Erişkinde Girişimsel Radyolojik İşlemlerde Radyasyon Maruziyeti ve Korunma Yolları
Özet
Girişimsel radyolojik işlemler (GRİ), görüntüleme kılavuzluğunda yapılan tanı ve tedavi müdahalelerini kapsamakta olup x-ışını kullanımı nedeniyle radyasyon maruziyetini beraberinde getirmektedir. Bu kompleks işlemler, floroskopi sürelerinin uzamasına ve hem hasta hem de uygulayıcı hekimler için yüksek dozda radyasyon riskine yol açmaktadır. Hastalarda eritrem ve cilt nekrozu gibi deterministik etkilerin önlenmesi için maksimum cilt dozunun (MSD) izlenmesi hayati önem taşırken; floroskopi süresi, hava kerma (AK) ve kerma-alan çarpımı (KAP) gibi parametreler doz niceliğinin tahmininde kritik belirteçlerdir. Personel için temel radyasyon kaynağı ise hastadan kaynaklanan saçılmadır. ALARA prensibi doğrultusunda, ışınlama süresinin minimumda tutulması, düşük film hızı ile darbeli floroskopi modu kullanımı, uygun kolimasyon, ideal hasta-dedektör mesafesinin ayarlanması ve statik çekimler esnasında odada bulunulmaması maruziyeti ciddi düzeyde düşürmektedir. Ek olarak, koruyucu önlük, tiroid ve baş koruyucu, kurşunsuz kompozit ekipmanlar ile katarakt riskini azaltan koruyucu gözlüklerin kullanımı personeli korumada kritiktir. Tüm girişimsel radyoloji çalışanlarının, hem kendilerini hem de hastaları korumak adına dozimetre takibi yapması, ekipmanların yıllık kontrollerini sağlaması ve güncel eğitimlere katılması gerekmektedir.
Interventional radiological procedures (IRP) encompass diagnostic and therapeutic interventions guided by imaging modalities, bringing along radiation exposure due to the inevitable use of x-rays. These increasingly complex procedures result in prolonged fluoroscopy times and higher radiation doses for both patients and practitioners. To prevent deterministic skin injuries like erythema and tissue necrosis in patients, tracking the maximum skin dose (MSD) is crucial, with fluoroscopy time, air kerma (AK), and kerma-area product (KAP) serving as key metrics for dose estimation. For the medical staff, the primary source of occupational radiation is the scatter radiation emitting from the patient. Adhering to the ALARA principle, minimizing exposure time, utilizing pulsed fluoroscopy at the lowest possible frame rates, proper collimation, optimizing patient-to-detector distance, and stepping outside the room during static acquisitions significantly reduce radiation doses. Furthermore, utilizing personal protective equipment including aprons, thyroid shields, lead glasses to prevent radiation-induced cataracts, and lead-free composite vests is essential for staff safety. All interventional radiology personnel must consistently wear personal dosimeters, ensure annual inspections of their protective gear, and undergo regular training to minimize radiation hazards.
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