Vascular Surgery Aortic Centre, Hôpital Cardiologique, CHRU Lille, France.
Vascular Radiology, Aortic Centre, Hôpital Cardiologique, CHRU Lille, France.
Eur J Vasc Endovasc Surg. 2015 Jul;50(1):21-36. doi: 10.1016/j.ejvs.2015.01.014. Epub 2015 Mar 25.
Endovascular procedures, requiring X-ray guidance, are commonly performed in vascular surgery. X-ray exposure is associated with biological risks for both patients and physicians. Medical X-ray use must follow "as low as reasonably achievable" (ALARA) principles, which aim at using the lowest radiation exposure to achieve a procedure safely. This is underlined by European and international recommendations that also suggest that adequate theoretical and practical training is mandatory during the initial education of physicians. However, the content of this education and professional practices vary widely from one country to another.
This review aims to summarize the basic knowledge required for vascular surgeons on X-ray physics and image production.
A panel of endovascular therapists (vascular surgeons and radiologists) and physicists dedicated to X-rays was gathered. International recommendations were summarized. A literature review was performed via MEDLINE to identify studies reporting dosages of common endovascular procedures.
The different mechanisms inducing biological risks, and the associated potential effects on health, are described. Details on dose metrics are provided and a common nomenclature to measure, estimate, and report dose is proposed in order to perform accurate comparisons between publications and practices. Key points of the European and international legislation regarding medical X-ray use are summarized, and radiation protection basics for patients and staff, are detailed. Finally, a literature review is proposed for physicians to evaluate their practice.
Today's trainees will be highly exposed to radiation throughout their practice. It is thus compulsory that they undergo dedicated radiation education during their initial training, and regular refresher sessions later. In daily practice, focus on dose reduction and monitoring of patient and staff exposure are mandatory.
血管内手术需要 X 射线引导，因此经常进行血管内手术。X 射线辐射对患者和医生都有生物风险。医疗 X 射线的使用必须遵循“尽可能低”（ALARA）原则，该原则旨在使用最低的辐射暴露来安全地进行手术。这一点得到了欧洲和国际建议的强调，这些建议还建议在医生的初始教育中必须进行足够的理论和实践培训。然而，这种教育的内容和专业实践在不同国家之间差异很大。
本综述旨在总结血管外科医生所需的 X 射线物理和图像制作基础知识。
召集了一组从事血管内治疗的治疗师（血管外科医生和放射科医生）和专门研究 X 射线的物理学家。总结了国际建议。通过 MEDLINE 进行文献综述，以确定报告常见血管内手术剂量的研究。
描述了引起生物风险的不同机制，以及对健康的潜在影响。提供了剂量指标的详细信息，并提出了一种通用的命名法来测量、估计和报告剂量，以便在出版物和实践之间进行准确的比较。总结了欧洲和国际关于医疗 X 射线使用的立法要点，并详细说明了患者和工作人员的辐射防护基础知识。最后，提出了一份文献综述，供医生评估他们的实践。
今天的受训者在整个实践过程中会受到大量辐射。因此，他们必须在初始培训期间接受专门的辐射教育，并在以后定期进行复习课程。在日常实践中，必须关注剂量减少和监测患者和工作人员的暴露。
