Uncertainty Associated with the Use of Software Solutions Utilizing Dicom RDSR for Skin dose Assessment in Interventional Radiology and Cardiology.

PURPOSE The purpose of this work is to provide a comprehensive analysis of uncertainties associated with the use of software solutions utilizing DICOM RDSRs for skin dose assessment in the interventional fluoroscopic environment. METHODS AND RESULTS Three different scenarios have been defined for determining the overall uncertainty, each with a specific assumption on the maximum deviations of factors affecting the calculated dose. Relative expanded uncertainty has been calculated using two approaches: the law of propagation of uncertainty and the propagation of distributions based on the Monte Carlo method. According to the propagation of uncertainty, it is estimated that the lowest possible relative expanded uncertainty of ~13% (at the 95% level of confidence, i.e. with the coverage factor of k = 2 assuming normal distribution) could only be achieved if all sources of uncertainties are carefully controlled, whereas maximum relative expanded uncertainty could reach up to 61% if none of the influencing parameters are controlled properly. When the influencing parameters are reasonably well-controlled, realistic relative expanded uncertainty amounts to 28%. Values for the relative expanded uncertainty obtained from the Monte Carlo propagation of distributions concur with the results obtained from the propagation of uncertainty to within 3% in all three considered scenarios, validating the assumption of normality. CONCLUSIONS The overall skin dose relative uncertainty has been found to range from 13 to 61%, emphasizing the importance of adequate analysis and control of all relevant uncertainty sources.