放射性介入操作中辐射剂量与防护措施

由放射性介入操作所导致的辐射剂量已引起人们越来越多的关注,尤其是考虑到该项操作的频率不断增加和日趋复杂化。现有研究的主要集中于三个方面:目前放射性介入操作中的剂量水平、操作人员和患者的辐射危险以及辐射防护措施。     

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。     

河南“4.26”~(60)Co源辐射事故受照者的生物剂量(染色体畸变)估算

目的　用染色体畸变分析方法对河南“4 2 6”6 0 Co辐射事故 7例受照者 ,进行了早期生物剂量估算。方法　照后 4～ 5d取血培养 ,分析第一次有丝分裂细胞“双 环”畸变率 ,并由此估算生物剂量。用“双 环”畸变在细胞间的泊松分布情况 ,检验照射的均匀性。结果　 7例受照者依据“双 环”畸变率估算的个体辐射剂量分别为 5 0 9Gy(梅 )、2 6 1Gy(天 )、2 49Gy(旺 )、0 89Gy(勇 )、0 70Gy(民 )、0 5 8Gy(义 )和 0 0 8Gy(宇 ) ,与用物理方法测定的剂量比较接近 ,亦与放射损伤的临床诊断完全吻合。泊松分布检验证实 ,“梅”和“旺”双 环畸变偏离泊松分布 ,其余 5例符合泊松分布。结论　染色体畸变分析是非常可靠的生物剂量估算方法。“梅”和“旺”受到不均照射 ,其他 5例受到比较均匀的照射。     

低剂量辐射兴奋效应及其机制

国内外有关低剂量辐射兴奋效应的研究始于70年代末,近年来已从低剂量诱导蛋白生成、基因调控方面研究其机制。本文分别从流行病学调查和放射生物学研究两大领域对低剂量辐射兴奋效应及其机制加以综述。     

A laboratory inter-comparison of the importance of serum serotonin levels in the measurement of a range of radiation-induced bystander effects: Overview of study and results presentation

Abstract

Purpose: Recent research has suggested that serotonin may play an important role in the expression of radiation-induced bystander effects. Serotonin levels in serum were reported to range from 6–22 μM and to correlate inversely with the magnitude of cellular colony-forming ability in medium transfer bystander assays. That is, high serotonin concentration correlated with a low cloning efficiency in cultures receiving medium derived from irradiated cells.

Methods: Because of the potential importance of this observation, the European Union's Non-targeted Effects Integrated Project (NOTE) performed an inter-comparison exercise where serum samples with high and low serotonin levels were distributed to seven laboratories which then performed their own assay to determine the magnitude of the bystander effect.

Results: The results provided some support for a role for serotonin in four of the laboratories. Two saw no difference between the samples and one gave inconclusive results. In this summary paper, full data sets are presented from laboratories whose data was inconclusive or insufficient for a full paper. Other data are published in full in the special issue.

Conclusion: The data suggest that there may be multiple bystander effects and that the underlying mechanisms may be modulated by both the culture conditions and the intrinsic properties of the cells used in the assay.     

一例亚急性放射病患者的生物剂量估算及 细胞遗传学随访观察

目的对一起^192Ir源辐射事故致亚急性放射病患者进行细胞遗传学动态观察，并估算受照剂量。方法对患者照后2d、1．5年和2．5年的外周血样本进行常规染色体畸变（CA）分析和微核（MN）检测，根据双＋环（d＋r）畸变频率，用G函数方法估算累积受照剂量。结果剂量估算结果与用物理方法估算的剂量接近，与临床表现基本相符；照后1．5年和2．5年，双着丝粒体（dic）明显减少，无着丝粒断片（ace）和MN减少不明显。结论用G函数方法估算迁延性受照者的累积受照剂量基本可反映实际辐射损伤程度；亚急性放射病患者CA和MN的衰减速度可能较急性放射病缓慢。     

A role for p53 in the response of bystander cells to receipt of medium borne signals from irradiated cells

Abstract

Purpose: A number of contradictory studies have reported a role or not for p53 (protein 53) in the production of radiation-induced bystander effects. Most of these studies looked at a range of cell lines with normal or compromised p53 function.

