Monte Carlo-based patient internal dosimetry in fluoroscopy-guided interventional procedures: A review

Abstract

This systematic review aims to understand the dose estimation approaches and their major challenges. Specifically, we focused on state-of-the-art Monte Carlo (MC) methods in fluoroscopy-guided interventional procedures. Methods: All relevant studies were identified through keyword searches in electronic databases from inception until September 2020. The searched publications were reviewed, categorised and analysed based on their respective methodology.Results: Hundred and one publications were identified which utilised existing MC-based applications/programs or customised MC simulations. Two outstanding challenges were identified that contribute to uncertainties in the virtual simulation reconstruction. The first challenge involves the use of anatomical models to represent individuals. Currently, phantom libraries best balance the needs of clinical practicality with those of specificity. However, mismatches of anatomical variations including body size and organ shape can create significant discrepancies in dose estimations. The second challenge is that the exact positioning of the patient relative to the beam is generally unknown. Most dose prediction models assume the patient is located centrally on the examination couch, which can lead to significant errors. Conclusion:The continuing rise of computing power suggests a near future where MC methods become practical for routine clinical dosimetry. Dynamic, deformable phantoms help to improve patient specificity, but at present are only limited to adjustment of gross body volume. Dynamic internal organ displacement or reshaping is likely the next logical frontier. Image-based alignment is probably the most promising solution to enable this, but it must be automated to be clinically practical.

Lean, Six Sigma, and Simulation: Evidence from Healthcare Interventions

“…Although few interventions of ABS along with lean or six sigma exist, the applicability of this dual intervention in healthcare seems promising as more attention is required for patient and staff interactions. Despite the fact that Monte Carlo (MC) simulation has been used on its own in different healthcare settings [170,171], we did not find a dual intervention of MC and improvement approaches.…”

Associated radiation exposure from medical imaging and excess lifetime risk of developing cancer in pediatric patients with pulmonary hypertension

“…As a result, the exam's total DAP was modeled as a single long exposure. Using an organ‐centric approach to estimate dose localization has been accepted for cardiac catheterization cases given current capacity of available technology and models used 12 . When DICOM reports were unavailable, DAP was extracted from procedure notes describing the cardiac catheterization case in the EHR.…”

“…Using an organ‐centric approach to estimate dose localization has been accepted for cardiac catheterization cases given current capacity of available technology and models used. 12 When DICOM reports were unavailable, DAP was extracted from procedure notes describing the cardiac catheterization case in the EHR. When X‐ray beam data were unavailable, beam energy, height, width, and location of the irradiated field, and beam angle measurements were imputed using median of data based on age.…”

Fluoroscopically guided vascular and cardiac transcatheter procedures: a comparison of occupational and patient dose by anatomical region

“…As the numbers and types of procedures performed by non-radiologists grow, so does the need for dedicated fluoroscopic suites beyond their traditional location within the medical imaging department and, as a consequence, there may be less awareness of the potential radiation risks and mitigation strategies by the staff performing them [ 2 , 5 ]. Due to the potentially detrimental effects to both the patient and staff involved [ 6 ], there are justifiable concerns over the radiation exposure during fluoroscopic procedures.…”

“…Skin damage to patients following fluoroscopically guided procedures has been well reported [ 8 , 9 ], as has the incidence of subcapsular cataracts in occupationally exposed staff [ 10 , 11 ]. Unlike visible tissue changes to the skin or the eyes, it is more difficult to observe tissue changes in internal organs and vascular systems [ 6 ]. It has been reported that there may be a causal relationship between occupational exposure and circulatory diseases [ 12 , 13 ], DNA damage [ 14 ], cognitive impairment [ 15 , 16 ] and the formation of cancer [ 17 ].…”