Pauwels Ernest K J, Bourguignon Michel
Leiden University Medical Center, Department of Radiology, Leiden, The Netherlands.
Acta Radiol. 2011 Sep 1;52(7):767-73. doi: 10.1258/ar.2011.100496. Epub 2011 Jul 8.
The considerable rise of computed tomography (CT) procedures over the past few decades has urged responsible authorities and researchers to evaluate the risk of carcinogenesis in the population in relation to the radiation dose delivered to the patient. A single patient undergoing CT may receive a radiation equivalent dose that varies between about 2 mSv (head ) to about 20 mSv (CT-based coronary angiography). Whereas the latter represents a substantial dose delivered to one patient it is, however, population-wise far below the area of the so-called low doses, i.e. 50 mSv in children and 100 mSv in adults. While at effective doses above 50 mSv the risk of cancer induction increases linearly with dose, this dose-response relation has not been demonstrated at doses below 50 mSv. Below 50 mSv no convincing epidemiological evidence for cancer risk exists. Calculations on this risk are based on scientifically questionable, if not invalid, extrapolations of data from higher doses. However, the failure to demonstrate that a risk of cancer exists does not mean that there is no risk. This paper summarizes the data mentioned in various articles from recent literature discussing cancer risks due to CT and puts the results of these studies in perspective of current scientific knowledge in the field of radiation protection. For this we follow the lead of the ICRP and UNSCEAR. Furthermore, we review the strategies and efforts of various national and international bodies and manufacturers of CT apparatus to lower the radiation dose to the patient.
在过去几十年里,计算机断层扫描(CT)检查数量显著增加,这促使相关部门和研究人员评估人群中与患者所接受辐射剂量相关的致癌风险。接受一次CT检查的患者所接受的辐射当量剂量在约2毫希沃特(头部)至约20毫希沃特(基于CT的冠状动脉造影)之间变化。虽然后者对一名患者来说是相当大的剂量,但从人群角度来看,却远低于所谓的低剂量范围,即儿童为50毫希沃特,成人为100毫希沃特。当有效剂量高于50毫希沃特时,诱发癌症的风险随剂量呈线性增加,但在低于50毫希沃特的剂量下,这种剂量反应关系尚未得到证实。在低于50毫希沃特的情况下,不存在令人信服的癌症风险流行病学证据。关于这种风险的计算是基于对高剂量数据的外推,这些外推即便不是无效的,在科学上也是有问题的。然而,未能证明存在癌症风险并不意味着没有风险。本文总结了近期文献中各篇文章提到的有关CT导致癌症风险的数据,并将这些研究结果置于辐射防护领域当前科学知识的背景下进行考量。为此,我们遵循国际辐射防护委员会(ICRP)和联合国原子辐射效应科学委员会(UNSCEAR)的指引。此外,我们还回顾了各个国家和国际机构以及CT设备制造商为降低患者辐射剂量所采取的策略和做出的努力。