Purpose or Case Report: It is important for radiologists to recognize and discuss with patients and families the potential risks and clinical manifestations of high Peak Skin Dose. In children undergoing complex Interventional procedures accurate Peak Skin Dose estimates are complicated and time consuming despite reference point doses being available. The availability of the Dose Structure Report (SR) on modern fluoroscopic equipment allows such estimates to be timely and consistent. The process of creating a Peak Skin Dose estimate using a validated radiation data management system (RDMS), capable of collecting detailed acquisition data and modeling will be discussed.
Methods & Materials: Interventional fluoroscopic equipment is configured to transfer the SR to the hospital PACS system (PACS). PACS sends SR to a RDMS, which interprets SR reports and provides details of each study acquisition including: dose area product, reference point dose, beam on time, pulse rate, pulse width and height, table positions, collimation, preliminary and secondary angulations, distances of source to table and receptor. Acquisition protocols, timeline, and angulation maps are generated for each study. A Peak Skin Dose estimate for each study is performed using the detailed acquisition data, with manual adjustments made for table offsets in lateral and longitudinal directions, patient orientation and skin model (i.e. patient size). The skin dose map can be captured and used for initial and follow-up discussions with patients and families.
Results: For all studies, a default Peak Skin Dose estimate and a color skin dose map are automatically generated. With a pre-set institutional threshold (1 Gy) for Peak Skin Dose evaluation, RSMS automatically alerts the lead staff members of IR and physicist if the threshold level is exceeded upon completion of the study. The Peak Skin Dose estimate is then re-calculated with minor adjustments as described above. The skin dose map can be captured and used for initial and follow-up evaluations with patients and families.
Two cases are selected for demonstration: 1) >1Gy Reference Point Dose, < 2Gy Peak Skin Dose; 2) >1Gy Reference Point Dose, > 2Gy Peak Skin Dose.
Conclusions: Using SR in RDMS for estimates of Peak Skin Dose can provide clinicians with timely Peak Skin Dose data to inform clinical patient follow up. This technology can also be a useful tool in the investigation of a potential sentinel event and in planning future similar interventions