Strahlenexposition von Patienten durch diagnostische und interventionelle Röntgenanwendungen

Man-made radiation exposure to the German population predominantly results from the medical use of ionizing radiation. According to the most recent evaluation, the mean effective dose per inhabitant and year from X-ray procedures increased from 1.6 to 1.8 mSv between 1996 and 2001. This rise is mainly caused by the expanding use of CT and reflects the growing importance of this imaging modality. Besides actual data on the frequency and dose of various types of X-ray examinations, patient-specific factors will be highlighted which have to be considered in the assessment of the associated individual and collective radiation risk. Moreover, different concepts to reduce radiation exposure of patients will be discussed as well as some current trends in health service that may affect radiation hygiene -- such as diagnosis-related groups for inpatients and CT screening.     

Establishing diagnostic reference levels for interventional procedures in Kenya

PurposeTo quantify ionizing radiation exposure to patients during interventional procedures and establish national diagnostic reference levels (NDRLs) for clinical radiation exposure management.MethodsThe cumulative reference point air kerma, kerma area product, fluoroscopy time and other operational parameters were monitored for 50 children and 261 adult patient procedures in five catheterization medical laboratories in Kenya. To estimate the risk associated with the exposure, effective doses were derived from the kerma area product using conversion factors from Monte Carlo models.ResultsAbout 3% of the measured cumulative reference point air kerma for the interventional procedures approached the threshold dose limit with the potential to cause deterministic effects such as skin injuries. In interventional cardiology, the results obtained for both children and adults indicated 33% were below the diagnostic reference levels (DRLs). In adult interventional radiology, 29% for cumulative reference point air kerma, and 43% for kerma area product and fluoroscopy time respectively were below the diagnostic reference levels. NDRLs were proposed for routine use in the procedures considered and for the non-existent DRLs situations in paediatric interventional cardiology.ConclusionThe measured patient doses were above the DRLs available in the literature indicating a need for radiation optimization through, continuous monitoring and recording of patient dose. To promote radiation safety, facilities performing interventional procedures need to establish a radiation monitoring notification threshold for possible deterministic effects, in addition to the use of the newly established national diagnostic reference levels, as a quality assurance measure.     

Large-scale quality improvement for radiation protection of children worldwide: lessons from the past applied to the present

OBJECTIVE: The objective of this article is to highlight strategies that can be used to implement changes locally for improved safety of pediatric patients. Specific examples of international organizations engaged with quality improvement are discussed. CONCLUSION: Large-scale quality improvement to promote radiation protection for children is being aggressively pursued by numerous international organizations. These international agencies use quality improvement methods on a global scale to optimize medical imaging for all diagnostic imaging modalities that use ionizing radiation with the intent of lowering radiation dose to children. This work, although vast in scope, requires highly focused project goals with access to scientific expertise. In addition, these coordinated efforts must provide education, collegial support, and resources (both financial and technical) that enable radiology professionals to implement change locally for improved safety of pediatric patients.     

Subjective perception of radiation risk

Physicians, medical staff, and patients, much like the general population, are becoming increasingly sensitized to the issue of radiation exposure from diagnostic or therapeutic procedures. The attitudes of patients undergoing diagnostic imaging procedures that use ionizing radiation vary widely. Patient perception of radiation dose strongly influences their acceptance of diagnostic examinations or therapies involving radioactivity. Here, we review perceptions and concerns about radiation and radioactivity by laypersons and medical experts. Several studies show that physicians are frequently poorly informed about radiation levels associated with nuclear medicine and radiologic examinations. In addition, patients' decisions against undergoing an imaging procedure are frequently based on partial and sometimes incorrect information. Thus, physicians must take the concerns of their patients seriously. From the literature and our own experience, we conclude that it is extremely important to thoroughly and carefully educate all involved in patient work-up about radiation exposure levels and perceived or actual health risks. Although the choice and timing of imaging examinations should always outweigh the risk that secondary illness will develop, the patients' concerns still must be alleviated.     

Patient Radiation Exposure: Imaging During Radiation Oncology Procedures: Executive Summary of NCRP Report No. 184

The National Council on Radiation Protection and Measurements (NCRP) recently assessed patient radiation exposure in the United States, which was summarized in its 2019 NCRP Report No. 184. This work involved an estimation of the number of medical procedures using ionizing radiation, as well as the associated effective doses from these procedures. The NCRP Report No. 184 committee elected to not incorporate radiation dose from radiotherapy into its calculated population dose exposures, as the assessment of effective dose for the population undergoing radiotherapy is more complex than that for other medical radiation exposures. However, the aim of NCRP Report No. 184 was to raise awareness of ancillary radiation exposures to patients undergoing radiotherapy. Overall, it was estimated that annually, in 2016, approximately 800,000 patients received approximately 1 million courses of radiation therapy. Each of these treatments includes various types of imaging that may not be familiar to radiologists or others. Exposures from radiotherapy planning and delivery are reviewed in the report and summarized in this executive summary. The imaging techniques, use of this imaging, and associated tissue doses are described. Imaging can contribute a few percent to the planned treatment doses (which are prescribed to specified target volumes) as well as exposing patients to radiation outside of the target volume (in the imaging field of view).     

