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Optimized radiological alert thresholds based on device-dosimetric information to predict peak skin dose between 2 and 4 Gy during vascular fluoroscopically guided intervention

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To provide radiologists and physicists with methodological tools to improve patient management after vascular fluoroscopically guided intervention (FGI) by providing optimized thresholds (OT) values that could be used as a surrogate to the thresholds classically proposed by the National Council on Radiation Protection (NCRP) or could be useful to adapt their own substantial radiation dose levels (SRDL) values.

Methods

PSD of 2000–4000 mGy after FGI were calculated for 258 patients with dedicated software. Overall, the kerma and KAP 3D-ROC curves were used to assess the sensitivity (SEN) and specificity (SPE) of NCRP thresholds and OT for each PSD. Kiviat diagram and density curves were plotted for the best SEN/SPE pair of 3D-ROC curves and compared to the NCRP thresholds.

Results

OT for both kerma and KAP generating the best SEN/SPE couple for PSD of 2000–4000 mGy were obtained. The SEN/SPE couple of each OT was always better than that obtained using NCRP ones. The best OT among all those calculated providing the highest SEN/SPE values for kerma (3020.5 mGy) and KAP (741.02 Gy.cm2) were obtained when PSD was equal to 3300 mGy.

Conclusions

We have calculated OT in terms of kerma and KAP based on 3D-ROC curves analysis and peak skin dose calculations that can be obtained to better predict high skin dose. The use of OT that predicted PSD greater than 3000 mGy is likely to improve patient follow-up. The methodology developed in this work could be adapted to other institutions in order to better define their own SRDL.

Key Points

• Optimized dose thresholds in terms of kerma and KAP based on 3D-ROC curves analysis and peak skin dose calculations between 2000 and 4000 mGy can be obtained to better predict high skin dose.

• Patients receiving a peak skin dose between 2000 and 4000 mGy have their follow-up enhanced by using the optimized thresholds instead of the NCRP thresholds.

• The best-optimized thresholds, corresponding to 3020.5 mGy and 741.02 Gy.cm 2 for kerma and KAP respectively can be used instead of NRCP ones to trigger patient follow-up after fluoroscopically guided vascular interventions.

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Abbreviations

ACR:

American College of Radiology

AUC:

Area under the curve

DICOM:

Digital imaging and communications in medicine

FGI:

Fluoroscopically guided intervention

FN:

False negative

FP:

False positive

ICRP:

International Commission on Radiological Protection

KAP:

Kerma-area product

NCRP:

National Council on Radiation Protection

NPV:

Negative predictive value

OT:

Optimized threshold

PPV:

Positive predictive value

PSD:

Peak skin dose

RAD-IR:

Radiation Dose in Interventional Radiology

RDSR:

Radiation dose structured report

SIR:

Society of Interventional Radiology

SRDL:

Substantial radiation dose levels

TN:

True negative

TP:

True positive

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Medical Physics, Jean Perrin Comprehensive Cancer Center, 63000, Clermont-Ferrand, France

    Nicolas Sas, Jean-Baptiste Lacroix & Véronique Dedieu

  2. Clermont-Ferrand University, UMR 1240 INSERM IMoST, 63000, Clermont-Ferrand, France

    Nicolas Sas, Jean-Baptiste Lacroix & Véronique Dedieu

  3. Pôle Interhospitalier d’Imagerie Diagnostique Et de Radiologie Interventionnelle, CHU, 63003, Clermont-Ferrand, France

    Louis Boyer

  4. TGI Institut Pascal, UMR 6602, UCA/CNRS/SIGMA, Aubière, France

    Louis Boyer

Authors
  1. Nicolas Sas
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  2. Jean-Baptiste Lacroix
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  3. Véronique Dedieu
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  4. Louis Boyer
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Corresponding author

Correspondence to Nicolas Sas.

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Guarantor

The scientific guarantor of this publication is Pr. Louis Boyer, Pôle Interhospitalier d’Imagerie Diagnostique et de Radiologie Interventionnelle.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because of its retrospective character and the analysis being based only on data acquired during the clinical routine.

Ethical approval

Institutional Review Board approval was not required because this is a retrospective study and all data are anonymized. Thereby, no ethical approval is required.

Study subjects or cohorts overlap

Patient database was larger in this study: 258 against 105 in the former publication.

Methodology

  • retrospective

  • cross-sectional study

  • performed at one institution

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Sas, N., Lacroix, JB., Dedieu, V. et al. Optimized radiological alert thresholds based on device-dosimetric information to predict peak skin dose between 2 and 4 Gy during vascular fluoroscopically guided intervention. Eur Radiol 33, 5707–5716 (2023). https://doi.org/10.1007/s00330-023-09538-8

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  • DOI: https://doi.org/10.1007/s00330-023-09538-8

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