Linet Martha S, Slovis Thomas L, Miller Donald L, Kleinerman Ruth, Lee Choonsik, Rajaraman Preetha, Berrington de Gonzalez Amy
Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7238, USA.
Chief, Pediatric Radiology, Department of Radiology, Children's Hospital of Michigan, Detroit, MI.
CA Cancer J Clin. 2012 Mar-Apr;62(2):75-100. doi: 10.3322/caac.21132. Epub 2012 Feb 3.
The 600% increase in medical radiation exposure to the US population since 1980 has provided immense benefit, but increased potential future cancer risks to patients. Most of the increase is from diagnostic radiologic procedures. The objectives of this review are to summarize epidemiologic data on cancer risks associated with diagnostic procedures, describe how exposures from recent diagnostic procedures relate to radiation levels linked with cancer occurrence, and propose a framework of strategies to reduce radiation from diagnostic imaging in patients. We briefly review radiation dose definitions, mechanisms of radiation carcinogenesis, key epidemiologic studies of medical and other radiation sources and cancer risks, and dose trends from diagnostic procedures. We describe cancer risks from experimental studies, future projected risks from current imaging procedures, and the potential for higher risks in genetically susceptible populations. To reduce future projected cancers from diagnostic procedures, we advocate the widespread use of evidence-based appropriateness criteria for decisions about imaging procedures; oversight of equipment to deliver reliably the minimum radiation required to attain clinical objectives; development of electronic lifetime records of imaging procedures for patients and their physicians; and commitment by medical training programs, professional societies, and radiation protection organizations to educate all stakeholders in reducing radiation from diagnostic procedures.
自1980年以来，美国民众接受的医疗辐射剂量增加了600%，这带来了巨大益处，但也增加了患者未来患癌的潜在风险。辐射剂量增加主要源于诊断性放射检查。本综述的目的是总结与诊断性检查相关的癌症风险的流行病学数据，描述近期诊断性检查的辐射暴露与癌症发生相关的辐射水平之间的关系，并提出一个降低患者诊断性成像辐射的策略框架。我们简要回顾辐射剂量定义、辐射致癌机制、关于医疗及其他辐射源与癌症风险的关键流行病学研究，以及诊断性检查的剂量趋势。我们描述实验研究中的癌症风险、当前成像检查未来预计的风险，以及遗传易感人群中更高风险的可能性。为了减少诊断性检查未来预计导致的癌症，我们主张广泛使用基于证据的适宜性标准来决定成像检查；对设备进行监督，以可靠地提供达到临床目标所需的最低辐射；为患者及其医生建立成像检查的电子终身记录；医学培训项目、专业协会和辐射防护组织承诺对所有利益相关者进行教育，以减少诊断性检查的辐射。
