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低剂量电离辐射致癌风险——当前的流行病学证据及其对放射防护的影响。

Cancer risk following low doses of ionising radiation - Current epidemiological evidence and implications for radiological protection.

机构信息

Helmholtz Center Munich German Research Center for Environmental Health, Neuherberg, Germany.

Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France.

出版信息

Mutat Res Genet Toxicol Environ Mutagen. 2022 Jan;873:503436. doi: 10.1016/j.mrgentox.2021.503436. Epub 2021 Dec 13.

Abstract

Recent studies suggest that every year worldwide about a million patients might be exposed to doses of the order of 100 mGy of low-LET radiation, due to recurrent application of radioimaging procedures. This paper presents a synthesis of recent epidemiological evidence on radiation-related cancer risks from low-LET radiation doses of this magnitude. Evidence from pooled analyses and meta-analyses also involving epidemiological studies that, individually, do not find statistically significant radiation-related cancer risks is reviewed, and evidence from additional and more recent epidemiological studies of radiation exposures indicating excess cancer risks is also summarized. Cohorts discussed in the present paper include Japanese atomic bomb survivors, nuclear workers, patients exposed for medical purposes, and populations exposed environmentally to natural background radiation or radioactive contamination. Taken together, the overall evidence summarized here is based on studies including several million individuals, many of them followed-up for more than half a century. In summary, substantial evidence was found from epidemiological studies of exposed groups of humans that ionizing radiation causes cancer at acute and protracted doses above 100 mGy, and growing evidence for doses below 100 mGy. The significant radiation-related solid cancer risks observed at doses of several 100 mGy of protracted exposures (observed, for example, among nuclear workers) demonstrate that doses accumulated over many years at low dose rates do cause stochastic health effects. On this basis, it can be concluded that doses of the order of 100 mGy from recurrent application of medical imaging procedures involving ionizing radiation are of concern, from the viewpoint of radiological protection.

摘要

最近的研究表明,由于放射性影像学检查的反复应用,全世界每年可能有大约 100 万患者接触到 100mGy 量级的低 LET 辐射剂量。本文综合了最近关于这种低 LET 辐射剂量与癌症风险相关的流行病学证据。本文还回顾了来自汇集分析和荟萃分析的证据,这些分析也涉及个别研究未发现具有统计学意义的辐射相关癌症风险的流行病学研究,并且还总结了来自更多近期流行病学研究的辐射暴露与癌症风险增加相关的证据。本文讨论的队列包括日本原子弹幸存者、核工作者、出于医疗目的暴露的患者以及因环境暴露于天然本底辐射或放射性污染而受到照射的人群。总而言之,这里总结的整体证据基于包括数百万个体的研究,其中许多个体随访了半个多世纪以上。总之,大量流行病学研究证据表明,在 100 mGy 以上的急性和迁延性剂量下,电离辐射会引发癌症,而在 100 mGy 以下的剂量下也会引发癌症,证据不断增加。在迁延性暴露数 100 mGy 剂量下观察到的显著与辐射相关的实体癌风险(例如,在核工作者中观察到的风险)表明,多年来以低剂量率积累的剂量确实会导致随机健康效应。基于这一点,可以得出结论,从放射防护的角度来看,反复应用涉及电离辐射的医学成像程序所产生的 100 mGy 量级的剂量令人担忧。

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