1
|
Fum WK, Md Shah MN, Raja Aman RRA, Abd Kadir KA, Leong S, Tan LK. Automatic localization of anatomical landmarks in head cine fluoroscopy images via deep learning. Med Phys 2024. [PMID: 39140650 DOI: 10.1002/mp.17349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Fluoroscopy guided interventions (FGIs) pose a risk of prolonged radiation exposure; personalized patient dosimetry is necessary to improve patient safety during these procedures. However, current FGIs systems do not capture the precise exposure regions of the patient, making it challenging to perform patient-procedure-specific dosimetry. Thus, there is a pressing need to develop approaches to extract and use this information to enable personalized radiation dosimetry for interventional procedures. PURPOSE To propose a deep learning (DL) approach for the automatic localization of 3D anatomical landmarks on randomly collimated and magnified 2D head fluoroscopy images. MATERIALS AND METHODS The model was developed with datasets comprising 800 000 pseudo 2D synthetic images (mixture of vessel-enhanced and non-enhancement), each with 55 annotated anatomical landmarks (two are landmarks for eye lenses), generated from 135 retrospectively collected head computed tomography (CT) volumetric data. Before training, dynamic random cropping was performed to mimic the varied field-size collimation in FGI procedures. Gaussian-distributed additive noise was applied to each individual image to enhance the robustness of the DL model in handling image degradation that may occur during clinical image acquisition in a clinical environment. The model was trained with 629 370 synthetic images for approximately 275 000 iterations and evaluated against a synthetic image test set and a clinical fluoroscopy test set. RESULTS The model shows good performance in estimating in- and out-of-image landmark positions and shows feasibility to instantiate the skull shape. The model successfully detected 96.4% and 92.5% 2D and 3D landmarks, respectively, within a 10 mm error on synthetic test images. It demonstrated an average of 3.6 ± 2.3 mm mean radial error and successfully detected 96.8% 2D landmarks within 10 mm error on clinical fluoroscopy images. CONCLUSION Our deep-learning model successfully localizes anatomical landmarks and estimates the gross shape of skull structures from collimated 2D projection views. This method may help identify the exposure region required for patient-specific organ dosimetry in FGIs procedures.
Collapse
Affiliation(s)
- Wilbur Ks Fum
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Universiti Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Division of Radiological Sciences, Singapore General Hospital, Bukit Merah, Singapore
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Universiti Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Raja Rizal Azman Raja Aman
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Universiti Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azmi Abd Kadir
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Universiti Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Bukit Merah, Singapore
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Universiti Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
Portugal M, Baptista M, Vaz P, Belchior A. Patients’ organ dose and risk assessment in interventional cardiology procedures. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
4
|
Manicardi M, Nocetti L, Brigidi A, Cadioli C, Sgreccia D, Valenti AC, Vitolo M, Arrotti S, Monopoli DE, Sgura F, Rossi R, Guidi G, Boriani G. Anthropometric parameters and radiation doses during percutaneous coronary procedures. Phys Med 2022; 100:164-175. [PMID: 35901630 DOI: 10.1016/j.ejmp.2022.06.013] [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: 11/16/2021] [Revised: 05/24/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Body size is a major determinant of patient's dose during percutaneous coronary interventions (PCI). Body mass index, body surface area (BSA), lean body mass and weight are commonly used estimates for body size. We aim to identify which of these measures and which procedural/clinical characteristics can better predict received dose. METHODS Dose area product (DAP, Gycm2), fluoroscopy DAP rate (Gycm2/min), fluoroscopy DAP (Gycm2), cine-angiography DAP (Gycm2), Air Kerma (mGy) were selected as indices of patient radiation dose. Different clinical/procedural variables were analysed in multiple linear regression models with previously mentioned patient radiation dose parameters as end points. The best model for each of them was identified. RESULTS Overall 6623 PCI were analysed, median fluoroscopy DAP rate was 35 [IQR 2.7,4.4] Gycm2, median total DAP was 62.7 [IQR 38.1,107] Gycm2. Among all anthropometric variables, BSA showed the best correlation with all radiation dose parameters considered. Every 1 m2 increment in BSA added 4.861 Gycm2/min (95% CI [4.656, 5.067]) to fluoroscopy DAP rate and 164 Gycm2 (95% CI [145.3, 182.8]) to total DAP. Height and female sex were significantly associated to a reduction in fluoroscopy DAP rate and total DAP. Coronary angioplasty, diabetes, basal creatinine and the number of treated vessels were associated to higher values. CONCLUSIONS Main determinants of patient radiation dose are: BSA, female sex, height and number of treated vessels. In an era of increasing PCI complexity and obesity prevalence, these results can help clinicians tailoring X-ray administration to patient's size.
