胸部数字X射线摄影所致中国成人受检者剂量研究
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摘要
目的:研究胸部数字X射线摄影所致中国成人受检者器官组织的吸收剂量,为评价人群辐射危险和患者辐射防护提供依据。材料与方法:本课题首先在湖南省区域内对不同级别的卫生机构进行抽样,对抽样单位的每台胸部摄影设备抽取10例成年受检者,采用热释光剂量计(TLD,成份为LiF,Mg,Cu,P),在临床条件下测量了接受胸部后前位(PA)和侧位(LAT)X射线摄影受检者的入射体表剂量(ESD),并记录临床条件下胸部放射摄影所使用的技术参数以用于后续理论计算和实验测量中。再利用蒙特卡罗(Monte Carlo,MC)技术,选择医学内照射剂量(MIRD)人体数学模型,以现场调查所得的胸部X射线摄影技术参数和几何条件为输入参数,从理论上估算了成人胸部PA和LAT摄影所致各器官组织的吸收剂量和由ESD转换成组织器官吸收剂量的剂量转换因子(DCF)。然后,利用仿真中国人体模型,在其体内布放TLD元件,选择一台数字式胸部X射线摄影设备(DR机),在管电压为110kV、自动曝光控制(AEC)、焦皮距为152cm的条件下,分别用PA和LAT程序对仿真人体模型进行摄影,测量人体内部各器官组织的吸收剂量和DCF。最后,将三部分内容进行综合分析,计算出中国成人典型条件下胸部放射摄影所致受检者器官组织的吸收剂量。结果:本研究共抽取了30家卫生医疗机构共35台放射诊断设备,接受胸部PA和LAT检查的受检者人数分别为226例和73例,平均每次放射摄影所致受检者的ESD分别为0.38±0.49mGy/次、0.79±0.57mGV/次,与上次全国性调查结果相比,PA检查所致受检者的剂量低于上次调查的湖南省水平,但与上次全国水平无明显差异,而LAT摄影所致受检者的剂量有明显的降低。在胸部放射诊断摄影中使用不同的管电压模式,除DR系统外,屏片系统和计算机摄影(CR)系统使用高仟伏模式进行胸部PA摄影时,ESD均较低,胸部LAT摄影时,无论何种系统,两种管电压模式所致受检者的ESD影响无差异。用MC模拟和仿真人体模型实验测量方法计算出的当前典型临床条件下胸部数字X射线摄影所致成人器官组织的DCF,对于照射野内的器官组织,两者结果具有良好的一致性。最后,在典型条件下,以ICRP60号出版物为计算依据,估算出胸部X射线PA摄影所致成年男女有效剂量值分别为0.14mSv、0.17mSv,女性LAT摄影所致受检者的有效剂量为0.99mSv。如果以ICRP103号出版物为依据,则相应的有效剂量值分别为0.24mSv、0.53mSv、2.0mSv。推导出从ESD到有效剂量的转换系数,对于PA检查,成年男性,两种方法所得的转换系数分别为0.19、0.32,相应的女性成年受检者分别为0.25、0.78。而对于LAT检查,成年女性的转换系数分别为0.31、0.63。结论:本研究获得的胸部摄影所致中国成人器官组织剂量,可为进一步优化胸部放射摄影提供科学依据,对于受照人群辐射危险评估和患者放射防护具有重要的意义。利用中国成人仿真人体模型测量胸部数字X射线摄影中ESD与器官组织吸收剂量的DCF并与MC理论计算结果相比较、分别以ICRP60号和103号出版物对有效剂量进行估算,是本课题的创新点。
To study organ and tissue doses delivered to Chinese adult patient in digital chest radiography procedure in order to provide evidence for the evaluation of population radiation risk and patient radiation protection. Material and methods: Firstly, the clinic measurements were carried out in Hunan province. Local hospitals and the Centers of Disease Control (CDC) of different levels were sampled. Entrance skin dose (ESD) of every 10 adult patients who received chest postero-anterior view (PA) or lateral (LAT) diagnostic radiography were measured for all the equipment of the sampling units, Thermoluminescence detectors (TLD, the materials were LiF,Mg,Cu,P) were used to detect the ESD. Technical parameters used in clinical condition were recoded and were then used in the consequent studies. Secondly, a Monte Carlo (MC) technical with an adult "Medical Internal Irradiation Dose" (MIRD) mathematical model and the parameters used in clinical condition of chest radiography were used to calculate organ and tissue doses, and the doses were normalize to ESD, thus the dose converse factors (DCF) were archived. Thirdly, male and female Chinese adult anthropomorphic phantoms with TLDs placed in organs and tissues were irradiated by a direct radiography (DR) system with PA and LAT procedure, respectively. The technical parameters used in the procedures were the followings: the tube potential was 110kV, automatic exposure control (AEC), focus to skin distance (FSD) was 152cm. And then, the absorbed dose of the organs and tissues were measured to calculate the DCF. Finally, the result of each steps were summarized to obtain typical organ and tissue doses in the typical irradiation parameters. Results: 35 radiation equipments of 30 hospitals and CDCs were sampled, and the number of the patient who received chest PA and LAT procedure were 226 and 73, respectively. The mean patient ESD was 0.38±0.49mGy/graphy, 0.79±0.57mGy/graphy for chest PA and LAT procedure, respectively. Compared the results with that of the last national survey, it was found that for PA procedure, there were no significant difference between the national level and the result of this study, but lower than that of the Hunan provincial level. As for LAT procedure, the result of this study was significantly lower than that of last national survey. The high kV technical model used in PA procedure may be resulted in lower ESD in the screen-film system and the computed radiography (CR) system than the conventional kV model, except for the DR system. As for the LAT procedure, no difference was found between the two different tube potential models, without reference to different systems. Absorbed doses and DCF of organs or tissues in typical clinical chest radiography were archived using MC simulation and experiment measurement, respectively. Good agreement was found for organs and tissues which were lay under the direct radiation field between the two methods. For the typical condition of digital chest PA procedure, the calculated effective dose according to ICRP publication 60 was 0.14mSv, 0.17mSv for adult male and female, respectively, and for the LAT procedure, the patient effective dose for female was 0.99mSv. However, the corresponding effective doses were 0.24mSv, 0.53mSv and 2.0mSv when it was calculated according to ICRP publication 103. DCF from ESD to effective dose were also calculated according to ICRP publication 60 and 103. For male patient, the DCF was 0.19 and 0.32 for chest PA procedure, respectively. And for female, the DCF was 0.25, 0.78, respectively. As for LAT procedure, the female patient DCF was 0.31, 0.63, respectively. Conclusion: The result of Chinese adult patient dose in chest radiography provides scientific evidence for further chest image optimization, and can be of great useful to evaluate the radiation risk of population and to patient radiation protection. The use of adult Chinese Anthropomorphic phantom in the measurement of DCF from ESD to organ and tissue absorbed doses in chest digital radiography, the comparison of these to MC calculation, and the comparison of the calculation of effective dose in chest radiography according to ICRP 60 and 103 publication is the innovation point of this study.
