Niemann T, Zbinden I, Roser H W, Bremerich J, Remy-Jardin M, Bongartz G
Department of Radiology and Nuclear Medicine, University Hospital, Basel, Switzerland.
Acta Radiol. 2013 Sep;54(7):778-84. doi: 10.1177/0284185113485069. Epub 2013 May 9.
The principal concern of any radiation exposure in computed tomography (CT) is the induction of stochastic risks of developing a radiation-induced cancer. The results given in this manuscript will allow to (re-)calculate yield of chest CT.
To demonstrate a method to evaluate the lifetime attributable risk (LAR) of cancer incidence/mortality due to a single diagnostic investigation in a 1-year cohort of consecutive chest CT for suspected pulmonary embolism (PE).
A 1-year cohort of consecutive chest CT for suspected PE using a standard scan protocol was analyzed retrospectively (691 patients, 352 men, 339 women). Normalized patient-specific estimations of the radiation doses received by individual organs were correlated with age- and sex-specific mean predicted cancer incidence and age- and sex-specific predicted cancer mortality based on the BEIR VII results. Additional correlation was provided for natural occurring risks.
LAR of cancer incidence/mortality following one chest CT was calculated for cancer of the stomach, colon, liver, lung, breast, uterus, ovaries, bladder, thyroid, and for leukemia. LAR remains very low for all age and sex categories, being highest for cancer of the lungs and breasts in 20-year-old women (0.61% and 0.4%, respectively). Summation of all cancer sites analyzed raised the cumulative relative LAR up to 2.76% in 20-year-old women.
Using the method presented in this work, LAR of cancer incidence and cancer mortality for a single chest CT for PE seems very low for all age groups and both sexes, but being highest for young patients. Hence the risk for radiation-induced organ cancers must be outweighed with the potential benefit or a treatment and the potential risks of a missed and therefore untreated PE.
计算机断层扫描（CT）中任何辐射暴露的主要关注点是引发辐射诱发癌症的随机风险。本手稿给出的结果将有助于（重新）计算胸部CT的致癌率。
展示一种方法，用于评估因对疑似肺栓塞（PE）进行连续胸部CT的1年队列中的单次诊断检查导致癌症发病/死亡的终生归因风险（LAR）。
回顾性分析了一组使用标准扫描方案对疑似PE进行连续胸部CT检查的1年队列（691例患者，352例男性，339例女性）。根据BEIR VII结果，将各器官接受的归一化患者特异性辐射剂量估计值与年龄和性别特异性平均预测癌症发病率以及年龄和性别特异性预测癌症死亡率相关联。还提供了自然发生风险的额外相关性。
计算了一次胸部CT检查后胃癌、结肠癌、肝癌、肺癌、乳腺癌、子宫癌、卵巢癌、膀胱癌、甲状腺癌以及白血病的癌症发病/死亡LAR。所有年龄和性别类别的LAR仍然非常低，20岁女性的肺癌和乳腺癌LAR最高（分别为0.61%和0.4%）。分析的所有癌症部位的总和使20岁女性的累积相对LAR高达2.76%。
使用本研究中提出的方法，对于所有年龄组和男女两性，单次PE胸部CT检查的癌症发病和癌症死亡LAR似乎都非常低，但年轻患者的LAR最高。因此，辐射诱发器官癌症的风险必须与治疗的潜在益处以及漏诊进而未治疗的PE的潜在风险相权衡。