Collapse
Affiliation(s)
- Marcella Manicardi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Luca Nocetti
- Medical Physics Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Alessio Brigidi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Cecilia Cadioli
- Medical Physics Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Daria Sgreccia
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Daniel Enrique Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Fabio Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Rosario Rossi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gabriele Guidi
- Medical Physics Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
| |
Collapse
|
5
|
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
|
6
|
Bednarek DR. Real-Time Patient Skin Dose Mapping for Fluoroscopically Guided Interventional Procedures. J Vasc Interv Radiol 2022; 33:233-237. [PMID: 35221044 DOI: 10.1016/j.jvir.2021.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Daniel R Bednarek
- Department of Radiology, University at Buffalo, Clinical and Translational Research Center, 8th floor, 875 Ellicott Street, Buffalo, NY 14203.
| |
Collapse
|
7
|
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
| | | | | |
Collapse
|
8
|
Greffier J, Belaouni A, Dabli D, Goupil J, Perolat R, Akessoul P, Kammoun T, Hoballah A, Beregi JP, Frandon J. Comparison of peak skin dose and dose map obtained with real-time software and radiochromic films in patients undergoing abdominopelvic embolization. Diagn Interv Imaging 2022; 103:338-344. [DOI: 10.1016/j.diii.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
|
9
|
Feghali JA, Delépierre J, Belac OC, Dabin J, Deleu M, De Monte F, Dobric M, Gallagher A, Hadid-Beurrier L, Henry P, Hršak H, Kiernan T, Kumar R, Knežević Ž, Maccia C, Majer M, Malchair F, Noble S, Obrad D, Merce MS, Sideris G, Simantirakis G, Spaulding C, Tarantini G, Van Ngoc Ty C. Establishing a priori and a posteriori predictive models to assess patients' peak skin dose in interventional cardiology. Part 2: results of the VERIDIC project. Acta Radiol 2021; 64:125-138. [PMID: 34935520 DOI: 10.1177/02841851211062089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Optimizing patient exposure in interventional cardiology is key to avoid skin injuries. PURPOSE To establish predictive models of peak skin dose (PSD) during percutaneous coronary intervention (PCI), chronic total occlusion percutaneous coronary intervention (CTO), and transcatheter aortic valve implantation (TAVI) procedures. MATERIAL AND METHODS A total of 534 PCI, 219 CTO, and 209 TAVI were collected from 12 hospitals in eight European countries. Independent associations between PSD and clinical and technical dose determinants were examined for those procedures using multivariate statistical analysis. A priori and a posteriori predictive models were built using stepwise multiple linear regressions. A fourfold cross-validation was performed, and models' performance was evaluated using the root mean square error (RMSE), mean absolute percentage error (MAPE), coefficient of determination (R²), and linear correlation coefficient (r). RESULTS Multivariate analysis proved technical parameters to overweight clinical complexity indices with PSD mainly affected by fluoroscopy time, tube voltage, tube current, distance to detector, and tube angulation for PCI. For CTO, these were body mass index, tube voltage, and fluoroscopy contribution. For TAVI, these parameters were sex, fluoroscopy time, tube voltage, and cine acquisitions. When benchmarking the predictive models, the correlation coefficients were r = 0.45 for the a priori model and r = 0.89 for the a posteriori model for PCI. These were 0.44 and 0.67, respectively, for the CTO a priori and a posteriori models, and 0.58 and 0.74, respectively, for the TAVI a priori and a posteriori models. CONCLUSION A priori predictive models can help operators estimate the PSD before performing the intervention while a posteriori models are more accurate estimates and can be useful in the absence of skin dose mapping solutions.
