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Pitfalls in interventional X-ray organ dose assessment—combined experimental and computational phantom study: application to prostatic artery embolization

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Abstract

Purpose

With X-ray radiation protection and dose management constantly gaining interest in interventional radiology, novel procedures often undergo prospective dose studies using anthropomorphic phantoms to determine expected reference organ-equivalent dose values. Due to inherent uncertainties, such as impact of exact patient positioning, generalized geometry of the phantoms, limited dosimeter positioning options, and composition of tissue-equivalent materials, these dose values might not allow for patient-specific risk assessment. Therefore, first the aim of this study is to quantify the influence of these parameters on local X-ray dose to evaluate their relevance in the assessment of patient-specific organ doses. Second, this knowledge further enables validating a simulation approach, which allows employing physiological material models and patient-specific geometries.

Methods

Phantom dosimetry experiments using MOSFET dosimeters were conducted reproducing imaging scenarios in prostatic arterial embolization (PAE). Associated organ-equivalent dose of prostate, bladder, colon, and skin was determined. Dose deviation induced by possible small displacements of the patient was reproduced by moving the X-ray source. Dose deviation induced by geometric and material differences was investigated by analyzing two different commonly used phantoms. We reconstructed the experiments using Monte Carlo (MC) simulations, a reference male geometry, and different material properties to validate simulations and experiments against each other.

Results

Overall, MC-simulated organ dose values are in accordance with the measured ones for the majority of cases. Marginal displacements of X-ray source relative to the phantoms lead to deviations of 6–135% in organ dose values, while skin dose remains relatively constant. Regarding the impact of phantom material composition, underestimation of internal organ dose values by 12–20% is prevalent in all simulated phantoms. Skin dose, however, can be estimated with low deviation of 1–8% at least for two materials.

Conclusions

Prospective reference dose studies might not extend to precise patient-specific dose assessment. Therefore, online organ dose assessment tools, based on advanced patient modeling and MC methods, are desirable.

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Notes

  1. www.helmholtz-muenchen.de/en/institute-of-innovative-radiotherapy/index.html, accessed January 28, 2019.

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Authors and Affiliations

  1. Pattern Recognition Lab, FAU Erlangen-Nürnberg, Erlangen, Germany

    Philipp Roser, Xia Zhong & Andreas Maier

  2. Siemens Healthcare GmbH, Forchheim, Germany

    Annette Birkhold, Philipp Ochs, Elizaveta Stepina, Markus Kowarschik & Rebecca Fahrig

  3. Erlangen Graduate School in Advanced Optical Technologies (SAOT), Erlangen, Germany

    Philipp Roser & Andreas Maier

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  1. Philipp Roser
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Correspondence to Philipp Roser.

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P. Roser is funded by the Erlangen Graduate School in Advanced Optical Technologies (SAOT). X. Zhong is now with the Siemens Healthcare GmbH. During the work on this research, X. Zhong has not been affiliated with Siemens. A. Birkhold, P. Ochs, E. Stepina, M. Kowarschik, and R. Fahrig are employees of the Siemens Healthcare GmbH. A. Maier has no conflict of interest to declare.

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Roser, P., Birkhold, A., Zhong, X. et al. Pitfalls in interventional X-ray organ dose assessment—combined experimental and computational phantom study: application to prostatic artery embolization. Int J CARS 14, 1859–1869 (2019). https://doi.org/10.1007/s11548-019-02037-6

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