核医学诊断工作场所辐射水平及防护现状调查

目的 对我国核医学诊断工作场所辐射防护现状进行调查.方法 2013年2—12月期间,在东北、华中和华北地区分别选择1家三甲医院,用γ剂量率仪巡测核医学诊断制药、淋洗、分装、注射、扫描过程中工作场所周围剂量当量率,光致发光剂量计测量放射工作人员个人有效剂量和当量剂量.结果 在放射性药物分装、注射和受检者摆位等操作环节中周围剂量当量率较高, 分装时最高达1.92 mSv/h,注射时距针管5 cm处剂量率最高达1.2 mSv/h,受检者体表30 cm处剂量率范围为5.36~240 μSv/h,某医院护士手部当量剂量为0.01~0.02 mGy,部分工作场所存在人员路线交叉及注射后受检者停留在公众区域的现象.结论 核医学实践中放射工作人员应加强个人防护,提高操作熟练程度以缩短作业时间,应优化放射工作人员出入路线,加强注射后受检者的管理,以免公众人员受到不必要的照射.     

99Tcm-MDP全身骨显像受检者外照射剂量的研究

目的 研究99Tcm-亚甲基二膦酸盐（MDP）全身骨显像受检者对非核医学科人员的外照射剂量,以有效减少非受检者的受照辐射剂量。 方法 选取 2018年8月至2019年1月在中国科学技术大学附属第一医院行99Tcm-MDP全身骨显像的51例受检者进行回顾性研究,其中男性26例、女性25例,年龄22~91（62.23±13.36）岁。所有受检者注射925 MBq 99Tcm-MDP后,根据饮水1000 mL后0.5 h内有无排尿分为排尿组（n=39）和未排尿组（n=12）,检测注射药物后0.5、1、2、3、4、6 h时受检者腹部和头部水平距离0.5、1、2、4、6 m处的辐射剂量当量率和累积剂量当量。2组间比较采用两独立样本的Mann-Whitney U检验,多次测量的不同时间、不同距离辐射剂量当量率的比较采用重复测量方差分析,配对样本采用非参数Wilcoxon检验。 结果 排尿组受检者在腹部水平距离0.5、1、2、4、6 m处的辐射剂量当量率均低于未排尿组[（40.29±4.67）μSv/h对（77.29±10.71）μSv/h、（15.22±1.64）μSv/h对（29.48±4.56）μSv/h、（4.15±0.47）μSv/h对（7.45±1.07）μSv/h、（1.32±0.10）μSv/h对（2.63±0.31）μSv/h、（0.45±0.05）μSv/h对（0.78±0.15）μSv/h],且差异均有统计学意义（Z=5.148~5.251,均P<0.001）。排尿组受检者腹部和头部的辐射剂量当量率均随着时间和距离的增加而迅速降低,且差异有统计学意义（F=3105.426~5397.675,均P<0.001）;排尿组受检者的辐射剂量当量率随着药物注射后时间的延长而显著下降。与排尿组受检者腹部水平距离0.5 m处6 h的累积剂量当量[（148.51±13.83）μSv]相比,1 m处6 h的累积剂量当量[（55.85±5.22）μSv]显著下降,且差异有统计学意义（Z=5.610,P<0.001）;与排尿组受检者头部水平距离0.5 m处6 h的累积剂量当量[（132.74±12.95）μSv]相比,1 m处6 h的累积剂量当量[（49.88±4.72）μSv]显著下降,且差异有统计学意义（Z=5.438,P<0.001）;排尿组受检者的累积剂量当量随着照射时间的延长而增加、随着距离的增加而减少。 结论 99Tcm-MDP全身骨显像对于非核医学科人员的照射剂量远远小于国内、国际法律规定限值（个人年有效剂量当量≤1 mSv）,与注射药物后3 h的受检者距离1 m以上即可避免大部分额外辐射。     

90Y树脂微球选择性内放射治疗放射防护检测与剂量评估

目的对90Y树脂微球选择性内放射治疗过程进行放射防护检测和剂量评估, 为放射防护工作提供参考。方法对90Y树脂微球介入手术治疗各操作环节和患者体表的外照射水平进行检测, 估算相关人员的受照剂量水平。结果 90Y树脂微球分装及转运过程的剂量率水平为1.12～454 μSv/h, 手术操作过程为2.06～58.2 μSv/h;3名患者术后0.5 h, 体表5 cm和1 m处的剂量率分别为22.7～64.1和0.82～2.55 μSv/h。按照每年200例患者的工作量, 90Y树脂微球药物操作对工作人员年个人有效剂量贡献为0.12～1.03 mSv/年, 术后患者对公众、家属及陪护志愿者的个人有效剂量贡献为0.02～0.24 mSv/年。结论在患者治疗、护理和出院过程中, 工作人员、陪护志愿者和公众的照射剂量均低于(GB 18871-2002《电离辐射防护与辐射源安全基本标准》)中的剂量限值和医疗机构设定的管理目标值。     