Effective doses to members of the public from the diagnostic application of ionizing radiation in Germany

The exposure of the German population to man-made radiation results mainly from diagnostic X-ray and nuclear medical examinations. Data are presented about the annual frequency and the average dose of the various examination types for West Germany in the years 1990–1992. According to these data a yearly average of approximately 1550 diagnostic examinations using ionizing radiation were performed per 1000 inhabitants resulting in an annual per caput effective dose of 1.9 mSv. Despite the frequent use of alternative examination techniques, such as sonography, nuclear magnetic resonance and endoscopy, the frequency of X-ray and nuclear medical examinations is still increasing. If collective risk assessments are done using the per caput effective dose, at least the age distribution of the patients must be considered. This leads to a “risk-modifying factor“ of 0.6–0.7 for patients to be applied to the ICRP risk coefficient of 5 % per Sv valid for the general population. However, radiation risk must always be viewed in context with disease- and therapy-related risks and balanced against the benefit of the diagnostic examination, which should always exceed the risk for a well-indicated procedure. Received 12 June 1996; Revision received 21 October 1996; Accepted 8 November 1996     

中国人受电离辐射照射剂量份额研究

系统总结了各种电离辐射源对正常生活条件的中国人所致照射剂量，为评价剂量－效应关系提供有意义的背景材料。方法基于大量调查研究和监测数据进行分析对比研究。结果中国人受各种电离辐射源的照射剂量，年有效剂量为２．５ｍＳｖ／ａ，来自天然辐射的剂量占总剂量的９２％。结论至今我国广大公众所受到的电离辐射照射仍以天然辐射为主。本文给出了各种电离辐射源所致剂量份额     

Radiation safety for radiologic technologists

Radiologic technologists and ancillary staff who work with or near ionizing radiation face possible short- and long-term effects of occupational radiation exposure. Further, radiologic technologists must minimize unnecessary exposure that risks the patient's safety, while achieving the best possible image or outcome. This article reviews occupational dose limits, dose calculation, devices used to measure exposure, and safety best practices that can help technologists keep radiation exposure "as low as reasonably achievable" for them and their patients. The article also discusses the appropriate use of mounted and mobile equipment, personal protective equipment, and safety features on imaging equipment to minimize unnecessary radiation exposure.     

核医学工作人员和受检者辐射防护现状

诊断核医学使用的放射性药物具有电离辐射效应,有可能损害核医学工作人员和受检者的健康或危及生命。笔者介绍了国内外诊断核医学近年来的发展趋势,并对核医学工作人员和受检者在不同检查项目中的辐射剂量进行重点分析,评估他们的辐射防护状况。笔者分析了近年来核医学辐射防护领域的研究,结果表明在采取有效防护措施的情况下,核医学工作人员的年有效剂量低于放射性工作人员的年剂量限值。受检者接受SPECT检查所致的辐射剂量主要来自99Tcm标记的单光子放射性药物,接受PET/CT检查所致的辐射剂量绝大部分来自CT扫描,所以选择合适的放射性药物活度和CT采集条件可以显著降低受检者的辐射剂量。     

Implications of ICRP 60 and the patient directive 97/43 Euratom for nuclear medicine.

The Council of the European Union has completely renewed the framework regarding radiation protection by adopting 2 directives: Directive 97/43 Euratom lays down the general principles of the radiation protection of individuals undergoing exposure to ionizing radiations related to medical exposures, as a supplement of Directive 96/29 Euratom laying down the basic safety standards for the protection of the health of workers and the general public against the dangers arising from ionizing radiations. Member States shall bring into force the laws, regulations and administrative provisions necessary to comply with these two directives before 13 May 2000. Since medical applications represent the largest man-made sources of radiation exposure for the European population and exposure to low levels of ionizing radiations has become a sensitive issue for the public, the nuclear medicine community is concerned by the set of European legislation which appear to be more restrictive than the previous one. It is based on the scientific knowledge concerning radiation protection as expressed in particular in Recommendation No. 60 of the International Commission on Radiological Protection. In this paper, the directives are carefully analyzed and evaluated in terms of their potential impact on nuclear medicine practice.     

