使用现代医疗技术时医务人员受到辐射的问题

封面

如何引用文章

全文:

详细

论证。电离辐射源在医疗实践（心血管内外科、内窥镜检查、创伤科、泌尿科、神经外科、牙科、放射性同位素诊断部门）中的广泛使用导致眼球晶状体和手部皮肤受到低强度散射辐射。国际原子能机构引入的关于减少晶状体的年度等效剂量限制（20毫西弗）的新建议导致基于有效剂量的晶状体剂量评估是不正确的。

该研究的目的是分析方法和评估医务人员在X射线辐射和放射性药物的伽马射线影响下进行各种诊断检查时眼球晶状体和手部皮肤的等效辐射剂量，并对所得结果与以前公布的数据进行比较。

材料和方法。采用了热释光剂量测定法。评估了心血管内外科、内窥镜、同位素诊断、牙科和泌尿科人员的剂量。

结果。心血管外科医生眼球晶状体的计算年度等效剂量为35至90毫西弗，护理人员的为6至19毫西弗（在某些情况下，医生的高达225毫西弗，护士的高达180毫西弗），放射性同位素诊断部门人员的为4.5至9毫西弗。心血管内外科人员手部皮肤的计算年度等效剂量为17至100毫西弗，而在使用放射性药物的工作中，则为24至220毫西弗。事实证明，使用心脑血管外科医生每次手术时的平均剂量估算，通常不可避免地会在一定数量的手术后导致晶状体的超标等效剂量。

结论。超过一定数量的手术（100至200），心血管内外科医生每年接受的眼球晶状体的等效剂量可能超过20毫西弗。在现有辐射水平下，心血管内外科医生眼球晶状体的病变已经是确定的。所得结果证明，有必要进行进一步的剂量测定和流行病学调查，在此基础上可以制定在散射、伽马和X射线的低强度辐射影响下工作的医务人员的眼球晶状体和手部皮肤的辐射防护建议。

作者简介

Sergey A. Ryzhkin

Russian Medical Academy of Continuous Professional Education; Kazan State Medical University

Email: rsa777@inbox.ru
ORCID iD: 0000-0003-2595-353X
SPIN 代码: 5955-5712
俄罗斯联邦, Moscow; Kazan

Yuliya V. Druzhinina

Russian Medical Academy of Continuous Professional Education; Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: druzhininaYV2@zdrav.mos.ru
ORCID iD: 0000-0002-3230-3722
SPIN 代码: 1973-2848
俄罗斯联邦, Moscow; Moscow

Zoya A. Lantukh

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: LantukhZA@zdrav.mos.ru
ORCID iD: 0000-0001-6623-9610
SPIN 代码: 5486-6496
俄罗斯联邦, Moscow

Ilya V. Soldatov

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: SoldatovIV2@zdrav.mos.ru
ORCID iD: 0000-0002-4867-0746
SPIN 代码: 4065-6048
俄罗斯联邦, Moscow

Viktor N. Lesnyak

Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies

Email: Iesnyak_kb83@mail.ru
ORCID iD: 0000-0002-2739-0649
SPIN 代码: 5483-3113
俄罗斯联邦, Moscow

Dmitry P. Lebedev

Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies

Email: lebedevdp@gmail.com
ORCID iD: 0000-0003-1551-3127
SPIN 代码: 4770-5722
俄罗斯联邦, Moscow

Denis N. Samochatov

City Clinical Hospital No. 67 named after L.A. Vorokhobov

Email: dnsamochatov@gmail.com
ORCID iD: 0000-0002-5230-2006
SPIN 代码: 3340-2715
俄罗斯联邦, Moscow

Maria P. Semenova

State Research Center ― Burnasyan Federal Medical Biophysical Center

Email: mps-fmbc@yandex.ru
ORCID iD: 0000-0003-0904-0415
SPIN 代码: 7205-0062
俄罗斯联邦, Moscow

Vitaliy А. Sukhov

The First Sechenov Moscow State Medical University (Sechenov University)

Email: cyxowv@gmail.com
ORCID iD: 0000-0003-2993-0108
俄罗斯联邦, Moscow

Sergey E. Okhrimenko

Russian Medical Academy of Continuous Professional Education

编辑信件的主要联系方式.
Email: ooniii@mail.ru
ORCID iD: 0000-0002-8282-1798
SPIN 代码: 8712-2710
俄罗斯联邦, Moscow

