介入放射学辐射剂量与放射防护状况

介入放射学与传统Ｘ射线检查比较，具有长时间曝光且曝光条件较大的特点，因此，前者辐射剂量明显高于后者。本文扼要介绍国外对介入放射学辐射剂量和放射防护调查研究及采取的相应防护措施。     

介入放射学辐射剂量与放射防护状况

本文扼要介绍国外对介入放射学辐射剂量和放射防护调查研究及采取的相应防护措施。     

如何改善介入室内的放射防护

介入手术室是实施介入检查和治疗的场所，根据介入检查和治疗目的的不同。介入治疗场所包括导管室、CT室、开放式MR室和胃肠X线室，其中产生和使用X线最多的是导管室（即DSA室）。介入室内放射防护水平的好坏，不但直接关系到放射介入工作人员和患者的健康问题，甚至关系到一个医院、一个地方的放射介入治疗的可持续发展问题，现结合我院导管室内防护的情况，提出我对改善导管室内射线防护的几点看法。     

三级医院介入放射防护能力及个人防护现状调查

目的 调查三级医院介入放射防护能力及个人防护现状.方法 2014年6月至2015年11月于广东省某三级医院对108名在介入室、CT/MR室、介入导管室、放疗科、放射科的在岗的医师、技术人员及护理人员进行问卷调查.采用自行设计的问卷,调查医务人员的一般人口学资料、个人辐射接触及防护资料,自制医院介入放射防护能力问卷(I-CVI、S-CVI均为0.9)调查医院的介入放射防护能力.结果 广东省某三级医院在屏蔽设施、操作时间及距离防护方面的防护能力较强,但仍缺乏完善保健休假制度,职业危害检测不足,存在对防护及培训制度执行力不足等现象.个人防护方面,介入手术过程中铅围裙的使用率仅为72.2％,不佩戴放射检测仪高达4.6％,表示不确定放射检测仪佩戴位置的医务人员高达9.3％.结论 医疗机构对放射介入医务人员个人防护、职业健康重视不足;部分医务人员防护意识淡薄,防护知识缺乏,对职业防护缺乏足够重视,有待进一步加强.     

无锡市2020年度放射诊疗资源及医疗照射应用频度调查

目的 调查无锡市放射诊疗资源配置、分布及医疗照射应用频度,为合理调配医疗资源,规范医疗照射管理提供依据。方法 根据"江苏省放射卫生信息管理平台"2020年度监测数据,结合无锡市统计年鉴提供的2019年底无锡市常住人口,对无锡市放射诊疗机构的人员、设备、医疗照射应用频度进行描述性分析。结果 2020年无锡市的放射诊疗设备923台,放射诊疗工作人员2 480人,每百万人口拥有的设备及人员数量分别为140.03台和376.24人;2020年度无锡市医疗照射应用频度为1 137.53人次/千人口,其中常规X射线诊断为646.17人次/千人口,CT诊断为394.11人次/千人口,介入诊疗5.34人次/千人口,放射治疗0.79人/千人口,核医学诊疗7.12人/千人口。介入治疗、核医学诊疗及放疗主要集中在三级医院。结论 无锡市放射诊疗资源配备,高于全国及全省平均水平,然存在资源配置不均衡的情况。常规X射线及CT检查应用频度高于全省水平,医疗照射引起的人群集体剂量较高,需加强放射诊疗活动正当性判断。     

浙江省部分介入放射工作场所防护现状及辐射水平调查

目的 了解浙江省介入放射学放射防护现状和存在的问题,并提出相应对策。方法 采用简单随机抽样的方法在杭州、宁波、温州、绍兴、金华5个地市抽取70个介入放射工作场所进行监测,医院介入放射机房个人防护用品和辅助防护设施采用医院填报的方法收集,透视防护区工作人员各部位和机房外辐射水平采用现场辐射水平检测的方法收集。结果 41家医院均配备了个人防护用品和个人防护设施,但有22家医院配备不完整;下X射线管照射时,介入放射工作人员的胸部、腹部、下肢部比头部更容易受到大剂量的射线照射,差异有统计学意义（F=4.85、4.92,P<0.05）;透视防护区工作人员各部位辐射水平合格率不同,差异有统计学意义（χ²=35.14、14.92,P<0.05）;防护吊帘可以显著降低透视防护区工作人员各部位辐射水平,差异有统计学意义（t=11.61~68.28,P<0.05）;同时,防护吊帘可以提高透视防护区工作人员各部位的检测合格率,差异有统计学意义（χ²=6.09~28.45,P<0.05）。结论 介入放射工作人员应该充分利用辅助防护设备,加强对胸部、腹部和下肢部等部位的保护;医院必须积极开展放射工作场所的日常监测,及时对防护薄弱环节进行整改。     

