Kataoka Akihisa, Takata Takeshi, Yanagawa Ayaka, Kito Kento, Arakawa Masataka, Ishibashi Ruri, Katayama Taiga, Mitsui Miho, Nagura Fukuko, Kawashima Hideyuki, Hioki Hirofumi, Watanabe Yusuke, Kozuma Ken, Kotoku Jun'ichi
Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan.
Advanced Comprehensive Research Organization, Teikyo University, Tokyo, Japan.
JACC Asia. 2023 Mar 28;3(2):301-309. doi: 10.1016/j.jacasi.2022.12.008. eCollection 2023 Apr.
The distribution of radiation exposure on the body surface of interventional echocardiographers during structural heart disease (SHD) procedures is unclear.
This study estimated and visualized radiation exposure on the body surface of interventional echocardiographers performing transesophageal echocardiography by computer simulations and real-life measurements of radiation exposure during SHD procedures.
A Monte Carlo simulation was performed to clarify the absorbed dose distribution of radiation on the body surface of interventional echocardiographers. The real-life radiation exposure was measured during 79 consecutive procedures (44 transcatheter edge-to-edge repairs of the mitral valve and 35 transcatheter aortic valve replacements [TAVRs]).
The simulation demonstrated high-dose exposure areas (>20 μGy/h) in the right half of the body, especially the waist and lower body, in all fluoroscopic directions caused by scattered radiation from the bottom edge of the patient bed. High-dose exposure occurred when obtaining posterior-anterior and cusp-overlap views. The real-life exposure measurements were consistent with the simulation estimates: interventional echocardiographers were more exposed to radiation at their waist in transcatheter edge-to-edge repair than in TAVR procedures (median 0.334 μSv/mGy vs 0.053 μSv/mGy; 0.001) and in TAVR with self-expanding valves than in those with balloon-expandable valves (median 0.067 μSv/mGy vs 0.039 μSv/mGy; 0.01) when the posterior-anterior or the right anterior oblique angle fluoroscopic directions were used.
During SHD procedures, the right waist and lower body of interventional echocardiographers were exposed to high radiation doses. Exposure dose varied between different C-arm projections. Interventional echocardiographers, especially young women, should be educated regarding radiation exposure during these procedures. (The development of radiation protection shield for catheter-based treatment of structural heart disease [for echocardiologists and anesthesiologists]; UMIN000046478).
在结构性心脏病（SHD）手术过程中，介入性超声心动图医生体表的辐射暴露分布尚不清楚。
本研究通过计算机模拟和SHD手术期间辐射暴露的实际测量，估计并可视化进行经食管超声心动图检查的介入性超声心动图医生体表的辐射暴露情况。
进行蒙特卡洛模拟以明确介入性超声心动图医生体表辐射的吸收剂量分布。在连续79例手术（44例二尖瓣经导管缘对缘修复术和35例经导管主动脉瓣置换术[TAVR]）期间测量实际辐射暴露情况。
模拟显示，在所有透视方向上，由于患者床底部边缘的散射辐射，身体右半部分，尤其是腰部和下半身存在高剂量暴露区域（>20μGy/h）。在获取前后位和瓣叶重叠视图时会出现高剂量暴露。实际暴露测量结果与模拟估计一致：在经导管缘对缘修复术中，介入性超声心动图医生腰部受到的辐射比TAVR手术更多（中位数0.334μSv/mGy对0.053μSv/mGy；P<0.001），在使用自膨胀瓣膜的TAVR手术中比使用球囊扩张瓣膜的手术更多（中位数0.067μSv/mGy对0.039μSv/mGy；P=0.01），当采用前后位或右前斜位透视方向时。
在SHD手术期间，介入性超声心动图医生的右腰和下半身受到高辐射剂量照射。不同C形臂投影下的暴露剂量有所不同。应就这些手术期间的辐射暴露对介入性超声心动图医生，尤其是年轻女性进行教育。（用于结构性心脏病导管治疗的辐射防护屏蔽的研发[针对超声心动图医生和麻醉医生]；UMIN000046478）
