五种介入程序中职业人员手部受照剂量水平的评估

Assessment of the hand dose to occupational staff in five procedures of interventional radiology

目的评估5种临床介入程序中,职业人员手部受照剂量水平。方法选择北京4家医院进行5种介入程序的治疗,职业人员术中左右手各佩戴1枚热释光指环剂量计(TLD, LiF: Mg, Ti),进行手部剂量当量Hp(0.07)监测,同时分别记录患者的透视电压、透视电流、透视时间、摄影数,总累积剂量、剂量面积乘积等影响因素信息,对影响因素进行分析。结果本研究共监测5种介入程序,119例手术。对5种介入程序中职业人员左手与右手受照剂量进行分析,差异有统计学意义(t=1.99,P<0.05)。不同介入程序的第一术者手部受照剂量左手、右手差异均有统计学意义(F=455.83、116.45,P<0.01)。影响因素分析中,随着透视管电压,透视电流,透视时间,摄影数的增加,操作者手部剂量也增加(r=0.570、0.712、0.564、0.711,P<0.05)。将上述单因素分析有统计学意义的变量引入多元线性回归方程中,采用逐步回归法拟合方程。经拟合方程为y=225.763+1.862x1-98.125x2(F=22.726,P<0.05)。其中变量x1为透视时间,x2为摄影数。表明影响操作者手部剂量的主要因素是透视时间和摄影数。结论在开展上述5种介入程序治疗时,第一术者的手部剂量最高,其次第二术者、助手或护士;5类介入程序中,第一术者的手部受照剂量水平高低排列为心脏起搏器植入术(PM)>射频消融(RFA)>冠状动脉血管造影术(CA)>支架植入术(PTCA+PCI)>脑动脉瘤介入术(ITCA);大量开展PM手术时,第一术者手部的年当量剂量有可能超过限值。

Objective To estimate the hand dose of occupational staff in five procedures of interventional radiology. Methods The thermoluminescence ring dosimeter(TLD, LiF: Mg, Ti)calibrated in dose equivalent Hp(0.07) was used to monitor the radiation dose to the both hands in five procedures of interventional radiology in four hospitals. Meanwhile, the tube voltage and current and the fluoroscopy time, accumulated doses, DAPs (Dosed-Area Product) and photographic frames were also recorded for statistical analysis(SPSS 18.0). Results In this study, five interventional procedures were monitored in 119 cases. The doses to the left and right hands of occupational personnel in the five interventional procedures were analyzed, and the difference was statistically significant (t=1.99, P< 0.05). The differences in the dose to the left hand and the right hand of the first operator with different interventional procedures were statistically significant (F=455.83, 116.45, P<0.01). Tube voltage, current, fluoroscopy time, and photographic frames in influence factor analysis were statistically significant (r=0.570, 0.712, 0.564, 0.711, P<0.05), indicating that four factors might affect the operator′s hand doses. In addition, increasing these four factors directly led to increase in the operator′s hand doses. The variables with statistical significance in the above single factor analysis were introduced into the multiple linear regression equation and the stepwise regression method was used to fit the equation. The fitting equation was y=225.763+ 1.862x1-98.125x2(F=22.726, P<0.05). Where, x1 was the fluoroscopy time and x2 was the photographic frames which showed that they were the main factors affecting the hand dose. Conclusions The dose to the hands of the primary operator was the highest, followed by the second operator, the assistant or nurses.The order of average doses to the hands of the primary operator was PM>RFA>CA> PTCA+ PCI > ITCA in the five procedures.The annual equivalent dose to primary operator′s hands may exceed the dose limit for hands in practicing large amount of the PM procedures.