毛喻萱,张冰洁,孙全富,贾天合,吕玉民,刘玉龙,赵风玲,王建伟,王轩,刘彤桢.一起介入治疗意外照射导致背部大面积放射性皮肤损伤的调查及分析[J].中华放射医学与防护杂志,2021,41(12):881-885
一起介入治疗意外照射导致背部大面积放射性皮肤损伤的调查及分析
Investigation and analysis of an extensive skin injury to the back caused by accidental irradiation in interventional procedure
投稿时间:2021-07-12  
DOI:10.3760/cma.j.issn.0254-5098.2021.12.001
中文关键词:  介入治疗  剂量估算  放射性皮肤损伤  临床诊治
英文关键词:Interventional therapy  Dose estimation  Radiation-induced skin injury  Clinical diagnosis and treatment
基金项目:
作者单位E-mail
毛喻萱 新乡市职业病防治研究所 453003  
张冰洁 新乡市职业病防治研究所 453003 15690789220@126.com 
孙全富 中国疾病预防控制中心辐射防护与核安全医学所, 北京 100088  
贾天合 新乡市职业病防治研究所 453003  
吕玉民 河南省职业病防治研究院, 郑州 450052  
刘玉龙 苏州大学附属第二医院 215004  
赵风玲 河南省职业病防治研究院, 郑州 450052  
王建伟 新乡市职业病防治研究所 453003  
王轩 新乡市职业病防治研究所 453003  
刘彤桢 新乡市职业病防治研究所 453003  
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中文摘要:
      目的 通过调查分析1例由于介入治疗意外照射致背部大面积放射性损伤的病例,探讨该事件发生过程中存在的问题,为今后避免类似事件发生提供建议。方法 询问受照患者详细病史,收集分析患者临床诊疗资料,追踪观察患者临床表现和体征。采集患者外周血估算生物剂量,现场采集介入治疗医院照射设备数据等。结果 患者全身生物剂量估算为0.95 Gy。测得介入设备减影模式和透视模式下透视受检者入射体表空气比释动能率典型值分别为373.5和47.8 mGy/min。该介入医生习惯长时间曝光操作,其年有效剂量为20.51 mSv,高于同科室其他工作量相近的介入医生(3.09 mSv)。患者全身及局部临床表现均符合放射损伤,辗转多家医院未予明确诊断,局部损伤治疗效果不明显。结论 结合生物剂量估算结果及临床表现,该病例被诊断为放射性皮肤损伤Ⅳ度。放射性损伤与是否按规范操作及X射线机输出剂量等因素密切相关,非专科医院在辐射损伤的临床诊断及治疗有待加强。
英文摘要:
      Objective To carry out investigation and analysis of an extensive skin radiation injury to the back accidentally caused by interventional procedure and to explore the problems faced in the event with emphasis on avoiding the reoccurance of similar events in the future. Methods The data were collected by consulting the patient's detailed medical history, collecting and analyzing clinical diagnosis and treatment data, tracking and observing their clinical manifestations and signs. The patient's peripheral blood samples were also collected, together with the biological dose estimated and the equipment data collected on the site of the interventional treatment hospital. Results The whole body dose to the patient was estimated to be 0.95 Gy. The typical values of kerma rate of radiation incident on the body surface due to fluoroscopic procedures were 373.5 mGy/min in subtraction modality and 47.8 mGy/min in fluoroscopy modality, respectively. The annual effective dose to the interventional radiologist was 20.51 mSv due to his operation in long-time radiation exposure conditions, higher than 3.09 mSv for other interventional radiologists with similar workload in the same department. The whole body and local clinical manifestations of the patients were in line with radiation injury. No clear diagnosis has been obtained in several hospitals, nor can obvious treatment outcomes be obsevered. Conclusion Combined with the biological dose estimation result and clinical manifestations, the case was diagnosed as degree Ⅳ skin radiation injury. Radiation injury is closely related to whether the operation is conducted according to the standard and the output dose of X-ray machine. Non-specialized hospitals should strengthen clinical diagnosis and treatment of radiation injury.
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