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Sources of information used to calculate PSD in Case 1: (a)  for each DAS was listed in a proprietary dose report; (b) distances were listed in the DICOM header; (c) the location of the IRP was listed in the equipment operator's manual.
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First, the ESAK for each DAS was calculated by applying the inverse square law correction to the reported  for each DAS in the dose report (Fig. 1(a)). The relevant distances were extracted from the DICOM header for each DAS (Fig. 1(b)) and from the equipment manual (Fig. 1(c)).
Data used to estimate the BSF and f-factor. kV and added filtration* were listed in both the (a) proprietary dose report and (b) the DICOM header. Data used to calculate the x-ray field size (c) were available in the DICOM header.. *Cu filter thickness is in tag Private_0021_100a.
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The kV and added filtration were available in both the dose report (Fig. 2(a)) and the DICOM header (Fig. 2(b)), and the X-ray field size at the patient location was estimated from the collimator positions, source-to-image distance, and source-to-patient distance, which were all extracted from the DICOM header (Fig. 2(c)).
Flowchart outlining the methods and sources of data used to estimate the PSD for a single digital acquisition series. The same method was used to estimate the PSD for other digital acquisition series and fluoroscopy.
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Flowchart outlining the methods and sources of data used to estimate the PSD for a single digital acquisition series. The same method was used to estimate the PSD for other digital acquisition series and fluoroscopy.
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Flowchart outlining the methods and sources of data used to estimate the PSD for Case 2. The concept of the biologically effective dose (BED) is presented in Balter et al.(

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The calculation steps used in this case are outlined in Fig. 4.
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Image from postprocedural CT in Case 3 that was used to measure patient thickness in the anteroposterior direction. Patient thickness was measured at the location of the newly created shunt, which is visible in the image.
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The patient thickness was estimated to be 32 cm based on a measurement obtained from a postprocedure CT scan at the location of the shunt (Fig. 5).
Simulation setup used to measure data for estimation of PSD when no dose metrics were available. The setup was based on recorded procedural information and a review of archived images: (a) source-to-chamber distance, which was equal to the SPD used during the actual procedure; (b) patient-equivalent thickness of polymethylmethacrylate (PMMA); (c) SID as used during the actual procedure; (d) ionization chamber or solid-state dosimeter; (e) indicated focal spot on X-ray tube housing.
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Figure 6 shows the experimental setup. Note in Fig. 6(d) that a solid-state dosimeter was used.
Flowchart outlining the methods and sources of data used to estimate the PSD for Case 3.
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The calculation steps used in this case are outlined in Fig. 7.
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Flowchart outlining the methods and sources of data used to estimate the PSD for Case 4.
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The calculation steps used during this case are outlined in Fig. 8.