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目前,DTC的发病率逐年升高,“手术+131I清甲治疗+甲状腺激素抑制治疗”的综合治疗是国际上公认的DTC的理想治疗方案[1]。清甲治疗后患者需要定期复查,以降低复发率,改善生活质量[2],诊断性131I SPECT/CT全身显像是常见的复查项目之一。目前国内外研究的重点是DTC患者接受大剂量131I治疗后对周围及自身的辐照情况[3-5],而清甲治疗后行诊断性131I SPECT/CT全身显像患者对周围的辐照情况未见相关报道,患者服131I后对周围的辐射剂量水平和安全性一直是患者、医护人员及公众非常关心的问题[6]。本研究探讨了清甲治疗后行诊断性131I SPECT/CT全身显像中,DTC患者服131I后对周围的辐射剂量及其变化规律,为该检查的辐射安全评价和职业防护研究提供数据支持。
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患者服131I后2 h,胸前体表的辐射剂量率最高[186.12(135.52~201.01) μSv/h],且随着服31I后时间的延长和距体表距离的增加,辐射剂量率均明显下降;服131I后96 h以上胸前体表的辐射剂量率,以及任何时间距离胸前体表3.0 m处的辐射剂量率均可达到本底辐射水平,见表1(结果包含本底)。
时间点 胸前体表 距胸前体表1.0 m 距胸前体表2.0 m 距胸前体表3.0 m 2 h 186.12(135.52~201.01) 15.16(7.35~20.26) 1.76(1.23~2.01) 0.18a 24 h 23.18(10.50~35.11) 2.61(1.43~3.52) 0.71(0.46~0.92) 0.18a 48 h 4.01(1.52~5.13) 0.50(0.46~0.52) 0.18a 0.18a 72 h 0.41(0.18~0.92) 0.18a 0.18a 0.18a 96 h 0.18a 0.18a 0.18a 0.18a 注:a表示此处测定的结果为本底辐射剂量率(0.18 μSv/h);SPECT为单光子发射计算机体层摄影术;CT为计算机体层摄影术 表 1 分化型甲状腺癌患者清甲治疗后诊断性131I SPECT/CT全身显像服131I后不同时间、不同距离的辐射剂量率(μSv/h)
Table 1. The radiation dose rates of patients with differentiated thyroid cancer after iodine remnant ablation at different times and different distances (μSv/h)
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患者服131I后,第1天对周围的辐射当量剂量为(1.19±0.28) mSv,范围为0.90~1.66 mSv;第2天为(1.21±0.27) mSv,较前1天增加0.02 mSv;第3天为(1.21±0.24) mSv,较前1天未增加;第4天为(1.22±0.26) mSv,较前1天增加0.01 mSv(结果已扣除本底)。
DTC清甲治疗后诊断性131I SPECT/CT全身显像中的辐射剂量分析
Analysis of radiation dose of diagnostic 131I SPECT/CT whole-body imaging in patients with differentiated thyroid cancer after iodine remnant ablation
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摘要:
目的 探讨分化型甲状腺癌(DTC)清甲治疗后诊断性131I SPECT/CT全身显像中,患者服131I后对周围的辐射剂量及其变化规律,为辐射安全评价和职业防护研究提供依据。 方法 采用方便抽样方法,回顾性分析2021年6至12月在联勤保障部队第九八〇医院行诊断性131I SPECT/CT全身显像的20例患者[男性5例、女性15例,年龄(45.7±11.7)岁,范围24.0~65.0岁]。采用X、γ剂量率仪分别测量患者服131I后胸前体表不同时间(2、24、48、72、96 h)、距离胸前体表不同距离(1.0、2.0、3.0 m)的辐射剂量率,采用热释光探测器分别测量患者服131I后第1~4天的辐射当量剂量。 结果 患者服131I后2 h,胸前体表的辐射剂量率最高[186.12(135.52~201.01) μSv/h],且随着服131I后时间的延长和距胸前体表距离的增加,辐射剂量率均明显下降;服131I后96 h以上胸前体表的辐射剂量率,以及任何时间距离胸前体表3.0 m处的辐射剂量率均可达到本底辐射水平。患者服131I后,第1天对周围的辐射当量剂量为(1.19±0.28) mSv(范围为0.90~1.66 mSv),从第2天开始及之后均较前1天不再明显增加。 结论 清甲治疗后行诊断性131I SPECT/CT全身显像的DTC患者对周围的辐射剂量较低,且衰减较快,无需进行隔离;但是在服131I的早期,患者体表辐射剂量较高,应避免长时间近距离接触他人,并做好内照射的防护。 -
关键词:
- 分化型甲状腺癌 /
- 甲状腺清除 /
- 碘放射性同位素 /
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机 /
- 全身显像 /
- 辐射剂量
