Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Hereditary Hemorrhagic Telangiectasia Program, Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre and the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Can Assoc Radiol J. 2014 May;65(2):135-40. doi: 10.1016/j.carj.2013.02.007. Epub 2013 Aug 6.
To determine the cumulative effective dose (CED) of radiation from medical imaging and intervention in patients with hereditary hemorrhagic telangiectasia (HHT) who have pulmonary arteriovenous malformations and to identify clinical factors associated with exposure to high levels of radiation.
All patients with at least 1 pulmonary arteriovenous malformation were identified from the dedicated patient database of a tertiary HHT referral centre. Computerized imaging and electronic patient records were systematically examined to identify all imaging studies performed from 1989-2010. The effective dose was determined for each study, and CED was calculated retrospectively.
Among 246 patients (mean age, 53 years; 62.2% women) with a total of 2065 patient-years, 3309 procedures that involved ionizing radiation were performed. CED ranged from 0.2-307.6 mSv, with a mean of 51.7 mSv. CED exceeded 100 mSv in 26 patients (11%). Interventional procedures and computed tomography (CT) were the greatest contributors, which accounted for 51% and 46% of the total CED, respectively. Factors associated with high cumulative exposure were epistaxis (odds ratio 2.7 [95% confidence interval, 1.1-6.3]; P = .02), HHT-related gastrointestinal bleeding (odds ratio 2.0 [95% confidence interval, 1.0-3.8]; P = .04) and number of patient-years (P < .0001).
Patients with HHT are exposed to a significant cumulative radiation dose from diagnostic and therapeutic interventions. Identifiable subsets of patients are at increased risk. A proportion of patients receive doses at levels that are associated with harm. Imaging indications and doses should be optimized to reduce radiation exposure in this population.
确定患有遗传性出血性毛细血管扩张症（HHT）并伴有肺动静脉畸形的患者在接受医学影像学和介入治疗过程中接受的辐射累积有效剂量（CED），并确定与高剂量辐射暴露相关的临床因素。
从三级 HHT 转诊中心的专用患者数据库中确定至少存在 1 个肺动静脉畸形的所有患者。系统地检查计算机化成像和电子患者记录，以确定从 1989 年至 2010 年进行的所有影像学研究。确定每项研究的有效剂量，并进行回顾性 CED 计算。
在 246 例（平均年龄 53 岁，62.2%为女性）患者中，共进行了 2065 患者年的研究，共进行了 3309 次涉及电离辐射的操作。CED 范围为 0.2-307.6 mSv，平均为 51.7 mSv。26 例（11%）患者的 CED 超过 100 mSv。介入性操作和计算机断层扫描（CT）是最大的贡献因素，分别占总 CED 的 51%和 46%。与高累积暴露相关的因素是鼻出血（优势比 2.7[95%置信区间，1.1-6.3]；P =.02）、HHT 相关的胃肠道出血（优势比 2.0[95%置信区间，1.0-3.8]；P =.04）和患者年数（P <.0001）。
HHT 患者接受诊断和治疗干预的辐射累积剂量显著。可识别的亚组患者的风险增加。一部分患者接受的剂量会导致伤害。应优化影像学检查指征和剂量，以减少该人群的辐射暴露。
