McCarthy Colin J, Kilcoyne Aoife, Li Xinhua, Cahalane Alexis M, Liu Bob, Arellano Ronald S, Uppot Raul N, Gee Michael S
Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
Cardiovasc Intervent Radiol. 2018 Dec;41(12):1935-1942. doi: 10.1007/s00270-018-2066-1. Epub 2018 Aug 21.
To determine the radiation dose associated with CT-guided percutaneous liver ablations and identify potential risk factors that result in higher radiation doses.
Between June 2011 and June 2015, 245 consecutive patients underwent 304 CT-guided liver ablation treatments. Patient demographics, tumor characteristics and procedural parameters were identified and analyzed. The peak skin dose and effective dose were assessed for each procedure. Excess relative risk related to radiation effects was calculated. A logistic regression model was prepared by means of stepwise logistic regression to identify variables predictive of increased radiation exposure.
Tumor ablations were performed with microwave (n = 220), radiofrequency (n = 74) or irreversible electroporation (IRE) (n = 10). The mean peak skin dose for ablations was 239.2 ± 136.4 mGy, and the mean effective dose was 36.6 ± 22.3 mSv. Of the patient and procedural parameters that were analyzed, increasing weight, use of intravenous contrast and/or hydrodissection during the procedure, together with treatment of multiple lesions in the same sitting were all associated with higher radiation exposure. The mean increase in the absolute risk of fatal malignancy from a single procedure was 0.18% (range 0.02-0.9%). No deterministic skin changes were identified in the patient cohort.
The overall risk of stochastic and deterministic effects from radiation associated with CT-guided ablations is low compared with other inherent procedural complications. This study identifies several factors that are associated with higher radiation dose in percutaneous liver ablation procedures.
确定CT引导下经皮肝消融术相关的辐射剂量，并识别导致较高辐射剂量的潜在风险因素。
2011年6月至2015年6月期间，245例连续患者接受了304次CT引导下的肝消融治疗。确定并分析患者的人口统计学特征、肿瘤特征和手术参数。评估每次手术的皮肤峰值剂量和有效剂量。计算与辐射效应相关的超额相对风险。通过逐步逻辑回归建立逻辑回归模型，以识别预测辐射暴露增加的变量。
采用微波（n = 220）、射频（n = 74）或不可逆电穿孔（IRE）（n = 10）进行肿瘤消融。消融的平均皮肤峰值剂量为239.2±136.4 mGy，平均有效剂量为36.6±22.3 mSv。在分析的患者和手术参数中，体重增加、术中使用静脉造影剂和/或水分离术以及在同一次手术中治疗多个病灶均与较高的辐射暴露相关。单次手术导致致命恶性肿瘤的绝对风险平均增加0.18%（范围为0.02 - 0.9%）。在患者队列中未发现确定性的皮肤变化。
与其他固有的手术并发症相比，CT引导下消融术相关辐射的随机和确定性效应的总体风险较低。本研究确定了经皮肝消融术中与较高辐射剂量相关的几个因素。
