北京某郊区基层医疗机构成人头颅及胸部CT检查辐射剂量调查与分析

张斌; 魁学妍; 廖建勇; 王旭; 聂文环; 冯洪杰; 马严丽; 王文武; 张永县

doi:10.15953/j.ctta.2024.351

北京某郊区基层医疗机构成人头颅及胸部CT检查辐射剂量调查与分析

张斌^1,,
魁学妍¹,
廖建勇¹,
王旭³,
聂文环⁴,
冯洪杰⁵,
马严丽⁶,
王文武⁷,
张永县^2, ,

1.
北京市大兴区人民医院，北京 102600
2.
首都医科大学附属北京同仁医院，北京 100730
3.
大兴区卫生健康委科技保障中心，北京 102699
4.
大兴区卫生健康监督所，北京 102600
5.
大兴区疾病预防控制中心，北京 102699
6.
大兴区医院管理中心，北京 102699
7.
大兴区榆垡镇中心卫生院，北京 102602

基金项目: 大兴区预防医学会科研课题基金（大兴区基层医疗机构CT检查辐射剂量调查与分析XHKY202406）。

详细信息

作者简介:
张斌，男，北京市大兴区人民医院，副主任技师，主要从事医学影像技术工作，E-mail：56195020@qq.com

通讯作者:
张永县✉，男，硕士，首都医科大学附属北京同仁医院放射科副主任技师，主要从事医学影像技术基础理论、影像质量管理和放射诊断辐射防护学等方面的研究，E-mail:zhyx20000@163.com。

中图分类号: R 814；R 144.1
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出版历程
- 收稿日期: 2024-12-30
- 修回日期: 2025-02-22
- 录用日期: 2025-03-05
- 网络出版日期: 2025-04-05

Investigation and Analysis of Radiation Dose in Adult Head and Chest CT Examinations at Primary Healthcare Institutions in a Suburban District of Beijing

1.
Department of Radiology, Beijing Daxing District People's Hospital, Daxing District, Beijing 102600, China
2.
Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Dongcheng District, Beijing 100730, China
3.
Health Commission Science and technology support center, Daxing district, Beijing 102699, China
4.
Health and Sanitation Supervision Institute, Daxing district, Beijing 102600, China
5.
Center for Disease Control and Prevention, Daxing district, Beijing 102699, China
6.
Administrative Management Center, Daxing District Hospital, Daxing district, Beijing 102699, China
7.
Yufa Town Central Health Center, Daxing District, Beijing 102602, China

摘要

摘要:
目的：调查北京某郊区基层医疗机构成人头颅和胸部CT检查的辐射剂量水平，评估其合理性，并为建立该区域的诊断参考水平（DRL）提供依据。方法：基于辖区内11家基层医疗机构的15台CT设备，采集头颅和胸部CT检查的相关扫描参数及辐射剂量数据，统计分析剂量分布情况，同时与国内外DRL推荐值进行比较。结果：头颅CT的CTDI和DLP的DRL分别为59.83mGy和814.08 mGy·cm，胸部CT的CTDI_vol和DLP的DRL分别为13.68 mGy和444.51 mGy·cm，均低于我国行业标准。头颅CT的DRL优于大部分国家标准，其余DRL差异不大。三级医院的辐射剂量明显低于一级医院，且扫描参数和辐射剂量均存在显著差异。结论：本地区基层医疗机构的成人头颅和胸部CT辐射剂量总体处于合理水平，但部分基层医院的CT扫描参数有待优化，以进一步降低受检者的辐射风险。
- 辐射剂量 /
- 诊断参考水平 /
- CT
Abstract:
Objective: To investigate the radiation dose levels of adult head and chest CT examinations at primary healthcare institutions in a suburban district of Beijing, evaluate their appropriateness, and provide a basis for establishing diagnostic reference levels (DRL) in the region. Methods: Data were collected from 15 CT scanners in 11 primary healthcare institutions within the district, including scan parameters and radiation dose data for head and chest CT examinations. Statistical analysis was performed to evaluate the distribution of radiation dose levels, and the results were compared with domestic and international DRL recommendations. Results: The DRL for head CT, defined by CTDI and DLP, were 59.83 mGy and 814.08 mGy·cm, respectively. The DRL for chest CT were 13.68 mGy and 444.51 mGy·cm, both of which are lower than the national industry standards. The DRL for head CT were better than those in most other countries, while the differences in other parameters were not significant. The radiation dose levels at tertiary hospitals were significantly lower than those at primary hospitals, and significant differences in scanning parameters and radiation dose were observed across hospitals . Conclusion: The overall radiation dose levels for adult head and chest CT examinations at primary healthcare institutions in the region are within reasonable limits. However, there is still room for optimization of CT scan parameters in some primary healthcare institutions to further reduce patient radiation exposure.
- radiation dose /
- diagnostic reference levels /
- CT

