Skip to main content

Advertisement

SpringerLink
Log in

Clinical evaluation of a dose management system-integrated 3D skin dose map by comparison with radiochromic films

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To validate the performance of an automatic tool to estimate a patient’s peak skin dose (PSD) and a skin dose map from data collected by a radiation dose management system (RDMS) during interventional procedures.

Methods

In total, 288 eligible consecutive patients undergoing abdominopelvic embolisation or planned coronary angioplasty using radiochromic films were screened between June 2018 and March 2019. For 98 included patients, PSD was measured using radiochromic films (PSDFilm) and computed by RDMS (PSDRDMS) using one flat and two anthropomorphic phantoms. Statistical concordance between PSDFilm and PSDRDMS was computed with Lin’s concordance correlation coefficient and clinical concordance with the Bland and Altman graphic; values were compared using the paired Mann-Whitney-Wilcoxon test.

Results

In total, 190/288 patients were excluded and 98 patients were analysed (69 men, mean age 66 ± 14 years). The PSDFilm median (1st; 3rd quartile) was 0.59 Gy (0.40; 1.08). PSDRDMS was 0.62 Gy (0.43; 1.22) for the flat phantom and 0.62 Gy (0.42; 1.19) for anthropomorphic phantoms. The concordance between PSDFilm and PSDRDMS was good for both phantoms (flat: 0.94 [0.91; 0.95]; anthropomorphic 0.94 [0.91; 0.96]). Compared with the values of PSDFilm, the values of PSDRDMS were significantly increased by 5% (− 4%; 16%) for flat phantom (p = 0.001) and 7% (− 6%; 22%) for anthropomorphic phantoms (p = 0.002) for vascular procedures and 9% (− 4%; 26%, p = 0.01) and 6% (− 4%; 23%, p = 0.02) for cardiac procedures, respectively. Dose map representations matched for most patients. The gaps identified were due to table displacement during fluoroscopy events and the use of a wedge filter.

Conclusions

The RDMS skin dose map tool allowed the computation of the PSD and skin dose distribution for all patients with fewer constraints than radiochromic films. However, the computed PSD was overestimated, increasing the number of patients requiring follow-up.

Key Points

• A good concordance correlation was identified between the peak skin dose (PSD) values measured with radiochromic films and estimated with the radiation dose management system (RDMS) skin dose map tool.

• Differences were related to table displacement during fluoroscopy events and the use of a wedge filter, which are not accounted in the Digital Imaging and Communications in Medicine Radiation Dose Structured Reports.

• For all procedures, the estimated PSDs were significantly higher than the measured PSDs by 5% (− 4%; 18%) for flat phantom (p < 0.001) and 6% (− 5%; 22%) for anthropomorphic phantoms (p < 0.001).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

AEE:

Abdominal elective embolisation for renal or hepatic tumours and visceral aneurysms

AUE:

Abdominal urgent embolisation for active bleeding or vascular injury from splenic, renal, hepatic, mesenteric or hypogastric arteries

BMI:

Body mass index

CA:

Coronary angioplasty

CA-PTCA:

Coronary angiography and coronary angioplasty for one vessel

CTO:

Coronary angioplasty of complex chronic total occlusion

DICOM:

Digital Imaging and Communications in Medicine

HCE:

Hepatic transarterial chemoembolisation with iodised oil

ICRP:

International Commission on Radiological Protection

IRP:

Interventional reference point

Ka:

Air kerma

Ni:

Number of fluorography images

PEE:

Pelvis elective embolisation for planned prostatic embolisation

PSD:

Peak skin dose

PUE:

Pelvis urgent embolisation for bleeding from the pelvis (prostatic, cystic, trauma bleeding)

RDMS:

Radiation dose management system

RDSR:

Radiation dose structured report

ROI:

Region of interest

SDM:

Skin dose map

SRPD:

Source to reference point distance

Tf:

Fluoroscopy time

UEE:

Uterine elective embolisation for fibroids or vascular malformations

UUE:

Uterine urgent embolisation for postpartum haemorrhage

References

  1. Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ (2010) Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair. Radiology 254:326–341

    Article  Google Scholar 

  2. Koenig TR, Wolff D, Mettler FA, Wagner LK (2001) Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR Am J Roentgenol 177:3–11

    Article  CAS  Google Scholar 

  3. Miller DL, Balter S, Cole PE et al (2003) Radiation doses in interventional radiology procedures: the RAD-IR study: part II: skin dose. J Vasc Interv Radiol 14:977–990

    Article  Google Scholar 

  4. Shope TB (1996) Radiation-induced skin injuries from fluoroscopy. Radiographics 16:1195–1199

    Article  CAS  Google Scholar 

  5. Vano E, Goicolea J, Galvan C et al (2001) Skin radiation injuries in patients following repeated coronary angioplasty procedures. Br J Radiol 74:1023–1031

    Article  CAS  Google Scholar 

  6. Greffier J, Goupil J, Larbi A et al (2018) Assessment of patient's peak skin dose during abdominopelvic embolisation using radiochromic (Gafchromic) films. Diagn Interv Imaging 99:321–329

    Article  CAS  Google Scholar 

  7. Greffier J, Moliner G, Pereira F et al (2017) Assessment of patient’s peak skin dose using Gafchromic films during interventional cardiology procedures: routine experience feedback. Radiat Prot Dosimetry 174:395–405

    CAS  PubMed  Google Scholar 

  8. Greffier J, Van Ngoc TC, Bonniaud G et al (2017) Assessment of peak skin dose in interventional cardiology: a comparison between Gafchromic film and dosimetric software em.dose. Phys Med 38:16–22

