辐射防护内照射剂量估算软件的开发

目的 建立辐射防护内照射剂量估算的计算机系统。方法 基于医学内照射吸收剂量(MIRD)的人体及其器官的数学模型,采用MS Visual Basic 6.0编程语言,结合内照射剂量学方法,建立辐射防护内照射剂量估算的计算机系统。结果 成功研制了能够用于内照射剂量估算的计算机系统。结论 本系统方便、快捷,能够用于辐射防护多种情况中的内照射剂量估算,而且也能用于核突发事件内照射的剂量估算。     

Development and validation of a psychometric scale for assessing PA chest image quality: A pilot study

PurposeTo develop and validate a psychometric scale for assessing image quality perception for chest X-ray images.MethodsBandura's theory was used to guide scale development. A review of the literature was undertaken to identify items/factors which could be used to evaluate image quality using a perceptual approach. A draft scale was then created (22 items) and presented to a focus group (student and qualified radiographers). Within the focus group the draft scale was discussed and modified. A series of seven postero-anterior chest images were generated using a phantom with a range of image qualities. Image quality perception was confirmed for the seven images using signal-to-noise ratio (SNR 17.2–36.5). Participants (student and qualified radiographers and radiology trainees) were then invited to independently score each of the seven images using the draft image quality perception scale. Cronbach alpha was used to test interval reliability.ResultsFifty three participants used the scale to grade image quality perception on each of the seven images. Aggregated mean scale score increased with increasing SNR from 42.1 to 87.7 (r = 0.98, P < 0.001). For each of the 22 individual scale items there was clear differentiation of low, mid and high quality images. A Cronbach alpha coefficient of >0.7 was obtained across each of the seven images.ConclusionThis study represents the first development of a chest image quality perception scale based on Bandura's theory. There was excellent correlation between the image quality perception scores derived using the scale and the SNR. Further research will involve a more detailed item and factor analysis.     

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。     

On the justification of justification in radiation protection - legal and sociological considerations

ObjectivesThe objectives of the review were to investigate the legal and sociological basis of justification in society in order to fully assess its relevance to radiation protection. The difference between the justification of practices as distinct from the justification of reasons for the justification of individual activities within a practice and the relevance of cost–benefit analysis to this process are key elements.Key findingsJustification of practices as a principle of radiation protection is automatically enshrined within the appropriate legislation once it has been enacted. However, the justification of reasons for justification of activities within a practice are subject to many sociological factors, which are often conflicting and indeterminate and can be subject to political, economic and environmental factors that may change over time. This applies especially to new developments where the primary reason for justification is based upon potential but possibly ill-defined future benefits.ConclusionThe primary mechanism whereby society develops a collective consensus on the justification of practices lies within a legal framework. This represents the mechanism by which society defines the accepted standards that must be applied for acceptance of a practice. The justification of reasons for justifying activities that form part of a practice has largely been ignored within the framework of radiation protection.Implications for practiceThe employment of justification of practices as a fundamental principle of radiation protection should be eliminated since it is already enshrined within the legal framework applicable to applications of ionising radiation. Justification of reasons for pursuing new or modified practices is based upon their perceived benefits to society, which underpins most developments in society.     

核医学从业人员的职业暴露与放射防护

职业暴露是指由于职业关系而暴露在危险因素中,从而有可能损害健康或危及生命的一种情形.该文介绍了有关职业暴露的基本概念以及核医学从业人员职业暴露的特点,并对国内外近年来迅猛发展的核医学诊疗趋势进行了分析.文章中对核医学外照射防护的三要素即时间、距离和屏蔽防护进行了重点描述,同时对孕妇胎儿、PET-CT检查和低剂量辐射生物...     

床旁防护装置对冠状动脉造影术者辐射防护效果的体模研究

目的 测量冠状动脉造影8个投照体位在有与无床旁防护装置防护下术者所受辐射剂量,为冠心病介入治疗中减少术者辐射暴露提供参考。方法 在第一及第二术者站位,距地面20至180 cm处,每隔20 cm放置一个实时剂量测量仪。采用冠状动脉造影8个体位投照,测量在有与无床旁防护装置防护下,术者在不同投照体位的不同高度接受辐射剂量情况。结果 在第一术者位,除1.2 m高度仍可测到较高剂量(剂量率0.35~4.78 mSv/h,屏蔽率27.67%~89.33%),其余各点屏蔽率均在91%以上。左前斜尾位、左前斜位、左前斜头位辐射剂量较高。第二术者位屏蔽率较第一术者位低,剂量峰值可出现在0.8、1.0及1.4 m高度(剂量率0.27~1.86 mSv/h,屏蔽率30.34%~92.13%)。右前斜尾位、左前斜尾位、正头位、左前斜位辐射剂量较高。结论 床旁防护装置防护下,术者在左前斜尾位、左前斜位、左前斜头位、右前斜尾位的辐射暴露较高,应尽量少采用上述投照体位长时间曝光。同时应加强0.8~1.4 m高度的辐射防护。     

