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# Medical staff dosimetry: simulation of an interventional
cardiac catheterization procedure

Frank Schultz, Lara Struelens, jean-marc bordy

► To cite this version:

Frank Schultz, Lara Struelens, jean-marc bordy. Medical staff dosimetry: simulation of an interventional cardiac catheterization procedure. International Workshop on Uncertainty Assessment in Computational Dosimetry, A Comparison of Approaches, Oct 2007, Bologne, Italy. cea-05461280

HAL Id: cea-05461280

https://cea.hal.science/cea-05461280v1

Submitted on 3 Feb 2026

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Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
Medical Staff Dosimetry

Simulation of an Interventional
Cardiac Catheterization
Procedure
Medical Staff Dosimetry

Restricted Problem – CONRAD WP4 & WP7

Labs involved
in problem
definition and
analysis:

Jean-Marc Bordy - Design of a Realistic Calibration
Field for Diagnostic Radiology

Frank Schultz - Simulation of an Interventional
Cardiac Catheterization
Procedure

Lara Struelens - Summary of the Submitted
Problem Solutions

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<figure><img src="image_4.png" /></figure>

Delft University of Technology

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STUDIECENTRUM VOOR KERNENERGIE
CENTRE D'ÉTUDE DE L'ÉNERGIE NUCLÉAIRE

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INSTITUT
DE RADIOPROTECTION
ET DE SÛRETÉ NUCLÉAIRE

Frank Schultz - Simulation of an Interventional Cardiac Catheterization Procedure

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Delft University of Technology

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# Interventional Cardiology

Image guided minimal invasive medical procedure
Replaces open heart surgery

<figure><img src="image_9.png" /></figure>

© Copyright 2004
The Cleveland Clinic Foundation

N Engl J Med 2000; 342:256.
Copyright © 2000 Massachusetts
Medical Society

catheters and miniaturized instruments

RF ablation – heart rhythm disturbance

Patent DA occlusion – disconnect shunt

ASD closure – close hole in chamber wall

balloon dilatation – open clogged artery

diagnostic catheterizations

<figure><img src="image_10.png" /></figure>

<figure><img src="image_11.png" /></figure>
# Fluoroscopy guided catheterization

<figure><img src="image_12.png" /><figcaption>UMCN, Nijmegen</figcaption></figure>

<figure><img src="image_13.png" /><figcaption>Cath Lab - UCSF</figcaption></figure>

CONRAD WP4

BOLOGNA, 8-10 June 2007

Frank Schultz - Simulation of an Interventional Cardiac Catheterization Procedure

<figure><img src="image_14.png" /></figure>

TUDelft

Delft University of Technology
# Relevance: Individual monitoring

* Protection of workers exposed to ionizing radiation

* EC council directive 96/29/Euratom, 1996
  → national legislation

- Monitoring personal dose (effective dose)

- Dose limits

* Personal dosimeter (TLD or film badge, EPD)

- Personal dose equivalent, $H_p(10)$

- Registration in National Database

<figure><img src="image_15.png" /></figure>

<figure><img src="image_16.png" /></figure>
Complication

(highly) exposed workers wear protective clothing

• dosimeter outside apron or under apron?

• position of dosimeter?

• correction factor? what relation?

<figure><img src="image_17.png" /></figure>

• dosimeter reading ↔ $H_p(10)$ ↔ E ↔ risk

<figure><img src="image_18.png" /></figure>
# Problem, P2

Simulate an interventional cardiology procedure
(heart catheterization)

Requested:

Monte Carlo technique

Provided:

- Geometry

- Technical parameters

- Materials properties

- Dosimeter reading
  at 3 positions on cardiologist,
  - without protective clothing
  - outside or under the apron

- Organ doses
  (effective dose) to the
  cardiologist

Objective:

Variation in personal dose estimates per unit Air Kerma Area Product
due to different participants simulating a clinical situation

<figure><img src="image_19.png" /></figure>

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Free Choice of Anthropomorphic Phantoms

<figure><img src="image_21.png" /><figcaption>Mathematical, ADAM
(adult male) 1986</figcaption></figure>

GSF Bericht S-885

<figure><img src="image_22.png" /><figcaption>Voxel, FAX
(adult female) 2004</figcaption></figure>

Phys. Med. Biol. 49: 5203–5216

<figure><img src="image_23.png" /><figcaption>Voxelized CT model, Rando
phantom (adult male) 2004</figcaption></figure>

Rensselaer Polytechnic Institute
www.phantomlab.com/rando.html
# PA irradiation

in AIR

cardiologist

adult
patient

image intensifier

<figure><img src="image_24.png" /></figure>

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X-ray unit

CONRAD WP4

BOLOGNA, 8-10 June 2007

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# Geometry

O<sub>C</sub>: “cardiologist” phantom ADAM

O<sub>P</sub>: “patient” phantom ADAM

distances (cm):

$$a = 76-(80+10) = -14$$
(O<sub>c</sub> below O<sub>p</sub>!)

$$b = 0$$

$$c = (55/2)+2+2+10 = 41.5$$
(table, dosimeters on and under
the apron, ½ cardiol. thickness)

$$d = 80+10 = 90$$
(table, ½ patient thickness)

$$e = 51$$
(position of the heart region)

$$f = 65+10 = 75$$
(FSD, ½ patient thickness)

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# Protective clothing

The cardiologist may wear a wrap-around protective apron of 0.35 mm Pb-equivalent material, leaving the arms free

In combination with the apron he also wears a thyroid collar of the same material and thickness

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Wrap-around apron and thyroid collar;

example, in case the mathematical phantom ADAM is being used to represent the cardiologist.

