Department of Interventional Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, China.
Department of Radiology, Shanghai Jiaotong University, Shanghai Chest Hospital, Shanghai, China.
Diagn Interv Radiol. 2022 Jul;28(4):376-382. doi: 10.5152/dir.2022.211327.
PURPOSE This study aimed to compare the radiation dose received by the operator among different patients' positions via transradial access (TRA) or transfemoral access (TFA) during transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS A total of 120 patients with HCC undergoing TACE for the first time between January and November 2019 were randomized into 4 groups with 30 patients in each group. In group A, patients were placed in the foot-first position with the left upper arm abducted, and TACE was performed via the left radial artery. In group B, patients were placed in the conventional headfirst position with the left hand placed at the left groin, and TACE was performed via the left radial artery. In group C, patients were placed in the conventional head-first position, and TACE was performed via the right radial artery. In group D, patients were placed in the conventional head-first position, and TACE was performed via the right femoral artery. Before each procedure, thermoluminescent dosimeters were taped at 7 different body parts of the operator and the radiation dose was measured and collected after the procedure. The normalized radiation dose was also calculated. Procedural parameters included radiation dose, fluoroscopy time (FT), dose-area product (DAP), and air kerma (AK) were recorded. Patients' demographics, tumor baseline characteristics, radiation dose, and procedural parameters were compared between groups. RESULTS No significant differences were found in patients' demographics, tumor baseline characteristics, as well as in total FT, DAP, and AK. However, significant differences were found in the total radiation dose received by the operator and the doses on the pelvic cavity and the right wrist (P < .05). In group C, the radiation doses received on the pelvic cavity, the right wrist, and the total radiation doses were relatively higher. Significant differences were also found in the normalized radiation doses received by the operator on the thyroid, chest, left wrist, right wrist, and pelvic cavity, and the total normalized doses (all P < .05). Similarly, the radiation doses received by the operator at the aforementioned parts in group C were higher, while those in group A were lower. CONCLUSION No statistically significant differences were observed in the FT, DAP, and AK in TACE via TRA when patients were placed in different positions. However, TACE via the left TRA, with patients in the feet-first position, reduced the radiation dose received by the operator, thereby reducing the radiation risk.
目的 本研究旨在比较经桡动脉入路（TRA）和经股动脉入路（TFA）行肝动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）时，不同患者体位下术者接受的辐射剂量。
方法 2019 年 1 月至 11 月期间，120 例首次接受 TACE 治疗的 HCC 患者被随机分为 4 组，每组 30 例。在 A 组中，患者取足先位，左上臂外展，经左侧桡动脉行 TACE。在 B 组中，患者取常规头先位，左手置于左腹股沟，经左侧桡动脉行 TACE。在 C 组中，患者取常规头先位，经右侧桡动脉行 TACE。在 D 组中，患者取常规头先位，经右侧股动脉行 TACE。在每次操作前，将热释光剂量计贴在术者身体的 7 个不同部位，并在操作后测量和收集辐射剂量。还计算了归一化辐射剂量。记录了手术过程中的参数，包括辐射剂量、透视时间（FT）、剂量面积乘积（DAP）和空气比释动能（AK）。比较了各组患者的一般资料、肿瘤基线特征、辐射剂量和手术过程参数。
结果 各组患者的一般资料、肿瘤基线特征、总 FT、DAP 和 AK 差异均无统计学意义。但术者总辐射剂量和盆腔、右腕部辐射剂量差异有统计学意义（P <.05）。在 C 组中，盆腔、右腕部和术者总辐射剂量相对较高。术者甲状腺、胸部、左腕部、右腕部和盆腔的归一化辐射剂量以及总归一化剂量差异也有统计学意义（均 P <.05）。同样，C 组术者上述部位接受的辐射剂量较高，而 A 组较低。
结论 经桡动脉入路行 TACE 时，患者体位不同，FT、DAP 和 AK 差异无统计学意义。然而，采用左 TRA，患者取足先位，可降低术者接受的辐射剂量，从而降低辐射风险。
