白家瑢,王凤,吴琳,陆颖,袁超,杨昊晟

• 1:复旦大学附属儿科医院心血管中心
• 2:自然科学学院德克萨斯大学奥斯汀分校

摘要(Abstract)：

目的建立常见先天性心脏病(先心病)介入手术的单中心辐射剂量值,以加强国内先心病介入医师的术中辐射防护意识。方法回顾性收集复旦大学附属儿科医院2016年1月至2018年10月采用低辐射剂量影像策略下进行的先心病介入手术的辐射剂量值,包括透视时间、空气比释动能和剂量-面积乘积(DAP)。纳入先心病介入手术种类包括动脉导管未闭封堵术、房间隔缺损封堵术、室间隔缺损封堵术、肺动脉瓣狭窄成形术、主动脉缩窄球囊血管成形术和复杂体-肺动脉侧支堵闭术。结果纳入496例先心病患儿介入手术中,动脉导管未闭封堵术、房间隔缺损封堵术、室间隔缺损封堵术、肺动脉瓣狭窄成形术、主动脉缩窄球囊血管成形术和复杂体-肺动脉侧支堵闭术分别为178例、77例、96例、68例、36例和41例,介入手术的辐射剂量DAP/kg中位数分别为7.25μGy·m2/kg、8.99μGy·m2/kg、24.61μGy·m2/kg、12.61μGy·m2/kg、11.68μGy·m2/kg和30.74μGy·m2/kg。结论本研究建立了低辐射剂量影像策略下六类常见先心病患儿介入手术的单中心辐射剂量值,可用于儿童先心病介入手术辐射防护质量的初步评价。

关键词(KeyWords)： 辐射剂量;儿童;先天性心脏病;介入治疗

Abstract:

Keywords:

基金项目(Foundation): 2016年国家重点研发项目(2016YFC1000500)

作者(Author): 白家瑢,王凤,吴琳,陆颖,袁超,杨昊晟

参考文献(References)：

• [1] Ait-Ali L, Andreassi MG, Foffa I, et al. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart,2010,96(4):269-274.
• [2] Walsh MA, Noga M, Rutledge J. Cumulative radiation exposure in pediatric patients with congenital heart disease. Pediatr Cardiol,2015,36(2):289-294.
• [3] Connolly B, Racadio J, Towbin R. Practice of ALARA in the pediatric interventional suite. Pediatr Radiol,2006,36(Suppl 2):163-167.
• [4] Cevallos PC, Armstrong AK, Glatz AC, et al. Radiation dose benchmarks in pediatric cardiac catheterization:A prospective multicenter C3PO-QI study. Catheter Cardiovasc Interv,2017,90(2):269-280.
• [5] Ghelani SJ, Glatz AC, David S, et al. Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States. JACC Cardiovasc Interv,2014,7(9):1060-1069.
• [6] Kobayashi D, Meadows J, Forbes TJ, et al. Standardizing radiation dose reporting in the pediatric cardiac catheterization laboratory-a multicenter study by the CCISC(Congenital Cardiovascular Interventional Study Consortium). Catheter Cardiovasc Interv,2014,84(5):785-793.
• [7] Chambers CE, Fetterly KA,Holzer R,et al. Radiation safety program for the cardiac catheterization laboratory. Catheter Cardiovasc Interv,2011,77(4):546-556.
• [8]中国医师协会儿科医师分会先天性心脏病专家委员会,中华医学会儿科学分会心血管学组,编辑委员会中华儿科杂志.儿童常见先天性心脏病介入治疗专家共识.中华儿科杂志,2015,53(1):17-24.
• [9] Ubeda C, Miranda P, Vano E, et al. Organ and effective doses from paediatric interventional cardiology procedures in Chile. Phys Med,2017,40:95-103.
• [10]陆轶,李春坚.冠心病介入治疗的辐射防护.中国介入心脏病学杂志,2018,26(11):641-644.
• [11]白家瑢,吴琳.儿童先天性心脏病介入治疗中的辐射防护.中华儿科杂志,2017,55(10):796-799.
• [12]王凤,陆颖,袁超,等.低剂量影像策略在儿童室上性心动过速射频消融术中的辐射防护作用分析.中华儿科杂志,2017,55(4):272-276.
• [13] Borik S, Devadas S, Mroczek D, et al. Achievable radiation reduction during pediatric cardiac catheterization:How low can we go? Catheter Cardiovasc Interv,2015,86(5):841-848.
• [14] Covi SH, Whiteside W, Yu S, et al. Pulse fluoroscopy radiation reduction in a pediatric cardiac catheterization laboratory. Congenit Heart Dis,2015,10(2):E43-E47.
• [15] Ubeda C, Vano E, Gonzalez L, et al. Influence of the antiscatter grid on dose and image quality in pediatric interventional cardiology X-ray systems. Catheter Cardiovasc Interv,2013,82(1):51-57.
• [16] Osei FA, Hayman J, Sutton NJ, et al. Radiation dosage during pediatric diagnostic or interventional cardiac catheterizations using the"air gap technique"and an aggressive"as low as reasonably achievable"radiation reduction protocol in patients weighing <20 kg.Ann Pediatr Cardiol,2016,9(1):16-21.
• [17]冯俊,程景林,郭杰,等.小儿先天性心脏病介入治疗中辐射剂量的评价.安徽医药,2012,16(2):184-186.
• [18]刘晓晗,王子军.数字减影血管造影低剂量技术在儿童介入诊疗中的应用.中国医学装备,2015,12(4):71-73.
• [19] Sulieman A, Vlychou M, Tsougos I, et al. Radiation doses to paediatric patients and comforters undergoing chest X rays. Radiat Prot Dosimetry,2011,147(1-2):171-175.
• [20] Olgar T, Sahmaran T. Establishment of radiation doses for pediatric X-ray examinations in a large pediatric hospital in turkey. Radiat Prot Dosimetry,2017,176(3):302-308.
• [21] Wambani JS, Korir GK, Tries MA, et al. Patient radiation exposure during general fluoroscopy examinations. J Appl Clin Med Phys,2014,15(2):4555.
• [22] Obara H, Takahashi M, Kudou K, et al. Estimation of effective doses in pediatric X-ray computed tomography examination. Exp Ther Med,2017,14(5):4515-4520.
• [23] Hui P, Goo HW, Du J, et al. Asian consortium on radiation dose of pediatric cardiac CT(ASCI-REDCARD). Pediatr Radiol,2017,47(8):899-910.
• [24] Miksys N, Gordon CL, Thomas K, et al. Estimating effective dose to pediatric patients undergoing interventional radiology procedures using anthropomorphic phantoms and MOSFET dosimeters. AJR Am J Roentgenol,2010,194(5):1315-1322.
• [25] Yakoumakis EN, Gialousis GI, Papadopoulou D, et al. Estimation of children's radiation dose from cardiac catheterisations, performed for the diagnosis or the treatment of a congenital heart disease using TLD dosimetry and Monte Carlo simulation. J Radiol Prot,2009,29(2):251-261.
• [26] Chida K, Ohno T, Kakizaki S, et al. Radiation dose to the pediatric cardiac catheterization and intervention patient. AJR Am J Roentgenol,2010,195(5):1175-1179.
• [27] Onnasch DG, Schroder FK, Fischer G, et al. Diagnostic reference levels and effective dose in paediatric cardiac catheterization. Br J Radiol,2007,80(951):177-185.