综合性放射防护措施在介入治疗防护中的应用

目的探讨综合性放射防护措施在介入治疗防护中的应用价值。方法在84例介入手术治疗中联合应用床下铅橡胶帘、铅玻璃防护屏、铅防护服、铅围脖、铅眼镜及距离等对介入操作人员进行综合性防护。利用FJ-2000个人剂量仪监测X射线辐射剂量,并对相关数据进行统计分析。结果床下铅橡胶帘防护效率为93.4%;铅玻璃防护屏防护效率为93.5%;铅防护服防护效率为88.4%这些放射防护器材前后X线辐射剂量差异均具有统计学意义(P<0.01)。距球管1 m处X线衰减量为58.6%,距球管3 m处的X线衰减量为86.4%。1 m与2 m之间,2 m与3 m之间的辐射剂量差异均具有统计学意义(P<0.01)。结论综合性防护措施在介入操作中可有效降低X射线辐射、减少对介入操作人员身体危害。     

立体放射防护在介入治疗中的应用

目的:评价立体放射防护方法在介入治疗中的防护效果及其应用价值。方法:174例患者,介入治疗中分别采用床下铅橡胶帘、床边悬挂可活动式铅玻璃防护屏、医用铅防护服、铅防护围脖、铅防护眼镜及增加距离等X射线辐射防护措施,利用RAD60S个人报警剂量仪测量防护材料防护前后的X射线辐射剂量,并进行统计学分析。结果:铅玻璃防护屏、铅防护服、距离的增加可明显减少X射线辐射剂量,有显著性防护意义;X射线辐射剂量与透视和数字减影血管造影时间呈正相关,随着透视和减影造影时间的增加,医务人员和患者所接受的X射线辐射剂量明显增加。结论:立体防护在介入治疗中可有效减少X射线辐射剂量,保护医务人员和患者的身体健康。     

直接数字摄影应用对防护的改善

ICRP提出的电离辐射的基本防护原则：辐射实践的正当化；防护水平的最优化；个人剂量限值。X线防护基本任务就是保障X线工作者和公众及其后代的健康和安全，提高X线防护的效益，促进X线工作的发展。随着直接数字摄影的应用，在做X线检查时的防护有很大的改善。直接数字摄影的应用与传统的X线摄影相比提高防护水平的最优化。个人剂量限值问题：由于辐射剂量、曝光次数和重拍次数的减少使公众中的个人受到的年剂量当量大大的降低。辐射实践的正当化：直接数字摄影的应用减少了一些不必要的检查使辐射实践更加正当化。     

放射防护的再认识

从发现X线到现在，人们对辐射的应用，防护积累了大量经验。X线工作者受辐射的影响大为减少。在现防护条件下虽然放射病为数不多了，但射线对机体的危害是不可低估的。     

移动式介入治疗辐射防护装置研究与应用

为了降低介入治疗中医务人员所受的辐射剂量 ,笔者研制出 1台移动式介入治疗辐射防护装置。经临床使用后 ,有效地降低了介入治疗医生的剂量负担 ,但不妨碍医生的操作 ,深受介入医生的欢迎。一、材料和方法1 材料 :防护屏采用 90 0ｍｍ× 180 0ｍｍ铅玻璃 (0 5ｍｍ铅当量 ) ,下面装有 4只万向轮 ,可任意移动。副防护屏采用0 5ｍｍ铅当量的橡胶 ,其中上面一块为 4 0 0ｍｍ× 6 0 0ｍｍ ,下面 1块为 6 0 0ｍｍ× 90 0ｍｍ ,分别附着在主屏右侧的立杆上 ,可根据病人的位置进行上、下、前、后调节 ,其中上面的防护屏采用分条式铅橡胶 ,避免压痛…     

利用体表铅橡胶减少辐射的新方法

在X线透视下,进行腹腔经皮穿刺的介入性造影时,工作人员接受的X线量往往远高于安全剂量水平。作者介绍一极简便方法,可使工作人员的X线照射最多减少75％。该方法是用两片25×20cm~2铅橡胶(0.5～0.7mm当量铅),以胶布固定在病     

