上海市2009-2012年放射诊疗机构监督情况分析

Supervision Practice of Radiation Protection in Medical Radiography during 2009-2012 in Shanghai

[目的]了解上海市放射诊疗机构监督管理现状,掌握放射诊疗管理中存在的问题,提出相应的放射诊疗管理对策。[方法]资料来源于上海卫生监督综合应用平台,包括现场监督、行政处罚、许可信息、一户一档等管理系统,及上海卫生监督状况年度评估报告。对2009—2012年放射诊疗防护监督检查、行政处罚等情况进行分析,并采用分层抽样方法,按照医疗机构级别,随机抽取710家放射诊疗机构进行放射防护检测。[结果]上海市放射诊疗机构总体放射防护检测合格率近100%,违法率为8.0%,行政处罚率为4.0%,对违法放射诊疗机构予以行政处罚的比例为50.4%。2009—2012年,各年度行政处罚率分别为2.5%、3.4%、4.0%、6.3%;对违法放射诊疗机构予以行政处罚的比例,各年度分别为35.7%、44.9%、57.3%、61.2%,均呈现逐年上升趋势(χ2=54.24、36.53,P<0.001)。458件行政处罚案件中,主要案由为未对放射诊疗工作人员进行个人剂量监测、健康检查,超出批准范围从事放射诊疗工作,未对放射诊疗工作场所进行放射防护检测等。[结论]上海市放射诊疗防护总体情况较好,但在健康监护、放射诊疗许可、放射防护检测等方面仍然存在一些不足之处,应进一步加强放射诊疗机构自律性,加大执法力度,增强放射诊疗工作人员和受检者放射防护意识。

To evaluate the situation and problems in the supervision management of radiodiagnosis and radiotherapy in Shanghai, and to put forward corresponding [ Methods ]Data were collected from the Shanghai Health Supervision and Comprehensive Application Platform （an integrated management system including on-site supervision, administrative penalties, license information, and customer-specified file archiving） and the annual evaluation reports about supervision status in Shanghai to analyze the supervision and administrative punishment levels of radiotherapy radiation protection during 2009-2012 in Shanghai. Radiation-involved medical institutions （n=710） were selected using stratified random sampling method by the national medical institutional grading system to assess radiotherapy radiation protection levels. [ Results ] The overall qualified rate of radiotherapy radiation protection was nearly 100%, while the unlawful practice rate and administrative penalty rate were 8.0% and 4.0%, respectively, and thus 50.4% of the institutions with unlawful practice were issued administrative penalties. From 2009 to 2012, the administrative penalty rates were 2.5%, 3.4%, 4.0%, and 6.3%, respectively; and there were 35.7%, 44.9%, 57.3%, and 61.2%, respectively, of the institutions with unlawful practice were received administrative penalties, showing an increasing trend （χ^2=54.24, 36.53, P〈 0.001）. For the 458 cases of administrative penalty, the leading causes included no personal dose monitoring or health examination conducted to radiotherapy staff, providing radiodignosis and radiotherapy services beyond the licensed service areas, and no radiation protection conducted in radiotherapy workstations. [ Conclusion ] The radiation protection is generally at a high level in Shanghai, except for some deficiencies that still exist in health surveillance, radiodiagnosis and radiotherapy licensing, and radiation protection detection. We propose to strengthen self-regulation of radiation involved medical practices in relevant institutions, law enforcement, and self-protection awareness of radiation protection in medical practitioners and patients.