CAJ | 학술논문

目的采用胶片法对进行心血管介入手术中患者所受峰值皮肤剂量(PSD)进行测量研究,包括冠状动脉血管造影术(CA)和经皮穿刺腔内冠状动脉成形术(PTCA).方法选用Gafchromic XR-RV3胶片在两家医院进行患者峰值皮肤剂量的测量.手术时将胶片放在患者身下的诊视床上.记录手术中监视器上显示的kV、mA、透视时间、剂量面积乘积(DAP)、参考点累积剂量等相关信息.采用Epson V750平板扫描仪对胶片进行分析扫描及分析,选用FilmQA软件分别测量图像的红、绿、蓝三色通道的像素值,使用红通道数据计算患者的PSD.对PSD与设备显示参数进行相关分析,对相关的变量进行多元线性回归分析.结果共测量CA手术26例,CA+ PTCA手术19例.CA手术中,透视时间最高为17.62 min,累积剂量和DAP最大分别为1 498.50 mGy和109.68 Gy.cm2,PSD最大为361.20 mGy.CA+ PTCA手术中,曝光时间最长为64.48 min,累积剂量和DAP最大分别为6 976.20 mGy和5 336.00 Gy·cm2,17例患者的PSD在1 Gy以内,1例患者PSD在1 ～2 Gy之间,1例患者PSD超出了发生皮肤损伤2 Gy的阈值,达到了2 195.70 mGy.CA程序中,患者PSD与DAP相关(R2=0.815,P＜0.05),CA+ PTCA程序中,患者PSD与累积剂量相关(R2=0.916,P＜0.05).结论心脏介入放射学程序中部分患者的PSD会超出ICRP建议的发生皮肤确定性效应的2 Gy阈值.DSA设备上显示的剂量相关的参数,只能粗略估算患者PSD的大小.使用XR-RV3胶片精确测量介入手术中患者的峰值皮肤剂量是一种非常快捷、有效的方法.
목적 채용효편법대진행심혈관개입수술중환자소수봉치피부제량(PSD)진행측량연구,포괄관상동맥혈관조영술(CA)화경피천자강내관상동맥성형술(PTCA).방법 선용Gafchromic XR-RV3효편재량가의원진행환자봉치피부제량적측량.수술시장효편방재환자신하적진시상상.기록수술중감시기상현시적kV、mA、투시시간、제량면적승적(DAP)、삼고점루적제량등상관신식.채용Epson V750평판소묘의대효편진행분석소묘급분석,선용FilmQA연건분별측량도상적홍、록、람삼색통도적상소치,사용홍통도수거계산환자적PSD.대PSD여설비현시삼수진행상관분석,대상관적변량진행다원선성회귀분석.결과 공측량CA수술26례,CA+ PTCA수술19례.CA수술중,투시시간최고위17.62 min,루적제량화DAP최대분별위1 498.50 mGy화109.68 Gy.cm2,PSD최대위361.20 mGy.CA+ PTCA수술중,폭광시간최장위64.48 min,루적제량화DAP최대분별위6 976.20 mGy화5 336.00 Gy·cm2,17례환자적PSD재1 Gy이내,1례환자PSD재1 ～2 Gy지간,1례환자PSD초출료발생피부손상2 Gy적역치,체도료2 195.70 mGy.CA정서중,환자PSD여DAP상관(R2=0.815,P＜0.05),CA+ PTCA정서중,환자PSD여루적제량상관(R2=0.916,P＜0.05).결론 심장개입방사학정서중부분환자적PSD회초출ICRP건의적발생피부학정성효응적2 Gy역치.DSA설비상현시적제량상관적삼수,지능조략고산환자PSD적대소.사용XR-RV3효편정학측량개입수술중환자적봉치피부제량시일충비상쾌첩、유효적방법.
Objective To measure the peak skin dose (PSD) in two cardiovascular interventional procedures,including coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) using radiochromic film.Methods Gafchromic XR-RV3 film was selected to measure PSD in two hospitals.The films were placed on the table underneath the patient during interventional surgery.The kV,mA,fluoroscopy time,dose-area product (DAP),and cumulative dose at reference point and other relevant information were recorded for all cases.Using the Epson V750 flatbed scanner for scanning and analyzing film,FilmQA software was chosen to analyze the pixel value of red,green and blue color channels.The PSD was determined using red channel data.The correlation and linear regression analysis between PSD and device-displayed parameters was carried out.Results PSD were measured using XR-RV3 film for 26 CA and 19 CA + PTCA procedures.For CA procedures,maximum fluoroscopy time,cumulative dose and DAP were 17.62 min,1 498.50 mGy and 109.68 Gy · cm2,respectively.The maximum PSD was 361.20 mGy.However,for CA + PTCA procedures,maximum fluoroscopy time,cumulative dose and DAP were 64.48 min,6 976.20 mGy and 5 336.00 Gy· cm2,respectively.One patient with CA + PTCA procedures was found to have received the PSD value more than 2 Gy,up to 2 195.70 mGy.DAP was found to be a good indicator (R2 =0.815,P ＜0.05) of PSD for CA procedure,and correlated with cumulative dose (R2 =0.916,P ＜ 0.05) for CA + PTCA procedures.Conclusions The PSD value of some patients in cardiac interventional procedures would exceed 2 Gy,the threshold of deterministic effects recommended by ICRP.The dose-related parameters value showed on DSA device can only used to estimate PSD roughly.Using XR-RV3 film accurate measurement of the PSD in interventional projects is a very fast and effective method.