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。

Analysis of radiation protection testing results in the radiation diagnosis and treatment workplaces in Tianjin in 2019

Objective To understand the basic situation of radiation protection in the radiation diagnosis and treatment workplaces in Tianjin; to improve protection status; and to provide supporting data for regulatory authorities. Methods According to the stratified random sampling method, 105 medical institutions (19 tertiary medical institutions, 10 secondary medical institutions, 22 primary medical institutions, and 54 private medical institutions) in all administrative regions of Tianjin in 2019 were selected. A total of 434 radiological diagnosis and treatment workplaces (including 413 X-ray diagnosis workplaces (including X-ray cameras, X-ray fluoroscopy equipment, CT equipment room), 13 radiological diagnosis and treatment workplaces (including post-installation equipment and accelerators room), and 8 nuclear medicine workplaces (including PET/CT and SPECT/CT room)) were chosen to conduct a retrospective study on the analysis of radiation protection detection results. Radiation protection testing and evaluation were performed according to national and health industry standards. The comparison of the qualification rates of various radiological diagnosis and treatment workplaces was performed by R×C contingency table χ2 test. Results The overall initial pass rate of radiation protection testing in the 434 radiological diagnosis and treatment workplaces was 95.4% (414/434). In the radiological diagnosis, the radiation protection initial inspection rate of the CT computer room was the lowest at 79.6% (43/54). The CT and X-ray fluoroscopy room (95.5% (128/134)) had lower radiation protection qualification rate than the X-ray camera room (99.6% (224/225)), and the difference was statistically significant (χ2=7.146, 11.820, both P<0.05). In radiotherapy, the initial radiation protection pass rate of the accelerator room was the lowest at 81.8% (9/11). The unqualified indicator of the CT and X-ray fluoroscopy room was the door of the computer room, whereas that of the accelerator room was the wall of the computer room (secondary shielding area). The post-installation and radiation protection initial inspection pass rate of the nuclear medicine workplace reached 100% (2/2, 8/8). The digital subtraction angiography X-ray equipment and X-ray fluoroscopy machines operating in the same room near the platform had a 100% (35/35) pass rate for the air kernel energy rate in the protective area of the X-ray machine. The radiation protection testing qualification rate of secondary and tertiary medical institutions was relatively low, that is, 97.4% (38/39) and 93.3% (265/284), respectively. The radiation protection tests of primary medical institutions and private medical institutions were all qualified (100% (34/34, 77/77)). The qualification rate of the radiation protection testing in the workplace of private medical institutionswas higher than that of tertiary medical institutions, and the difference was statistically significant (χ2=5.438, P<0.05). Conclusions The radiation protection of radiation diagnosis and treatment workplaces in Tianjin in 2019 failed to meet the standard requirements. Medical institutions, especially secondary and tertiary medical institutions, should strengthen the emphasis on and improvement of radiation protection in radiation diagnosis and treatment workplaces. Supervisory departments should also strengthen the key supervision and management of workplaces with unqualified protection.