11（征求意見(jiàn)稿）IDB11/TXXXXX—XXXX前言 II 2規(guī)范性引用文件 3術(shù)語(yǔ)和定義 4基本要求 5DR檢查的診斷參考水平 36CT檢查的診斷參考水平 77介入放射診療成像的診斷參考水平 8診斷參考水平的應(yīng)用要求 DB11/TXXXXX—XXXXII本文件按照GB/T1.1-2020《標(biāo)準(zhǔn)化工作導(dǎo)則第1部分:標(biāo)準(zhǔn)化文件的結(jié)構(gòu)和起草規(guī)則》的規(guī)定起草。本文件由北京市衛(wèi)生健康委員會(huì)提出并歸口。本文件由北京市衛(wèi)生健康委員會(huì)組織實(shí)施。本文件起草單位：本文件主要起草人：DB11/TXXXXX—XXXX3醫(yī)療服務(wù)放射成像輻射參考劑量成年人本文件給出了成年人醫(yī)學(xué)放射成像輻射劑量參考水平的基本要求、普通數(shù)字X射線攝影（DR）和乳腺DR檢查的診斷參考水平、X射線計(jì)算機(jī)體層成像（CT）檢查的診斷參考水平和介入放射診療成像的診斷參考水平、診斷參考水平的應(yīng)用要求。本文件適用于醫(yī)學(xué)放射成像中成年受檢者的DR、CT和介入放射診療常見(jiàn)成像項(xiàng)目。2規(guī)范性引用文件下列文件中的內(nèi)容通過(guò)文中的規(guī)范性引用而構(gòu)成本文件必不可少的條款。其中，注日期的引用文件，僅該日期對(duì)應(yīng)的版本適用于本文件:不注日期的引用文件，其最新版本(包括所有的修改單)適用于本文件。WS/T637X射線計(jì)算機(jī)斷層攝影成年人診斷參考水平3術(shù)語(yǔ)和定義下列術(shù)語(yǔ)和定義適用于本文件。3.1診斷參考水平diagnosticreferencelevel，DRL在醫(yī)學(xué)診斷成像中，用于受檢者放射防護(hù)最優(yōu)化的劑量水平，以評(píng)估在常規(guī)條件下某個(gè)特定的放射檢查項(xiàng)目給予中等體型受檢者的劑量是否異常高或異常低。3.2診斷參考水平表征量DRLquantity一種常用、易于測(cè)量和確定的用于表示醫(yī)學(xué)成像任務(wù)中診斷參考水平的電離輻射量。3.3診斷參考水平值DRLvalue全國(guó)或某地域的調(diào)查范圍內(nèi)，醫(yī)療機(jī)構(gòu)中適當(dāng)DRL表征量中位數(shù)分布的第75百分位數(shù)。4基本要求4.1在放射診斷成像中，輻射劑量診斷參考水平應(yīng)根據(jù)對(duì)放射成像實(shí)踐中的輻射劑量調(diào)查而得到，并作為優(yōu)化受檢者輻射劑量的一種工具。4.2根據(jù)放射成像實(shí)踐的相關(guān)要求選擇適宜的診斷參考水平表征量，所選用的量應(yīng)是該成像類(lèi)型的常用量。條件允許時(shí)，可選擇多個(gè)診斷參考水平表征量。4.3診斷參考水平值應(yīng)每隔3年至5年修訂或更新一次，必要時(shí)縮短修訂時(shí)間間隔。5DR檢查的診斷參考水平DB11/TXXXXX—XXXX45.1普通DR常見(jiàn)檢查項(xiàng)目的輻射劑量和診斷參考水平見(jiàn)表1。表1普通DR常見(jiàn)檢查項(xiàng)目的輻射劑量和診斷參考水平位位位位位(mGy）第250.060.170.650.690.710.20.191.243.10.190.16第500.090.210.841.041.060.290.331.854.450.290.29第750.140.311.252.181.860.510.532.978.390.370.37乘積(mGy●cm2)第2570.00152.00968.00363.001104.00122.00124.001189.001086.00136.00136.00第50122.00202.001534.00977.001606.00210.00215.002009.001526.00200.00187.00第75159.00259.001917.002336.002867.00312.00301.003500.003359.00269.00255.00第250.020.030.090.120.090.010.010.190.12<0.001<0.001第500.020.040.140.190.130.020.010.30.18<0.001<0.001第750.030.050.200.430.230.030.020.470.35<0.001<0.001有效劑量為人體各組織或器官的當(dāng)量劑量乘以相應(yīng)的組織權(quán)重因數(shù)（引自國(guó)際5.2普通DR常見(jiàn)檢查項(xiàng)目的器官劑量診斷參考水平見(jiàn)表2。表2普通DR常見(jiàn)檢查項(xiàng)目的器官劑量診斷參考水平（mGy）檢查項(xiàng)位位位位位位位位位DB11/TXXXXX—XXXX5目紅骨髓0.040.030.030.310.150.090.020.020.130.29<0.01<0.01腎上腺0.100.050.040.780.21<0.01<0.01<0.010.190.23<0.01<0.01大腦<0.01<0.01<0.01<0.01<0.01<0.010.030.04<0.01<0.01<0.01<0.01乳腺0.020.130.140.050.03<0.01<0.01<0.010.020.01<0.01<0.01結(jié)腸<0.010.010.010.200.830.45<0.01<0.010.960.83<0.01<0.01胸廓外氣道0.01<0.01<0.01<0.01<0.01<0.010.250.15<0.01<0.01<0.01<0.01膽囊0.010.070.020.241.040.03<0.01<0.011.360.89<0.01<0.010.040.060.090.120.12<0.01<0.01<0.010.080.03<0.01<0.01腎臟0.010.060.051.080.200.01<0.01<0.010.200.84<0.01<0.01肝臟0.040.170.010.340.830.01<0.01<0.010.741.58<0.01<0.01肺0.100.100.090.430.630.030.030.010.670.04<0.01<0.01淋巴結(jié)0.020.030.040.450.690.020.030.