輻射劑量日益漸增,介入性治療團隊該怎麼提高防護力?
TAVR、CTO、多血管、周邊血管等較複雜、耗時長的血管內手術量日益漸增,使得醫療團隊面臨更高的輻射暴露,影響長期健康風險。2021年美國心血管攝影與介入治療學會SCAI(The Society for Cardiovascular Angiography and Interventions)對此提供11項最佳操作指引要協助介入治療團隊人員降低輻射暴露:

1.選擇低劑量的螢光透視設定,例如較低的每幀劑量、較低的每秒幀數
Select low dose settings on fluoroscope, such as lower dose per frame, lower frame rate (4-7.5 fps for fluoroscopy, 7.5-15 fps for cine).

2.盡可能使用”Fluoro Save”擷取畫面取代”Cine Mode”
Use “Fluoro Save” instead of cine when possible.

3.使用Collimation (準直功能)減低散射到病人和工作人員的輻射劑量
Use collimation to lower radiation dose and scatter to patient and staff.

4.避免使用太傾斜的照射角度並應時常改變照射角度以分散輻射劑量分佈
Avoid working in steep angles and change working angles to “spread the dose.”

5.提高手術台高度、減少病人與X光接收器的距離以降低病人與工作人員的輻射劑量
Raise table height to decrease patient dose, and minimize distance between patient and detector to decrease patient dose and scatter to operator.

6.使用低放大倍率(Magnification)
Use lower magnification (example 22 cm FOV instead of 19 cm).

7.病人四肢遠離X光照射路徑與X光管
Keep patient’s extremities out of the beam path and away from the x-ray tube.

8.“選擇長度長的導管”並且”離X光管後退一步“保持與X光管之間的距離,特別是經由橈動脈進入的病例。確認正確安裝移動式鉛護具與鉛桌圍
Maintain furthest possible distance from x-ray tube by using long tubing, especially for radial cases, and “taking a step back”. Ensure proper use of moveable lead shields and under-table drapes.

9.使用移動式鉛屏保護工作人員
Consider moveable lead screens to protect CCL staff.

10.使用即時輻射劑量監控裝置、輻射防護蓋巾以及機械手臂減少輻射曝露
Consider use of real-time radiation monitoring, radiation protection drapes and robotic PCI to lower operator radiation exposure.

11.定期評估與升級設備(硬體與軟體)以減少輻射劑量
Regular assessment and upgrading of equipment (hardware and/or software) to minimize radiation dose.

除此之外,亦可以在您的工作環境中整合使用EggNest™輻射防護系統,減少90%的室內散射輻射、保護所有工作人員,為團隊打造最友善的工作環境。

The EggNest™ 輻射防護系統
減少90%整體散射輻射,保護整個團隊

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#保護自己、保護他人

參考資料:
1. 11 steps every Cath Lab can take to reduce scatter radiation exposure to physicians and staff – EGG Medical

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