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电离辐射对人类健康的影响一直备受关注,已有研究结果显示,电离辐射可对眼晶状体产生损伤[1-3],如造成眼晶状体混浊以及白内障等眼部疾病[4-5]。2011年国际辐射防护委员会(International Commission on Radiological Protection,ICRP)118号出版物[6]对眼晶状体的年当量剂量限值做了重大修改,将每年不超过150 mSv修订为5年内年平均当量剂量不超过20 mSv,单一年不超过50 mSv。自限值修订以来,介入放射学工作人员眼晶状体的当量剂量受到了国内外研究人员的广泛关注。由于工作量的增加或采取的防护措施不当,介入放射学工作人员眼晶状体的年当量剂量有可能超过新的国际剂量限值[7]。目前,我国眼晶状体年当量剂量限值仍为《电离辐射防护与辐射源安全基本标准》(GB 18871-2002)[8]规定的职业限值:眼晶状体的年当量剂量不超过150 mSv。 随着医疗技术的发展,从事介入放射学工作的人员在增加,介入手术也在增加,并且不是所有的医护人员都佩戴防护眼镜或防护面罩,因此介入放射学工作人员的健康应得到持续关注。自2016年,职业放射性疾病与职业健康风险监测机构就要求对介入放射学工作人员眼晶状体的当量剂量进行相关监测,高度关注介入放射学工作人员的健康。近年来,医院大多直接把个人剂量计发放给医护人员自行监测,但医护人员的配合度不高,因此剂量监测结果的意义不大。本研究采取调查人员现场督促医护人员佩戴并收回个人剂量计的方法,对重庆市3家医院介入放射学工作人员开展为期1个月的眼晶状体当量剂量监测。通过监测得到1个月的实际受照剂量,并估算其年当量剂量是否超过国家标准,为加强推进放射工作人员眼晶状体的监测提供参考。
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3家医院99名介入放射学工作人员的左眼晶状体当量剂量为0.45(0.21,1.09) mSv,估算年当量剂量为5.38(2.46,13.10) mSv;右眼晶状体当量剂量为0.30(0.13,0.71) mSv,估算年当量剂量为3.54(1.55,8.48) mSv。B医院1名放射工作人员左眼晶状体估算年当量剂量为48.00 mSv,1名右眼晶状体估算年当量剂量为42.72 mSv。具体当量剂量的分布情况见表1、2。
年当量剂量(mSv) 左眼[名(%)] 右眼[名(%)] 0~10 66(66.67) 81(81.82) 10~20 21(21.21) 13(13.13) 20~30 8(8.08) 2(2.02) 30~40 2(2.02) 2(2.02) 40~50 2(2.02) 1(1.01) 表 1 2020年重庆市3家医院介入放射学工作人员眼晶状体估算年当量剂量的分布情况(n=99)
Table 1. Distribution of estimated annual equivalent dose of eye lens of interventional radiology staff of three hospitals in Chongqing in 2020 (n=99)
医院 监测人数(名) 左眼[M(Q1,Q3),mSv] 右眼[M(Q1,Q3),mSv] Z值 P值 A 34 0.22(0.11,0.36) 0.14(0.07,0.23) −4.236 <0.001 B 49 0.95(0.43,1.69) 0.63(0.29,1.03) −3.545 <0.001 C 16 0.24(0.12,0.86) 0.19(0.11,0.34) −2.551 0.011 合计 99 0.45(0.21,1.09) 0.30(0.13,0.71) −5.599 <0.001 表 2 2020年重庆市3家医院介入放射学工作人员左、右眼晶状体的当量剂量
Table 2. Left eye lens and right eye lens equivalent dose of interventional radiology workers of three hospitals in Chongqing in 2020
由表2可知,同一条件下,3家医院介入放射学工作人员的左眼与右眼晶状体当量剂量的差异有统计学意义(P<0.001)。
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多元线性回归分析结果表明,性别、吸烟习惯、手术曝光时间、仪器输出剂量对左、右眼晶状体的当量剂量均无影响(均P>0.05,表3)。
自变量 左眼晶状体当量剂量 右眼晶状体当量剂量 β值 P值 方差膨胀
系数β值 P值 方差膨胀
系数性别 0.176 0.461 1.022 −0.140 0.478 1.022 吸烟习惯 −0.038 0.878 1.126 0.004 0.983 1.126 手术曝光时间 −2.007 0.833 3.594 2.207 0.778 3.594 仪器输出剂量 1.507 0.082 3.663 7.694 0.279 3.663 表 3 2020年重庆市3家医院介入放射学工作人员左、右眼晶状体当量剂量影响因素的多元线性回归分析结果(n=99)
Table 3. Multiple linear regression analysis of influencing factors of equivalent dose in left and right eyes lens of interventional radiology staff of three hospitals in Chongqing in 2020(n=99)
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本研究中的介入放射学工作人员主要涉及4类手术:下肢静脉造影术(18名)、肝动脉化疗栓塞术(25名)、冠状动脉血管造影术(44名)和其他手术(12名)。不同手术类型的医护人员左、右眼晶状体当量剂量的差异均有统计学意义(均P<0.05);由图1、2可见,Bonferroni法两两比较结果显示,下肢静脉造影术与冠状动脉血管造影术、其他手术左眼晶状体当量剂量的差异均有统计学意义(均P<0.05),下肢静脉造影术与肝动脉化疗栓塞术、其他手术右眼晶状体当量剂量的差异均有统计学意义(均P<0.05)。
