Hendrick R Edward
University of Colorado School of Medicine, Department of Radiology, Aurora, CO.
J Breast Imaging. 2020 Jun 3;2(3):188-200. doi: 10.1093/jbi/wbaa016.
This article describes radiation doses and cancer risks of digital breast imaging technologies used for breast cancer detection. These include digital mammography (DM), digital breast tomosynthesis (DBT), and newer technologies such as contrast-enhanced digital or spectral mammography (CEM), whole-breast computed tomography, breast-specific gamma imaging (BSGI), molecular breast imaging (MBI), and positron emission mammography (PEM). This article describes the basis for radiation risk estimates, compares radiation doses and risks, and provides benefit-to-radiation-risk ratios for different breast imaging modalities that use ionizing radiation. Current x-ray-based screening modalities such as DM and DBT have small to negligible risks of causing radiation-induced cancers in women of normal screening age. Possible new screening modalities such as CEM have similar small cancer risks. Potential screening modalities that involve radionuclide injection such as BSGI, MBI, and PEM have significantly higher cancer risks unless efficient detection systems and reduced administered doses are used. Benefit-to-radiation-risk estimates are highly favorable for screening with DM and other modalities having comparable (or higher) cancer detection rates and comparably low radiation doses.
本文描述了用于乳腺癌检测的数字乳腺成像技术的辐射剂量和癌症风险。这些技术包括数字乳腺钼靶摄影（DM）、数字乳腺断层合成（DBT），以及更新的技术，如对比增强数字或光谱乳腺摄影（CEM）、全乳计算机断层扫描、乳腺专用伽马成像（BSGI）、分子乳腺成像（MBI）和正电子发射乳腺摄影（PEM）。本文阐述了辐射风险估计的依据，比较了辐射剂量和风险，并提供了使用电离辐射的不同乳腺成像方式的效益与辐射风险比。当前基于X射线的筛查方式，如DM和DBT，在正常筛查年龄的女性中导致辐射诱发癌症的风险很小甚至可忽略不计。诸如CEM等可能的新筛查方式具有类似的低癌症风险。涉及放射性核素注射的潜在筛查方式，如BSGI、MBI和PEM，除非使用高效检测系统并降低给药剂量，否则癌症风险会显著更高。对于使用DM和其他具有可比（或更高）癌症检测率且辐射剂量相当低的方式进行筛查，效益与辐射风险估计非常有利。
