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1.
BMJ Open ; 11(8): e048576, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344681

RESUMO

PURPOSE: The COCCINELLE study is a nationwide retrospective French cohort set up to evaluate the risk of cancer in patients who undergone cardiac catheterisation (CC) procedures for diagnosis or treatment of congenital heart disease during childhood. PARTICIPANTS: Children who undergone CC procedures from 1 January 2000 to 31 December 2013, before the age of 16 in one of the 15 paediatric cardiology departments which perform paediatric CC in mainland France were included. The follow-up started at the date of the first recorded CC procedure until the exit date, that is, the date of death, the date of first cancer diagnosis, the date of the 18th birthday or the 31 December 2015, whichever occurred first. The cohort was linked to the National Childhood Cancer Registry to identify patients diagnosed with cancer and with the French National Directory for the Identification of Natural Persons to retrieve the patients' vital status. FINDINGS TO DATE: A total of 17 104 children were included in the cohort and followed for 110 335 person-years, with 22 227 CC procedures collected. Among the patients, 81.6% received only one procedure. Fifty-nine cancer cases were observed in the cohort. Standardised incidence ratios (SIRs) were increased for all-cancer (SIR=3.8, 95% CI: 2.9 to 4.9), leukaemia (SIR=3.3, 95% CI: 2.0 to 5.4), lymphoma (SIR=14.9, 95% CI: 9.9 to 22.5) and solid cancers excluding central nervous system (CNS) tumours (SIR=3.3, 95% CI: 2.0 to 5.5) compared with the general population. FUTURE PLANS: Dose reconstruction is currently underway to estimate individual cumulative doses absorbed to relevant organs, including red bone marrow and brain for respectively haematologic disorders and CNS tumours risk estimation. A dose-response analysis will be conducted with consideration to confounding factors such as age at exposure, gender, predisposing factors to cancer and other sources of medical diagnostic low-dose ionising radiation.


Assuntos
Neoplasias , Cateterismo Cardíaco/efeitos adversos , Criança , França/epidemiologia , Humanos , Incidência , Neoplasias/epidemiologia , Neoplasias/etiologia , Radiação Ionizante , Estudos Retrospectivos , Fatores de Risco
2.
Int J Mol Sci ; 22(14)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34299125

RESUMO

Medical staff represent the largest group of workers occupationally exposed to ionizing radiation (IR). Chronic exposure to low-dose IR may result in DNA damage and genotoxicity associated with increased risk of cancer. This review aims to identify the genotoxicity biomarkers that are the most elevated in IR-exposed vs. unexposed health workers. A systematic review of the literature was performed to retrieve relevant studies with various biomarkers of genotoxicity. Subsequent meta-analyses produced a pooled effect size for several endpoints. The search procedure yielded 65 studies. Chromosome aberrations (CA) and micronuclei (MN) frequencies were significantly different between IR-exposed and unexposed workers (θpooled = 3.19, 95% CI 1.46-4.93; and θpooled = 1.41, 95% CI 0.97-1.86, for total aberrant cells and MN frequencies, respectively), which was not the case for ring chromosomes and nucleoplasmic bridges. Although less frequently used, stable translocations, sister chromatid exchanges (SCE) and comet assay endpoints were also statistically different between IR-exposed and unexposed workers. This review confirms the relevance of CA and MN as genotoxicity biomarkers that are consistently elevated in IR-exposed vs. unexposed workers. Other endpoints are strong candidates but require further studies to validate their usefulness. The integration of the identified biomarkers in future prospective epidemiological studies is encouraged.


Assuntos
Biomarcadores/análise , Aberrações Cromossômicas/efeitos da radiação , Dano ao DNA , Pessoal de Saúde/estatística & dados numéricos , Exposição Ocupacional/análise , Radiação Ionizante , Relação Dose-Resposta à Radiação , Humanos , Exposição Ocupacional/efeitos adversos
3.
Radiat Res ; 196(1): 74-99, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33914893

RESUMO

Within the European Epidemiological Study to Quantify Risks for Paediatric Computerized Tomography (EPI-CT study), a cohort was assembled comprising nearly one million children, adolescents and young adults who received over 1.4 million computed tomography (CT) examinations before 22 years of age in nine European countries from the late 1970s to 2014. Here we describe the methods used for, and the results of, organ dose estimations from CT scanning for the EPI-CT cohort members. Data on CT machine settings were obtained from national surveys, questionnaire data, and the Digital Imaging and Communications in Medicine (DICOM) headers of 437,249 individual CT scans. Exposure characteristics were reconstructed for patients within specific age groups who received scans of the same body region, based on categories of machines with common technology used over the time period in each of the 276 participating hospitals. A carefully designed method for assessing uncertainty combined with the National Cancer Institute Dosimetry System for CT (NCICT, a CT organ dose calculator), was employed to estimate absorbed dose to individual organs for each CT scan received. The two-dimensional Monte Carlo sampling method, which maintains a separation of shared and unshared error, allowed us to characterize uncertainty both on individual doses as well as for the entire cohort dose distribution. Provided here are summaries of estimated doses from CT imaging per scan and per examination, as well as the overall distribution of estimated doses in the cohort. Doses are provided for five selected tissues (active bone marrow, brain, eye lens, thyroid and female breasts), by body region (i.e., head, chest, abdomen/pelvis), patient age, and time period (1977-1990, 1991-2000, 2001-2014). Relatively high doses were received by the brain from head CTs in the early 1990s, with individual mean doses (mean of 200 simulated values) of up to 66 mGy per scan. Optimization strategies implemented since the late 1990s have resulted in an overall decrease in doses over time, especially at young ages. In chest CTs, active bone marrow doses dropped from over 15 mGy prior to 1991 to approximately 5 mGy per scan after 2001. Our findings illustrate patterns of age-specific doses and their temporal changes, and provide suitable dose estimates for radiation-induced risk estimation in epidemiological studies.

