冠状动脉造影不同体位辐射剂量的对比研究

Comparison the Impact of Different Projections in Coronary Artery Angiography

目的:比较冠状动脉造影不同体位的辐射剂量。方法:采用PHILIP Allura Xper FD 20进行冠状动脉造影患者77例。分别选择头位30o、足位30o、右肩位、左肩位、肝位、蜘蛛位进行左冠状动脉造影;选择左前斜45o和头倾30o进行右冠状动脉造影。记录每位患者总的透视时间(FT)、累积剂量(CD)和剂量面积乘积(DAP)以及每个体位的投照角度、采集图像总数、管电压、管电流和DAP值,计算不同体位单帧图像的DAP值并进行比较。结果:77例患者平均FT、CD和DAP值分别为216.56±115.52s、281.28.±126.28mGy和34114.74±16587.81 mGy.cm^2。左冠状动脉造影6个体位中,左前斜位的DAP值显著高于头足位和右前斜位,差异具有统计学意义(P值均<0.05);头足方向即左肩位和蜘蛛位、头位和足位、右肩位和肝位之间的DAP值差异均没有统计学意义(P值均>0.05)。结论:冠状动脉造影不同投照体位对辐射剂量有影响;球管左右方向倾斜对辐射剂量影响较大,球管头足方向倾斜对辐射剂量影响不明显;利用单帧图像的DAP值进行辐射剂量对比研究,方法简单,易于推广。

Objective:To compare the radiation dose of different projections in coronary artery angiography(CAG).Methods:77 patients who received CAG procedures with the equipment of PHILIPS Allura Xper FD 20 were enrolled in this study.Selective coronary angiography were performed with different projections as followings:cranial(CRA)30 o,caudal(CAU)30 o,right anterior oblique(RAO)30 o+cranial(CRA)20 o,left anterior oblique(LAO)45 o+cranial(CRA)20 o,RAO30 o+CAU20 o and LAO45 o+CAU20 o were used for left coronary artery;LAO45 oand CRA30 owere for right coronary artery.Then the total fluoroscopy time(FT),dose-area product(DAP),cumulative dose(CD)were recorded,and the tube potential,current,time,position of the x ray tube(both rotation and cranial/caudal),DAP values and number of images were recorded for each projection and for all patients.The DAP of single frame in different projections were calculated and compared.Results:The averages of FT,CD and DAP of all 77 patients were 216 s,281.28 mGy and 34114.74 mGy.cm^2 respectively.Of all the six left coronary angiographic projections,the DAP of both LAO cranial and LAO caudal were higher significantly than that of the other projections(P<0.05);but the diferences between LAO cranial and LAO caudal,CRA and CAU,RAO cranial and RAO caudal had no statistical significance(P>0.05).Conclusion:Different projections had an effect on the radiation dose in CAG.LAO projections were associated with higher radiation doses compared to PA and RAO projections,but the differences between cranial and caudal projections showed no significant.the way of evaluating the radiation doses by comparing the DAP of single frame images was simple and easy to popularize.