Automatic Monitoring of Localized Skin Dose with Fluoroscopic and Interventional Procedures

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• 作者：Yasaman Khodadadegan (1)
  Muhong Zhang (1) muhong.zhang@asu.edu
  William Pavlicek (2)
  Robert G. Paden (2)
  Brian Chong (2)
  Beth A. Schueler (3)
  Kenneth A. Fetterly (4)
  Steve G. Langer (3)
  Teresa Wu (1)
• 关键词：Peak skin dose – sentinal event – DICOM structured report dose – patient entrance reference point – fluoroscopy – interventional radiology – Joint Commission (JC) – radiation dose – Digital Imaging and Communications in Medicine (DICOM)
• 刊名：Journal of Digital Imaging
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：24
• 期：4
• 页码：626-639
• 全文大小：808.7 KB
• 参考文献：1. Food and Drug Administration: Public Health Advisory: Avoidance of Serious X-Ray-Induced Skin Injuries to Patients during Fluoroscopically-Guided Procedures. September 30, 1994.
  2. Wagner LK, McNeese MD, Marx MV, Siegel EL: Severe skin reactions from interventional fluoroscopy: case report and review of the literature. Radiology 213:773–776, 1999
  3. Ukisu R, Kushihashi T, Soh I: Skin injuries caused by fluoroscopically guided interventional procedures: case-based review and self-assessment module. American Journal of Radiology 193:59–69, 2009
  4. Miller DL, Balter S, Noonan PT, Georgia JD: Minimizing radiation-induced skin injury in interventional radiology procedures. Radiology 225(2):329–36, 2002
  5. Balter S, Miller D: The new Joint Commission sentinel event pertaining to prolonged fluoroscopy. Journal of the American College of Radiology 4(7):497–500, 2007
  6. Joint Commission. Radiation Overdose as a Reviewable Sentinel Event. March 7, 2006. http://www.jointcommission.org/NR/rdonlyres/10A599B4-832D-40C1-8A5B-5929E9E0B09D/0/Radiation_Overdose.pdf
  7. International Electrotechnical Commission. Medical electrical equipment—Part 2–54: Particular requirements for the basic safety and essential performance of X-ray equipment for radiography and radioscopy Geneva: IEC 60601-2-54; 2009.
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  9. Miller DL, Balter S, Cole PE, Lu HT, Berenstein A, Albert R, Schueler BA, Georgia JD, Noonan PT, Russell EJ, Malisch TW, Vogelzand RL, Geisinger M, Cardella JF, George JS, Miller 3rd, GL, Anderson J: Radiation doses in interventional radiology procedures: the RAD-IR study: part II: skin dose. Journal of Vascular and Interventional Radiology 14(8):977–990, 2003
  10. Man-Systems Integration Standards. Revision B, NASA-STD-3000. Vol 1, July 1995.
  11. Kerr GD, Hwang JML, JONES RM: A mathematical model of a phantom developed for use in calculations of radiation dose to the body and major internal organs of a Japanese adult. Journal of Radiation Research 17:211–229, 1976
  12. Eckerman CM: Specific Absorbed Dose Fractions of Energy at Various Ages from Internal Photon Sources. Appendix A: Description of the Mathematical Phantoms. ORNL/TM-8381/VI. Oak Ridge National Laboratory, Oak Ridge, 1987
  13. Digital Imaging and Communications in Medicine (DICOM) Supplement 4 X-Ray Angiographic Image Objects and Media Storage. Oct 9, 1996.
  14. ICRU: International Commission on Radiation Units and Measurements. Patient Dosimetry for X–rays used in Medical Imaging. Journal of ICRU, 5, No 2, Report 74, Oxford University Press, 2005.
  15. Wang S, Pavlicek W, Langer SG, Wu T, Zhang M, Morin RL, Hu M, Schueler BA. The ‘Dose Index Tracker’: An Automated Database of Patient Radiation Dose Records for Quality Monitoring. Journal of Digital Imaging, 2010 (in press).
  16. Balter S: Capturing patient doses from fluoroscopically based diagnostic and interventional systems. Health Physics 95–5:535–540, 2008
  17. Ma C-M, Seuntjens JP: Mass-energy absorption coefficient and backscatter factor ratios for kilovoltage X-ray beams. Physics Medical Biology 44:131–143, 1999
  18. Mcparland BJ: Entrance skin dose estimates derived from dose–area product measurements in interventional radiological procedures. The British journal of Radiology 71:1288–1295, 1998
  19. Paden RG, Pavlicek W, Peter MB: Review of Cumulative Skin Dose in Estimation for Multi-episode Interventional Examinations. Proceedings of the 39th Midyear Topical Meeting, Medical and Laboratory Health Physics, Scottsdale, Arizona, 2006.
• 作者单位：1. School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ 85281, USA2. Department of Radiology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ 85258, USA3. Department of Radiology, Mayo Clinic Rochester, 200 First St. SW, Rochester, MN 55905, USA4. Department of Cardiology, Mayo Clinic Rochester, 200 First St. SW, Rochester, MN 55905, USA
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  
• 出版者：Springer New York
• ISSN：1618-727X

文摘

This software tool locates and computes the intensity of radiation skin dose resulting from fluoroscopically guided interventional procedures. It is comprised of multiple modules. Using standardized body specific geometric values, a software module defines a set of male and female patients arbitarily positioned on a fluoroscopy table. Simulated X-ray angiographic (XA) equipment includes XRII and digital detectors with or without bi-plane configurations and left and right facing tables. Skin dose estimates are localized by computing the exposure to each 0.01?×?0.01 m2 on the surface of a patient irradiated by the X-ray beam. Digital Imaging and Communications in Medicine (DICOM) Structured Report Dose data sent to a modular dosimetry database automatically extracts the 11 XA tags necessary for peak skin dose computation. Skin dose calculation software uses these tags (gantry angles, air kerma at the patient entrance reference point, etc.) and applies appropriate corrections of exposure and beam location based on each irradiation event (fluoroscopy and acquistions). A physicist screen records the initial validation of the accuracy, patient and equipment geometry, DICOM compliance, exposure output calibration, backscatter factor, and table and pad attenuation once per system. A technologist screen specifies patient positioning, patient height and weight, and physician user. Peak skin dose is computed and localized; additionally, fluoroscopy duration and kerma area product values are electronically recorded and sent to the XA database. This approach fully addresses current limitations in meeting accreditation criteria, eliminates the need for paper logs at a XA console, and provides a method where automated ALARA montoring is possible including email and pager alerts.