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D'Alessio A, Strocchi S, Dalmasso F, Cannillo B, Matheoud R, Ponzetti A, Aimonetto S, Cernigliaro M, Azzalin G, Giorgianni A, Natrella M, Carriero A, Guzzardi G, Brambilla M. Effective and organ doses in patient undergoing interventional neuroradiology procedures: A multicentre study. Phys Med 2024; 122:103383. [PMID: 38810393 DOI: 10.1016/j.ejmp.2024.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/22/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Radiation doses to adult patients submitted to cerebral angiography and intracranial aneurysms treatments were assessed by using DICOM Radiation Dose Structured Reports (RDSR) and Monte Carlo simulations. Conversion factors to estimate effective and organ doses from Kerma-Area Product (PKA) values were determined. METHODS 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis. RESULTS Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose. CONCLUSIONS Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.
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Affiliation(s)
- Andrea D'Alessio
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
| | - Sabina Strocchi
- Medical Physics Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Federico Dalmasso
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Barbara Cannillo
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Roberta Matheoud
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Alex Ponzetti
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy; Medical Physics Postgraduate School, University of Turin, Turin, Italy
| | - Stefania Aimonetto
- Medical Physics Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | | | - Giulia Azzalin
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Andrea Giorgianni
- Neuroradiology Department, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Massimiliano Natrella
- Radiology Department, AUSL Valle d'Aosta 'U. Parini' Regional Hospital, Aosta, Italy
| | - Alessandro Carriero
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy
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Hadid-Beurrier L, Geryes BH, Jean-Pierre A, Gaudin PA, Feghali JA. Clinical benchmarking of a commercial software for skin dose estimation in cardiac, abdominal, and neurology interventional procedures. Med Phys 2024; 51:3687-3697. [PMID: 38277471 DOI: 10.1002/mp.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Radiation exposure from interventional radiology (IR) could lead to potential risk of skin injury in patients. Several dose monitoring software like radiation dose monitor (RDM) were developed to estimate the patient skin dose (PSD) distribution in IR. PURPOSE This study benchmarked the accuracy of RDM software in estimating PSD as compared to GafChromic film baseline in-vivo measurements on patients during cardiac, abdominal, and neurology IR procedures. METHODS The prospective study conducted in four IR departments included 81 IR procedures (25 cardiac, 31 abdominal, and 25 neurology procedures) on three angiographic systems. PSD and field geometry were measured by placing GafChromic film under the patient's back. Statistical analyses were performed to compare the software estimation and film measurement results in terms of PSD and geometric accuracy. RESULTS Median values of measured/calculated PSD were 1140/1005, 591/655.9, and 538/409.7 mGy for neurology, cardiac, and abdominal procedures, respectively. For all angiographic systems, the median (InterQuartile Range, IQR) difference between calculated and measured PSD was -10.2% (-21.8%-5.7%) for neurology, -4.5% (-19.5%-15.5%) for cardiac, and -21.9% (-38.7%--3.6%) for abdominal IR procedures. These differences were not significant for all procedures (p > 0.05). Discrepancies increased up to -82% in lower dose regions where the measurement uncertainties are higher. Regarding the geometric accuracy, RDM correctly reproduced the skin dose map and estimated PSD area dimensions closely matched those registered on films with a median (IQR) difference of 0 cm (-1-0.8 cm). CONCLUSIONS RDM is proved to be a useful solution for the estimation of PSD and skin dose distribution during abdominal, cardiac and neurology IR procedures despite a geometry phantom which is not specific to the latter type of IR procedures.