Abstract:Objective To explore the radiation dose and its variation patterns of diagnostic 131I SPECT/CT whole-body imaging in patients with differentiated thyroid cancer after iodine remnant ablation to provide a basis for radiation safety evaluation and occupational protection research. Methods Using convenience sampling, retrospective analysis was conducted on 20 patients (including 5 males and 15 females, aged (45.7±11.7) years, ranging from 24.0 to 65.0 years old) who underwent diagnostic 131I SPECT/CT whole-body imaging at the 980th Hospital of the Joint Logistics Support Force of PLA from June to December 2021. An X-γ dose rate meter was used to measure the radiation dose rate on the chest surface of patients at different time periods (2, 24, 48, 72, and 96 h) and at different distances (1.0, 2.0, and 3.0 m) after taking 131I. The effective dose equivalent of patients was measured on the first to fourth day by using a thermoluminescent dosimeter after taking 131I. Results After 2 h of taking 131I, the highest radiation dose rate was observed on the chest surface of patients (186.12 (135.52–201.01) μSv/h), and the radiation dose rate significantly decreases with the prolongation of time after taking 131I and with the increase of distance from the chest surface. The radiation dose rate on the chest surface above 96 h after taking 131I, as well as the radiation dose rate at any time 3.0 m away from the body surface, can reach the background radiation level. After taking 131I, the radiation equivalent dose on the chest surface of patients was (1.19±0.28) mSv (ranging from 0.90 to 1.66 mSv) on the first day, and no significant increase was found from the second day onwards compared with the previous day. Conclusions The radiation dose rate of patients with differentiated thyroid cancer who underwent diagnostic 131I SPECT/CT whole-body imaging after iodine remnant ablation was low, and it decreased rapidly. Therefore, quarantine is not required for patients, but the radiation dose on the body surface is relatively high in the early stages of taking 131I, so abstaining the patients from contacting others is necessary. -
表 1 分化型甲状腺癌患者清甲治疗后诊断性131I SPECT/CT全身显像服131I后不同时间、不同距离的辐射剂量率(μSv/h)
Table 1. The radiation dose rates of patients with differentiated thyroid cancer after iodine remnant ablation at different times and different distances (μSv/h)
时间点 胸前体表 距胸前体表1.0 m 距胸前体表2.0 m 距胸前体表3.0 m 2 h 186.12(135.52~201.01) 15.16(7.35~20.26) 1.76(1.23~2.01) 0.18a 24 h 23.18(10.50~35.11) 2.61(1.43~3.52) 0.71(0.46~0.92) 0.18a 48 h 4.01(1.52~5.13) 0.50(0.46~0.52) 0.18a 0.18a 72 h 0.41(0.18~0.92) 0.18a 0.18a 0.18a 96 h 0.18a 0.18a 0.18a 0.18a 注:a表示此处测定的结果为本底辐射剂量率(0.18 μSv/h);SPECT为单光子发射计算机体层摄影术;CT为计算机体层摄影术 -
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