放射防护反馈模拟器培训对提高住院医师放射防护能力及介入操作技能的效果:一项随机对照试验

Integrating radiation protection feedback into simulation-based training increase the ability of radiation protection and vascular intervention for residents: preliminary results from a randomized controlled study

目的 探讨血管介入模拟器Mentice在住院医师放射防护培训中的作用。方法 纳入在佛山市第一人民医院培训的2019级至2021级住院医师24名,随机分成观察组(n=12)及对照组(n=12)。所有志愿者均根据标准的血管介入操作流程重复case 203操作10次,观察组操作过程给予Mentice放射防护参数反馈及教师实时放射防护、介入操作反馈,对照组操作过程只给予介入操作反馈。结果 观察组放射防护技能评分、造影剂剂量、DSA时间、皮肤辐射剂量峰值(患者)、相对点空气比释动能(患者)、空气比释动能-面积乘积(患者)、眼睛辐射剂量(操作者)、甲状腺辐射剂量(操作者)、性腺辐射剂量(操作者)均显著低于对照组(均P<0.05),而造影时间无显著差异(P>0.05)。经过10次的Mentice模拟器培训,住院医师的血管介入技能评分、总操作时间、操作错误次数均显著改善(均P<0.05);观察组和对照组的血管介入技能评分、操作错误次数均无显著差异(均P>0.05),但观察组的总操作时间显著高于对照组(P<0.05)。结论 运用Mentice放射安全模块结合实时的放射防护反馈可更有效提高住院医师的放射防护技能,减少操作者及患者的器官辐射剂量,且不影响血管介入技能的改善。

Objective To explore the effect of simulation-based training on decreasing radiation exposure for residents. Methods A total of 24 residents at Grade 2019, 2020 and 2021 in Foshan First People’s Hospital were randomized into experiment group(n=12) and control group(n=12). Each participant completed case 203 in Mentice VIST for 10 times. Those in experiment group would be given feedback on vascular intervention, radiation protection index recorded in Mentice and by the teacher, while those in control group would receive only feedback on vascular intervention. Results The score of radiation protection skill, contrast used, total DSA time, Peak Skin Dose(Patient),Reference Point Air Kerma(Patient), Kerma Area Product(Patient), Eye Dose(Operator), Thyroid Dose(Operator),Gonad Dose(Operator), Number of handling errors were significantly improved in experiment group(P<0.05),while total fluoroscope time showed no significant difference(P>0.05). Through 10-time Mentice-based training on vascular intervention, the score of vascular intervention skill, total handling errors and total time were all improved(all P<0.05);the score of vascular intervention skill and total handling errors of the residents in experiment group were similar(all P>0.05), while total time in experiment group was significantly longer than that in control group(P<0.05).Conclusion Mentice VIST radiation protection module combined with teachers’ feedback on radiation protection can effectively improve the radiation protection skills and reduce organ-specific exposure dose for patients and operators, without affecting the improvement of vascular intervention skill.