Yuan Mei-Kang, Chang Shih-Chieh, Yuan Mei-Chun, Foo Ning-Ping, Chan Shan-Ho, Wang Shyh-Yau, Lin Cheng-Li, Hsu Chung-Y, Kao Chia-Hung
Department of Radiology, An Nan Hospital, China Medical University, Tainan, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Front Med (Lausanne). 2021 Dec 20;8:764849. doi: 10.3389/fmed.2021.764849. eCollection 2021.
To evaluate the association between radiation exposure from repeated nuclear medicine (NM) examinations and the subsequent risk of neoplasm in pediatric patients. From 2000 to 2017, participants under 18 years of age who underwent NM scanning were identified using the Health and Welfare Data Science Center (HWDC) dataset, which was extracted from the Taiwan National Health Insurance Research Database (NHIRD). Both the exposed cohort and unexposed subjects were followed up with until the presence of any malignancy arose, including malignant brain, lymphoid and hematopoietic tumors and benign brain or other central nervous tumors. There were 35,292 patients in the exposed cohort and 141,152 matched subjects in the non-exposed group. The exposed cohort had an overall higher IR (IR: incidence rate, per 100,000 person-years) of any malignancy and benign central nervous tumor than the non-exposed group [IR, 16.9 vs. 1.54; adjusted hazard ratio (HR), 10.9; 95% CI, 6.53-18.2]. Further stratifying the number of NM examinations into 1-2, 3-4, and 5 or more times revealed that the IR of pediatric neoplasms increased gradually with the increased frequency of NM examinations (IR, 11.5; adjusted HR, 7.5; 95% CI, 4.29-13.1; IR, 25.8; adjusted HR, 15.9; 95% CI, 7.00-36.1; IR, 93.8; adjusted HR, 56.4; 95% CI, 28.8-110.3). NM examination is significantly associated with a higher risk of pediatric neoplasms, according to our population-based data. Thorough radiation protection and dose reduction in pediatric NM procedures should be an issue of concern.
评估儿科患者重复进行核医学（NM）检查所受辐射暴露与随后发生肿瘤风险之间的关联。2000年至2017年期间，利用从台湾国民健康保险研究数据库（NHIRD）提取的健康与福利数据科学中心（HWDC）数据集，确定了接受NM扫描的18岁以下参与者。对暴露队列和未暴露受试者进行随访，直至出现任何恶性肿瘤，包括恶性脑肿瘤、淋巴和造血系统肿瘤以及良性脑肿瘤或其他中枢神经系统肿瘤。暴露队列中有35292名患者，非暴露组中有141152名匹配对象。暴露队列中任何恶性肿瘤和良性中枢神经系统肿瘤的总体发病率（IR：发病率，每10万人年）均高于非暴露组[IR，16.9对1.54；调整后风险比（HR），10.9；95%置信区间（CI），6.53 - 18.2]。将NM检查次数进一步分为1 - 2次、3 - 4次以及5次或更多次，结果显示儿科肿瘤的发病率随NM检查频率增加而逐渐升高（IR，11.5；调整后HR，7.5；95%CI，4.29 - 13.1；IR，25.8；调整后HR，15.9；95%CI，7.00 - 36.1；IR，93.8；调整后HR，56.4；95%CI，28.8 - 110.3）。根据我们基于人群的数据，NM检查与儿科肿瘤的较高风险显著相关。儿科NM检查程序中的全面辐射防护和剂量降低应成为关注的问题。
