D9.143 - Acceptance and quality control protocols for skin dose calculating software solutions in interventional cardiology

Acceptance and quality control (QC) testing protocols for the accuracy of skin dose calculation (SDC) software in interventional cardiology (IC) were developed. The Acceptance protocol is composed of 13 fundamental irradiation set-ups and 3 clinical procedures, intended to represent more realistic conditions. The QC protocol is based upon the Acceptance protocol and is made of 8 fundamental irradiation set-ups. Measurements were performed following the Acceptance protocol on a GE Innova IGS 540, a Philips Allura Xper, a Siemens Artis Zee biplane and a Canon Infinix CF-i biplane. Calibrated solid-state dosimeters (multimeters), gafchromic films and thermoluminescent dosimeters were used for the measurements. Skin dose estimates were performed with 10 SDC software products in total: CareMonitor, Dose Tracking System, DOSE by Qaelum, DoseMap, em.dose, OpenSkin, Radiation Dose Monitor, DoseWatch Skin Dose Map (two versions) and SkinCare. At least 4 software products and up to 8 were used in combinations with a specific angiographic unit, depending on compatibility. The maximum skin dose (MSD) estimated by most SDC software products was within ±40% of the measurements during the fundamental irradiations and the clinical procedures. However, about half of the software products could not provide MSD estimates for lateral irradiations because a flat phantom was used. Among the remaining software products, accuracy of the MSD estimate for lateral irradiations was quite variable and could be very poor. Most SDC software produced maps representing acceptably the dimensions, the shape and the relative position of the MSD region. Some software, however, could miss the MSD region when situated at the thin intersection of multiple fields. The dimensions and shape of the MSD region were inaccurate for all SDC software on the Philips system because wedge filters were used, while most SDC software assumes square irradiation fields SDC software solutions can produce acceptable results and may include fine technical details of the procedure as calculation input; however, the determination of the patient body contour and position remains challenging. This can dramatically degrade the software accuracy particularly for lateral irradiations and irradiations that are not centred on the patient’s back.