Methods: In this study, Human Colon Tumour line 116 (HCT 116) cells with confirmed wild type p53 function and a corresponding p53 null HCT 116 line were used to test for bystander signal production and response to bystander signals in a mix/match protocol using the medium transfer technique.

Results: The results showed that both the null cells and the wild type cells produced bystander signals. However, only the p53 wild type cells responded to signals from either cell line. The Human Papilloma Virus transfected keratinocyte line G (HPV-G) reporter cell line used routinely in our laboratory was used to confirm that the null cells were producing signals.

Conclusions: We conclude that in this system the p53 pathway is involved in response of cells to bystander signals but that signals can be produced by cells which do not have functional p53. If these results apply in vivo, they could be important in radiotherapy where tumours may have compromised p53 function but surrounding (and distant) normal tissue may have wild type functional p53.     

DNA excision repair and double-strand break repair gene polymorphisms and the level of chromosome aberration in children with long-term exposure to radon

Purpose: To study polymorphic variants of repair genes in people affected by long-term exposure to radon. The chromosome aberration frequency in peripheral blood lymphocytes was used as the biological marker of genotoxicity.

Materials and methods: Genotyping of 12 single nucleotide polymorphisms in DNA repair genes (APE, XRCC1, OGG1, ADPRT, XpC, XpD, XpG, Lig4 and NBS1) was performed in children with long-term resident exposure to radon. Quantification of the aberrations was performed using light microscopy.

Results: The total frequency of aberrations was increased in carriers of the G/G genotype for the XpD gene (rs13181) polymorphism in recessive model confirmed by the results of ROC-analysis (‘satisfactory predictor’, AUC?=?0.609). Single chromosome fragments frequency was increased in carriers of the G/G genotype in comparison with the T/T genotype. In respect to the total frequency of aberrations, the G/G genotype for the XpG gene (rs17655) polymorphism was also identified as a ‘satisfactory predictor’ (AUC?=?0.605). Carriers of the T/C genotype for the ADPRT gene (rs1136410) polymorphism were characterized by an increased level of single fragments relative to the T/T genotype.

Conclusion: The relationships with several types of cytogenetic damage suggest these three SNP (rs13181, rs17655 and rs1136410) may be considered radiosensitivity markers.     

Biological effects of low-dose radiation from computed tomography scanning

Abstract

Purpose: With the widespread use of computed tomography (CT), the risks of low-dose radiation from CT have been increasingly highlighted. This study aims to illustrate the CT-induced biological effects and analyze the potential beneficial or harmful outcomes so as to provide radiologists with reasonable advice on CT usage.

Materials and methods: The related literature was analyzed according to the topics of stochastic effect, hereditary effect, deterministic effect, accumulative injuries, hormesis and adaptive response; population epidemiology data were also analyzed.

Results: CT accounts for 9% of X-ray examinations and approximately 40–67% of medical-related radiation, the dose is within the range of low-dose radiation (LDR). Two opposite viewpoints exist nowadays regarding the biological effects of CT scanning: They are either harmful or harmless. Approximately 0.6% and 1.5% of the cumulative cancer risk could be attributed to diagnostic X-rays in the UK and Germany, respectively. The probability of CT scans induced-cancer is about 0.7% and CT angiography's risk is around 0.13%. It is estimated that approximately 29,000 cancers could be related to CT scans in the USA every year. Meanwhile, another investigation of 25,104 patients who underwent 45,632 CT scans in 4 years showed that the majority of CT-induced cancers were accidents rather than certainties of frequent CT scans.

