Skin Dose Monitor Research Articles

Effectiveness of a novel real-time dosimeter in interventional radiology: a comparison of new and old radiation sensors

Radiation dose management is important in interventional radiology (IR) procedures, such as percutaneous coronary intervention, to prevent radiation-induced injuries. Therefore, radiation dose should be monitored in real time during IR. This study evaluated the fundamental characteristics of a novel real-time skin dosimeter (RTSD) developed at our institution. In addition, we compared the performance of our new and old radiation sensors and that of a skin dose monitor (SDM), with ion chamber reference values. We evaluated the fundamental characteristics (e.g., energy dependence, dose dependence, and angular dependence) of the RTSD developed by us in the diagnostic X-ray energy range. The performance of our RTSD was similar to that of the SDM. In particular, the new radiation sensor of our RTSD demonstrated better dose rate dependence compared to the old sensor. In addition, the new sensor had the advantage of being small in size and thus minimally affecting the X-ray images compared to the old sensor. Therefore, the developed skin dosimeter and radiation sensor may be useful in real-time measurement of patients' exposure to and multi-channel monitoring of radiation in IR procedures. The new dosimeter system can be recommended for visualization and management of the radiation dose to which the patients' skin is exposed.

Efficacy of radiation dose reduction due to real-time monitoring and visualization of peak skin dose during coronary angiography and percutaneous coronary intervention.

This study assessed that the use of real-time monitoring and visualization of peak skin dose could reduce radiation dose during coronary angiography (CAG) and percutaneous coronary intervention (PCI). Exposure to ionizing radiation has dose related effects including skin damage. Reducing the radiation exposure is important during CAG and PCI. The skin dose-tracking system (DTS) has a real-time monitor of radiation peak skin dose. A total of 323 consecutive patients who underwent CAG and PCI between September 2014 and June 2015 were enrolled. Patients were classified into with DTS group (CAG alone in 104 and PCI in 57 patients) or without DTS group (CAG alone in 106 and PCI in 56 patients). There was no significant difference in reference air kerma between CAG alone with and without DTS groups. Reference air kerma with DTS group during PCI was lower than without DTS group (204.6 ± 141.1 mGy vs. 294.2 ± 237.4 mGy, P = 0.016). Moreover, kerma area product (17.8 ± 13.0 Gycm2 vs. 25.2 ± 19.3 Gycm2 , P = 0.019) and number of cine runs (12.8 ± 5.0 vs. 15.5 ± 6.5, P = 0.013) with DTS group were lower than without DTS group. Multiple regression analysis showed increased reference air kerma was associated with male gender, body mass index and type B2/C lesion. Conversely, DTS correlated with decreased reference air kerma. The use of DTS could reduce radiation dose during PCI. Real-time radiation monitoring and visualization of peak skin dose was effective for the patients with PCI.

A cross-sectional study of the radiation dose and image quality of X-ray equipment used in IVR.

There are case reports of injuries caused by the radiation from interventional radiology (IVR) X‐ray systems. Therefore, the management of radiation doses in IVR is important. However, no detailed report has evaluated image quality for a large number of IVR X‐ray systems. As a result, it is unclear whether the image quality of the X‐ray equipment currently used in IVR procedures is optimal. We compared the entrance surface doses and image quality of multiple IVR X‐ray systems. This study was conducted in 2014 at 13 medical facilities using 18 IVR X‐ray systems. We evaluated image quality and simultaneously measured the radiation dose. Entrance surface doses for fluoroscopy (duration, 1 min) and cineradiography (duration, 10 s) are measured using a 20‐cm‐thick acrylic plate and skin dose monitor. The image quality (such as spatial resolution and low‐contrast detectability) of both fluoroscopy and cineradiography was evaluated using a QC phantom. For fluoroscopy, the average entrance surface dose using the 20‐cm‐thick acrylic plate was 13.9 (range 2.1–28.2) mGy/min. For cineradiography, the average entrance surface dose was 24.6 (range 5.1–49.3) mGy/10 s. We found positive correlations between radiation doses and image quality scores, in general, especially for fluoroscopy. The differences in surface dose among the 18 IVR X‐ray systems were high (max/min, 9.7‐fold for cineradiography; 13.4‐fold for fluoroscopy). The differences in image quality scores (spatial resolution, low‐contrast detectability, and dynamic range) were also very large. In general, there tended to be a correlation between radiation dose and image quality. Periodical measurements of the radiation dose and image quality of the X‐ray equipment used for cineradiography and fluoroscopy in IVR are necessary. The need to minimize patient exposure requires that the dose be reduced to the minimum level that will generate an image with an acceptable degree of noise.PACS number(s): 87.57.C, 87.57.uq, 87.59.B, 87.59.bf, 87.59.C, 87.59.cf, 87.59.Dj

