Crowhurst James A, Whitby Mark, Savage Michael, Murdoch Dale, Robinson Brendan, Shaw Elizabeth, Gaikwad Niranjan, Saireddy Ramkrishna, Hay Karen, Walters Darren L
Heart and Lung Program, The Prince Charles Hospital, Chermside, Queensland, Australia.
University of Queensland, St Lucia, Queensland, Australia.
J Med Radiat Sci. 2019 Mar;66(1):20-29. doi: 10.1002/jmrs.315. Epub 2018 Nov 28.
Diagnostic coronary angiography (CA) uses ionising radiation with relatively high doses, which impact on both patients and staff. This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA.
Patient and procedure related variables impacting on Kerma area product (P ) and operator dose (OD) were collected for 16 months. Procedures were separated into 10 different procedure categories. P was used for patient dose and OD was measured with an instantly downloadable dosimeter (IDD) - downloaded at the end of each procedure. High and low radiation dose was defined by binary variables based on the 75th percentile of the continuous measures. Univariate and multivariate regression were used to identify predictors.
Of 3860 patients included, the IDD was worn for 2591 (61.7%). Obesity (BMI > 30 compared to BMI < 25) was the strongest predictor for both a P (odds ratio (OR) = 19.1 (95% CI 13.5-26.9) P < 0.001) and OD (OR = 3.3 (2.4-4.4) P < 0.001) above the 75th percentile. Male gender, biplane imaging, the X-ray unit used, operator experience and procedure type also predicted a high P . Radial access, male gender, biplane imaging and procedure type also predicted a high OD.
Radiation dose during CA is multifactorial and is dependent on patient and procedure related variables. Many factors impact on both P and OD but obesity is the strongest predictor for both patients and operators to receive a high radiation dose.
诊断性冠状动脉造影（CA）使用具有相对高剂量的电离辐射，这对患者和工作人员都会产生影响。本研究旨在确定在冠状动脉造影期间，哪些患者和操作因素对患者和操作者剂量影响最大。
收集了16个月内影响比释动能面积乘积（P）和操作者剂量（OD）的患者及操作相关变量。操作被分为10种不同的操作类别。P用于衡量患者剂量，OD通过可即时下载的剂量计（IDD）进行测量——在每次操作结束时下载。根据连续测量值的第75百分位数，通过二元变量定义高辐射剂量和低辐射剂量。采用单因素和多因素回归来确定预测因素。
在纳入的3860例患者中，2591例（61.7%）佩戴了IDD。肥胖（BMI>30与BMI<25相比）是P高于第75百分位数（优势比（OR）=19.1（95%CI 13.5 - 26.9），P<0.001）和OD高于第75百分位数（OR = 3.3（2.4 - 4.4），P<0.001）的最强预测因素。男性、双平面成像、使用的X射线设备、操作者经验和操作类型也可预测高P。桡动脉穿刺、男性、双平面成像和操作类型也可预测高OD。
冠状动脉造影期间的辐射剂量是多因素的，并且取决于患者和操作相关变量。许多因素对P和OD都有影响，但肥胖是患者和操作者接受高辐射剂量的最强预测因素。
