Shorrock Deborah, Christopoulos Georgios, Wosik Jedrek, Kotsia Anna, Rangan Bavana, Abdullah Shuaib, Cipher Daisha, Banerjee Subhash, Brilakis Emmanouil S
VA North Texas Health Care System, Cardiology, 4500 South Lancaster Road, Dallas, TX 75216 USA.
J Invasive Cardiol. 2015 Jul;27(7):313-6.
Daily radiation exposure over many years can adversely impact the health of medical professionals.
Operator radiation exposure was recorded for 124 percutaneous coronary interventions (PCIs) performed at our institution between August 2011 and May 2013: 69 were chronic total occlusion (CTO)-PCIs and 55 were non-CTO PCIs. A disposable radiation protection sterile drape (Radpad; Worldwide Innovations & Technologies, Inc) was used in all CTO-PCI cases vs none of the non-CTO PCI cases. Operator radiation exposure was compared between CTO and non-CTO PCIs.
Mean age was 64.6 ± 6.2 years and 99.2% of the patients were men. Compared with non-CTO PCI, patients undergoing CTO-PCI were more likely to have congestive heart failure, to be current smokers, and to have longer lesions, and less likely to have prior PCI and a saphenous vein graft target lesion. CTO-PCI cases had longer procedural time (median: 123 minutes [IQR, 85-192 minutes] vs 27 minutes [IQR, 20-44 minutes]; P<.001), fluoroscopy time (35 minutes [IQR, 19-54 minutes] vs 8 minutes [IQR, 5-16 minutes]; P<.001), number of stents placed (2.4 ± 1.5 vs 1.7 ± 0.9; P<.001), and patient air kerma radiation exposure (3.92 Gray [IQR, 2.48-5.86 Gray] vs 1.22 Gray [IQR, 0.74-1.90 Gray]; P<.001), as well as dose area product (267 Gray•cm² [IQR, 163-4.25 Gray•cm²] vs 84 Gray•cm² [IQR, 48-138 Gray•cm²]; P<.001). In spite of higher patient radiation exposure, operator radiation exposure was similar between the two groups (20 μSv [IQR, 9.5-31 μSv] vs 15 μSv [IQR, 7-23 μSv]; P=.07).
Operator radiation exposure during CTO-PCI can be reduced to levels similar to less complicated cases with the use of a disposable sterile radiation protection shield.
多年来每日的辐射暴露会对医学专业人员的健康产生不利影响。
记录了2011年8月至2013年5月在本机构进行的124例经皮冠状动脉介入治疗（PCI）中术者的辐射暴露情况：69例为慢性完全闭塞（CTO）-PCI，55例为非CTO-PCI。所有CTO-PCI病例均使用了一次性辐射防护无菌巾（Radpad；全球创新技术公司），而非CTO-PCI病例均未使用。比较了CTO-PCI和非CTO-PCI之间术者的辐射暴露情况。
平均年龄为64.6±6.2岁，99.2%的患者为男性。与非CTO-PCI相比，接受CTO-PCI的患者更易发生充血性心力衰竭、为当前吸烟者且病变更长，而既往有PCI和大隐静脉桥血管靶病变的可能性更小。CTO-PCI病例的手术时间更长（中位数：123分钟[四分位间距，85 - 192分钟] vs 27分钟[四分位间距，20 - 44分钟]；P<0.001）、透视时间更长（35分钟[四分位间距，19 - 54分钟] vs 8分钟[四分位间距，5 - 16分钟]；P<0.001）、置入支架数量更多（2.4±1.5 vs 1.7±0.9；P<0.001）、患者空气比释动能辐射暴露更高（3.92戈瑞[四分位间距，2.48 - 5.86戈瑞] vs 1.22戈瑞[四分位间距，0.74 - 1.90戈瑞]；P<0.001）以及剂量面积乘积更高（267戈瑞•平方厘米[四分位间距，163 - 425戈瑞•平方厘米] vs 84戈瑞•平方厘米[四分位间距，48 - 138戈瑞•平方厘米]；P<0.001）。尽管患者辐射暴露更高，但两组术者的辐射暴露相似（20微希沃特[四分位间距，9.5 - 31微希沃特] vs 15微希沃特[四分位间距，7 - 23微希沃特]；P = 0.07）。
使用一次性无菌辐射防护屏蔽可将CTO-PCI期间术者的辐射暴露降低至与较简单病例相似的水平。
