Department of Respiratory Medicine, Centre for Medical Research, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
Respir Care. 2010 Nov;55(11):1469-74.
Fluoroscopic guidance may be utilized in some bronchoscopic procedures, including ultrasound-guided bronchoscopy for investigation of peripheral pulmonary lesions. Some authors have suggested this procedure may be performed without fluoroscopy, to minimize risks due to radiation exposure. However, the radiation dose has never been quantified, so the risk remains unknown.
To determine the patient and clinician radiation exposure from fluoroscopy during bronchoscopy.
We recorded exposure parameters during 45 consecutive ultrasound bronchoscopies with fluoroscopic guidance with a mobile C-arm fluoroscopy system. We calculated the patient effective radiation dose with Monte Carlo computer simulations. Passive personal film dosimeters were placed on 4 sites on both the proceduralist and the primary nursing assistant.
The mean fluoroscopy screening time was 96 ± 55 s. Patients received a median effective radiation dose of 0.49 ± 0.37 milli-Sieverts (mSv) (range 0.16-1.3 mSv). Only the film dosimeters worn outside the clinicians' protective aprons recorded measurable radiation doses. Based on typical attenuation properties of the protective garments across the diagnostic x-ray energy range, we estimate that the effective radiation dose per procedure to the proceduralist was 0.4 micro-Sieverts (μSv) and to the assistant was 0.2 μSv.
Patients are exposed to relatively small amounts of radiation from fluoroscopy during bronchoscopy. Clinically indicated fluoroscopic guidance during bronchoscopy should not be precluded on the basis of radiation safety concerns. Adequate shielding of clinicians results in negligible radiation doses during ultrasound bronchoscopy.
荧光透视引导可用于某些支气管镜检查程序，包括超声引导下的支气管镜检查以探查外周肺部病变。一些作者建议可以在不使用荧光透视的情况下进行该程序，以最大程度地减少因辐射暴露而导致的风险。然而，辐射剂量从未被量化过，因此风险仍然未知。
确定支气管镜检查过程中荧光透视下患者和临床医生的辐射暴露。
我们使用移动 C 臂荧光透视系统记录了 45 例连续超声支气管镜检查过程中的曝光参数。我们使用蒙特卡罗计算机模拟计算了患者的有效辐射剂量。在程序医生和主要护理助理的 4 个部位放置了被动个人胶片剂量计。
荧光透视筛查时间的平均值为 96 ± 55 秒。患者接受的中位数有效辐射剂量为 0.49 ± 0.37 毫西弗（mSv）（范围 0.16-1.3 mSv）。只有程序医生未穿防护围裙的胶片剂量计记录到可测量的辐射剂量。根据防护服在诊断 X 射线能量范围内的典型衰减特性，我们估计每次程序对程序医生的有效辐射剂量为 0.4 微西弗（μSv），对助手的有效辐射剂量为 0.2 μSv。
患者在支气管镜检查过程中接受相对较小量的荧光透视辐射。在基于辐射安全考虑的情况下，不应因荧光透视引导而排除支气管镜检查的临床指征。对临床医生进行充分屏蔽可使超声支气管镜检查过程中的辐射剂量微不足道。
