X线透视引导下常见疼痛手术的辐射暴露及防护

Radiation exposure and protection for standard procedures of pain management guided by X-ray fluoroscopy

摘要:

目的：评价X线透视引导下常见疼痛手术的辐射暴露和防护方法。方法：选取中日医院疼痛科2021年1月至2021年5月的住院行X线透视引导下手术140例。从C形臂历史资料中获得病人术中X线透视数据,求得常见术式的平均透视次数和透视时间。用个人辐射剂量测试仪,分别在影像增强器位于床上和床下两种位置,以及距离床面20cm、40cm、60cm时手术床面的辐射剂量率。另在距离C臂1m、2m、3cm位置,测量铅板(铅板正中、铅板边缘、铅板外10cm处)、铅衣、无防护时的辐射剂量率。结果：“临时脊髓电刺激植入术”透视次数最多,辐射剂量为5.0μSv,“脊神经后支等离子消融术”透视次数最少,辐射剂量仅0.8μSv。影像增强器在上时辐射剂量率20cm＞40cm＞60cm(P＜0.01),影像增强器在下亦然(P＜0.01)。影像增强器在上时的辐射剂量率明显低于在下时(P＜0.01)。影像增强器在上,距离C臂1m时无防护和铅板外10cm的辐射剂量率明显高于铅衣、铅板边缘和铅板中央(P＜0.01)；在距离C臂2m时亦然,但辐射剂量率显著下降(P＜0.01)；在距离C臂3m时,各防护方式的辐射剂量率均接近背景辐射。影像增强器在下时情况类似。结论：X线透视引导下疼痛手术辐射暴露最大的术式是“临时脊髓电刺激植入术”,术中辐射暴露剂量与距离成密切负相关,铅板和铅衣均能有效减少辐射暴露,影像增强器置于手术床上方并远离床面有助于减少辐射暴露。

Abstract:

Objective: To evaluate the radiation exposure and protection methods for standard pain management procedures guided by X-ray fluoroscopy. Methods: One hundred and forty inpatient X-ray fluoroscopy-guided procedures from January 2021 to May 2021 in the Department of Pain Medicine of China-Japan Friendship Hospital were selected. Intraoperative X-ray fluoroscopy data of patients were obtained from the C-arm history data to find the average number of fluoroscopies and fluoroscopy time for standard pain management procedures. With a personal radiation dose tester, radiation dose rates were obtained at the surgical bed surface and 20cm, 40cm, and 60cm from the bed surface, respectively, when the image intensifier was located in both over-bed and under-bed positions. Radiation dose rates were also measured at 1m, 2m, and 3cm from the C-arm, when the lead plate glass (including right in the middle of the lead plate glass, at the edge of the lead plate glass, and 10cm outside the lead plate glass), the radiation-proof clothes were applied or unprotected. Results: "Short-term spinal cord stimulation" had the highest number of fluoroscopy with a radiation dose of 5.0 μSv. In comparison, "Low-temperature plasma radiofrequency ablation on the posterior ramus of spinal nerve μSv. When the image intensifier is over-bed, the radiation dose rate measured at 20 cm > 40 cm > 60 cm from bed surface (P < 0.01), and similar results were obtained for the image intensifier was in the under-bed position (P < 0.01). The radiation dose rate measured when the image intensifier in the over-bed position was significantly lower than when it was in the under-bed position (P < 0.01). With the image intensifier, over-bed and measure spot was 1 m from the C-arm, the radiation dose rate unprotected and at 10 cm outside the lead plate glass, were significantly higher than values measured at the inside of radiation-proof clothes, the edge and the center of lead plate glass (P < 0.01), and the similar results were gotten at 2 m from the C-arm. Still, the radiation dose rate decreased significantly (P < 0.01). When measured at 3 m from the C-arm, the radiation dose rate was close to the background radiation for all protection methods. The results were similar when the image intensifier was under-bed. Conclusion: The procedure with the highest radiation exposure for X-ray fluoroscopy-guided pain management is "Short-term spinal cord stimulation," The intraoperative radiation exposure dose is closely and negatively correlated with the distance. Both lead plates glass and radiation-proof clothes effectively reduce radiation exposure, and image intensifiers placed over-bed and away from the surgical bed can help reduce radiation exposure.