肝动脉化疗栓塞治疗肝癌患者的X射线辐射评价

Estimate of X-radiation to patients during transhepatic artery chemoembolization for heptocarcinoma

目的 研究经肝动脉化疗栓塞 (THACE)治疗肝癌过程中 ,患者受到的X射线辐射 ,为THACE放射防护提供依据。方法 回顾性分析 82例HCC患者的辐射剂量资料 ,DSA机 (Angiostar Plus)配置穿透电离室型剂量监测系统 (DiamentorK1andDiamentorED) ,在线读取面积剂量乘积DAP(cGy cm2 )和入射表面剂量ESD(mGy) ,采用Monte Carlo转换因子估算有效剂量ED(mSv)。并分析近期 10例THACE患者 ,在提高基值管电压、减低透视脉冲频率和摄影帧数下对辐射剂量的影响。结果 82例HCC患者透视时间 (35 3± 2 1 1)min ,摄影 (2 34± 10 8)帧 ,DAP为 (2 174 8± 12 4 2 4 )cGy cm2 ,ESD为 (96 4± 6 32 )mGy ,ED为 (34 8± 19 9)mSv。透视对总DAP的贡献 (2 4 0± 12 7) %小于摄影 (75 9± 12 7) % ,透视对ESD值的贡献 (4 9 8± 14 9) % ,与摄影相似 (5 1 6± 14 2 ) %。近期的 10例THACE患者的每分钟透视剂量、每帧摄影剂量及总剂量都比HCC患者明显降低。结论 在THACE过程中患者受到一次性较大剂量X射线照射。适度提高基值管电压、减低透视脉冲频率和缩减摄影帧数 。

Objective\ To evaluate the X- radiation to patients of hepatocarcinoma during transhepatic artery chemoembolization(THACE). Methods\ The radiation dose was measured in 82 patients(group A) during THACE for hepatocarcinoma.Measurements were carried out using a dosimeter system(Diamentor K1 and Diamentor ED) equipped in DSA setting Angiostar-Plus(Siemens,Germany),dose-area product(DAP) and entrance surface dose(ESD) were recorded on-line,and the effect dose(ED) was estimated by Monte-Carlo conversion coefficient from DAP.The effects of elevated tube voltage,reduced pulsed fluoroscopy(PF) frequency and curtailed total photography frames on radiation to the patients were studied by comparison with another 10 THACE cases treated recently(group B). Results\ In group A,the mean fluoroscopic time was (35.3±21.1) minutes,and the mean number of angiographic exposure was (234±108) frames,the mean DAP dose was((21 748±)(12 424)) cGy/cm\+2,and the mean ESD was (964±632)mGy,ED was (34.8±19.9)mSv.The contribution of pulsed fluoroscopy(PF) dose to the total DAP(24.0±12.7)% was smaller than photography(R)(75.9±10.7)%,and of PF to total ESD(49.8±14.9)% was similar to R (51.7±14.2)%.The total dose,fluoroscopy dose per minute and photography dose per frame in group B was reduced obviously than in group A. Conclusion\ The HCC patients suffered a large dose of X-ray exposure in THACE procedure.The radiation exposure of patients can be reduced by elevating tube voltage,reducing pulsed fluoroscopy frequency and curtailing total photography frames moderately.\;