Present Situation of Fluoroscopy Radiation Doses in Many IVR Systems.

Japan Network for Research and Information on Medical Exposures (J-RIME) released the primary diagnostic reference levels (DRLs 2015) to optimize/manage the radiation dose for interventional radiology (IVR) on June 7, 2015 in Japan. However, this DRLs 2015 has a wide range of selection bias for only certified IVR technologists' dates. Therefore, it is important to know the radiation dose including non-certified IVR technologists' facilities. In this study, we verified the fluoroscopy radiation dose rates for many IVR systems in the present situation. This study was conducted at 13 cardiac catheterization laboratories (18 X-ray systems) around Sendai. We measured the entrance doses at the patient entrance reference point (interventional reference point) using a 20-cm-thick acrylic plate and skin-dose monitor. Although the DRLs 2015 of IVR is 20 mGy/min, the result of a fluoroscopy radiation dose in 18 X-ray systems was median (inter quartile range: IQR), 24.4 (16.3, 35.5) mGy/min. The optimization/managing the radiation dose of IVR X-ray systems is an important issue. In addition, it is necessary to intensify the activities to raise awareness for DRLs 2015.

TCT-281 Real-Time Radiation Monitoring Reduces Patient Peak Skin Dose During Coronary Angiography

Exposure to ionizing radiation during coronary angiography can have dose related effects including skin damage. Angiography systems providing a real-time pictorial display of patient skin dose are now available. Hypothesis: The use of a real-time radiation skin dose monitor displaying a color

Novel Dosimeter Using a Nontoxic Phosphor for Real-Time Monitoring of Patient Radiation Dose in Interventional Radiology.

To our knowledge, no feasible method exists for real-time measurement of the radiation dose given to the patient during interventional radiology (IR) procedures. Therefore, we produced a prototype of a real-time dosimeter for patients undergoing IR that uses a nontoxic phosphor. The basic characteristics of the real-time dosimeter prototype are comparable to those of the previously used skin dose monitor, with the exception that our prototype has the distinct advantage of including multichannel sensors. The novel real-time dosimeter system is expected to be useful for measuring patient exposure to the radiation dose during IR procedures.

Radiation dose of cardiac IVR x-ray systems: a comparison of present and past

Objective Although many patients benefi t greatly from fluoroscopically guided intervention (IVR) procedures such as percutaneous coronary intervention (PCI), one of the major disadvantages associated with these procedures, such as cardiac IVR, is the increased patient radiation dose. This study compared the entrance surface doses of x-ray equipment for cardiac IVR at the same seven cardiac catheterization laboratories between today and the past to determine the radiation doses of current cardiac IVR x-ray systems.Methods and results This study was conducted in 2001, 2007, and 2014 at the same seven cardiac catheterization laboratories in and around Sendai City, Japan. The entrance surface doses with cineangiography and fl uoroscopy were compared in 2001 (11 x-ray systems), 2007, and 2014 (12 x-ray systems) using a 20-cm-thick acrylic plate and skin dose monitor. The x-ray conditions used in the measurements, including the image receptor fi eld magnifi cation mode and the recording speed for cineangiography and fl uoroscopy, were those normally used in the facilities performing PCI. Although presently, the entrance doses of x-ray equipment used for cardiac IVR tend to be lower than previously (fl uoroscopy dose in 2001, 19.3 ± 6.3 mGy/min; in 2014, 13.2 ± 6.5 mGy/min), some equipment has a high radiation dose. In addition, the dose diff erences of the x-ray systems in 2014 were greater than those in the past (fl uoroscopy dose in 2001, 3.4-fold; in 2014, 10.5-fold).Conclusions In IVR procedures, managing the radiation dose of cardiac IVR x-ray systems is a very important issue. Periodical measurement of the radiation dose of the x-ray equipment used for both cineangiography and fl uoroscopy for cardiac IVR is necessary.

