CT引导肝癌介入中患者有效辐射剂量的研究

Radiation effective dose received by performing CT-guided interventional procedures in the patients with liver cancer

目的探讨肝癌患者在5种CT引导介入操作中接受的有效辐射剂量。方法回顾性分析2014年9月至12月在首都医科大学附属北京佑安医院肝病肿瘤介入治疗中心进行CT引导介入诊断和治疗的390次肝癌患者的检查资料。介入操作包括肝穿刺、化学消融、射频消融、微波消融、冷冻消融5种方法。记录患者所接受的介入操作方式、扫描时间、照射量、容积CT剂量指数、剂量长度乘积。有效辐射剂量根据转换公式进行计算。结果肝穿刺、化学消融、射频消融、微波消融、冷冻消融平均扫描时间分别为(49.7±23.4)s、(88.9±21.3)s、(89.5±40.6)s、(106.0±43.5)s和(87.7±27.6)s;平均有效辐射剂量分别(19.5±14.9)m Sv、(30.0±10.2)m Sv、(34.2±17.6)m Sv、(38.1±19.9)m Sv和(33.1±13.1)m Sv。肝穿刺组患者的有效剂量明显低于消融治疗组。有效剂量与管电流、扫描时间、照射量、容积CT剂量指数均存在明显的正相关关系。结论 CT引导下单次介入操作有效辐射剂量相对较小,引起辐射损伤及后续合并症的危险小,是相对安全的;但多次介入治疗累积的有效辐射剂量可能会较大,需要引起重视。

Objective Totally To explore the effective radiation dose taken during 5 kinds CT-guided interventional procedures to the patients with liver cancer. Methods Totally 390 case-time inspection records from Sept. to Dec. 2014, of who were diagnosed and treated by the CT-guided interventional procedures, were retrospectively analyzed. The interventional procedures include liver biopsy, chemical ablation, radiofrequency ablation, microwave ablation, and cryoablation. The type of CT-guided interventional procedure, the scanning time, the exposure dose（ total mAs）, volume-weighted CT dose index（CTDIvol） and the total does-length product （DLP） were recorded. Effective dose（ED） was calculated. Results The average scanning time of liver biopsy, chemical ablation, radiofrequency ablation, microwave ablation, and cryoablation were （49. 7 ± 23.4） s, （ 88.9 ± 21.3 ） s, （ 89. 5 ± 40. 6 ） s, （ 106. 0 ±43.5 ） s and （ 87.7 ± 27.6） s. The EDs of the five procedures were （ 19.5 ± 14. 9） mSv, （ 30. 0± 10. 2） mSv, （ 34. 2 ± 17. 6） mSv, （38. 1± 19. 9 ） mSv and （33.1 ± 13.1 ） mSv, respectively. The EDs in biopsy procedure were significantly lower than those in ablation procedures. It was represented that the ED are positively correlative with the tube current, the scanning time, the exposure dose and the CTDIvol. Conclusion The effective radiation dose of single CT-guided interventional procedure is relatively lower. Therefore the risk of radiational damage and subsequent complications is lower as well. It should be paid attention that the cumulated effective dose for several times of CT- guided interventional treatments may exceed the acceptable range.