Conclusion: Although the LDR effects of CT are still controversial, the current problems include the high frequency-use and abuse of CT scans, the increase of radiation dose and accumulative dose in high-accuracy CT, and the poor understanding of carcinogenic risks. The underlying biological basis needs further exploring and the ratio of risks and benefits should be considered.     

桡动脉与股动脉入路模拟冠脉造影术患者和术者辐射剂量比较

 目的 比较经桡动脉与经股动脉途径行冠脉造影术中患者及术者的辐射剂量。方法 采用同一拟人体模模拟临床条件下的冠脉造影。根据不同造影入路(均为右侧入路),实验分为经股动脉行冠脉造影组(transfemoral intervention ,TFI)和经桡动脉行冠脉造影组(transradial intervention,TRI),根据不同测量位置和不同辐射防护措施,TFI组进一步分为TFI1-TFI4四个亚组,TRI组进一步分为TRI1-TRI8八个亚组。使用皮肤辐射剂量仪和造影机随机配备的射线剂量仪(DAP和AK)分别记录术者和患者的辐射剂量,使用机器预设程序自动调节造影体位并控制透视及造影时间,每组数据重复测量10次取均值进行比较。结果 TRI组总剂量均值、透视累计剂量均值、造影累计剂量均值较TFI组均明显增加。造影过程7个体位中,DAP、AK值最大的三个体位均为左前斜体位。经桡动脉操作时,使用桡动脉专用护具的各亚组,其术者的辐射剂量均明显低于未使用护具的亚组。结论 与TFI相比,TRI时术者手部、胸部辐射剂量明显高于前者,而胸部辐射剂量的差异在左前斜体位时最为显著,其他体位并不明显;无论何种入路行冠脉造影,患者辐射剂量在左前斜体位时最高。因此术者在操作过程中应该合理使用造影体位,减少不必要的辐射。桡动脉专用护具配合常规防护设备共同使用可以大大减少经桡动脉操作时术者辐射剂量,值得推广。     

Persistence of genetic damage in mice exposed to low dose of X rays

Purpose:?The aim of this work was to evaluate the persistence of genetic damage in CBA/J mice treated with a single irradiation of 0.1 or 1 Gy of X rays.

Materials and methods:?Peripheral blood was collected from irradiated and control mice after 30 min, 24 h, 7 days, 1, 3 and 6 months from exposure and analysed by comet assay. To investigate if the whole-body irradiation affect DNA repair, half of the sampled blood cells were in vitro-irradiated with additional 4 Gy and immediately analysed. Six months from exposure haematopoietic organs were sampled for measuring apoptotic index.

Results:?In mice exposed to 1 Gy genetic damage was initially high and decreased during the experimental-time, while in the 0.1 Gy group damage, at first low, persisted and slightly increased. The 0.1 Gy-irradiated mice showed also a time-dependent increasing sensitivity to the in vitro-irradiation. Six months after whole-body irradiation, the percentage of apoptotic cells observed in haematopoietic compartments from 0.1 Gy-irradiated mice was significantly higher compared to controls and to 1 Gy mice.

Conclusions:?Results demonstrated that a single exposure to low-dose might induce long-term damage. Persistence of genetic damage might have relevant implications for estimating risk for low doses.     

高电压胸部摄影诊断和防护效果研究

作者以体模实验为基础。测定了不同管电压拍摄胸片时的病人剂量，考察了提高管电压对胶片影像质量的影响，结果表明，使用高电压拍摄胸片比使用低电压有利于降低病人剂量，在增加影像信息量，提高肋骨阴影区和纵膈区灶检出率方面更有较大优越性，此外，使用高电压技术不家利于延长Ｘ射线管的使用寿命。     

Dotting the eyes: mouse strain dependency of the lens epithelium to low dose radiation-induced DNA damage

Purpose: Epidemiological evidence regarding the radiosensitivity of the lens of the eye and radiation cataract development has led to changes in the EU Basic Safety Standards for protection of the lens against ionizing radiation. However, mechanistic details of lens radiation response pathways and their significance for cataractogenesis remain unclear. Radiation-induced DNA damage and the potential impairment of repair pathways within the lens epithelium, a cell monolayer that covers the anterior hemisphere of the lens, are likely to be involved.

