Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Germany.
AJR Am J Roentgenol. 2011 Jul;197(1):217-23. doi: 10.2214/AJR.10.4979.
Little is known about the long-term effects of exposure to diagnostic ionizing radiation in childhood. Current estimates are made with models derived mainly from studies of atomic bomb survivors, a population that differs from today's patients in many respects.
We analyzed the cancer incidence among children who underwent diagnostic x-ray exposures between 1976 and 2003 in a large German university hospital. We reconstructed individual radiation doses for each examination and sorted results by groups of referral criteria for all cancers combined, solid tumors, and leukemia and lymphoma combined.
A total of 68 incidence cancer cases between 1980 and 2006 were identified in a 78,527-patient cohort in the German childhood cancer registry: 28 leukemia, nine lymphoma, six tumors of the CNS, and 25 other tumors. The standardized incidence ratio for all cancers was 0.97 (95% CI, 0.75-1.23). Dose-response relations were analyzed by multivariable Poisson regression. Although the cancer incidence risk differed by initial referral criterion for radiographic examination, a positive dose-response relation was observed in five patients with endocrine or metabolic disease.
Overall, we observed no increase in cancer risk among children and youths with very low radiation doses from diagnostic radiation, which is compatible with model calculations. The growing use of CT warrants further studies to assess associated cancer risk. Our work is an early contribution of epidemiologic data for quantifying these risks among young patients.
目前对于儿童时期接触诊断性电离辐射的长期影响知之甚少。当前的估计是使用主要源自原子弹幸存者研究的模型得出的，而这些模型在许多方面与当今的患者不同。
我们分析了一家德国大型大学医院在 1976 年至 2003 年间进行诊断性 X 射线照射的儿童的癌症发病率。我们为每次检查重建了个体辐射剂量，并根据所有癌症、实体瘤和白血病及淋巴瘤的转诊标准将结果进行分类。
在德国儿童癌症登记处的 78527 名患者队列中，1980 年至 2006 年间共发现 68 例癌症病例：28 例白血病，9 例淋巴瘤，6 例中枢神经系统肿瘤和 25 例其他肿瘤。所有癌症的标准化发病比为 0.97（95%CI，0.75-1.23）。通过多变量泊松回归分析了剂量-反应关系。尽管癌症发病率风险因初始放射检查的转诊标准而异，但在 5 例内分泌或代谢疾病患者中观察到了阳性剂量-反应关系。
总体而言，我们在接受极低剂量诊断性辐射的儿童和青少年中并未观察到癌症风险增加，这与模型计算结果一致。CT 的广泛应用需要进一步研究以评估其相关的癌症风险。我们的工作是量化年轻患者中这些风险的早期流行病学数据贡献。
