Patient radiation dosimetry for fluoroscopically guided interventions - a review of the history and limitations.

Fluoroscopically guided interventions (FGIs) play a critical role in modern medicine, though they potentially deliver high radiation doses that require accurate and patient-specific dosimetry for risk assessment and patient management. This review provides a historical overview of radiation dosimetry in fluoroscopy, tracing the evolution from rudimentary dose estimation methods to modern tools leveraging standardized dose indices and radiation dose structured reports (RDSRs) for radiation dosimetry at the skin surface as well as at depth in soft tissue. Despite these advancements, substantial uncertainties remain due to technical limitations, beam geometry, dose mapping challenges, and hardware-induced variability. Key sources of uncertainty are examined, some well-known and others that are not well-understood. This work also underscores the need for a deeper understanding of the assumptions and limitations in automated dosimetry systems and calls for enhanced reporting standards and dose mapping capabilities to improve accuracy. Addressing these limitations is essential for integrating radiobiological principles into clinical medical physics and optimizing patient care in FGIs.