Journal
PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS
Volume 84, Issue -, Pages 228-240Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejmp.2021.03.004
Keywords
Interventional radiological procedures; Patient organ dosimetry; Fluoroscopy-guided; Monte Carlo methods
Funding
- Fundamental Research Grant Scheme (FRGS) [FRGS/1/2020/SKK0/UM/02/30]
- Ministry of Higher Education Malaysia
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This systematic review examined the applications of Monte Carlo methods in dose estimation in fluoroscopy-guided interventional procedures. Two major challenges were identified, involving anatomical model mismatches and lack of patient positioning information. With increasing computing power, MC methods are likely to become a practical solution for routine clinical dosimetry in the near future.
Purpose: This systematic review aims to understand the dose estimation approaches and their major challenges. Specifically, we focused on state-of-the-art Monte Carlo (MC) methods in fluoroscopy-guided interventional procedures. Methods: All relevant studies were identified through keyword searches in electronic databases from inception until September 2020. The searched publications were reviewed, categorised and analysed based on their respective methodology. Results: Hundred and one publications were identified which utilised existing MC-based applications/programs or customised MC simulations. Two outstanding challenges were identified that contribute to uncertainties in the virtual simulation reconstruction. The first challenge involves the use of anatomical models to represent individuals. Currently, phantom libraries best balance the needs of clinical practicality with those of specificity. However, mismatches of anatomical variations including body size and organ shape can create significant discrepancies in dose estimations. The second challenge is that the exact positioning of the patient relative to the beam is generally unknown. Most dose prediction models assume the patient is located centrally on the examination couch, which can lead to significant errors. Conclusion: The continuing rise of computing power suggests a near future where MC methods become practical for routine clinical dosimetry. Dynamic, deformable phantoms help to improve patient specificity, but at present are only limited to adjustment of gross body volume. Dynamic internal organ displacement or reshaping is likely the next logical frontier. Image-based alignment is probably the most promising solution to enable this, but it must be automated to be clinically practical.
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