某医疗机构数字减影血管造影放射风险评估探讨  

Study on radiation risk assessment of digital subtraction angiography in a medical institution

作　　者：黄梓培 杨宇华[1] 李晓华 陈慧峰[1] 林海辉[1] 夏冰[1] HUANG Zipei;YANG Yuhua;LI Xiaohua;CHEN Huifeng;LIN Haihui;XIA Bing(Guangdong Province Hospital for Occupational Disease Prevention and Treatment,Guangdong Provincial Key Laboratory of Occupational Disease Prevention and Treatment,Guangzhou 510300 China;School of Public Health,Guangdong Pharmaceutical University)

机构地区：[1]广东省职业病防治院广东省职业病防治重点实验室,广东广州510300 [2]广东药科大学公共卫生学院

出　　处：《中国辐射卫生》2020年第4期382-386,共5页Chinese Journal of Radiological Health

基　　金：卫生行业科研专项(201002009);广东省医学科学技术研究基金(A2017227);广东省职业病防治重点实验室(2017B030314152)。

摘　　要：目的评估某医疗机构放射风险水平,为医疗机构做好DSA的放射防护工作提供科学依据。方法调查广州某医院的DSA放射防护基本情况和放射事故历史资料并进行现场剂量监测。参照国家有关法规标准,利用AS/NZS ISO31000:2009风险评估指数矩阵法对DSA放射风险因素进行识别、分析和评价,并提出控制对策。结果DSA机房外各检测点周围剂量当量率范围为0.17~1.69μSv/h;近台同室操作中,第一术者位剂量当量率范围为95~153μGy/h,第二术者位为82~318μGy/h;放射工作人员年有效剂量范围为0.16~1.12 mSv,平均年有效剂量为(0.49±0.31)mSv。机房放射防护措施合理并有效,工作人员健康状况良好,基本符合相关法规标准要求。该医院DSA放射风险因素主要来源于设备安全性、环境安全和防护、人员安全和防护、安全与应急管理等4方面。初步确定设备参数安全不稳定、个人防护用品缺乏或失效、职业技能欠缺或操作失误、因手术复杂而增加透视时间、安全防护意识不足及无放射事故应急预案属于高风险事件。结论初步建立了放射风险评估体系,能相对有效地评估该医院DSA机房的放射风险水平。Objective In order to assess the radiation risk level in a medical institution and provide scientific basis for the radiation protection work of DSA in medical institutions.Methods To investigate the DSA radiation protection information and radiation accident history data and monitor dose on site of a hospital in Guangzhou.With reference to relevant national regulations and standards,DSA radiation risk factors were identified,analyzed and evaluated by AS/NZS ISO31000:2009 risk assessment index matrix method,and control countermeasures were proposed.Results The range of ambient dose equivalent rate around each detection points outside DSA room was 0.17~1.69μSv/h.In the near-stage and inroom operation,the dose equivalent rate was 95~153μGy/h for the first operator and 82~318μGy/h for the second operator.The annual effective dose of radiation workers ranged from 0.16~1.12 mSv,and the average annual effective dose was(0.49±0.31)mSv.The radiation protection measures are reasonable and effective,and the staffs are in good health and basically meet the requirements of relevant regulations and standards.Radiation risk factors of DSA in this hospital mainly come from the following four aspects:equipment safety,environmental safety and protection,personnel safety and protection,safety and emergency management.It was preliminarily determined that high-risk events include:unstable safety of equipment parameters,lack or failure of personal protective equipment,lack of professional skills or misoperation,increased fluoroscopy time due to complex surgery,lack of safety protection awareness and no radiation accident emergency plan.Conclusion The radiation risk assessment system was preliminarily established,which can evaluate the radiation risk level of the DSA room of the hospital relatively efficiently.

关 键 词：数字减影血管造影 风险评估 放射防护 医院 

分 类 号：X591[环境科学与工程—环境工程]