X线透视引导下常见疼痛手术的辐射暴露及防护

Radiation exposure and protection for standard procedures of pain management guided by X-ray fluoroscopy

目的:评价X线透视引导下常见疼痛手术的辐射暴露和防护策略。方法:选取中日友好医院疼痛科2021年1月至5月住院行X线透视引导下手术病人140例。从C形臂历史资料中获得病人术中X线透视数据,求得常见术式的平均透视次数和透视时间。用个人辐射剂量测试仪,分别在影像增强器位于床上方和床下方两种位置,以及距离床面20 cm、40 cm、60 cm时测量手术床面的剂量当量率评估病人所受电离辐射。另在距离C形臂1 m、2 m、3 m位置,测量铅板(铅板正中、铅板边缘、铅板外10 cm处)、铅衣、无防护时的剂量当量率评估术中医师所受电离辐射。结果:X线透视引导下疼痛微创介入手术平均辐射暴露均小于5μSv。影像增强器在上时剂量当量率20 cm>40 cm>60 cm(P<0.01),影像增强器在下结果与之相同(P<0.01)。影像增强器在上时的剂量当量率明显低于在下时(P<0.01)。影像增强器在上,距离C形臂1 m时无防护和铅板外10 cm的剂量当量率明显高于铅衣、铅板边缘和铅板中央(P<0.01);在距离C形臂2 m时亦然,但剂量当量率显著下降(P<0.01);在距离C形臂3 m时,各防护方式的剂量当量率均接近背景辐射。影像增强器在下时情况类似。结论:中日医院X线透视引导下疼痛微创介入手术平均辐射剂量小于5μSv,提示操作者应提高手术效率,减少透视次数并利用距离、铅衣、铅板等做好防护。

Objective:To evaluate radiation exposure and protection strategies for common pain procedures guided by X-ray.Methods:One hundred and forty patients underwent X-ray-guided pain procedures from January to May 2021 in the Department of Pain Medicine of China-Japan Friendship Hospital were selected.Intraoperative X-ray fluoroscopy data of all the patients were obtained from the C-arm history data to get the average number of fluoroscopies and fluoroscopy time for common pain procedures.Using a personal radiation dose tester,the dose equivalent rate was measured at the surgical bed with the image intensifier in both above-bed and under-bed positions and at the distance of 20 cm,40 cm,and 60 cm from the bed.The patient’s exposure to ionizing radiation is assessed in this way.The dose equivalent rates were also measured at 1 m,2 m,and 3 m from the C-arm,when the lead glass(right in the middle of the lead glass,at the edge of the lead glass,and 10 cm outside the lead glass),lead suits or unprotected was applied.This is used to assess the surgeon’s exposure to ionizing radiation during surgery.Results:The average radiation exposure for X-ray-guided pain procedures was less than 5μSv.The dose equivalent rate was 20 cm>40 cm>60 cm when the image intensifier was above-bed(P<0.01)and the same for the image intensifier below-bed(P<0.01).The dose equivalent rate was significantly lower when the image intensifier was above-bed than under-bed(P<0.01).With the image intensifier was above-bed,the dose equivalent rates were significantly higher for unprotected and 10 cm outside the lead glass at 1 m from the C-arm than for the lead suits,the edge of the lead glass,and the center of the lead glass(P<0.01);the same was true at 2 m from the C-arm,but the dose equivalent rates were significantly decreased(P<0.01);at 3 m from the C-arm,the dose equivalent rates for all protection methods were similar to the background radiation.The situation was similar when the image intensifier was under-bed.Conclusion:The average radiation dose of X-ray-guided pain surgery at China-Japan Friendship Hospital was less than 5μSv.Operators should improve the efficiency of the procedure,reduce the number of fluoroscopies and use distance from C-arm,lead glass,and lead suits for protection from radiation.