The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk.
The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk.
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DOI：
10.1001/jamapediatrics.2013.311
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发表时间：
2013-08-01
期刊：
影响因子：
26.1
通讯作者：
Smith-Bindman, Rebecca
中科院分区：
文献类型：
--
作者：
Miglioretti, Diana L.;Johnson, Eric;Williams, Andrew;Greenlee, Robert T.;Weinmann, Sheila;Solberg, Leif I.;Feigelson, Heather Spencer;Roblin, Douglas;Flynn, Michael J.;Vanneman, Nicholas;Smith-Bindman, Rebecca
量化儿科计算机断层扫描（CT）使用趋势以及相关辐射暴露和癌症风险。回顾性观察研究。美国的七个医疗体系从1996年至2010年，对15岁以下儿童的CT使用情况进行了评估，包括4，857，736儿童年的观察。计算了2001-2011年间进行的744次CT扫描的辐射剂量。CT使用率，器官和有效剂量，以及预期的终生癌症风险。1996-2005年期间，5岁以下儿童使用CT的人数增加了一倍，5-14岁儿童增加了两倍，2007年之前保持稳定，然后下降。有效剂量范围为0.03-69.2mSv/次扫描。14-25%的腹部/骨盆CT、6-14%的脊柱CT和3-8%的胸部CT输送了≥ 20 mSv的有效剂量。实体癌的预期终生归因风险在年轻患者和女孩中较高，腹部/骨盆和脊柱CT也较高。在女孩中，根据年龄，每300-390次腹部/骨盆CT、330-480次胸部CT和270-800次脊柱CT预计会导致辐射诱发的实体癌。头部CT <5的儿童白血病风险最高，为1.9/10，000。在全国范围内，每年进行的头部，腹部/骨盆，胸部或脊柱的400万例儿科CT预计将导致4870例未来癌症。将最高剂量的25%减少到中位数可能会预防43%的癌症。儿科CT使用的增加加上辐射剂量的广泛变化导致许多儿童接受高剂量检查。针对最高四分之一剂量的减少剂量战略可大幅减少辐射诱发癌症的数量。
To quantify trends in pediatric computed tomography (CT) use and associated radiation exposure and cancer risk. Retrospective observational study. Seven US healthcare systems. CT use was evaluated in children <15 years from 1996-2010, including 4,857,736 child-years of observation. Radiation doses were calculated for 744 CT scans performed between 2001-2011. Rates of CT use, organ and effective doses, and projected lifetime attributable cancer risks. CT use doubled in children <5 years and tripled in children 5-14 between 1996-2005, stabilized until 2007, then declined. Effective doses varied from 0.03-69.2mSv per scan. An effective dose of ≥20mSv was delivered by 14-25% of abdomen/pelvis CTs, 6-14% of spine CTs, and 3-8% of chest CTs. Projected lifetime attributable risks of solid cancer were higher in younger patients and girls, and for abdomen/pelvis and spine CTs. In girls, a radiation-induced solid cancer is projected to result from every 300-390 abdomen/pelvis CTs, 330-480 chest CTs, and 270-800 spine CTs, depending on age. Leukemia risk was highest for head CTs in children <5 at 1.9/10,000. Nationally, 4 million pediatric CTs of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers. Reducing the highest 25% of doses to the median might prevent 43% of these cancers. Increased use of pediatric CT combined with wide variability in radiation doses has resulted in many children receiving a high-dose examination. Dose-reduction strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers.
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影响因子：
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作者：
Dorfman, Adam L.;Fazel, Reza;Einstein, Andrew J.;Applegate, Kimberly E.;Krumholz, Harlan M.;Wang, Yongfei;Christodoulou, Emmanuel;Chen, Jersey;Sanchez, Ramon;Nallamothu, Brahmajee K.
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Nallamothu, Brahmajee K.
影响因子：
2.3
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Linet MS;Kim KP;Rajaraman P
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Rajaraman P
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Berrington de González A;Mahesh M;Kim KP;Bhargavan M;Lewis R;Mettler F;Land C
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Huda, Walter;Vance, Awais
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Vance, Awais
影响因子：
168.9
作者：
Kuppermann, Nathan;Holmes, James F.;Wootton-Gorges, Sandra L.
通讯作者：
Wootton-Gorges, Sandra L.