冠脉介入诊疗术中不同投照角度对术者辐射剂量的影响

The influence of different projection angles on the radiation dose of the operators during coronary interventional diagnosis and treatment

目的探讨冠脉介入诊疗术中不同投照角度对术者辐射剂量的影响。方法模拟冠脉介入诊疗术中常规操作,对标准体模进行造影曝光,采集8种投照角度下第一术者和第二术者各左手腕处和左脚踝处的辐射剂量,每处测量点重复采集5次。使用配对t检验、独立样本t检验对两名术者在8种投照角度下每处测量点辐射剂量差异进行分析。结果第一术者脚踝处辐射剂量与第二术者脚踝处辐射剂量在大部分投照角度下的差异均有统计学意义(t=-97.91~-3.94,P<0.05),且第二术者脚踝处辐射剂量大于第一术者脚踝处辐射剂量;第一术者脚踝处和第二术者脚踝处在RAO投照角度与LAO投照角度下辐射剂量差异均有统计学意义(t=-29.5、-36.88,P<0.05),且LAO投照角度脚踝处辐射剂量要大于RAO投照角度。所有投照角度下,第一术者和第二术者在手腕处辐射剂量和脚踝处辐射剂量差异均有统计学意义(t=19.17~149.33,P<0.05)、(t=27.95~207.95,P<0.05),且手腕处辐射剂量要大于脚踝处辐射剂量。结论冠脉介入诊疗中术者脚踝部辐射剂量和手腕处剂量受投照角度、站位和防护器材等因素的影响,下肢防护器具铅帘应该得到改善,以适应第二术者站位和不同投照角度的辐射防护需求,上肢辐射防护器具应该参考下肢防护器具材质和模式,以减少术者的暴露剂量。

Objective To investigate the relationship between the different projection angles and the radiation dose of the operators during coronary interventional diagnosis and treatment.Methods The routine operation of coronary interventional diagnosis and treatment was simulated,the standard phantom was subjected to contrast exposure,and the radiation doses on the left wrist and left ankle of both the first operator and the second operator were separately determined at 8 different projection angles.The radiation dose acquisition was repeated five times for each measurement point.By using paired t-test and independent t-test,the differences in the radiation dose received at each measurement point at 8 projection angles between the two surgeons were analyzed。Results The radiation doses at the ankle of the first operator and the ankle of the second operator were significantly different at most projection angles(t=-97.91 to-3.94,P<0.05),and the radiation dose at the ankle of the second operator was greater than that of the first operator.At RAO projection angle and LAO projection angle the radiation doses at the ankle of the first operator and the second operator were significantly different(t=-29.5,t=-36.88,P<0.05),and the radiation dose at the ankle in LAO projection angle was greater than that in RAO projection angle.Under all projection angles,significant differences in radiation dose at the wrist and the ankle existed between the first and second operators(t=19.17 to 149.33,P<0.05,and t=27.95 to 207.95,P<0.05 respectively),and the radiation dose at the wrist was greater than that at the ankle.Conclusion The radiation dose at the ankle and the wrist of the operators during coronary interventional diagnosis and treatment are affected by several factors including projection angle,position and protective equipment.The lead curtain of the lower limb protective device should be improved so as to be suitable for radiation protection needs for the second operator’s standing position and different projection angles.The products of upper limb radiation protection equipment should refer to the material and pattern of the lower limb radiation protection equipment so as to reduce the exposure dose of the operators.