Collapse
Affiliation(s)
- Joelle Ann Feghali
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Julie Delépierre
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Olivera Ciraj Belac
- Department of Radiation and Environmental Protection, Vinca Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jérémie Dabin
- SCK CEN Belgian Nuclear Research Center, Mol, Belgium
| | - Marine Deleu
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Milan Dobric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aoife Gallagher
- Department of Medical Physics, University Hospital Limerick, Limerick, Ireland
| | - Lama Hadid-Beurrier
- Department of Radiation Protection and Medical Physics, Lariboisière University Hospital, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Tom Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | | | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | | | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | | | - Marta Sans Merce
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Georgios Sideris
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Christian Spaulding
- Department of Cardiology, European Georges Pompidou University Hospital, Paris, France
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claire Van Ngoc Ty
- Department of Radiology, European Georges Pompidou Hospital, Paris, France
| |
Collapse
|
10
|
Fernández-Bosman D, von Barnekow A, Dabin J, Malchair F, Vanhavere F, Amor Duch M, Ginjaume M. Validation of organ dose calculations with PyMCGPU-IR in realistic interventional set-ups. Phys Med 2021; 93:29-37. [PMID: 34920380 DOI: 10.1016/j.ejmp.2021.12.004] [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: 07/20/2021] [Revised: 11/16/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Interventional radiology procedures are associated with high skin dose exposure. The 2013/59/EURATOM Directive establishes that the equipment used for interventional radiology must have a device or a feature informing the practitioner of relevant parameters for assessing patient dose at the end of the procedure. This work presents and validates PyMCGPU-IR, a patient dose monitoring tool for interventional cardiology and radiology procedures based on MC-GPU. MC-GPU is a freely available Monte Carlo (MC) code of photon transport in a voxelized geometry which uses the computational power of commodity Graphics Processing Unit cards (GPU) to accelerate calculations. METHODOLOGIES PyMCGPU-IR was validated against two different experimental set-ups. The first one consisted of skin dose measurements for different beam angulations on an adult Rando Alderson anthropomorphic phantom. The second consisted of organ dose measurements in three clinical procedures using the Rando Alderson phantom. RESULTS The results obtained for the skin dose measurements show differences below 6%. For the clinical procedures the differences are within 20% for most cases. CONCLUSIONS PyMCGPU-IR offers both, high performance and accuracy for dose assessment when compared with skin and organ dose measurements. It also allows the calculation of dose values at specific positions and organs, the dose distribution and the location of the maximum doses per organ. In addition, PyMCGPU-IR overcomes the time limitations of CPU-based MC codes.
Collapse
Affiliation(s)
| | - Ariel von Barnekow
- Universitat Politècnica de Catalunya, Avda. Diagonal 647, 08028 Barcelona, Spain
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium
| | | | - Filip Vanhavere
- Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium
| | - Maria Amor Duch
- Universitat Politècnica de Catalunya, Avda. Diagonal 647, 08028 Barcelona, Spain
| | - Mercè Ginjaume
- Universitat Politècnica de Catalunya, Avda. Diagonal 647, 08028 Barcelona, Spain
| |
Collapse
|
11
|
Petrovic B, Vicko F, Radovanovic D, Samac J, Tot A, Radovanovic Z, Ivkovic-Kapicl T, Lukic D, Marjanovic M, Ivanov O. Occupational radiation dose of personnel involved in sentinel node biopsy procedure. Phys Med 2021; 91:117-120. [PMID: 34773831 DOI: 10.1016/j.ejmp.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/24/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Sentinel node biopsy is a procedure used for axillary nodal staging in breast cancer surgery. The process uses radioactive 99mTc isotope for mapping the sentinel node(s) and all the staff involved in the procedure is potentially exposed to ionizing radiation. The colloid for radiolabelling (antimone-sulphide) with 99mTc isotope (half-life 6 h) is injected into the patient breast. The injection has activity of 18.5 MBq. The surgeon removes the primary tumor and detects active lymph nodes with gamma detection unit. The tumor as well as the active nodal tissue is transferred to pathologist for the definitive findings. The aim of the study was to measure dose equivalents to extremities and whole body for all staff and suggest practice improvement in order to minimize exposure risk. MATERIALS AND METHODS The measurements of the following operational quantities were