探讨模拟新生儿胸部摄影附设防护的铅当量

目的:探讨新生儿胸部摄影时附加防护将照射野外腺体表面的吸收剂量降到最低的铅当量。方法:采用改变肢体对应于X线管的不同方位,测量6组曝光条件下,未加和附加铅当量为0.35及0.7mm的铅橡皮后,中心线及照射野外各腺体表面的平均吸收剂量。结果:①头侧置于X线管阴极端,腺体表面的平均吸收剂量:未加防护时,中心线最大为34.89μGy、阴极端的甲状腺次之为34.88μGy、阳极端的性腺最小为0.083μGy。附加铅当量为0.35mm的铅橡皮后,中心线仍最大为0.07μGy,阴极端的甲状腺次之为0.06μGy。晶体和性腺为0μGy。附加铅当量为0.7mm的铅橡皮后,四者均为0μGy;②头侧置于X线管阳极端,腺体表面的平均吸收剂量:未加防护时,中心线最大为35.67,阳极端的甲状腺次之为31.6μGy。阴极端的性腺>阳极端晶体即0.33>0.08μGy。附加铅当量为0.35mm铅橡皮后,中心线为0.070μGy、晶体<甲状腺即0<0.02μGy、性腺为0μGy。附加铅当量为0.7mm的铅橡皮后,四者均为0μGy。结论:新生儿胸部摄影接触屏蔽的铅当量应≥0.7mm。     

低能X射线术中放射治疗的辐射屏蔽

目的 依据国内外标准和指南评估低能X射线术中放射治疗室的屏蔽需求,测量屏蔽材料的透射系数、关注位置的周围剂量当量率水平以及防护装置的应用效果,为此类设备屏蔽方案的设计和防护装置的应用提供参考。方法 分别依据我国GBZ 121标准、英国医学物理与工程研究所（IPEM）75号报告和美国国家辐射防护与测量委员会（NCRP）151号报告计算INTRABEAM术中放射治疗室所需的屏蔽厚度。实际测量固体水板、屏蔽贴片和防辐射围裙对于此设备产生低能X射线的透射系数,对模拟治疗条件下关注位置处的周围剂量当量率进行测量并评估辐射防护屏的应用效果。结果 依据不同标准和指南计算得到治疗室全部关注点处所需铅屏蔽厚度均<0.6 mm,差异为亚毫米水平。此设备产生的低能X射线在屏蔽物质中衰减明显,0.05 mm铅当量屏蔽贴片和0.25 mm铅当量防辐射围裙的透射系数为0.068和0.0038。使用球形施用器在空气中进行照射时,距离射线源1和2 m处测得的周围剂量当量率为10.7和2.6 mSv/h。将施用器置于小水箱中后,相应的周围剂量当量率降为3.8和0.9 μSv/h,防护屏的使用可以使2 m处的周围剂量当量率降为本底水平。结论 低能X射线术中放射治疗设施的屏蔽需求较低,设备产生的射线有效能量低,但在邻近未屏蔽辐射源位置的剂量率较高,应优化设计治疗室屏蔽方案并合理使用防护装置。     

小照射野面积在颅面部X线摄影检查中的价值

目的 通过颅面部X线摄影检查中使用小照射野面积,减少电离辐射剂量和散射线,提高图像质量.资料与方法 自制暗盒号码标记曝光开关,采用自然光感光X射线号码标记;依据颅面部X线摄影的几何形状,设计颅面部专用铅遮线板,缩小照射野面积;合理选用静止固定密纹滤线栅.结果 颅面部X线摄影号码标记感光清晰,规范、不占据图像;颅面部X线摄影照射野面积平均减少41.25%～85.32%;X线照片图像清晰.结论 颅面部X线摄影中使用小照射野面积,有效地降低了受检者所受辐射剂量,同时显著提高了X线照片图像质量.     

新型铅围裙在X射线检查中的应用

在Ｘ射线检查中 ,除必要的检查部位受到Ｘ射线照射外 ,其周围也受到一定量的辐射。这给受照射的组织造成损害。性腺对射线很敏感 ,更容易受损害。儿童、青少年性腺处在生长发育时期 ,此时性腺受损害不仅影响儿童、青少年的发育 ,而且可能给其下代造成潜在的不良后果。为了防止儿童和青少年在Ｘ射线检查中受到不必要的损害 ,我们在Ｘ射线检查中用新型、自制的铅围裙来防护儿童和青少年性器官。铅围裙用相当于 1ｍｍ铅当量的铅橡皮制作。长 5 5ｍｍ ,宽 5 0ｍｍ ,上缘两侧各有系带。在照后前位胸片时。围裙扎系于被检查者的后部。紧贴被检查者…     

