摘要
X射线介入治疗放射学就是在X射线影像引导下,采取各种检查手段和方法诊断和治疗疾病。由于直接暴露在x射线辐射场内,患者和医务人员受到较高剂量。输卵管阻塞的介入治疗,患者为育龄妇女,卵巢处于射野内,受照剂量高。而卵巢位于盆腔深部,没有办法对其受照剂量进行直接测量。所以测定术中医务人员和患者的受照剂量水平、确定一个能方便准确确定患者卵巢受照剂量的方法具有非常重要的意义。
鉴于以上情况,本文从阐述致电离辐射的原理和过程出发,研究了应用热释光剂量计测量患者体表和靶器官剂量以及医务人员受照剂量情况:用比释动能面积积分仪KAP测量了X光机出射窗处的比释动能面积积分值,计算了患者靶器官剂量;并应用蒙特卡罗程序模拟了不同体厚和射野照射情况下患者重要靶器官剂量沉积情况。通过以上研究工作,取得了以下成果:
(1) 得到了输卵管阻塞介入治疗中,患者和医务人员的受照剂量水平;
(2) 确定了照射条件(Kv,mA等)对患者剂量的影响;
(3) 计算得到了医务人员受到的有效剂量当量:
(4) 通过修正,得到了一种更为准确的计算患者靶器官剂量的方法。
X-ray interventional radiology is a method to diagnose and treat patient follow the picture of X-ray. When x-ray through of the body of patient ,there will be a real time picture. With the picture , doctors can use many methods to check the patient. Because of being in the field of x-ray, patients and doctors have a high dose.The one whose Fallopian tube is stopped and need treatment is the woman who is in procreative age. There is a high dose in ovary and no effective method to measure it for ovary sit in the deep of the woman. So it is very important to find out the dose of ovary from the data that we can measure convenient.We used TLD to confirm where and how much the doses patient and doctor accepted are. And measured the kerma area product with special instrument KAP. We computed out the apparatus dose of patients, effective dose of doctors . we also simulated the X-ray' s journey in tissues and the magnitude of energy the x-ray give to the tissues. We learned the magnitude of the dose patients and doctors accepted during the operation with our works. Also studied the connections between the dose and the condition of x-ray tube. With the results we got from simulating the operation with monte carlo methods, we corrected a compute formula. With the corrected formula we can compute the dose in ovary better.
引文
[1] 王连生,孙秀玲,袁杨.介入放射学X射线辐射场分布调查分析.职业卫生与应急救援.2002:20(3):158.
[2] 李强,潘芝悔.输卵管阴塞的介入治疗.中国使用妇科与产科杂志.2000.16:441-442.
[3] Vehmas T. Radiation exposure during standand and complex interventional proceduresi[J]. BrJ Radiol, 1997, 70:296-298.
[4] US food and Drug Administration. Avoidance o serious X-ray induced skin injuries to patients during fluor scopically guided procedures[J]. MedBull, 1994, 24:7～17.
[5] 卢春林,阮明等.介入放射学医学照射与职业照射剂量水平.中国辐射卫生.2000:9:230-231
[6] 候金鹏,邓大平.介入放射学辐射剂量与放射防护现状。国外医学放射医学核医学分册.1998.22:41—43
[7] L Bogner. Strahlenexposition des Personals bei Angiographic und percutaner Transluminaler Angioplastie(PTA). Rontgenpraxis, 1993: 8(2):83-87
[8] 武小文.罗丽兰,庄风娣.应用输卵管导向管经宫颈行输卵管造影及再通术.中华妇产杂志.1994,29:165-167.
[9] 袁志强、林秀华等.X线导视下输卵管造影再通术的辐射监测与评价,介入放射学杂质.1998,7:113-114.
[10] 李强,潘芝梅。女性不孕症患者在诊治时接受X线辐射剂量的调查.现代医学影像学.2002.11:145-148
[11] 李士俊.电离辐射剂量学.原子能出版社.1986.11
[12] 杨燕生,郝敏,祝育德,等.输卵管性不育及输卵管病变的腹腔镜诊断[J].中华妇产科杂志,1996,31(6):327.