RDS111型回旋加速器辐射剂量监测与防护

目的监测回旋加速器运行过程中产生的辐射水平及其与靶电流之间的关系,为相关人员的防护提供参考.方法用剂量仪分别测量美国CTI RDS111型回旋加速器在靶电流为40μA时生产11C、13N、15O、18F 4种核素在大厅内外的γ和中子剂量率及不同靶电流下的剂量当量率,并计算相关人员可能的年剂量当量.结果回旋加速器大厅内除1个点外,其余各处剂量当量率均小于15 μSv/h,大厅外周围环境则均小于0.5 μSv/h.相关人员可能的年剂量当量小于1.04mSv.线性拟合示,剂量当量率与束流强度呈正比.结论正常情况下,相关人员吸收剂量均未超过国家安全标准中关于职业人员（20 mSv）和公众个人（5 mSv）的年剂量当量限值.     

68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量的估算

目的 估算68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量。 方法 采用简单随机抽样的方法选取2021年10至12月于北京大学肿瘤医院接受68Ga-奥曲肽PET/CT显像的20例患者进行前瞻性研究,其中男性15例、女性5例,年龄30~68（49.0±12.2）岁。在患者静脉注射68Ga-奥曲肽0 h后,使用辐射监测剂量仪测量距患者1.0 m处的空气吸收剂量率,注射1.0 h后测量距患者0.3 m处的空气吸收剂量率,注射1.5 h后测量距患者0.3、0.5、1.0和1.5 m处的空气吸收剂量率。依据美国国家辐射防护和测量委员会第155号报告提出的人类社会活动模式,采用积分法估算68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量。 结果 注射68Ga-奥曲肽0 h后,距患者1.0 m处的空气吸收剂量率为12.97~33.67 （20.24±6.57） μSv/h;注射1.0 h后,距患者0.3 m处的空气吸收剂量率为32.73~57.69（48.98±6.20） μSv/h;注射1.5 h后,距患者0.3、0.5、1.0、1.5 m处的空气吸收剂量率分别为24.04~42.39（35.98±4.56） μSv/h、11.83~28.83（20.70±4.55） μSv/h、5.17~13.42（8.07±2.61） μSv/h、1.51~7.01（3.75±1.72） μSv/h。与68Ga-奥曲肽显像患者白天接触的家庭成员受照的有效剂量为8.22~21.33（12.83±4.15） μSv,夜间同床共睡的家庭成员受照的有效剂量为38.92~68.62（58.25±7.38） μSv,单位同事受照的有效剂量为8.37~21.73（13.06±4.23） μSv,同车邻座乘客受照的有效剂量为32.97~58.15（49.36±6.26） μSv。每接触一例患者,操作人员受照的有效剂量为2.66~4.69（3.98±0.50） μSv,陪护护士受照的有效剂量为9.70~25.17（15.13±4.90） μSv。 结论 68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量远低于国家标准规定的有效剂量限值。     

受过量照射工作人员的医学管理

剂量限值是指不应超过的从受控实践中个人所受的有效剂量值或当量剂量值[1 ] 。职业照射的有效剂量限值适用于在 1年工作期间由外照射源产生的有效剂量与同一年内由摄入放射性核素所产生的待积有效剂量的总和[2 ] 。《国际电离辐射防护和辐射源安全的基本安全标准》(IBSS) [1 ] 规定 :“必须对任何工作人员的职业照射加以控制 ,使其不超过下列限值 :连续 5年以上年平均有效剂量 2 0mSv ;任何单独 1年内有效剂量 5 0mSv ;一年内眼晶体所受的当量剂量 15 0mSv ;一年内四肢 (手和足 )或皮肤所受的当量剂量 5 0 0mSv”。我国发布的新辐射防…     

