Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
AJR Am J Roentgenol. 2020 Aug;215(2):433-440. doi: 10.2214/AJR.19.22227. Epub 2020 Jun 6.
The purpose of this article was to investigate the medical condition of patients who received substantial cumulative effective dose (CED) in fluoroscopically guided interventional (FGI) procedures. We examined 25,253 patients (mean age, 58.2 years; 50.6% male) who underwent 46,491 FGI procedures at a tertiary care center in the United States from January 2010 to January 2019. Radiation dosage data were retrieved from an in-house semiautomated dose-tracking system. A cohort was identified as those who received a CED of 100 mSv or greater and was categorized by medical disorder from longitudinal medical records. Statistical software was used to determine mean value, five percentiles (10th, 25th, 50th, 75th, 95th), and interquartile range for age and dose. Among 1011 (4.0%) patients (30.4% female) with a CED of 100 mSv or more, the median number of procedures was 2.0, the median age at first procedure was 60.0 years old, and the median value of CED was 177.2 mSv. The patients' medical disorders included cancer (36.7%), chronic disease of the torso (30.0%), internal bleeding (24.8%), trauma (4.6%), organ transplant (3.2%) and cerebrovascular disease (0.7%). Eight-hundred (79.1%) patients underwent all of their procedures within 365 days. This is the first cohort study of the medical condition of patients receiving substantial cumulative doses from FGI procedures over a long period. In the critical care of patients with serious medical disorders, 4.0% of patients may be exposed to substantial radiation dose (CED ≥ 100 mSv). The risks associated with such a high level of radiation warrant continued attention.
本文旨在探讨在接受大量累积有效剂量（CED）的荧光透视引导介入（FGI）治疗的患者的医学状况。我们检查了 2010 年 1 月至 2019 年 1 月期间在美国一家三级保健中心接受 46491 次 FGI 治疗的 25253 名患者（平均年龄 58.2 岁；50.6%为男性）。从内部半自动剂量跟踪系统中检索了辐射剂量数据。通过纵向病历确定了一个队列，将那些接受 CED 剂量为 100 mSv 或更高的患者分类。统计软件用于确定年龄和剂量的平均值、五个百分位数（第 10、25、50、75 和 95 个百分位数）和四分位距。在 1011 名（4.0%）CED 剂量为 100 mSv 或更高的患者（30.4%为女性）中，中位数的治疗例数为 2.0 次，首次治疗时的中位年龄为 60.0 岁，CED 的中位数为 177.2 mSv。患者的医学疾病包括癌症（36.7%）、躯干慢性疾病（30.0%）、内出血（24.8%）、创伤（4.6%）、器官移植（3.2%）和脑血管疾病（0.7%）。800 名（79.1%）患者在 365 天内完成了所有治疗。这是第一项关于接受 FGI 治疗的患者在较长时间内接受大量累积剂量的医学状况的队列研究。在对患有严重医学疾病的患者的重症监护中，4.0%的患者可能会暴露于大量辐射剂量（CED≥100 mSv）。如此高剂量辐射相关的风险值得持续关注。