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表 1 头颅和胸部CT检查主要扫描参数

Table 1 Main scanning parameters for head and chest CT examinations

检查部位	管电压（kV）		管电流时间积（mAs）		扫描长度（cm）		螺距		准直宽度(mm）
检查部位	P₅₀(P₂₅, P₇₅)	范围	P₅₀(P₂₅, P₇₅)	范围	P₅₀(P₂₅, P₇₅)	范围	P₅₀(P₂₅, P₇₅)	范围	P₅₀(P₂₅, P₇₅)	范围
头颅	120(120,120)	100~120	212(187.6,252.7)	43~377	13.5(12.5,14.5)	9.3~45.5	1.0(0.7,1.0)	0.5~1.8	20(20,22)	10~160
胸部	120(120,120)	100~130	201(153,245.5)	18~419	31.5(29.5,34.0)	19.3~49.1	1.1(1.1,1.4)	0.6~1.5	22(22,40)	5~160
注：P₅₀:第50百分位数。

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表 2 受检者头颅和胸部CT检查的CTDI_vol、DLP和ED

Table 2 CTDI_vol, DLP, and ED for head and chest CT examinations of patients

	CTDI_vol^a (mGy)			范围	DLP(mGy·cm)			范围	ED(mSv)			范围
	P₂₅	P₅₀	P₇₅	范围	P₂₅	P₅₀	P₇₅	范围	P₂₅	P₅₀	P₇₅	范围
头颅	42.90	56.16	59.83	7.57~84.40	583.44	646.31	814.08	102.65~1809.99	1.21	1.36	1.69	0.23~7.62
胸部	8.55	11.16	13.68	1.90~33.30	267.48	351.18	444.51	29.90~1490.67	6.40	8.21	10.15	1.09~35.77
注：^a：头颅为CTDI_w；P₂₅:第25百分位数；P₅₀:第50百分位数；P₇₅:第75百分位数；CTDI_vol:容积CT剂量指数；DLP：剂量长度乘积；ED：有效剂量。

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Table 3 Differences in CT scanning parameters and radiation dose across hospitals of different levels

参数	头颅				胸部
参数	一级医院	三级医院	Z值	P值	一级医院	三级医院	Z值	P值
管电压(KV)	120(120,120)	120(120,120)	−0.198	0.843	120(120,120)	120(120,120)	−0.786	0.432
管电流时间积(mAs)	252(252,353)	204(171,212)	−58.188	＜0.001	210(178,246)	153(131,247)	−26.598	＜0.001
扫描长度(mm)	135(135,145)	135(114,145)	−6.598	＜0.001	310(295,330)	331(315,355)	−27.372	＜0.001
螺距	1.0(0.6,1.0)	1.0(1.0,1.0)	−32.797	＜0.001	1.0(1.0,1.4)	1.3(1.1,1.4)	−25.253	＜0.001
准直宽度(mm)	20(19,20)	20(20,40)	−36.194	＜0.001	22(20,40)	40(38,80)	−40.474	＜0.001
CTDI_vol(mGy)	56.7(47.6,56.9)	43.3(38.9,60.8)	−18.215	＜0.001	13.4(9.7,20.1)	10.4(8.5,13)	−26.477	＜0.001
DLP(mGy·cm)	651.4(627,819.6)	603.6(529.8,810.2)	−14.583	＜0.001	442.8(333.2,606.9)	325.3(259,406.2)	−30.975	＜0.001
ED(mSv)	1.37(1.24,1.74)	1.38(1.17,1.68)	−7.999	＜0.001	10.17(7.94,14.74)	7.68(6.23,9.34)	−31.700	＜0.001
注：CTDI_vol:容积CT剂量指数；DLP：剂量长度乘积；ED：有效剂量

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表 4 本次调查与国内外CT辐射剂量诊断参考水平比较

Table 4 Comparison of this survey with domestic and international CT DRLs

国家/地区	头颅		胸部
国家/地区	CTDI_vol（mGy）	DLP（mGy·cm）	CTDI_vol（mGy）	DLP（mGy·cm）
本次调查	59.83	814.08	13.68	444.51
行业标准^[7]	60	860	15	470
上海^[8]	57	862	11	361
河北^[9]	56.76	751.24	15.58	515.90
宁夏^[10]	65.67	860.74	29.32	490
江苏^[11]	60	755	15	465
福建^[12]	57	760	11	395
淮安^[13]	63	858.6	12.4	301.2
广州^[14]	58.2	785	13.3	350
青岛^[15]	52	649.2	8.2	285.7
日本^[16]	77	1350	13	510
英国^[17]	63	970	12	610
爱尔兰^[18]	58	940	9	390
加拿大^[19]	79	1302	14	521
美国^[20]	56	962	12	443
意大利^[21]	69	1312	15	569
澳大利亚^[22]	52	880	10	390
土耳其^[23]	66	810	12	289
注：CTDI_vol:容积CT剂量指数；DLP：剂量长度乘积。

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