Investigation of Radiation Exposure of Patients with Acute Ischemic Stroke during Mechanical Thrombectomy
Investigation of Radiation Exposure of Patients with Acute Ischemic Stroke during Mechanical Thrombectomy
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DOI：
10.1055/a-0924-5945
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发表时间：
2019-12-01
影响因子：
1.8
通讯作者：
Rohde, Stefan
中科院分区：
文献类型：
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作者：
Baerenfaenger, Felix;Block, Andreas;Rohde, Stefan
目的在放射干预中，皮肤是暴露最多的器官。材料与方法对2016年9月至2017年4月连续50例接受机械血栓摘除的卒中患者的检查方案进行评估。所有手术均在一套双平面血管造影仪上进行。利用记录的辐射数据和先前测量的换算系数，回顾计算了局部皮肤当量剂量H-P(0.07)。结果血管闭塞位于大脑中动脉M1和M2段(n=32)，颈内动脉或颈动脉-T段(n=12)和基底动脉(n=6)。透视时间5.7min~137.3 min，平均39.5±-4.1min。测得的皮肤当量剂量范围为0.16+/-0.02~4.80+/-0.51GY，平均值为1.00+/-0.14GY。在50例中，有3例(6%)的皮肤反应超过了德国辐射防护委员会公布的3Gy值。另有15例患者(36%)接受1-3Gy射线照射。在后循环和颈动脉闭塞的长时间手术中，剂量值达到最高。结论即使在现代神经放射学介入治疗中，如机械血栓摘除术，也会产生辐射剂量，约有6%的病例会对皮肤造成明确的辐射损伤。系统地监测局部剂量量，如H-P(0.07)，似乎是合适的。记录和减少局部剂量负荷的可能性应由介入小组与医学物理学专家合作开发。
Purpose In radiological interventions, the skin is the most exposed organ. The aim of this study was to investigate the local dose exposure and the resulting risk of deterministic radiation effects for patients who underwent mechanichal thrombectomy.Materials and Methods The examination protocols of 50 consecutive stroke patients who underwent mechanical thrombectomy from September 2016 to April 2017 were evaluated in this study. All procedures were performed on a biplanar angiographic suite. The local skin equivalent dose H-P(0.07) was calculated retrospectively using the recorded radiation data and previously measured conversion factors. The in-vitro determination of the conversion factors was performed with a silicon semiconductor detector on the surface of an Alderson-Rando head phantom depending on the radiation quality.Results Vessel occlusion was located in the M1 and M2 segments of the cerebral artery media (n = 32), the internal carotid artery or carotid-T (n = 12) and the basilar artery (n = 6). The fluoroscopy times ranged from 5.7 minutes to 137.3 minutes with an average value of 39.5 +/- 4.1 minutes. The determined skin equivalent dose values ranged from 0.16 +/- 0.02 Gy to 4.80 +/- 0.51 Gy, with the mean value being 1.00 +/- 0.14 Gy. In 3 out of 50 cases (6 %), the threshold value for skin reactions of 3 Gy published by the German Radiation Protection Commission was exceeded. A further 15 patients (36 %) were exposed to a dose of 1-3 Gy. The highest dose values were achieved during long procedures with occlusions in the posterior circulation and carotid occlusions. In addition, a local dose reference level of 1.24 +/- 0.15 Gy could be determined for the skin equivalent dose in mechanical thrombectomies for our center.Conclusion Even during a modern neuroradiological intervention, such as mechanical thrombectomy, radiation doses to the patient are produced and can lead to deterministic radiation damage to the skin in approximately 6 % of cases. Systematic monitoring of local dose quantities, such as H-P(0.07), seems appropriate. Possibilities for recording and reducing the local dose load should be developed by the interventional teams in cooperation with a medical physics expert.