Estimation of X-radiation protective coats in abdominal angiography

Medical personnel involved in abdominal angiography are exposed not only to direct radiation but also scattered radiation from inspection tables, patients, image intensifiers, and the beam-limiting system (collimator), among others. Japanese standard JISZ4831 prescribes protective coats of at least 0.25 mm lead equivalent, which is the uniform thickness of lead equivalent. The most commonly used protective coats are 0.25 mm Pb, 0.35 mm Pb, or 0.5 mm Pb in thickness. The weight of a typical protective coat is about 3 kg. While some coats weigh up to 6 kg, wearing such heavy coats becomes physically burdensome as inspection time increases. The trade-off between physical burden and protection was considered by analyzing the X-ray intensity distribution and attenuation rate of scattered radiation in each position assumed by the medical staff. In the case of inspections performed at an x-ray tube voltage of 80 kV, it may be possible to reduce the weight of the lead rubber apron by about 33%. Namely, the lead thickness can be reduced uniformly by 0.20 mm Pb at 70 cm and 0.05 mm Pb at 100 cm, when the shielding capability of a 0.25 mm thick Pb layer is accepted as the standard at 40 cm above the gonad position. The same range of permeated X-ray dose for the gonad position may be reduced as well. In the case of 110 kV, when the lead thicknesses are 0.30 mm Pb at 40 cm and 70 cm, and 0.10 mm Pb at 100 cm, it is possible to reduce the weight of the lead rubber apron by about 28%.     

Using a sterile disposable protective surgical drape for reduction of radiation exposure to interventionalists.

OBJECTIVE: The purpose of this paper is to show the effectiveness of a new radiation protection method designed to decrease the amount of scatter radiation received by practitioners performing procedures under fluoroscopic guidance. MATERIALS AND METHODS: A sterile, disposable, lead-free surgical drape containing radiation protection material composed primarily of bismuth was evaluated for effectiveness in reducing radiation doses to health care personnel. Measurements of phantom scatter, patient scatter, skin entrance, and the effects of collimation, together with comparative monthly thermoluminescent dosimeter recordings, were taken to determine the effectiveness of X-ray beam attenuation using the bismuth drapes. RESULTS: Scatter radiation to physicians, as measured by thermoluminescent dosimeters placed on each eye, the thyroid, and the wrist, was reduced by 12-fold for the eyes, 25-fold for the thyroid, and 29-fold for the hands when the radiation-attenuating surgical drape was used when compared with control studies performed with a standard nonattenuating surgical drape alone. Monthly thermoluminescent dosimeter measurements decreased fourfold in one physician. Using the protective drape reduced exposure to the assistant in each case to negligible levels. Skin entrance dose was not increased unless the protective drape was placed directly in the X-ray beam. An X-ray attenuation factor equivalent to 0.1 mm of lead with 8 x 8 cm collimation reduced the scatter rates from five- to ninefold despite a 30-40% increase in entrance exposure rate as the lead equivalence increased. CONCLUSION: Depending on the procedure, the height of the practitioner, and the positioning of the radiation-attenuating surgical drape, use of this drape can substantially reduce the radiation dose to personnel with minimal or no additional radiation exposure to the patient.     

介入放射人员眼晶状体防护用品的选择和使用探讨

眼晶状体剂量限值的降低,使介入手术中职业人员的眼晶状体剂量监测和防护备受关注。基于文献中模拟计算和实验测量结果的调研,分析了介入人员眼晶状体防护用品的防护效果及影响因素,并提出了选择和使用建议。介入人员的眼晶状体剂量主要来自未被屏蔽而直接入射到眼部的射线;制约眼晶状体防护效果的重点不是铅当量厚度,而是防护用品结构、投照方位、位置布局、人员姿态等几何条件。0.5 mm铅当量对于介入人员眼晶状体防护是足够的;在临床实践中,组合使用铅眼镜和铅屏风能更好地对眼晶状体进行防护。     

The radiation protective devices for interventional procedures using computed tomography

A scattered dose and a surface dose from phantom measurements during interventional procedures with computed tomography (IVR-CT) were evaluated. To reduce the personnel exposure in IVR-CT, the new protective devices were developed and its effect evaluated. Two radiation protection devices were experimentally made using a lead vinyl sheet with lead equivalent 0.125mmPb. The first device is a lead curtain which shields the space of CT-gantry and phantom for the CT examination. The second device is a lead drape which shields on the phantom surface adjacent to the scanning plane for the CT-fluoroscopy. Scattered dose and phantom surface dose were measured with an abdominal phantom during Cine-CT (130 kV, 150 mA, 5 seconds, 10 mm section thickness). They were measured by using ionization chamber dosimeter. They were measured with and without a lead curtain and a lead drape. Scattered dose rate was measured at distance of 50-150 cm from the scanning plane. And, surface dose was measured at distance of 4-21 cm from the scanning plane on the phantom. On operator's standing position, scattered dose rates were from 8.4 to 11.6 micro Gy/sec at CT examination. The lead curtain and the lead drape reduced scattered dose rate at distance of 50 cm from the scanning plane by 66% and 58.3% respectively. Surface dose rate were 118 micro Gy/sec at distance of 5 cm from the scanning plane at CT-fluoroscopy. The lead drape reduced the surface dose by 60.5%. High scattered exposure to personnel may occur during interventional procedures using CT. They were considerably reduced during CT-arteriography by attaching the lead curtain in CT equipment. And they were substantially reduced during CT-fluoroscopy by placing the lead drape adjacent to the scanning plane, in addition, operator's hand would be protected from unnecessary radiation scattered by phantom. It was suggested that the scattered exposure to personnel could be sufficiently reduced by using radiation protection devices in IVR-CT. The radiation protection devices and the CT equipment should be improved or developed based on the radiation protection.     