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Affiliation(s)
- Lama Hadid-Beurrier
- Medical Physics and Radiation Protection Department, APHP Lariboisière University Hospital, Paris, France
| | - Bouchra Habib Geryes
- Radiology Department, APHP Necker-Enfants Malades University Hospital, Paris, France
| | - Antonella Jean-Pierre
- Medical Physics and Radiation Protection Department, APHP Lariboisière University Hospital, Paris, France
| | - Paul-Adrien Gaudin
- URC Lariboisière-Saint Louis, Hôpital Fernand Widal, PARIS Cedex, France
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Nana RN, Inkoom S, Moyo MN, Mvoufo F, Hasford F, Owusu-Manteaw P, Motapon O. Patient skin dose measurement and risk of deterministic effect during fluoroscopy cardiac procedures. RADIATION PROTECTION DOSIMETRY 2023; 199:2053-2060. [PMID: 37491996 DOI: 10.1093/rpd/ncad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
This study aimed at assessing patient's peak skin doses (PSD) during fluoroscopy cardiac procedures and proposed a look up table to enhance patient's dose management. Perspex phantom and thermoluminescent dosemeters (TLD) were irradiated for different dose levels with X-ray equipment (Philips Azurion 7). It was found that PSD measures were higher than the kerma at the interventional reference point [K (IRP)] reported with factors 1.55, 1.75 and 2.88 for anterior posterior (AP0o), left anterior oblique (LAO45o) and right anterior oblique (RAO45o), respectively. The equations describing the correlation between the PSD measured kerma area product and cumulative air kerma were found with R-square values of 0.98 and 0.99, respectively. The statistical analysis shows a strong linear correlation between PSD and K (IRP) (P-value = 0.05). It was also found that 27% of the patients population considered in this work, received a skin dose higher than the threshold of deterministic effect of 2 Gy and a look up table with the equation of fitness were proposed to be implemented in the facility for K (IRP) higher than 500 mGy.
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Affiliation(s)
- Ruth Njantang Nana
- Fundamental Physics Laboratory, Postgraduate School for Fundamental and Applied Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- National Radiation Protection Agency (NRPA), P.O. Box 5331, Akwa, Douala, Cameroon
| | - Stephen Inkoom
- School of Nuclear and Allied Sciences, University of Ghana, P.O. Box AE 1, Atomic, Accra, Ghana
- Radation Protection Institute, Ghana Atomic Energy Commission, P.O. Box LG80, Legon, Accra, Ghana
| | - Maurice Ndontchueng Moyo
- Fundamental Physics Laboratory, Postgraduate School for Fundamental and Applied Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- National Radiation Protection Agency (NRPA), P.O. Box 5331, Akwa, Douala, Cameroon
| | - Fokou Mvoufo
- Fundamental Physics Laboratory, Postgraduate School for Fundamental and Applied Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- National Radiation Protection Agency (NRPA), P.O. Box 5331, Akwa, Douala, Cameroon
| | - Francis Hasford
- School of Nuclear and Allied Sciences, University of Ghana, P.O. Box AE 1, Atomic, Accra, Ghana
- Radiological and Medical Science Research Institute, Ghana Atomic Energy Commission, P.O. Box LG80, Legon, Accra, Ghana
| | - Philip Owusu-Manteaw
- Radation Protection Institute, Ghana Atomic Energy Commission, P.O. Box LG80, Legon, Accra, Ghana
| | - Ousmanou Motapon
- Fundamental Physics Laboratory, Postgraduate School for Fundamental and Applied Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- University of Maroua, Faculty of Science, P.O. Box 814, Maroua, Cameroon
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Villa M, Nasr B, Benoit D, Padoy N, Visvikis D, Bert J. Fast dose calculation in x-ray guided interventions by using deep learning. Phys Med Biol 2023; 68:164001. [PMID: 37433326 DOI: 10.1088/1361-6560/ace678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/11/2023] [Indexed: 07/13/2023]
Abstract
Objective.Patient dose estimation in x-ray-guided interventions is essential to prevent radiation-induced biological side effects. Current dose monitoring systems estimate the skin dose based in dose metrics such as the reference air kerma. However, these approximations do not take into account the exact patient morphology and organs composition. Furthermore, accurate organ dose estimation has not been proposed for these procedures. Monte Carlo simulation can accurately estimate the dose by recreating the irradiation process generated during the x-ray imaging, but at a high computation time, limiting an intra-operative application. This work presents a fast deep convolutional neural network trained with MC simulations for patient dose estimation during x-ray-guided interventions.Approach.We introduced a modified 3D U-Net that utilizes a patient's CT scan and the numerical values of imaging settings as input to produce a Monte Carlo dose map. To create a dataset of dose maps, we simulated the x-ray irradiation process for the abdominal region using a publicly available dataset of 82 patient CT scans. The simulation involved varying the angulation, position, and tube voltage of the x-ray source for each scan. We additionally conducted a clinical study during endovascular abdominal aortic repairs to validate the reliability of our Monte Carlo simulation dose maps. Dose measurements were taken at four specific anatomical points on the skin and compared to the corresponding simulated doses. The proposed network was trained using a 4-fold cross-validation approach with 65 patients, and evaluating the performance on the remaining 17 patients during testing.Main results.The clinical validation demonstrated a average error within the anatomical points of 5.1%. The network yielded test errors of 11.5 ± 4.6% and 6.2 ± 1.5% for peak and average skin doses, respectively. Furthermore, the mean errors for the abdominal region and pancreas doses were 5.0 ± 1.4% and 13.1 ± 2.7%, respectively.Significance.Our network can accurately predict a personalized 3D dose map considering the current imaging settings. A short computation time was achieved, making our approach a potential solution for dose monitoring and reporting commercial systems.
