Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures

Järvinen, H; Farah, Jad; Siiskonen, T.; Ciraj-Bjelac, Olivera; Dabin, Jérémie; Carinou, E.; Domienik-Andrzejewska, Joanna; Kluszczynski, D.; Knežević, Željka; Kopeć, Renata; Majer, Marija; Malchair, F; Negri, A.; Pankowski, P.; Sarmento, S.; Trianni, Annalisa

doi:10.1016/j.ejmp.2018.01.010

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…The indirect approach generally refers to measurements made with Kerma-area product (KAP) meters, either with the meter attached to the X-ray tube housing or integral to the equipment. The measurement can be conducted during actual clinical procedures, or separately on a phantom [23][24][25].…”

Section: Indirect Measurementmentioning

confidence: 99%

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

2021

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

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Section: Indirect Measurementmentioning

confidence: 99%

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

2021

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“…The use of DRLs is emphasized also in the new European Basic Safety Standard [3]. However, since the implementation of DRLs in interventional procedures varies significantly with the complexity and are only applicable to groups of patients, alert levels have been introduced to indicate doses that are high enough to cause tissue reactions such as skin effects on individual patients [4,5]. Alert levels typically use the online dose indicator (e.g.…”

Section: Introductionmentioning

confidence: 99%

Establishing the European diagnostic reference levels for interventional cardiology

et al. 2018

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“…It is concluded that this study provided new European DRL values proposed for CTO, TAVI and PI procedures. The results of this study can be used further to promote optimization in patient radiation protection before national or local DRLs are set and also to provide a basis for comparison when these levels are being set (Siiskonen et al 2018). Finally it is important to note that EURADOS is a self-sustainable scientific network with financial resources from membership fees, income of intercomparison exercises and trainings and other actions, and levies from third party funding of research projects.…”

Section: European Diagnostic Reference Levels For Interventional Card...mentioning

confidence: 93%

“…The differences in the irradiation patterns explained why the correlation between DAP and MSD was better for TACE than for NE or PCI. Furthermore, the X-ray field dimensions in TACE procedures are typically larger than those in PCI or NE procedures leading to a high DAP/MSD value (Table1) and, accordingly, higher alert level (Jarvinen et al 2018).…”

Section: Alert Levels For Maximum Skin Dose In Fluoroscopically Guide...mentioning

confidence: 99%

The European radiation dosimetry group – Review of recent scientific achievements

Rühm

Ainsbury

Breustedt

et al. 2020

Radiation Physics and Chemistry

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Feasibility of setting up generic alert levels for maximum skin dose in fluoroscopically guided procedures

Cited by 14 publications

References 30 publications

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

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

Establishing the European diagnostic reference levels for interventional cardiology

The European radiation dosimetry group – Review of recent scientific achievements

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