DPPRI: Patient Skin Dose in Interventional Radiology
Study Details
Study Description
Brief Summary
Studies on radiation induced patients' skin lesions in interventional radiology highlighted the need for optimized and personalized patient dosimetry and adapted patient follow-up. Measurements using Gafchromic® films or thermoluminescent dosimeters have long been the only way to accurately evaluate the maximum absorbed dose to the patient skin. However as these dose measurements are tedious and expensive, they could not be systematically applicable in clinical practice. Therefore, more practical calculation methods have been developed. These software programs calculate the skin dose using dosimetric information from images DICOM header or radiation dose structured reports (RDSRs). Validation studies of these software programs are rare and when existent have many limitations.
Radiation Dose Monitor (RDM from Medsquare) is a software program for archiving and monitoring of radiation dose (DACS, Dosimetry Archiving Communication System) used in routine in the investigator's hospitals. A new functionality developed in RDM allows quick estimation without in-vivo measurements of the absorbed dose to the skin of the patient. Comparing RDM calculations with in-vivo measurements will enable this software validation so that it can be used in clinical routine.
Main objective: to validate RDM software for calculating patient skin dose in interventional radiology.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Methodology:
The study will consist of:
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Placing a rectangular dosimeter film (dimensions: 21 x 30 cm², 1mm thick) on the examination table under the sheet before installing the patient. This film is then read using a desktop scanner and specific software to determine the absorbed dose to the patient's skin. The film is not in direct contact with the patient and will not modify the standard procedure of interventional radiology.
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Collecting the weight and height of the patient
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Collecting the dosimetric information indicated in the dose report (RDSR) generated by the radiology equipment and automatically sent to the RDM DACS server at the end of the procedure (air kerma at the interventional reference point, dose area product, fluoroscopy time, X-ray tube, table and detector positions, field size, beam filtration, high voltage kV and mA current). This data is currently archived in a regulatory way, without modifying the usual patients' care pathway. This dosimetric information in addition to the technical information related to the equipment (radiology equipment brand and model, kerma calibration factor, examination table and mattress thickness) will be used as input data to the RDM software for skin dose calculations.
These last two points are realized in the classic framework of the patient care pathway and do not modify the standard procedure.
The comparison between measured and calculated absorbed dose for the validation of the calculation software will be done anonymously. The information collected does not permit the patient identification.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Therapeutic interventional radiology Patients undergoing an interventional radiology procedure, at risk for developing radiation-induced skin lesions, including acts of therapeutic interventional neuroradiology (angioplasties, embolization of aneurysms, embolization of arteriovenous malformations , etc…), embolizations and ablations of thoracic tumors, therapeutic cardiac acts (transluminal angioplasties and chronic coronary occlusions) and abdominal embolizations. |
Procedure: Interventional radiology : skin dose measurements
Therapeutic interventional radiology procedure for the following anatomical regions:
cerebral (neuroradiology)
thoracic (cardiology, lungs)
abdominal
Assessment of peak skin dose and dose mapping with use of Gafchromic film dosimeter and the estimation of the absorbed dose to the skin with use of RDM software program.
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Outcome Measures
Primary Outcome Measures
- Maximum absorbed skin dose and dose distribution [Standard duration of the interventional radiology procedure carried out as part of usual care (maximum of 8 hours)]
Measurement of the maximum absorbed dose value and dose mapping by the Gafchromic® film dosimeter (in-vivo measurements within interventional radiology procedure). Comparison between measured and calculated values by the RDM software.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adult patients (≥ 18 years old) who have a therapeutic interventional radiology procedure for the following anatomical regions:
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cerebral (neuroradiology)
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thoracic (cardiology, lungs)
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abdominal
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Patient informed and having expressed his non-opposition to participate in the research
Exclusion Criteria:
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Patients <18 years old
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Diagnostic interventional radiology procedure
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Demented patients unable to receive information regarding their inclusion in the research protocol.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | AP-HP, Bicêtre Hospital, Nuclear medicine department | Le Kremlin-Bicêtre | France | 94275 | |
| 2 | AP-HP, Lariboisière Hospital, Cardiology department | Paris | France | 75010 | |
| 3 | AP-HP, Lariboisière Hospital, Neuroradiology department | Paris | France | 75010 | |
| 4 | AP-HP, Cochin Hospital, Radiology A department | Paris | France | 75014 | |
| 5 | AP-HP, Necker-Enfants Malades Hospital, Pediatric radiology department | Paris | France | 75743 |
Sponsors and Collaborators
- Assistance Publique - Hôpitaux de Paris
Investigators
- Principal Investigator: Lama HADID-BEURRIER, PhD, AP-HP, Lariboisière hospital
- Principal Investigator: Catherine BOUCHARD, AP-HP, Cochin hospital
- Principal Investigator: Bouchra HABIB GERYES, PhD, AP-HP, Necker hospital
- Principal Investigator: Joëlle Ann FEGHALI, PhD, AP-HP, Bicêtre hospital
Study Documents (Full-Text)
None provided.More Information
Publications
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- IEC 61267. Medical Diagnostic X-ray Equipment - Radiation Conditions for Use in the Determination of Characteristics, 2005.
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- Khodadadegan Y, Zhang M, Pavlicek W, Paden RG, Chong B, Huettl EA, Schueler BA, Fetterly KA, Langer SG, Wu T. Validation and initial clinical use of automatic peak skin dose localization with fluoroscopic and interventional procedures. Radiology. 2013 Jan;266(1):246-55. doi: 10.1148/radiol.12112295. Epub 2012 Nov 9.
- Khodadadegan Y, Zhang M, Pavlicek W, Paden RG, Chong B, Schueler BA, Fetterly KA, Langer SG, Wu T. Automatic monitoring of localized skin dose with fluoroscopic and interventional procedures. J Digit Imaging. 2011 Aug;24(4):626-39. doi: 10.1007/s10278-010-9320-7.
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- Rana VK, Rudin S, Bednarek DR. A tracking system to calculate patient skin dose in real-time during neurointerventional procedures using a biplane x-ray imaging system. Med Phys. 2016 Sep;43(9):5131. doi: 10.1118/1.4960368.
- Sanchez RM, Vano E, Fernandez JM, Escaned J. Evaluation of a real-time display for skin dose map in cardiac catheterisation procedures. Radiat Prot Dosimetry. 2015 Jul;165(1-4):240-3. doi: 10.1093/rpd/ncv033. Epub 2015 Mar 18.
- Valentin J. Avoidance of radiation injuries from medical interventional procedures. Ann ICRP. 2000;30(2):7-67. Review.
- Ying CK, Kandaiya S. Patient skin dose measurements during coronary interventional procedures using Gafchromic film. J Radiol Prot. 2010 Sep;30(3):585-96. doi: 10.1088/0952-4746/30/3/012. Epub 2010 Sep 8.
- APHP191082
- 2019-A02411-56