介入放射学中高剂量辐射病例的监测和随访。
Monitoring and Follow-Up of High Radiation Dose Cases in Interventional Radiology.
机构信息
Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357987, Seattle, WA 98195.
Department of Radiology, Section of Interventional Radiology, University of Washington and Harborview Medical Center, Seattle, Washington.
出版信息
Acad Radiol. 2019 Feb;26(2):163-169. doi: 10.1016/j.acra.2018.04.020. Epub 2018 Jun 19.
RATIONALE AND OBJECTIVES
To assess the implementation of radiation dose monitoring software, create a process for clinical follow-up and documentation of high-dose cases, and quantify the number of patient reported radiation-induced tissue reactions in fluoroscopically guided interventional radiology (IR) and neuro-interventional radiology (NIR) procedures.
MATERIALS AND METHODS
Web-based radiation dose monitoring software was installed at our institution and a process to flag all procedures with reference point air kerma (K) > 5000 mGy was implemented. The entrance skin dose was estimated and formal reports generated, allowing for physician-initiated clinical follow-up. To evaluate our process, we reviewed all IR and NIR procedures performed at our hospital over a 1-year period. For all procedures with K > 5000 mGy, retrospective medical chart review was performed to evaluate for patient reported tissue reactions.
RESULTS
Three thousand five hundred eighty-two procedures were performed over the 1-year period. The software successfully transferred dose data on 3363 (93.9%) procedures. One thousand three hundred ninety-three (368 IR and 1025 NIR) procedures were further analyzed after excluding 2189 IR procedures with K < 2000 mGy. Ten of 368 (2.7%) IR and 52 of 1025 (5.1%) NIR procedures exceeded estimated skin doses of 5000 mGy. All 10 IR cases were abdominal/pelvic trauma angiograms with/without embolization; there were no reported tissue reactions. Of 52 NIR cases, 49 were interventions and 3 were diagnostic angiograms. Five of 49 (10.2%) NIR patients reported skin/hair injuries, all of which were temporary.
CONCLUSION
Software monitoring and documentation of radiation dose in interventional procedures can be successfully implemented. Radiation-induced tissue reactions are relatively uncommon.
背景与目的
评估辐射剂量监测软件的实施情况，制定高剂量病例的临床随访和记录流程，并量化荧光透视引导介入放射学（IR）和神经介入放射学（NIR）手术中患者报告的辐射诱导组织反应的数量。
材料与方法
在我院安装基于网络的辐射剂量监测软件，并实施了一个标记所有参考点空气比释动能（K）>5000mGy 的程序。估计入口皮肤剂量并生成正式报告，以便医生发起临床随访。为了评估我们的流程，我们回顾了我院在一年期间进行的所有 IR 和 NIR 手术。对于所有 K>5000mGy 的手术，我们进行了回顾性病历审查，以评估患者报告的组织反应。
结果
在一年期间进行了 3582 例手术。该软件成功传输了 3363 例（93.9%）手术的剂量数据。在排除了 2189 例 K<2000mGy 的 IR 手术后，进一步分析了 1393 例（368 例 IR 和 1025 例 NIR）手术。在 368 例（2.7%）IR 中，有 10 例和在 1025 例（5.1%）NIR 中，有 52 例手术的预估皮肤剂量超过 5000mGy。所有 10 例 IR 病例均为腹部/盆腔创伤血管造影术，有/无栓塞；无组织反应报告。在 52 例 NIR 病例中，49 例为介入治疗，3 例为诊断性血管造影术。49 例 NIR 患者中有 5 例（10.2%）报告皮肤/毛发损伤，均为暂时性的。
结论
在介入手术中，辐射剂量的软件监测和记录可以成功实施。辐射诱导的组织反应相对较少见。
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