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Affiliation(s)
| | - Bahaa Nasr
- LaTIM, INSERM UMR1101, Brest, France
- Brest University Hospital, France
| | | | - Nicolas Padoy
- ICube, Strasbourg University, CNRS, Strasbourg, France
- IHU Strasbourg, France
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Anim-Sampong S, Antwi WK, Adomako JB, Botwe BO, Sarkodie BD, Brakohiapa EK. Patient radiation dose during diagnostic and interventional cardiology procedures: A study in a tertiary hospital. J Med Imaging Radiat Sci 2023; 54:298-305. [PMID: 36746713 DOI: 10.1016/j.jmir.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fluoroscopy-guided diagnostic and interventional cardiology (IC) procedures help to identify and treat several problems associated with the heart. However, these procedures expose patients, cardiologists, radiographers, and nurses to radiation doses. Due to the risk that ionizing radiation poses, concerns have been raised and studies are continually being done to ensure that optimization is achieved during such procedures. This study assessed patient radiation dose during diagnostic and interventional cardiology procedures as well as right heart studies at a tertiary hospital in Ghana to formulate the facility's diagnostic reference levels (DRLs) for optimization purposes. As this study was the first of its kind in Ghana, it was a vital step towards dose optimization within the local department, as well as contributing to future DRLs in Ghana. METHODS The study collected dose (air kerma, and kerma area product (KAP) and procedural data, and assessed any correlation between parameters such as fluoroscopy time and KAP, and between body mass index (BMI) and KAP. The DRL values were determined as the 75th percentile level for the dose distribution for the various IC procedures including percutaneous coronary interventions (PCI), coronary angiography (CA), and right heart catheterization (RHC). Data were analyzed using SPSS version 23. RESULTS CA was the most frequently performed IC procedure (77.3%), while RHC was the least recorded (3.3%). The highest mean KAP was observed during the PCI procedure. The proposed diagnostic reference levels (DRLs) were 162.0 Gy.cm2 (PCI), 69.4 Gy.cm2 (CA), 39.8 Gy.cm2 (RHC) and 159.9 Gy.cm2 (CA+PCI). Patients who presented for the CA+PCI and RHC procedures received the highest and lowest mean KAP of 159.9 Gy.cm2 and 39.8 Gy.cm2 of radiation respectively. CONCLUSION This study, therefore, concludes that there is a need for dose optimization of radiation exposures for IC procedures at the cardiothoracic center in Ghana.
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Affiliation(s)
- Samuel Anim-Sampong
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - William Kwadwo Antwi
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana.
| | - John Bright Adomako
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - Benard Ohene Botwe
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana; Department of Midwifery and Radiography Division School of Health & Psychological Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Benjamin Dabo Sarkodie
- Department of Radiology, University of Ghana School of Medical and Dental Science, Accra, Ghana
| | - Edmund K Brakohiapa
- Department of Radiology, University of Ghana School of Medical and Dental Science, Accra, Ghana
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Li X, Hirsch JA, Rehani MM, Yang K, Marschall TA, Liu B. Patient follow-up for possible radiation injury from fluoroscopically-guided interventions: Need to consider high cumulative exposure from multiple procedures. Phys Med 2023; 106:102521. [PMID: 36610179 DOI: 10.1016/j.ejmp.2022.102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Patient skin dose from interventional fluoroscopy procedures may exceed the threshold of tissue injuries and established guidelines recommend patient follow-up for air kerma at reference point (Ka,r) ≥ 5 Gy for individual procedures. Patients may undergo multiple procedures and skin injuries may be possible by cumulative exposure, even when individually insufficient to cause injury. This study sought to quantify the frequency of patients whose individual procedure doses are below 5 Gy but whose cumulative Ka,r is ≥ 5 Gy. METHODS This retrospective study analyzed 37,917 consecutive procedures in interventional radiology and vascular surgery at a tertiary-care hospital between January 2016 and June 2021. Radiation dosage was retrieved from the fluoroscopy acquisition systems. For a patient receiving multiple procedures, but each with Ka,r < 5 Gy, cumulative Ka,r within 2, 7, 14, 30, 183, and 365 days was assessed. RESULTS Nearly 1/3rd (37.4 %) patients underwent multiple procedures. With individual procedures of Ka,r < 5 Gy exclusively, 1.9, 4.4, and 5.6 in 1000 patients received cumulative Ka,r of 5-14.1 Gy from the procedures within 30, 183, and 365 days, respectively. From the procedures within 14 days, 1.3 in 1000 patients received cumulative Ka,r of 5-11.4 Gy; and from those within 7 days, 0.87 in 1000 patients received 5-9.1 Gy. In comparison, 4.3 in 1000 patients received Ka,r of 5-12 Gy from a single procedure. CONCLUSIONS In the absence of guidelines on patient follow-up for multiple procedures, our study may provide good material for setting up such guidelines.