Materials and Methods: In this work, the lens epithelium has been analyzed for its DNA double-strand break (DSB) repair response to ionizing radiation. The responses of epithelial cells located at the anterior pole (central region) have been compared to at the very periphery of the monolayer (germinative and transitional zones). Described here are the different responses in the two regions and across four strains (C57BL/6, 129S2, BALB/c and CBA/Ca) over a low dose (0–25 mGy) in-vivo whole body X-irradiation range up to 24?hours post exposure.

Results: DNA damage and repair as visualized through 53BP1 staining was present across the lens epithelium, although repair kinetics appeared non-uniform. Epithelial cells in the central region have significantly more 53BP1 foci. The sensitivities of different mouse strains have also been compared.

Conclusions: 129S2 and BALB/c showed higher levels of DNA damage, with BALB/c showing significantly less inter-individual variability and appearing to be a more robust model for future DNA damage and repair studies. As a result of this study, BALB/c was identified as a suitable radiosensitive lens strain to detect and quantify early low dose ionizing radiation DNA damage effects in the mouse eye lens specifically, as an indicator of cataract formation.     

生殖细胞中辐射诱导适应性反应的研究Ⅰ 辐射剂量及间隔时间对适应性反应的影响

本文作者利用小鼠初级精母细胞的短期实验和精原干细胞的长期实验，对低剂量辐射的剂量、照射方式和大剂量辐射的剂量以及间隔时间进行了研究。结果证明；１０～２００ｍＧｙＸ射线都能诱导适应性反应出现；大剂量辐射的剂量水平对适应性反应的影响不太明显，即在０．７５～４．５Ｇｙ之间均可见到适应性反应；小剂量辐射与相继大剂量辐射之间的间隔时间对适应性反应的出现有很大影响，即０．５小时，大于和等于２４小时不出现适应性反应；５０ｍＧｙ×４的多次照射和慢性小剂量照射１．１０Ｇｙ￣（６０）Ｃｏγ射线仍可诱导明显的适应性反应出现。这些结果表明，在生殖细胞中可见到辐射诱导的适应性反应现象。     

Involvement of MAPK signalling in radioadaptive response in BALB/c mice exposed to low dose ionizing radiation

To investigate low dose ionizing radiation (LDIR)-induced adaptive response in lymphocytes of BALB/c mice and to elucidate related molecular mechanisms. Mice were exposed to a priming dose (PD) of 0.1?Gy and challenge dose (CD) of 2?Gy ionizing radiation. Proliferation response to mitogen concanavalin A was assessed using ³H thymidine incorporation and carboxyfluoresceinsuccinamidylester (CFSE) dye dilution. Early activation markers were assessed by flow cytometry, cytokines by ELISA, DNA damage by comet assay and mitogen activated protein kinase (MAPK) signaling by Western blotting. Radioadaptive response was observed in lymphocytes of mice exposed to PD prior to CD of ionizing radiation in terms of DNA damage, early activation markers CD69, CD71, cytokines IL-2, IFN-γ as well as proliferation. This effect was transient and observed 24?h after CD and not after 0?h or 72?h. Hyper activation of MAPK signaling pathways in lymphocytes from LDIR-exposed mice and abrogation by ERK and p38 inhibitors suggests the involvement of MAPK signaling in radioadaptive response. Our study demonstrates that LDIR-induced transient adaptive response was due to hyper activation of MAPK signaling. Our findings contribute towards the understanding of LDIR-induced adaptive response.     

