Myocardial perfusion scans: projected population cancer risks from current levels of use in the United States.
Myocardial perfusion scans: projected population cancer risks from current levels of use in the United States.
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DOI：
10.1161/circulationaha.110.941625
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发表时间：
2010-12-07
期刊：
影响因子：
37.8
通讯作者：
McAreavey D
中科院分区：
文献类型：
--
作者：
Berrington de Gonzalez A;Kim KP;Smith-Bindman R;McAreavey D
心肌灌注扫描占美国人口估计年度集体辐射剂量的20%。我们根据暴露时的年龄和美国目前的使用频率估计了这些扫描的潜在未来癌症风险。使用模式是根据国家调查数据确定的，放射性核素剂量是基于当前的指南。癌症风险预测模型是根据国家研究理事会电离辐射生物效应第七号报告生成的，假设风险与辐射照射存在线性关系，即使在低剂量下也是如此。使用蒙特卡罗模拟估计了与辐射有关的癌症事件的平均预测数和95%的不确定性区间。在50岁时进行扫描的估计风险范围从2个癌症/10，000次扫描（95%UI：1-15）的正电子发射断层扫描氨-13测试到25个（95%UI：9-58）癌症/10，000次扫描的双同位素（铊-201+锝-99 m）扫描。70岁时风险降低50%，但男性和女性相似。癌症风险估计与使用频率数据的结合表明，美国每年进行的910万次心肌灌注扫描可能导致7400例（95%UI：3300-13700）额外的未来癌症。单次心肌灌注扫描的终生癌症风险很小，应与可能的益处和测试的适当性进行平衡。估计数取决于包括预期寿命在内的若干假设。它们直接适用于预期寿命与一般人群相似的无症状个体。对于具有症状性临床特征的个人，通常进行此类扫描，由于预期寿命较短，风险将较低。
Myocardial perfusion scans contribute up to 20% of the estimated annual collective radiation dose to the U.S. population. We estimated potential future cancer risk from these scans by age at exposure and current frequency of use in the U.S. Usage patterns were determined from national survey data, and radionuclide dosage was based on current guidelines. Cancer risk projection models were generated based on the National Research Council Biologic Effects of Ionizing Radiation VII report, under the assumption that risk has a linear relationship with radiation exposure even at low doses. The mean projected number of radiation-related incident cancers and 95% uncertainty intervals (UI) were estimated using Monte Carlo simulations. Estimated risks for a scan performed at age 50 years ranged from 2 cancers/10,000 scans (95%UI:1–15) for a positron emission tomography ammonia-13 test to 25 (95%UI:9–58) cancers/10,000 scans for a dual-isotope (thallium-201+technetium-99m) scan. Risks were 50% lower at age 70 years, but were similar for males and females. Combination of cancer risk estimates with data on frequency of use suggested that the 9.1 million myocardial perfusion scans performed annually in the U.S. could result in 7400 (95%UI:3300–13700) additional future cancers. The lifetime cancer risk from a single myocardial perfusion scan is small, and should be balanced against likely benefit and appropriateness of the test. The estimates depend on a number of assumptions including life-expectancy. They apply directly to asymptomatic individuals with life-expectancies similar to the general population. For individuals with a symptomatic clinical profile, on whom such scans are typically performed, the risks will be lower because of shorter life-expectancy.