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Affiliation(s)
- Xinhua Li
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Joshua Adam Hirsch
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Kai Yang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Theodore A Marschall
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Bob Liu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Samara ET, Fitousi N, Bosmans H. Quality assurance of dose management systems. Phys Med 2022; 99:10-15. [DOI: 10.1016/j.ejmp.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/05/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022] Open
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Vano E, Loose R, Frija G, Paulo G, Efstathopoulos E, Granata C, Corridori R, Torresin A, Andersson JS, Tsapaki V, Ammon J, Hoeschen C. Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures. Eur Radiol 2022; 32:5525-5531. [PMID: 35294584 PMCID: PMC9279248 DOI: 10.1007/s00330-022-08675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/04/2022]
Abstract
The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels. KEY POINTS: • Notifications and alerts on patient dose values for computed tomography (CT) and fluoroscopy-guided interventional procedures (FGIP) allow to improve radiation safety and contribute to the avoidance of radiation injuries and unintended and accidental exposures. • Alerts may be established before the imaging procedures (as in CT) or during and after the procedures as for FGIP. • Dose management systems should include notifications and alerts and their registry for the hospital quality programmes.
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Affiliation(s)
- Eliseo Vano
- Radiology Department, Complutense University, 28040, Madrid, Spain.
| | - Reinhard Loose
- Institute of Medical Physics, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| | - Guy Frija
- Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Graciano Paulo
- Medical Imaging and Radiotherapy Department, Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854, Coimbra, Portugal
| | - Efstathios Efstathopoulos
- Department of Radiology, Medical Physics Unit, National and Kapodistrian University of Athens, Attikon University Hospital, 12462, Athens, Greece
| | - Claudio Granata
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Virginia Tsapaki
- Medical Physics, Konstantopoulio General Hospital, Nea Ionia, Greece
| | - Josefin Ammon
- Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Christoph Hoeschen
- Institut Für Medizintechnik, Otto-Von-Guericke Universität, Magdeburg, Germany
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Fisher RF, Applegate KE, Berkowitz LK, Christianson O, Dave JK, DeWeese L, Harris N, Jafari ME, Jones AK, Kobistek RJ, Loughran B, Marous L, Miller DL, Schueler B, Schwarz BC, Springer A, Wunderle KA. AAPM Medical Physics Practice Guideline 12.a: Fluoroscopy dose management. J Appl Clin Med Phys 2022; 23:e13526. [PMID: 35174964 PMCID: PMC8906204 DOI: 10.1002/acm2.13526] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ryan F Fisher
- Department of Radiology, The Metro Health System, Cleveland, Ohio, USA
| | - Kimberly E Applegate
- Department of Radiology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | | | - Olav Christianson
- Clinical Dose Optimization Service, LANDAUER Medical Physics, Glenwood, Illinois, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lindsay DeWeese
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Nichole Harris
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mary Ellen Jafari
- Department of Radiation Physics & Safety, Atlantic Medical System Morristown, Morristown, New Jersey, USA
| | - A Kyle Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Brendan Loughran
- Clinical Dose Optimization Service™/OPTIMIZE™ Division, LANDAUER Medical Physics, Glenwood, Illinois, USA
| | - Loren Marous
- Upstate Medical Physics, P.C., Victor, New York, USA
| | - Donald L Miller
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Beth Schueler
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, USA
| | - Bryan C Schwarz
- Department of Radiology, University of Florida, Gainesville, Florida, USA