Total Entrance Skin Dose: An Effective Indicator of Maximum Radiation Dose to the Skin During Percutaneous Coronary Intervention

A number of cases of radiation-associated patient skin injury during percutaneous coronary intervention (PCI) have been reported. To protect against this complication, maximum skin dose to the patient should be monitored in real time. Unfortunately, in most cardiac intervention procedures, real-time monitoring of maximum skin dose is not possible. Angiographic X-ray units, however, display the patient's total entrance skin dose in real time. We therefore investigated the relation between maximum skin dose and total entrance skin dose to determine whether total entrance skin dose can be used to estimate maximum skin dose during PCI. The dose-area product was measured, and maximum skin dose and total entrance skin dose were calculated with a skin-dose-mapping software program. The target vessels of 194 PCI procedures were divided into four groups according to the American Heart Association (AHA) segment system. The maximum skin dose constituted 48%, 52%, 50%, and 52% of the total entrance skin dose during PCI on AHA segments 1-3, 4, 5-10, and 11-15, respectively. There were significant correlations between maximum skin dose and total entrance skin dose during PCI (r = 0.894, 0.935, 0.859, and 0.898 for segments 1-3, 4, 5-10, and 11-15, respectively; p < 0.001). Maximum skin dose during PCI is approximately 50% of the total entrance skin dose for each target vessel. Correlation between the two doses was very good. Total entrance skin dose is an effective predictor of maximum skin dose during PCI when the formula used is maximum skin dose = 0.5 x total entrance skin dose. Our results provide useful information for avoiding deterministic radiation skin injury to patients undergoing PCI.

Patient skin dose in cardiac interventional procedures: Conventional fluoroscopy versus pulsed fluoroscopy

To investigate whether pulsed fluoroscopy reduces a patient's exposure compared with the exposure owing to conventional (continuous) fluoroscopy, we simulated the skin radiation doses of patients at cardiac catheterization facilities with various X-ray systems used in fluoroscopically guided intervention procedures. Although many reports have noted that "pulsed fluoroscopy" provides important further reductions in radiation exposure, it has been determined that when comparing dose rates between different vendor systems, "pulsed fluoroscopy" does not reduce patients' exposure as compared with "conventional fluoroscopy". We examined 13 X-ray systems; 10 used pulsed fluoroscopy and three used conventional fluoroscopy. The entrance surface doses with fluoroscopy were compared for the 13 X-ray systems by using acrylic plates (20-cm thick) and a skin dose monitor. The X-ray conditions used in the measurements were those normally used in the facilities performing percutaneous coronary intervention. The average surface dose for systems from three different vendors producing conventional fluoroscopy systems was 23.93+/-2.77 mGy/min vs. an average surface dose of 22.52+/-4.50 mGy/min from five vendors of pulsed fluoroscopy systems (25, 30, and 50 pulses/sec) (P=0.646). The average entrance surface dose was significantly (P<0.0001) higher with conventional fluoroscopy and pulsed fluoroscopy at 25, 30, and 50 pulses/sec (23.05+/-3.78 mGy/min) than with pulsed fluoroscopy at 15 pulses/sec (13.86+/-3.22 mGy/min). Pulsed fluoroscopy did not in itself reduce radiation exposure. In general, the use of pulsed fluoroscopy at a pulse rate lower than 25 pulses/sec should reduce the skin dose in fluoroscopically guided intervention procedures. Nevertheless, some X-ray systems are not designed to reduce the dose rate as the number of pulses per second is decreased. Physicians should be aware of the entrance surface dose of the X-ray system that they use for cardiac IVR.

