Skin Dose Mapping in Interventional Cardiology: A Practical Solution

Abstract

<jats:title>Abstract</jats:title> <jats:p>Numerous cases of radiation-induced tissue reactions following interventional cardiology (IC) procedures have been reported, resulting in the need for an optimized and personalized dosimetry. At present, there are many fluoroscopy units without Digital Imaging and Communications in Medicine (DICOM) Radiation Dose Structured Report globally installed. Many of these have not been updated yet, and may never be, therefore, the main objectives of this paper are to develop an offline skin dose mapping application, which uses DICOM headers for the peak skin dose (PSD) assessment and to compare the PSD assessment results to XR-RV3 Gafchromic film for common IC procedures. The mean deviation between the measured and the calculated PSD was 8.7 ± 26.3%. Simulated skin dose map showed good matching with XR-RV3 Gafchromic film. The skin dose mapping application presented in this paper is an elegant solution and a suitable alternative to XR-RV3 Gafchromic film.</jats:p>

Accuracy of skin dose mapping in interventional cardiology: Comparison of 10 software products following a common protocol

“…For patient studies with DoseMap [13] [16], em.dose [14] [15] and SkinCare [11], which included between 10 and 86 procedures, the result ranges were considerably larger than observed during simulated procedures in the present study. The absolute maximum deviation, however, was comparable for em.dose [14] [15] and SkinCare [11] Table 5: comparison of skin dose mapping (SDM) software results with existing literature.…”

“…As the number and complexity of IC procedures have been steadily growing [2,3], patient-specific dose calculation in IC has become a priority for European professional societies [4] and a European dosimetry network [5] over the years. To address this issue, online and offline skin dose mapping (SDM) software products have been developed to estimate the skin dose delivered to the patient during IC procedures [6][7][8][9][10][11]. A recent review of the literature can be found in Malchair et al [12].…”

“…Various studies have compared skin dose measurements with SDM software. Some studies included real clinical cases [11,[13][14][15][16] while others used physical phantoms [8,10,15,[17][18][19]. The dosimetric capabilities and accuracy of the SDM products could strongly differ depending on the irradiation settings and the interventional X-ray system tested.…”

Quality assurance of dose management systems

“…From this publication it follows that prior to the use of the DMS skin dose map, dose validation tests are necessary to compare calculated and measured dose distributions. Publications of skin dose validation for different DMS's are available and may provide the required answer [23,24,25]. A straightforward validation method would consist of comparing calculated and measured skin dose distributions using radiochromic films or thermoluminescent dosimeters (or any other validated dosimeter that measures both incident and backscattered radiation).…”

Optimization of the Maximum Skin Dose Measurement Technique Using Digital Imaging and Communication in Medicine—Radiation Dose Structured Report Data for Patients Undergoing Cerebral Angiography

“…When considering alternative means of direct D skin, max measurements in real time, the correlation between the indirect measurement value, the air kerma at the patient entrance reference point (K a,r ) displayed on the device, and the directly measured D skin, max has been widely discussed [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. For directly measuring D skin,max , methods using thermoluminescent dosemeters (TLDs) [ 14 , 15 , 20 ] and Gafchromic film [ 15 , 16 , 17 , 18 , 19 , 20 ] have been reported. It was shown that the correlation between K a,r and the directly measured D skin,max is high, and if the K a,r values are measured accurately, D skin,max can be sufficiently predicted by indirect measurement through K a,r .…”