| 牛延涛,张永县,康天良,鲜军舫.成年人CT扫描中辐射剂量和诊断参考水平的探讨[J].中华放射医学与防护杂志,2016,36(11):862-867 |
| 成年人CT扫描中辐射剂量和诊断参考水平的探讨 |
| Investigation of radiation dose and diagnostic reference levels in CT scanning for adult patients |
| 投稿时间：2016-07-07 |
| DOI：10.3760/cma.j.issn.0254-5098.2016.11.013 |
| 中文关键词: CT 辐射剂量 诊断参考水平 辐射剂量优化 |
| 英文关键词:CT Radiation dose Diagnostic reference level Radiation dose optimization |
| 基金项目: |
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| 中文摘要: |
| 目的 通过全国范围内CT辐射剂量的调查，了解成年人辐射剂量的现状，进而探讨成年人CT的诊断参考水平不符，需要根据我国的实际建立自己的DRL。方法 2015年9月至2016年3月在全国30个省、自治区、直辖市调查168家医院，其中三级和二级医院各约占一半。随机调查年度状态检测合格的168台CT，包括了临床应用中普遍使用的品牌和型号。每台CT收集头颅、鼻窦、颈部、胸部、腹部、盆腔、腰椎、尿路造影、冠状动脉CT血管造影（CTA）、颅脑CTA、颈部CTA和胸腹CTA共12个检查项目、每个项目10个随机病例。以容积CT剂量指数（CTDIvol）和剂量长度乘积（DLP）作为剂量参量，每个检查项目的所有数据按照大小排序，取25%、50%和75%位数，其中75%位数为参考水平。所得剂量数值与国际相关放射防护组织发布的DRL进行比较。结果 共收集16 244个标准体型成年病例的剂量数据，经逐一检查剔除274个无效数据，剩余15 970个病例数据。全国范围内不同的CT使用单位，同一检查项目的CTDIvol、DLP和扫描期项都有很大差异。与国际放射防护组织发布的数据相比，不同检查项目的诊断参考水平的差异程度各不相同，颅脑诊断水平与参考值相当、胸部腹部较低。剂量指数值最大的几种检查项目为头颅、冠状动脉CTA、颅脑CTA和鼻窦。尿路造影的CTDIvol虽然仅为20 mGy，但DLP却高达2 620 mGy·cm。结论 我国现有的CT剂量水平与国际相关组织发布的诊断标准水平（DRL）不符，需要根据我国的实际建立自己的DRL。 |
| 英文摘要: |
| Objective To understand the CT radiation dose status of adult patients, and to investigate the diagnostic reference levels in adults by a nationwide survey for CT radiation dose. Methods From Sept 2015 to Mar 2016, 168 hospitals in 30 provinces, autonomous regions and municipalities were surveyed randomly, which included tertiary hospitals and second grade general hospitals with each for about half. 168 CT units with annual qualified state inspection randomly surveyed including brands and models commonly used in clinical applications. The clinical cases were collected for a total of 12 scanning items such as head, sinuses, neck, chest, abdomen, pelvis, lumbar spine, urography, coronary CTA, head CTA, neck CTA, chest and abdomen CTA, with each of 10 random cases. The CTDIvol and DLP were selected as radiation dose parameters. All data for each item were sorted in accordance with numerical value, and obtained 25th percentile, 50th percentile and 75th percentile (diagnostic reference levels). The resulting dose values were compared with the diagnostic reference levels published by relevant international organizations on radiological protection. Results A total of 16 244 dose values of adult patients with standard body figure were collected and 15 970 dose values were left while 274 invalid values removed. For different CT users nationwide, CTDIvol, DLP and scanning phases were quite different for the same scanning item. Compared with values released by international radiological protection organizations, the degree of difference in the diagnostic reference levels varied for different scanning items. They had similar level in brain scanning and lower levels in chest/abdomen scanning. The items with maximum dose index were head, coronary CTA, head CTA and sinuses. Although CTDIvol for urography was only 20 mGy, DLP was as high as 2 620 mGy·cm. Conclusions The existing CT dose levels in our country does not accord with the DRLs released by related international organizations, and we should set up our own DRLs according to the clinical reality. |
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