模拟CT引导下经皮穿刺射频治疗三叉神经痛时患者的辐射剂量与防护  

Radiation dose and protection measures during simulating CT guided percutaneous radiofrequency puncture in patients with trigeminal neuralgia

作　　者：邢伟[1] 黄冰 褚丹涛 任小妹 姚明[2] 张利 谢可越 费勇 Xing Wei;Huang Bing;Chu Dantao;Ren Xiaomei;Yao Ming;Zhang Li;Xie Keyue;Fei Yong(Department of Pain Medicine,the Second People Hospital of Haining,Haining City,Zhejiang Province 314200,China;Department of Pain Medicine,the First Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China)

机构地区：[1]海宁市第二人民医院疼痛科,浙江省海宁市314200 [2]嘉兴学院附属医院疼痛科,浙江省嘉兴市314000

出　　处：《中华疼痛学杂志》2020年第3期220-224,共5页Chinese Journal Of Painology

摘　　要：目的比较不同扫描模式、扫描条件、防护方式下探测器的辐射剂量,以优化CT引导治疗时的放射防护措施。方法将78枚热释光剂量探测片平均分为13组。第1组不做任何干预;第2、3组置于拍摄野内分别用于探测标准头部模式和标准鼻旁窦模式拍摄定位像;第4~8组及11~13组均置于扫描野内、第9、10组置于扫描野外20 cm处,其中第6、7组分别用5 mm厚铅衣板对探测元件进行上覆盖、下垫衬,第8、10组包裹防护。第4组接受标准头部模式扫描,第5~10组接受标准鼻旁窦模式扫描;第11~13组用鼻旁窦模式下降低至不同扫描条件扫描。随后对各探测片进行辐射剂量测定分析。结果鼻旁窦模式扫描时辐射剂量较常规头部模式低,差异有统计学意义[(6.413±0.363)mSv比(39.740±2.020)mSv,t=39.78,P<0.001]。采取5 mm厚铅衣板覆盖遮蔽、下垫、包裹防护和降低扫描条件均能显著减少受辐射剂量,差异均有统计学意义(P均<0.001),其中以鼻旁窦模式下80 kV,110 mAs扫描辐射剂量最小。结论CT引导下经皮穿刺射频治疗三叉神经痛时,选择鼻旁窦模式,将扫描条件降至80 kV,110 mAs,并对患者头部下垫上盖包裹5 mm厚铅衣板遮蔽,仅露出穿刺层面,缩小扫描范围,减少扫描次数,可最大程度地减少患者射线暴露。Objective To determine the radiation dose of the detector under different scanning modes,scanning conditions and protective modes during simulating CT guided percutaneous radiofrequency puncture for the treatment of trigeminal neuralgia for optimizing protection measures.Methods Seventy-eight thermoluminescence dose detectors were divided into 13 groups on average.Detectors were not intervened to measure the background dose in group 1.Detectors were placed in standard head pattern and the standard paranasal sinus pattern in group 2 and 3 respectively.Detectors were placed in the field of view in group 4-8 and 11-13,while were placed at 20 cm away of the scanning field in group 9 and 10,and covered and lined with 5 mm thick lead plates in group 6 and 7 respectively,or packaged with 5 mm thick lead plates in group 8 and 10.Standard head pattern scan was performed in group 4 and paranasal sinus pattern scan was performed in group 5-10,paranasal sinus pattern with low scanning conditions were in group 11-13 respectively.Then the radiation dosimetry of each detection element was analyzed.Results Compared with the standard head pattern,the radiation dose was low in the standard paranasal sinus pattern[(6.413±0.363)mSv vs.(39.740±2.020)mSv,t=39.78,P<0.001].Compared with the standard paranasal sinus pattern,the radiation dose was decreased significantly with 5 mm thick lead panels covering shelter,underlay,wrapping protection and low scanning conditions(all P<0.001).Among them,the scanning radiation dose of 80 kV,110 mAs in paranasal sinus mode was the smallest.Conclusion During CT guided percutaneous radiofrequency therapy for trigeminal neuralgia,the paranasal sinus pattern,the scan condition of 80 kV,110 mAs,covering the patient's head with 5 mm thick lead plates,exposing the puncture level only,and reducing the scope of the scan and the number of scans,can minimize the patient's radiation exposure.

关 键 词：三叉神经痛 导管消融术 辐射防护测定 

分 类 号：R745.11[医药卫生—神经病学与精神病学]