介入放射防护铅围脖的制作与应用

随着介入放射学技术的广泛应用 ,Ｘ射线防护意识日益加强 ,大多医院购置了铅衣 ,防护躯干部位。但颈部甲状腺和颌下腺的防护未受重视。而铅围脖产品难购买 ,尺寸又不合适 ,颈部得不到全方位的保护。进口产品价格昂贵。为了更好的开展介入放射工作 ,加强Ｘ射线的防护 ,节省开支 ,作者制作了实用铅围脖。经临床使用效果很好 ,卸戴方便 ,实用省时 ,防护性能好 ,现报道如下。一、材料和方法取 5 9ｃｍ× 10ｃｍ的废旧铅衣软皮和 6 0ｃｍ× 11ｃｍ的白布料。先用 5 9ｃｍ× 10ｃｍ的长方形旧铅皮裁剪成如图 1形状 ,再用 6 0ｃｍ× 11ｃｍ的白布料…     

介入诊疗的防护现状及对策

1．现状 介入诊疗这一新兴的边缘诊疗技术，其诊疗范围涵盖了内科，外科，神经科，小儿科，妇科，肿瘤科等诸多病种。该技术以其创伤小，疗效好，病人住院时间短等优势，已被广大患者和医务工作者所接受，所以发展非常迅速。目前三级医院大多都设有独立的介入中心，二级医院开展此项手术的也很普遍，发达地区的多数一级医院也开展该项手术，甚至某些个体诊所也做一些简单的介入治疗。这样的形势无疑对本学科来说是非常有利的，但是在一片繁荣的背后也隐藏着诸多隐患，其中最明显也是最容易被人们忽视的就是辐射防护的问题。因为大多数人们所想到所看到的只是所治疗的疾病的疗效，而很少有人去考虑某次治疗医生与患者所接受的辐射量是多少，是不是合理的。这无疑就导致了被检者及术者所接受辐射剂量的增高。     

综合性放射防护措施在介入治疗防护中的应用

目的探讨综合性放射防护措施在介入治疗防护中的应用价值。方法在84例介入手术治疗中联合应用床下铅橡胶帘、铅玻璃防护屏、铅防护服、铅围脖、铅眼镜及距离等对介入操作人员进行综合性防护。利用FJ-2000个人剂量仪监测X射线辐射剂量,并对相关数据进行统计分析。结果床下铅橡胶帘防护效率为93.4%;铅玻璃防护屏防护效率为93.5%;铅防护服防护效率为88.4%这些放射防护器材前后X线辐射剂量差异均具有统计学意义(P<0.01)。距球管1 m处X线衰减量为58.6%,距球管3 m处的X线衰减量为86.4%。1 m与2 m之间,2 m与3 m之间的辐射剂量差异均具有统计学意义(P<0.01)。结论综合性防护措施在介入操作中可有效降低X射线辐射、减少对介入操作人员身体危害。     

一台引起放射性皮肤损伤的介入放射学设备检测结果调查与分析

目的 通过调查和分析一台引起放射性皮肤损伤的介入放射学设备的质量控制检测结果,为介入放射学程序运行过程中的放射防护最优化提供建议。方法 调取一台引起患者放射性皮肤损伤的介入放射学设备近3年的5次质量控制检测报告,比较检测结果的差异并分析存在的问题。结果 对于“透视受检者入射体表空气比释动能率典型值”项目,3家机构5次检测结果在6.08~24.89 mGy/min之间,符合相关标准的要求;不同曝光模式(普通剂量率透视模式、高剂量率透视模式、电影模式)和不同帧率对受检者入射体表空气比释动能率和透视防护区检测平面上周围剂量当量率检测结果影响较大;操作该设备的介入医生对设备的曝光模式了解不足,手术后未记录患者剂量。结论 通过对介入放射学设备的调试可显著降低患者剂量;建议在标准修订时增加参考点累积剂量或剂量面积乘积准确性指标的检测;加强对介入医生和技师的专业培训,使其充分了解设备不同曝光模式对患者和术者剂量的影响。     

