床旁防护装置对冠状动脉造影术者辐射防护效果的体模研究

Analysis of radiation dose to operators involved in coronary angiography with radiation protection shields： a phantom study

目的 测量冠状动脉造影8个投照体位在有与无床旁防护装置防护下术者所受辐射剂量,为冠心病介入治疗中减少术者辐射暴露提供参考.方法 在第一及第二术者站位,距地面20至180 cm处,每隔20 cm放置一个实时剂量测量仪.采用冠状动脉造影8个体位投照,测量在有与无床旁防护装置防护下,术者在不同投照体位的不同高度接受辐射剂量情况.结果 在第一术者位,除1.2m高度仍可测到较高剂量（剂量率0.35 ～4.78 mSv/h,屏蔽率27.67％ ～ 89.33％）,其余各点屏蔽率均在91％以上.左前斜尾位、左前斜位、左前斜头位辐射剂量较高.第二术者位屏蔽率较第一术者位低,剂量峰值可出现在0.8、1.0及1.4m高度（剂量率0.27 ～ 1.86 mSv/h,屏蔽率30.34％ ～92.13％）.右前斜尾位、左前斜尾位、正头位、左前斜位辐射剂量较高.结论 床旁防护装置防护下,术者在左前斜尾位、左前斜位、左前斜头位、右前斜尾位的辐射暴露较高,应尽量少采用上述投照体位长时间曝光.同时应加强0.8～1.4m高度的辐射防护.

Objective To measure the dose to the primary operator and assistant operators by employing eight beam projections commonly used in coronary angiography with and without radiation protection shields in order to supply helpful guidance on radiation protection in cardiac intervention.Methods From 20 to 180 cm above the ground at the primary and assistant operators＇ locations,a DoseAware personal dose meter was placed in terms of an increment of 20 cm to measure radiation dose.Eight commonly used beam projections were performed,including LAO （left anterior oblique） 45°,RAO （right anterior oblique） 30°,CRAN （cranial）25°,cranial LAO （LAO45°/25°）,caudal LAO（LAO45°/ 25°）,CAUD （caudal） 25°,cranial RAO （RAO30°/25°）,caudal RAO （caudal RAO30°/25°）.Under the two different conditions,with or without radiation protection shields,the doses to the operators in the selected beam projections were respectively recorded at nine measuring positions and the shielding factor were calculated.Results The primary operator was effectively protected with radiation protection shields.In the standing area of the primary operator,except for the position at the height of 120 cm （radiation dose rate：0.35-4.78 mSv/h;shielding factor：27.67%-89.33%）,the shielding factor for each measuring position was above 91%.Higher radiation doses were found at caudal LAO,LAO,and cranial LAO.The shielding factor for the assisting operator was lower than for the primary operator.In the standing area of the assisting operator （radiation dose rate：0.27-1.86 mSv/h;shielding factor：30.34%-92.13%）,the peak levels were found at the height of 80,100,140 cm.And caudal RAO,caudal LAO,CRAN,LAO were found to have received higher radiation doses.Conclusions Emphasis should be attached to the use of radiation shields in coronary angiography.With radiation protection shields,higher dose is still recorded in caudal LAO,LAO,cranial LAO,caudal RAO.Furthermore,it should be paid more attention to radiation protection at 80-140 cm height,and less prolonged exposure should be employed in those beam projections mentioned above.