Cusma J T, Bell M R, Wondrow M A, Taubel J P, Holmes D R
Mayo Foundation and Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 1999 Feb;33(2):427-35. doi: 10.1016/s0735-1097(98)00591-9.
The aim of this study was to accurately assess the radiation exposure received by patients during cardiac catheterization in a large sample representative of the current state of practice in cardiac angiography.
Radiation exposure to patients and laboratory staff has been recognized as a necessary hazard in coronary angiography. The effects on x-ray exposure of the increased complexity of coronary angiographic procedures and, in particular, the increasing use of coronary artery stenting, have not been adequately addressed in previous studies.
X-ray exposure measurements were performed on a consecutive series of 972 patients undergoing 992 diagnostic and interventional studies in the Mayo Clinic catheterization laboratory within an eight week period in late 1997. Data were acquired from 706 diagnostic procedures and 286 interventional procedures using a real-time exposure measurement system to continuously calculate and record the exposure rate and total exposure, reflecting all parameters relevant to the specific patient and procedure situation.
The median exposure for all 992 procedures was 41.8 mC/kg (162.1 R); the corresponding values for diagnostic and interventional procedures were 34.9 and 95.6 mC/kg, respectively (135.3 vs. 370.5 R). There were significant differences in the fluoroscopy exposure time between diagnostic and interventional procedures: 4.7 min vs. 21.0 min. Heavier patients (>83 kg) received x-ray exposures at a significantly higher rate than did lighter patients (<83 kg) during both fluoroscopy and cine; 44.9 mC/kg/min (173.9 R/min) vs. 27.9 mC/kg/min (108.3 R/min) for cine exposure rate and 2.3 mC/kg/min (8.8 R/min) vs. 1.5 mC/kg/min (5.8 R/min) for fluoroscopy exposure rate.
Changes in practice have led to higher values for patient x-ray radiation exposures during cardiac catheterization procedures. The real-time display and recording of x-ray exposure facilitates the reduction of exposure in the catheterization laboratory.
本研究旨在对大量能代表当前心脏血管造影实际情况的样本进行准确评估，以确定患者在心脏导管插入术中所接受的辐射剂量。
患者及实验室工作人员所受的辐射暴露，已被视为冠状动脉造影中不可避免的风险。冠状动脉造影术日益复杂，尤其是冠状动脉支架置入术的使用不断增加，这些对X线暴露的影响，在以往研究中尚未得到充分探讨。
于1997年末的八周内，在梅奥诊所导管插入实验室，对连续的972例患者进行了992项诊断性和介入性研究，并进行了X线暴露测量。通过实时暴露测量系统，从706项诊断性操作和286项介入性操作中获取数据，持续计算并记录暴露率和总暴露量，反映与特定患者及操作情况相关的所有参数。
所有992项操作的中位暴露量为41.8 mC/kg（162.1伦琴）；诊断性和介入性操作的相应值分别为34.9和95.6 mC/kg（135.3对370.5伦琴）。诊断性和介入性操作的透视暴露时间存在显著差异：分别为4.7分钟和21.0分钟。在透视和电影摄影期间，体重较重的患者（>83千克）接受X线暴露的速率显著高于体重较轻的患者（<83千克）；电影摄影暴露率分别为44.9 mC/kg/分钟（173.9伦琴/分钟）和27.9 mC/kg/分钟（108.3伦琴/分钟），透视暴露率分别为2.3 mC/kg/分钟（8.8伦琴/分钟）和1.5 mC/kg/分钟（5.8伦琴/分钟）。
实践中的变化导致心脏导管插入术期间患者的X线辐射暴露值更高。X线暴露的实时显示和记录有助于减少导管插入实验室中的暴露。
