Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
JACC Cardiovasc Interv. 2012 Aug;5(8):866-73. doi: 10.1016/j.jcin.2012.05.003.
This paper investigates the effects of sustained practice and x-ray system technical changes on the radiation dose administered to adult patients during invasive cardiovascular procedures.
It is desirable to reduce radiation dose associated with medical imaging to minimize the risk of adverse radiation effects to both patients and staff. Several clinical practice and technical changes to elevate radiation awareness and reduce patient radiation dose were implemented under the guidance of a cardiovascular invasive labs radiation safety committee. Practice changes included: intraprocedure radiation dose announcements; reporting of procedures for which the air-kerma exceeded 6,000 mGy, including procedure air-kerma in the clinical report; and establishing compulsory radiation safety training for fellows. Technical changes included establishing standard x-ray imaging protocols, increased use of x-ray beam spectral filters, reducing the detector target dose for fluoroscopy and acquisition imaging, and reducing the fluoroscopy frame rate to 7.5 s(-1).
Patient- and procedure-specific cumulative skin dose was calculated from air-kerma values and evaluated retrospectively over a period of 3 years. Data were categorized to include all procedures, percutaneous coronary interventions, coronary angiography, noncardiac vascular angiography and interventions, and interventions to treat structural heart disease. Statistical analysis was based on a comparison of the cumulative skin dose for procedures performed during the first and last quarters of the 3-year study period.
A total of 18,115 procedures were performed by 27 staff cardiologists and 65 fellows-in-training. Considering all procedures, the mean cumulative skin dose decreased from 969 to 568 mGy (40% reduction) over 3 years.
This work demonstrates that a philosophy of radiation safety, implemented through a collection of sustained practice and x-ray system changes, can result in a significant decrease in the radiation dose administered to patients during invasive cardiovascular procedures.
本文旨在研究持续性实践和 X 射线系统技术变化对接受心血管介入治疗的成年患者所接受的辐射剂量的影响。
降低与医学成像相关的辐射剂量，以最大限度地降低患者和医护人员辐射不良影响的风险，这一点很有必要。在心血管介入实验室辐射安全委员会的指导下，实施了几项临床实践和技术改变，以提高辐射意识并降低患者的辐射剂量。实践中的改变包括：术中辐射剂量通报；报告空气比释动能超过 6000mGy 的程序，包括临床报告中的程序空气比释动能；为研究员强制进行辐射安全培训。技术上的改变包括建立标准的 X 射线成像协议，增加 X 射线束光谱滤波器的使用，降低透视和采集成像的探测器靶剂量，以及将透视帧率降低至 7.5s(-1)。
从空气比释动能值计算患者和程序特异性累积皮肤剂量，并在 3 年期间进行回顾性评估。数据分为所有程序、经皮冠状动脉介入治疗、冠状动脉造影、非心脏血管造影和介入治疗以及治疗结构性心脏病的介入治疗。统计分析基于对 3 年研究期间前两个和最后一个季度进行的程序累积皮肤剂量的比较。
共有 27 名工作人员心脏病专家和 65 名研究员完成了 18115 例程序。考虑所有程序，3 年内平均累积皮肤剂量从 969 减少到 568mGy（减少 40%）。
本研究表明，通过实施一系列持续的实践和 X 射线系统改变，建立辐射安全理念可以显著降低心血管介入治疗中患者所接受的辐射剂量。