血管造影検査における術者の被曝線量評価と放射線防護用具による被曝低減

A study was performed to evaluate operator dose during diagnostic and interventional radiology procedures (IVR) and to establish methods of operator dose reduction with a radiation protective device. Operator dose was measured by glass dosimeters worn on the neck and on the abdomen outside the lead apron. In addition, the dose of the primary beam at the collimator surface was measured, which made it possible to define the correlation between the entrance air kerma, measured with Skin Dose Monitor, and operator dose exposed during the monitored procedure. IVR protectors were developed to decrease the amount of scatter radiation received by operators performing the procedures, and their effects were evaluated in abdominal and cardiac angiography procedures. The average effective dose and doses of the neck and abdomen outside the lead apron, estimated for individual procedures, were as follows: abdominal angiography procedures: effective dose, 0.07 mSv; neck area, 0.18 mSv; abdominal area, 0.51 mSv; cardiac angiography procedures: effective dose, 0.07 mSv; neck area, 0.13 mSv; abdominal area, 0.68 mSv. Operator doses were well correlated with exposure dose in abdominal angiography procedures (diagnostic procedure r=0.84, IVR r=0.77). It was found that 68.0% of the effective dose in abdominal angiography procedures and 43.0% of the effective dose in cardiac angiography procedures could be reduced by the use of IVR protectors. Operator and patient doses in interventional radiology were interdependent. The minimization of operator doses is particularly important during interventional radiology, and it is necessary to be aware of practical radiation protection procedures. Measures that reduce patient dose will also reduce occupational exposure. Moreover, operator dose could be substantially reduced by the use of IVR protectors in addition to wearing a protective lead apron during IVR. It was suggested that IVR protectors are effective radiation protective devices in interventional radiology procedures.

Evaluation and estimation of entrance skin dose in patients during diagnostic and interventional radiology procedures

A study was performed to evaluate the total entrance skin dose (ESD) of patients during diagnostic and interventional radiology procedures (IVR) and to estimate ESD with body mass index (BMI) and fluoroscopy time. The study included 26 cases of transcatheter arterial embolization therapy (TAE) for hepatocellular carcinoma (HCC) and 19 cases of diagnostic digital subtraction angiography (DSA) for HCC. The ESD of patients was evaluated with a zinc-cadmium sensor linked to a digital counter (SDM: skin dose monitor). Exposure doses were measured with SDM attached to the front of the X-ray beam-limiting device like a dose area product monitor. ESD was calculated from the measured exposure dose. In 26 TAE for HCC, ESD was 1793.7+/-739.1 mGy, with the mean fluoroscopic time of 23.5 minutes and 4.4 DSA acquisitions. The fluoroscopic dose rate was 52.4+/-11.5 mGy/min. In 19 diagnostic DSA for HCC, ESD was 962.9+/-375.2 mGy, with the mean fluoroscopic time of 11.1 minutes and 4.0 DSA acquisitions. The fluoroscopic dose rate was 32.7+/-12.7 mGy/min. Although 33.2% of ESD was from fluoroscopy in diagnostic procedures, the figure was 68.8% in TAE procedures. It was demonstrated that the increase in ESD during IVR was caused by the rise of fluoroscopy dose rate caused by high-magnification fluoroscopy and the extension of fluoroscopy time. In order to reduce ESD, it is necessary to use a low fluoroscopy dose rate with low-rate pulse fluoroscopy, in addition to shortening fluoroscopy time. Fluoroscopy time was a poor predictor of risk because it did not correlate well with ESD during IVR (diagnostic procedures r(2)= 0.897, IVR r(2)= 0.594). However, ESD correlated well with the product of BMI and fluoroscopy time (diagnostic procedures r(2)= 0.910, IVR r(2)= 0.783). The linear relationship between ESD and the product of BMI and fluoroscopy time provides a simple monitoring mechanism of the ESD delivered to the patient during interventional radiology procedures. This linear relationship needs to be established for other types of interventional procedures.

Evaluation of physical performance of a scintillation dosemeter for patient dosimetry in diagnostic radiology.

The physical performance of the patient scintillation dosemeter Skin Dose Monitor (SDM) was evaluated for use in diagnostic radiology. The SDM response was found to be linear, with output air kerma and output air kerma rate having a reproducibility in time lower than +/- 2.4%) (one standard deviation). A calibration protocol taking into account the more significant parameters, such as radiation quality dependence and the relative sensitivity of SDM detectors of the same batch, can be applied so that the maximum overall uncertainty is +/- 18% at the 95% confidence level. The SDM detectors did not show any loss of sensitivity during the 5-month period of evaluation. SDM performance was evaluated against thermoluminescent dosemeters (TLDs) (GR200A) by monitoring chest X-rays in 18 adult patients. The difference in entrance surface dose (ESD) values between the SDM and TLDs was less than 10%, but a lack of accuracy in ESD values of less than 0.3 mGy was observed. The main benefit of the SDM device compared with TLDs is the real-time read-out of dose combined with a better flexibility and rapidity of use for approximately the same cost per measurement. The SDM device is a good candidate for regular measurement of patient doses in diagnostic imaging departments as required under implementation of the European Council Medical Exposure Directive of 30 June 1997.

