Speaker
Description
Background:
Interventional radiology (IR) procedures involve significant localized radiation, which can cause deterministic skin effects. Precise estimation of the peak skin dose (PSD) is crucial for patient safety, dose optimization, and follow-up. However, directly measuring the PSD is challenging because of the dynamic beam geometry and patient variability.
Objective:
This review assesses the current dosimetric methodologies employed for estimating skin dose in interventional radiology, emphasizing their underlying principles, benefits, limitations, and clinical applicability.
Methods:
A narrative review of the contemporary literature and international guidelines was conducted, focusing on commonly used dosimetric approaches in fluoroscopically guided procedures. The methods were categorized into system-reported dose metrics, direct skin dosimetry, dose reconstruction techniques, and computational modeling.
Results:
Metrics displayed by fluoroscopy systems, particularly the cumulative air kerma at the interventional reference point (Ka,r) and the kerma–area product (KAP), are extensively utilized for real-time monitoring and ensuring adherence to regulatory standards. Although these indicators are practical, they only provide indirect estimates of the peak skin dose (PSD). Direct dosimetry methods, such as thermoluminescent dosimeters (TLDs), optically stimulated luminescence (OSL), metal-oxide semiconductor field-effect transistors (MOSFETs), and radiochromic films, provide enhanced local accuracy but are constrained by placement uncertainties and workflow restrictions. Advanced dose reconstruction techniques employing Radiation Dose Structured Reports (RDSR) and system geometry facilitate patient-specific skin dose mapping and yield more reliable PSD estimations. Monte Carlo–based simulations further improve accuracy; however, they are predominantly restricted to research environments due to their computational and operational complexity.
Conclusion:
The current practice in interventional radiology dosimetry is evolving from a dependence on surrogate console metrics to the adoption of integrated geometry-based dose-tracking systems. Although cumulative air kerma continues to serve as a practical screening tool, real-time skin dose mapping has emerged as the most promising method for precise peak skin dose estimation and prevention of radiation-induced skin injury. The ongoing incorporation of advanced modeling techniques into clinical workflows is anticipated to enhance patient dose management.