In vivo validation of Dosemap software use in interventional cardiology with dosimetrics indicators and peak skin dose evaluation

Abstract

Objectives The aim of this study was to determine the accuracy of DoseMap™ software as compared to gafchromic film in real clinical practices. Background The radiation exposure from cardiovascular procedures could expose patients to potential risk of cancer and/or skin injury. New tools like Dosemap software were developed to estimate the patient skin dose in the cardiac catheterization laboratory. However, little data are available to validate this estimation of patient radiation skin dose. Methods This is a prospective cross‐sectional study comparing the peak skin dose (PSD) measured by gafchromic film used as reference with an estimated PSD given by Dosemap software, in patients with BMI > 30 kg/m2 undergoing elective diagnostic and/or therapeutic interventional cardiology procedures, from April 2016 to December 2016, at the Brest University Hospital Centre, France. Results After four exclusions of patients for poor quality of gafchromic films, 90 patients were included, with 58 angiography (67.4%), 14 percutaneous interventions (16.3%), and 14 both (16.3%). The median PSDDosemap and PSDFilm were similar with 157 mGy [IQR: 99; 273] versus 158 mGy [IQR: 101; 295] (P = 0.65), respectively, with an excellent correlation (r = 0.95). The comparison between cumulative air kerma and PSDFilm was different 366 mGy [IQR: 246; 575] versus 158 mGy [IQR: 101; 295] (P < 0.01) with moderate correlation (r = 0.79). No correlation was found between the dose area product and PSDFilm (r = 0.51). Conclusion DoseMap is an effective and valid method as compared to gafchromic films to estimate PSDs during interventional cardiologic procedures.

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

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

Feasibility of dosimetric measurements using Al2O3:C OSL dosimeter during fluoroscopy-guided procedures

“…However, using cumulative air kerma as a surrogate for PSD is limited because it is estimated without considering the height of the table, distribution of the radiation dose caused by tube angulation, attenuation by the table, and backscatter radiation [8,9,46]. Recently, skin dose mapping software have been studied vigorously and several studies have reported promising results [7,[10][11][12][13][14][15]47]. It has the advantage of providing PSD and dose map is automatically calculated considering distribution of the radiation dose without interfering with the clinical practice.…”

“…To predict and appropriately manage the potential skin injury, it is important to estimate the peak skin dose (PSD), defined as the highest absorbed dose to the patient's skin [4,5]. Easily applicable methods in the clinical practice are indirect methods such as cumulative air kerma measured at the interventional reference point (IRP, defined as 15 cm from the isocenter toward the X-ray tube) and skin dose mapping [6][7][8][9][10][11][12][13][14][15]. However, these indirect methods may have limitations when compared to the direct measurement of PSD because the estimated position of the patient does not always reflect the actual position and the evaluation of the backscatter radiation is limited [9][10][11][12]14].…”

“…However, these indirect methods may have limitations when compared to the direct measurement of PSD because the estimated position of the patient does not always reflect the actual position and the evaluation of the backscatter radiation is limited [9][10][11][12]14]. Although radiochromic films provide a direct method for measuring the PSD in the large area, they suffer from high uncertainty (approximately 20%), lack of reusability, and high cost [5,7,8,14,16,17].…”

Performance testing of dosimeters used in interventional radiology: Results from the VERIDIC project

“…The main consequence of ionising radiation interactions with the radiochromic films is the film color alteration, whereas the alteration intensity is proportionate to the dose value. The quantitative post-irradiation analysis and determination of skin dose is strongly dependent on various film properties and performance under clinical irradiation conditions (Greffier et al, 2017;Didier et al, 2019). Major factors contributing to the variation in the film response are the energy dependence and dose rate dependence.…”