儿童放射诊断检查辐射风险认知研究

发布时间：2018-09-06 14:00

【摘要】：研究背景随着放射诊疗技术的迅猛发展及广泛应用,在促进诊疗技术进步、提高诊疗水平,造福广大患者和受检者的同时,如果防护不当将可能会对人体造成不必要的危害。儿童作为电离辐射致健康效应的敏感人群,对电离辐射致癌更为敏感,其放射诊疗的合理应用和防护显得尤为重要,也一直受到国际组织的关注。放射诊断检查实践的正当化和防护最优化是降低患者剂量的主要手段,而放射诊断检查中涉及的主要利益相关者的辐射风险认知是提高防护正当化和最优化的重要影响因素之一。国内关于儿童放射诊断检查辐射风险认知的研究很少,需要在这些方面给予更多的关注,加强儿童放射诊断检查辐射风险认知的健康宣教及健康教育极其重要。本研究选择北京大型综合和专科医院,开展儿童放射诊断检查辐射风险认知的研究,旨在了解相关人群的辐射风险及放射防护的认知程度,为今后制定儿童放射诊断检查相关政策和策略提供参考依据。研究目的调查放射诊断检查中涉及的主要利益相关者,包括医院儿科医生、放射科工作人员及就诊患儿家长对儿童放射诊断检查辐射风险及防护的认知状况和影响因素,为放射诊断检查技术应用的正当化及采取必要的防护措施和健康宣教提供科学依据。研究方法1.研究设计本研究采用横断面研究、方便抽样的方法确定研究对象。选择北京地区3家三级甲等医院(包括首都医科大学附属北京儿童医院、首都儿科研究所附属儿童医院、北京大学第三医院),将调查时在岗的儿科医生、放射科工作人员和就诊的患儿家长作为调查对象,发放问卷进行现场调查。2.调查方法经过预调查,按照组间均数比较,确定了应该调查的样本量。由经过培训调查人员现场发放调查问卷,按照要求填写问卷,由调查人员将问卷当场收回,当即检查填写有无遗漏或明显矛盾。本次调查共发放问卷609份,回收有效问卷600份,回收率98.5%,调查过程中有5人拒访。3.数据录入和统计分析调查问卷回收后,经过审核和处理,选出600份有效问卷进行编号,用epidata3.1数据录入,SPSS 23进行统计分析,统计学方法主要有:①描述性分析,包括频数、均数、标准差、构成比等。②多因素分析,包括多重线性回归和二分类Logistic回归分析等。研究结果1.不同人群对辐射基础知识客观评估知晓状况不同(1)儿科医生辐射知晓程度客观评估正确回答率达62.5%,大于50%,处于中上水平;女性辐射知晓程度低于男性,p=0.002,具有统计学意义(p0.05)。(2)放射科工作人员辐射知晓程度客观评估正确回答率达64.5%,大于50%,处于中上水平;职业分类中放射科技师(p=0.017)、本科及以上文化程度(本科p=0.029、硕士p=0.004、博士p=0.002)均对辐射基础知识知晓程度有影响,具有统计学意义(p0.05)。(3)就诊患儿家长辐射知晓程度客观评估7道有4道题正确回答小于50%,处于中下水平;就诊患儿家长文化程度(本科p=0.007;硕士p=0.002)、职业(家务及待业p=0.023;医务人员及教师p=0.018)均对辐射基础知识的知晓程度有影响,具有统计学意义(p0.05)。(4)三组人群辐射风险认知女性辐射知晓程度低于男性,p=0.000;人群分类中就诊患儿家长辐射基础知识低于儿科医生,儿科医生低于放射科工作人员,p=0.000,具有统计学意义(p0.05)。2.不同人群对儿童放射诊断检查辐射风险认知不同。(1)儿科医生84.0%在多种检查手段时出于诊断的需要;55.5%在确诊病情时首选X线检查;49.0%在儿童头晕、头痛(非外伤或者轻微外伤)首选核磁检查。(2)放射科工作人员55.0%认为比较了解辐射;98.5%认为辐射影响的器官是性腺;98.5%回答放射检查时给患者特殊部位屏蔽防护;70.0%在放射检查前进行辐射风险告知。(3)就诊患儿家长73.5%认为放射线对儿童健康有影响;35.0%认为放射检查时佩戴防护用品;75.0%在医生开具放射检查时不会担心对身体有影响而放弃。3.儿童放射诊断检查辐射风险认知信息环境以及获取健康宣教的最佳途径。(1)儿科医生和放射科工作人员首选健康宣教方式希望通过专业培训(54.0%和68.5%)、现场讲座(35.5%和53.5%)以及宣传挂图(37.5%和32.5%)等进行。(2)就诊患儿家长首选宣教方式通过宣传挂图(45.0%)、互联网和电视(35.5%)以及手机短信(28.0%)等进行。研究结论1.儿童放射诊断检查辐射风险认知中,不同人群辐射评估知晓状况不同,因而针对不同人群加强辐射风险认知的培训和管理突显重要。2.儿科医生和放射科工作人员健康宣教的最佳途径是专业培训及现场讲座;就诊患儿家长最佳途径是宣传挂图、互联网和电视,同时采用多元化健康宣教途径提高辐射相关知识的健康传播。3.在儿科放射诊断三组利益相关者中,就辐射认知水平而言,放射科工作人员优于儿科医生,就诊患儿家长认知水平还需整体提高,尤其要加强对儿科医师不同放射检查导致的辐射剂量和健康效应的培训,以提高其辐射认知水平。建议加强儿科医生、放射科工作人员以及就诊患儿家长辐射风险认知的健康教育。儿科医生要加大辐射相关知识的培训力度;放射科工作人员应继续加强专业知识及法规培训;需要对就诊患儿家长加强科普知识宣传,提高参与主动性,从而更好的提高儿童放射诊断检查中相关人群的辐射防护意识和认知水平。
[Abstract]:BACKGROUND With the rapid development and wide application of radiation diagnosis and treatment technology, it is possible to cause unnecessary harm to human body if the protection is improper, while promoting the progress of diagnosis and treatment technology, improving the level of diagnosis and treatment, benefiting the vast number of patients and subjects. For the sake of sensitivity, the rational application and protection of Radiology Diagnosis and treatment are particularly important, and have been concerned by international organizations. The legitimacy and optimization of radiology diagnosis practice are the main means to reduce patients'doses, and the radiation risk awareness of the major stakeholders involved in radiology diagnosis is to improve the legitimacy and protection. There are few studies on children's radiation risk perception of radiological diagnostic examination in China. More attention should be paid to these aspects. It is very important to strengthen health education and health education on children's radiation risk perception of radiological diagnostic examination. The purpose of this study is to understand the radiation risk and radiation protection awareness of the population concerned, and to provide reference for the formulation of relevant policies and strategies for children's radiation diagnosis. The knowledge and influencing factors of radiation risk and protection in children's radiological diagnosis and examination provided scientific basis for the application of radiological diagnosis and examination technology and the adoption of necessary protective measures and health education. Methods The subjects were selected from 3 first-class hospitals in Beijing area (including Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Children's Hospital Affiliated to Capital Institute of Pediatrics and Peking University Third Hospital). The pediatricians, radiologists and parents of the children who were on the job were investigated and questionnaires were sent out. Field investigation. 