悬吊防护屏对介入医师最佳防护方案的体模研究

目的：探讨悬吊防护屏规格及摆放位置对介入手术中第一及第二术者辐射防护效果,为选择悬吊防护屏最佳辐射防护方案提供科学依据。方法在第一及第二术者站位,从地面20 cm至180 cm处,每隔20 cm放置一个个人计量仪。投照体位选择正位与左侧位。悬吊防护屏为铅玻璃(简称玻璃式)与铅玻璃下接铅橡胶皮(简称混搭式)两种。防护屏摆位分别为靠近术者、远离术者、在术者左侧及贴近球管4种。测量2种投照体位下,不同防护屏规格与摆位在第一及第二术者位9个高度的实时辐射剂量率,计算剂量屏蔽率。结果两种防护屏防护效果接近,以玻璃式略优。对于第一术者,正位投照时以近术者摆位的防护效果最佳,侧位投照则以术者左侧摆位的防护效果最好;对于第二术者,正及侧位投照均以近术者摆位防护效果最优。在最佳摆位情况下：正位投照时第一术者在120 cm高度、侧位投照时第一及第二术者各高度仍可检测到较高的辐射剂量率;第一与第二术者总体接受的辐射剂量接近;第一术者的剂量屏蔽率除正位120 cm高度稍低(玻璃式为60.11%,混搭式为39.89%)外,其余各点均高达93%以上,第二术者剂量屏蔽率为57%~97%;侧位屏蔽率整体略高于正位屏蔽率。结论两种防护屏防护效果接近,均能取得较好的防护效果,但正位投照时第一术者的120 cm高度及侧位投照时2位术者的各高度辐射剂量率仍相对较高,需加强对120 cm高度的辐射防护,并尽量少用侧位投照。     

低温核供热堆辐射防护安全准则

作者提出了低温核供热堆辐射防护安全准则的建议，即①要求半径５０ｋｍ范围内加权人口不超过１０６；②禁区半径为２５０ｍ；③限制发展区半径２ｋｍ；④低温核供热堆正常运行期间，由于放射性向环境释放所致公众个人剂量（全身或有效）不应超过０．１ｍＳｖ／ａ，集体剂量不超过１００ｍａｎ·Ｓｖ／ａ；⑤低温核供热堆事故期间，公众个人剂量不超过５ｍＳｖ，集体剂量不超过１０００ｍａｎ·Ｓｖ；⑥低温核供热堆正常运行期间，放射性流出物（气体、液体）的释放量不应超过国标ＧＢ６２４９规定值的２／５；⑦热网水中的放射性活度不应超过０．３７Ｂｑ／Ｌ；⑧建议应急状态分为三级，即应急待命、厂房应急和场区应急。     

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.     

The effect of genetic background and dose on non-targeted effects of radiation

Abstract

Purpose: This work investigates the hypothesis that genetic background plays a significant role in the signalling mechanisms underlying induction and perpetuation of genomic instability following radiation exposure.

Materials and methods: Bone marrow from two strains of mice (CBA and C57) were exposed to a range of X-ray doses (0, 0.01, 0.1, 1 and 3 Gy). Different cellular signalling endpoints: Apoptosis, cytokine levels and calcium flux, were evaluated at 2 h, 24 h and 7 d post-irradiation to assess immediate and delayed effects.

Results: In CBA (radiosensitive) elevated apoptosis levels were observed at 24 h post X-irradiation, and transforming growth factor-β (TGF-β) levels which increased with time and dose. C57 showed a higher background level of apoptosis, and sustained apoptotic levels 7 days after radiation exposure. Levels of tumor necrosis factor-α (TNF-α were increased in C57 at day 7 for higher X-ray doses. TGF-β levels were higher in CBA, whilst C57 exhibited a greater TNF-α response. Calcium flux was induced in reporter cells on exposure to conditioned media from both strains.

Conclusions: These results show genetic and dose specific differences in radiation-induced signalling in the initiation and perpetuation of the instability process, which have potential implications on evaluation of non-targeted effects in radiation risk assessment.