performed: Hp(10) personal dose equivalent to whole body and Hp(0.07) to extremities for staff as well as ambiental dose for operating theatre and during injection. Hp(0.07) were measured at surgeon's finger by ring thermoluminescent dosimeter (TLD) type MTS-N, and reader RADOS RE2000. Surgeon and nurse were wearing TLD personal dosimeter at the chest level. Anesthesiologist and anesthetist were wearing electronic personal dosimeters, while pathologist was wearing ring TLD while manipulating tissue samples. Electronic dosimeters used were manufactured by Polimaster, type PM1610. All TLD and electronic dosimeters data were reported, including background radiation. Background radiation was also monitored separately. Personal TLDs are standard for this type of personal monitoring, provided by accredited laboratory. Measurements of ambiental dose in workplaces of other staff involved around the patient was performed before the surgery took place, by calibrated survey meters manufactured by Atomtex, type 1667. The study involved two surgeons and one pathologist, two anesthesiologists and three anesthetists during two months period. RESULTS AND DISCUSSION The doses received by all staff are evaluated using passive and active personal dosimeters and ambiental dose monitors and practice was improved based on results collected. Average annual whole body dose for all staff involved in the procedure was less than 0.8 mSv. Extremity dose equivalents to surgeon and pathologist were far below the limits set for professionally exposed (surgeon) and for public (pathologist). CONCLUSIONS Although has proven to be very safe for all staff, additional measures for radiation protection, in accordance to ALARA principle (As Low As Reasonably Achievable) should be conducted. The recommendations for practice improvement with respect to radiation protection were issued.
Collapse
Affiliation(s)
- Borislava Petrovic
- Faculty of Sciences, Department of Physics, University Novi Sad, Trg D. Obradovica 3, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia.
| | - Ferenc Vicko
- Faculty of Medicine, University Novi Sad, Hajduk Veljka 11, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Dragana Radovanovic
- Faculty of Medicine, University Novi Sad, Hajduk Veljka 11, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Jelena Samac
- Clinical Center Vojvodina, Department of Nuclear Medicine, Novi Sad, Serbia
| | - Arpad Tot
- Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia; Institute of Nuclear Sciences Vinca, PO Box 522, Vinca, Belgrade, Serbia
| | - Zoran Radovanovic
- Faculty of Medicine, University Novi Sad, Hajduk Veljka 11, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Tatjana Ivkovic-Kapicl
- Faculty of Medicine, University Novi Sad, Hajduk Veljka 11, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Dejan Lukic
- Faculty of Medicine, University Novi Sad, Hajduk Veljka 11, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Milana Marjanovic
- Faculty of Sciences, Department of Physics, University Novi Sad, Trg D. Obradovica 3, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Olivera Ivanov
- Faculty of Medicine, University Novi Sad, Hajduk Veljka 11, Novi Sad, Serbia; Oncology Institute Vojvodina, Put dr Goldmana 4, Sremska Kamenica, Serbia
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Papanastasiou E, Protopsaltis A, Finitsis S, Hatzidakis A, Prassopoulos P, Siountas A. Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures. Phys Med 2021; 89:63-71. [PMID: 34352677 DOI: 10.1016/j.ejmp.2021.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Institutional (local) Diagnostic Reference Levels for Cerebral Angiography (CA), Percutaneous Transhepatic Cholangiography (PTC), Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) are reported in this study. MATERIALS AND METHODS Data for air kerma-area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT) and number of images (NI) as well as estimates of Peak Skin Dose (PSD) were collected for 142 patients. Therapeutic procedure complexity was also evaluated, in an attempt to incorporate it into the DRL analysis. RESULTS Local PKA DRL values were 70, 34, 189 and 54 Gy.cm2 for CA, PTC, TACE and PTBD respectively. The corresponding DRL values for Ka,r were 494, 194, 1186 and 400 mGy, for FT they were 9.2, 14.2, 27.5 and 22.9 min, for the NI they were 844, 32, 602 and 13 and for PSD they were 254, 256, 1598 and 540 mGy respectively. PKA for medium complexity PTBD procedures was 2.5 times higher than for simple procedures. For TACE, the corresponding ratio was 1.6. PSD was estimated to be roughly 50% of recorded Ka,r for procedures in the head/neck region and 10% higher than recorded Ka,r for procedures in the body region. In only 5 cases the 2 Gy dose alarm threshold for skin deterministic effects was exceeded. CONCLUSION Procedure complexity can differentiate DRLs in Interventional Radiology procedures. PSD could be deduced with reasonable accuracy from values of Ka,r that are reported in every angiography system.
