Cancer risk from paediatric computed tomography scanning: implications for radiation protection in medicine.
Cancer risk from paediatric computed tomography scanning: implications for radiation protection in medicine.
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DOI：
10.1177/0146645318756236
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发表时间：
2018-10-01
影响因子：
--
通讯作者：
Cardis, E
中科院分区：
文献类型：
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作者：
Kesminiene, A;Cardis, E
计算机断层扫描（CT）成像的使用显然对数百万患者有益。然而，生命早期CT电离辐射暴露的潜在不良健康影响，特别是癌症，是辐射防护、医疗和公共卫生界日益关注的问题。虽然已经努力量化这些影响，但报告的风险的精确性和准确性需要确认。EPI-CT是一项欧洲合作流行病学研究，旨在量化儿科CT的风险，以优化儿科诊断方案。该研究由国际癌症研究机构协调，是一项针对接受CT扫描长期随访的儿童和年轻人的多国队列研究。它结合了来自法国、英国和德国现有和扩展队列的数据，以及来自比利时、丹麦、荷兰、挪威、西班牙和瑞典的新队列的数据。开发了一种灵活的剂量重建方法，该方法可以适应从历史来源（2000年之前）收集数据，并自动从Picture Data Communication System中记录图像的医学数字成像和通信标题中提取数据。使用不同性别和年龄的混合体模，通过基于蒙特-卡罗的辐射传输计算得出每个儿童的个体器官剂量估计值。为了解释由于输入数据缺失而导致的不确定性，使用了一种模拟方法，该方法保持了具有相似暴露属性的亚组内人员的剂量相关性，并模拟了不确定的剂量模型参数值。基于来自一些EPI-CT国家和/或合理情景的数据，进行了模拟研究，以评价一系列潜在混杂因素（例如，基础医学状况、社会经济状况、在参与医院以外进行的缺失医疗程序）对风险估计的潜在影响。总共有1，170，186例患者（审查前）入组国家队列。大多数患者（75%）仅接受过一次CT扫描，29%的患者年龄较大
The use of computed tomography (CT) imaging is clearly beneficial for millions of patients. However, the potential adverse health effects, particularly cancer, of ionising radiation exposure from CT early in life are an issue of growing concern in the radiological protection, medical, and public health communities. Although efforts to quantify these effects have been conducted, the precision and accuracy of reported risks needs confirmation. EPI-CT, a European collaborative epidemiological study, was set up to quantify risks from paediatric CT to optimise paediatric diagnostic protocol. The study, coordinated by the International Agency for Research on Cancer, was designed as a multi-national cohort study of children and young adults who underwent CT scanning for long-term follow-up. It combined data from existing and extended cohorts in France, the UK, and Germany, and from new cohorts assembled in Belgium, Denmark, the Netherlands, Norway, Spain, and Sweden using a common protocol. A flexible dose reconstruction approach that can accommodate collection of data from historical sources (prior to 2000) and automatically extract data from the Digital Imaging and Communications in Medicine headers of recorded images available in the Picture Archiving Communication System was developed. Individual organ dose estimates for each child were derived from Monte-Carlo-based radiation transport calculations using hybrid phantoms of different sexes and ages. To account for uncertainties due to missing input data, a simulation method that maintains correlations of doses for persons within subgroups with similar exposure attributes and simulates uncertain dose-model parameter values was used. Simulation studies to evaluate the potential impact of a range of potential confounders (e.g. underlying medical conditions, socio-economic status, missing medical procedures performed outside of participating hospitals) on risk estimates were conducted based on data from some EPI-CT countries and/or reasonable scenarios. In total, 1,170,186 patients (before censorship) were enrolled in the national cohorts. Most patients (75%) had only undergone one CT scan and 29% of all patients were aged