Importance of establishing radiation protection culture in Radiology Department

The increased use of ionization radiation for diagnostic and therapeutic purposes, the rapid advances in computed tomography as well as the high radiation doses delivered by interventional procedures have raised serious safety and health concerns for both patients and medical staff and have necessitated the establishment of a radiation protection culture (RPC) in every Radiology Department. RPC is a newly introduced concept. The term culture describes the combination of attitudes, beliefs, practices and rules among the professionals, staff and patients regarding to radiation protection. Most of the time, the challenge is to improve rather than to build a RPC. The establishment of a RPC requires continuing education of the staff and professional, effective communication among stakeholders of all levels and implementation of quality assurance programs. The RPC creation is being driven from the highest level. Leadership, professionals and associate societies are recognized to play a vital role in the embedding and promotion of RPC in a Medical Unit. The establishment of a RPC enables the reduction of the radiation dose, enhances radiation risk awareness, minimizes unsafe practices, and improves the quality of a radiation protection program. The purpose of this review paper is to describe the role and highlight the importance of establishing a strong RPC in Radiology Departments with an emphasis on promoting RPC in the Interventional Radiology environment.     

10种介入诊疗程序中患者的辐射剂量调查

目的 调查研究介入诊疗程序中患者的受照剂量,评估其放射诊疗风险.方法 利用配置有符合IEC 60601-2标准的穿透型电离室的飞利浦Allura Xper FD20 DSA系统,收集记录10种介入诊疗程序共198例患者的剂量参数,估算出可供评估皮肤损伤的最高皮肤剂量及有效剂量.结果 累计透视时间范围为2.1～80.9 min,摄影帧数范围为15～678帧,剂量面积乘积范围为11～825 Gy·cm2,累计剂量范围为24～3374 mGy.有16例患者最高皮肤剂量超过1 Gy,79例患者有效剂量大于20 mSv.结论 有部分病例的最高皮肤剂量超过了皮肤损伤阈值,所以对患者的放射防护应给予足够的重枧.

Abstract：

Objective To investigate radiation dose to the patients undergoing interventional radiology and make radiation risk assessment.Methods Data was collected on 198 instances of 10 interventional radiology procedures by using Philips Allura Xper FD20 DSA, which was equipped with the transparent ionization chamber system in compliance with IEC 60601-2.Patient peak skin dose and effective dose were estimated.Results Cumulative fluoroscopy time was 2.1 - 80.9 min, and number of images monitored for PSD were above 1 Gy and 79 cases monitored for E were above 20 mSv.Conclusions Substantial number of cases exceeded the dose threshold for erythema.Due attention should be paid to radiation protection of patients.     

Activity-based cost analysis in catheter-based angiography and interventional radiology

The aim of this study was to analyse the costs of the interventional radiology unit and to identify the cost factors in the different activities of catheter-based angiographies and interventional radiology. In 1999 the number of procedures in the interventional radiological unit at Tampere University Hospital was 2968; 1601 of these were diagnostic angiographies, 526 endovascular and 841 nonvascular interventions. The costs were analysed by using Activity Based Cost (ABC) analysis. The budget of the interventional unit was approximately 1.8 million Euro. Material costs accounted for 67%, personnel costs for 17%, equipment costs for 14% and premises costs for 2% of this. The most expensive products were endografting of aortic aneurysms, with a mean price of 5291 Euro and embolizations of cerebral aneurysms (4472 Euro). Endografts formed 87.3% of the total costs in endografting and Guglielmi detachable coils accounted for 63.3% of the total costs in embolizations. The material costs formed the majority of the costs, especially in the newest and most complicated endovascular treatments. Despite the high cost of angiography equipment, its share of the costs is minor. In our experience ABC system is suitable for analysing costs in interventional radiology.     