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Ria F, D’Ercole L, Origgi D, Paruccini N, Pierotti L, Rampado O, Rossetti V, Strocchi S, Torresin A, Torresin A, Pierotti L, Belli G, Bregant P, Isoardi P, Mari A, Nitrosi A, Nocetti L, Paruccini N, Quattrocchi MG, Radice A, Rampado O, Scrittori N, Sottocornola C, Strocchi S, Sutto M, Zatelli G, Acchiappati D, Aoja RA, Brambilla M, Branchini M, Cannatà V, Costi T, Cutaia C, D.’Ercole L, Del Vecchio A, Delle Canne S, Di Pasquale M, Elisabetta S, Fabbri C, Faico MD, Fantinato D, Ghetti C, Giannelli M, Giordano C, Grisotto S, Guidi G, Lisciandro F, Manco L, Giorgio Marini P, Moresco P, Oberhofer N, Origgi D, Palleri F, Pasquali C, Pasquino M, Peruzzo A, Petrillo G, Pini S, Rembado D, Ria F, Riccardi L, Rosasco R, Serelli G, Soavi R, Stasi M, Taddeucci A, Tonini E, Trianni A, Turano P, Venturi G, Zefiro D, Zito F. Statement of the Italian Association of Medical Physics (AIFM) task group on radiation dose monitoring systems. Insights Imaging 2022; 13:23. [PMID: 35124735 PMCID: PMC8818083 DOI: 10.1186/s13244-022-01155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
The evaluation of radiation burden in vivo is crucial in modern radiology as stated also in the European Directive 2013/59/Euratom—Basic Safety Standard. Although radiation dose monitoring can impact the justification and optimization of radiological procedure, as well as effective patient communication, standardization of radiation monitoring software is far to be achieved. Toward this goal, the Italian Association of Medical Physics (AIFM) published a report describing the state of the art and standard guidelines in radiation dose monitoring system quality assurance. This article reports the AIFM statement about radiation dose monitoring systems (RDMSs) summarizing the different critical points of the systems related to Medical Physicist Expert (MPE) activities before, during, and after their clinical implementation. In particular, the article describes the general aspects of radiation dose data management, radiation dose monitoring systems, data integrity, and data responsibilities. Furthermore, the acceptance tests that need to be implemented and the most relevant dosimetric data for each radiological modalities are reported under the MPE responsibility.
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11
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Fong G, Wunderle K. Technical Note: Relationship between peak skin dose and fluoroscopic K a,r : Clinical variations and application in establishing substantial radiation dose levels. Med Phys 2022; 49:935-942. [PMID: 34982480 DOI: 10.1002/mp.15441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The reference point cumulative air kerma (Ka,r ) is a commonly used dose quantity for establishing substantial radiation dose levels (SRDLs) that can provide guidance for patient dose management actions following fluoroscopically guided procedures. However, the Ka,r may not correlate well with the patient peak skin dose (Dskin,max ) because the relationship between Ka,r and Dskin,max may vary widely due to clinical variations. Therefore, it may be prudent for institutions to establish different Ka,r -based SRDL values based on the clinical procedure type. PURPOSE The present study investigates the relationship between Ka,r and Dskin,max for different clinical services and how that variation may overestimate or underestimate the need for patient follow-up. Additionally, the study suggests a possible framework for establishing Ka,r SRDLs based on the clinical data analysis. METHODS A retrospective analysis was performed for fluoroscopically guided interventions exceeding 5 Gy Ka,r . For each procedure, the patient Dskin,max was estimated and the ratio of Dskin,max to Ka,r (DKR) was calculated. Results were pooled into one of three clinical service categories: body interventions (n = 33), cardiac interventions (n = 81), or neurological (neuro) interventions (n = 44). The distributions in Ka,r , Dskin,max , and DKR were analyzed in aggregate and by the clinical service category. RESULTS The median Ka,r values for procedures exceeding 5 Gy were 6.0 Gy (95% CI [5.6, 6.4]) for body interventions, 5.8 Gy (95% CI [5.5, 6.0]) for cardiac interventions, and 6.3 Gy (95% CI [5.9, 6.6]) for neuro interventions. Dskin,max for the same procedure data sets were 5.0 Gy (95% CI [4.4, 5.6]) for body interventions, 5.5 Gy (95% CI [5.2, 5.8]) for cardiac interventions, and 3.7 Gy (95% CI [3.4, 4.0]) for neuro interventions. This resulted in median DKR values of 0.81 for body interventions, 0.91 for cardiac interventions, and 0.59 for neuro interventions. CONCLUSIONS This study illustrates the need to understand the relationship between the reported Ka,r and the patient Dskin,max for different types of interventional procedures. This is especially important when an institution uses Ka,r as the parameter for establishing an SRDL threshold to identify patients who may require clinical follow-up. The implications of this research and a guide for how to implement these findings are elaborated on in the Discussion.
