Optimization of the Maximum Skin Dose Measurement Technique Using Digital Imaging and Communication in Medicine—Radiation Dose Structured Report Data for Patients Undergoing Cerebral Angiography

Understanding the maximum skin dose is important for avoiding tissue reactions in cerebral angiography. In this study, we devised a method for using digital imaging and communication in medicine—radiation dose structured report (DICOM-RDSR) data to accurately estimate the maximum skin dose from the total air kerma at the patient entrance reference point (Total K(a,r)). Using a test data set (n = 50), we defined the mean ratio of the maximum skin dose obtained from measurements with radio-photoluminescence glass dosimeters (RPLGDs) to the Total K(a,r) as the conversion factor, CF(Ka,constant), and compared the accuracy of the estimated maximum skin dose obtained from multiplying Total K(a,r) by CF(Ka,constant) (Estimation Model 1) with that of the estimated maximum skin dose obtained from multiplying Total K(a,r) by the functional conversion factor CF(Ka,function) (Estimation Model 2). Estimation Model 2, which uses the quadratic function for the ratio of the fluoroscopy K(a,r) to the Total K(a,r) (K(a,r) ratio), provided an estimated maximum skin dose closer to that obtained from direct measurements with RPLGDs than compared with that determined using Estimation Model 1. The same results were obtained for the validation data set (n = 50). It was suggested the quadratic function for the K(a,r) ratio provides a more accurate estimate of the maximum skin dose in real time.