【作者】 马卫东；

【导师】 苏旭；

【作者基本信息】 吉林大学 ， 公共卫生硕士（专业学位）， 2019， 硕士

【摘要】 目的:随着我国国民经济的快速发展和科学技术的不断进步,核能核技术已广泛运用于工农业生产、科研、军事和医疗事业,尤其是放射诊疗技术的应用发展迅猛,放射诊疗技术已成为医学诊疗中不可或缺的技术手段,极大地促进了医学的发展和进步。然而,辐射是一把“双刃剑”,放射诊疗技术在造福人类的同时,如果在放射诊疗活动中“正当性”和“最优化”原则得不到落实,必将给放射工作人员带来不必要的辐射照射,进而影响其健康和生命安全,尤其是介入放射学操作人员近距离操作,接受辐射照射剂量较大,如果介入放射学操作人员在放射诊疗活动中“正当性”和“最优化”原则得不到落实,将存在较大健康风险。近期研究表明:介入放射学操作人员健康状况堪忧。因此,研究介入放射学操作人员个人剂量监测与健康风险分析具有重要的现实意义。本研究在原研究计划内容上进行了较大扩展,不仅仅对放射学操作人员个人剂量监测与健康风险进行了分析,而是进一步扩展了研究内容,对我国放射诊疗辐射防护的整体现状进行了分析,并在此基础上提出了相应对策。本研究结果及对策建议对提高我国放射诊疗辐射防护与质量控制水平具有重要意义。方法:按照《中华人民共和国职业病防治法》(中华人民共和国主席令第81号)、《放射性同位素与射线装置安全和防护条例》(国务院令449号)、《放射工作人员职业健康管理办法》(卫生部令第55号)、《放射诊疗管理办法》(卫生部令第46号)和放射诊疗辐射防护与质量控制相关标准,通过从医用辐射防护监测网信息系统、放射工作人员个人剂量信息系统、职业性放射性疾病报告系统中提取相关数据,并结合文献调查研究、现场调查等方法对相关数据进行综合分析。重点关注接受辐射照射剂量较大的介入放射学工作人员的剂量和防护状况,查找存在的问题,提出对策与建议。为国家有关部门加强放射诊疗管理,制定相关政策、法规和标准提供科学依据。结果:1.我国放射诊疗机构2013年50555家,2014年53358家,2015年56663家,放射诊疗机构每年以6%的速度在增长。2.我国放射诊疗设备2013年10.3万台,2014年11.1万台,2015年11.8万台,放射诊疗设备每年6%--8%的速度增长。3.我国放射诊疗频次2013年3.94亿人次/年,2014年4.06亿人次/年,2015年4.54亿人次/年,诊疗频次每年以3%--11.8%的速度增长,尤其是2014至2015年诊疗频次增长达11.8%。4.2017年放射诊疗机构放射工作人员职业健康检查率为83.9%,个人剂量监测率达94.5%。5.国家建立了较为完善的法律法规标准体系。结论:1.我国放射诊疗机构、设备和诊疗频次迅速增长,放射诊疗技术的应用发展迅猛,并已成为医学诊疗不可或缺的技术手段,极大地促进了医学事业的进步。2.放射诊疗辐射防护仍存在诸多问题亟待解决,放射诊疗技术滥用的问题依然存在,医疗机构放射工作人员辐射防护意识淡薄,尤其是介入放射学工作人员健康状况堪忧,介入放射学工作人员辐射防护亟待加强。3.国家有关方面应进一步完善国家有关法律法规,推进《放射损伤防治管理条例》的立法工作;进一步提高放射卫生标准的可操作性和适用性;加强对放射工作人员的培训,提高防护意识;推动放射诊疗“正当性”原则的真正落实;进一步规范核医学工作场所布局;加强核医学工作人员的内照射个人剂量监测;进一步加强对放射诊疗机构的监督管理;建立健全医学物理师制度;完善放射卫生信息系统。更多还原

