Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden.
Phys Med Biol. 2017 Nov 21;62(24):9177-9188. doi: 10.1088/1361-6560/aa959c.
The aim of this study is to implement lifetime attributable risk (LAR) predictions of cancer for patients of various age and gender, undergoing diagnostic investigations or treatments in nuclear medicine and to compare the outcome with a population risk estimate using effective dose and the International Commission on Radiological Protection risk coefficients. The radiation induced risk of cancer occurrence (incidence) or death from four nuclear medicine procedures are estimated for both male and female between 0 and 120 years. Estimations of cancer risk are performed using recommended administered activities for two diagnostic (F-FDG and Tc-phosphonate complex) and two therapeutic (I-iodide and Ra-dichloride) radiopharmaceuticals to illustrate the use of cancer risk estimations in nuclear medicine. For F-FDG, the cancer incidence for a male of 5, 25, 50 and 75 years at exposure is 0.0021, 0.0010, 0.0008 and 0.0003, respectively. For Tc phosphonates complex the corresponding values are 0.000 59, 0.000 34, 0.000 27 and 0.000 13, respectively. For an I-iodide treatment with 3.7 GBq and 1% uptake 24 h after administration, the cancer incidence for a male of 25, 50 and 75 years at exposure is 0.041, 0.029 and 0.012, respectively. For Ra-dichloride with an administration of 21.9 MBq the cancer incidence for a male of 25, 50 and 75 years is 0.31, 0.21 and 0.09, respectively. The LAR estimations are more suitable in health care situations involving individual patients or specific groups of patients than the health detriment based on effective dose, which represents a population average. The detriment consideration in effective dose adjusts the cancer incidence for suffering of non-lethal cancers while LAR predicts morbidity (incidence) or mortality (cancer). The advantages of these LARs are that they are gender and age specific, allowing risk estimations for specific patients or subgroups thus better representing individuals in health care than effective dose.
本研究旨在为接受核医学诊断性检查或治疗的不同年龄和性别的患者预测终生归因风险（LAR），并将结果与使用有效剂量和国际辐射防护委员会风险系数的人群风险估计进行比较。对四种核医学程序的男性和女性患者，在 0 至 120 岁之间，估计了辐射致癌发生（发病率）或死亡的风险。使用推荐的两种诊断性（F-FDG 和 Tc-膦酸盐复合物）和两种治疗性（I-碘化物和 Ra-二氯化物）放射性药物的放射性药物管理活动来估算癌症风险，以说明核医学中癌症风险估算的应用。对于 F-FDG，5 岁、25 岁、50 岁和 75 岁男性的暴露致癌发生率分别为 0.0021、0.0010、0.0008 和 0.0003。对于 Tc 膦酸盐复合物，相应的值分别为 0.00059、0.00034、0.00027 和 0.00013。对于 3.7GBq 放射性碘化物治疗，24 小时后摄取率为 1%，25 岁、50 岁和 75 岁男性的暴露致癌发生率分别为 0.041、0.029 和 0.012。对于 21.9MBq 的 Ra-二氯化物，25 岁、50 岁和 75 岁男性的致癌发生率分别为 0.31、0.21 和 0.09。与基于有效剂量的健康危害相比，LAR 估计更适合涉及个体患者或特定患者群体的医疗保健情况，而有效剂量则代表人群平均值。有效剂量中的危害考虑因素调整了非致命性癌症的发病风险，而 LAR 则预测发病率（发病率）或死亡率（癌症）。这些 LAR 的优势在于它们是性别和年龄特异性的，允许对特定患者或亚组进行风险估计，从而比有效剂量更能代表医疗保健中的个体。
