Paisey J R, Yue A M, White A, Moss A, Morgan J M, Roberts P R
Wessex Cardiothoracic Centre, Southampton University Hospitals, UK.
Int J Cardiovasc Imaging. 2004 Aug;20(4):285-8. doi: 10.1023/b:caim.0000041943.73199.d3.
Ionising radiation is has the potential to cause harm both by increasing the probability future malignancy (stochastic mechanisms) and by direct physical injury (deterministic mechanisms). Several measures have been developed to quantify radiation exposure during a procedure and cardiologists usually refer to fluoroscopic screening time (FST). FST, however, has limitations for predicting deterministic injury which is directly dependant on peak skin dose (PSD). We compared FST to PSD for a range of interventional cardiac electrophysiology procedures.
All patients undergoing electrophysiology procedures during a 2-month period in our institution were studied. Demographic details, nature of procedure, FST and PSD were measured. The FST to PSD ratio was calculated and compared between patient and procedural factors.
67 procedures on patients (23 female) with body mass index (BMI) of 28 (SD 5) Kg/m2 were studied. Screening times ranged from 0.2 to 96.6 min (median 11.2). PSD ranged from <0.1 to 1108 mGy (median 141). There was a positive correlation between PSD to FST ratio and BMI (r = 0.59, p < 0.001). The PSD to FST ratio was higher in cardiac resynchronization therapy (CRT) devices than single or dual chamber ICDs (p = 0.002).
FST is not a reliable predictor of deterministic skin injury and in high-risk procedures such as CRT devices and those on individuals of high BMI PSD should be measured.
电离辐射有可能通过增加未来患恶性肿瘤的概率（随机机制）和直接的物理损伤（确定性机制）来造成危害。已经开发了几种措施来量化手术过程中的辐射暴露，心脏病专家通常参考荧光透视筛查时间（FST）。然而，FST在预测直接取决于皮肤峰值剂量（PSD）的确定性损伤方面存在局限性。我们比较了一系列心脏介入电生理手术中FST与PSD的关系。
对我们机构在2个月期间接受电生理手术的所有患者进行研究。测量人口统计学细节、手术性质、FST和PSD。计算FST与PSD的比值，并在患者和手术因素之间进行比较。
研究了67例体重指数（BMI）为28（标准差5）kg/m²的患者（23名女性）的手术。筛查时间从0.2分钟到96.6分钟不等（中位数为11.2）。PSD范围从<0.1到1108 mGy（中位数为141）。PSD与FST比值与BMI之间存在正相关（r = 0.59，p < 0.001）。心脏再同步治疗（CRT）设备的PSD与FST比值高于单腔或双腔植入式心脏除颤器（ICD）（p = 0.002）。
FST不是确定性皮肤损伤的可靠预测指标，在诸如CRT设备以及高BMI个体的高风险手术中，应测量PSD。
