title: A study on maximum skin dose in cerebral embolization procedures.
abstract: OBJECTIVE
  It is essential to measure the skin dose of radiation received by patients during interventional neuroradiologic procedures performed under fluoroscopic guidance, such as embolization of cerebral aneurysms, which is regarded as a high-dose interventional radiology procedure. In this study, we report a method for evaluating maximum skin dose (MSD), an ideal marker of radiation-induced effects, based on an innovative use of radiochromic films.
  
  
  METHODS
  Forty-eight procedures were studied in 42 patients undergoing embolization of cerebral aneurysms. Fluoroscopic and digital dose-area product (DAP), fluoroscopy time, and total number of acquired images were recorded for all procedures. The MSD was measured using Gafchromic XR type R films.
  
  
  RESULTS
  The MSD was measured in one group of 21 procedures. The coefficient (kappa) of the interpolation line between the skin dose and the DAP (kappa = 0.0029 cm(-2)) was determined. An approximate value of MSD from the DAP for the remaining 27 procedures was estimated by means of an interpolation line. The mean MSD was found to be 1.16 Gy (range, 0.23-3.20 Gy).
  
  
  CONCLUSIONS
  The use of radiochromic XR type R films was shown to be an effective method for measuring MSD. These films have the advantage of supplying information on both the maximum dose and the distribution of the dose: this satisfies the most stringent interpretation of Food and Drug Administration, American College of Radiology, and international recommendations for recording skin dose.
authors.affiliation: Department of Medical Physics, Istituto di Ricovero e Cura a Carattere Scientifico, San Matteo Hospital, Pavia, Italy. l.dercole@smatteo.pv.it
authors.forename: L
authors.initials: L
authors.lastname: D'Ercole
authors.forename: L
authors.initials: L
authors.lastname: Mantovani
authors.forename: F Zappoli
authors.initials: FZ
authors.lastname: Thyrion
authors.forename: M
authors.initials: M
authors.lastname: Bocchiola
authors.forename: A
authors.initials: A
authors.lastname: Azzaretti
authors.forename: F
authors.initials: F
authors.lastname: Di Maria
authors.forename: C Massa
authors.initials: CM
authors.lastname: Saluzzo
authors.forename: P
authors.initials: P
authors.lastname: Quaretti
authors.forename: G
authors.initials: G
authors.lastname: Rodolico
authors.forename: P
authors.initials: P
authors.lastname: Scagnelli
authors.forename: L
authors.initials: L
authors.lastname: Andreucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011834:Radiation Monitoring / Q000379:methods; D015641:Radiography, Interventional; D011874:Radiometry / Q000379:methods*; D012867:Skin / Q000528:radiation effects; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy*