Johnson Jason N, Hornik Christoph P, Li Jennifer S, Benjamin Daniel K, Yoshizumi Terry T, Reiman Robert E, Frush Donald P, Hill Kevin D
From the Division of Pediatric Cardiology (J.N.J., C.P.H., J.S.L., K.D.H.) and Division of Radiology (T. T. Y., R.E.R., D.P.F.), Department of Pediatrics, Duke University Medical Center, Durham, NC; and Duke Clinical Research Institute, Durham, NC (J.S.L., D.K.B., K.D.H.).
Circulation. 2014 Jul 8;130(2):161-7. doi: 10.1161/CIRCULATIONAHA.113.005425. Epub 2014 Jun 9.
Children with heart disease are frequently exposed to imaging examinations that use ionizing radiation. Although radiation exposure is potentially carcinogenic, there are limited data on cumulative exposure and the associated cancer risk. We evaluated the cumulative effective dose of radiation from all radiation examinations to estimate the lifetime attributable risk of cancer in children with heart disease.
Children ≤6 years of age who had previously undergone 1 of 7 primary surgical procedures for heart disease at a single institution between 2005 and 2010 were eligible for the study. Exposure to radiation-producing examinations was tabulated, and cumulative effective dose was calculated in millisieverts. These data were used to estimate lifetime attributable risk of cancer above baseline using the approach of the Committee on Biological Effects of Ionizing Radiation VII. The cohort included 337 children exposed to 13 932 radiation examinations. Conventional radiographs represented 92% of examinations, whereas cardiac catheterization and computed tomography accounted for 81% of cumulative exposure. Overall median cumulative effective dose was 2.7 mSv (range, 0.1-76.9 mSv), and the associated lifetime attributable risk of cancer was 0.07% (range, 0.001%-6.5%). Median lifetime attributable risk of cancer ranged widely depending on surgical complexity (0.006%-1.6% for the 7 surgical cohorts) and was twice as high in females per unit exposure (0.04% versus 0.02% per 1-mSv effective dose for females versus males, respectively; P<0.001).
Overall radiation exposures in children with heart disease are relatively low; however, select cohorts receive significant exposure. Cancer risk estimation highlights the need to limit radiation dose, particularly for high-exposure modalities.
患有心脏病的儿童经常接受使用电离辐射的影像学检查。尽管辐射暴露具有潜在致癌性，但关于累积暴露量及其相关癌症风险的数据有限。我们评估了所有辐射检查的累积有效剂量，以估计患有心脏病儿童的终生癌症归因风险。
2005年至2010年间在单一机构接受过7种主要心脏病外科手术之一的6岁及以下儿童符合本研究条件。记录接受产生辐射检查的情况，并以毫西弗计算累积有效剂量。使用电离辐射生物效应委员会VII的方法，这些数据用于估计高于基线的终生癌症归因风险。该队列包括337名接受了13932次辐射检查的儿童。传统X线照片占检查的92%，而心导管检查和计算机断层扫描占累积暴露量的81%。总体累积有效剂量中位数为2.7 mSv（范围为0.1 - 76.9 mSv），相关的终生癌症归因风险为0.07%（范围为0.001% - 6.5%）。根据手术复杂性，癌症终生归因风险中位数差异很大（7个手术队列的范围为0.006% - 1.6%），并且每单位暴露女性的风险是男性的两倍（女性每1 mSv有效剂量的风险为0.04%，男性为0.02%；P<0.0
