Radiation Exposure From Pediatric CT Scans and Subsequent Cancer Risk in the Netherlands
Radiation Exposure From Pediatric CT Scans and Subsequent Cancer Risk in the Netherlands
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DOI：
10.1093/jnci/djy104
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发表时间：
2019-03-01
影响因子：
10.3
通讯作者：
Hauptmann, Michael
中科院分区：
文献类型：
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作者：
Meulepas, Johanna M.;Ronckers, Cecile M.;Hauptmann, Michael
背景 计算机断层扫描 (CT) 是一种强大的诊断工具，可提供比大多数成像方式更高的辐射剂量。随着 CT 使用的迅速增加，辐射防护非常重要，特别是对于儿童而言。我们评估儿童期接受 CT 扫描的低剂量电离辐射后患白血病和脑肿瘤的风险。方法对于 1979 年至 2012 年间在荷兰一家医院接受过一次或多次 CT 扫描的全国范围内 168394 名 18 岁以下儿童的回顾性队列，我们通过与外部登记处的记录链接获得了癌症发病率、生命状态和混杂信息。使用荷兰普通人群的癌症发病率计算标准化发病率。使用泊松回归计算每 100 mGy 器官剂量的过度相对风险 (ERR)。所有统计检验都是双面的。结果 所有癌症部位的标准化发病率均升高。随访结束时平均累积骨髓剂量为9.5 mGy，白血病风险（不包括骨髓增生异常综合征）与累积骨髓剂量无关（44例）。累积脑剂量平均为 38.5 mGy，与恶性和非恶性脑肿瘤的综合风险具有统计学显着相关性（ERR/100 mGy：0.86，95% 置信区间 = 0.20 至 2.22，P = 0.002，84 例）。排除结节性硬化症患者并没有显着改变风险。结论我们发现有证据表明 CT 相关辐射暴露会增加脑肿瘤风险。没有观察到与白血病的关联。与一般人群相比，接受 CT 扫描的儿童群体中脑肿瘤的发病率较高，需要谨慎解释研究结果。
Background Computed tomography (CT), a strong diagnostic tool, delivers higher radiation doses than most imaging modalities. As CT use has increased rapidly, radiation protection is important, particularly among children. We evaluate leukemia and brain tumor risk following exposure to low-dose ionizing radiation from CT scans in childhood.Methods For a nationwide retrospective cohort of 168394 children who received one or more CT scans in a Dutch hospital between 1979 and 2012 who were younger than age 18 years, we obtained cancer incidence, vital status, and confounder information by record linkage with external registries. Standardized incidence ratios were calculated using cancer incidence rates from the general Dutch population. Excess relative risks (ERRs) per 100 mGy organ dose were calculated with Poisson regression. All statistical tests were two-sided.Results Standardized incidence ratios were elevated for all cancer sites. Mean cumulative bone marrow doses were 9.5 mGy at the end of follow-up, and leukemia risk (excluding myelodysplastic syndrome) was not associated with cumulative bone marrow dose (44 cases). Cumulative brain dose was on average 38.5 mGy and was statistically significantly associated with risk for malignant and nonmalignant brain tumors combined (ERR/100 mGy: 0.86, 95% confidence interval = 0.20 to 2.22, P = .002, 84 cases). Excluding tuberous sclerosis complex patients did not substantially change the risk.Conclusions We found evidence that CT-related radiation exposure increases brain tumor risk. No association was observed for leukemia. Compared with the general population, incidence of brain tumors was higher in the cohort of children with CT scans, requiring cautious interpretation of the findings.