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| 1 | 儿科CT应用和辐射暴露与癌症预测风险联系的研究显示文摘背景和目的计算机断层扫描(CT)在儿科的使用增加了人们对电离辐射暴露导致癌症风险的关注。本回顾性研究的目的在于量化确定在儿科使用CT和相关辐射暴露与癌症风险联系的趋势。方法调查自1996年至2010年间15岁以下接受过CT检查的儿童,共4,857,736人年。对五家保健系统于2001年至2011年间进行的744起对头部、腹部/骨盆、胸部和脊柱的随机CT扫描进行研究后,计算辐射剂量和预估癌症风险率。上述这些部位的扫描检查数量占所有CT扫描数量的95%以上。预估的癌症终生归因风险率计算基于《电离辐射的生物学效应》(BEIR)的第七次报告———针对乳腺癌、结肠癌、肝癌、肺癌、卵巢癌、前列腺癌、胃癌、甲状腺癌、膀胱癌、子宫癌和白血病——以及使用类似方法开发出的针对口腔、食管、直肠、胰腺、肾及脑部肿瘤的计算机模型,这些肿瘤在美国所有癌症病例中所占的比例高达85%。结果在1996年至2005年间,5岁以下儿童CT检查率增加了1倍而5到14岁儿童使用率增加了2倍;2006至2007年间,儿童CT检查率保持稳定,而之后开始下降。有效剂量幅度为每次扫描0.03到69.2毫希弗。有效剂量在20毫希弗或以上的检查出现在14%~25%的腹部或盆腔扫描、6%~14%的脊柱扫描以及3%~8%的胸部扫描。与年长儿童及男性患儿相比,低龄者及女性患儿终生罹患实体癌症的风险更高;接受腹部、盆腔或脊柱CT扫描的患儿也较接受其他部位CT扫描更易引发实体癌。对于女性患儿,根据年龄不同,不同部位CT扫描辐射诱导实体癌发生情况分别为每300到390例腹部或盆腔扫描、每330到480例胸部扫描以及每270到800例脊柱扫描。对于5岁以下的患儿,进行头部CT扫描导致白血病的风险最高,达1.9/10000。美国卫生保健机构每年共对儿童各器官进行4百万次的CT扫描,这可能导致未来约4870例癌症病例。如果将最高辐射剂量降低25%,就可减少2090例癌症病例,相当于患癌风险降低43%。取消不必要的扫描,可减少3020例癌症病例,相当于患癌风险降低62%。结论CT在儿科使用的增加以及放射剂量的较大变化,导致很多儿童接受了高剂量检查。降低最高照射剂量1/4的策略可以显著地减少辐射诱发癌症的数量。 | Miglioretti DL Johnson E Williams A 陈斯乐 张信华 | 2014 | 消化肿瘤杂志(电子版)2014，0，1： | 2 |
| 2 | Factors associated with imaging and procedural events used to detect breast cancer after screening mammography显示文摘 | Carney PA Abraham LA Miglioretti DL | 2007 | AJR Am J Roentgenol2007，188，2： | 1 |
| 3 | Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography 显示文摘 | Carney PA Miglioretti DL Yankaskas BC | 2003 | Ann Intern Med2003，138，3： | 1 |
| 4 | Dose utilization of screening mammography explain racial and ethnic differences in breast cancer?显示文摘 | Smith-Bindman R Miglioretti DL Lurie N | 2006 | Ann Intern Med2006，144，8： | 1 |
| 5 | Effect of breast augmentation on the accuracy of mammography and cancer characteristics显示文摘 | Miglioretti DL Rutter CM Geller BM | 2004 | J Am Med Assoc2004，291，4： | 1 |
| 6 | Physician Predictors of Mammographic Accuracy显示文摘 | Smith-Bindman R Chu P Miglioretti DL | 2005 | J Natl Cancer Inst2005，97，5： | 1 |
| 7 | Ctdivol, dip, and effective dose are excellent measures for use in ct quality improvement 显示文摘 | Smith-Binclman R Miglioretti DL | 2011 | Radi- ology2011，261，： | 1 |
| 8 | Individual and combined effects of age,breast density,and hormone replacement therapy use on the accuracy of screening mammography显示文摘 | Carney PA Miglioretti DL Yankaskas BC | 2003 | Ann Intern Med2003，138，3： | 1 |
| 9 | Physician predictors of mammographic accuracy显示文摘 | Smith-Bindman R Chu P Miglioretti DL | 2005 | J Natl Cancer Inst2005，97，5： | 1 |
| 10 | Physicianpredictors of mammographic accuracy显示文摘 | Smith Bindman R Chu P Miglioretti DL | 2005 | J Natl Cancer Inst2005，97，5： | 1 |
| 11 | Physician predictors of mammographic accuracy显示文摘 | Smith-Bindman R Chu P Miglioretti DL | 2005 | J Natl Cancer Inst2005，97，5： | 1 |
| 12 | Early detection of breast cancer the second time around:Mammography in women with a personal history of breast cancer显示文摘 | Houssami N Miglioretti DL | | 0，，09： | 1 |
| 13 | Physician predictors of mammographic accuracy显示文摘 | Smith-Bindman R Chu P Miglioretti DL | 2005 | J Natl Cancer Inst2005，97，5： | 1 |
| 14 | Individual and com-bined effects of age,breast density,and hormone replacement therapy use on the accuracy of screening mammography显示文摘 | Carney PA Miglioretti DL Yankaskas BC | 2003 | Ann Intern Med2003，138，3： | 1 |
| 15 | Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography显示文摘 | Carney PA Miglioretti DL Yankaskas BC | 2003 | Ann Intern Med2003，138，3： | 1 |
| 16 | Declines in invasive breast cancer and use of postmenopausal hormone therapy in a screening mammography population显示文摘 | Kerlikowske K Miglioretti DL Buist DS | 2007 | J Natl Cancer Inst2007，99，17： | 1 |
| 17 | Performance benchmarks for diagnostic mammography 显示文摘 | Sickles EA Miglioretti DL Ballard-barbash K | 2005 | Radiology2005，235，： | 1 |
| 18 | Optimizing pa- rameters for terminating cortical afterdiseharges with pulse stimulation显示文摘 | Motamedi GN Lesser RP Miglioretti DL | 2002 | Epilcpsia2002，43，8： | 1 |
| 19 | Individual and combined effects of age, breast density and hormone replacement therapy use on the accurancy of screening mammography 显示文摘 | Camey PA Miglioretti DL Yankaskas BC | 2003 | Ann Intern Med2003，138，： | 1 |
| 20 | Optimizing parameters for terminating cortical afterdischarges with pulse stimulation显示文摘 | Motamedi GK Lesser RP Miglioretti DL | | 0，，： | 1 |
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