参考

  1. Ivanov SI, Loginova SV, Akopova NA, et al. Problems of dosimetry of the eye lens. Med Radiol Radiation Safety. 2014;59(4):67–72. (In Russ).
  2. International Commission on Radiological Protection [Internet]. ICRP, 1996. Conversion coefficients for use in radiological protection against external radiation. ICRP Publication 74. Ann. ICRP 26 (3-4). Available from: https://icrp.org/publication.asp?id=ICRP+Publication+74. Accessed: 15.04.2023.
  3. International Atomic Energy Agency [Internet]. Radiation protection and safety of radiation sources: International basic safety standards. Interim edition. IAEA; 2011. 329 p.
  4. International Atomic Energy Agency [Internet]. Radiation protection and safety of radiation sources: International basic safety standards. No. GSR Part 3. Vienna, IAEA; 2015. Available from: https://www.iaea.org/publications/8930/radiation-protection-and-safety-of-radiation-sources-international-basic-safety-standards. Accessed: 15.04.2023.
  5. International Commission on Radiological Protection [Internet]. CRP, 2007. The 2007 recommendations of the international commission on radiological protection. ICRP Publication 103. Ann. ICRP 37 (2-4). Available from: https://icrp.org/publication.asp?id=ICRP%20Publication%20103. Accessed: 15.04.2023.
  6. International Commission on Radiological Protection [Internet]. ICRP statement on tissue reactions. Ref. 4825-3093-1464, April 21, 2011. Available from: https://icrp.org/docs/2011%20Seoul.pdf. Accessed: 15.04.2023.
  7. International Commission on Radiological Protection [Internet]. Implications for occupational radiation protection of the new dose limit for the lens of the eye. Interim guidance for use and comment. Draft 1. ICRP; 2013. Available from: https://www.iaea.org/publications/10628/implications-for-occupational-radiation-protection-of-the-new-dose-limit-for-the-lens-of-the-eye. Accessed: 15.04.2023.
  8. International Commission on Radiological Protection [Internet]. ICRP, 2012 ICRP statement on tissue reactions / early and late effects of radiation in normal tissues and organs: threshold doses for tissue reactions in a radiation protection context. ICRP Publication 118. Ann. ICRP 41(1/2). Available from: https://icrp.org/publication.asp?id=ICRP%20Publication%20118. Accessed: 15.04.2023.
  9. UNSCEAR 2010 Report [Internet]. Report of the United Nations Scientific Committee on the Effects of Atomic Radiation 2010. Summary of low-dose radiation effects on health. United Nations, New York; 2011. Available from: https://www.unscear.org/docs/reports/2010/UNSCEAR_2010_Report_M.pdf. Accessed: 15.04.2023.
  10. Karpov NA, Okhrimenko SE, Ivanov SI, et al. Dose in the lens of the eye. In: All-Russian conference with international participation dedicated to the 85th anniversary of the birth V.A. Kuhtina: Collection of materials, 3–4 April. Cheboksary, 2014. P. 235–236. (In Russ).
  11. Nuclear Energy Agency [Internet]. NEA Expert Group on the Dose Limit for the lens of the eye launches survey. nuclear energy agency [cite 2020 April 8]. Available from: https://oecd-nea.org/jcms/pl_40031/nea-expert-group-on-the-dose-limit-for-the-lens-of-the-eye-launches-survey. Accessed: 15.04.2023.
  12. Okhrimenko SE, Korenkov IP, Shandala NK, et al. Dose assessment to the lens of the eye and skin of the personnel in advanced medical technologies. Med Radiol Radiation Safety. 2022;67(1):44–49. (In Russ).
  13. Okhrimenko SE, Osipov AN, Korenkov IP, et al. Assessment of doses of irradiation of the skin of the hands in cardioendovascular surgery and the number of double-strand DNA breaks in the culture of skin fibroblasts on the phantom of the hands. In: Collection of abstracts of the All-Russian scientific and practical conference with international participation “Radiation hygiene and continuing professional education: New challenges and ways of development” dedicated to the 65th anniversary of the Department of Radiation Hygiene and Radiation Safety named after Academician F.G. Krotkov”, October 27, 2022. Moscow; 2022. Р. 64–68. (In Russ).
  14. Okhrimenko SE, Korenkov IP, Prokhorov NI, et al. Radiation-hygienic assessment of modern medical technologies. Hygiene Sanitation. 2020;99(9):939–946. (In Russ). doi: 10.47470/0016-9900-2020-99-9-939-946
  15. Shleenkova EN, Bazhin SY, Kaidanovsky GN, et al. The necessity of regular dose monitoring for the eye lens of the staff working with radiopharmaceuticals. Radiation Hygiene. 2021;14(3):101–111. (In Russ). doi: 10.21514/1998-426X-2021-14-3-101-111
  16. Wrzesień M. 18F-FDG production procedures as a source of eye lens exposure to radiation. J Radiol. 2018;(38):382–393. doi: 10.1088/1361-6498/aaa287
  17. Wrzesień M. The effect of work system on the hand exposure of workers in 18F-FDG production centers. Australasian Physical Engineering Sciences Med. 2018;41(2):541–548. doi: 10.1007/s13246-018-0644-9
