Department of Radiation Sciences, Radiation Physics, Umeå University, SE-901 85, Umeå, Sweden.
State University of New York, 875 Ellicott St, Buffalo, NY, 14203-1070, USA.
Med Phys. 2021 Jul;48(7):e671-e696. doi: 10.1002/mp.14910. Epub 2021 May 20.
Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin.
The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation.
The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed.
The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.
医生在许多介入放射学和心脏病学程序中使用固定 C 臂透视设备。由于介入放射学和心脏病学程序的获益-风险比几乎肯定是高度有利的，因此患者接受的相关有效剂量通常被认为风险较低。然而，由于复杂的透视引导介入（FGI）中患者皮肤吸收剂量高，可能会发生 X 射线引起的皮肤损伤。对于特定患者的随访，合适的行动水平可以提高临床实践水平。需要有一种针对 X 射线引起的患者损伤的随访的细化指标，并且必须填补透视设备中与皮肤剂量相关的患者信息的知识空白。最有用的指标是指示红斑、脱毛或更大皮肤损伤风险的指标，同时还包括可操作信息，即皮肤最大剂量，即皮肤区域的最大剂量。
本报告基于对科学文献中发现的最佳实践和估计峰值皮肤剂量的方法的全面审查，并确定了数字成像和通信在医学（DICOM）标准的重要性，该标准详细说明了 FGI 设备中包含的相关信息。此外，专家组和顾问的专业知识已被用于弥合和讨论不同的方法和相关的可用 DICOM 信息，以估计峰值皮肤剂量。
本报告对 FGI 程序中估计峰值皮肤剂量的最新技术进行了广泛的总结和讨论，涉及方法和 DICOM 信息。建议并讨论了使用更精细的 DICOM 信息改进皮肤剂量估计的工作。
皮肤剂量估计工作得到了科学医学物理学界的持续努力、众多技术增强、FGI 设备制造商提供的剂量控制功能以及 DICOM RDSR 的出现和更广泛的可用性的极大帮助。不断发展和完善的新剂量测量系统为进一步提高准确性奠定了基础。用于患者剂量监测和大型多医院企业质量保证工具的与剂量相关的内容和信息系统正在出现。