Collapse
Affiliation(s)
- Emmanouil Papanastasiou
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| | - Athanasios Protopsaltis
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Stefanos Finitsis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Adam Hatzidakis
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Panos Prassopoulos
- Department of Radiology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Anastasios Siountas
- Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| |
Collapse
|
14
|
Andersson J, Bednarek DR, Bolch W, Boltz T, Bosmans H, Gislason-Lee AJ, Granberg C, Hellstrom M, Kanal K, McDonagh E, Paden R, Pavlicek W, Khodadadegan Y, Torresin A, Trianni A, Zamora D. Estimation of patient skin dose in fluoroscopy: summary of a joint report by AAPM TG357 and EFOMP. Med Phys 2021; 48:e671-e696. [PMID: 33930183 DOI: 10.1002/mp.14910] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/04/2021] [Accepted: 04/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin. MATERIALS AND METHODS The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation. RESULTS The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed. CONCLUSIONS The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.
Collapse
Affiliation(s)
- Jonas Andersson
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Daniel R Bednarek
- State University of New York, 875 Ellicott St, Buffalo, NY, 14203-1070, USA
| | - Wesley Bolch
- University of Florida, 1275 Center Drive, Gainesville, FL, 32611-6131, USA
| | - Thomas Boltz
- Orange Factor Imaging Physicists, 4035 E Captain Dreyfus Ave, Phoenix, AZ, 85032, USA
| | - Hilde Bosmans
- University of Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | | | - Christoffer Granberg
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Max Hellstrom
- Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden
| | - Kalpana Kanal
- University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Ed McDonagh
- Joint Department of Physics, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Robert Paden
- Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | | | - Yasaman Khodadadegan
- Progressive Insurance, Customer Relation Management, 6300 Wilson Mills Rd., Mayfield Village, OH, 44143, USA
| | - Alberto Torresin
- Niguarda Ca'Granda Hospital, Via Leon Battista Alberti 5, Milano, 20149, Italy
| | - Annalisa Trianni
- Udine University Hospital, Piazzale S. Maria Della Misericordia, n. 15, 33100, Udine, Italy
| | - David Zamora
- University of Washington Medical Center, 6852 31st Ave NE, Seattle, WA, 98115-7245, USA
| |
Collapse
|
15
|
Werner GS, Yaginuma K, Koch M, Tischer K, Silber M, Werner J, Keuser T, Moehlis H. Reducing fluoroscopic and cineangiographic contribution to radiation exposure for chronic total coronary occlusion interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:58-64. [PMID: 33931375 DOI: 10.1016/j.carrev.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The treatment of chronic total coronary occlusions (CTO) carries the highest radiation exposure among percutaneous coronary interventions (PCI). In order to minimize radiation damage, we need to understand and optimize the contribution of all components of radiation exposure. METHODS A total of 1000 CTO procedures performed between 2011 and 2020 were compared according to implemented radiation modifications. Group 1 used the original set-up of the X-ray equipment (Artis Zee, Siemens). In group 2 a modified protocol aimed at reducing the fluoroscopy exposure, in group 3 further modifications aimed at reducing cineangiographic exposure. RESULTS Despite an increased lesion complexity, Air Kerma (AK) was reduced from 2619 mGy (1653-4574) in group 1 to 2178 mGy (1332-3500; p < 0.001) in group 2 by mainly reducing fluoroscopic contribution by 54.1%, the cineangiographic contribution was lowered by only 6.6%. In group 3 AK dropped drastically to 746 mGy (480-1225; p < 0.001) mainly by reducing the cineangiographic contribution by 53.4%, still there was a further reduction of fluoroscopy contribution of 8.2%. This also led to a reduction of the skin entry dose from 1038 mGy (690-1589) in group 2 to 359 mGy (204-591; p < 0.001) in group 3. This was achieved both in normal weight and obese patients, and both in antegrade and retrograde procedures. CONCLUSIONS The present study demonstrates that by modifying both the fluoroscopic and cineangiographic contribution to radiation exposure a drastic reduction of radiation risk can be achieved, even in obese patients. Currently accepted radiation thresholds may no longer be a limit for CTO PCI.
