Stahl Cosette M, Meisinger Quinn C, Andre Michael P, Kinney Thomas B, Newton Isabel G
1 Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA 92161.
2 Department of Radiology, UC San Diego Medical Center, San Diego, CA.
AJR Am J Roentgenol. 2016 Oct;207(4):737-744. doi: 10.2214/AJR.16.16555.
Recent articles discussing cases of brain cancer in interventionalists have raised concerns regarding the hazards of occupational exposure to ionizing radiation. We review the basics of radiation dose and the potential radiation effects, particularly as they pertain to the operator. Then we present the data regarding the risk of each type of radiation effect to the fluoroscopy operator and staff, with special attention on cancer induction, radiation-induced cataracts, and the pregnant operator.
Although the evidence overwhelmingly shows that exposure to higher doses of radiation carries a risk of cancer and tissue reactions, the risks of chronic exposure to low-level radiation are less clear. Many studies examining occupational exposure to radiation fail to show an increased risk of stochastic effects of radiation, but the positive results raise concern that the studies are underpowered to consistently detect the small risk. The lack of information in these studies about radiation doses and adherence to radiation protection further confound their interpretation. Large prospective studies of populations with occupational exposure to low-level radiation might clarify this issue. More clearly established are the risks of radiation to the fetus and the risk of cataracts in interventional cardiologists and interventional radiologists. Interventionalists can mitigate these risks by following established radiation safety practices.
近期关于介入放射科医生患脑癌病例的文章引发了人们对职业性接触电离辐射危害的担忧。我们回顾辐射剂量的基础知识以及潜在的辐射效应，特别是与操作人员相关的效应。然后我们展示关于透视操作人员和工作人员发生各类辐射效应风险的数据，特别关注癌症诱发、辐射性白内障以及怀孕的操作人员。
尽管大量证据表明，接触高剂量辐射存在患癌风险和组织反应风险，但长期接触低水平辐射的风险尚不明确。许多研究职业性辐射接触的研究未能显示辐射随机效应风险增加，但阳性结果令人担忧这些研究的效能不足以持续检测到这种小风险。这些研究中缺乏关于辐射剂量和辐射防护依从性的信息，进一步混淆了对它们的解读。对职业性接触低水平辐射人群进行的大型前瞻性研究可能会阐明这个问题。辐射对胎儿的风险以及介入心脏病学家和介入放射科医生患白内障的风险则更为明确。介入放射科医生可通过遵循既定的辐射安全规范来降低这些风险。
