Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology.,Nature Reviews Urology

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Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology.
Nature Reviews Urology ( IF 12.1 ) Pub Date : 2019-04-01 , DOI: 10.1038/s41585-019-0148-8
Andrea Ferrero ₁ , Naoki Takahashi ₁ , Terri J Vrtiska ₁ , Amy E Krambeck ₂ , John C Lieske ₃ , Cynthia H McCollough ₁

Affiliation

An estimated 4-5 million CT scans are performed in the USA every year to investigate nephrourological diseases such as urinary stones and renal masses. Despite the clinical benefits of CT imaging, concerns remain regarding the potential risks associated with exposure to ionizing radiation. To assess the potential risk of harmful biological effects from exposure to ionizing radiation, understanding the mechanisms by which radiation damage and repair occur is essential. Although radiation level and cancer risk follow a linear association at high doses, no strong relationship is apparent below 100 mSv, the doses used in diagnostic imaging. Furthermore, the small theoretical increase in risk of cancer incidence must be considered in the context of the clinical benefit derived from a medically indicated CT and the likelihood of cancer occurrence in the general population. Elimination of unnecessary imaging is the most important method to reduce imaging-related radiation; however, technical aspects of medically justified imaging should also be optimized, such that the required diagnostic information is retained while minimizing the dose of radiation. Despite intensive study, evidence to prove an increased cancer risk associated with radiation doses below ~100 mSv is lacking; however, concerns about ionizing radiation in medical imaging remain and can affect patient care. Overall, the principles of justification and optimization must remain the basis of clinical decision-making regarding the use of ionizing radiation in medicine.

中文翻译：

了解、论证和优化肾脏泌尿科 CT 成像的辐射暴露。

据估计，美国每年进行 4-500 万次 CT 扫描，以调查尿路结石和肾脏肿块等肾脏泌尿系统疾病。尽管 CT 成像具有临床益处，但人们仍然担心与接触电离辐射相关的潜在风险。为了评估电离辐射造成的有害生物效应的潜在风险，了解辐射损伤和修复发生的机制至关重要。尽管在高剂量下辐射水平和癌症风险呈线性相关，但在诊断成像中使用的剂量低于 100 毫西弗时，没有明显的强关系。此外，理论上癌症发病风险的小幅增加必须考虑到医学上 CT 所带来的临床益处以及一般人群中癌症发生的可能性。消除不必要的成像是减少成像相关辐射的最重要方法；然而，医学上合理的成像技术方面也应进行优化，以便保留所需的诊断信息，同时最大限度地减少辐射剂量。尽管进行了深入的研究，但仍缺乏证据证明与低于约 100 毫希的辐射剂量相关的癌症风险增加；然而，对医学成像中电离辐射的担忧仍然存在，并可能影响患者护理。总体而言，合理化和优化的原则必须仍然是有关在医学中使用电离辐射的临床决策的基础。

更新日期：2019-02-07

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