A narrative review of e-learning in professional education of healthcare professionals in medical imaging and radiation therapy

ObjectivesThis literature review attempts to explore the characteristics of e-learning tools used to develop the qualifications and skills of healthcare professionals in medical imaging and radiation therapy, and to promote the effectiveness and acceptance of e-learning through highlighting the outcomes of its implementation where applicable.Key findingsFrom the literature search in the PubMed and ResearchGate databases we concluded to 21 articles, which were included in the qualitative synthesis. Acceptance of e-learning tools was confirmed. Also, e-learning can be part of healthcare professionals' blended learning. The acquisition of new or improvement of existing knowledge, the improvement of clinical skills and the increase of the self-confidence of healthcare professionals in their daily practice were recorded, as outcomes of the e-learning implementation. The importance of human–computer interaction for the comprehension of theoretical concepts and practical aspects using multimedia was also captured. No significant findings emerged among the 21 articles against the adoption of the e-learning for the training of healthcare professionals. The Internet is the channel used for synchronous and asynchronous interaction of trainees with instructors.ConclusionsWe concluded that e-learning is an attractive training method, equally or occasionally more effective than the traditional educational methods for the lifelong training of healthcare professionals in the field of medical imaging and radiation therapy. Also, many collaborative web-based applications provide the necessary means to build an e-learning program, according to the training needs of each professional team.Implications for practiceThis new knowledge corroborates the perspective of e-learning beneficial contribution to remote interaction and collaboration of healthcare professionals in medical imaging and radiation therapy. Collaborative web-based tools are already available to decision makers and stakeholders, who want to develop an e-learning program.     

数值模拟在民航飞行宇宙辐射防护中的应用研究

目的 研究简便可行的民航飞行人员所受宇宙辐射有效剂量的估算工具。方法用欧洲飞行航程剂量计算程序EPCARD计算民航飞行航程中的有效剂量和剂量率，计算结果与有关文献实测的数据进行对比分析。结果计算机估算系统计算的数据在多数航线上与实测数据较吻合，但实测数据由于实施人员不同、仪器不同及估算方法的差别，对同一时期同一条航线，实测结果差别较大。结论在飞行高度用简便的个人剂量计测定宇宙辐射的各种成分目前还相当困难。宇宙辐射有效剂量不能直接测量获得，而必须用计算的方法或是从接近实际剂量值的测量数据转换而来，因此计算机模拟系统是最简便实用的宇宙辐射有效剂量估算工具。     

螺旋断层放射治疗室内泄漏辐射与散射辐射监测与评价研究

目的 检测螺旋断层放射治疗(TOMO)室内泄漏辐射与散射辐射的剂量水平,揭示TOMO室内与常规放射治疗不同的剂量分布规律,为TOMO放射防护提供科学依据。方法 以Tomotherapy Hi-Art TOMO装置为出束治疗设备,在模拟治疗照射条件下累积出束100 Gy,使用GR-200A型LiF(Mg,Cu,P)热释光剂量计(TLD),测量治疗床平面不同方向和TOMO室内空间泄漏辐射和散射辐射的空气比释动能,求出各测量位点的泄漏辐射比和散漏(散射+泄漏)辐射比(辐射比为测量点的辐射剂量与等中心点处标准治疗的输出剂量之比)。结果 TOMO室内泄漏辐射与散射辐射的剂量水平均基本以旋转等中心和治疗床纵轴呈左右对称分布,治疗设备前方的辐射水平明显高于设备后方;治疗床平面上,距等中心100 cm处的泄漏辐射比最高值仅为1.3×10^-4,距等中心300 cm处的泄漏辐射比均不高于2.0×10^-5;距等中心200~300 cm处的散射辐射仅为相应位置泄漏辐射的25%~30%,室内散射辐射相对于泄漏辐射衰减更快。结论 TOMO室内泄漏和散射辐射水平远低于常规放射治疗室内的辐射水平。     

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.     

