Linet Martha S, Kitahara Cari M, Ntowe Estelle, Kleinerman Ruth A, Gilbert Ethel S, Naito Neal, Lipner Rebecca S, Miller Donald L, Berrington de Gonzalez Amy
From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, NCI Shady Grove, 9609 Medical Center Dr, Room 7E452, Bethesda, MD 20892-9778 (M.S.L., C.M.K., E.N., R.A.K., E.S.G., A.B.d.G.); Retired, U.S. Navy, Washington, DC (N.N.); American Board of Internal Medicine, Philadelphia, Pa (R.S.L.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Md (D.L.M.). Members of the Multi-Specialty Occupational Health Group are listed at the end.
Radiology. 2017 Aug;284(2):482-494. doi: 10.1148/radiol.2017161306. Epub 2017 Feb 23.
Purpose To compare total and cause-specific mortality rates between physicians likely to have performed fluoroscopy-guided interventional (FGI) procedures (referred to as FGI MDs) and psychiatrists to determine if any differences are consistent with known radiation risks. Materials and Methods Mortality risks were compared in nationwide cohorts of 45 634 FGI MDs and 64 401 psychiatrists. Cause of death was ascertained from the National Death Index. Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for FGI MDs versus psychiatrists, with adjustment (via stratification) for year of birth and attained age. Results During follow-up (1979-2008), 3506 FGI MDs (86 women) and 7814 psychiatrists (507 women) died. Compared with psychiatrists, FGI MDs had lower total (men: RR, 0.80 [95% CI: 0.77, 0.83]; women: RR, 0.80 [95% CI: 0.63, 1.00]) and cancer (men: RR, 0.92 [95% CI: 0.85, 0.99]; women: RR, 0.83 [95% CI: 0.58, 1.18]) mortality. Mortality because of specific types of cancer, total and specific types of circulatory diseases, and other causes were not elevated in FGI MDs compared with psychiatrists. On the basis of small numbers, leukemia mortality was elevated among male FGI MDs who graduated from medical school before 1940 (RR, 3.86; 95% CI: 1.21, 12.3). Conclusion Overall, total deaths and deaths from specific causes were not elevated in FGI MDs compared with psychiatrists. These findings require confirmation in large cohort studies with individual doses, detailed work histories, and extended follow-up of the subjects to substantially older median age at exit. RSNA, 2017 Online supplemental material is available for this article.
目的 比较可能进行透视引导介入（FGI）操作的医生（称为FGI医生）和精神科医生的全因死亡率和特定病因死亡率，以确定是否存在与已知辐射风险相符的差异。材料与方法 在全国范围内的45634名FGI医生和64401名精神科医生队列中比较死亡风险。死亡原因从国家死亡指数中确定。采用泊松回归估计FGI医生与精神科医生的相对风险（RR）和95%置信区间（CI），并按出生年份和达到年龄进行分层调整。结果 在随访期间（1979 - 2008年），3506名FGI医生（86名女性）和7814名精神科医生（507名女性）死亡。与精神科医生相比，FGI医生的全因死亡率（男性：RR，0.80 [95% CI：0.77, 0.83]；女性：RR，0.80 [95% CI：0.63, 1.00]）和癌症死亡率（男性：RR，0.92 [95% CI：0.85, 0.99]；女性：RR，0.83 [95% CI：0.58, 1.18]）较低。与精神科医生相比，FGI医生因特定类型癌症、全因和特定类型循环系统疾病以及其他原因导致的死亡率并未升高。基于少量数据，1940年前毕业的男性FGI医生中白血病死亡率升高（RR，3.86；95% CI：1.21, 12.3）。结论 总体而言，与精神科医生相比，FGI医生的全因死亡和特定病因死亡并未增加。这些发现需要在大型队列研究中得到证实，该研究需包含个体剂量、详细工作史以及将受试者随访至更高的中位退出年龄。RSNA，2017 本文提供在线补充材料。
