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甲状腺癌是头颈部最为常见的恶性肿瘤之一。全国肿瘤登记中心的数据显示,我国城市地区女性甲状腺癌发病率位居女性所有恶性肿瘤的第4位,我国甲状腺癌将以每年20%的速度持续增长[1]。甲状腺癌中大部分为分化型甲状腺癌(differentiated thyroid cancer,DTC),国内外关于DTC的治疗指南中[2-3]均将术后进行131I治疗列于其中,并且治疗预后良好。大剂量131I治疗对患者有直接的辐射损伤,患者体内的131I对周围人群也是潜在的辐射源,患者排泄物中的131I对环境形成辐射污染。因此,对接受131I治疗的患者须采取适当的辐射隔离[4]。根据我国现有法规,如131I单次治疗剂量>400 MBq(10.8 mCi),应为患者建立专用的辐射隔离病房[5]。
目前,我国放射性核素治疗病房主要收治甲状腺癌和甲状腺机能亢进(简称甲亢)患者,其中以甲状腺癌患者最为常见。随着甲状腺癌发病率的持续上升,临床上对放射性核素治疗病房的需求激增,而现有的专用病房数远不能满足需求,建设标准化放射性核素治疗病房十分必要。另外,新病房建设环节多、要求高,设计、建设以及管理成本非常高,除了考虑工作特点及流程外,更重要的是考虑放射防护的特殊要求。我们根据我国现行的相关政策法规,参考国内相关专家的学术观点[6],结合中国人民解放军联勤保障部队第九八三医院核医学科131I治疗病房的建设经验,对放射性核素治疗病房的场所选址、布局设计、辐射防护以及病房管理等进行探讨,为医院核医学科建设放射性核素治疗病房提供参考。
浅谈放射性核素治疗病房的建设与管理
Building and management of the radionuclide treatment ward
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摘要: 根据我国现行的政策法规、相关规范及工作流程,笔者从场所选址、布局设计及废物处理等方面简要分析放射性核素治疗病房建设的相关问题,并对病房的辐射防护及医患管理进行探讨,总结提出医院建设放射性核素治疗病房的基本原则及具体方案、辐射防护的原则和要求,以及医患管理的初步意见,为医院建设放射性核素治疗病房提供参考。Abstract: According to the current management policy in China, the regulations and workflow, to briefly discuss the relative problem about the site selection, layout design, waste treatment, radiation protection and the management of radionuclide treatment ward. To provide the proposal of the radionuclide treatment ward about establishment and radiation protection, as well as preliminary opinions on the management of ward. Then provide references and suggestions for establishing a radionuclide treatment ward in department of nuclear medicine of hospital.
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Key words:
- Radionuclide treatment /
- Radiation protection /
- Ward establishment /
- Site selection /
- Layout design
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