McCandlish John Austin, Feizullayeva Chinara, Cronin Paul P, O'Connell William, Barish Matthew A, Sanelli Pina C, Cohen Stuart L
Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, New York; Georgia Institute of Technology, Atlanta, Georgia.
Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, New York; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
J Emerg Med. 2023 Mar;64(3):295-303. doi: 10.1016/j.jemermed.2022.10.014. Epub 2023 Mar 15.
Imaging for diagnosis of suspected pulmonary embolism in pregnancy presents radiation concerns for patient and fetus.
Estimate the risks of radiation-induced breast cancer and childhood leukemia from common imaging techniques for the evaluation of suspected pulmonary embolism in pregnancy.
Breast and uterine absorbed doses for various imaging techniques were input into the National Cancer Institute Radiation Risk Assessment Tool to calculate risk of breast cancer for the patient and childhood leukemia for the fetus. Absorbed doses were obtained by synthesizing data from a recent systematic review and the International Commission on Radiological Protection. Primary outcomes were the estimated excess incidences of breast cancer and childhood leukemia per 100,000 exposures.
Baseline incidences of breast cancer for a 30-year-old woman and childhood leukemia for a male fetus were 13,341 and 939, respectively. Excess incidences of breast cancer were 0.003 and 0.275 for a single and two-view chest radiograph, respectively, 9.53 and 20.6 for low- and full-dose computed tomography pulmonary angiography (CTPA), respectively, 0.616 and 2.54 for low- and full-dose perfusion scan, respectively, and 0.732 and 2.66 for low- and full-dose ventilation perfusion scan, respectively. Excess incidences of childhood leukemia were 0.004 and 0.007 for a single and two-view chest radiograph, respectively, 0.069 and 0.490 for low- and full-dose CTPA, respectively, 0.359 and 1.47 for low- and full-dose perfusion scan, respectively, and 0.856 and 1.97 for low- and full-dose ventilation perfusion scan, respectively.
Excess cancer risks for all techniques were small relative to baseline cancer risks, with CTPA techniques carrying slightly higher risk of breast cancer for the patient and ventilation perfusion techniques a higher risk of childhood leukemia.
孕期疑似肺栓塞的诊断成像对患者和胎儿存在辐射担忧。
评估孕期用于评估疑似肺栓塞的常见成像技术导致辐射诱发乳腺癌和儿童白血病的风险。
将各种成像技术的乳房和子宫吸收剂量输入美国国家癌症研究所辐射风险评估工具，以计算患者患乳腺癌和胎儿患儿童白血病的风险。吸收剂量通过综合近期系统评价的数据和国际放射防护委员会的数据获得。主要结局是每10万次照射估计的乳腺癌和儿童白血病额外发病率。
一名30岁女性的乳腺癌基线发病率和男性胎儿的儿童白血病基线发病率分别为13341例和939例。单视图胸部X光片的乳腺癌额外发病率分别为0.003例和0.275例，低剂量和全剂量计算机断层扫描肺动脉造影（CTPA）分别为9.53例和20.6例，低剂量和全剂量灌注扫描分别为0.616例和2.54例，低剂量和全剂量通气灌注扫描分别为0.732例和2.66例。单视图和双视图胸部X光片的儿童白血病额外发病率分别为0.004例和0.007例，低剂量和全剂量CTPA分别为0.069例和0.490例，低剂量和全剂量灌注扫描分别为0.359例和1.47例，低剂量和全剂量通气灌注扫描分别为0.856例和1.97例。
相对于基线癌症风险，所有技术的额外癌症风险都较小，CTPA技术使患者患乳腺癌的风险略高，通气灌注技术使儿童患白血病的风险更高。