  18. Okhrimenko SE, Korenkov IP, Yashkina EI, et al. Irradiation of the skin of the hands in interventional cardiac surgery (report). In: III National Congress with international participation “Sysin readings”, November 16–18, 2022. Moscow; 2022. (In Russ).
  19. McParland BJ, Nosil J, Barry B. A survey of radiation exposure received by the staff at two cardiac catherization laboratories. Br J Radiol. 1990;63(755):885–888. doi: 10.1259/0007-1285-63-755-885
  20. Steffanino G, Rossetti V, Rubichini F, et al. Short communication: Staff dose reduction during coronary angiography using low framing speed. Br J Radiol. 1996;69(825):860–864. doi: 10.1259/0007-1285-69-825-860
  21. Li IB, Kai M, Takano K, et al. Occupational exposure in pediatric cardiac cauterization. Health Phis. 1995;69(2):261–264. doi: 10.1097/00004032-199508000-00011
  22. Medeiros RD, Mennucci TA. [Evolution of X-ray exposure dosage during coronary cineangiolography. (In Portuguese)] Arg Bras Cardiol. 1990;55(1):31–33.
  23. Karppinen J, Parviainen T, Servomaa A, Komppa T. Radiation risk and exposure of radiologists and patients during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA). Radiation Protection Dosimetry. 1995;57(1-4):481–484.
  24. David EF, Andrew K, Christopher O, Sanjog P. The risk of radiation exposure to the eyes of the interventional pain. Physician Radiol Res Practice. 2011;2011:609537. doi: 10.1155/2011/609537
  25. Vecchia ED, Modenese A, Loney T. Risk of cataract in health care workers exposed to ionizing radiation: A systematic review. Med Lav. 2020;111(4):269–284. doi: 10.23749/mdl.v111i4.9045
  26. Morcillo AB, Alejo L, Huerga C, et al. Occupational doses to the eye lens in pediatric and adult noncardiac interventional radiology procedures. Med Physics. 2021;48(4):1956–1966. doi: 10.1002/mp.14753
  27. Merrachi NA, Bouchard-Bellavance R, Perreault P. Eye lens dosimetry in interventional radiology: Assessment with dedicated Hp(3) dosimeters. Can Assoc Radiol J. 2021;72(2):317–323. doi: 10.1177/0846537120911755
  28. Thrapsanioti Z, Askounis P, Datseris I, et al. Eye lens radiation exposure in Greek interventional cardiology article. Radiation Protection Dosimetry. 2017;175(3):344–356. doi: 10.1093/rpd/ncw356
  29. Domienik-Andrzejewska J, Kałużny P, Piernik G. Occupational exposure to ionizing radiation and lens opacity in interventional cardiologists. Int J Occupational Med Environmental Health. 2019;32(5):663–675. doi: 10.13075/ijomeh.1896.01456
  30. Kaydanovsky GN, Shleenkova EN. On problems of the lens ofthe eye radiation dose monitoring. Radiation Hygiene. 2016;9(3):75–80. (In Russ). doi: 10.21514/1998-426Х-2016-9-3-75-80
  31. Shleenkova EN, Golikov VY, Kaidanovsky GN, et al. Results of eye lens doses control of medical personnel in St. Petersburg. Radiation Hygiene. 2019;12(4):29–36. (In Russ). doi: 10.21514/1998-426X-2019-12-4-29-36
  32. UPCommons. Global access to UPC knowledge [Internet]. Ginjaume M, Carnicer A. Oramed: Optimization of radiation protection of medical staff. 2012. EURADOS Report 2012-02. Available from: https://upcommons.upc.edu/handle/2117/17229. Accessed: 15.04.2023.
  33. Vanhavere F, Carinou E, Domienik JL, et al. Measurements of eye lens doses in interventional radiology and cardiology: Final results of the ORAMED project. Radiation Measurements. 2011;46(11):1243–1244. doi: 10.1016/j.radmeas.2011.08.013
  34. EUR-Lex [Internet]. Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. Available from: https://eur-lex.europa.eu/eli/dir/2013/59/oj. Accessed: 15.04.2023.
  35. Azizova TV, Hamada N, Grigorieva ES, Bragin EV. Risk of various types of cataracts in the cohort of workers exposed to occupational chronic radiation. Med Radiology Radiation Safety. 2020;65(4):48–57. (In Russ). doi: 10.12737/1024-6177-2020-65-4-48-57
  36. Mikryukova LD, Krestinina LY, Epiphanova SB. A study of layered lens change in the process of cataract formation in persons exposed to radiation as a result of radiation accidents in the Southern Urals. Radiation Hygiene. 2018;11(4):51–63. (In Russ). doi: 10.21514/1998-426Х-2018-11-4-51-63
  37. Ryzhkin SA, Slesareva AN, Galeeva GZ, Ivanov SI. Clinical examination of the eyes functional status and assessment of equivalent dose to eye lens in medical staff performing endovascular interventions under X-ray guidance. Radiation Risks. 2017;26(3):90–99. (In Russ). doi: 10.21870/0131-3878-2017-26-3-90-99
  38. Galeeva GZ, Ryzhkin SA, Sergeeva SU. The effect of ionizing radiation on a person and the organ of vision. Practical Med. 2016; 99(7): 37–41. (In Russ).
  39. Ryzhkin SA, Galeeva GZ, Sergeeva SU. Radiation cataract in the light of modern research achievements in ophthalmology (review). Bulletin Medical Institute REAVIZ: Rehabilitation Doctor Health. 2016;24(4):37–42. (In Russ).

版权所有 © Eco-Vector, 2024

Creative Commons License
此作品已接受知识共享署名-非商业性使用-禁止演绎 4.0国际许可协议的许可。

##common.cookie##