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Affiliation(s)
- Grant Fong
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Wunderle
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Yamaguchi S, Ieko Y, Ariga H, Yoshioka K. Characterization of an under-development capacitor dosimeter equipped with a silicon x-ray diode. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:123101. [PMID: 34972425 DOI: 10.1063/5.0061061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/06/2021] [Indexed: 06/14/2023]
Abstract
Herein, we evaluated a capacitor dosimeter under development by a manufacturer, which is designed to monitor the entrance dose in x-ray diagnosis and comprises a silicon x-ray diode (Si-XD), a 0.1 µF capacitor, and a dosimeter dock. The Si-XD is a high-sensitivity photodiode optimized for x-ray detection. The dosimeter was charged to 3.30 V using the dock before x-ray irradiation. The charging voltage was reduced by photocurrents flowing through the Si-XD during irradiation, and the discharging voltage was measured. For the fundamental characterization of this capacitor dosimeter, we investigated the x-ray tube-current and tube-voltage dependences of the measured dose using an industrial x-ray tube; the angular dependence was also investigated. A commercially available semiconductor dosimeter (RaySafe ThinX) was used for dose calibration. The doses were proportional to the tube current at a constant tube voltage of 100 kV and increased with increasing tube voltage at a constant tube current of 1.0 mA. The dose difference with respect to the commercially available semiconductor dosimeter was within 1.0% when the tube current was varied and it was within 3.0% when the tube voltage was varied. In the angular dependence measurement, a difference of up to 6.0% was observed as the angle varied from 0° to 355° in steps of 5°. The dose-calibration results indicated that the determination of the initial charging voltage was important for dose conversion using the capacitor dosimeter.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Radiology, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
| | - Yoshiro Ieko
- Department of Radiation Oncology, Iwate Medical University Hospital, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
| | - Hisanori Ariga
- Department of Radiation Oncology, Iwate Medical University Hospital, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
| | - Kunihiro Yoshioka
- Department of Radiology, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
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Krajinović M, Vujisić M, Ciraj-Bjelac O. UNCERTAINTY ASSOCIATED WITH THE USE OF SOFTWARE SOLUTIONS UTILIZING DICOM RDSR FOR SKIN DOSE ASSESSMENT IN INTERVENTIONAL RADIOLOGY AND CARDIOLOGY. RADIATION PROTECTION DOSIMETRY 2021; 196:129-135. [PMID: 34580734 DOI: 10.1093/rpd/ncab146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/14/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE The purpose of this work is to provide a comprehensive analysis of uncertainties associated with the use of software solutions utilizing DICOM RDSRs for skin dose assessment in the interventional fluoroscopic environment. METHODS AND RESULTS Three different scenarios have been defined for determining the overall uncertainty, each with a specific assumption on the maximum deviations of factors affecting the calculated dose. Relative expanded uncertainty has been calculated using two approaches: the law of propagation of uncertainty and the propagation of distributions based on the Monte Carlo method. According to the propagation of uncertainty, it is estimated that the lowest possible relative expanded uncertainty of ~13% (at the 95% level of confidence, i.e. with the coverage factor of k = 2 assuming normal distribution) could only be achieved if all sources of uncertainties are carefully controlled, whereas maximum relative expanded uncertainty could reach up to 61% if none of the influencing parameters are controlled properly. When the influencing parameters are reasonably well-controlled, realistic relative expanded uncertainty amounts to 28%. Values for the relative expanded uncertainty obtained from the Monte Carlo propagation of distributions concur with the results obtained from the propagation of uncertainty to within 3% in all three considered scenarios, validating the assumption of normality. CONCLUSIONS The overall skin dose relative uncertainty has been found to range from 13 to 61%, emphasizing the importance of adequate analysis and control of all relevant uncertainty sources.
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Affiliation(s)
- Marko Krajinović
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
- "VINČA" Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Miloš Vujisić
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Olivera Ciraj-Bjelac
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
- "VINČA" Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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