1 Institute of Medical Physics, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany .
2 Department of Urology, Nuremberg General Hospital, Paracelsus Medical University , Nuremberg, Germany .
J Endourol. 2018 Oct;32(10):897-903. doi: 10.1089/end.2018.0324. Epub 2018 Jul 16.
Due to new radiobiologic data, the International Commission on Radiological Protection recommends a dose limit of 20 mSv per year to the eye lens. Therefore, the IAEA International Basic Safety Standard and the European council directive 2013/59/EURATOM require a reduction of the annual dose limit from 150 to 20 mSv. Urologists are exposed to an elevated radiation exposure in the head region during fluoroscopic interventions, due to the commonly used overtable X-ray tubes and the rarely used radiation protection for the head. Aim of the study was to analyze real radiation exposure to the eye lens of the urologist during various interventions, during which the patient is in the lithotomy position.
The partial body doses (forehead and apron collar) of the urologists and surgical staff were measured over a period of 2 months. 95 interventions were performed on Uroskop Omnia Max workplaces (Siemens Healthineers, Erlangen, Germany). Interventions were class-divided in less (stage I) and more complex (stage II) interventions. Two dosimeter-types were applied, well-calibrated electronic personal dosimeter Mk2 and self-calibrated thermoluminescent dosimeter-100H (both Thermo Fisher Scientific, Waltham, MA). The radiation exposure parameters were documented using the dose area product (DAP) and the fluoroscopy time.
The correlation between DAP and the apron dose of the urologist was in average 0.07 μSv per 1 μGym. The more experienced urologists yielded a mean DAP of 166 μGym for stage I and 415 μGym for stage II procedures. The interventionist was exposed with 10 μSv in mean outside the lead apron collar. The mean dose value of the eye lenses per intervention was ascertained to 20 μSv (mean DAP: 233 μGym).
The study setup allows a differentiated and time-resolved measurement of the radiation exposure, which was found heterogeneous depending on intervention and surgeon. In this setting, ∼1000 interventions can be performed until the annual eye lens dose limit is achieved.
由于新的放射生物学数据，国际放射防护委员会建议每年对晶状体的剂量限制为 20 毫希沃特。因此，国际原子能机构的国际基本安全标准和欧洲理事会指令 2013/59/EURATOM 要求将每年的剂量限制从 150 毫希沃特降低到 20 毫希沃特。泌尿科医生在进行透视介入时，由于常用的可移动 X 射线管和很少使用的头部辐射防护，头部区域会受到较高的辐射暴露。本研究的目的是分析泌尿科医生在各种介入过程中对晶状体的实际辐射暴露，在此期间，患者处于截石位。
在 2 个月的时间里，对泌尿科医生和手术人员的部分身体剂量（额头和围裙领）进行了测量。在 Uroskop Omnia Max 工作场所（西门子健康，德国埃朗根）进行了 95 次介入。介入分为较简单（阶段 I）和较复杂（阶段 II）。应用了两种剂量计类型，校准良好的电子个人剂量计 Mk2 和自校准的热释光剂量计-100H（均来自 Thermo Fisher Scientific，马萨诸塞州沃尔瑟姆）。使用剂量面积乘积（DAP）和透视时间记录辐射暴露参数。
DAP 与泌尿科医生围裙剂量的相关性平均为每 1 微希沃特 0.07 微希沃特。经验更丰富的泌尿科医生在阶段 I 中产生的平均 DAP 为 166 微希沃特，在阶段 II 中为 415 微希沃特。干预者在铅围裙领外平均暴露 10 微希沃特。每例介入的平均晶状体剂量值为 20 微希沃特（平均 DAP：233 微希沃特）。
该研究方案允许对辐射暴露进行差异化和时间分辨的测量，结果发现辐射暴露取决于介入和外科医生而异质。在此设置下，大约可以进行 1000 次介入，直到达到每年晶状体剂量限制。
