Estimation of patient skin dose in fluoroscopy: summary of a joint report by AAPM TG357 and EFOMP

Background Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio almost certainly highly favorable. However, X-ray-induced skin injuries may occur due high absorbed doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve clinical practice. There need refined metric regarding of knowledge gap dose-related information devices must be filled. most useful indicate risk erythema, epilation or greater injury that also includes actionable peak dose, is, largest region skin. Materials Methods report based on comprehensive review best practices methods estimate found in scientific literature situates importance Digital Imaging Communication Medicine (DICOM) standard detailing pertinent contained Radiation Dose Structured Report (RDSR) DICOM image headers FGI devices. Furthermore, expertise task group members consultants have been used bridge discuss different available estimation. Results contributes an extensive summary discussion current state art estimating procedures regard methodology information. Improvements estimation efforts more are suggested discussed. Conclusions endeavor greatly aided by continuing medical physics community, numerous technology enhancements, dose-controlling features provided device manufacturers, emergence availability RDSR. Refined new dosimetry systems continue evolve form infrastructure further improvements accuracy. Dose-related content capable handling big data emerging monitoring quality assurance tools large-scale multihospital enterprises.