To study organ and tissue doses delivered to Chinese adult patient in digital chest radiography procedure in order to provide evidence for the evaluation of population radiation risk and patient radiation protection. Material and methods: Firstly, the clinic measurements were carried out in Hunan province. Local hospitals and the Centers of Disease Control (CDC) of different levels were sampled. Entrance skin dose (ESD) of every 10 adult patients who received chest postero-anterior view (PA) or lateral (LAT) diagnostic radiography were measured for all the equipment of the sampling units, Thermoluminescence detectors (TLD, the materials were LiF,Mg,Cu,P) were used to detect the ESD. Technical parameters used in clinical condition were recoded and were then used in the consequent studies. Secondly, a Monte Carlo (MC) technical with an adult "Medical Internal Irradiation Dose" (MIRD) mathematical model and the parameters used in clinical condition of chest radiography were used to calculate organ and tissue doses, and the doses were normalize to ESD, thus the dose converse factors (DCF) were archived. Thirdly, male and female Chinese adult anthropomorphic phantoms with TLDs placed in organs and tissues were irradiated by a direct radiography (DR) system with PA and LAT procedure, respectively. The technical parameters used in the procedures were the followings: the tube potential was 110kV, automatic exposure control (AEC), focus to skin distance (FSD) was 152cm. And then, the absorbed dose of the organs and tissues were measured to calculate the DCF. Finally, the result of each steps were summarized to obtain typical organ and tissue doses in the typical irradiation parameters. Results: 35 radiation equipments of 30 hospitals and CDCs were sampled, and the number of the patient who received chest PA and LAT procedure were 226 and 73, respectively. The mean patient ESD was 0.38±0.49mGy/graphy, 0.79±0.57mGy/graphy for chest PA and LAT procedure, respectively. Compared the results with that of the last national survey, it was found that for PA procedure, there were no significant difference between the national level and the result of this study, but lower than that of the Hunan provincial level. As for LAT procedure, the result of this study was significantly lower than that of last national survey. The high kV technical model used in PA procedure may be resulted in lower ESD in the screen-film system and the computed radiography (CR) system than the conventional kV model, except for the DR system. As for the LAT procedure, no difference was found between the two different tube potential models, without reference to different systems. Absorbed doses and DCF of organs or tissues in typical clinical chest radiography were archived using MC simulation and experiment measurement, respectively. Good agreement was found for organs and tissues which were lay under the direct radiation field between the two methods. For the typical condition of digital chest PA procedure, the calculated effective dose according to ICRP publication 60 was 0.14mSv, 0.17mSv for adult male and female, respectively, and for the LAT procedure, the patient effective dose for female was 0.99mSv. However, the corresponding effective doses were 0.24mSv, 0.53mSv and 2.0mSv when it was calculated according to ICRP publication 103. DCF from ESD to effective dose were also calculated according to ICRP publication 60 and 103. For male patient, the DCF was 0.19 and 0.32 for chest PA procedure, respectively. And for female, the DCF was 0.25, 0.78, respectively. As for LAT procedure, the female patient DCF was 0.31, 0.63, respectively. Conclusion: The result of Chinese adult patient dose in chest radiography provides scientific evidence for further chest image optimization, and can be of great useful to evaluate the radiation risk of population and to patient radiation protection. The use of adult Chinese Anthropomorphic phantom in the measurement of DCF from ESD to organ and tissue absorbed doses in chest digital radiography, the comparison of these to MC calculation, and the comparison of the calculation of effective dose in chest radiography according to ICRP 60 and 103 publication is the innovation point of this study.
引文
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