Zöller G, Konstanz V, Brönner J, Hödlmoser H
Klinik für Urologie und Kinderurologie, Klinikum Bad Hersfeld, Seilerweg 29, 36251, Bad Hersfeld, Deutschland.
Auswertungsstelle, Helmholtz Zentrum München, Otto-Hahn-Ring 6, 81739, München, Deutschland.
Urologe A. 2020 Oct;59(10):1231-1236. doi: 10.1007/s00120-020-01208-7.
Eye lens radiation exposure during fluoroscopy-guided interventional procedures may result in occupational radiation-induced cataracts. We evaluated the eye lens radiation doses and the protective effect of X‑ray protective visors during ureteroscopic procedures.
Eye lens doses were measured in front of and behind X‑ray protective visors using eye lens dosemeters during ureteroscopic procedures done by 4 different endourologic surgeons within a 12-week period. Background radiation dose, simultaneously measured with transport dosemeters, was subtracted. Measured eye lens doses below the detection limit of the eye lens dosemeters were adjusted to the detection limit of 0.028 mSv. Correlating the eye lens doses (ELD) to the dose-area-product (DAP) an ELD/DAP ratio was calculated. Applying this ELD/DAP ratio the potential reduction of the eye lens radiation dose was retrospectively calculated for all ureteroscopic procedures done within one year.
Within the 12-week period 76 ureteroscopies were done by the 4 endourologic surgeons. The accumulated eye lens radiation dose was 0.796 mSv in front of the X‑ray protective visors, and 0.338 mSv behind the X‑ray protective visors. Thus, the eye lens radiation exposure was reduced to at least 42% by using X‑ray protective visors. Considering the 215 documented ureteroscopies in our clinic in the year before starting the study, occupational radiation exposure to the eye lens would have been reduced by X‑ray protective visors from 4.090 to 1.737 mSv.
X‑ray protective visors can effectively reduce the radiation exposure to the eye lens during fluoroscopy-guided endourologic procedures and should be used especially by high-volume endourologic surgeons.
在荧光透视引导下的介入手术过程中，眼部晶状体受到辐射照射可能会导致职业性辐射性白内障。我们评估了输尿管镜检查过程中眼部晶状体的辐射剂量以及X射线防护面罩的防护效果。
在12周内，由4位不同的泌尿外科内镜医师进行输尿管镜检查时，使用眼部晶状体剂量仪在X射线防护面罩前后测量眼部晶状体剂量。减去同时用运输剂量仪测量的本底辐射剂量。将低于眼部晶状体剂量仪检测限的测量眼部晶状体剂量调整到0.028 mSv的检测限。将眼部晶状体剂量（ELD）与剂量面积乘积（DAP）相关联，计算出ELD/DAP比值。应用该ELD/DAP比值，回顾性计算了一年内所有输尿管镜检查中眼部晶状体辐射剂量的潜在降低情况。
在12周内，4位泌尿外科内镜医师共进行了76次输尿管镜检查。在X射线防护面罩前，累积眼部晶状体辐射剂量为0.796 mSv，在X射线防护面罩后为0.338 mSv。因此，使用X射线防护面罩可将眼部晶状体辐射暴露降低至少42%。考虑到在本研究开始前一年我们诊所记录的215次输尿管镜检查，使用X射线防护面罩可使眼部晶状体的职业辐射暴露从4.090 mSv降至1.737 mSv。
X射线防护面罩可有效降低荧光透视引导下泌尿外科内镜手术过程中眼部晶状体的辐射暴露，尤其是高手术量的泌尿外科内镜医师应使用。
