论文标题

介入X射线器官剂量评估中的陷阱 - 实验和计算幻影研究:前列腺动脉栓塞的应用

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

论文作者

Roser, Philipp, Birkhold, Annette, Zhong, Xia, Ochs, Philipp, Stepina, Elizaveta, Kowarschik, Markus, Fahrig, Rebecca, Maier, Andreas

论文摘要

随着X射线辐射保护和剂量管理不断引起人们对介入放射学的兴趣,新的程序经常使用拟人化幻象进行前瞻性剂量研究以确定预期的剂量值。由于固有的不确定性,这些剂量值可能不允许进行特定于患者的风险评估。因此,首先,这项研究的目的是量化这些参数对局部X射线剂量的影响,以评估其在评估患者特异性器官剂量中的相关性。其次,这些知识进一步允许验证模拟方法,该方法允许采用生理材料模型和患者特定的几何形状。使用MOSFET剂量计的幻影剂量学实验是在前列腺动脉栓塞(PAE)中重现成像场景的。确定相关的器官等效剂量的前列腺,膀胱,结肠和皮肤。通过移动X射线源来重现患者可能的小位移引起的剂量偏差。通过分析两个不同常用的幻象来研究由物质差异引起的剂量偏差。我们使用蒙特卡洛(MC)模拟,参考雄性几何形状和不同的材料特性重建了实验。总体而言,MC模拟器官剂量值与大多数病例的测量值相一致。 X射线源相对于幻象的边际位移导致器官剂量值的偏差为6%至135%,而皮肤剂量保持相对恒定。关于幻影材料组成的影响,在所有模拟的幻象中,都普遍低估内器官剂量值12%至20%。但是,对于两种材料,可以估计皮肤剂量的偏差低1%至8%。前瞻性参考剂量研究可能不会扩展到精确的患者特异性剂量评估。

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 dose values. Due to inherent uncertainties, 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. 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 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. 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% to 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% to 20% is prevalent in all simulated phantoms. Skin dose, however, can be estimated with low deviation of 1% to 8% at least for two materials. Prospective reference dose studies might not extend to precise patient-specific dose assessment.

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