Jaco John W, Miller Donald L
Department of Radiology, National Capital Consortium, Washington, DC, USA.
Tech Vasc Interv Radiol. 2010 Sep;13(3):188-93. doi: 10.1053/j.tvir.2010.03.009.
The principal problem in measuring patient radiation dose during fluoroscopically guided procedures is that dose is not administered uniformly throughout the patient's body. Four dose metrics have been developed to quantify patient radiation dose for fluoroscopically guided procedures: fluoroscopy time, peak skin dose, reference dose, and kerma-area-product. Each metric must be understood to be used appropriately. Fluoroscopy time correlates poorly with other dose metrics. It should not be used as the sole method to estimate, monitor, or record patient radiation dose unless no alternative is available. Kerma-area-product is a good metric for estimating stochastic risk. Reference dose is a conservative method to estimate peak skin dose and deterministic risk and is recommended for this purpose. Every fluoroscope sold in the USA since mid 2006 is able to measure, display, and record reference dose. Radiation dose should be monitored during fluoroscopically guided procedures, either by the operator or by a designated individual in the procedure room, such as a technologist or nurse. Patient radiation dose should be recorded appropriately in the medical record. Patients who have received a sufficiently large radiation dose should have follow-up at 10-14 days and at 1 month after the procedure for possible deterministic effects.
在透视引导操作过程中测量患者辐射剂量的主要问题是，剂量并非均匀地施加于患者全身。已开发出四种剂量指标来量化透视引导操作中的患者辐射剂量：透视时间、皮肤峰值剂量、参考剂量和比释动能面积乘积。必须理解每种指标以便正确使用。透视时间与其他剂量指标的相关性较差。除非没有其他选择，否则不应将其用作估计、监测或记录患者辐射剂量的唯一方法。比释动能面积乘积是估计随机风险的良好指标。参考剂量是估计皮肤峰值剂量和确定性风险的保守方法，为此推荐使用该指标。自2006年年中以来在美国销售的每台荧光透视仪都能够测量、显示和记录参考剂量。在透视引导操作过程中，应由操作人员或操作室内指定人员（如技术人员或护士）监测辐射剂量。患者辐射剂量应妥善记录在病历中。接受了足够大辐射剂量的患者应在操作后第10 - 14天和1个月进行随访，以检查是否可能出现确定性效应。