新型自屏蔽放射治疗系统辐射屏蔽性能防护检测与评估

目的 通过对新型自屏蔽ZAP-X治疗系统辐射屏蔽性能的全面检测,依据我国相关标准对该设备的辐射屏蔽性能进行评估,探讨无屏蔽治疗室的放射治疗系统用于我国的可能性。方法 ZAP-X治疗系统辐射源为3 MV的直线加速器,在该设备周边、距设备边缘1.3、2.3和3.3 m处,共选择了33个检测点位,在5种固定方向的照射条件下,使用电离室巡检仪分别测量33个检测点位在每种照射条件下的最大周围剂量当量率。选用临床常用治疗计划模拟临床治疗过程,对于一次完整治疗过程,测定了上述33个点位的累积剂量。并选择适用的我国现行放 射治疗辐射防护标准,对该系统辐射屏蔽性能进行评估。结果 依据设备周边33个检测点位周围剂量当量率测量结果,在该自屏蔽放射治疗设备现有的1 m控制区外,提出了重新划定控制区的建议,使得新控制区外任意点的周围剂量当量率不大于10 μSv/h,满足我国标准GBZ 121-2020中的要求。结论 依据我国现有标准,该无屏蔽治疗室的自屏蔽放射治疗系统具有在我国开展临床应用的可能性,但针对该新型自屏蔽放射治疗系统,我国应制定出与之相应的性能检测与辐射防护新标准。     

2019年天津市放射诊疗工作场所辐射防护检测结果分析

目的 掌握天津市放射诊疗工作场所辐射防护的基本情况,以便改善其防护现状,为监管部门提供数据支持。 方法 采用方便随机抽样方法,选取2019年天津市全部行政区域105家医疗机构（三级医疗机构19家、二级医疗机构10家、一级医疗机构22家、民营医疗机构54家）中的434个放射诊疗工作场所[X射线诊断工作场所（包括X射线摄影机、X射线透视机、CT机房）413个、放射治疗工作场所（包括后装机和加速器机房）13个和核医学工作场所（包括PET/CT和SPECT/CT机房）8个]进行辐射防护检测,对其结果进行回顾性分析。根据国家标准和卫生行业标准进行辐射防护检测与评价。各放射诊疗工作场所检测合格率的比较采用R×C列联表的χ2检验。 结果 434个放射诊疗工作场所辐射防护检测整体初检合格率为95.4%（414/434）。放射诊断中CT机房的辐射防护初检合格率最低,为79.6%（43/54）,CT和X射线透视机机房的辐射防护初检合格率[95.5%（128/134）]均低于X射线摄影机机房[99.6%（224/225）],且差异均有统计学意义（χ2=7.146、11.820,均P<0.05）。CT和X射线透视机机房的不合格指标均为机房门。放射治疗中加速器机房的辐射防护初检合格率最低,为81.8%（9/11）。加速器机房的不合格指标为机房墙体（主墙的次屏蔽区）。后装机及核医学工作场所辐射防护初检合格率均为100%（2/2、8/8）。数字减影血管造影X射线机和近台同室操作的X射线透视机透视防护区的空气比释动能率的检测合格率为100%（35/35）。二、三级医疗机构的辐射防护检测合格率较低,分别为97.4%（38/39）和93.3%（265/284）。一级医疗机构和民营医疗机构的辐射防护检测合格率均为100%（34/34、77/77）。民营医疗机构工作场所辐射防护检测初检合格率高于三级医疗机构,且差异有统计学意义（χ2=5.438,P<0.05）。 结论 2019年天津市放射诊疗工作场所的辐射防护存在不符合标准要求的现象,医疗机构,特别是二级和三级医疗机构应加强对放射诊疗工作场所辐射防护的重视与改进,监管部门应加强对防护不合格工作场所的重点监督和管理。     

SPECT/螺旋CT融合技术的辐射风险与防护研究进展

大量临床研究已证实SPECT/螺旋CT一体机在疾病的诊断中具有独特的优势。然而反映功能影像的SPECT与反映解剖影像的螺旋CT同机进行采集必然会增加受检者所受辐射剂量,因此需要权衡融合显像诊断价值与辐射剂量的利弊。国际辐射防护委员会建议在对病人进行SPECT/螺旋CT检查时,应对病人所受的额外辐射剂量及可能增加的恶性肿瘤的发生概率予以充分考虑。SPECT/螺旋CT检查应遵循实践正当化与辐射防护最优化的原则,辐射水平不应超过国际规定的辐射剂量限值水平。     

医用电子直线加速器的防护

文章论述了使用医用电子直线加速器时采取辐射防护措施的必要性,提示了使用与维修加速器等方面必须遵循的一些基本原则.     

