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医学影像辐射风险:明辨事实与幻想。

Radiation risks of medical imaging: separating fact from fantasy.

机构信息

Department of Radiology, Mayo Clinic, Rochester, MN 55901, USA.

出版信息

Radiology. 2012 Aug;264(2):312-21. doi: 10.1148/radiol.12112678.

Abstract

During the past few years, several articles have appeared in the scientific literature that predict thousands of cancers and cancer deaths per year in the U.S. population caused by medical imaging procedures that use ionizing radiation. These predictions are computed by multiplying small and highly speculative risk factors by large populations of patients to yield impressive numbers of "cancer victims." The risk factors are acquired from the Biological Effects of Ionizing Radiation (BEIR) VII report without attention to the caveats about their use presented in the BEIR VII report. The principal data source for the risk factors is the ongoing study of survivors of the Japanese atomic explosions, a population of individuals that is greatly different from patients undergoing imaging procedures. For the purpose of risk estimation, doses to patients are converted to effective doses, even though the International Commission on Radiological Protection warns against the use of effective dose for epidemiologic studies or for estimation of individual risks. To extrapolate cancer incidence to doses of a few millisieverts from data greater than 100 mSv, a linear no-threshold model is used, even though substantial radiobiological and human exposure data imply that it is not an appropriate model. The predictions of cancers and cancer deaths are sensationalized in electronic and print public media, resulting in anxiety and fear about medical imaging among patients and parents. Not infrequently, patients are anxious about a scheduled imaging procedure because of articles they have read in the public media. In some cases, medical imaging examinations may be delayed or deferred as a consequence, resulting in a much greater risk to patients than that associated with imaging examinations. © RSNA, 2012.

摘要

在过去的几年中,科学文献中出现了几篇文章,预测美国每年将有数千例癌症和癌症死亡病例是由使用电离辐射的医学成像程序引起的。这些预测是通过将小而高度推测的风险因素乘以大量患者来计算得出的,从而得出令人印象深刻的“癌症受害者”数字。风险因素是从电离辐射生物效应(BEIR)VII 报告中获取的,而没有注意到 BEIR VII 报告中关于其使用的警告。风险因素的主要数据源是对日本原子弹爆炸幸存者的持续研究,这是一个与接受成像程序的患者大不相同的人群。为了进行风险估计,即使国际辐射防护委员会警告不要将有效剂量用于流行病学研究或个体风险估计,也将患者的剂量转换为有效剂量。从大于 100 mSv 的数据推断出几毫希沃特的癌症发病率,使用了线性无阈值模型,尽管大量放射生物学和人类暴露数据表明该模型不适用。癌症和癌症死亡的预测在电子和印刷大众媒体中被大肆宣传,导致患者和家长对医学成像感到焦虑和恐惧。患者经常因为在大众媒体上读到的文章而对预定的成像程序感到焦虑。在某些情况下,可能会延迟或推迟医学成像检查,从而导致患者面临比成像检查更大的风险。©RSNA,2012。

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