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。     

Radiation effects analysis in a group of interventional radiologists using biological and physical dosimetry methods

Interventional radiologists and staff members are frequently exposed to protracted and fractionated low doses of ionizing radiation, which extend during all their professional activities. These exposures can derive, due to the effects of direct and scattered radiation, in deterministic effects (radiodermitis, aged skin, cataracts, telangiectasia in nasal region, vasocellular epitelioms, hands depilation) and/or stochastic ones (cancer incidence). A methodology has been proposed for estimating the radiation risk or detriment from a group of six exposed interventional radiologists of the Hospital Universitario La Fe (Valencia, Spain), which had developed general exposition symptoms attributable to deterministic effects of ionizing radiation. Equivalent doses have been periodically registered using TLD’s and wrist dosimeters, H_p(10) and H_p(0.07), respectively, and estimated through the observation of translocations in lymphocytes of peripheral blood (biological methods), by extrapolating the yield of translocations to their respective dose-effect curves. The software RADRISK has been applied for estimating radiation risks in these occupational radiation exposures. This software is based on transport models from epidemiological studies of population exposed to external sources of ionizing radiation, such as Hiroshima and Nagasaki atomic bomb survivors [UNSCEAR, Sources and effects of ionizing radiation: 2006 report to the general assembly, with scientific annexes. New York: United Nations; 2006]. The minimum and maximum average excess ratio for skin cancer has been, using wrist physical doses, of [1.03×10⁻³, 5.06×10⁻²], concluding that there is not an increased risk of skin cancer incidence. The minimum and maximum average excess ratio for leukemia has been, using TLD physical doses, of [7.84×10⁻², 3.36×10⁻¹], and using biological doses, of [1.40×10⁻¹, 1.51], which is considerably higher than incidence rates, showing an excess radio-induced risk of leukemia in the group under study. Finally, the maximum radiological detriment in the group, evaluated as the total number of radio-induced cancers using physical dosimetry, has been of 2.18/1000 person-year (skin and leukemia), and using biological dosimetry of 9.20/1000 PY (leukemia). As a conclusion, this study has provided an assessment of the non-deterministic effects (rate of radio-induced cancer incidence) attributable to the group under study due to their professional activity.     

100 classic papers of interventional radiology: A citation analysis

AIM: To define the 100 citation classic papers of interventional radiology.METHODS: Using the database of Journal Citation Reports the 40 highest impact factor radiology journals were chosen. From these journals the 100 most cited interventional radiology papers were chosen and analysed.RESULTS: The top paper received 2497 citations and the 100 th paper 200 citations. The average number of citations was 320. Dates of publication ranged from 1953- 2005. Most papers originated in the United States(n = 67) followed by Italy(n = 20) and France(n = 10). Harvard University(n = 18) and Osped Civile(n = 11) were the most prolific institutions. Ten journals produced all of the top 100 papers with "Radiology" and "AJR" making up the majority. SN Goldberg and T Livraghi were the most prolific authors. Nearly two thirds of the papers(n = 61) were published after 1990.CONCLUSION: This analysis identifies many of the landmark interventional radiology papers and provides a fascinating insight into the changing discourse within the field. It also identifies topics, authors and institutions which have impacted greatly on the specialty.     

介入病房对介入放射学学科发展影响的研究

目的探讨成立介入病房对介入放射学学科发展的影响。方法通过问卷调查的方法对东北地区三级甲等医院2005年介入放射学现状进行调查,并对从事介入诊疗医师数量、开展介入技术种类、介入诊疗例数等按有无介入病房分为2组进行统计学分析处理。结果52所三甲医院开展介入治疗,有病房组29所,占55.8%,无病房组23所,占44.2%。有病房组与无病房组对比:医师数平均为(4.8±1.7)名:(2.8±1.5)名(P<0.01),2组平均每所医院完成介入手术例数为481∶150(P<0.01),开展介入手术种类为8∶5(P<0.01)。结论成立介入病房有利于介入放射学科的发展。