两种介入放射学(CA和PTCA)所致患者辐射剂量研究  

Radiation dose to patients from the coronary angiography and percutaneous transluminal coronary angioplasty in interventional radiology procedures

作　　者：白玫[1] 刘彬[1] 郑钧正[1] 彭明辰[1] 

机构地区：[1]首都医科大学宣武医院医学工程科,北京100053

出　　处：《中国医学影像技术》2007年第12期1876-1881,共6页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金资助项目(30470531)

摘　　要：目的以首都医科大学宣武医院的介入放射学中心为现场,着重选取介入放射学中较常实施的冠状动脉血管造影术(CA)和经皮穿刺腔内冠状动脉成形术(PTCA),对这两种医疗实践所致患者的辐射剂量进行调查监测和评价,探索临床介入放射学实践中较为恰当的监控方法。方法现场调查监测两种介入放射学实践所致患者的面积剂量乘积(DAP)和介入参考点的累积剂量(CD)等,样本积累了CA患者84例,PTCA患者51例;采用基于蒙特卡罗技术的PCXMC软件,根据现场在线监测的DAP和CD值数据,估算患者器官或组织的吸收剂量和全身有效剂量水平。运用热释光(TLD)剂量测量方法进行人体模型模拟实验研究,测量体内主要器官的吸收剂量,并与软件估算的结果进行比较。结果根据DAP和CD值采用软件估算得到的器官吸收剂量值与TLD测量的器官吸收剂量相比较,经配对t检验,检验结果P>0.05。对于PTCA,所监测的DAP范围为16423mGy·cm2至161973mGy·cm2,介入参考点处的累积剂量CD值为287mGy至2883mGy,有效剂量为2.3mSv至20.1mSv。对于CA,所监测的DAP范围为7611mGy·cm2至60538mGy·cm2,CD范围从120·0mGy至1016.0mGy,有效剂量为1·1mSv至6.9mSv。所得CA患者有效剂量与DAP值的转换系数为0.114mSv·Gy-1·cm-2至0.139mSv·Gy-1·cm-2;PTCA患者有效剂量与DAP值的转换系数为0.124mSv·Gy-1·cm-2至0.142mSv·Gy-1·cm-2。依据软件估算得到的介入患者各器官平均剂量水平和在线监测的CD值,还建立两种介入放射学实践所致患者器官剂量与CD值的转换系数。结论采用在线监测的DAP和CD值作为介入放射学实践所致患者辐射剂量的表征量,可以比较方便快捷地估算出患者有关器官的吸收剂量和全身有效剂量,为介入放射学实践及时提供患者受照的辐射剂量学信息,有利于指导和加强介入放射学中患者所受医疗照射的防护,有效防范患者可能受到的潜在电离辐射危险。�Objective To survey and assess radiation dose to patients from coronary angiography （CA） and percutaneous transluminal coronary angioplasty （PTCA） in Beijing Xuanwu Hospital of Capital University of Medical Sciences. Methods The dose-area product （DAP） values to the patient and cumulative dose （CD）were recorded from 84 coronary angiographies and 51 percutaneous transluminal coronary angioplastys. A Monte-Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Organ doses were also measured by thermoluminescent dosimeters （TLD）using a human-shaped phantom to compare the calculated organ dose from DAP. Results The difference between the organ doses measured by TLDs and those from PCXMC software （P〉0. 05） were tolerable. The DAP value ranged from 7611- 60538 mGy·cm^2 for CA and 16423-161973 mGy·cm^2 for PTCA. The effective dose for all procedures was determined to be in the range of 1.1-6.9 mSv for CA and 2.3-20.1 mSv for PTCA. CD ranged from120. 0 to 1016. 0 mGy for CA and 287 to 2883mGy for PTCA. Conversion factors between effective dose and DAP were 0. 114-0. 139 mSv·Gy^-1·cm^2 for CA and 0. 124-0. 142 mSv·Gy^-1·cm^-2 for PTCA; Conversion factors between organ dose and CD were derived for CA and PTCA, respectively. Conclusion DAP and CD can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. Using this method can provide important information of patient absorbed dose and enhance the radiation protection of patient in interventional radiology procedures.

关 键 词：辐射剂量 介入放射学 冠状动脉血管造影术 血管成形术 经腔 经皮冠状动脉 

分 类 号：R814.3[医药卫生—影像医学与核医学]