一起介入治疗意外照射导致背部大面积放射性皮肤损伤的调查及分析

Investigation and analysis of an extensive skin injury to the back caused by accidental irradiation in interventional procedure

目的通过调查分析1例由于介入治疗意外照射致背部大面积放射性损伤的病例,探讨该事件发生过程中存在的问题,为今后避免类似事件发生提供建议。方法询问受照患者详细病史,收集分析患者临床诊疗资料,追踪观察患者临床表现和体征。采集患者外周血估算生物剂量,现场采集介入治疗医院照射设备数据等。结果患者全身生物剂量估算为0.95 Gy。测得介入设备减影模式和透视模式下透视受检者入射体表空气比释动能率典型值分别为373.5和47.8 mGy/min。该介入医生习惯长时间曝光操作,其年有效剂量为20.51 mSv,高于同科室其他工作量相近的介入医生(3.09 mSv)。患者全身及局部临床表现均符合放射损伤,辗转多家医院未予明确诊断,局部损伤治疗效果不明显。结论结合生物剂量估算结果及临床表现,该病例被诊断为放射性皮肤损伤Ⅳ度。放射性损伤与是否按规范操作及X射线机输出剂量等因素密切相关,非专科医院在辐射损伤的临床诊断及治疗有待加强。

Objective To carry out investigation and analysis of an extensive skin radiation injury to the back accidentally caused by interventional procedure and to explore the problems faced in the event with emphasis on avoiding the reoccurance of similar events in the future.Methods The data were collected by consulting the patient's detailed medical history,collecting and analyzing clinical diagnosis and treatment data,tracking and observing their clinical manifestations and signs.The patient's peripheral blood samples were also collected,together with the biological dose estimated and the equipment data collected on the site of the interventional treatment hospital.Results The whole body dose to the patient was estimated to be 0.95 Gy.The typical values of kerma rate of radiation incident on the body surface due to fluoroscopic procedures were 373.5 mGy/min in subtraction modality and 47.8 mGy/min in fluoroscopy modality,respectively.The annual effective dose to the interventional radiologist was 20.51 mSv due to his operation in long-time radiation exposure conditions,higher than 3.09 mSv for other interventional radiologists with similar workload in the same department.The whole body and local clinical manifestations of the patients were in line with radiation injury.No clear diagnosis has been obtained in several hospitals,nor can obvious treatment outcomes be obsevered.Conclusion Combined with the biological dose estimation result and clinical manifestations,the case was diagnosed as degreeⅣskin radiation injury.Radiation injury is closely related to whether the operation is conducted according to the standard and the output dose of X-ray machine.Non-specialized hospitals should strengthen clinical diagnosis and treatment of radiation injury.