Patient maximum skin dose in interventional procedures in radiology and cardiology: summary of WG 12 activities

Fluoroscopically guided interventional procedures in radiology (IR) and cardiology (IC) are techniques that have had wide diffusion in the last decades. Scarcely invasive, they reduce most of the risks to patients and the expenses of operating theatres. Nevertheless, prolonged exposures due, for instance, to complicated interventional procedures or inappropriate equipment may result in high doses to both patients and staff members, in particular, with potentially high radiation doses to the skin of a patient. Working group 12 of EURADOS is dealing with various aspects of dosimetry in medical imaging. In line with most recent developments in radiation protection in medicine, a lot of effort has been made in the area of patient dosimetry in medical imaging. As the number and complexity of interventional procedures have been steadily growing, it becomes crucial to provide patient-specific, skin dose estimate during these procedures. To tackle this issue, EURADOS Working group 12 has initiated a number of activities to estimate the maximum skin dose in various procedures in radiology and cardiology. This report presents Working group 12 activities in the area of dosimetry for interventional procedures in cardiology and radiology. The document is dealing with characterization of different dosimetric methods for skin dose assessment in interventional procedures, their application for skin doses measurement in clinical practice and establishment of trigger levels in order to evaluate the feasibility of identifying a common dosimetric indicator that correlates with the maximum skin dose. In order to determine the suitability of XR-TypeR Gafchromic™ films and of detectors based on thermolumiescent materials: pellets, chips and foils to measure skin dose, an intercomparison exercise has been organized within EURADOS Working Group 12. Furthermore, an assessment of the uncertainty associated with the sampling process of point detector grids used for maximum skin dose measurements was performed. Among all possible solutions, film dosimetry represents the most convenient method to determine skin dose. Hence, EURADOS Working Group 12 performed a comprehensive evaluation in order to investigate the optimal use of films in the interventional environment while addressing the means to reduce uncertainties in the quantitative assessment of patient skin dose. Finally, patient skin dose measurements, along with assessment of other dose indices as dose area product and cumulative dose at interventional reference point was performed at different European hospitals for selected high dose interventional procedures in radiology and cardiology. The inter-center variability of online dose indicators and their correlation with the maximum skin dose were examined along with feasibility to establish the generic alert levels for skin injuries.