Guidelines for Patient Radiation Dose Management
Guidelines for Patient Radiation Dose Management
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DOI：
10.1016/j.jvir.2009.04.037
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发表时间：
2009-07-01
影响因子：
2.9
通讯作者：
Cardella, John F.
中科院分区：
文献类型：
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作者：
Stecker, Michael S.;Balter, Stephen;Cardella, John F.
20世纪90年代初，美国食品药品监督管理局（FDA）收到了与介入性荧光透视相关的严重辐射诱导皮肤损伤的报告（2），促使1994年和1995年发布了三份关于记录辐射使用的指南出版物（3-5）。从那时起，包括SIR在内的一些专业放射学会一直在努力减少这些事件的发生频率。2007年，美国放射学会（ACR）发表了关于医疗中患者辐射暴露相关问题的建议。本文件主要关注诊断成像程序，如计算机断层扫描（CT）和核医学，而不是介入程序（6）。ACR的2008年修订版技术标准与X线透视引导手术中放射使用的管理有关（7），采用了与本SIR指南不同但互补的方法。透视引导的侵入性手术可能需要使用大量的辐射才能完成。这可能使患者面临确定性辐射损伤的风险。此外，所有接受放射治疗的患者都有随机性损伤发生率增加的风险，本指南旨在用于与介入放射学操作相关的辐射剂量管理。最重要的护理过程是：（a）患者选择;（B）手术操作;（c）患者监测;（d）适当的文件记录和随访。这些过程的结果测量或指标是个体化患者辐射风险评估、与辐射风险相关的适当知情同意以及遵守记录给药剂量。对患者辐射剂量的担忧是有效的。尽管如此，必须清楚地认识到，所有介入放射学程序的目标是治疗患者，从而改善他们的福祉。这几乎总是需要给予一些辐射，有时可能需要给予临床显著量的辐射。一般来说，辐射的风险是低相比，
In the early 1990s, the US Food and Drug Administration (FDA) received reports of significant radiation-induced skin injuries associated with interventional fluoroscopy (2), prompting the release in 1994 and 1995 of three guidance publications on documenting radiation use (3–5). A number of professional radiological societies, including the SIR, have been working since then to reduce the frequency of these events. In 2007, the American College of Radiology (ACR) published its recommendations on issues related to patient radiation exposure in medicine. This document focuses mostly on diagnostic imaging procedures, such as computed tomography (CT) and nuclear medicine, and not interventional procedures (6). The ACR’s 2008 revision of the Technical Standard pertaining to the management of the use of radiation in fluoroscopically guided procedures (7) takes a different, but complementary, approach to the topic than that used in this SIR guideline. Fluoroscopically guided invasive procedures may require the use of significant quantities of radiation for their completion. This can put patients at risk for deterministic radiation injuries. In addition, all irradiated patients are at risk for an increased incidence of stochastic injuries.These guidelines are written to be used for radiation dose management related to interventional radiologic procedures. The most important processes of care are (a) patient selection,(b) procedure performance,(c) patient monitoring, and (d) appropriate documentation and follow-up. The outcome measures or indicators for these processes are individualized patient radiation risk assessment, appropriate informed consent relating to radiation risk, and compliance with recording administered dose. Concerns over patient radiation doses are valid. Nonetheless, it must be clearly understood that the goal of all interventional radiology procedures is to treat patients and thereby improve their well-being. This will almost always require administration of some radiation and may sometimes require the administration of clinically significant amounts of radiation. In general, the risk of radiation is low compared to