010.720.33<0.01<0.01肌肉0.020.020.030.470.740.020.030.010.780.33<0.01<0.01食管0.060.050.050.490.790.010.030.010.830.04<0.01<0.01<0.01<0.01<0.01<0.01<0.01<0.010.240.11<0.01<0.01<0.01<0.016黏膜卵<0.0<0.0<0.00.260.680.47<0.0<0.00.730.60<0.0<0.0巢1111111胰0.040.030.100.310.590.01<0.0<0.00.580.18<0.0<0.0腺1111前列腺<0.01<0.01<0.010.020.140.86<0.01<0.010.190.05<0.01<0.01唾<0.0<0.0<0.0<0.0<0.0<0.00.180.25<0.0<0.0<0.0<0.0液腺1111111111骨骼0.060.040.040.320.160.160.070.060.140.240.020.03皮膚0.020.030.030.170.220.260.040.030.210.320.020.03小<0.00.010.010.280.850.38<0.0<0.01.020.73<0.0<0.0腸11111脾0.050.010.210.700.330.01<0.0<0.00.260.04<0.0<0.0臟1111胃0.020.010.130.201.230.02<0.01<0.011.370.08<0.01<0.01睪<0.0<0.0<0.0<0.00.031.95<0.0<0.00.030.01<0.0<0.0丸11111111胸0.020.050.040.020.02<0.00.01<0.00.010.01<0.0<0.0腺1111甲狀腺0.02<0.01<0.01<0.01<0.01<0.010.510.27<0.01<0.01<0.01<0.01膀<0.0<0.0<0.00.070.811.16<0.0<0.01.070.14<0.0<0.0胱1111111子<0.0<0.0<0.00.220.840.66<0.0<0.01.060.36<0.0<0.0宮1111111注2：入射空氣比釋動(dòng)能為在受檢者或模體表面射線束中心軸上測(cè)量得DB11/TXXXXX—XXXX75.3乳腺DR常見(jiàn)檢查項(xiàng)目的輻射劑量和診斷參考水平見(jiàn)表3。表3乳腺DR檢查項(xiàng)目的乳腺平均劑量和診斷參考水平（mGy）能第25百分位數(shù)3.693.78第50百分位數(shù)4.805.27第75百分位數(shù)6.707.32第25百分位數(shù)0.991.02第50百分位數(shù)1.201.46第75百分位數(shù)1.871.946CT檢查的診斷參考水平6.1CT常見(jiàn)檢查項(xiàng)目的輻射劑量和診斷參考水平見(jiàn)表4。表4CT常見(jiàn)檢查項(xiàng)目的輻射劑量和診斷參考水平第25百分位數(shù)第50百分位數(shù)第75百分位數(shù)(mGy?cm)(mGy)(mGy?cm)(mGy)(mGy?cm)43.45650.5848.25693.7953.34787.3242.25751.4447.08862.0253.64993.7242.40854.5155.801089.45120.001564.2514.38217.3523.50358.3030.81485.929.50244.2912.53342.4814.63437.116.64248.168.62349.8511.40436.391.6061.162.1080.803.30120.9010.54409.1413.08520.9014.84930.42腹部+盆腔11.29563.3913.80746.7715.79910.34胸部+腹部+盆腔9.96742.5312.24965.2016.011396.3611.29405.3314.13501.6816.85540.3714.38419.7616.60515.8019.21588.39DB11/TXXXXX—XXXX810.681027.1113.831940.7716.912394.9229.85709.4848.001058.0058.061274.1712.91247.9817.58306.9729.00442.278.27324.2711.71453.5824.34621.877.37388.7811.10496.1215.85769.204.76507.9612.12692.7515.281014.624.93629.707.30896.0313.031515.866.06178.959.01226.3313.15355.257介入放射診療成像的診斷參考水平介入放射診療成像常見(jiàn)項(xiàng)目的輻射劑量和診斷參考水平見(jiàn)表5。表5介入放射診療成像常見(jiàn)項(xiàng)目的輻射劑量和診斷參考水平第25百分位數(shù)第50百分位數(shù)第75百分位數(shù)(Gy·cm2)(mGy)(Gy·cm2)(mGy)(Gy·cm2)(mGy)10.00110.0025.00330.0035.00510.0050.00605.0075.001100.00115.001750.00------7.0060.0020.0090.0040.00310.00------10.0045.0015.0055.0040.0080.005.0020.007.0030.0010.0050.005.0035.0015.0070.0025.00155.0070.00390.00110.00595.00195.00870.0075.00460.00155.001020.00300.001225.0010.0055.0035.00170.0080.00220.0050.00240.00115.00390.00165.00690.0010.0035.0030.00105.0065.00150.0040.00205.0060.00260.00100.00445.00DB11/TXXXXX—XXXX9入射參考點(diǎn)空氣比釋動(dòng)能為距焦點(diǎn)一定距離的空間點(diǎn)累積的空氣8診斷參考水平的應(yīng)用要求8.1診斷參考水平不宜用于個(gè)體受檢者的劑量評(píng)價(jià)。診斷參考水平值不應(yīng)作為劑量限值來(lái)使用。8.2醫(yī)療機(jī)構(gòu)應(yīng)按照WS/T63