天津市X射线诊断设备医疗照射频度调查

目的 掌握天津市X射线诊断设备医疗照射频度,为规范医疗照射管理,合理配置和使用医疗卫生资源提供建议。方法 采用普查的方式,以行政文件形式下发调查表格,对天津市687家医院（部队和武警医院除外）的X射线诊断设备基本情况和医疗照射诊疗情况进行调查,了解天津市2018年X射线诊断设备的基本情况和诊疗人次。将调查的各类型放射诊疗人次数除以2018年全市常住人口数,得出不同X射线诊断设备的应用频度,并对结果加以分析。结果 2018年天津市共有X射线诊断设备（含介入放射学）1 562台,平均每万人拥有1.00台。天津市从事X射线诊断工作（含介入放射学）的放射工作人员共4 782人,操作每台设备的放射工作人员数为3.06人/台,其中三级医院最高,为5.25人/台、未定级医院最低,为1.18人/台。全市X射线诊断医疗照射8 905 970人次,其中三级医院占54.81%、二级医院占18.00%、一级医院占16.21%、未定级医院占10.98%;X射线摄影检查占71.30%,年频度为407.84人次/千人口、CT检查占21.81%,年频度为124.74人次/千人口、介入放射学占1.04%,年频度为5.98人次/千人口,其他X射线检查占5.85%,年频度为33.47人次/千人口。结论 天津市X射线诊断设备配置基本合理,X射线诊断医疗照射频度呈上升趋势,各X射线诊断检查类别分布的合理性还需进一步提高,做好医疗照射防护,降低群体剂量水平,保护广大公众的健康和安全,是今后放射防护工作的重要课题。     

Strategies for Dose Optimization: Views From Health Care Systems

BackgroundAdvances in CT have facilitated widespread use of medical imaging while increasing patient lifetime exposure to ionizing radiation.PurposeTo describe dose optimization strategies used by health care organizations to optimize radiation dose and image quality.Materials and methodsA qualitative study of semistructured interviews conducted with 26 leaders from 19 health care systems in the United States, Europe, and Japan. Interviews focused on strategies that were used to optimize radiation dose at the organizational level. A directed content analysis approach was used in data analysis.ResultsAnalysis identified seven organizational strategies used by these leaders for optimizing CT dose: (1) engaging radiologists and technologists, (2) establishing a CT dose committee, (3) managing organizational change, (4) providing leadership and support, (5) monitoring and benchmarking, (6) modifying CT protocols, and (7) changes in equipment and work rules.ConclusionsLeaders in these health systems engaged in specific strategies to optimize CT dose within their organizations. The strategies address challenges health systems encounter in optimizing CT dose at the organizational level and offer an evolving framework for consideration in dose optimization efforts for enhancing safety and use of medical imaging.     

医学工作者的职业照射：剂量水平、辐射危害和个人剂量监测

辐射的医学应用是核能应用中最为活跃的领域，特别是近20年来介入放射学突飞猛进的发展，医学工作者是职业受照群体中增长最快的，也是最大的受照群体。由于辐射防护管理和培训的滞后，辐射防护意识和装备满足不了迅猛发展的需要，医学工作者（特别是介入放射学工作者）的职业性受照剂量较高，因此医学工作者是职业受照群体中最应受到关注的群体。为此。告诫职业受照的医学工作者，在用辐射技术造福于病人的同时，要关注自已的安全和健康，加强防护。接受完整的个人剂量监测。     

Perception of Radiation Exposure and Risk Among Patients,Medical Students,and Referring Physicians at a Tertiary Care Community Hospital

Background

It is important for physicians to be aware of the radiation doses as well as the risks associated with diagnostic imaging procedures that they are ordering.

Methods

A survey was administered to patients, medical students, and referring physicians from a number of specialties to determine background knowledge regarding radiation exposure and risk associated with commonly ordered medical imaging tests.

Results

A total of 127 patients, 32 referring physicians, and 30 medical students completed the survey. The majority of patients (92%) were not informed of the radiation risks associated with tests that they were scheduled to receive and had false perceptions about the use of radiation and its associated risks. Physicians and medical students had misconceptions about the use of ionizing radiation in a number of radiologic examinations; for example, 25% and 43% of physicians and medical students, respectively, were unaware that interventional procedures used ionizing radiation, and 28% of physicians were unaware that mammography used ionizing radiation. Computed tomographies and barium studies were thought to be associated with the least ionizing radiation among physicians.

Conclusion

There is a need for educating the public, medical students, and referring physicians about radiation exposure and associated risk so that (1) patients receiving multiple medical imaging tests are aware of the radiation that they are receiving and (2) physicians and future physicians will make informed decisions when ordering such tests to limit the amount of radiation that patients receive and to promote informed consent among patients.     