The Principle of Digital Subtraction Angiography and Radiological Protection

Recent improvements in x-ray technology have greatly contributed to the advancement of diagnostic imaging. Fluoroscopically guided neurointerventional procedures with digital subtraction angiography (DSA) are being performed with increasing frequency as the treatment of choice for a variety of neurovascular diseases. Radiation-induced skin injuries can occur after extended fluoroscopic exposure times, and the injuries have recently been reported. In this article, measured radiation doses at the surface of Rando Phantom with Skin Dose Monitor, and estimated and measured entrance skin doses in patients underwent neurointerventional procedures are reported as well as means of reducing radiation doses absorbed by patients and personnel to avoid occurrence of radiation-induced injuries.

Reduction of Radiation Exposure in the Cardiac Electrophysiology Laboratory

The purpose of this study was to determine the effects of various protective measures on patient and operator radiation dose levels in catheter ablation procedures. Catheter ablation procedures are associated with significant radiation levels. The patient's skin and operator radiation levels were measured (1) at baseline, (2) after primary beam filtration by 0.3-mm copper sheet and 2-mm aluminium plate and implementation of the LocaLisa system, and (3) after reduction of the left anterior oblique fluoroscopic pulse rate and installation of a lead glass screen. Additionally, a comparative analysis of radiation exposure levels was performed in the seven Dutch catheter ablation centers. Filtration of both primary beams resulted in a more than two-fold reduction in patient skin dose. Together with the LocaLisa system, this resulted in a six-fold reduction in patient and operator dose. As expected, lowering of the left anterior oblique pulse rate from 25 to 12.5 Hz reduced the corresponding patient skin dose with a factor 2 while the lead-glass protection caused an extra factor 2 reduction for the operator. Large differences were observed between fluoroscopy systems used for catheter ablation in the Netherlands. Depending on patient body mass and fluoroscopy system, patient skin dose varied between 0.2 and 8.4 Gy/hour. Proper measures may allow for a significant reduction of patient and operator radiation exposure in catheter ablation procedures. The large influence of body mass and equipment on patient's skin dose requires a more direct monitoring of skin dose than total fluoroscopy time.

The potential for radiation-induced skin damage in interventional neuroradiological procedures: a review of 522 cases using automated dosimetry.

The Food and Drug Administration (FDA) has recommended the monitoring of radiation skin dose to patients during procedures having the potential for radiation damage. Radiologists need information about typical radiation doses during interventional procedures. The skin doses to patients during 522 interventional neuroradiological procedures have been monitored using an automated dosimetry system. Estimated entrance skin doses (ESD) were binned into 0.5 Gy increments and compared to FDA recommended thresholds for inclusion in the patient record. Percentages of procedures exceeding the above mentioned thresholds are presented. In addition, the percentage of dose in each view and the percentage of dose in fluoroscopic and digital angiographic modes are shown. Six percent of embolization procedures and one percent of cerebral angiograms are estimated to have potential for main erythema (ESD>6 Gy). All types of procedures have potential for temporary erythema and exceed the threshold for inclusion in the patient record (ESD> 1 Gy) at the 95% percentile. The types of procedures with most potential for skin damage also have significant percentages of dose in the digital angiographic mode. Thus, monitoring fluoroscopic time alone underestimates the potential for skin injury. On the other hand, combining the doses in the posterior-anterior and lateral views, tends to overestimate the potential for radiation injury.

Real-time portal monitoring to estimate dose to skin of patients from high dose fluoroscopy.

