医学影像那些你不知道的事儿

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                    <section powered-by="gulangu"><section><section><section data-role="paragraph" data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section><p><p><img src="image/20201014/86b79d371e9862b01189f0252a03b2cd_1.png" /></p></p></section><section><section><span><strong></strong></span></section><p><span>医疗器械媒体报道先锋</span></p><p><span>分享专业医疗器械知识</span></p></section><section><section><section>关注</section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><p><br  /></p><p>首先，我们来讲讲两枚戒指的故事。</p><p>&nbsp;</p><p>威廉·康拉德·伦琴发现X光的时候，整个伦敦的贵族圈子都开始为这神奇的光沸腾。这光居然能透视伦琴夫人那戴戒指的手。</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/ae271f224c1d7dcb96e19f5923736510_2.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p><br  /></p><p>借着这两枚戒指的故事，我们今天就来聊聊和放射影像检查有关的那些事儿。<br  /></p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/65515bba88a8114bcac92a9ebbac2116_3.gif" /></p></section></section><section><section><br  /></section></section></section><section powered-by="gulangu"><section><section><p>影像检查不仅能给医生带来直观的结果，也能使病人及时发现自己的问题并且治疗，所以影像检查越来越普及。但人们总是对放射线“谈虎色变”，每次检查时都战战兢兢。真的有那么可怕吗？</p></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span><strong>一、哪些影像学检查有辐射？</strong></span></p></section></section></section><section powered-by="gulangu"><section><section></section></section></section></section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/0228daa10018a4b055ac0eed1ada5ced_4.png" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span>对于人们最担心的辐射问题，在临床常用的影像学检查项目中，与 CT 和 X 光拍片不同的是，&nbsp;核磁共振与 B 超在检查过程中没有用到 X 射线，不会发出电离辐射，因此这两种检查是相当安全的，对人体无害。比如 B 超就大量运用在母婴检查中。而X线、CT、DSA（数字减影血管造影）由于电离效应，会产生一定的辐射，超过一定的剂量，会对人体造成危害。CT的辐射量大于X线。</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/447b1f3f6300eb7dad6480e73c8fda61_5.jpg" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span><strong>二、辐射无处不在</strong></span></p></section></section></section><section powered-by="gulangu"><section><section></section></section></section></section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/0228daa10018a4b055ac0eed1ada5ced_4.png" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span>有些市民一听到有辐射，就感到恐慌。首先，我们要了解一个事实：辐射无处不在。<br  /></span></p><p><br  /></p><p><span>地球上存在天然的本底辐射，比如来自外层空间的宇宙射线，站在阳光下，都不可避免受到辐射；乘坐飞机也会受到少量宇宙辐射；坐地铁行李过安检，国外的透视安检，用的都是X射线呐……</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/bf0092844e947c731188892efac9b0aa_7.jpg" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span><strong>三、放射性检查的辐射有多大？</strong></span></p></section></section></section><section powered-by="gulangu"><section><section></section></section></section></section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/0228daa10018a4b055ac0eed1ada5ced_4.png" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span>短期大剂量或长期小剂量接受辐射，累积效应可能导致细胞突变，与恶性肿瘤发病率正相关，这已成共识。所以，不以剂量为前提谈辐射危害都是在耍流氓！</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/0ecd328733b53307e2250d0e4b0e6c0f_9.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p><span>那么，多少剂量的辐射是在可接受的范围内？</span></p><p><br  /></p><p><span>世界卫生组织的标准是：人体每年接受的辐射量不要超过5mSv（毫希伏）。</span></p><p><br  /></p><p><span>大家在单位例行体检时一般会拍X光胸片，它的辐射量大约是0.1mSv；而做一次低剂量CT胸片是1mSv。</span></p><p><br  /></p><p><span>其实，大多数市民一年中也就是在体检的时候才会接触放射性检查，不必过于担忧。</span></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span><strong>四、如何减少放射性检查对人体的影响？</strong></span></p></section></section></section><section powered-by="gulangu"><section><section></section></section></section></section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/0228daa10018a4b055ac0eed1ada5ced_4.png" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span>明白放射性检查没那么可怕之后，再来谈谈如何减少这类检查对人体的影响。医生在为患者进行放射性检查时，会遵循以下原则：</span></p><p><br  /></p><p><span>1.当患者的表面症状不足以确诊疾病，或者需进一步确定疾病的程度时，医生确实需要借助X光和CT等来明确诊断，才会开出检查单。而且每一项检查都有严格的适应症，会让患者做对应的检查。</span></p><p><br  /></p><p><span>2.尽量选择辐射小的检查项目：能用低剂量技术的就不用高剂量技术；能用X线解决的就不用CT；每年必要的体检尽量不做常规CT，而做低剂量CT筛查。</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/73111d5fb26b1ae4c98b20862a36cfee_11.