重庆市部分介入放射学工作人员眼晶状体的剂量监测与结果分析
Monitoring and results analyses of eye lens doses of some interventional radiology workers in Chongqing
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摘要:
目的 调查重庆市3家医院部分介入放射学工作人员眼晶状体的受照剂量,分析相关的影响因素并提出降低当量剂量的对策。 方法 2020年6月至8月采用热释光剂量计对重庆市3家医院(2家综合性医院、1家肿瘤医院)的99名介入放射学工作人员眼晶状体的受照剂量进行监测,其中男性92名、女性7名,年龄20~40(30.0±6.2)岁,监测时间为1个月,根据监测结果估算眼晶状体的年当量剂量。采用Wilcoxon秩和检验比较介入放射学工作人员左、右眼晶状体当量剂量的差异;采用多元线性回归分析介入放射学工作人员左、右眼晶状体当量剂量的影响因素。采用独立样本Kruskal-Wallis H检验分析3家医院介入放射学工作人员不同手术类型左、右眼晶状体当量剂量总体分布的差异;采用Bonferroni法对不同手术类型左、右眼晶状体的当量剂量进行两两比较。 结果 3家医院99名介入放射学工作人员的左眼晶状体估算年当量剂量为5.38(2.46,13.10) mSv,右眼晶状体估算年当量剂量为3.54(1.55,8.48) mSv。其中有2名工作人员左、右眼晶状体的估算年当量剂量分别为42.72 mSv和48.00 mSv,接近国际辐射防护委员会单一年当量剂量限值50 mSv,但未超过我国眼晶状体年当量剂量限值150 mSv。3家医院介入放射学工作人员的左、右眼晶状体当量剂量的差异有统计学意义(Z=−5.599,P<0.001)。性别、吸烟习惯、手术曝光时间、仪器输出剂量对左、右眼晶状体的当量剂量无影响(β =−2.007~7.694,均P>0.05)。下肢静脉造影术与冠状动脉血管造影术、其他手术医护人员左眼晶状体当量剂量的差异均有统计学意义(H=24.115、39.569,均P<0.05),下肢静脉造影术与肝动脉化疗栓塞术、其他手术医护人员右眼晶状体当量剂量的差异均有统计学意义(H=23.719、39.347,均P<0.05)。 结论 重庆市3家医院部分介入放射学工作人员的估算年当量剂量均未超过现有国家标准。应注意下肢静脉造影术医护人员的排班情况、防护措施和健康监测。 Abstract:Objective To investigated the dose of eye lens of some interventional-radiology workers in three hospitals in Chongqing, as well as to analyze the related factors and to put forward the countermeasures to reduce the equivalent dose. Methods A total of 99 interventional radiology workers (92 males and 7 females; aged 20–40(30.0±6.2) years) from three hospitals (two general hospitals and one cancer hospital) in Chongqing were included. They were monitored by thermoluminescence dosimetry for one month, and the annual equivalent dose of eye lens was estimated according to the number of surgeries. Wilcoxon rank sum test was used to compare the difference in lens equivalent dose between the left and right eyes of interventional radiology workers. Multiple linear regression was used to analyze the factors influencing lens equivalent dose in the left and right eyes of interventional-radiology workers. Kruskal-Wallis H test was used to analyze the difference in the overall distribution of lens equivalent dose of the left or right eyes of interventional-radiology workers in three hospitals with different operation types. Bonferroni method was used to compare the lens equivalent dose of left or right eyes with different operation types. Results For the 99 interventional radiologists in the three hospitals, the median estimated annual equivalent dose was 5.38(2.46, 13.10) mSv for the left eyes and 3.54(1.55, 8.48) mSv for the right eyes. The estimated annual equivalent dose of the lens in the left and right eyes of two radiation workers were 42.72 mSv and 48.00 mSv respectively, which were close to the