Aarsnes Anette, Dahle Gry, Fosse Erik, Rein Kjell Arne, Aaberge Lars, Martinsen Anne Catrine T
Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.
Department of Thoracic Surgery, Oslo University Hospital, Oslo, Norway.
Radiat Prot Dosimetry. 2018 Apr 1;179(1):9-17. doi: 10.1093/rpd/ncx184.
Occupational doses during fluoroscopy in interventional procedures vary largely (Kim et al. (Occupational radiation doses to operators performing cardiac catheterization procedures. Health Phys. 2008;94:211-227)). In transcatheter aortic valve implantation, the operators' positions and use of radiation shielding are particularly related to the entry choice on the patient's heart. This study evaluates how occupational doses depend on operator positioning during transfemoral and transaortal access. Occupational dosimetric readings were collected with electronic dosemeters on two cardiothoracic surgeons and one cardiologist during 31 procedures. The findings were significantly higher body doses and eye lens doses to the surgeons during transaortal access compared to transfemoral access. The median equivalent eye lens dose per procedure received by the cardiologists was 0.05-0.06 mSv; hence, the cardiologists should wear protective eye wear to prevent reaching the proposed annual dose limit of 20 mSv to the eye lens. Surgeons ought to use protective eye wear as well, and should only perform a restricted number of transcatheter aortic valve implantations with transaortal access annually.
介入手术中透视检查期间的职业剂量差异很大（Kim等人，《心脏导管插入术操作人员的职业辐射剂量。健康物理学》，2008年；94:211 - 227）。在经导管主动脉瓣植入术中，操作人员的位置和辐射防护的使用与在患者心脏上的入路选择特别相关。本研究评估了经股动脉和经主动脉入路期间职业剂量如何取决于操作人员的位置。在31例手术过程中，使用电子剂量计收集了两位心胸外科医生和一位心脏病专家的职业剂量读数。结果显示，与经股动脉入路相比，经主动脉入路期间外科医生的身体剂量和晶状体剂量显著更高。心脏病专家每次手术接受的等效晶状体剂量中位数为0.05 - 0.06毫希沃特；因此，心脏病专家应佩戴防护眼镜，以防止达到提议的晶状体年剂量限值20毫希沃特。外科医生也应使用防护眼镜，并且每年经主动脉入路进行经导管主动脉瓣植入术的次数应限制在一定数量以内。