2. Investigation methods: After pre-investigation, according to the mean comparison between groups, determine the sample size should be investigated. By trained investigators on-the-spot distribution of questionnaires, fill in the questionnaire according to the requirements, by the investigators will be returned on the spot, immediately check whether there are omissions or obvious contradictions in filling. This survey issued 609 questionnaires, recovery. After data entry and statistical analysis, 600 valid questionnaires were selected and numbered. Epita 3.1 data entry and SPSS 23 were used for statistical analysis. The main statistical methods were: (1) descriptive analysis, including frequency, mean and standard deviation. (2) Multivariate analysis, including multiple linear regression and binary logistic regression analysis. Results 1. Different groups of people have different knowledge about the objective assessment of radiation knowledge. (1) The correct answer rate of objective assessment of pediatrician's radiation awareness reached 62.5%, more than 50%, which was in the middle and upper level. Male, P = 0.002, with statistical significance (p0.05). (2) Radiological staff radiation awareness objective assessment of the correct answer rate of 64.5%, more than 50%, in the upper level; occupational classification of Radiology scientist (p = 0.017), bachelor degree and above education (undergraduate P = 0.029, master P = 0.004, doctor P = 0.002) are all aware of the level of basic radiation knowledge. (3) there were 4 questions correctly answered less than 50% in the objective assessment of the radiation awareness of the parents of the children; the parents'educational level (undergraduate P = 0.007; master P = 0.002), occupation (housework and unemployment P = 0.023; medical staff and teachers P = 0.018) were all aware of the basic radiation knowledge. (4) the awareness of radiation risk among the three groups was lower than that of men (p = 0.000); the basic radiation knowledge of the parents of the patients was lower than that of the pediatricians, and that of the pediatricians was lower than that of the radiologists (p = 0.000), which was statistically significant (p 0.05). 2) the radiation risk of the children in different groups was lower than that of the pediatricians (p = 0.05). (1) 84.0% of pediatricians had different perceptions of radiation risk in various examinations; 55.5% preferred X-ray examination when they were diagnosed; 49.0% preferred magnetic resonance examination when they were dizzy and headache (non-traumatic or mild traumatic). (2) 55.0% of radiologists believed that the radiation was comprehended; 98.5% believed that radiation had an effect on them. Organs were gonads; 98.5% responded to radiation screening and protection for special parts of patients; 70.0% informed of radiation risk before radiation examination. (3) 73.5% of parents thought that radiation had an impact on children's health; 35.0% thought that they wore protective equipment during radiation examination; 75.0% did not worry about shadowing the body when doctors gave radiation examination. (1) Pediatricians and radiological staff preferred health education through professional training (54.0% and 68.5%), on-site lectures (35.5% and 53.5%) and publicity wall charts (37.5% and 32.5%). Parents preferred propaganda and education through wall charts (45.0%), Internet and television (35.5%) and mobile phone text messages (28.0%). Conclusion 1. In children's radiation risk awareness, different groups have different awareness of radiation assessment, so it is important to strengthen training and management of radiation risk awareness for different groups. The best way for doctors and radiologists to conduct health education is professional training and on-the-spot lectures; the best way for parents of children to see a doctor is to publicize wall charts, the Internet and television, and to adopt diversified health education approaches to improve the health dissemination of radiation-related knowledge. 3. Radiation awareness among three groups of pediatric radiological diagnostic stakeholders As far as radiation level is concerned, radiologists are superior to pediatricians, and parents'cognitive level should be improved as a whole. In particular, training of pediatricians on radiation dose and health effects caused by different radiation examinations should be strengthened to improve their radiation awareness. Health education on radiation risk awareness. Pediatricians should strengthen the training of radiation-related knowledge; radiological staff should continue to strengthen professional knowledge and legal training; parents of children need to strengthen the publicity of scientific knowledge, improve the initiative to participate, so as to better improve the radiation prevention of the relevant groups in children's radiological diagnosis and examination. Nursing consciousness and cognition level.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R146

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