Zusammenfassung
Der Einsatz von Röntgenstrahlen im gefäßchirurgischen Operationsraum hat in den letzten 2 Jahrzehnten durch die Zunahme der endovaskulären Eingriffe, aber auch aufgrund deren Komplexität insbesondere bei endovaskulären Aorteneingriffen (EVAR) durch den Einsatz von Fluoroskopie, Angiographie und Cone-Beam-CT zugenommen. Die Entwicklung und Etablierung von Hybrid-Operationssälen haben das endovaskuläre Therapiespektrum an den jeweiligen Standorten zudem stark erweitert. Der persönliche Strahlenschutz im (Hybrid‑)Operationssaal für jedes einzelne Teammitglied inkl. Anästhesie und Pflegepersonal hat deshalb eine relevante und zunehmende Bedeutung erlangt. Theoretische (physikalische und biologische) Grundkenntnisse, vor allem aber praktische Kenntnisse zur Strahlenreduktion, Strahlenexposition und zum Strahlenschutz sind für endovaskulär tätige Gefäßchirugen/-innen unabdingbar. Durch Umsetzung des ALARA-Prinzips, durch konsequentes Tragen von Strahlenschutzkleidung, Anwendung strahlenschützender Maßnahmen und durch ein bewusstes Verhalten im Umgang mit Röntgenstrahlungsquellen unter Einsatz softwarebasierter Applikationen (z. B. „fusion imaging“) sowie dosimetrischer Echtzeitkontrollen der Strahlenexposition kann die individuelle Strahlenexposition signifikant reduziert werden. Neue Low-dose-Technologien müssen zur optimalen Strahlenreduktion mit sog. „good clinical practic“ und „awareness“ verbunden werden. Jeder einzelne Schritt hat einen hohen Einfluss auf die verwendete Strahlendosis. Strahlenreduktion ist neben Reduktion von Kontrastmittelgabe und verbesserten technischen Erfolgsraten ein notwendiges Ziel im endovaskulären Operationssaal. Ausbildung und kontinuierliches Training des Strahlenschutzes ist eine weitere wichtige Maßnahme zur Reduktion von Strahlenexposition im Hybrid-Operationsaal.
Abstract
The spectrum and complexity of endovascular procedures especially in aortic surgery (EVAR) and the implementation of hybrid operating theaters over the last two decades have significantly increased the use of X‑rays when performing fluoroscopy, angiography and cone beam computed tomography (CT). It is therefore mandatory for all members of operating teams including anesthesia and nursing personnel to improve individual knowledge, behavior and awareness of radiation exposure and radiation protection. For vascular surgeons, theoretical (physical and biological) basic knowledge and especially practical knowledge about radiation physics, radiation exposure and protection have become indispensable. This article provides tips on how to use and apply X‑rays based on the ALARA principle to reduce radiation exposure to the staff in operating theaters or interventional suites as much as possible but without diminishing image quality and subsequently patient safety. Individual protection with lead shields, personalized dosimetry as well as the use of new software-based applications (e.g. fusion imaging) together with modern hybrid operating theater imaging hardware equipment can significantly reduce the individual radiation exposure. New low-dose technologies must be coupled with good clinical practice and awareness for optimal radiation reduction. Each single stage has a high influence on the radiation dose used. Radiation reduction is a main goal beside lowering the amounts of contrast medium used and optimizing clinical results. Education and continuous training of personnel in radiation safety are important measures to reduce radiation exposure in the hybrid operating theater.
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D. Böckler übt Beratertätigkeiten für Siemens Healthineers aus und erhielt in der Vergangenheit Forschungsförderung und Honorare für Vorträge.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Böckler, D. Praktische Tipps für den persönlichen Strahlenschutz bei endovaskulären Eingriffen im Hybrid-Operationssaal. Gefässchirurgie 25, 19–30 (2020). https://doi.org/10.1007/s00772-020-00620-9
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DOI: https://doi.org/10.1007/s00772-020-00620-9