血管腔内治疗患者在数字减影血管造影中所受辐射剂量分析

Radiation dose in digital subtraction angiography for patients undergoing endovascular treatment

目的:统计血管腔内治疗患者在数字减影血管造影(DSA)中所接受的辐射剂量及影响辐射的相关因素,分析各部位接受辐射剂量的差别,为辐射防护提供参考依据。方法:收集200例受检者的全部辐射剂量值及其与剂量相关的技术参数值,按照疾病名称B型主动脉夹层、腹主动脉瘤、颈动脉狭窄、髂动脉狭窄和下肢动脉硬化闭塞症(ASO)进行分类。统计出每例受检者辐射总剂量、透视辐射剂量、DSA造影辐射剂量、射线照射总时间、透视照射时间和DSA造影时间;分别计算出相应的透视辐射剂量、造影辐射剂量与时间的比值;分别提取主动脉夹层和下肢ASO剂量DSA造影剂量报告各1例。结果:总累积辐射剂量,由高至低依次为主动脉夹层、颈动脉狭窄、腹主动脉瘤、髂动脉狭窄和下肢ASO。最高的是主动脉夹层,人均皮肤入射剂量值,为680.2 mGy,最低的是下肢ASO,为208.6 mGy。人均射线照射的时间由高至低依次为下肢ASO、颈动脉狭窄、髂动脉狭窄、腹主动脉瘤和主动脉夹层,其中最低的人均照射时间为主动脉夹层(337.8 s),下肢ASO最高,为935.4 s。辐射总剂量中的大部分是由DSA造影产生的,其中颈动脉狭窄的占比最高,占比约81.6%。单位时间DSA造影辐射剂量主动脉夹层最高,为11.24 mGy/s,下肢ASO最低,为1.38 mGy/s。照射部位体厚的增加和电子放大的使用成倍增加患者接受的辐射剂量。结论:DSA中各部位所接受的辐射剂量,胸部相对较高,其次为腹部和头颈部,外周部位最低;DSA减影所产生的辐射剂量占辐射总剂量中的绝大部分。

Objective To analyze the radiation dose received by patients treated with endovascular surgery during digital subtraction angiography(DSA),investigate the related factors affecting radiation dose,and compare the difference of radiation dose received by different sites,so as to provide reference for radiation protection.Methods All the radiation doses and dose-related technical parameters of 200 patients were collected and classified according to different diseases,namely type B aortic dissection,abdominal aortic aneurysm,carotid artery stenosis,iliac artery stenosis,and lower extremity arteriosclerosis obliterans(ASO).The total radiation dose,fluoroscopy radiation dose,DSA radiation dose,total radiation exposure time,fluoroscopy exposure time,and DSA time were collected from each patient.The fluoroscopy radiation dose per unit time and contrast radiation dose per unit time were calculated.The DSA dose reports of 1 case of aortic dissection and 1 case of lower extremity ASO were analyzed.Results The total cumulative radiation dose was highest in aortic dissection(entrance skin dose per capita of 680.2 mGy),followed by carotid artery stenosis,abdominal aortic aneurysm,iliac artery stenosis,and lowest in lower extremity ASO(entrance skin dose per capita of 208.6 mGy).The exposure time per capita from high to low was lower extremity ASO,carotid artery stenosis,iliac artery stenosis,abdominal aortic aneurysm,and aortic dissection;and the shortest exposure time per capita was 337.8 s in aortic dissection,and the longest was 935.4 s in lower extremity ASO.The majority of the total radiation dose was generated by DSA,among which the proportion in carotid artery stenosis(about 81.6%)was highest.The DSA radiation dose per unit time was highest in aortic dissection(11.24 mGy/s)and lowest in lower extremity ASO(1.38 mGy/s).An increase in the thickness of the irradiated site and the use of electronic amplification multiply the radiation dose received by the patient.Conclusion The radiation dose received by the chest was the highest,followed by the abdomen,head and neck,and the lowest is in the peripheral region.The radiation dose of DSA subtraction accounted for the majority of the total radiation dose.