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胃肠内镜检查的职业辐射剂量,特别强调内镜逆行胰胆管造影术中晶状体的剂量。

Occupational radiation dose from gastrointestinal endoscopy procedures with special emphasis on eye lens doses in endoscopic retrograde cholangiopancreatography.

作者信息

Kaasalainen Touko, Pekkarinen Antti, Kylänpää Leena, Rainio Mia, Tenca Andrea, Jokelainen Kalle, Barner-Rasmussen Nina, Puustinen Lauri, Udd Marianne, Lindström Outi

机构信息

HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, Finland.

Radiation and Nuclear Safety Authority - STUK, Helsinki, Finland.

出版信息

Endosc Int Open. 2023 Mar 8;11(3):E237-E246. doi: 10.1055/a-2022-2663. eCollection 2023 Mar.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) procedures may result in remarkable radiation doses to patients and staff. The aim of this prospective study was to determine occupational exposures in gastrointestinal endoscopy procedures, with a special emphasis on eye lens dose in ERCP. Altogether 604 fluoroscopy-guided procedures, of which 560 were ERCPs belonging to four American Society for Gastrointestinal Endoscopy procedural complexity levels, were performed using two fluoroscopy systems. Personal deep-dose equivalent H (10), shallow-dose equivalent H (0.07), and eye lens dose equivalent H (3) of eight interventionists and H (3) for two nurse dosimeters were measured. Thereafter, conversion coefficients from kerma-area product (KAP) for H (10), H (0.07), and H (3) were determined and dose equivalents per procedure to an operator and assisting staff were estimated. Further, mean conversion factors from H (10) and H (0.07) to H (3) were calculated. The median KAP in ERCP was 1.0 Gy·cm , with mobile c-arm yielding higher doses than a floor-mounted device (  < 0.001). The median H (3) per ERCP was estimated to be 0.6 µSv (max. 12.5 µSv) and 0.4 µSv (max. 12.2 µSv) for operators and assisting staff, respectively. The median H (10) and H (0.07) per procedure ranged from 0.6 to 1.8 µSv. ERCP procedural complexity level (  ≤ 0.002) and interventionist (  < 0.001) affected dose equivalents. Occupational dose limits are unlikely to be exceeded in gastrointestinal endoscopy practice when following radiation-hygienic working methods and focusing on dose optimization. The eye lens dose equivalent H (3) may be estimated with sufficient agreement from the H (10) and H (0.07).

摘要

内镜逆行胰胆管造影(ERCP)操作可能会给患者和工作人员带来相当高的辐射剂量。这项前瞻性研究的目的是确定胃肠内镜检查操作中的职业暴露情况,特别关注ERCP中的眼晶状体剂量。使用两个荧光透视系统共进行了604例荧光透视引导下的操作,其中560例为ERCP,属于美国胃肠内镜学会的四个操作复杂程度级别。测量了8名介入医生的个人深部剂量当量H(10)、浅表剂量当量H(0.07)和眼晶状体剂量当量H(3)以及两名护士剂量仪的H(3)。此后,确定了H(10)、H(0.07)和H(3)的比释动能面积乘积(KAP)转换系数,并估算了每次操作对操作者和辅助人员的剂量当量。此外,还计算了从H(10)和H(0.07)到H(3)的平均转换因子。ERCP中的KAP中位数为1.0 Gy·cm²,移动C型臂产生的剂量高于落地式设备(P<0.001)。每次ERCP中操作者和辅助人员的H(3)中位数估计分别为0.6 μSv(最大值12.5 μSv)和0.4 μSv(最大值12.2 μSv)。每次操作的H(10)和H(0.07)中位数范围为0.6至1.8 μSv。ERCP操作复杂程度级别(P≤0.002)和介入医生(P<0.001)会影响剂量当量。在胃肠内镜检查实践中,遵循放射卫生工作方法并注重剂量优化时,职业剂量限值不太可能被超过。眼晶状体剂量当量H(3)可以根据H(10)和H(0.07)以足够的一致性进行估算。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d0b/9995179/a3bc344c0eb9/10-1055-a-2022-2663-i2874ei1.jpg

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