Abstract
The frequency of diagnostic radiation examinations in medical institutions has recently increased to 220 million cases in 2011, and the annual exposure dose per capita was 1.4 mSv, 51% and 35% respectively, compared to those in 2007. The number of chest radiography was found to be 27.59% of them, the highest frequency of normal radiography. In this study, we developed a shielding device to minimize radiation exposure by shielding areas of the body which are unnecessary for image interpretation, during the chest radiography. And in order to verify its usefulness, we also measured the difference in entrance surface dose (ESD) and the absorbed dose, before and after using the device, by using an international standard pediatric (10 years) phantom and a glass dosimeter. In addition, we calculated the effective dose by using a Monte Carlo simulation-based program (PCXMC 2.0.1) and evaluated the reduction ratio indirectly by comparing lifetime attributable risk of cancer incidence (LAR). When using the protective device, the ESD decreased by 86.36% on average, nasal cavity $0.55{\mu}Sv$ (74.06%), thyroid $1.43{\mu}Sv$ (95.15%), oesophagus $6.35{\mu}Sv$ (78.42%) respectively, and the depth dose decreased by 72.30% on average, the cervical spine(upper spine) $1.23{\mu}Sv$ (89.73%), salivary gland $0.5{\mu}Sv$ (92.31%), oesophagus $3.85{\mu}Sv$ (59.39%), thyroid $2.02{\mu}Sv$ (73.53%), thoracic vertebrae(middle spine) $5.68{\mu}Sv$ (54.01%) respectively, so that we could verify the usefulness of the shielding mechanism. In addition, the effective dose decreased by 11.76% from $8.33{\mu}Sv$ to $7.35{\mu}Sv$ before and after wearing the device, and in LAR assessment, we found that thyroid cancer decreased to male 0.14 people (95.12%) and female 0.77 people (95.16%) per one million 10-year old children, and general cancers decreased to male 0.14 people (11.70%) and female 0.25 people (11.70%). Although diagnostic radiation examinations are necessary for healthcare such as the treatment of diseases, based on the ALARA concept, we should strive to optimize medical radiation by using this shielding device actively in the areas of the body unnecessary for the diagnosis.
최근 의료기관에서의 진단방사선검사 빈도는 2011년 2억 2천만건, 연간 일인당 피폭선량은 1.4 mSv로 2007년 대비 각 51%, 35% 증가하였다. 여기서 흉부촬영건수는 일반촬영 중 가장 높은 빈도인 27.59%로 나타났다. 따라서 본 연구에서는 흉부 방사선 촬영 시 영상판독에 불필요한 신체부위를 차폐하여 피폭선량을 최소화 시키는 차폐기구를 개발하고, 그 유용성 평가를 위해 국제 표준 소아(10세) 팬텀과 유리선량계를 사용하여 기구 사용 전, 후의 입사표면선량(entrance surface dose; ESD)과 장기의 흡수선량 차를 측정하였다. 또한 몬테카를로 시뮬레이션 기반 프로그램(PCXMC 2.0.1)을 이용하여 유효선량을 산출하였고 암발생의 생애귀속위험도(lifetime attributable risk of cancer incidence; LAR)를 비교하여 그 감소율을 간접적으로 평가하였다. 방어기구를 사용할 때, 입사표면선량(감소율)은 비강 $0.55{\mu}Sv$ (74.06%), 갑상선 $1.43{\mu}Sv$ (95.15%), 식도 $6.35{\mu}Sv$ (78.42%)로 평균 86.36% 감소되었고, 심부선량(감소율)은 경추 $1.23{\mu}Sv$ (89.73%), 침샘 $0.5{\mu}Sv$ (92.31%), 식도 $3.85{\mu}Sv$ (59.39%), 갑상선 $2.02{\mu}Sv$ (73.53%) 흉추 $5.68{\mu}Sv$ (54.01%) 로 평균 72.30%로 감소되어 차폐기구의 유용성을 확인할 수 있었다. 또한, 유효선량은 착용 전 $8.33{\mu}Sv$에서 착용 후 $7.35{\mu}Sv$로 11.76% 감소하였고, LAR 평가에서는 갑상선 암은 10세 소아 백만 명당 남아 0.14명(95.12%), 여아 0.77명(95.16%), 모든 암은 남아 0.14명(11.70%), 여아 0.25명(11.70%)의 감소(감소율)를 확인할 수 있었다. 진단방사선검사는 질병과 치료 등 건강을 위해 꼭 필요한 검사이지만, 가능한 진단에 불필요한 부위에 이러한 차폐기구를 적극적으로 사용하여 ALARA 개념에 입각한 의료방사선 최적화를 도모해야 할 것이다.
