Bedetti G, Botto N, Andreassi M G, Traino C, Vano E, Picano E
Hospital S Maria della Scaletta, Imola, Italy.
Br J Radiol. 2008 Sep;81(969):699-705. doi: 10.1259/bjr/29507259. Epub 2008 May 28.
Medical radiation from X-rays and nuclear medicine is the largest non-natural (man-made) source of radiation exposure in Western countries. The aim of this study was to assess the individual cumulative effective dose in patients admitted to our cardiology ward. We collected a cumulative radiological history from a structured questionnaire and access to hospital records in 50 consecutive adult patients (36 males; age, 66.7+/-10.8 years) admitted to the Institute of Clinical Physiology in Pisa. The cumulative effective dose was assessed as an indicator of stochastic risk of cancer. We derived the effective dose for each individual examination from the Medical Imaging Guidelines of the European Commission (2001). On average, each patient underwent a median of 36 examinations (interquartile range, 23-46). The median cumulative effective dose was 60.6 mSv. Three types of procedures were responsible for approximately 86% of the total collective effective dose: (i) arteriography and interventional cardiology (12% of examinations, 48% of average dose per patient); (ii) nuclear medicine (5% of examinations, 21% of average dose per patient); and (iii) CT (4% of examinations, 17% of average dose per patient). The median estimated extra risk of cancer was approximately 1 in 200 exposed subjects. In conclusion, the average contemporary cardiological patient is exposed to a significant cumulative effective dose from diagnostic and therapeutic interventions. It is important to log cumulative dose for each patient at the time of each examination. Every effort should be made to justify the indications and to optimize the doses.
在西方国家，来自X射线和核医学的医疗辐射是最大的非自然（人为）辐射暴露源。本研究的目的是评估入住我们心内科病房患者的个体累积有效剂量。我们通过结构化问卷收集了50例连续入住比萨临床生理研究所的成年患者（36例男性；年龄66.7±10.8岁）的累积放射史，并查阅了医院记录。累积有效剂量被评估为癌症随机风险的指标。我们根据欧盟委员会《医学成像指南》（2001年）得出每次个体检查的有效剂量。平均而言，每位患者接受的检查中位数为36次（四分位间距为23 - 46次）。累积有效剂量中位数为60.6毫希沃特。三种类型的检查约占总集体有效剂量的86%：（i）血管造影和介入心脏病学检查（占检查次数的12%，占每位患者平均剂量的48%）；（ii）核医学检查（占检查次数的5%，占每位患者平均剂量的21%）；以及（iii）CT检查（占检查次数的4%，占每位患者平均剂量的17%）。估计每200名受检者中约有1人额外患癌风险为中位数。总之，当代心内科患者平均因诊断和治疗干预而暴露于显著的累积有效剂量。在每次检查时记录每位患者累积剂量很重要。应尽一切努力证明检查指征的合理性并优化剂量。
