Tsapaki Virginia, Ahmed Nada A, AlSuwaidi Jamila Salem, Beganovic Adnan, Benider Abdelkader, BenOmrane Latifa, Borisova Rada, Economides Sotirios, El-Nachef Leila, Faj Dario, Hovhannesyan Ashot, Kharita Mohammad Hassan, Khelassi-Toutaoui Nadia, Manatrakul Nisakorn, Mirsaidov Ilkhom, Shaaban Mohamed, Ursulean Ion, Wambani Jeska Sidika, Zaman Areesha, Ziliukas Julius, Zontar Dejan, Rehani Madan M
Konstantopoulio Hospital, Attiki, Greece.
AJR Am J Roentgenol. 2009 Aug;193(2):559-69. doi: 10.2214/AJR.08.2115.
The purpose of our study was to investigate the level of radiation protection of patients and staff during interventional procedures in 20 countries of Africa, Asia, and Europe.
In a multinational prospective study, information on radiation protection tools, peak skin dose (PSD), and kerma-area product (KAP) was provided by 55 hospitals in 20 mainly developing countries (nine mostly in Eastern Europe, five in Africa, and six in Asia).
Nearly 40% of the interventional rooms had an annual workload of more than 2,000 patients. It is remarkable that the workload of pediatric interventional procedures can reach the levels of adult procedures even in developing countries. About 30% of participating countries have shown a 100% increase in workload in 3 years. Lead aprons are used in all participating rooms. Even though KAP was available in almost half of the facilities, none had experience in its use. One hundred of 505 patients monitored for PSD (20%) were above the 2-Gy threshold for deterministic effects.
Interventional procedures are increasing in developing countries, not only for adults but also for pediatric patients. The situation with respect to staff protection is considered generally acceptable, but this is not the case for patient protection. Many patients exceeded the dose threshold for erythema. A substantial number (62%) of percutaneous transluminal coronary angioplasty procedures performed in developing countries in this study are above the currently known dose reference level and thus could be optimized. Therefore, this study has significance in introducing the concept of patient dose estimation and dose management.
我们研究的目的是调查非洲、亚洲和欧洲20个国家介入手术过程中患者和工作人员的辐射防护水平。
在一项多国前瞻性研究中，20个主要发展中国家（9个大多在东欧、5个在非洲、6个在亚洲）的55家医院提供了有关辐射防护工具、皮肤峰值剂量（PSD）和比释动能面积乘积（KAP）的信息。
近40%的介入手术室年工作量超过2000例患者。值得注意的是，即使在发展中国家，儿科介入手术的工作量也能达到成人手术的水平。约30%的参与国在3年内工作量增长了100%。所有参与的手术室都使用了铅围裙。尽管近一半的机构有KAP数据，但没有一家有使用经验。在监测PSD的505例患者中，有100例（20%）超过了确定性效应的2戈瑞阈值。
在发展中国家，介入手术不仅在成人中增加，在儿科患者中也在增加。工作人员的防护情况总体上被认为是可以接受的，但患者防护并非如此。许多患者超过了红斑剂量阈值。本研究中发展中国家进行的大量经皮冠状动脉腔内血管成形术（62%）高于目前已知的剂量参考水平，因此可以进行优化。因此，本研究在引入患者剂量估算和剂量管理概念方面具有重要意义。
