were respectively 389 mGy and 65 Gy cm 22 for CAs, and 916 mGy and 69 Gy cm 22 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r50.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion: Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. Interventional cardiology procedures such as repeated diagnostic coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) may cause radio-induced skin damage. Deterministic skin effects might occur as soon as the dose to the patient's skin exceeds 2 Gy and might correspond to a range of lesions from erythema to necrosis [1]. In relation to the risk of skin lesions, the X-ray dose depends on clinical, therapeutic and technical factors. First of all, the dose to the patient increases with increasing body mass index (BMI) [1][2][3]. Second, dose, fluoroscopy time and number of cine frames might differ depending on the number of treated vessels and/or stenoses [4][5][6], localisation and severity of lesions [2,7], stage of occlusion [7,8], tortuosity of treated vessels [6][7][8], number of stents and balloons [2,4,[7][8][9], and artery approach [10,11]. With the aim of optimising the interventional cardiology procedures (i.e. minimising the X-ray dose to the patient while preserving the quality of treatment), the use of low fluoroscopy pulse rate, image intensifier field size and collimation are recommended [1,12,13]. However, the studies that concluded that there was an impact on dose of some technical parameters had mostly used descriptive or univariate analyses and/or were carried out on a phantom [2,...

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Section: Discussionmentioning

confidence: 99%

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Journy

Sinno‐Tellier²,

Maccia³

et al. 2012

BJR

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“…The films were scanned with a Canon MX310 scanner (75 DPI, color mode) 24 h after the exposure, and the red channel of the image was used as recommended by Giles and Murphy. 19 All films were exposed and scanned in the same orientation, so as to minimize the error due to the polarization effect of the film. 20,21 A calibration curve was acquired by plotting the dose versus the respective red channel values 22 and fitting the data with a fourth degree polynomial equation which had an r 2 value of 0.997 48.…”

Section: H2 Comparison With Gafchromic Filmmentioning

confidence: 99%

A tracking system to calculate patient skin dose in real‐time during neurointerventional procedures using a biplane x‐ray imaging system

2016

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Purpose: Neurovascular interventional procedures using biplane fluoroscopic imaging systems can lead to increased risk of radiation-induced skin injuries. The authors developed a biplane dose tracking system (Biplane-DTS) to calculate the cumulative skin dose distribution from the frontal and lateral x-ray tubes and display it in real-time as a color-coded map on a 3D graphic of the patient for immediate feedback to the physician. The agreement of the calculated values with the dose measured on phantoms was evaluated. Methods: The Biplane-DTS consists of multiple components including 3D graphic models of the imaging system and patient, an interactive graphical user interface, a data acquisition module to collect geometry and exposure parameters, the computer graphics processing unit, and functions for determining which parts of the patient graphic skin surface are within the beam and for calculating dose. The dose is calculated to individual points on the patient graphic using premeasured calibration files of entrance skin dose per mAs including backscatter; corrections are applied for field area, distance from the focal spot and patient table and pad attenuation when appropriate. The agreement of the calculated patient skin dose and its spatial distribution with measured values was evaluated in 2D and 3D for simulated procedure conditions using a PMMA block phantom and an SK-150 head phantom, respectively. Dose values calculated by the Biplane-DTS were compared to the measurements made on the phantom surface with radiochromic film and a calibrated ionization chamber, which was also used to calibrate the DTS. The agreement with measurements was specifically evaluated with variation in kVp, gantry angle, and field size. Results: The dose tracking system that was developed is able to acquire data from the two x-ray gantries on a biplane imaging system and calculate the skin dose for each exposure pulse to those vertices of a patient graphic that are determined to be in the beam. The calculations are done in real-time with a typical graphic update time of 30 ms and an average vertex separation of 3 mm. With appropriate corrections applied, the Biplane-DTS was able to determine the entrance dose within 6% and the spatial distribution of the dose within 4% compared to the measurements with the ionization chamber and film for the SK150 head phantom. The cumulative dose for overlapping fields from both gantries showed similar agreement. Conclusions: The Biplane-DTS can provide a good estimate of the peak skin dose and cumulative skin dose distribution during biplane neurointerventional procedures. Real-time display of this information should help the physician manage patient dose to reduce the risk of radiation-induced skin injuries. C 2016 American Association of Physicists in Medicine. [http://dx

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“…Giles and Murphy 8 demonstrated that the optical density of an exposed GafChromic XR film became fairly stabilized by 24 h post exposure. They monitored the changes in the optical density to about 12 days post‐exposure.…”

Section: Discussionmentioning

confidence: 99%

“…– 3 Specifically, the GafChromic dosimetry media (International Specialty Products, Wayne, NJ) has been very useful for the mapping of dose distributions in radiation therapy 4 7 Increasing concern for the potentially high radiation dose in interventional radiological procedures has led to the use of radiochromic films in this imaging modality 8 . The GafChromic XR Type R Dosimetry film (International Specialty Products, Wayne, NJ) has recently been introduced to meet this need.…”

Section: Introductionmentioning

confidence: 99%

A study of GafChromic XR Type R film response with reflective‐type densitometers and economical flatbed scanners

Thomas

Chu

Rabe

2003

J Applied Clin Med Phys

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The GafChromic XR Type R film is a relatively new product for recording high radiation dose in interventional radiological procedures. Means of measuring the film response were studied in this investigation. Two handheld reflective‐type densitometers of different models were compared in the range of 0–8 Gy. They were found to be in excellent agreement. Five reflective flatbed scanners of different models were compared by a simple preliminary test. Their widely differed performances suggest the need of testing a scanner before using it for dosimetry measurement. A selected scanner was further tested for its ability to measure radiation in the range of 0–8 Gy and for the development of a scanning protocol. This experiment suggested the inclusion of a calibration pattern with known exposures and a black reference step in the scanning of a film in RGB mode. Then the red component of this image should be used for dosimetry computation. This method was compared to the use of a red acetate filter. The latter was demonstrated to be a possible alternative for measurement below 5 Gy and when there is no software ability to split an image into color components.PACS number(s): 87.66.–a, 87.52.–g

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Measuring Skin Dose With Radiochromic Dosimetry Film in the Cardiac Catheterization Laboratory

Cited by 63 publications

References 10 publications

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

A tracking system to calculate patient skin dose in real‐time during neurointerventional procedures using a biplane x‐ray imaging system

A study of GafChromic XR Type R film response with reflective‐type densitometers and economical flatbed scanners

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