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p><span>随着影像检查设备的更新换代，低辐射剂量技术的应用，患者所受的辐射也就越来越小。</span></p><p><br  /></p><p><span>3.避免多次重复检查。</span></p><p><br  /></p><p><span>4.做放射性检查时规范操作，对非检查部位、重要部位采取严格的防护措施。如做胸部X线检查，腹部、甲状腺等部位会用铅衣等防护设备予以保护。</span></p><p><br  /></p><p><span>5.对于特殊人群予以特殊关注。</span></p><p><br  /></p><p><span>备孕女性、怀孕3个月内的女性，以及儿童等特殊群体，应少接触或根本不接触放射检查。怀孕3个月之后，如果病情确实需要通过放射性检查来诊断，在做好必要的防护之后，建议该检查的还是得检查，以免延误治疗。</span></p></section></section></section><section powered-by="gulangu"><section><section><span>Q</span></section><section><section>A</section></section><section>&amp;</section></section></section><section powered-by="gulangu"><section><section><p><span><strong><span>①怀孕前受到照射会影响胎儿吗?</span></strong></span></p><p><span>怀孕前两周内如果女性接受了高于10&nbsp;rads的X线照射（相当于连续拍10000÷0.02=500000张X线胸部平片），才可能会杀死胚胎。但是这是一个0或者1的问题，也就是说如果胎儿存活了，就不会有问题。大家也想想一个人一生都不可能拍到这么多X线平片。</span></p><p><span>&nbsp;</span></p><p><span><strong><span>②有孕妇接受胸部X线检查结果孩子畸形了！?</span></strong></span></p><p><span>记住，不接受X线照射，同样会有4%-6%的新生儿有各种各样的畸形，但绝大多数是轻微的，比如胎痣，多一个手指或脚趾等。孩子有畸形并不是诊断性放射线的结果。但也有些甚至没有接触X线生出来的孩子也会出现畸形。</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/f2bc16346a95ddce9edf7e7b70595c38_12.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p><span><strong>③那超声波对胎儿也有害吗?</strong></span></p><p><span>超声波使用的是一种声波，不是离子射线。到目前为止，从没有过诊断性超声波造成胎儿损伤的报道出现，包括多普勒彩超。孕期超声波是安全的，这也是为什么现代妇产科产检不用X线，而常规用超声波。</span></p><p><br  /></p><p><span><strong><span>④那磁共振是安全的吗?</span></strong></span></p><p><span>磁共振同超声一样不使用离子射线，而是使用磁场改变体内的氢离子能量状态而成像。所以是不会对胎儿造成损害的。所以当需要检查胎儿中央神经系统发育情况或者确诊胎盘前置等胎盘异常时，磁共振是最佳选择。</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/6c192cc1801c3defa6dd775998d62300_13.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p>对于孕妇以下是注意事项</p></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><p>1.首先，也是最重要的，如果你怀孕了，或者怀疑怀孕了，一定要告诉你的医生。这不光是X线照射的问题，其他用药的选择，都是很重要的。</p><p><br  /></p><p>2.如果你怀孕期间需要做X线检查，记得一定告诉你的医生，你是否近期做过相似检查。也许这次的检查就可以省掉。</p><p><br  /></p><p>3.总之，如果你怀孕了，或者怀疑怀孕了，请咨询医生，不管是做任何方面的检查。但不必要去担心，更不是堕胎的理由。</p></section></section></section></section><section></section></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span><strong>五、放射性检查利大于弊</strong></span></p></section></section></section><section powered-by="gulangu"><section><section></section></section></section></section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/0228daa10018a4b055ac0eed1ada5ced_4.png" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><p><span>放射性检查对人类健康带来的益处远远大于坏处。全身各系统疾病几乎无一不结合放射学检查而得以诊断，甚至有些疾病的放射学检查是唯一确诊手段。</span></p><p><br  /></p><p><span>但是从小到大，吃了几十年的饭，走了几十年的路，进了无数次的医院，相信有一件事你们到现在也没有搞清楚：X光 、CT、B超、磁共振成像这四样影像学检查到底它们的成像原理和区别是什么？到底它们各自针对哪些情况的检查?</span></p><p><p><img src="image/20201014/4290895604dee19e64837c19af442790_15.gif" /></p></p></section></section></section><section powered-by="gulangu"><section><section><p><span>一般而言，对这四种影像检查的解释是这样的：</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/a4990df9e78d01871bc3c7653b4a7bac_16.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p><span>这些检查分别针对哪些情况使用，也就是说进了医院这些检查该怎么选？</span></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/ccca86c8cbdcdd1e978d68debb28d6fb_17.jpg" /></p></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section></section><section><section powered-by="gulangu"><section><section><p><span>注意</span></p></section></section></section></section></section></section><section powered-by="gulangu"><section><section><p><span>上面说的都是常规情况，不是绝对的，需要具体问题具体分析。</span><br  /></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201014/a07dcd371eb98cec18eedd83fc73ecfb_18.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp;<span>而对于一些特殊群体，比如孕妇或者备孕人群，在准备进行 X 线相关检查时，请务必告知放射科检查技师，寻求他们的建议。</span></p><p><br  /></p><p><span><strong><span>来源：健康中国、全国卫生12320、北京大学深圳医院、&nbsp;深圳市中医院</span></strong></span></p></section></section></section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><p><br  /></p><section 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