International Commission on Radiological Protection's single annual dose limit of 50 mSv. They did not exceed the annual equivalent dose limit of 150 mSv for eye lens in China. A significant difference existed in the equivalent dose of lens in the left and right eyes of interventional-radiology workers in three hospitals (Z=−5.599, P<0.001). Among the influencing factors, gender, smoking habit, operation exposure time, and instrument output dose had no significant effect on the equivalent dose of left and right eyes ( β=−2.007–7.694; all P>0.05). A significant difference existed in the equivalent dose of lens in the left eye between the lower extremity venography and coronary angiography or other operations (H=24.115, 39.569; both P<0.05). A significant difference existed in the equivalent dose of lens in the right eye between lower extremity venography and hepatic artery chemoembolization or other operations (H=23.719, 39.347; both P<0.05). Conclusions The estimated annual equivalent dose of some interventional-radiology workers in three hospitals in Chongqing did not exceed the existing national standard. Attention should be paid to the shift arrangement, protective measures, and health monitoring of medical workers in lower extremity venography operation. -
Key words:
- Radiology, interventional /
- Lens, crystalline /
- Equivalent dose /
- Radiation workers
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表 1 2020年重庆市3家医院介入放射学工作人员眼晶状体估算年当量剂量的分布情况(n=99)
Table 1. Distribution of estimated annual equivalent dose of eye lens of interventional radiology staff of three hospitals in Chongqing in 2020 (n=99)
年当量剂量(mSv) 左眼[名(%)] 右眼[名(%)] 0~10 66(66.67) 81(81.82) 10~20 21(21.21) 13(13.13) 20~30 8(8.08) 2(2.02) 30~40 2(2.02) 2(2.02) 40~50 2(2.02) 1(1.01) 表 2 2020年重庆市3家医院介入放射学工作人员左、右眼晶状体的当量剂量
Table 2. Left eye lens and right eye lens equivalent dose of interventional radiology workers of three hospitals in Chongqing in 2020
医院 监测人数(名) 左眼[M(Q1,Q3),mSv] 右眼[M(Q1,Q3),mSv] Z值 P值 A 34 0.22(0.11,0.36) 0.14(0.07,0.23) −4.236 <0.001 B 49 0.95(0.43,1.69) 0.63(0.29,1.03) −3.545 <0.001 C 16 0.24(0.12,0.86) 0.19(0.11,0.34) −2.551 0.011 合计 99 0.45(0.21,1.09) 0.30(0.13,0.71) −5.599 <0.001 表 3 2020年重庆市3家医院介入放射学工作人员左、右眼晶状体当量剂量影响因素的多元线性回归分析结果(n=99)
Table 3. Multiple linear regression analysis of influencing factors of equivalent dose in left and right eyes lens of interventional radiology staff of three hospitals in Chongqing in 2020(n=99)
自变量 左眼晶状体当量剂量 右眼晶状体当量剂量 β值 P值 方差膨胀
系数β值 P值 方差膨胀
系数性别 0.176 0.461 1.022 −0.140 0.478 1.022 吸烟习惯 −0.038 0.878 1.126 0.004 0.983 1.126 手术曝光时间 −2.007 0.833 3.594 2.207 0.778 3.594 仪器输出剂量 1.507 0.082 3.663 7.694 0.279 3.663 -
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