VERIDIC — Validation and estimation of radiation skIn dose in interventional cardiology: Commissioning and quality control protocols for skin dose calculation software

In interventional cardiology (IC), patients may be exposed to high doses to the skin, resulting in tissue reactions, following a single or multiple procedures. To address this issue, online and offline software tools have been developed to estimate the maximum skin dose (MSD) to the patient from IC procedures. However, the capabilities and accuracy of such skin dose calculation (SDC) software to estimate MSD and 2D dose distributions markedly differ among software vendors, and the reporting of the MSD estimate and the related accuracy in the radiation dose structured report (RDSR) is neither systematic nor harmonised. In addition, there is currently no acceptance testing and quality control (QC) protocols of such systems. The VERIDIC project focuses on the harmonisation of the RDSR and on the validation and control of SDC software products in IC, which will foster radiation protection of patients. SDC software solutions will be analysed according to their calculation algorithms and their capabilities. In particular, the factors considered in the MSD calculation (such as the backscatter radiation, the patient table and mattress attenuation or the patient’s body shape) and how they are reported will be investigated. Furthermore, recommendations for harmonising the MSD reporting will be formulated. Commonly used dosimeters, including Gafchromic films, thermoluminescent detectors as well as dosimeters readily accessible to medical physicists in a clinical environment, will be thoroughly characterised for a wide range of conditions encountered in IC. Protocols for acceptance and QC tests to be used in clinical practice will be developed and tested. Tolerance levels and technical criteria for acceptance of SDC systems will be proposed. Those protocols will also be used for comparing different SDC software. In at least 15 European hospitals, detailed information from more than 750 cardiac therapeutic procedures will be collected, including RDSR and clinical indications. Those data serve to develop reference levels, and investigate correlations between clinical parameters and the patient exposure. Recommendations for patient dose optimisation will be derived. In addition, several months of dose reports will be collected to estimate the proportion of high doses procedures in IC. Skin dose will be calculated using SDC software.