Kuon E, Weitmann K, Hummel A, Dörr M, Reffelmann T, Riad A, Busch M C, Felix S B, Hoffmann W, Empen K
Department of Cardiology, Klinik Fraenkische Schweiz, Feuersteinstr. 2, 91320, Ebermannstadt, Germany,
Herz. 2015 May;40 Suppl 3:233-9. doi: 10.1007/s00059-013-4015-8. Epub 2013 Dec 8.
The radiation risk of patients undergoing invasive cardiology remains considerable and includes skin injuries and cancer. To date, submillisievert coronary angiography has not been considered feasible.
In 2011, we compared results from 100 consecutive patients undergoing elective coronary angiography using the latest-generation flat-panel angiography system (FPS) with results from examinations by the same operator using 106 historic controls with a conventional image-intensifier system (IIS) that was new in 2002.
The median patient exposure parameters were measured as follows: dose-area product (DAP) associated with radiographic cine acquisitions (DAP(R)) and fluoroscopy (DAP(F)) scenes, radiographic frames and runs, and cumulative exposure times for radiography and fluoroscopy. On the FPS as compared to the traditional IIS, radiographic detector entrance dose levels were reduced from 164 to 80 nGy/frame and pulse rates were lowered from 12.5/s to 7.5/s during radiography and from 25/s to 4/s during fluoroscopy. The cardiologist's performance patterns remained comparable over the years: fluoroscopy time was constant and radiography time even slightly increased. Overall patient DAP decreased from 7.0 to 2.4 Gy × cm(2); DAP(R), from 4.2 to 1.7 Gy × cm(2); and DAP(F), from 2.8 to 0.6 Gy × cm(2). Time-adjusted DAP(R)/s decreased from 436 to 130 mGy × cm(2) and DAP(F)/s, from 21.6 to 4.4 mGy × cm(2). Cumulative patient skin dose with the FPS amounted to 67 mGy, and the median (interquartile range) of effective dose was 0.5 (0.3 … 0.7) mSv.
Consistent application of radiation-reducing techniques with the latest-generation flat-panel systems enables submillisievert coronary angiography in invasive cardiology.
接受侵入性心脏病学检查的患者面临的辐射风险仍然很大，包括皮肤损伤和癌症。迄今为止，亚毫西弗冠脉造影尚未被认为是可行的。
2011年，我们将连续100例接受选择性冠脉造影的患者使用最新一代平板血管造影系统（FPS）的检查结果，与同一位操作者使用2002年新款传统影像增强器系统（IIS）对106例历史对照患者进行检查的结果进行了比较。
测量了患者的中位暴露参数如下：与射线电影采集（DAP(R)）和透视（DAP(F)）场景、射线帧数和运行次数以及射线摄影和透视的累积暴露时间相关的剂量面积乘积（DAP）。与传统的IIS相比，在FPS上，射线探测器入口剂量水平在射线摄影期间从164 nGy/帧降至80 nGy/帧，脉冲率从12.5次/秒降至7.5次/秒，在透视期间从25次/秒降至4次/秒。多年来心脏病专家的操作模式保持可比：透视时间不变，射线摄影时间甚至略有增加。患者的总体DAP从7.0降至2.4 Gy×cm²；DAP(R)从4.2降至1.7 Gy×cm²；DAP(F)从2.8降至0.6 Gy×cm²。时间调整后的DAP(R)/秒从436降至130 mGy×cm²，DAP(F)/秒从21.6降至4.4 mGy×cm²。使用FPS时患者的累积皮肤剂量为67 mGy，有效剂量的中位数（四分位间距）为0.5（0.3…0.7）mSv。
在侵入性心脏病学中，对最新一代平板系统持续应用减少辐射的技术可实现亚毫西弗冠脉造影。