Protective aprons in imaging departments: manufacturer stated lead equivalence values require validation

The composition of protective aprons worn by X-ray personnel to shield against secondary radiation is changing. Lead is being replaced by either lead-free or composite (lead with other high atomic numbered elements) materials. These newer aprons are categorised by manufacturers in terms of lead equivalent values, but it is unclear how these stated values compare with actual lead equivalent values. In this work, the actual lead equivalence of 41 protective aprons from four manufacturers, all specified as having 0.25 mm lead equivalence, were investigated with transmission experiments at 70 and 100 kVp. All aprons were in current use. The aprons were screened for defects, and age, weight and design was recorded along with details of associated quality assurance (QA). Out of the 41 protective aprons examined for actual lead equivalence, 73% were outside tolerance levels, with actual levels in some aprons demonstrating less than half of the nominal values. The lack of compatibility between actual and nominal lead equivalent values was demonstrated by aprons from three of the four manufacturers investigated. The area of the defects found on screening of the protective aprons were within recommendations. The results highlight the need for acceptancy and ongoing checks of protective aprons to ensure that radiation exposure of imaging personnel is kept to a minimum.     

全数字大型血管造影机周围辐射剂量的初步研究

目的：通过对全数字大型血管造影机周围X线辐射剂量分布的研究,为介入工作人员科学合理的防护提供依据。方法：利用X线防护监测仪测量照射野周围水平、垂直两个方向的X线强度分布,并测量不同曝光模式下的X线强度,对测量结果进行统计分析。结果：正位时,在水平方向,辐射剂量由照射野向外逐渐衰减;在垂直方向,从地面向上逐渐增高,在130 cm处达到最高,此后逐渐衰减。斜位时,在水平方向,辐射剂量由照射野向外逐渐衰减;在垂直方向,从地面向上逐渐增高,至110 cm处达到最高,此后逐渐衰减。数字减影采集模式辐射剂量最高,心脏采集模式下加装悬挂式铅玻璃防护可减少50%的辐射剂量;透视模式下,15F/S比30F/S辐射剂量低。结论：合理利用各种曝光模式,了解X线辐射剂量在周围的分布情况,可有效减少工作人员接受的辐射剂量。     

合理应用X射线检查 优化辐射剂量

X射线的影像学检查是现代化精准医疗中的重要环节，在诊治疾病和判断疾病转归及手术方案制定中发挥着不可替代的作用。随着数字X射线和CT检查的广泛应用，重复的和过度的X射线检查时有发生，使受检者接受了过多的或额外辐射剂量，引起辐射损伤。如何优化辐射剂量，达到既满足疾病的诊断，又能降低受检者的辐射损伤，是研究者和设备研发者关注的重要课题。以致X射线的辐射损伤引起了政府、社会、受检者和X射线检查工作者的高度关注。本文探讨了降低辐射剂量的方法，评述其进展。     

CT引导下125I粒子植入对相关医务人员的辐射剂量评估

目的评估CT引导下125I粒子植入过程中相关医务人员在不同距离及有无辐射防护措施下的周围剂量当量率。方法125I粒子植入后立即使用多功能射线检测仪测量50例125I粒子植入患者距粒子植入部位体表不同垂直距离（5 cm、10 cm、1 m、2 m和3 m）及有无防护措施条件下的周围剂量当量率,评估医务人员受到的辐射剂量。组间比较采用单因素方差分析。结果距离粒子植入部位体表垂直距离为5 cm、10 cm、1 m、2 m和3 m处的周围剂量当量率分别为（1091.75±10.53）、（1055.50±31.68）、（123.45±20.83）、（20.95±6.10）和（7.78±3.24）μSv/h。0.5 mm铅当量铅衣屏蔽后5 cm、10 cm、1 m、2 m和3 m处的周围剂量当量率分别为（1.36±2.03）、（0.97±1.48）、（0.46±0.63）、（0.29±0.34）和（0.14±0.12）μSv/h。屏蔽前后周围剂量当量率的差异均有统计学意义（F=183.718、71.202、217.411、184.169、108.222,均P < 0.05）。结论CT引导下125I粒子植入过程中相关医务人员采取适当的距离防护及穿戴个人防护用品可以大大降低125I粒子带来的辐射影响。