Moore J D, Shim D, Sweet J, Arheart K L, Beekman R H
Division of Cardiology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Catheter Cardiovasc Interv. 1999 Aug;47(4):449-54. doi: 10.1002/(SICI)1522-726X(199908)47:4<449::AID-CCD13>3.0.CO;2-H.
The risks of excessive exposure to ionizing radiation are well described and measures are routinely taken to limit such exposure to both patient and personnel in the catheterization laboratory. Coll occlusion of the patent ductus arteriosus (PDA) as well as other more complex pediatric interventions has raised concern regarding radiation exposure, particularly as minimally invasive surgical techniques are being developed which lack such exposure risk. In eight consecutive patients, aged 0.7-7 years (median, 2.3 years), coil occlusion of a PDA was performed and surface entrance radiation dose determined by thermoluminescent dosimetry (TD). Total cumulative doses (PA + lateral dose) were also calculated for each patient. Entrance and cumulative dose was likewise measured in 12 patients undergoing standard diagnostic catheterization (DC) and in 5 consecutive patients undergoing pulmonary balloon valvuloplasty (PBV). The groups were comparable in age, weight, and body surface area (BSA). Total cumulative dose in the PDA patients was 97 +/- 25 mGy (mean +/- SE). There was no significant difference between the three groups in entrance dose absorbed at each location or in total cumulative dose. The mean total fluoroscopy time in the PDA occlusion group was significantly less than that of the PBV group (10.1 +/- 1.81 min vs. 19.3 +/- 2.29 min, P < 0.05) but was comparable to the DC group (13.2 +/- 1.5 min, P = NS). When the subjects were analyzed collectively, no correlation between fluoroscopy time and measured entrance dose was observed. The strongest correlates of total cumulative dose were patient weight (r = 0.67, P < 0.001) and BSA (r = 0.62, P = 0.001). Patients undergoing coil occlusion of a PDA are not exposed to increased radiation entrance dose compared to those undergoing standard DC and PBV. Furthermore, surface entrance radiation dose as determined by TD varies according to patient size for a given fluoroscopy time.
过度暴露于电离辐射的风险已得到充分描述，并且在导管实验室中通常会采取措施限制患者和工作人员受到此类辐射。动脉导管未闭（PDA）的线圈封堵以及其他更复杂的儿科介入操作引发了对辐射暴露的关注，尤其是随着缺乏此类暴露风险的微创手术技术的发展。在连续8例年龄为0.7 - 7岁（中位数为2.3岁）的患者中，进行了PDA的线圈封堵，并通过热释光剂量测定法（TD）确定表面入射辐射剂量。还计算了每位患者的总累积剂量（PA + 侧位剂量）。同样对12例接受标准诊断性心导管检查（DC）的患者和5例连续接受肺动脉球囊瓣膜成形术（PBV）的患者测量了入射剂量和累积剂量。这些组在年龄、体重和体表面积（BSA）方面具有可比性。PDA患者的总累积剂量为97±25 mGy（平均值±标准误）。三组在每个位置吸收的入射剂量或总累积剂量方面无显著差异。PDA封堵组的平均总透视时间明显少于PBV组（10.1±1.81分钟对19.3±2.29分钟，P < 0.05），但与DC组相当（13.2±1.5分钟，P = 无显著性差异）。当对受试者进行综合分析时，未观察到透视时间与测量的入射剂量之间存在相关性。总累积剂量的最强相关因素是患者体重（r = 0.67，P < 0.001）和BSA（r = 0.62，P = 0.001）。与接受标准DC和PBV的患者相比，接受PDA线圈封堵的患者并未受到更高的辐射入射剂量。此外，对于给定的透视时间，通过TD确定的表面入射辐射剂量会根据患者体型而变化。
