DSA冠脉造影对病人及医护人员辐射剂量的研究

发布时间：2018-01-16 15:05

本文关键词：DSA冠脉造影对病人及医护人员辐射剂量的研究　出处：《吉林大学》2013年硕士论文　论文类型：学位论文

【摘要】：冠心病是目前致死率最高的疾病之一，据统计，本病在欧美发达国家比较常见，美国约有700万人患有冠心病，而每年约有50万人死于该病，占人口死亡数的1/3~1/2，占心脏病死亡数的50%~75%，我国虽然不如欧美多见，但近年来也呈快速地增长趋势，是严重危害人们健康的常见病。目前，临床经验已经表明，冠状动脉造影（CoronaryAngiography, CA）为经典的冠心病检查方法，因其准确度较高，被誉为诊断冠心病的金标准，而DSA冠状动脉造影出现时间最早，，技术比较成熟，且可以引导治疗，目前，在绝大多数医院都在使用DSA进行冠脉造影。同时，在放射性介入手术中，冠状动脉介入程序所占比例也是相当高的，在1996年，美国执行的放射性介入程序的次数就超过了700000，而心源性干预措施的冠脉程序与其它介入程序相比为700000：30000。在放射性介入程序过程中，介入放射工作人员必须长时间在X射线下操作，因此，患者和介入放射工作人员都会受到大量的辐射照射，不仅有可能引发确定性效应，如患者皮肤损伤，术者眼晶状体损伤等，同时还会增加随机性效应发生的概率，如血象发生改变（白血病）和年轻女性的乳腺癌发病率等。然而，人们通常为了追求高质量的图像，在很多时候都使用较高条件的X射线照射，这就增加介入工作人员和患者的辐射剂量，据调查，很多介入工作人员的个人剂量水平已经超过个人剂量约束值，同时，根据文献报道，介入过程中的患者的放射性损伤也时有发生，因此，我们必须要高度重视X射线的防护问题，将介入放射工作人员和患者的受照剂量尽可能地降低，并将其限制在合理地可接受的水平，以防止放射性损伤的发生。本实验根据进行冠状动脉造影介入时的摄影和透视条件，利用仿真人体模型，模拟冠脉造影手术，对患者各敏感器官的剂量，介入放射工作人员铅衣前和铅衣后皮肤表面的辐射剂量进行测量并分析，目的是在实行介入手术过程中，对X射线照射是否可以引发放射性损伤，以及介入手术过程中的辐射剂量学问题进行分析，为介入工作人员实行介入手术时，在防护问题方面，提供一些指导性的建议。
[Abstract]:The mortality rate of coronary heart disease is one of the highest disease, according to statistics, the disease is more common in developed countries, about 7 million Americans suffer from coronary heart disease, and every year there are about 500 thousand people died of the disease, the number of deaths accounted for 1/3~1/2, heart disease deaths accounted for 50%~75% in China, although more common than in Europe and America, but in recent years also showed a rapid growth trend, is a common disease which is harmful to people's health. At present, clinical experience has shown that coronary angiography for coronary heart disease (CoronaryAngiography, CA) to check the classical methods, because of its high accuracy, is known as the gold standard for the diagnosis of coronary heart disease, coronary angiography and DSA appeared in the earliest time and the technology is relatively mature, and can guide the treatment, at present, in the vast majority of hospitals are using DSA to coronary angiography. At the same time, the radioactive interventional treatment of coronary artery interventional procedures, the proportion is quite high, In 1996, the number of radioactive intervention procedures performed by the United States exceeded 700000, while the coronary intervention procedures of cardiac interventions were compared with other interventional procedures for 700000:30000..
In the process of interventional procedures, interventional radiology staff must be long time under X ray, therefore, patients and interventional radiology staff will be a lot of radiation, not only may lead to deterministic effects, such as patients with skin damage of eye lens damage, but will also increase the probability of occurrence of random the effect of change, such as blood cells (leukemia) and young women, the incidence of breast cancer. However, people usually in order to pursue high quality image, X rays are used in most of the time is high, which increases the radiation dose in staff and patients according to the survey, many involved in the staff level the personal dose has exceeded the individual dose constraint value, at the same time, according to reports, in the process of interventional radiation injury patients have also occurred, therefore, we must attach great importance to X ray The issue of protection is to minimize the exposure dose of the interventional radiology staff and patients and limit it to a reasonable acceptable level, so as to prevent the occurrence of radiation damage.
This experiment was carried out according to the coronary artery angiography and X-ray photography conditions, using the simulation model of the human body, simulation of coronary angiography in patients with surgery, the sensitive organ dose of radiation workers in the lead clothes before and lead clothes after radiation dose on the surface of the skin was measured and analyzed, the purpose is in the process of interventional operation. The X ray can cause radiation damage, radiation dosimetry problems and intervention in the process of analysis, for the intervention staff through surgical intervention, in protection issues, provide some constructive suggestions.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R144.1

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