Estimating Fluoroscopic Peak Skin Dose Using Manual Calculations

Abstract

Not all healthcare providers can afford to purchase commercially available programs that can quickly and easily provide peak skin dose estimations for patients undergoing diagnostic and international fluoroscopic procedures. The air kerma reference point exposure, Ka,r, available on all equipment manufactured after 2006, may over or under estimate the patient's peak skin dose. The total air kerma reference point exposure provided at the end of a case might be on the order of 20 Gy for a patient, indicating that a Joint Commission 'sentinel event' may have occurred. An investigation to determine whether a sentinel event has occurred becomes necessary. This article will introduce information available to the investigating health physicist for data mining, how to process that information, and then how best to interpret the results. I have used this system of data mining and analysis to effectively influence how physicians performing diagnostic and interventional fluoroscopic procedures use fluoroscopic equipment. Arriving at an answer is not simple; it is time consuming, and the methodologies are imperfect. Your effort can result in improved utilization of fluoroscopic equipment at your institution which in turn will lower patient and staff doses.

Review of skin dose calculation software in interventional cardiology

“…From measurements on a table with a 5-cm thick mattress, Bordier et al [6] observed about 10% difference in the beam intensity comparing Postero-Anterior (PA) and Right Anterior Oblique (RAO) 40 • projections. In agreement with this, DeLorenzo et al [4] observed a decrease of 6% for RAO 40 • projection. It should be noted that, in addition to the mattress attenuation, Dose Map accounts explicitly for the contribution of the scatter originating from the mattress.…”

“…Since significant dose differences can occur depending on whether a given parameter is accurately considered in the MSD calculation, available SDC software solutions were collected and analysed according to their calculation algorithms and their specific features [4,5].…”