A model for estimating peak skin dose in CT

In interventional radiology patient care can be improved by accurately assessing peak skin dose (PSD) from procedures, as it is the main predictor for tissue-reactions such as erythema. Historically, high skin dose procedures performed in radiology departments were almost exclusively planar fluoroscopy. However, with the increase in use of technologies involving repeated or adjacent computed tomography (CT) such as CT fluoroscopy and multi-modality rooms, the peak skin dose delivered by CT needs to be considered. In this paper, a model to estimate the PSD delivered to a patient undergoing CT has been developed to assist in determining the overall PSD. This model relates the PSD to the device-reported CT Dose Index (CTDI_vol) by accounting for a variety of CT technique and patient factors. It includes a novel method for estimating dose contributions as a function of patient or phantom size, scanner geometry, and physical measurement of lateral and depth-based beam profiles. Physical measurements of PSD using radiochromic film on several phantoms have been used to determine needed model parameters. The resulting fitted model was found to agree with measured data to a standard deviation of 5.1% for the data used to fit the model, and 6.8% for measurements that were not used for fitting the model. Two methods for adapting the model for specific scanners are provided, one based on local PSD measurements with radiochromic film and another using CTDI_vol measurements. The model, when suitably adapted, can accurately assess individual patients' CT PSD. This information can be integrated with radiation exposure data from other modalities, such as planar fluoroscopy, to predict the overall risk of tissue reactions, allowing for more tailored patient care.