甲状腺癌病人行131I治疗急症处理中个人受照剂量的评估  

Preliminary dose estimation for medical staff during the emergency treatment of patients with recurrent papillary thyroid cancer treated with radioiodine (131I) radiotherapy

作　　者：杨素云[1] 胡婷婷[1] 王宏力[2] 师晓丽[1] 刘丽娜[1] 唐国华[2] 池翠萍[2] YANG Suyun;HU Tingting;WANG Hongli;SHI Xiaoli;LIU Lina;TANG Guohua;CHI Cuiping(Department of Nuclear Medicine,The First Hospital of Shanxi Medical University,Taiyuan 030001;China Institute for Radiation Protection,Taiyuan 030006)

机构地区：[1]山西医科大学第一医院核医学科,太原030001 [2]中国辐射防护研究院,太原030006

出　　处：《辐射防护》2019年第3期228-233,共6页Radiation Protection

基　　金：山西省重点研发计划项目资助(编号:201803D31105)

摘　　要：甲状腺乳头状癌病人复发行二次131I治疗时并发进行性喉头水肿,对参与急救治疗的相关医务人员个人剂量进行了回顾性评估。采用辐射实时监测系统和选取一例类似甲癌治疗病人进行照射过程重建和模拟剂量实时监测。辐射实时监测系统由3个置于不同位置的个人剂量计、中继器、集线器及主机系统组成。其功能为个人剂量计数字信号经无线通讯传输到中继器,将信号放大后传输出屏蔽病房后到集线器,然后到主机系统进行实时显示和储存及计算处理。医务人员救治时接受总剂量由各时段累积剂量当量之和给出。结果表明,3位护士和7位医生接受的剂量范围为7.5-4μSv和8.2-0.1μSv,其中核医学科医务人员接受的剂量相对较大。通过剂量评估说明辐射实时监测系统可以在医学应用中及时调整和优化治疗过程,是一个更好地执行ALARA原则的有效而方便的工具。The aim of the present study was to evaluate the radiation doses received by medical staff during the emergency treatment of patients with recurrent papillary thyroid cancer received radioiodine(131I) radiotherapy, by using a real-time radiation monitoring system, for the purpose of radiation protection of occupational exposure. The patient was treated with radioiodine(131I) for the second time and larynx edema occurred after treatment of 131I. There were three nurses and seven doctors participating in the emergency treatment of the patient and none of them wore a radiation dosimeter. In order to retrospectively assess the doses received by the medical staff, a new patient undergoing the same 131I radiotherapy was selected to simulate the radiation scenario of the original case. Real-time radiation monitoring system contained three personal dosimeters loaded with the function of delivering data by wireless to the repeater, where the signals were magnified and went through the radiation shielded wall of the ward to the hub, finally to the main unit of the system at the nurse station. One of the dosimeters was worn by the patient at the anatomic position of the sternal angle, the other two were laid at 20 cm(the bedside cupboard) and 150 cm away( the wooden sill). Data of dose equivalent of the three dosimeters and corresponding accumulated dose equivalent were collected by the monitoring system. Data analyzing and graph making were performed with Microsoft Excel. The dose received by each medical staff was given by the sum of accumulated dose equivalent at different periods according to data at 20 cm or at 150 cm. The monitoring time was 86.4 hrs long after the patient was treated with 131I. Time-dose equivalent and-accumulated dose equivalent curves were made with average 6 000 data points for each curve. The fitting curves present exponential functions for time-dose equivalent courses, and logarithmic functions for time-accumulated dose equivalent courses. As a result, three nurses N1, N2, N3 received accumulate

关 键 词：DTC(分化型甲状腺癌) 131^I放射治疗 辐射实时监测系统 

分 类 号：R144.1[医药卫生—公共卫生与预防医学]