Collapse
Affiliation(s)
- Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany.
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Tokyo, Japan
| | - Matthias Koch
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | - Martin Silber
- Institut für Radioonkologie und Strahlentherapie, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Juliane Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Thomas Keuser
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Hiller Moehlis
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| |
Collapse
|
16
|
Dabin J, Blidéanu V, Ciraj Bjelac O, Deleu M, De Monte F, Feghali JA, Gallagher A, Knežević Ž, Maccia C, Malchair F, Sans Merce M, Simantirakis G. Accuracy of skin dose mapping in interventional cardiology: Comparison of 10 software products following a common protocol. Phys Med 2021; 82:279-294. [PMID: 33706118 DOI: 10.1016/j.ejmp.2021.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Online and offline software products can estimate the maximum skin dose (MSD) delivered to the patient during interventional cardiology procedures. The capabilities and accuracy of several skin dose mapping (SDM) software products were assessed on X-ray systems from the main manufacturers following a common protocol. METHODS Skin dose was measured on four X-ray systems following a protocol composed of nine fundamental irradiation set-ups and three set-ups simulating short, clinical procedures. Dosimeters/multimeters with semiconductor-based detectors, radiochromic films and thermoluminescent dosimeters were used. Results were compared with up to eight of 10 SDM products, depending on their compatibility. RESULTS The MSD estimates generally agreed with the measurements within ± 40% for fundamental irradiation set-ups and simulated procedures. Only three SDM products provided estimates within ± 40% for all tested configurations on at least one compatible X-ray system. No SDM product provided estimates within ± 40% for all combinations of configurations and compatible systems. The accuracy of the MSD estimate for lateral irradiations was variable and could be poor (up to 66% underestimation). Most SDM products produced maps which qualitatively represented the dimensions, the shape and the relative position of the MSD region. Some products, however, missed the MSD region when situated at the intersection of multiple fields, which is of radiation protection concern. CONCLUSIONS It is very challenging to establish a common protocol for quality control (QC) and acceptance testing because not all information necessary for accurate MSD calculation is available or standardised in the radiation dose structured reports (RDSRs).
Collapse
Affiliation(s)
- Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Boeretang 200, 2400 Mol, Belgium.
