Department of Gastroenterology, Oncology and Diabetology, Theresienkrankenhaus and St. Hedwig Hospital, Academic Teaching Hospital of Heidelberg University, Bassermannstr.1, 68165, Mannheim, Germany.
Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
Eur Radiol. 2019 Jul;29(7):3390-3400. doi: 10.1007/s00330-019-06208-6. Epub 2019 Apr 23.
Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs.
A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs.
Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4-21,510 cGy·cm) and FTs (range 0.07-180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm) than those of follow-up PBIs (median 464 cGy·cm). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm) (p = 0.85). FT varied substantially (0.07-180.33 min).
DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm for initial PBIs and 1400 cGy·cm for follow-up PBIs are recommended.
• DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. • PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture. • DRLs of 4300 cGy·cmfor initial PBIs (establishing a transhepatic tract) and 1400 cGy·cmfor follow-up PBIs (transhepatic tract already established) are recommended.
经皮肝胆道介入（PBI）可能会使患者受到较高的辐射剂量，如果能牢记国家诊断参考水平（DRL），则可以降低这种剂量。本多中心研究旨在探讨不同经皮肝胆道介入术式中患者的辐射暴露情况，以便为制定国家 DRL 提供依据。
向 200 家高级护理医院发放了一份调查问卷，内容涉及超声或透视引导下胆管穿刺的不同 PBI 中的剂量面积乘积（DAP）和透视时间（FT）。推荐的国家 DRL 设定为所有 DAP 的第 75 个百分位数。
23 家机构（9 个介入放射科和 14 个胃肠科）返回了问卷（12%）。分析中纳入了 565 例 19 种不同介入术式的 PBI。DAP（范围 4-21510 cGy·cm）和 FT（范围 0.07-180.33 min）因中心和 PBI 类型的不同而有很大差异。初始 PBI 的 DAP（中位数 2162 cGy·cm）明显高于（p<0.0001）后续 PBI 的 DAP（中位数 464 cGy·cm）。超声引导胆管穿刺的初始 PBI 与透视引导胆管穿刺的初始 PBI 之间的 DAP 无显著差异（p=0.85）。FT 差异显著（0.07-180.33 min）。
经皮肝胆道介入术的 DAP 和 FT 因中心和 PBI 类型的不同而有很大差异。与透视引导胆管穿刺的 PBI 相比，超声引导胆管穿刺的 PBI 并未降低 DAP。推荐初始 PBI 的 DRL 为 4300 cGy·cm，后续 PBI 的 DRL 为 1400 cGy·cm。
经皮肝胆道介入术的 DAP 和 FT 因中心和 PBI 类型的不同而有很大差异。
与透视引导胆管穿刺的 PBI 相比，超声引导胆管穿刺的 PBI 并未降低 DAP。
推荐初始 PBI 的 DRL 为 4300 cGy·cm（建立经肝通道），后续 PBI 的 DRL 为 1400 cGy·cm（经肝通道已建立）。
