From the Departments of Radiology (B.L., J.A.H., X.L., R.M.S., M.M.R., J.D.R.) and Neurosurgery (J.D.R.), and the Biostatistics Center (H.Z.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
Radiology. 2019 Mar;290(3):744-749. doi: 10.1148/radiol.2019180799. Epub 2019 Jan 15.
Purpose To analyze the clinical effect of continuous dose monitoring and patient follow-up for fluoroscopically guided vascular interventional procedures over 8 years. Materials and Methods In this retrospective study, an in-house semiautomated system was developed for fluoroscopic dose monitoring. The quarterly number of procedures from January 2010 to December 2017 was analyzed with count time series to estimate quarterly change rate. Technologists recorded four dose surrogates in custom fields of institutional dictation software through a Web interface. Radiation doses were transferred automatically to the radiology report and a centralized dose database when the radiologist initiated procedure dictation. A medical physicist reported weekly on procedures with air kerma at the reference point (K) of 2 Gy or higher to a division-designated radiologist and hospital radiation safety committee who required the attending radiologist to set up follow-up appointments for patients who underwent procedures with a K greater than or equal to 5 Gy. Results There were a total of 41 585 procedures; 1553 (3.7%) procedures had a K of 2-5 Gy. Among 240 procedures with K greater than 5 Gy, 22 had K greater than 9 Gy. The percentage of high K procedures decreased over time, going from 5.9% in 2010 to 2.0% in 2017 for procedures with K of 2-5 Gy and from 1.0% in 2010 to 0.13% in 2017 for procedures with K greater than or equal to 5 Gy. Relative reduction per quarter was approximately 2.7% (95% confidence interval: 1.5%, 3.8%) for K of 2-5 Gy and 4.5% (95% confidence interval: 1.5%, 7.6%) for K greater than or equal to 5 Gy. Conclusion Eight-year temporal trends show three- to eightfold reduction in the number of high-dose procedures. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Balter in this issue.
目的 分析 8 年来连续剂量监测和患者随访对透视引导血管介入治疗的临床效果。
材料与方法 本回顾性研究开发了一种用于透视剂量监测的内部半自动系统。对 2010 年 1 月至 2017 年 12 月期间每季度的介入手术数量进行分析，采用计数时间序列估计季度变化率。技术员通过 Web 界面在机构口述软件的定制字段中记录 4 个剂量替代物。当放射科医生启动手术口述时，辐射剂量会自动传输到放射报告和集中剂量数据库。当患者的 K 值大于或等于 5 Gy 时，一位医学物理学家每周向一位指定给科室的放射科医生和医院放射安全委员会报告 K 值为 2 Gy 或更高的 K 值的手术，放射科医生需要为 K 值大于或等于 5 Gy 的患者设定随访预约。
结果 共进行了 41585 例手术；1553 例（3.7%）手术的 K 值为 2-5 Gy。在 240 例 K 值大于 5 Gy 的手术中，22 例 K 值大于 9 Gy。高 K 值手术的比例随时间逐渐降低，2010 年 K 值为 2-5 Gy 的手术中为 5.9%，2017 年为 2.0%，2010 年 K 值大于或等于 5 Gy 的手术中为 1.0%，2017 年为 0.13%。每季度的相对减少量约为 2.7%（95%置信区间：1.5%，3.8%），K 值为 2-5 Gy，4.5%（95%置信区间：1.5%，7.6%），K 值大于或等于 5 Gy。
结论 8 年的时间趋势显示，高剂量手术的数量减少了 3 到 8 倍。
版权所有 2019 年放射学会。在线补充材料可在本文中获得。也可参见本期巴尔特的社论。
