{"id":168,"date":"2021-10-03T22:58:16","date_gmt":"2021-10-03T22:58:16","guid":{"rendered":"https:\/\/hawon.choonsiklee.com\/?page_id=168"},"modified":"2022-09-26T03:01:27","modified_gmt":"2022-09-26T03:01:27","slug":"fluoroscopy-patient-dose-calculation-modules","status":"publish","type":"page","link":"https:\/\/hawon.choonsiklee.com\/?page_id=168","title":{"rendered":"Fluoroscopy patient dose calculation modules"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Hawon Lee<meta charset=\"utf-8\"><sup>1<\/sup>, Andreu Badal<meta charset=\"utf-8\"><sup>2<\/sup><br><meta charset=\"utf-8\"><sup>1<\/sup>Montgomery Blair High School, Silver Spring, MD<br><meta charset=\"utf-8\"><sup>2<\/sup>Division of Imaging Diagnostics and Software Reliability, CDRH, FDA, Silver Spring, MD<\/h2>\n\n\n\n<div class=\"wp-block-buttons is-horizontal is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-499968f5 wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button has-custom-font-size is-style-primary has-small-font-size\"><a class=\"wp-block-button__link\" href=\"https:\/\/hawon.choonsiklee.com\/?cat=25\" target=\"_blank\" rel=\"noreferrer noopener\">Research log<\/a><\/div>\n<\/div>\n\n\n\n<h1 class=\"wp-block-heading\">Background<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">Interventional fluoroscopy is an imaging modality that provides a real-time x-ray image of a patient\u2019s anatomy.&nbsp;The radiation dose delivered to patients and operators during interventional fluoroscopy procedures can be substantial, and cause radiation injuries. Dosimeter badges, the standard method used for dose estimation, measure radiation at discrete points, and the dose is only known after the procedure. With the increasing use of fluoroscopy, there is a need for new tools that can reduce the dose and minimize side effects. At CDRH\/OSEL\/DIDSR we are developing&nbsp;a <strong>Virtual Dosimeter<\/strong>&nbsp;system to estimate, computationally, the radiation delivered to operators and patients in real-time (Figure 1).<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">In the current project, I developed a <strong>Conductor Software<\/strong> tool that coordinates the execution of the 3 existing modules of the&nbsp;<strong>Virtual Dosimeter<\/strong>&nbsp;and created a new&nbsp;<strong>Display Module<\/strong>.<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"862\" src=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/Screen-Shot-2021-10-03-at-7.54.28-PM-1024x862.png\" alt=\"\" class=\"wp-image-228\"\/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h1 class=\"wp-block-heading\">Figure 1<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">A computational model&nbsp;of an operator standing next to a patient during an interventional fluoroscopy procedure.<\/h2>\n<\/div>\n<\/div>\n\n\n\n<h1 class=\"wp-block-heading\">Results: Conductor application<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">We developed a command-line application written in Python language within the Ubuntu Linux environment by using the Robot Operating System (ROS) library. We named the application, \u201cConductor Application\u201d because the application is \u201cconducting\u201d the communication between the four different modules to eventually estimate radiation dose to medical staff undergoing interventional fluoroscopy procedures. Figure 1 shows the workflow of the Virtual Dosimeter System where the Conductor application communicates messages among the four different modules. The process follows the four steps:<\/h2>\n\n\n\n<ul class=\"has-small-font-size wp-block-list\"><li>Step A: Receive x-ray source data from the Source Module.<\/li><li>Step B: Communicate with the Tracking Module to receive the operator position at the time of the irradiation.<\/li><li>Step C: Send source and operator data to Monte Carlo Module for fast x-ray transport simulation using MC-GPU and receive the estimated organ and skin doses.<\/li><li>Step D: Send dosimetry results to the Display Module to inform the operator of the received radiation exposure.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">The Conductor application was designed to repeat the process described above for each acquisition in the procedure.<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"923\" height=\"1000\" src=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_flowchart.png\" alt=\"\" class=\"wp-image-481\" srcset=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_flowchart.png 923w, https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_flowchart-277x300.png 277w, https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_flowchart-768x832.png 768w\" sizes=\"auto, (max-width: 923px) 100vw, 923px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<h1 class=\"wp-block-heading\">Figure 2<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">Flow chart of the Virtual Dosimetry system where the ROS messages are exchanged between modules using the new Conductor application: Source Module, Tracking Module, Monte Carlo Module, and Dose Display Module.