浅议放射卫生在医用辐射防护领域的几个问题

电离辐射在医学中的应用发展迅猛,与之紧密相连的医用电离辐射安全与防护问题始终是放射卫生工作的重要内容之一。本文从国民医疗照射水平与现状、医疗照射正当性判定、放射诊疗设备质量控制与保证、放射工作人员职业照射防护和放射诊疗患者健康效应研究等几个方面介绍我国当前的工作情况,分析存在的问题,提出相关建议。     

医学工作者的职业照射:剂量水平、辐射危害和个人剂量监测

辐射的医学应用是核能应用中最为活跃的领域,特别是近20年来介入放射学突飞猛进的发展,医学工作者是职业受照群体中增长最快的,也是最大的受照群体。由于辐射防护管理和培训的滞后,辐射防护意识和装备满足不了迅猛发展的需要,医学工作者(特别是介入放射学工作者)的职业性受照剂量较高,因此医学工作者是职业受照群体中最应受到关注的群体。为此,告诫职业受照的医学工作者,在用辐射技术造福于病人的同时,要关注自已的安全和健康,加强防护,接受完整的个人剂量监测。     

《心血管成像电离辐射优化使用安全性和效能的 最佳实践专家共识》解读

目前心血管成像技术在临床应用越来越多，随之而来的电离辐射损伤成为备受关注的重要问题，优化辐射剂量是大势所趋。2018年美国心脏病学会等多家学会联合推出了《心血管成像电离辐射优化使用的安全性和效能的最佳实践专家共识》，汇集并解释了当前与使用电离辐射有关的心血管成像知识，提出了安全性和有效性的最佳实践指南。     

Effective doses in radiology and diagnostic nuclear medicine: a catalog

Medical uses of radiation have grown very rapidly over the past decade, and, as of 2007, medical uses represent the largest source of exposure to the U.S. population. Most physicians have difficulty assessing the magnitude of exposure or potential risk. Effective dose provides an approximate indicator of potential detriment from ionizing radiation and should be used as one parameter in evaluating the appropriateness of examinations involving ionizing radiation. The purpose of this review is to provide a compilation of effective doses for radiologic and nuclear medicine procedures. Standard radiographic examinations have average effective doses that vary by over a factor of 1000 (0.01-10 mSv). Computed tomographic examinations tend to be in a more narrow range but have relatively high average effective doses (approximately 2-20 mSv), and average effective doses for interventional procedures usually range from 5-70 mSv. Average effective dose for most nuclear medicine procedures varies between 0.3 and 20 mSv. These doses can be compared with the average annual effective dose from background radiation of about 3 mSv.     

Therapy for prevention and treatment of skin ionizing radiation damage: a review

Abstract

Radiologic accidents or terrorist acts involving radioactive material, as well as radiation exposure in medical or industrial procedures are potential sources of risk for human health. All these risks share a common element, exposure to ionizing radiation. The extent of ionizing radiation injury will depend on a number of independent variables such as dose, type of radiation and tissue, etc. As a result of ionizing radiation exposure, biological effects can take place in acute or long-term manner. As in the case of other self-renewing tissues (e.g. hematopoietic system and intestinal epithelium), skin is also extremely sensitive to ionizing radiation. In this way, appropriate management of radiation skin effects might improve the therapeutic benefit of medical radiation therapy, as well as reduce the mortality associated with any radiological incident (e.g. accident or terrorist attack). For this reason, current and potential future treatment approaches for skin radiation injury are reviewed in this work. Unfortunately, there is no sufficient evidence for establishing a standard treatment to prevent or mitigate radiation-induced cutaneous injury. Thus, continued research is necessary to achieve effective therapies to address this important health problem.     

The importance and unique aspects of radiation protection in medicine

Radiation protection in medicine has unique aspects and is an essential element of medical practice. Medical uses of radiation occur throughout the world, from large cities to rural clinics. It has been estimated that the number of medical procedures using radiation grew from about 1.7 billion in 1980 to almost 4 billion in 2007. In spite of these large numbers, there are many parts of the world without adequate equipment, where the ability to perform additional medical procedures would likely result in a net benefit. Medicine accounts for more than 99.9% of the per caput effective dose from man-made sources. The goal in medical exposure is not to give the lowest dose, but to provide the correct dose to enable the practitioner to make the diagnosis or cure a tumour. Too little or too much dose is problematic and the risk of any given procedure ranges from negligible to potentially fatal. Radiation protection in medicine must deal with the issues of not having dose limits, purposely exposing sensitive subgroups, and purposely using doses that could cause deterministic effects. Radiation accidents involving medical uses have accounted for more acute radiation deaths than from any other source including Chernobyl. Many physicians have little or no training in radiation protection, and many have no qualified medical physics support. In many countries, medical radiation devices and uses are only minimally regulated and the rapidly evolving technology is a challenge. Medicine also accounts for the largest number of occupationally exposed workers and collective dose.