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介入放射学是继内科、外科后的一个新兴的医学领域。目前欧洲已开展了400多种不同的放射性介入操作,它已遍及医学影像的很多专业,例如:神经放射学、血管放射学及心血管照相等。
心血管病介入操作时患者受照剂量估算
Estimating the radiation dose of patient in cardiovascular disease interventional procedures
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摘要: 放射诊疗新技术给人类带来了巨大的利益,放射性介入操作是其中最具代表性的一类新技术。然而在放射性介入操作的过程中,患者受照剂量在医用X射线诊断和治疗中是最高的,其剂量可能大到能引起皮肤和眼晶体辐射损伤,而且其防护也是目前职业辐射防护中最困难的。目前有60%左右的介入术是在心血管病的治疗中开展,心血管病介入操作时患者的辐射防护问题已引起了国内外广泛的重视,并开展了较为广泛的研究。大量的研究结果表明,心血管病放射性介入操作可能给患者造成值得重视的高剂量辐射。但是许多研究都是集中在表面剂量,这个量对评估患者的风险是远远不够的。在外照射情况下,当人体受穿透力强的辐射(X射线、γ射线、中子)照射一定剂量时,可造成深部组织和器官损伤,因此在研究表面剂量的同时,研究深部组织和器官的剂量也是至关重要的。由于放射性介入操作可能引起肿瘤和遗传这类随机性效应损伤,因此需要估算其有效剂量。Abstract: Nuclear and radiation technology have a breakthrough development in the application of medical clinics. Some new radiological diagnosis and radiotherapy technologies have brought tremendous interest for human. Radiological intervention is the most representative of this type of radiation therapy technology. Large doses can cause possible skin and eye lens radiation damage, and is one of the most difficult occupational radiation protection. Because about 60 percent of surgical intervention is used in the treatment of cardiovascular diseases, the issue of radiation protection of patients in cardiovascular interventional has aroused widely attention both at home and abroad and carried out more extensive research. A large number of studies have shown that, cardiovascular intervention may cause high exposure doses to the patients that should be paid more attention. Surface dose is not enough to evaluate how much risk the patients suffering. When the human body suffer strongly penetrating power of radiation (X ray, γ ray, neutron) and the dose achieve a certain quantity, deep tissue and organ damage will happen. So when studying the surface dose, it is important to research the dose of the tissues and organs. Radiation intervention can result in stochastic effects such as oncology and genetic damage, therefore it is necessary to estimate the effective dose.
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[1] Valentin J. Avoidance of radiation injuries from medical interven-tional procedures. Ann ICRP, 2000, 30 (2) : 7-67. doi: 10.1016/S0146-6453(01)00004-5 [2] Suzuki S, Furui S, Isshiki T, et al. Factors affecting the patient's skin dose during percutaneous coronary intervention for chronic total oc-clusion. Circ J, 2007, 71(2): 229-233. doi: 10.1253/circj.71.229 [3] Kuon E, Dahm JB, Empen K, et al. Identification of less-irradiating tube angulations in invasive cardiology. J Am Coll Cardiol, 2004, 44(7): 1420-1428. doi: 10.1016/j.jacc.2004.06.057 [4] Hirshfeld JW Jr, Balter S, Brinker JA, et al. ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Car-diology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Cir-culation, 2005, 111(4): 511-532. [5] Charles M. UNSCEAR report 2000: sources and effects of ionizing radiation. United Nations Scientific Commitee on the Effects of Atomic Radiation. J Radiol Prot, 2001, 21(1): 83-86. doi: 10.1088/0952-4746/21/1/609 [6] 张良安. 放射性介入操作中的剂量和健康效应研究现状. 国外医学·放射医学核医学分册, 2003, 27(4): 174-177.
[7] Suzuki S, Furui S, Isshiki T, et al. Methods to reduce patients' maximum skin dose during percutaneous coronary intervention for chronic total occlusion. Catheter Cardiovasc Interv, 2008, 71(6): 792-798. doi: 10.1002/ccd.21481 [8] Balter S, Moses J. Managing patient dose in interventional cardiolo-gy. Catheter Cardiovasc Interv, 2007, 70(2): 244-249. doi: 10.1002/ccd.21141 [9] Chambers CE. Dosing radiation: limiting the invisible toxicity. Catheter Cardiovasc Interv, 2008, 71(6): 799. doi: 10.1002/ccd.21591 [10] McParland BJ. Entrance skin dose estimates derived from dosearea product measurements in interventional radiological procedures. Br J Radiol, 1998, 71(852): 1288-1295. doi: 10.1259/bjr.71.852.10319003 [11] Suzuki S, Furui S, Kohtake H, et al. Radiosensitive functional dye: clinical application for estimation of patient skin dose. Radiology, 2006, 239(2): 541-546. doi: 10.1148/radiol.2392050504 [12] Chida K, Saito H, Otani H, et al. Relationship between fluoroscopic time, dose-area product, body weight, and maximum radiation skin dose in cardiac interventional procedures. AJR Am J Roentgenol, 2006, 186(3): 774-778. doi: 10.2214/AJR.04.1653 [13] McFadden SL, Mooney RB, Shepherd PH. X-ray dose and associated risks from radiofrequency catheter ablation procedures. Br J Radiol, 2002, 75(891): 253 -265. doi: 10.1259/bjr.75.891.750253 [14] Chida K, Kagaya Y, Saito H, et al. Total entrance skin dose: an effective indicator of maximum radiation dose to the skin during percutaneous coronary intervention. AJR Am J Roentogenol, 2007, 189(4): W224-W227. doi: 10.2214/AJR.07.2422 [15] Mokhtari-Dizaji M, Sharafi AA, Larijani B, et al. Estimating the absorbed dose to critical organs during dual X-ray absorptiometry. Korean J Radiol, 2008, 9(2): 102-110. doi: 10.3348/kjr.2008.9.2.102 [16] Nishizawal K, Masuda Y, Morinaga K, et al. Surface dose measure-ment in patients and physicians and effective dose estimation in patients during uterine artery embolisation. Radiat Prot Dosi, 2008, 128(3): 343-350. [17] 肖锋, 徐国千, 涂, 等. 肝脏介人操作所致患者辐射剂量的初步研究. 苏州大学学报(医学版), 2005, 25(3): 405-408.
[18] 王继先, 陈如松, 诸洪达, 等. 中国参考人解剖生理和代谢数据. 北京: 原子能出版社, 1998: 54-66.
[19] Brambilla M, Marano G, Dominietto M, et al. Patient radiation dos-es and references levels in interventional radiology. Radiol Med, 2004, 107(4): 408-418.
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