| | - Valentin Blidéanu
- Commissariat à l'Energie Atomique (CEA), CEA-Saclay, 91191 Gif-sur-Yvette, France
| | - Olivera Ciraj Bjelac
- University of Belgrade, Vinca Institute of Nuclear Sciences and School of Electrical Engineering (VINCA), M .P. Alasa 12-14, 11351 Vinca, Serbia
| | - Marine Deleu
- University Hospital of Geneva (HUG), Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland; University Hospital of Lausanne (CHUV), Rue du Grand Pré 1, 1007 Lausanne, Switzerland
| | - Francesca De Monte
- Veneto Institute of Oncology IOV - IRCCS (IOV), Via Gattamelata 64, 35128 Padua, Italy
| | - Joëlle Ann Feghali
- Department of Radiology, Bicêtre University Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Aoife Gallagher
- University Hospital Limerick (UHL), St. Nessan's Road, Dooradoyle, V94135 Limerick, Ireland
| | - Željka Knežević
- Ruđer Bošković Institute (RBI), Bijenicka 54, 10000 Zagreb, Croatia
| | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), 119-121 Grande Rue, 92310 Sèvres, France
| | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), 119-121 Grande Rue, 92310 Sèvres, France
| | - Marta Sans Merce
- University Hospital of Geneva (HUG), Rue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland; University Hospital of Lausanne (CHUV), Rue du Grand Pré 1, 1007 Lausanne, Switzerland
| | - George Simantirakis
- Greek Atomic Energy Commission (EEAE), P. Grigoriou & Neapoleos, 15341 Athens, Greece
| |
Collapse
|
17
|
Loose R, Wucherer M. How to Measure/Calculate Radiation Dose in Patients? Cardiovasc Intervent Radiol 2021; 44:835-841. [PMID: 33660065 PMCID: PMC8172405 DOI: 10.1007/s00270-021-02772-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/12/2021] [Indexed: 10/28/2022]
Abstract
Patients in fluoroscopically guided interventions (FGI) may be exposed to substantial radiation dose levels (SRDL). The most commonly reported adverse reactions are skin injuries with erythema or necrosis. It is therefore important for the interventional radiologist to know deterministic effects with their threshold doses. If possible all relevant modality parameters should be displayed on the interventionalists screen. Dosimetric parameters should be displayed in digital imaging and communications in medicine (DICOM) units and stored as DICOM Radiation Dose Structured Report (RDSR). The peak skin dose (PSD) is the most relevant risk parameter for skin injuries. Dose management systems (DMS) help optimising radiation exposure of patients. However, their calculation of skin dose maps is only available after a FGI. Therefore, dose maps and PSD should preferably be calculated and displayed in real time by the modality.
Collapse
Affiliation(s)
- Reinhard Loose
- Institute of Medical Physics, Paracelsus Medical School, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany.
| | - Michael Wucherer
- Institute of Medical Physics, Paracelsus Medical School, Hospital Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
| |
Collapse
|
18
|
Validation of the MC-GPU Monte Carlo code against the PENELOPE/penEasy code system and benchmarking against experimental conditions for typical radiation qualities and setups in interventional radiology and cardiology. Phys Med 2021; 82:64-71. [PMID: 33588229 DOI: 10.1016/j.ejmp.2021.01.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Interventional procedures are associated with potentially high radiation doses to the skin. The 2013/59/EURATOM Directive establishes that the equipment used for interventional radiology must have a device or a feature informing the practitioner of relevant parameters for assessing patient dose at the end of the procedure. Monte Carlo codes of radiation transport are considered to be one of the most reliable tools available to assess doses. However, they are usually too time consuming for use in clinical practice. This work presents the validation of the fast Monte Carlo code MC-GPU for application in interventional radiology. METHODOLOGIES MC-GPU calculations were compared against the well-validated Monte Carlo simulation code PENELOPE/penEasy by simulating the organ dose distribution in a voxelized anthropomorphic phantom. In a second phase, the code was compared against thermoluminescent measurements performed on slab phantoms, both in a calibration laboratory and at a hospital. RESULTS The results obtained from the two simulation codes show very good agreement, differences in the output were within 1%, whereas the calculation time on the MC-GPU was 2500 times shorter. Comparison with measurements is of the order of 10%, within the associated uncertainty. CONCLUSIONS It has been verified that MC-GPU provides good estimates of the dose when compared to PENELOPE program. It is also shown that it presents very good performance when assessing organ doses in very short times, less than one minute, in real clinical set-ups. Future steps would be to simulate complex procedures with several projections.
Collapse
|
19
|
Colombo P, Felisi M, Riga S, Torresin A. On skin dose estimation software in interventional radiology. Phys Med 2021; 81:182-184. [DOI: 10.1016/j.ejmp.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/29/2022] Open
|