[13] 杨丹,雷贞武.输卵管性不孕的病因[J].实用妇产科杂志,1996,12(6):282.
[14] 裘华兴,张建英,蒋宁.介入治疗输卵管性不孕症62例临床分析.重庆医学.2003.32(11):1537
[15] Niklason LT etal Radiology, 1993; 187: 729-733(British)
[16] GB/T 16137-1995 x线诊断中受检者器官剂量的估算方法
[17] Oberhofer M,Scharmann A etal,张彤等译,应用热释光剂量学.中国计量出版社,1988
[18] 张建等.氟化锂热释光探测器剂量特性的实验研究.辐射防护,1996(1):44—50.
[19] 中华人民共和国国家标准.个人和环境监测用热释光剂量测量系统.GB10264-88.北京:中国标准出版社.1989.
[20] 刘保吕.实用医学辐射防护学.军事医学科学出版社.2004.104-105
[21] HedgpethPL, ThurmoudAS, FryRS, etal. Radio graphic fa llopian tube recanalization absorbed ovariandose. Radiology, 1991,180:121～122)
[22] Berthelsen B, Cederblad A. Radiation doses to patieots and personnelinvolved in embolization of intracerebral arteriovenous malformations[J}, Acta Radiol, 1991, 32 {6): 492-497
[23] 医川x射线诊断卫生防护标准(GBZ130—2002)
[24] 裴鹿成,张孝泽.蒙特卡罗方法及其在粒子输运问题中的应用.科学出版社.1980
[25] Faddegon BA, Rogers dwo. Comparations of thick-target brensstrahlung calculations by EGS4 and tts. NUC Inst Meth. A327, 1993, 556-565.
[26] Rogers DWO, Bielajew AF. The Use of egs for Monter Carlo Calculations. in medical Physics Lecture notes for Monter Carlo Refresh Course RC7, First interamerican meeting of medical physics Chicago. Tuly 17 1984.
[27] Rogers DWO Ewart GM, Bielajiew AF, etal. Calculation of electron contamination in a ~(60)Co therapy beam from AECL therapy Source. NRC Report No. pxnr-2710(1785)
[28] Rogers DWO, Ewart GM, Bielajiew AF, etal. Calculation of electron contamination in a ~(60)Co therapy beam Proceeding of the IAEA Intermational Symposium on dosimetry in radiotheraphy(IAEA, Vienna, 1988), vol. 1, 303-312.
[29] Andreo P. Monte Carlo techniques in medical physics. Phy Med Biol, 1991(36), 861-920.
[30] ICRU. Photon. electron, proton and neutron interaction data for body tisues, ICRU Report 46. 1992
[31] 日本医学放射线学会,日本同位素协会编,苏士杰译,放射诊断中医生和病人的辐射防护,1087:139—140
[32] Cundiff C.子宫输卵管造影正常的不孕妇女生育结果及正临床和腹腔镜的发现关系.国外医学(计划生育分册),1999,15:55-56.
[33] Faulkner K. Radiation protection in interventionat radiology[J]. BrJRadiol, 1997, 70: B25～326.
[34] Hoskins PR, Gillespie J. Ireland HM. Patient dose measurements from femoral angio graphy[J]. BrJRadiol. 1996, 69: 1159～1164.
[35] Thwaites JH, Rafferty MW. Gray N, etal. A patient dose survey for femoral anteriogram diagnostic radiographic examination using a dose-area product meter[J]. PhyMedBjiol, 1996,43:899～907.
[36] Mcparland BJ. A study of patient radiation doses in interventional radiological procedures[J]. Br J Radiol, 1998,71:175～185
[37] Vano E Arranz L, BeneytezF, etal Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories[J]. Br J Raiol, 1998,71:728～733.
[38] Vano E Arranz L, Sastre JM, etal Dosimetric and radiation protection consideeerations based on some cases of patient skin injuries in interventional cardiology[J]Br J Radiol 1998,71:510～516.
[39] Grant A. Infertility surgery of the oviduct. Fertil Steril, 1971, 22: 496.
[40] Arronet GH, Edulj ee SY. A nine-year survey of fallopian tube dysfunction in human fertility: diagnosis and theranv. Fertil Steril. 1969. 20:903