Musallam Anees, Volis Ina, Dadaev Svetlana, Abergel Eitan, Soni Amit, Yalonetsky Sergey, Kerner Arthur, Roguin Ariel
Department of Cardiology, Rambam Medical Center, Haifa, Israel.
Technion, Faculty of Medicine, Haifa, Israel.
Catheter Cardiovasc Interv. 2015 Jun;85(7):1164-70. doi: 10.1002/ccd.25777. Epub 2015 Feb 3.
To determine the efficacy of a 0.5-mm lead apron across the patient's abdomen in addition to standard operator protection for the reduction of scatter radiation on operator and patient radiation exposure
Cardiac angiography using the radial access compared to the femoral approach is associated with reduced complication rate and improved patient comfort but has significantly increased radiation dose. Improvements in radiation protection are needed
We randomly assigned 332 patients undergoing coronary angiography to a group with pelvic lead shielding and a group with standard protection. In each procedure, eight digital dosimeters were used to measure operator radiation dose [under the lead apron, outside the thyroid shield, and at the left side of the head], patient dose at the level of the umbilicus [above and beneath the lead apron], and two on the acrylic shielding and one on the image receptor to measure scattered radiation
Both groups were similar in BMI, procedures performed, and number of sequences. Usage of lead shielding statistically significantly reduced the radiation dose of the operator at all three sites measured: under lead apron [all in µSv]: 0.53 ± 1.4 vs. 0.17 ± 0.6, on thyroid collar 5.9 ± 7.7 vs. 2.9 ± 3.4, and left side of head 3.3 ± 3.4 vs. 2.1 ± 2.2, P<0.001. However the radiation to the patient was doubled from 15.4 ± 24.1 to 28.9 ± 81.1, P=0.04 CONCLUSIONS: The use of a pelvic lead shield during radial angiography reduced the operator radiation exposure at multiple measurement sites. However there was an increased exposure to the patient. This balance should be further investigated before the widespread adoption of this method. .
确定除标准的操作者防护外，在患者腹部使用0.5毫米铅围裙对减少操作者散射辐射及患者辐射暴露的效果。
与经股动脉途径相比，经桡动脉途径进行心脏血管造影术并发症发生率更低，患者舒适度更高，但辐射剂量显著增加。因此需要改进辐射防护措施。
我们将332例行冠状动脉造影术的患者随机分为盆腔铅屏蔽组和标准防护组。在每次操作中，使用八个数字剂量仪测量操作者的辐射剂量[在铅围裙下、甲状腺防护装置外和头部左侧]、脐水平处患者的剂量[铅围裙上方和下方]，以及在丙烯酸屏蔽装置上的两个剂量仪和图像接收器上的一个剂量仪测量散射辐射。
两组患者的体重指数、所进行的操作及序列数量相似。使用铅屏蔽在所有三个测量部位均显著降低了操作者的辐射剂量：铅围裙下[单位均为微希沃特]：0.53±1.4 vs. 0.17±0.6，甲状腺防护装置处5.9±7.7 vs. 2.9±3.4，头部左侧3.3±3.4 vs. 2.1±2.2，P<0.001。然而，患者所受辐射从15.4±24.1增加到28.9±81.1，增加了一倍，P=0.04。结论：桡动脉血管造影术中使用盆腔铅屏蔽可降低多个测量部位操作者的辐射暴露。然而，患者的辐射暴露增加。在广泛采用此方法之前，应进一步研究这种利弊平衡。
