侵入性心血管手术中使用防护围裙与标准铅围裙和防护装置时的辐射暴露情况
Radiation Exposure Using Rampart vs Standard Lead Aprons and Shields During Invasive Cardiovascular Procedures.
作者信息
Lisko John C, Shekiladze Nikoloz, Chamoun Joseph, Sheikh Noah, Rainer Katharine, Wei Jane, Binongo Jose, Raj Leah, Byku Isida, Rinfret Stephane, Devireddy Chandan, Jaber Wissam A, Greenbaum Adam B, Babaliaros Vasilis, Steuterman Stephen, Sandesara Pratik, Nicholson William J
机构信息
Section of Interventional Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia.
出版信息
J Soc Cardiovasc Angiogr Interv. 2023 Oct 19;3(1):101184. doi: 10.1016/j.jscai.2023.101184. eCollection 2024 Jan.
BACKGROUND
Radiation exposure during invasive cardiovascular procedures remains an important health care issue. Lead aprons and shields (LAS) are used to decrease radiation exposure but leave large portions of the body unshielded. The Rampart IC M1128 is a portable radiation shielding system that may significantly attenuate radiation exposure.
METHODS
Catheterization laboratory teams were randomized in a 1:1 fashion to perform elective invasive cardiovascular procedures utilizing either traditional LAS or the Rampart IC M1128. Radiation exposure was measured using real-time dosimetry monitoring in prespecified anatomic locations on 3 operators (position 1: first operator/fellow; position 2: second operator/attending; and position 3: catheterization laboratory nurse/technologist). Radiation exposure was measured on a per-case basis.
RESULTS
In total, 100 consecutive cases were randomized in this study (47 Rampart; 53 LAS). There was no difference in fluoroscopy time (12.3 minutes for Rampart vs 15.4 minutes for LAS; = .52), dose area product (288 Gy⋅cm for Rampart vs 376.5 Gy⋅cm for LAS; = .52), or scatter radiation (38.8 mRem for Rampart vs 46.8 mRem for LAS; = .61) between the groups. There was significantly lower total body radiation (in milliroentgen equivalent man) exposure using the Rampart than that using LAS for each team member: position 1-0.1 mRem for Rampart vs 2.2 mRem for LAS; < .001; position 2-0.1 mRem Rampart vs 3.2 mRem LAS; < .001; and position 3-0.0 mRem for Rampart vs 0.8 mRem for LAS; < .001.
CONCLUSIONS
During routine clinical procedures, the Rampart system significantly decreases total body radiation exposure compared with traditional LAS.
背景
侵入性心血管手术中的辐射暴露仍然是一个重要的医疗保健问题。铅围裙和防护屏（LAS）用于减少辐射暴露，但身体的大部分部位仍未得到防护。Rampart IC M1128是一种便携式辐射屏蔽系统，可能会显著降低辐射暴露。
方法
导管实验室团队以1:1的方式随机分组，使用传统的LAS或Rampart IC M1128进行择期侵入性心血管手术。在3名操作人员预先指定的解剖位置使用实时剂量测定监测来测量辐射暴露（位置1：第一名操作人员/研究员；位置2：第二名操作人员/主治医生；位置3：导管实验室护士/技术人员）。辐射暴露按每例进行测量。
结果
本研究共随机纳入100例连续病例（47例使用Rampart；53例使用LAS）。两组之间的透视时间（Rampart为12.3分钟，LAS为15.4分钟；P = 0.52）、剂量面积乘积（Rampart为288 Gy·cm，LAS为376.5 Gy·cm；P = 0.52）或散射辐射（Rampart为38.8 mRem，LAS为46.8 mRem；P = 0.61）没有差异。对于每个团队成员，使用Rampart时的全身辐射（以毫雷姆当量人计）暴露显著低于使用LAS时：位置1-Rampart为0.1 mRem，LAS为2.2 mRem；P < 0.001；位置2-Rampart为0.1 mRem，LAS为3.2 mRem；P < 0.001；位置3-Rampart为0.0 mRem，LAS为0.8 mRem；P < 0.001。
结论
在常规临床手术中，与传统的LAS相比Rampart系统显著降低了全身辐射暴露。
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