Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.
Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.
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DOI：
10.1001/archinternmed.2009.427
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发表时间：
2009-12-14
影响因子：
--
通讯作者：
Miglioretti DL
中科院分区：
文献类型：
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作者：
Smith-Bindman R;Lipson J;Marcus R;Kim KP;Mahesh M;Gould R;Berrington de González A;Miglioretti DL
在过去的二十年中，计算机断层扫描（CT）用于诊断评估的使用急剧增加。尽管CT与比常规X射线高得多的辐射暴露相关，但典型的临床剂量尚不清楚。我们试图估计与临床实践中常见CT研究相关的辐射剂量;评估不同类型研究、患者和机构的剂量差异;并量化与这些检查相关的潜在癌症风险。回顾性横断面研究，描述了2008年1月1日至5月30日期间在旧金山弗朗西斯科湾区四家机构对1,119名连续成人患者进行的11种最常见类型的诊断性CT研究相关的辐射剂量。我们根据这些测量的剂量，按研究类型估计了终生癌症归因风险。不同类型的CT研究之间的辐射剂量差异显着。总体中位有效剂量范围为2.1毫西弗（mSv）（常规头部CT）（四分位距[IQR] 1.8-2.8）至31 mSv（多相腹部和骨盆CT）（IQR 21-43）。在每种类型的CT研究中，有效剂量在机构内和机构间存在显著差异，每种研究类型的最高和最低剂量之间的平均差异为13倍。根据CT检查的具体类型以及患者的年龄和性别，导致癌症发展的CT估计数量变化很大。据估计，在40岁时接受冠状动脉造影CT的270名女性中有1人会因CT而患上癌症（600名男性中有1人），而在同一年龄接受常规头部CT的8,100名女性中估计有1人（11080名男性中有1人）。对于20岁的奥尔兹来说，风险大约增加一倍，而对于60岁的奥尔兹来说，风险大约降低50%。通常进行的诊断性CT检查的辐射剂量比通常引用的更高，更多变，突出了机构之间更大标准化的必要性。对于个人，特别是年轻女性患者，CT成像的好处必须与其相关辐射的潜在危害相平衡。
Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past two decades. Even though CT is associated with substantially higher radiation exposure than conventional x-rays, typical clinical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice; assess variation in dose across types of studies, patients, and institutions; and quantify the potential cancer risk associated with these examinations. Retrospective cross-sectional study describing radiation dose associated with the 11 most common types of diagnostic CT studies performed on 1,119 consecutive adult patients at four San Francisco Bay Area institutions between January 1 and May 30, 2008. We estimated lifetime attributable risks of cancer by study type from these measured doses. Radiation doses varied significantly between the different types of CT studies. The overall median effective doses ranged from 2.1 milli-Sieverts (mSv) for a routine head CT (interquartile range [IQR] 1.8–2.8) to 31 mSv (IQR 21–43) for a multiphase abdomen and pelvis CT. Within each type of CT study, effective dose varied significantly within and across institutions, with a mean 13-fold variation between the highest and lowest dose for each study type. The estimated number of CTs that will lead to the development of a cancer varied widely depending on the specific type of CT examination and the patient’s age and sex. An estimated 1 in 270 women who underwent a coronary angiography CT at age 40 will develop cancer from that CT (1 in 600 men), compared with an estimated 1 in 8,100 women who had routine head CT at the same age (1 in 11, 080 men). For 20-year olds the risks were approximately doubled, and for 60-year olds, the risks were approximately 50% lower. Radiation doses from commonly performed diagnostic CT examinations were higher and more variable than generally quoted, highlighting the need for greater standardization across institutions. For individuals, and especially younger female patients, the benefits of CT imaging must be balanced against the potential harm from its associated radiation.