인터벤션 시술 시 면적선량계를 이용한 환자 방사선 선량 평가
Evaluation of Patient Radiation Doses Using DAP Meter in Interventional Radiology Procedures
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초록
해외 각국에서 발표된 중재적 방사선 영역에서의 환자선량을 조사하였으며, 전국 23개 주요 병원에서 국내에서많이 시행되는 13개의 주요 중재적 방사선 시술에 대한 환자선량을 DAP meter를 이용하여 측정하였으며, 시술별피폭선량에 관한 8,415 건의 국내 자료를 확보하고, 각 주요 시술별로 참고 선량치를 제시하였다. 연구결과는 경동맥화학색전술 237.7 Gy·cm2, 투석용 동정맥루 인터벤션시술 17.3 Gy·cm2, 하지 혈관질환의인터벤션시술 114.1 Gy·cm2, 뇌혈관조영술 188.5 Gy·cm2, 뇌동맥류 코일색전술 383.5 Gy·cm2, 경피경간 담즙배액술 64.6 Gy·cm2, 담도 스텐트설치술 64.6 Gy·cm2, 요로 폐색에 대한 신루설치술 22.4 Gy·cm, 다목적 중심정맥 카테터 삽입시술 4.3 Gy·cm2, 항암제 주입 목적의 매몰형 중심정맥 카테터 삽입시술 2.8 Gy·cm2, 혈액투석 목적의 중심정맥 카테터 삽입시술4.4 Gy·cm2, 카테터를 이용한 배액시술 17.1 Gy·cm2 그리고 장기혈관색전술 357.9 Gy·cm2이다. 본 연구를 통해 얻은 선량참고치는 방사선 인터벤션 시술에서 환자선량을 줄일 수 있는 최소한의 가이드라인으로 활용될 수 있을 것으로 생각되며, 참고선량치에 대한 연구는 장비의 발달과 시술방법, 재료의 발전으로 변화될수 있음을 감안하고 선진국에서는 5년마다 시행되고 있음을 참고할 때, 향후 면적선량을 유효선량으로 변환할 수있는 국내시술에 적합한 한국형 변환계수가 연구되어야 할 것으로 사료된다.
Abstract
The author investigated interventional radiology patient doses in several other countries, assessed accuracy of DAP meters embedded in intervention equipments in domestic country, conducted measurement of patient doses for 13 major interventional procedures with use of Dose Area Product(DAP) meters from 23 hospitals in Korea, and referred to 8,415 cases of domestic data related to interventional procedures by radiation exposure after evaluation the actual effectives of dose reduction variables through phantom test. Finally, dose reference level for major interventional procedures was suggested. In this study, guidelines for patient doses were 237.7 Gy·cm2 in TACE, 17.3 Gy·cm2 in AVF, 114.1 Gy·cm2 in LE PTA & STENT, 188.5 Gy·cm2 in TFCA, 383.5 Gy·cm2 in Aneurysm Coil, 64.6 Gy·cm2 in PTBD, 64.6 Gy·cm2 in Biliary Stent, 22.4 Gy·cm2 in PCN, 4.3 Gy·cm2 in Hickman, 2.8 Gy·cm2 in Chemo-port, 4.4 Gy·cm2 in Perm-Cather, 17.1 Gy·cm2 in PCD, and 357.9 Gy·cm2 in Vis, EMB. Dose referenece level acquired in this study is considered to be able to use as minimal guidelines for reducing patient dose in the interventional radiology procedures. For the changes and advances of materials and development of equipments and procedures in the interventional radiology procedures, further studies and monitorings are needed on dose reference level Korean DAP dose conversion factor for the domestic procedures.
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