冠状动脉介入治疗中操作者所受剂量的综合研究

The radiation dose to operators in performing percutaneous coronary intervention:a comprehensive study

目的 测量和评价在冠状动脉介入治疗中第1术者在重要辐射剂量区域内所受辐射剂量，为操作者的辐射防护提供指导和帮助。方法 选用冠心病介入治疗中常用的7个体位，在无辐射防护情况下分别测定不同高度、不同视野、不同采集频率时第1术者体表入射剂量率，并绘制体表入射剂量分布图。结果 区域内剂量峰值都出现在20 ～ 70 cm高度范围内，在130 ～ 160 cm高度范围内又出现剂量次高峰，投照体位中以左脚位（spider位）时体表入射剂量最大；高采集频率时的剂量率明显高于低采集频率时；大视野剂量率明显高于小视野。结论 冠状动脉介入治疗过程中，重点关注20 ～ 70 cm高度区域的放射防护，而对于左脚位以及130 ～ 160 cm高度范围内的辐射剂量的防护也不容忽视。在不影响图像质量和操作的情况下，应当选取采集频率低和小视野的曝光参数，尽可能减少术者的吸收剂量。

Objective To measure the radiation dose to the main radiation areas of the chief operator in performing pereutaneous coronary intervention for coronary heart disease, and to provide helpful guidance for radiation protection. Methods Seven conventional positions commonly used in coronary intervention for coronary heart disease were selected. Under un-protected condition, the surface incident dose rates on the selected seven areas of the chief operator were separately measured at different heights and different fields of view, as well as with different acquisition frequencies, based on which the surface incident dose distribution map was drawn and the results were evaluated and analyzed. Results The results showed that the dose peaks at the selected important areas were within 20 - 70 cm high range, while the dose sub-peaks were within 130 - 160 cm high range. The maximum surface incident dose was seen in left foot position （spider position）. The surface incident dose rate in high acquisition frequency was much higher than that in low acquisition frequency. Besides, the surface incident dose rate using large field of view was obviously higher than that using small field of view. Conclusion In performing percutaneous coronary intervention, close attention should be paid to the radiation protection for 20 - 70 cm high range area, and the radiation protection for 130 - 160 cm high range area should not be ignored when spider position is employed. Besides, low acquisition frequency and small field of view exposure parameters should be used when the image quality as well as the manipulation will not be affected so that the absorbed dose can be reduced as far as possible. （J Intervent Radiol, 2013, 22： 834-837）