Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Tex.
Division of Medical Physics, Department of Radiology, UT Southwestern Medical Center, Dallas, Tex.
J Vasc Surg. 2018 Aug;68(2):567-571. doi: 10.1016/j.jvs.2017.12.054. Epub 2018 Mar 12.
Radiation to the interventionalist's brain during fluoroscopically guided interventions (FGIs) may increase the incidence of cerebral neoplasms. Lead equivalent surgical caps claim to reduce radiation brain doses by 50% to 95%. We sought to determine the efficacy of the RADPAD (Worldwide Innovations & Technologies, Lenexa, Kan) No Brainer surgical cap (0.06 mm lead equivalent at 90 kVp) in reducing radiation dose to the surgeon's and trainee's head during FGIs and to a phantom to determine relative brain dose reductions.
Optically stimulated, luminescent nanoDot detectors (Landauer, Glenwood, Ill) inside and outside of the cap at the left temporal position were used to measure cap attenuation during FGIs. To check relative brain doses, nanoDot detectors were placed in 15 positions within an anthropomorphic head phantom (ATOM model 701; CIRS, Norfolk, Va). The phantom was positioned to represent a primary operator performing femoral access. Fluorography was performed on a plastic scatter phantom at 80 kVp for an exposure of 5 Gy reference air kerma with or without the hat. For each brain location, the percentage dose reduction with the hat was calculated. Means and standard errors were calculated using a pooled linear mixed model with repeated measurements. Anatomically similar locations were combined into five groups: upper brain, upper skull, midbrain, eyes, and left temporal position.
This was a prospective, single-center study that included 29 endovascular aortic aneurysm procedures. The average procedure reference air kerma was 2.6 Gy. The hat attenuation at the temporal position for the attending physician and fellow was 60% ± 20% and 33% ± 36%, respectively. The equivalent phantom measurements demonstrated an attenuation of 71% ± 2.0% (P < .0001). In the interior phantom locations, attenuation was statistically significant for the skull (6% ± 1.4%) and upper brain (7.2% ± 1.0%; P < .0001) but not for the middle brain (1.4% ± 1.0%; P = .15) or the eyes (-1.5% ± 1.4%; P = .28).
The No Brainer surgical cap attenuates direct X rays at the superficial temporal location; however, the majority of radiation to an interventionalist's brain originates from scatter radiation from angles not shadowed by the cap as demonstrated by the trivial percentage brain dose reductions measured in the phantom. Radiation protective caps have minimal clinical relevance.
在荧光透视引导介入治疗（FGI）过程中，辐射可能会增加脑肿瘤的发病率。铅当量手术帽声称可以将辐射脑剂量降低 50%至 95%。我们旨在确定 RADPAD（全球创新与技术公司，堪萨斯州莱尼纳）无脑力手术帽（90 kVp 时为 0.06 毫米铅当量）在降低外科医生和学员在 FGI 过程中头部辐射剂量方面的功效，并确定相对脑剂量降低情况。
在左颞部位置的帽内和帽外使用光激励、发光纳米点探测器（Landauer，格伦伍德，伊利诺伊州）测量 FGI 过程中的帽衰减。为了检查相对脑剂量，在仿人头体模（ATOM 模型 701；CIRS，弗吉尼亚州诺福克）的 15 个位置放置纳米点探测器。将体模定位为代表进行股动脉入路的主要操作人员。在 80 kVp 下对塑料散射体模进行透视摄影，以 5 Gy 参考空气比释动能进行曝光，有或没有帽子。对于每个脑区位置，计算戴帽子时的剂量减少百分比。使用具有重复测量的组合线性混合模型计算平均值和标准误差。将解剖相似的位置组合成五个组：大脑上部、上部颅骨、中脑、眼睛和左颞部位置。
这是一项前瞻性、单中心研究，共纳入 29 例腹主动脉瘤介入治疗。平均手术参考空气比释动能为 2.6 Gy。主刀医生和学员颞部的帽子衰减率分别为 60%±20%和 33%±36%。等效体模测量显示衰减率为 71%±2.0%（P<0.0001）。在体模内部位置，颅骨（6%±1.4%）和大脑上部（7.2%±1.0%；P<0.0001）的衰减具有统计学意义，但中脑（1.4%±1.0%；P=0.15）或眼睛（-1.5%±1.4%；P=0.28）的衰减则没有统计学意义。
无脑力手术帽可衰减颞部的直接 X 射线；然而，介入医生大脑的大部分辐射来自于帽阴影以外的散射辐射，这一点可以从体模中测量到的微不足道的脑剂量降低百分比得到证明。辐射防护帽的临床相关性极小。
