摘要
目的探讨冠脉介入诊疗中术者上肢暴露部位射线剂量与部位高度、术者站位、造影体位及物理防护强度之间的关系。方法通过对仿真人体模型进行造影曝光,采集桡动脉途径时2位模拟术者左手、左上臂在不同防护条件、不同造影体位下的体表入射剂量率。采用T检验比较仅穿无袖铅衣时左手和左上臂间的体表入射剂量率及同一部位在两位术者间的体表入射剂量率,比较左手在床旁防护前后的体表入射剂量率;采用单因素方差分析比较仅穿无袖铅衣时同一部位在各体位间的体表入射剂量率,比较左上臂在不同防护条件间的体表入射剂量率;并计算左手、左上臂在不同防护措施下的射线屏蔽率。结果仅穿无袖铅衣时,第一术者上肢的体表入射剂量率均高于第二术者(左手t=38.9~86.5,左上臂t=13.0~83.8,P<0.05);两位术者左上臂大多数体位的体表入射剂量率高于左手(第一术者t=7.1~55.3,第二术者t=9.2~78.8,P<0.05)。左手给予床旁防护后体表入射剂量率明显较低(第一术者左手t=49.4~181.6,第二术者左手t=5.1~47.3,P<0.05);左上臂给予的防护越强,体表入射剂量率越低(第一术者左上臂F=84.6~531.3,第二术者左上臂F=7.0~326.3,P<0.05)。单纯床旁防护时,第一术者左手、左上臂的射线屏蔽率分别为22.46%~52.93%、23.83%~72.12%,第二术者左手、左上臂的射线屏蔽率分别为2.28%~17.39%、3.45%~50.62%,第一术者上肢的射线屏蔽率均高于第二术者,左上臂的射线屏蔽率在多数体位高于左手。半袖铅衣+床旁防护时第一、第二术者左上臂的射线屏蔽率升至73.32%~89.48%、63.97%~89.55%,两术者之间及各体位之间的射线屏蔽率差值较单纯床旁防护时明显缩小。结论经桡动脉冠脉介入诊疗中,术者上肢暴露部位的射线剂量受部位高度、术者站位、造影体位、物理防护强度等多种因素综合影响,单纯床旁防护对第一术者上肢尤其上臂的防护效果更好,而半袖铅衣弥补了单纯床旁防护的不足,应充分利用床旁防护及穿戴强化的射线防护用品以减少介入术者的辐射危害。
Objective To discuss the relationship of the radiation dose on the operator’s upper limb with the height of exposed area, standing position of the operator, imaging position(C-arm X-ray angle)and physical protection intensity in percutaneous coronary intervention(PCI). Methods The patient was replaced by an anthropomorphic phantom, PCI procedure via radial artery access was simulated, the entrance surface dose(ESD) rates of the simulated operator ’s left hand and left upper arm at different C-arm angles were collected under different radiation protections. The t-testing was used to compare the difference in ESD rate between left hand and left upper arm of operator wearing only sleeveless X-ray protective suits, to compare the difference in ESD rate of same site between the first operator and the second operator, as well as to compare the ESD rate of left arm before bedside protection was adopted with that after bedside protection was adopted. Single factor analysis was used to compare the same site ESD rate between different C-arm angles in operator wearing only sleeveless X-ray protective suits, and to compare the ESD rate of the left upper arm between different protection conditions. The X-ray shielding ratios of left hand and left upper arm und er different protection conditions were calculated. Results When only wearing sleeveless X-ray protective suits, the ESD rates of left upper limb in the first operator were higher than those in the second operator(left hand t=38.9-86.5, left upper arm t=13.0-83.8, P<0.05). The ESD rates of left upper arm were higher than those of left hand at most C-arm angles(the first operator t=7.1-55.3, the second operator t=9.2-78.8, P<0.05). Under bedside protection, the ESD rates of left hand were obviously decreased(the first operator t=49.4-181.6, the second operator t=5.1-47.3, P<0.05). The stronger the protection of left upper arm was, the lower the ESD rate would be(the first operator F=84.6-531.3, the second operator F=7.0-326.3, P<0.05). When only simple bedside protection was employed, the X-ray shielding ratios of left hand and left upper limb in the first operator were 22.46%-52.93% and 23.83%-72.12% respectively,which in the second operator were 2.28%-17.39% and 3.45%-50.62% respectively;the X-ray shielding ratios of upper limbs in the first operator were higher than those in the second operator;and the X-ray shielding ratios of left upper limb were higher than those of left hand at most C-arm angles. When simultaneously wearing half-sleeve X-ray protective suits and using bedside protection, the X-ray shielding ratios of left upper arms in the first operator and second operator rose up to 73.32%-89.48% and 63.97%-89.55%respectively;and the difference values of the X-ray shielding ratios between two operators and among different C-arm angles dropped down remarkably if compared with those when only simple bedside protection was adopted. Conclusion In performing PCI procedure via radial artery access, the radiation dose on operator’s upper limb is comprehensively affected by various factors, including height of exposed area,standing position, angiographic examination position, physical protection intensity, etc. The protective effect of simple bedside shielding device is better for upper limbs, especially for upper arms, of the first operator,while half-sleeve X-ray protective suits can make up for the inadequacy of simple bedside protection. It is very important to make full use of bedside protection and wearing enhanced protection equipment in order to reduce the radiation hazard.(J Intervent Radiol, 2021, 30: 523-528)
作者
钱海
楼钶楠
周军波
章璐幸
QIAN Hai;LOU Kenan;ZHOU Junbo;ZHANG Luxing(Department of Cardiology,Ningbo Medical Center,Lihuili Hospital,Ningbo,Zhejiang Province 315040,China)
出处
《介入放射学杂志》
CSCD
北大核心
2021年第5期523-528,共6页
Journal of Interventional Radiology
关键词
冠状动脉介入
上肢
体表入射剂量率
辐射防护
coronary intervention
upper limb
entrance surface dose rate
radiation protection
作者简介
通信作者:钱海,E-mail:doctorqianhai@163.com。
