Kardiologisch-Angiologische Praxis Herzzentrum Bremen, Bremen, Germany.
JACC Cardiovasc Interv. 2012 Apr;5(4):445-9. doi: 10.1016/j.jcin.2011.12.013.
This study sought to determine the efficacy of patient pelvic lead shielding for the reduction of operator radiation exposure during cardiac catheterization via the radial access in comparison with the femoral access.
Cardiac catheterization via the radial access is associated with significantly increased radiation dose to the patient and the operator. Improvements in radiation protection are needed to minimize this drawback. Pelvic lead shielding has the potential to reduce operator radiation dose.
We randomly assigned 210 patients undergoing elective coronary angiography by the same operator to a radial and femoral access with and without pelvic lead shielding of the patient. Operator radiation dose was measured by a radiation dosimeter attached to the outside breast pocket of the lead apron.
For radial access, operator dose decreased from 20.9 ± 13.8 μSv to 9.0 ± 5.4 μSv, p < 0.0001 with pelvic lead shielding. For femoral access, it decreased from 15.3 ± 10.4 μSv to 2.9 ± 2.7 μSv, p < 0.0001. Pelvic lead shielding significantly decreased the dose-area product-normalized operator dose (operator dose divided by the dose-area product) by the same amount for radial and femoral access (0.94 ± 0.28 to 0.39 ± 0.19 μSv × Gy(-1) × cm(-2) and 0.70 ± 0.26 to 0.16 ± 0.13 μSv × Gy(-1) × cm(-2), respectively).
Pelvic lead shielding is highly effective in reducing operator radiation exposure for radial as well as femoral procedures. However, despite its use, radial access remains associated with a higher operator radiation dose.
本研究旨在比较经桡动脉入路与股动脉入路行心导管检查时，患者盆腔铅屏蔽对降低术者辐射暴露的效果。
经桡动脉入路行心导管术会使患者和术者受到的辐射剂量显著增加。需要改进辐射防护措施来尽量减少这一缺点。盆腔铅屏蔽有可能降低术者的辐射剂量。
我们随机将 210 例行择期冠状动脉造影的患者分配到桡动脉入路和股动脉入路组，术中有和无患者盆腔铅屏蔽。术者辐射剂量用附在铅围裙外胸袋上的辐射剂量计测量。
对于桡动脉入路，使用盆腔铅屏蔽后术者剂量从 20.9 ± 13.8 μSv 降至 9.0 ± 5.4 μSv（p < 0.0001）。对于股动脉入路，术者剂量从 15.3 ± 10.4 μSv 降至 2.9 ± 2.7 μSv（p < 0.0001）。盆腔铅屏蔽使桡动脉和股动脉入路的剂量面积乘积归一化术者剂量（术者剂量除以剂量面积乘积）同等程度降低（0.94 ± 0.28 降至 0.39 ± 0.19 μSv × Gy(-1) × cm(-2)，0.70 ± 0.26 降至 0.16 ± 0.13 μSv × Gy(-1) × cm(-2)）。
盆腔铅屏蔽对于桡动脉和股动脉入路均能高度有效地降低术者的辐射暴露。然而，尽管使用了盆腔铅屏蔽，桡动脉入路仍与较高的术者辐射剂量相关。