18F-FDG PET延迟显像鉴别诊断原发性肺癌

目的　探讨18F 脱氧葡萄糖 (FDG)PET延迟显像对原发性肺癌和肺结核的鉴别诊断价值。方法　 70例受检者分为原发性肺癌组 (2 5例 )、肺结核组 (16例 )和正常对照组 (2 9例 ) ,分别行18F FDGPET早期头部～盆腔显像和注射后 4h胸部延迟显像。计算 2次显像肺部病灶感兴趣区 (ROI)与同一平面对侧正常组织的放射性比值 (T/B)。结果　18F FDGPET显像示 2 5例原发性肺癌早期显像阳性 2 2例 ,阴性 3例 ,灵敏度、特异性和阳性预测值分别为 88 0 %、87 5 %和 91 7% ;延迟显像阳性2 3例 ,阴性 2例 ,灵敏度、特异性和阳性预测值分别为 92 0 %、93 8%和 95 8%。T/B与原发性肺癌不同组织学类型存在明显关系。肺结核组早期显像T/B为 3 6 7± 2 17,其中 2例发现FDG高摄取灶 ,假阳性率为 12 5 % ,延迟显像 1例FDG阳性 ,假阳性率为 6 3%。早期显像原发性肺癌组T/B (4 33± 3 0 0 )和肺结核组差异无显著性 (t=0 94 5 ,P =0 347) ,延迟显像原发性肺癌组T/B (7 91± 7 0 8)较早期显像增高 3 4 9± 2 6 6 ,明显高于肺结核组 (3 6 7± 1 86 ,t=4 173,P =0 0 0 0 )。肺结核组和对照组T/B (1 15± 0 31,1 0 5± 0 13)延迟与早期显像差异无显著性 (t=0 0 4 9、1 5 6 4 ,P =0 96 6、0 199)。结论延迟显像比早期显像更     

~(18)F-FDG PET显像检查结肠腺瘤

目的 :评估 1 8F- FDG (1 8F-氟代脱氧葡萄糖 ) PET显像对检查结肠腺瘤性息肉的价值。方法 :作为对癌症筛查的一部分 ,对 110名无症状者同时进行了 1 8F- FDG PET和结肠镜检查 ,其中男 71名 ,女 39名 ,36～ 84岁 ,平均 5 6 .5± 9.3岁。所有受检者在进行 1 8F-FDG PET检查前禁食 4h,注射 2 6 0 MBq1 8F- FDG后 45～ 6 0min进行无衰减校正的全身显像。所采集到的横断和冠状影像 ,由一名具有从事 1 8F- FDG PET显像研究肿瘤方面不少于5年的医生进行分析 ,并与结肠镜的结果进行对照。在 1 8F-FDG PET影像上 ,沿着大肠走行分布…     

PET/CT检查中18F-FDG所致辐射剂量的研究

目的 研究在PET/CT检查中18F脱氧葡萄糖(FDG)所致的辐射剂量,使辐射防护更优化.方法 单纯随机法选取30名受检者,记录注射18F-FDG的活度;用451P-DE-DI型电离室巡测仪测量受检者的外照射剂量当量率;在职业人员的不同部位佩戴热释光个人剂量计(TLD),测其累积剂量当量,对有关数据分别进行曲线拟合和直线回归分析.结果 30名受检者注射18F-FDG活度为(432.9±51.8)MBq,有效剂量为(8.23±0.99)mSv;剂量当量率与距离和时间的相关系数(r)值分别为-0.994和-0.988,数据拟合后分别为乘幂曲线和指数曲线;职业人员不同部位TLD所测年累积剂量当量均小于相应的年剂量限值.结论 PET/CT检查中(432.9±51.8)MBq18F-FDG对受检者造成的剂量当量负担较小,但医师在申请检查时应综合考虑受检者的有效剂量;注射18F-FDG后的受检者为活动的辐射源,应从距离防护和时间防护方面对他们的活动稍加约束,减少对其他人员的照射;从医疗照射最优化的角度还可较大程度降低注射18F-FDG的活度.     

~(18)F-FDG PET显像检出和分期恶性淋巴瘤

目的 :首次前瞻性研究 1 8F- FDG (1 8F-氟代脱氧葡萄糖 )PET显像检出和分期恶性淋巴瘤的临床价值。方法 :1996年 10月～ 1998年 7月 ,前瞻性检查了连续5 2例未治疗的恶性淋巴瘤 (均经组织学证实 )病人 ,其中霍奇金病 2 7例 ,非霍奇金淋巴瘤 2 5例。以 1 8F- FDG PET显像、CT和骨髓活检 (BMB)对每例的淋巴结、淋巴结以外组织和骨髓进行研究。通过活检 ,MRI或临床随访 (4～ 2 4个月 )对1 8F- FDG PET显像与 CT和 BMB间的分歧发现进行验证。1 8F- FDG平均剂量为 390 (2 30～ 5 5 0 ) MBq。 1 8F- FDG PET扫描范围包括 :上…     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.