<\/h2>\n<\/div>\n<\/div>\n\n\n\n<h1 class=\"wp-block-heading\">Results: Illustrative dose to operator<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">We estimated illustrative doses using the Virtual Dosimeter system running through the Conductor application. Display Module was used to display dose results in two different modes: organ dose in bar graphs and dose distribution map. <\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Figure 3 shows the bar graph of doses to the skin, testes, bone, and red bone marrow received by the operator for two different fluoroscopic procedures: left anterior oblique 45 degree and posterior anterior views. The organ doses were calculated by Monte Carlo Module based on the input data from Source Module and Tracking Module. Skin received a substantially greater dose compared to other organs in both procedures.<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Figure 4 shows the illustrative dose distribution throughout the anatomy of the operator conducting the left anterior oblique 45-degree procedure for a patient. The high dose is focused on the right shoulder region of the operator.<\/h2>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_bargraph.png\" alt=\"\" class=\"wp-image-479\" width=\"524\" height=\"312\" srcset=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_bargraph.png 1000w, https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_bargraph-300x179.png 300w, https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_bargraph-768x459.png 768w\" sizes=\"auto, (max-width: 524px) 100vw, 524px\" \/><figcaption>Figure 3. Bar graph of computed operator organ doses in two fluoroscopy views generated by the Display module.<\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\"><div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_dosemap-e1633462137159.png\" alt=\"\" class=\"wp-image-480\" width=\"257\" height=\"490\" srcset=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_dosemap-e1633462137159.png 242w, https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/fluoro_dosemap-e1633462137159-157x300.png 157w\" sizes=\"auto, (max-width: 257px) 100vw, 257px\" \/><figcaption>Figure 4. Illustrative radiation dose distribution delivered to an operator conducting the left anterior oblique 45 degree procedure.<\/figcaption><\/figure>\n<\/div><\/div>\n<\/div>\n\n\n\n<h1 class=\"wp-block-heading\">Conclusion and Future Work<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">We developed the Conductor application to manage communication between multiple modules within the&nbsp;<strong>Virtual Dosimeter<\/strong>&nbsp;system using the popular, open-source Robot Operating System library. &nbsp;In the future, a volume renderer for the&nbsp;<strong>Display Module<\/strong>&nbsp;will be developed and an alarm to warn operators of potential overexposures will be implemented into the system.<\/h2>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/Presentation_2021.pdf\" type=\"application\/pdf\" style=\"width:100%;height:600px\" aria-label=\"Embed of Embed of Slides presented at the FDA Summer Research Presentation Event..\"><\/object><a id=\"wp-block-file--media-0bf61d49-045b-4176-99d3-117e840ec663\" href=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/Presentation_2021.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Slides presented at the FDA Summer Research Presentation Event<\/a><a href=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/Presentation_2021.pdf\" class=\"wp-block-file__button\" download aria-describedby=\"wp-block-file--media-0bf61d49-045b-4176-99d3-117e840ec663\">Download<\/a><\/div>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/2021_Poster_Lee_Badal.pdf\" type=\"application\/pdf\" style=\"width:100%;height:600px\" aria-label=\"Embed of Embed of Poster presented at the FDA Summer Research Presentation Event..\"><\/object><a id=\"wp-block-file--media-6bc003bf-c0ae-4055-97c0-95af791f3ca6\" href=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/2021_Poster_Lee_Badal.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Poster presented at the FDA Summer Research Presentation Event<\/a><a href=\"https:\/\/hawon.choonsiklee.com\/wp-content\/uploads\/2021\/10\/2021_Poster_Lee_Badal.pdf\" class=\"wp-block-file__button\" download aria-describedby=\"wp-block-file--media-6bc003bf-c0ae-4055-97c0-95af791f3ca6\">Download<\/a><\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hawon Lee1, Andreu Badal21Montgomery Blair High School, Silver Spring, MD2Division of Imaging Diagnostics and Software Reliability, CDRH, FDA, Silver Spring, MD Background Interventional fluoroscopy is an imaging modality that provides a real-time x-ray image of a patient\u2019s anatomy.&nbsp;The radiation dose delivered to patients and operators during interventional fluoroscopy procedures can be substantial, and cause radiation&hellip;&nbsp;<a href=\"https:\/\/hawon.choonsiklee.com\/?page_id=168\" rel=\"bookmark\">Read More &raquo;<span class=\"screen-reader-text\">Fluoroscopy patient dose calculation modules<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"class_list":["post-168","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/hawon.choonsiklee.com\/index.php?rest_route=\/wp\/v2\/pages\/168","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hawon.choonsiklee.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/hawon.choonsiklee.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/hawon.choonsiklee.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/hawon.choonsiklee.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=168"}],"version-history":[{"count":0,"href":"https:\/\/hawon.choonsiklee.com\/index.php?rest_route=\/wp\/v2\/pages\/168\/revisions"}],"wp:attachment":[{"href":"https:\/\/hawon.choonsiklee.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=168"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}