美国放射技师协助荧光透视引导介入手术的白内障风险：一项回顾性队列研究。
Cataract risk in US radiologic technologists assisting with fluoroscopically guided interventional procedures: a retrospective cohort study.
机构信息
Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Rockville, Maryland, USA.
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA.
出版信息
Occup Environ Med. 2019 May;76(5):317-325. doi: 10.1136/oemed-2018-105360. Epub 2019 Mar 19.
OBJECTIVES
To assess radiation exposure-related work history and risk of cataract and cataract surgery among radiologic technologists assisting with fluoroscopically guided interventional procedures (FGIP).
METHODS
This retrospective study included 35 751 radiologic technologists who reported being cataract-free at baseline (1994-1998) and completed a follow-up questionnaire (2013-2014). Frequencies of assisting with 21 types of FGIP and use of radiation protection equipment during five time periods (before 1970, 1970-1979, 1980-1989, 1990-1999, 2000-2009) were derived from an additional self-administered questionnaire in 2013-2014. Multivariable-adjusted relative risks (RRs) for self-reported cataract diagnosis and cataract surgery were estimated according to FGIP work history.
RESULTS
During follow-up, 9372 technologists reported incident physician-diagnosed cataract; 4278 of incident cases reported undergoing cataract surgery. Technologists who ever assisted with FGIP had increased risk for cataract compared with those who never assisted with FGIP (RR: 1.18, 95% CI 1.11 to 1.25). Risk increased with increasing cumulative number of FGIP; the RR for technologists who assisted with >5000 FGIP compared with those who never assisted was 1.38 (95% CI 1.24 to 1.53; p trend <0.001). These associations were more pronounced for FGIP when technologists were located ≤3 feet (≤0.9 m) from the patient compared with >3 feet (>0.9 m) (RRs for >5000 at ≤3 feet vs never FGIP were 1.48, 95% CI 1.27 to 1.74 and 1.15, 95% CI 0.98 to 1.35, respectively; pdifference=0.04). Similar risks, although not statistically significant, were observed for cataract surgery.
CONCLUSION
Technologists who reported assisting with FGIP, particularly high-volume FGIP within 3 feet of the patient, had increased risk of incident cataract. Additional investigation should evaluate estimated dose response and medically validated cataract type.
目的
评估与放射技师协助透视引导介入程序（FGIP）相关的辐射暴露工作史和白内障及白内障手术风险。
方法
这项回顾性研究纳入了 35751 名放射技师，他们在基线时报告无白内障（1994-1998 年）并完成了随访问卷调查（2013-2014 年）。从 2013-2014 年的附加自我管理问卷调查中得出 21 种 FGIP 的协助频率和 5 个时间段（1970 年之前、1970-1979 年、1980-1989 年、1990-1999 年、2000-2009 年）期间使用辐射防护设备的频率。根据 FGIP 工作史，估计自我报告的白内障诊断和白内障手术的多变量校正相对风险（RR）。
结果
随访期间，9372 名技师报告了经医生诊断的白内障发病；4278 例发病病例报告接受了白内障手术。与从未协助过 FGIP 的技师相比，曾协助过 FGIP 的技师发生白内障的风险更高（RR：1.18，95%CI 1.11 至 1.25）。风险随累积 FGIP 数量的增加而增加；与从未协助过 FGIP 的技师相比，协助过>5000 次 FGIP 的技师的 RR 为 1.38（95%CI 1.24 至 1.53；p 趋势<0.001）。当技师距离患者≤3 英尺（≤0.9 米）时，这些关联对于 FGIP 更为明显，与距离患者>3 英尺（>0.9 米）相比（RR 为>5000 次，距离患者≤3 英尺与从不 FGIP 分别为 1.48，95%CI 1.27 至 1.74 和 1.15，95%CI 0.98 至 1.35；pdifference=0.04）。对于白内障手术，也观察到了类似但无统计学意义的风险。
结论
报告协助 FGIP 的技师，特别是距离患者 3 英尺内的高容量 FGIP，发生白内障的风险增加。应进一步评估估计剂量反应和经医学验证的白内障类型。
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