The collar covers the front half of the neck, the underside of the chin and part of the lower mandible (in ADAM, from $Z_c=70$ through $Z_c= 75$, to fully shield the thyroid). A part of the trunk's top surface is also covered, connecting to the apron's front side.

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# Dosimeter

<figure><img src="image_31.png" /></figure>

Sphere with radius of 1 cm
Filled with ICRU 4-element tissue
Dosimeter reading is absorbed dose to the center, “$H_p(10)$”

Dosimeters are worn on the front of
the trunk at 3 levels:

- waist

- chest

- neck,
either outside or under the apron

When using the ADAM phantom,
the choice would be

- waist: $Z_c$= 20 cm

- chest: $Z_c$= 50 cm

- neck: $Z_c$= 69 cm,
in the sagittal plane of symmetry

<figure><img src="image_32.png" /></figure>

<figure><img src="image_33.png" /></figure>
# Other objects

## Image Intensifier (II)

<figure><img src="image_34.png" /></figure>

L.Struelens, SCK•CEN

## Patient table

Not modeled; width = 55 cm, surface at 80 cm above floor
Cardiologist leans against the table

## Air

Surrounding dry air is present, with composition and density according to ICRU specification

<figure><img src="image_35.png" /></figure>

<figure><img src="image_36.png" /></figure>
# Geometry for 2 ADAM Phantoms

in AIR

<figure><img src="image_37.png" /></figure>

CONRAD WP4

BOLOGNA, 8-10 June 2007

Frank Schultz - Simulation of an Interventional Cardiac Catheterization Procedure

<figure><img src="image_38.png" /></figure>

TUDelft

Delft University of Technology
# Technical parameters

## Beam quality:

X-ray beam of 70 kV

Filtration: 4.5 mm Al + 0.2 mm Cu

Anode angle is 12 degrees

The generator is assumed to show 0% ripple

<figure><img src="image_39.png" /></figure>

IPEM SRS-78

## Distances:

FSD = 65 cm

FID = 95 cm

## Field size:

17 cm x 17 cm at image intensifier

<figure><img src="image_40.png" /></figure>
# Materials

material: fraction by weight

<table><thead><tr><th>element</th><th>PMMA</th><th>water</th><th>ICRU tissue</th><th>ICRU air</th><th>aluminum</th><th>lead</th></tr></thead><tbody><tr><td>hydrogen</td><td>0.080538</td><td>0.111894</td><td>0.101</td><td>-</td><td>-</td><td>-</td></tr><tr><td>nitrogen</td><td>-</td><td>-</td><td>0.026</td><td>0.755268</td><td>-</td><td>-</td></tr><tr><td>oxygen</td><td>0.319614</td><td>0.888106</td><td>0.762</td><td>0.231781</td><td>-</td><td>-</td></tr><tr><td>carbon</td><td>0.599848</td><td>-</td><td>0.111</td><td>0.000124</td><td>-</td><td>-</td></tr><tr><td>argon</td><td>-</td><td>-</td><td>-</td><td>0.012827</td><td>-</td><td>-</td></tr><tr><td>aluminum</td><td>-</td><td>-</td><td>-</td><td>-</td><td>1.0</td><td>-</td></tr><tr><td>lead</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>1.0</td></tr><tr><td></td><td></td><td></td><td colspan="2">density (g cm<sup>-3</sup>)</td><td></td><td></td></tr><tr><td></td><td>1.19</td><td>1.0</td><td>1.0</td><td>1.205x10<sup>-3</sup></td><td>2.699</td><td>11.35</td></tr></tbody></table>
# Tasks

**2.1 Calculate “dosimeter readings” per unit of dose area product, at waist, chest and neck level**

a) without protective clothing

b) above the 0.35 mm Pb wrap-around apron

c) under the 0.35 mm Pb wrap-around apron

reference values for
Individual Monitoring
Protocol?

and, optionally,

**2.2 Calculate effective dose to the cardiologist per unit of dose area product,**

a) if no protective clothing is worn

b) if the cardiologist wears a 0.35 mm Pb wrap-around apron
(+ thyroid collar)

reference values for SWG2?

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# Participants' Solutions

See next lecture:

Lara Struelens - Summary of the Submitted Problem Solutions

Questions / Comments?

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Frank Schultz - Simulation of an Interventional Cardiac Catheterization Procedure

<figure><img src="image_44.png" /></figure>
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Frank Schultz - Simulation of an Interventional Cardiac
Catheterization Procedure

<figure><img src="image_46.png" /></figure>

TUDelft

Delft University of Technology