湘西自治州临床核医学检查医疗照射频率分析

文章论述了使用医用电子直线加速器时采取辐射防护措施的必要性,提示了使用与维修加速器等方面必须遵循的一些基本原则.     

放射防护检测信息系统的开发与初步应用

目的 开发一套放射防护检测信息系统,与正在运行的全国放射卫生信息平台-医用辐射监测子系统对接,提高检测工作效率。方法 依据相关工作规范和标准,开展需求调研和系统建模分析,采用B/S架构研究建立包括检测、审核和系统管理3个模块的放射防护检测信息系统,设置管理员、检测人、审核人和报告签发人4个级别用户。结果 试用结果表明,所开发的信息系统可实现放射防护检测信息从填报、审核、签发、出具检测报告到上传数据的全流程信息化,提高了检测工作效率。结论 开发的检测信息系统可提高检测工作效率,能与全国放射卫生信息平台-医用辐射监测子系统成功对接。     

全国医用辐射防护监测信息系统构建及应用情况

目的 依托全国放射卫生信息平台,建立全国医用辐射防护监测信息系统,支持国家医用辐射防护监测项目数据上报,全面了解医用辐射防护现状。方法 根据国家医用辐射防护监测方案、法规和标准,前端采用HTML、CSS、JavaScript,后端采用JAVA语言,平台数据库采用SQL server,开发中间件为Tomcat。系统通过B/S的架构建立数据上报和分析系统,并对2017年度的监测数据进行了统计分析。结果 平台的业务组成包括数据采集（通过各业务系统）、数据资源整合（整合业务系统公共数据）、应用和展现4个层次。实现架构灵活、信息集中、操作便捷的全国医用辐射防护监测系统,完成2017年国家医用辐射防护信息的上报,汇总和数据统计分析,2017年度共上报33 565所医院放射防护基本情况和10 624台放射诊疗设备性能及防护信息。共完成统计信息报表95个,分别从时间、行政地理信息、医院级别、设备种类4个维度描述全国医用辐射防护现状。结论 医用辐射防护监测系统达到设计目的,顺利完成2017年数据上报,为了解全国医用辐射防护现状和放射诊疗防护管理政策制定提供了数据支持。     

2019年全国监测医院辐射防护用品配备及放射工作人员职业健康管理现状

目的 调查我国放射诊疗机构辐射防护用品配备及放射工作人员职业健康管理情况。方法 根据"全国放射卫生信息系统"（职业性放射性疾病与职业健康监测子系统）2019年的监测数据，对监测医院上报的数据进行描述性分析。结果 2019年共监测3 806家医院，其中三级医院609家（16.00%），二级医院1 421家（37.34%），一级及未定级医院1 776家（46.66%）。不同级别监测医院放射工作人员数量相差较大，三级医院放射工作人员平均99人，二级医院和一级及未定级医院分别为19和2人。高风险岗位的介入与核医学工作人员人均配备铅橡胶围裙分别为0.40和0.43件，铅橡胶帽子分别为0.27和0.31件，铅橡胶颈套分别为0.38和0.45件，铅橡胶手套分别为0.18和0.08副，铅防护眼镜分别为0.31和0.22副。开展放射治疗的医院中有15.25%未配置个人剂量报警仪，27.90%未配置辐射巡测仪。监测医院中，《放射工作人员证》的持证率为88.13%，有83.69%的放射工作人员参加了岗中辐射防护知识培训，个人剂量监测率为99.20%，监测的放射工作人员中，发现年个人剂量H_p（10）≥20 mSv人员占0.40%，职业健康监护档案的建档率为98.05%，在岗人员职业健康检查率为96.00%，参加2019年在岗体检的76 627名放射工作人员中，有0.88%和0.11%的体检结论分别为建议暂时脱离放射工作岗位和不宜继续从事放射工作。结论 我国放射工作人员个人剂量监测率和职业健康检查率较高，放射诊疗机构应增加辐射监测设备和个人防护用品的配置。