    Article  CAS  Google Scholar 

  9. Jones AK, Ensor JE, Pasciak AS (2014) How accurately can the peak skin dose in fluoroscopy be determined using indirect dose metrics? Med Phys 41:071913

    Article  Google Scholar 

  10. Jones AK, Pasciak AS (2011) Calculating the peak skin dose resulting from fluoroscopically guided interventions. Part I: methods. J Appl Clin Med Phys 12:3670

    Article  Google Scholar 

  11. Ying CK, Kandaiya S (2010) Patient skin dose measurements during coronary interventional procedures using Gafchromic film. J Radiol Prot 30:585–596

    Article  CAS  Google Scholar 

  12. Bordier C, Klausz R, Desponds L (2015) Accuracy of a dose map method assessed in clinical and anthropomorphic phantom situations using Gafchromic films. Radiat Prot Dosimetry 165:244–249

    Article  CAS  Google Scholar 

  13. Bordier C, Klausz R, Desponds L (2015) Patient dose map indications on interventional X-ray systems and validation with Gafchromic XR-RV3 film. Radiat Prot Dosimetry 163:306–318

    Article  CAS  Google Scholar 

  14. Rana VK, Rudin S, Bednarek DR (2013) Updates in the real-time dose tracking system (DTS) to improve the accuracy in calculating the radiation dose to the patients skin during fluoroscopic procedures. Proc SPIE Int Soc Opt Eng 8668:86683Z

    PubMed  PubMed Central  Google Scholar 

  15. Magnier F, Poulin M, Van Ngoc TC et al (2018) Comparison of patient skin dose evaluated using radiochromic film and dose calculation software. Cardiovasc Intervent Radiol 41:762–771

    Article  Google Scholar 

  16. Habib Geryes B, Hadid-Beurrier L, Waryn MJ, Jean-Pierre A, Farah J (2018) Benchmarking the DACS-integrated Radiation Dose Monitor® skin dose mapping software using XR-RV3 Gafchromic® films. Med Phys 45:4683–4692

    Article  CAS  Google Scholar 

  17. Greffier J, Grussenmeyer-Mary N, Larbi A et al (2019) Experimental evaluation of a radiation dose management system-integrated 3D skin dose map by comparison with XR-RV3 Gafchromic® films. Phys Med 66:77–87

    Article  Google Scholar 

  18. Greffier J, Van Ngoc TC, Agelou M et al (2016) Impact of the calibration conditions of XR-RV3 films on peak skin dose measurements in interventional radiology. Radiat Prot Dosimetry. https://doi.org/10.1093/rpd/ncw116

  19. Niroomand-Rad A, Blackwell CR, Coursey BM et al (1998) Radiochromic film dosimetry: recommendations of AAPM radiation therapy committee task group 55. American Association of Physicists in Medicine. Med Phys 25:2093–2115

    Article  CAS  Google Scholar 

  20. Delle Canne S, Carosi A, Bufacchi A et al (2006) Use of GAFCHROMIC XR type R films for skin-dose measurements in interventional radiology: validation of a dosimetric procedure on a sample of patients undergone interventional cardiology. Phys Med 22:105–110

    Article  CAS  Google Scholar 

  21. Lin PJ, Schueler BA, Balter S et al (2015) Accuracy and calibration of integrated radiation output indicators in diagnostic radiology: a report of the AAPM Imaging Physics Committee Task Group 190. Med Phys 42:6815–6829

    Article  Google Scholar 

  22. ICRU (2005) Patient dosimetry for X rays used in medical imaging (Report 74). Available via https://standards.globalspec.com/std/1222512/REPORT%2074

  23. Menzel HG, Clement C, DeLuca P (2009) ICRP Publication 110. Realistic reference phantoms: an ICRP/ICRU joint effort. A report of adult reference computational phantoms. Ann ICRP 39:1–164

    PubMed  Google Scholar 

  24. Farah J, Trianni A, Carinou E et al (2015) Measurement of maximum skin dose in interventional radiology and cardiology and challenges in the set-up of European alert thresholds. Radiat Prot Dosimetry 164:138–142

    Article  CAS  Google Scholar 

  25. Farah J, Trianni A, Ciraj-Bjelac O et al (2015) Characterization of XR-RV3 GafChromic® films in standard laboratory and in clinical conditions and means to evaluate uncertainties and reduce errors. Med Phys 42:4211–4226

    Article  CAS  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, CHU Nimes, Medical Imaging Group Nimes, University Montpellier, EA 2415, Bd Prof Robert Debré, 30029, Nîmes Cedex 9, France

    Joël Greffier, Aymeric Hamard, Jean Goupil, Jean Paul Beregi & Julien Frandon

  2. GE Healthcare, DoseWatch, R&D, Strasbourg, France

    Nicolas Grussenmeyer-Mary & David E. Miller

  3. Department of Cardiology, CHU Nimes, University Montpellier, Nimes, France

    Guillaume Cayla & Bertrand Ledermann

  4. Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes,, University Montpellier, Nimes, France

    Christophe Demattei

Authors
  1. Joël Greffier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas Grussenmeyer-Mary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aymeric Hamard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Goupil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David E. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guillaume Cayla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bertrand Ledermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christophe Demattei
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jean Paul Beregi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Julien Frandon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joël Greffier.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Jean Paul Beregi.

Conflict of interest

N. Grussenmeyer-Mary and D. Miller declare relationships with the following companies: GE Healthcare.

Statistics and biometry

C. Demattei kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• experimental

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Greffier, J., Grussenmeyer-Mary, N., Hamard, A. et al. Clinical evaluation of a dose management system-integrated 3D skin dose map by comparison with radiochromic films. Eur Radiol 30, 5071–5081 (2020). https://doi.org/10.1007/s00330-020-06877-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-06877-8

Keywords

Search

Navigation