【Abstract】 ObjectiveWith the rapid development of national economy and the continuous advancement of science and technology in China,nuclear energy and nuclear technology have been widely used in industrial and agricultural production,scientific research,military and medical enterprise,especially the application of radiological diagnosis and treatment technology has developed rapidly,and radiological diagnosis and treatment technology has became the indispensable technical in medical diagnosis and treatment,it has greatly promoted the development and progress of the medical enterprise.However,radiation is a “double-edged sword”.While radiological diagnosis and treatment technology is beneficial to human beings,if the principles of “Justification” and “Optimization” are not implemented in radiological diagnosis and treatment activities,it would brought additional radiation exposure to radiation workers,even affected their health and life safety.Particularly for interventional radiologists who operated near to the radiation source and were exposed to high dose of radiation,there would be greater health risks if the principles of “Justification” and “Optimization” are not implemented in their work.Recent studies have shown that the health status of interventional radiology operators is worrying.Therefore,it is of great practical significance to study personal dose monitoring and health risk analysis of interventional radiology operators.This study has expanded the content of the original research plan.Not only the individual dose monitoring and health risks of interventional radiology operators were analyzed,but also the overall situation of protection in radiological diagnosis and treatment in China was analyzed,and the corresponding countermeasures were put forward on this basis.The research results and countermeasures are important to improve the level of radiation protection and quality control in radiological diagnosis and treatment activities in our country.MethodsAccording to the Law of the People’s Republic of China on the Prevention and Control of Occupational Diseases(Order No.81 of the President of the People’s Republic of China),Regulations for the Safety and Protection of Radioisotope and Radiological Devices(Order No.449 of State Council),the Measures for the Administration of Occupational Health of Radiation Workers(Order No.55 of the Ministry of Health),and the Measures for the Administration of radiological diagnosis and treatment(Order No.46 of the Ministry of Health,)and related standards of radiological protection and quality control in radiological diagnosis and treatment,We got the relevant data fromthe medical radiation protection monitoring network information system,personal dose information system of radiation worker and occupational radiological disease reporting system,combined analysis with literature research,field investigation,etc.Focus on the dose and protection status of interventional radiologists who received larger doses,find out the problems,and propose countermeasures and recommendations.Provide scientific basis for strengthening the management of radiological diagnosis and treatment for relevant national departments and formulating policies,regulations and standards.Results:1.In China,there were 50,555 institution of radiological diagnosis and treatment in 2013,53,358 in 2014,and 56,663 in 2015.The institution of radiological diagnosis and treatment s are growing at a rate of 6% per year.2.In China,there were 103,000 equipments of radiological diagnosis and treatment in 2013,111,000 in 2014,and 118,000 in 2015.Radiological diagnosis and treatment equipment grew at a rate of 6%-8% per year.3.In China,the frequency of radiology diagnosis and treatment was 394 million person-times/year in 2013,406 million person-times/year in 2014,and 454 million person-times/year in 2015.The frequency of diagnosis and treatment increased by 3%--11.8% every year,especially from 2014 to 2015 the growth rate increased to 11.8%.4.In 2017,the occupational health check rate of radiation workers was 83.9% in institution of radiological diagnosis and treatment,and the personal dose monitoring rate was 94.5%.5.In China it has established a relatively complete system of laws,regulations and standards.Conclusion:1.The number of radiological diagnosis and treatment institutions,equipment and the frequency of diagnosis and treatment in China has grown rapidly.The application of radiological diagnosis and treatment technology has developed rapidly,and it hasbecame an indispensable technical for medical diagnosis and treatment,which has greatly promoted the advancement of medical enterprise.2.There are still many problems in radiation protection of radiological diagnosis and treatment,and the abuse of radiological diagnosis and treatment technology still exists.The radiation protection awareness of radiation workers in medical institutions is weak,especially the health status of interventional radiology workers is worrying,radiation protection of interventional radiology workers need to be strengthened.3.The relevant state departments should make further efforts in the following areas.Further improve relevant laws and regulations and promote the legislative work of the Regulations on the Prevention and Control of Radiation Injury;further improve the operability and applicability of radiological health standards;strengthen the training of radiation workers and raise their consciousness of protection;promote the real implementation of the principle of “Justification”;further standardize the layout of nuclear medicine workplace;strengthen personal dose monitoring of internal radiation for nuclear medical staff;further strengthen the supervision and management of radiation diagnosis and treatment institutions;establish and perfect the medical physicists system;and improve the radiation health information system.更多还原