Since doses to skin of patients from fluoroscopically-guided interventional procedures can be very high, real-time monitoring of skin dose is important for both patient management and quality control. The use of a scintillation detector, placed on the X-ray port to measure potential skin dose, was investigated, focusing on the uncertainties related to the technique. Sources of uncertainty include performance characteristics of the dosemeter, errors in calibration, patient set-up and changes during the procedure. Some of the largest sources of error include uncertainty in source-to-skin distance, heel effect, difficulty in identifying the area of skin principally exposed, calibration error, energy dependence of the dosemeter and the dose rate dependence of the monitor. This technique is found to be beneficial for radiation management, but users must be cognizant of the potential errors of the method and the limitations that these place on quality control and patient management. Knowing the limitations and minimizing the sources of error enhance the utility of the technique.

Real-time measurement of skin radiation during cardiac catheterization.

A novel skin dose monitor was used to measure radiation incident on maximal X-ray exposed skin during 135 diagnostic and 65 interventional coronary procedures. For the diagnostic studies (n = 135), mean skin dose was 180 +/- 64 mGy; for PTCA (n = 35), it was 1021 +/- 674 mGy, single stents (n = 25) 1529 +/- 601 mGy, and multiple stents with rotational atherectomy (n = 5) 2496 +/- 1028 mGy. The dose independently increased with more cine runs, more fluoroscopy, and greater patient weight. Physicians should consider the potential for adverse radiation exposure when planning coronary interventional cases and deciding on the X-ray mode and angles used.

積算皮膚線量計（ＳＤＭ‐モデル１０４‐１０１）のエネルギー特性

The purpose of this study is to estimate the energy response of a SKIN DOSE MONITOR (SDM model 104-101), which was developed to measure and assess medical exposure conveniently. The energy responses of pre-calibrated sensors were estimated by comparative measurements in the same calibration fields with sensors calibrated by Japan Quality Assurance Organization. The relative energy responses obtained for the precalibrated sensors agreed approximately with those of the calibrated sensors. The differences of the calibration factors in different calibration fields for the pre-calibrated sensors were 5 percent at the most in the range from 30keVto 40keVof effective energies. The sensor and coupling optical fiber of the SDM are faintly visible on a radiograph taken under ordinary operating conditions. The influence on diagnosis of this phenomenon is to be considered hereafter.

A beta skin dose monitor using an Eberline RO-2 ion chamber

The authors have developed a portable beta skin dose monitor that uses an Eberline RO-2® ion chamber. The development was based, in part, upon the previous development of a beta skin dose monitor employing silicon detectors. In this current work, the two entrance windows of the RO-2 were replaced by windows having a total mass thickness of 1.74 mg/cm 2. A two section source-detector holder was constructed. One section fastens to the RO-2 and holds the detector at the right position to determine the contact skin dose from beta emitters located on surfaces. A second section attaches to the first, and provides fixed counting geometry for radioactive samples such as hot particles. The first section also contains a slide mechanism that allows the placement of absorbers of zero (0), 8.38, and 1000 mg/cm 2 between the detector window and the beta source. The detector response to these absorbers allows for the determination of beta skin dose. The system was modeled using a Monte Carlo beta attenuation code computing the beta skin dose to RO-2 detector response as a function of absorber thickness, average beta energy, source diameter and source position. Using the RO-2 reading from each of the three absorber configurations allows the calculation of beta skin dose and the average beta energy. The results of these calculations were confirmed through the use of three massless radioactive beta sources, traceable to the National Institute of Standards and Technology, and several utility-supplied hot particles having well-established contact skin doses. An extrapolation chamber was also used to confirm the results obtained from this monitor. This system is now use at the Pennsylvania Power and Light (PP&L) Company, the project sponsor.

Development of a beta skin dose monitor using a silicon detector

A prototype skin dose monitor has been constructed and tested successfully. The monitor uses an ion-implanted silicon detector available commercially. The detector was selected since it has a lower leakage current than the other type of silicon detectors. It operates on both a pulse mode and current mode, and there is an overlap in the measurable beat dose rate ranges of these two modes. The prototype device includes an 8-b A/D converter and an 8-b microprocessor to display the skin dose directly. The device presently covers more than five orders of magnitude in the measurable beta skin dose rate ranges. The device has been calibrated using an extrapolation chamber and has been used to measure the dose rates produced by several different beta and beta/gamma sources.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>