Room: Exhibit Hall | Forum 8
Purpose: Provide a comparison and independent validation of fluoroscopic dose metrics predicted by dose management software packages.
Methods: Several independent methods were used to compare the dose metrics that may be monitored to determine the need for patient follow-up after fluoroscopic procedures, including examination time, Dose Area Product (DAP), Reference Point Dose, Max Skin Entrance Dose and Peak Skin Dose (PSD). PSD is generally accepted to be the most relevant dose metric for predicting deterministic effects from fluoroscopic exams, but it is not always available and can be challenging to validate. We examined the utility of dose metrics provided by two dose tracking software systems, the dose report generated by a fluoroscopic system, and independent physics measurements for a series of Selective Visceral Arteriogram procedures.
Results: Peak Skin Dose predicted from a physics model utilizing the Radiation Dose Structured Report provided the most relevant dose metric for determining the need for patient follow-up after high dose fluoroscopic procedures. Surrogate dose metrics including time, DAP, Reference Point Dose, and the Max Skin Entrance Dose were found to be less reliable predictors for this purpose. The physics model used to generate the PSD was able to be further refined for specific cases by including specific details such as system table and pad attenuation, and patient size/backscatter. Observed differences between the two methodologies are attributed to differing assumptions for area averaging and the system specific details.
Conclusion: One dose tracking software system provides a PSD evaluation tool that can effectively identify patients that should be followed-up when institutional Dose Reference Levels are exceeded. While the tool currently utilizes a generic physics model, more accurate evaluations of PSD and extension to system generated skin doses are possible by integrating fluoroscopy system specific details and the analysis of high resolution skin dose maps.
Funding Support, Disclosures, and Conflict of Interest: The Ohio State University and Qaelum have a research agreement to evaluate and develop the dose management solution DOSE