Rusner Carsten, Stang Andreas, Dieckmann Klaus-Peter, Friedel Heiko
Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
Onkologie. 2013;36(4):188-92. doi: 10.1159/000349952. Epub 2013 Mar 18.
Exposure to radiation resulting from diagnostic imaging procedures probably increases late cancer risk. Patterns of care regarding the application of computed tomography (CT) imaging in testicular cancer patients were investigated.
The database of a large German health insurance company comprising 850,000 insured men was searched for cases of testicular cancer arising in the years 2005 and 2006. The number of CT scans applied during a 3-year period of follow-up was noted for each individual patient and the resulting cumulative radiation dose was estimated. The number of CT scans actually observed was compared to guideline recommendations.
177 patients were identified. Within the 3-year observation period, patients received a mean of 4.4 CT scans (standard error: 0.4) whereas a number of 6.2 would have been expected according to contemporary guidelines. Patients were exposed to an estimated total median diagnostic radiation dose of 30 millisieverts (mSv) (interquartile range: 10-54 mSv).
There is a considerable gap between recommendation and actual performance regarding the number of CT scans applied to testicular cancer patients. Unfamiliarity of clinicians with guidelines as well as poor acceptance of high numbers of CT scans scheduled may have contributed to create this particular pattern of care.
诊断成像程序产生的辐射暴露可能会增加晚期患癌风险。对睾丸癌患者应用计算机断层扫描（CT）成像的护理模式进行了调查。
在一家拥有85万参保男性的大型德国健康保险公司的数据库中，搜索2005年和2006年出现的睾丸癌病例。记录每位患者在3年随访期间接受的CT扫描次数，并估算由此产生的累积辐射剂量。将实际观察到的CT扫描次数与指南建议进行比较。
共识别出177例患者。在3年观察期内，患者平均接受4.4次CT扫描（标准误差：0.4），而根据当代指南预计应为6.2次。患者估计的诊断辐射总中位剂量为30毫希沃特（mSv）（四分位间距：10 - 54 mSv）。
在应用于睾丸癌患者的CT扫描次数方面，建议与实际执行情况之间存在相当大的差距。临床医生对指南不熟悉以及对安排大量CT扫描的接受度低，可能导致了这种特殊的护理模式。
