The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.
Catheter Cardiovasc Interv. 2011 Jul 1;78(1):136-42. doi: 10.1002/ccd.23008.
Increasingly complex structural/congenital cardiac interventions require efforts at reducing patient/staff radiation exposure. Standard follow-up protocols are often inadequate in detecting all patients that may have sustained radiation burns.
Single-center retrospective chart review divided into four intervals. Phase 1 (07/07-06/08, 413 procedures (proc)): follow-up based on fluoroscopy time only; frame rate for digital acquisition (DA) 30 fps, and fluoroscopy (FL) 30 fps. Dose-based follow-up was used for phase 2-4. Phase 2 (07/08-08/09, 458 proc): DA: 30 fps, FL: 15 fps. Phase 3 (09/09-06/10, 350 proc): DA: 15-30 fps, FL: 15 fps, use of added radiation protection drape. Phase 4 (07/10-10/10, 89 proc): DA: 15-30 fps, FL: 15 fps, superior noise reduction filter (SNRF) with high-quality fluoro-record capabilities.
There was a significant reduction in the median cumulative air kerma between the four study periods (710 mGy vs. 566 mGy vs. 498 mGy vs. 241 mGy, P < 0.001), even though the overall fluoroscopy times remained very similar (25 min vs. 26 min vs. 26 min vs. 23 min, P = 0.957). There was a trend towards lower physician radiation exposure over the four study periods (137 mrem vs. 126 mrem vs. 108 mrem vs. 59 mrem, P = 0.15). Fifteen patients with radiation burns were identified during the study period. When changing to a dose-based follow-up protocol (phase 1 vs. phase 2), there was a significant increase in the incidence of detected radiation burns (0.5% vs. 2%, P = 0.04).
Dose-based follow-up protocols are superior in detecting radiation burns when compared to fluoroscopy time-based protocols. Frame rate reduction of fluoroscopy and cine acquisition and use of modified imaging equipment can achieve a significant reduction to patient/staff exposure.
日益复杂的结构性/先天性心脏介入治疗需要努力降低患者/医务人员的辐射暴露。标准的随访方案通常不足以发现所有可能遭受辐射灼伤的患者。
单中心回顾性图表审查分为四个阶段。第 1 阶段（2007 年 7 月 7 日至 2008 年 6 月 8 日，413 例手术）：仅根据透视时间进行随访；数字采集帧率为 30 fps，透视帧率为 30 fps。第 2-4 阶段采用剂量为基础的随访。第 2 阶段（2008 年 7 月 8 日至 2009 年 8 月 9 日，458 例手术）：数字采集帧率 30 fps，透视帧率 15 fps。第 3 阶段（2009 年 9 月 9 日至 2010 年 6 月 10 日，350 例手术）：数字采集帧率 15-30 fps，透视帧率 15 fps，使用附加的辐射防护罩。第 4 阶段（2010 年 7 月 10 日至 10 月 10 日，89 例手术）：数字采集帧率 15-30 fps，透视帧率 15 fps，采用具有高质量荧光记录功能的高级降噪滤波器（SNRF）。
尽管总透视时间非常相似（25 分钟对 26 分钟对 26 分钟对 23 分钟，P = 0.957），但四个研究期间的中位数累积空气比释动能显著降低（710 mGy 对 566 mGy 对 498 mGy 对 241 mGy，P < 0.001）。四个研究期间，医生的辐射暴露呈下降趋势（137 mrem 对 126 mrem 对 108 mrem 对 59 mrem，P = 0.15）。在研究期间发现了 15 例辐射灼伤患者。当从基于透视时间的方案改为基于剂量的随访方案（第 1 阶段与第 2 阶段）时，发现辐射灼伤的发生率显著增加（0.5% 对 2%，P = 0.04）。
与基于透视时间的方案相比，基于剂量的随访方案在检测辐射灼伤方面更具优势。降低透视和电影采集的帧率，并使用改良的成像设备，可以显著降低患者/医务人员的辐射暴露。
