A comparison of entrance skin dose delivered by clinical angiographic c-arms using the real-time dosimeter: the MOSkin
Coronary angiography is a procedure used in the diagnosis and intervention of coronary heart disease. The procedure is often considered one of the highest dose diagnostic procedures in clinical use. Despite this, there is minimal use of dosimeters within angiographic catheterisation laboratories due to challenges resulting from their implementation. The aim of this study was to compare entrance dose delivery across locally commissioned c-arms to assess the need for real-time dosimetry solutions during angiographic procedures. The secondary aim of this study was to establish a calibration method for the MOSkin dosimeter that accurately produces entrance dose values from the clinically sampled beam qualities and energies. The MOSkin is a real-time dosimeter used to measure the skin dose delivered by external radiation beams. The suitability of the MOSkin for measurements in the angiographic catheterisation laboratory was assessed. Measurements were performed using a 30 × 30 × 30 cm3 PMMA phantom positioned at the rotational isocenter of the c-arm gantry. The MOSkin calibration factor was established through comparison of the MOSkin response to EBT2 film response. Irradiation of the dosimeters was performed using several clinical beam qualities ranging in energy from 70 to 105 kVp. A total of four different interventional c-arm machines were surveyed and compared using the MOSkin dosimeter. The phantom was irradiated from a normal angle of incidence using clinically relevant protocols, field sizes and source to image detector distance values. The MOSkin was observed to be radiotranslucent to the c-arm beam in all clinical environments. The MOSkin response was reproducible to within 2 % of the average value across repeated measurements for each beam setting. There were large variations in entrance dose delivery to the phantom between the different c-arm machines with the highest observed cine-acquisition entrance dose rate measuring 326 % higher than the lowest measured cine-acquisition entrance dose rate and with the highest measured fluoroscopic entrance dose rate measuring 346 % higher than the lowest measured fluoroscopic entrance dose rate. This comparison of entrance dose delivery across local clinical c-arms demonstrated the disparity in entrance dose delivery across catheterisation laboratories and outlined a need for real-time dose monitoring systems for patients during angiographic procedures. Through use of our calibration method, an average MOSkin calibration of 7.37 mV/cGy was established. The calibration method allowed entrance dose to be measured across a range of beam energies and beam qualities without the input of the c-arm beam characteristics. This calibration factor was proven to reproduce entrance dose values to within 5 % value of the reference dosimeter’s response, suggesting potential for further studies and utilisation of the dosimeter in this field.