Calicchia A, Chiacchiararelli L, De Felice C, Gigliotti T, Indovina P L, Mazzei F, Porfiri L M
Laboratorio di Fisica, Istituto Superiore di Sanità, Roma.
Radiol Med. 1998 Jan-Feb;95(1-2):93-7.
The optimization principle applied to the patient radioprotection, recently introduced in Italian legislation, requires a careful analysis of the working procedures and clinical protocols generally used in radiological practice, to avoid unnecessary exposures with no loss in diagnostic information. We carried out this analysis in hysterosalpingography, which is the radiological examination usually performed on fertile women to detect uterine and tubal conditions.
The dosimetric survey was carried out on 35 patients, 22 to 40 years old, to evaluate: a) entrance dose and dose x area product; b) doses to the most irradiated organs, that is ovaries and uterus; c) effective dose equivalent and effective dose. The doses were measured with LiF thermoluminescent dosimeters, while an ionization chamber enabled us to the calculate dose area product. Ovaries and uterus doses were calculated with a Monte Carlo program using skin entrance exposure data and some technical parameters of the examination.
The good agreement of the results obtained with both dosimetric methods demonstrated their equivalence in this specific case where the use of a clinical protocol, with no lateral projection, made the dosimeters lie always within the X-ray beam.
The mean dose was 4.5 mGy for the ovaries and 6.2 mGy for the uterus. Following the recommendations of the International Commission on Radiological Protection, both effective dose equivalent, with a mean value of 2.0 mSv, and effective dose, with a mean value of 1.95 mSv, were estimated. In conclusion, our results show that the patient dose can be reduced by limiting the use of fluoroscopy, using small size films and decreasing the number of exposures.
意大利立法最近引入的适用于患者辐射防护的优化原则，要求仔细分析放射实践中普遍使用的工作程序和临床方案，以避免在不损失诊断信息的情况下进行不必要的照射。我们在子宫输卵管造影检查中进行了此项分析，该检查是通常对育龄妇女进行的用于检测子宫和输卵管状况的放射检查。
对35名年龄在22至40岁之间的患者进行了剂量学调查，以评估：a）入射剂量和剂量面积乘积；b）受照剂量最高的器官，即卵巢和子宫的剂量；c）有效剂量当量和有效剂量。使用氟化锂热释光剂量计测量剂量，而电离室使我们能够计算剂量面积乘积。利用皮肤入射照射数据和检查的一些技术参数，通过蒙特卡罗程序计算卵巢和子宫的剂量。
两种剂量学方法获得的结果吻合良好，表明在这种特定情况下它们是等效的，即使用无侧位投影的临床方案时，剂量计始终位于X射线束内。
卵巢的平均剂量为4.5毫戈瑞，子宫的平均剂量为6.2毫戈瑞。根据国际放射防护委员会的建议，估算了有效剂量当量（平均值为2.0毫希沃特）和有效剂量（平均值为1.95毫希沃特）。总之，我们的结果表明，通过限制荧光透视的使用、使用小尺寸胶片以及减少照射次数，可以降低患者剂量。
