Staniszewska M A, Jankowski J
Zakładu Ochrony Radiologicznej, Instytutu Medycyny Pracy im. prof. dra med. Jerzego Nofera w Łodzi.
Med Pr. 2000;51(6):563-71.
Intervention radiology, known also as intravascular surgery, is a new medical specialisation that develops very rapidly. Radiological procedures performed under fluoroscopy include: dilatation of stenosed vessels, recanalization or vascular embolization and angioanastomosis. Although these procedures have been initiated by radiologists, the majority of them are performed now by physicians who are specialised in medical disciplines other than radiology (cardiologists, vascular surgeons, gastroenterologists, etc.). All these specialists are always aware of the fact that during radiological procedures, both the personnel and the patients are at risk of ionizing radiation. For that reason monitoring of the exposure in this occupational group is of particular importance. Bearing in mind that members of surgical teams are often in direct contact with x-ray tube, it is assumed that routine individual dosimetry of staff occupationally exposed to x-rays do not provide adequate assessment of the exposure risk. This paper describes measurements carried out among operating surgeons who perform the following procedures: cardiological interventions (percutaneous transluminal coronary angioplasty (PTCA) and bypass with preceding coronarography); neuroradiology (aneurysm embolization); and intravascular surgery within abdominal cavity (TIPS, nephrostomy). Dosimetric assessment was carried out in operating surgeons who are exposed mostly among the members of surgical teams as they have to be in direct contact with radiation sources. A comprehensive assessment of exposure included the following measurements: equivalent dose for the hands (measured by a specially designed finger dosimeter); equivalent dose for the trunk protected by a lead apron (a dosimeter placed under apron); and equivalent dose for the neck (a dosimeter placed on the upper, external edge of apron). In addition, a dose product and the surface of primary beam were measured (Diamentor dosimeter, PTW, Frieburg) which allowed to define the correlation between the entrance air kerma, measured with thermoluminscence dosimeters, and the amount of primary radiation emitted during the monitored procedure. In all, the surgical teams were monitored during 42 intervention procedures. The results of the study revealed that an operating surgeon is most exposed. The values of an annual effective dose and an annual equivalent dose for the hands and eyes, estimated for individual procedures, were as follows: (a) cardiological angioplastic procedures: effective dose--25 mSv, equivalent dose for the hands--438 mSv, equivalent dose for the eyes--265 mSv; (b) intravascular angioplastic procedures within the abdominal cavity and neuroradiological procedures: effective dose--4 mSv, equivalent dose for the hands--360 mSv, equivalent dose for the eyes--41 mSv. It should be stressed that the aforesaid maximum doses do not exceed relevant standard annual limits binding in Poland.
介入放射学，也被称为血管内手术，是一门发展非常迅速的新兴医学专业。在荧光透视下进行的放射学操作包括：狭窄血管的扩张、血管再通或血管栓塞以及血管吻合术。尽管这些操作最初是由放射科医生发起的，但现在大多数操作是由放射学以外其他医学专业的医生（心脏病专家、血管外科医生、胃肠病学家等）进行的。所有这些专家都始终清楚，在放射学操作过程中，工作人员和患者都面临电离辐射风险。因此，对这个职业群体的辐射暴露进行监测尤为重要。考虑到手术团队成员经常直接接触X射线管，人们认为对职业性接触X射线的工作人员进行常规个人剂量测定并不能充分评估辐射暴露风险。本文描述了对进行以下操作的外科手术医生所做的测量：心脏介入手术（经皮腔内冠状动脉成形术（PTCA）及冠状动脉造影后的搭桥手术）；神经放射学（动脉瘤栓塞）；以及腹腔内血管手术（经颈静脉肝内门体分流术、肾造瘘术）。剂量学评估是在手术外科医生中进行的，他们在手术团队成员中受辐射暴露最多，因为他们必须直接接触辐射源。辐射暴露的综合评估包括以下测量：手部的当量剂量（用专门设计的手指剂量计测量）；用铅围裙防护的躯干的当量剂量（在围裙下放置一个剂量计）；以及颈部的当量剂量（在围裙上部外缘放置一个剂量计）。此外，还测量了剂量乘积和原射线表面（Diamentor剂量计，PTW，弗赖堡），这使得能够确定用热释光剂量计测量的入射空气比释动能与监测过程中发出的原辐射量之间的相关性。总共对42例介入手术过程中的手术团队进行了监测。研究结果表明，手术外科医生受辐射暴露最多。针对各个手术估算的手部和眼睛的年有效剂量和年当量剂量值如下：（a）心脏血管成形手术：有效剂量——25毫希沃特，手部当量剂量——438毫希沃特，眼睛当量剂量——265毫希沃特；（b）腹腔内血管成形手术和神经放射学手术：有效剂量——4毫希沃特，手部当量剂量——360毫希沃特，眼睛当量剂量——41毫希沃特。应当强调的是，上述最大剂量未超过波兰现行的相关年度标准限值。
