双平板数字减影血管造影投照角度对介入医师辐射剂量影响的研究  

Study on the effect of projection angles of bi-plane DSA on radiation dose of intervention physician

作　　者：张文龙 董硕[1] 白玫[1] 吴航[1] ZHANG Wen-long;DONG Shuo;BAI Mei(Department of Medical Engineering,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院医学工程处,北京100053

出　　处：《中国医学装备》2020年第3期22-26,共5页China Medical Equipment

基　　金：北京市科学技术委员会首都临床特色应用研究课题(Z181100001718101)“神经介入诊疗双平板DSA辐射剂量分布及防护措施改进的研究”。

摘　　要：目的:通过监测神经介入手术中双平板数字减影血管造影(DSA)不同角度投照情况下第1、第2及第3介入医师(术者)位置的辐射剂量分布情况,为医生选择合适的投照角度及辅助防护设施的改进提供科学依据。方法:医院的3名术者行DSA介入手术时,分别在第1、第2和第3术者位、距地面20 cm、40 cm、60 cm、80 cm、105 cm、125 cm、140 cm、155 cm和180 cm处设置检测点,采用DSA标准配置防护设施,将标准水模(300 mm×300 mm×200 mm)置于射野中,使用双X射线管同时曝光,使用ATOMTEX AT1123型辐射剂量监测仪监测设置点位的辐射剂量。记录正位和侧位X射线管不同投照角度时的测量结果。结果:双平板DSA同时曝光时,介入术者所在位置均有散射线照射,腰部以上位置均>400μSv/h;正侧位X射线管在C臂沿体轴左侧(LAO)方向大角度旋转投照时,介入医师所在位置辐射剂量会有5~10的升高;两X射线管在C臂沿垂直轴足向(CAU)方向旋转投照时,投照方向朝向床尾时第1术者所在位置辐射剂量会有3~10倍的升高。结论:合理选择双平板DSA投照角度能够有效减少术者接受的辐射剂量;同时应对距地面>105 cm高度的位置加强辐射防护。Objective:To provide scientific reference for doctors to choose suitable projection angle and auxiliary protection equipment through monitored the distribution of radiation dose at the positions of the first,the second and the third intervention physicians(surgeons)under projection with different angle of bi-plane digital subtractive angiography(DSA)in neurological interventional surgery.Methods:When 3 surgeons of hospital performed DSA interventional operation,a series of detection points were set at 20 cm,40 cm,60 cm,80 cm,105 cm,125 cm,140cm,155cm and 180cm above the ground,and the positions of the first,the second and the third surgeon.The protection facility of DSA standard configuration was adopted,and the standard water tank(300 mm×300 mm×200 mm)was put in field.And the dual X-ray tubes were used for simultaneous exposure,and ATOMTEX AT1123 monitor of radiation dose was used to supervise the radiation dose at detection points.And the measured results of X-ray tube of front position and lateral position at different projection angles were recorded.Results:When bi-plane DSA was exposed simultaneously,all of the positions of surgeons were radiated by radioactive ray,and the positions above the waist of surgeons were>400μSv/h.When the X-ray tube of front-lateral position implemented rotation projection with large angle at the direction of C-arm LAO,the radiation dose of position of intervention staffs could be enhanced by 5-10 times.When two X-ray tubes implemented rotation projection at the direction of C-arm CAU and the projection direction at tailstock,the radiation dose of the first surgeon was enhanced by 3-10 times.Conclusion:The rational projection angle of bi-plane DSA can effectively reduce the radiation dose on surgeons,and the radiation protection of the position that is higher 105cm above ground should be strengthened.

关 键 词：介入放射 双平板数字减影血管造影(DSA) 辐射剂量 辐射防护 

分 类 号：R146[医药卫生—公共卫生与预防医学]