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甲状腺癌是内分泌系统最常见的恶性肿瘤之一,其中分化型甲状腺癌(differentiated thyroid cancer,DTC)是甲状腺癌中最常见的组织病理学类型,占所有甲状腺癌的80%以上[1]。美国甲状腺协会(American Thyroid Association,ATA)的DTC管理指南提示,中危患者应行131I辅助治疗,高危患者应常规行131I辅助治疗[2]。DTC患者行131I治疗的剂量较高,需住院隔离观察,测量患者体内残留的辐射剂量,评估患者的出院时间及病灶的131I摄取情况[3]。我国规定,接受131I治疗的患者体内的放射性活度降至400 MBq(约10.8 mCi)方可出院[4]。因此,131I治疗后对患者进行体内残余辐射剂量的监测与评估尤为重要。
DTC患者术后131I治疗期间体内辐射剂量的测量方法主要包括体外测量和体内测量两大类,体外测量包括尿液测量法和血液剂量测定法;体内测量主要包括局部测量法和全身测量法[5]。正确评估患者体内辐射剂量的分布、病灶的吸收剂量和全身的有效剂量,提高剂量测量的准确性,评估患者体内残留辐射的代谢趋势,对于实现辐射防护个体化,满足临床诊疗的需求至关重要。本文对体内和体外测量法及其相关临床应用进行综述,旨在为DTC患者术后131I治疗中体内剂量学的研究发展提供理论指导。
131I治疗分化型甲状腺癌术后患者体内剂量测定方法的临床应用进展
Advances in clinical application of residual radioactivity measurment method in patients with differentiated thyroid cancer surgery after 131I treatment
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摘要: 根据分化型甲状腺癌(DTC)患者术后不同危险度分层结果,部分患者可能需要进一步行131I治疗,但131I可对周围人群产生辐射,因此正确评估患者体内的辐射剂量,对辐射防护个体化及131I治疗流程的优化至关重要。DTC患者术后131I治疗期间辐射剂量的测量方法主要分为体内和体外测量两大类,体外测量包括尿液测量法和血液剂量测定法;体内测量主要包括局部测量法和全身测量法,笔者就辐射剂量相关测定方法及其临床应用进行综述。Abstract: According to different risk stratification results of differentiated thyroid cancer (DTC) patients after surgery, some patients may need further 131I treatment, but 131I can emit radiation to the surrounding population. Therefore, the correct assessment of radiation dose in patients is crucial to the individualization of radiation protection and the optimization of 131I treatment process. For the measurement method of radiation dose during 131I treatment after DTC, there are mainly two types, which are in vivo and in vitro. In vitro measurements include urine and blood measurement methods; in vivo measurements mainly include local and systemic measurement methods. The authors mainly discuss dose-related measurement methods and clinical application.
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