肝動脈血管栓塞X射線血管攝影之輻射劑量評估

Radiation Dose Estimate for Interventional Angiography of Transcatheter Arterial Embolization

林雍傑(Yung-Chieh Lin) ； 賴佩伶(Pei-Ling Lai) ； 田雨生(Yeu-Sheng Tyen) ； 李洋瑩(Yang-Ying Li) ； 蔡惠予(Hui-Yu Tasi)

《中華放射線技術學雜誌》 36卷3期 (2012/09) Pp. 135-144

https://doi.org/10.30045/CJRT.201209.0004

摘要

背景：國際輻射防護委員會建議複雜性的介入性血管攝影程序須評估病患之入射表面劑量，避免病人產生確定性效應如皮膚紅斑或紅腫，並建議設施對於常見之檢查建立其劑量閾值及劑量範圍。台灣人的肝細胞癌之發生率高，目前的治療方法主要使用經肝動脈血管栓塞術。目的：本研究目的乃評估病人接受經肝動脈血管栓塞時的入射表面劑量分布與皮膚峰值劑量。方法：實驗材料使用自顯色膠片Gafchromic XR-RV3測量臨床病人皮膚表面劑量，研究期間收集到37個經肝動脈血管栓塞病例，男女性別比分布為26與11位，年齡為38-84歲，平均年齡為63.5歲，並探討膠片的劑量反應與能量依存性，利用飽和生長率模型（下標 net）PV=（a x dose）/（b+dose），進行劑量反應的曲線擬合。而後推導皮膚峰值劑量（PSD）與平均劑量（D），記錄在控制台顯示參考點累積劑量（D（下標 ref））與劑量面積乘積（DAP）。結果：飽和生長率模型劑量反應結果這0.999相關性，在能量範圍65~95kVp所評估的劑量誤差是2.7%。37位病人的峰值皮膚劑量為786±540mGy（184-2890 mGy），且只有一名病人的峰值皮膚劑量超過2Gy的皮膚確定性效應劑量閾值。峰值皮膚劑量與參考點累積劑量的關係為PSD = 0.6709x Dref （R^2=0.937），平均劑量與劑量面積乘積的關係為D= 0.5226xDAP （R^2=O. 877）。結論：所建立的關係式可協助臨床工作者快速了解病人實際接受多少皮膚劑量，建議可使用自顯色膠片XR-RV3應用於介入性放射手術之皮膚劑量分布評估。

關鍵字

介入性血管攝影 ； 自顯色膠片 ； 皮膚表面劑量

並列摘要

Background. The International Commission on Radiological Protection recommended that fluoroscopically-guided complex interventional angiography procedures required to assess patient entrance skin dose, to avoid deterministic risk of skin erythema or swelling. It recommended to establish threshold doses and dose ranges for common fluoroscopic inspection. Taiwanese have high incidence of Hepatocellular carcinoma (HCC), which is often treated by transcatheter arterial embolization (TAE). Purpose. The purpose of this study is to assess the entrance skin dose distribution and peak skin dose (PSD) of patients underwent the procedures of TAE. Methods. Patients' dose measurements were used Gafchromic XR-RV3 films. The study cohort included a total of 37 patients, ratio of male to female distribution of 26 and 11, age 38-84 years, mean age 63.5 years. The dose response and energy dependence of films were also investigated. The dose-response curve was using a saturation growth-rate model of response = (a x dose)/(b + dose). The peak skin dose (PSD) and the average dose (D) of exposure area were then derived. The cumulative dose at reference point (D (subscript ref)) and dose-area product (DAP) shown on the console were recorded. Results. The dose-response curve fitted using the saturation growth-rate model was very well (R^2 = 0.999). The variation of film response at the same dose at tube voltages between 65 and 95 kVp was 2.7%. The peak skin dose of the study cohort was 786 ± 540 mGy (range, 184-2890 mGy). There was only one patient whose peak skin dose over the deterministic effect threshold of 2 Gy. The peak skin dose was related to the cumulative dose at reference point as PSD = 0.6709xD(subscript rer) (R^2 = 0.937). The average dose was related to the DAP as D = 0.5226xDAP (R^2 = 0.877). Conclusion. The above relationship equations can help clinicians to quickly calculate the peak skin dose of patient underwent the procedures of TAE. Using Gafchromic films of XR-RV3 to measure skin dose was recommended in interventional radiology procedures.

並列關鍵字

interventional angiography ； GafChromic film ； entrance skin dose