4.
Pediatr Radiol ; 51(1): 45-56, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32910229

RESUMO

BACKGROUND: Ionizing radiation use for medical diagnostic purposes has substantially increased over the last three decades. Moderate to high doses of radiation are well established causes of cancer, especially for exposure at young ages. However, cancer risk from low-dose medical imaging is debated. OBJECTIVE: To review the literature on cancer risks associated with prenatal and postnatal medical diagnostic ionizing radiation exposure among children and to assess this risk through a meta-analysis. MATERIALS AND METHODS: A literature search of five electronic databases supplemented by a hand search was performed to retrieve relevant epidemiological studies published from 2000 to 2019, including patients younger than 22 years of age exposed to medical imaging ionizing radiation. Pooled odds ratio (ORpooled) and pooled excess relative risk (ERRpooled) representing the excess of risk per unit of organ dose were estimated with a random effect model. RESULTS: Twenty-four studies were included. For prenatal exposure (radiographs or CT), no significant increased risk was reported for all cancers, leukemia and brain tumors. For postnatal exposure, increased risk was observed only for CT, mostly for leukemia (ERRpooled=26.9 Gy-1; 95% confidence interval [CI]: 2.7-57.1) and brain tumors (ERRpooled=9.1 Gy-1; 95% CI: 5.2-13.1). CONCLUSION: CT exposure in childhood appears to be associated with increased risk of cancer while no significant association was observed with diagnostic radiographs.

6.
Radiat Oncol ; 15(1): 201, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819449

RESUMO

BACKGROUND: Radiotherapy for breast cancer (BC) and its resulting cardiac exposure are associated with subclinical left ventricular dysfunction characterized by early decrease of global longitudinal strain (LS) measurement based on 2D speckle-tracking echocardiography. Recent software allows multi-layer and segmental analysis of strain, which may be of interest to quantify and locate the impact of cardiac exposure on myocardial function and potentially increase the early detection of radiation-induced cardiotoxicity. The aim of the study was to evaluate whether decrease in LS 6 months after radiotherapy is layer-specific and if it varies according to the left ventricular regional level and the coronary arterial territories. METHODS: LS was measured at baseline before radiotherapy and 6 months post-radiotherapy. The LS was obtained for each myocardial layer (endocardial, mid-myocardial, epicardial), left ventricular regional level (basal, mid, apical) and coronary artery territory (left anterior descending artery (LAD), circumflex artery, right coronary artery). RESULTS: The study included 64 left-sided BC patients. Mean age was 58 years, mean doses to the heart, the left ventricle and the LAD were respectively 3.0, 6.7 and 16.4 Gy. The absolute decrease of LS was significant for the three layers (endocardial: - 20.0 ± 3.2% to - 18.8 ± 3.8%; mid-myocardial: - 16.0 ± 2.7% to - 15.0 ± 3.1%; epicardial: - 12.3 ± 2.5% to - 11.4 ± 2.8%, all p = 0.02), but only the relative decrease of LS in the endocardial layer was close to be significant (- 4.7%, p = 0.05). More precisely, the LS of the endocardial layer was significantly decreased for the most exposed parts of the left ventricle corresponding to the apical level (- 26.3 ± 6.0% vs. -24.2 ± 7.1%, p = 0.03) and LAD territory (- 22.8 ± 4.0% vs. -21.4 ± 4.8%, p = 0.03). CONCLUSION: Six months post-radiotherapy, LS decreased predominantly in the endocardial layer of the most exposed part of the left ventricle. For precise evaluation of radiotherapy-induced cardiotoxicity and early left ventricular dysfunction, the endocardial layer-based LS might be the most sensitive parameter. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02605512 , Registered 6 November 2015 - Retrospectively registered.


Assuntos
Cardiotoxicidade/patologia , Miocárdio/patologia , Radioterapia/efeitos adversos , Neoplasias Unilaterais da Mama/radioterapia , Disfunção Ventricular Esquerda/patologia , Cardiotoxicidade/etiologia , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Prognóstico , Curva ROC , Neoplasias Unilaterais da Mama/patologia , Disfunção Ventricular Esquerda/etiologia
7.
Radiat Environ Biophys ; 59(4): 631-641, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32700049

RESUMO

A meta-analytic summary effect estimate often is calculated as an inverse-variance-weighted average of study-specific estimates of association. The variances of published estimates of association often are derived from their associated confidence intervals under assumptions typical of Wald-type statistics, such as normality of the parameter. However, in some research areas, such as radiation epidemiology, epidemiological results typically are obtained by fitting linear relative risk models, and associated likelihood-based confidence intervals are often asymmetric; consequently, reasonable estimates of variances associated with study-specific estimates of association may be difficult to infer from the standard approach based on the assumption of a Wald-type interval. Here, a novel method is described for meta-analysis of published results from linear relative risk models that uses a parametric transformation of published results to improve on the normal approximation used to assess confidence intervals. Using simulations, it is illustrated that the meta-analytic summary obtained using the proposed approach yields less biased summary estimates, with better confidence interval coverage, than the summary obtained using the more classical approach to meta-analysis. The proposed approach is illustrated using a previously published example of meta-analysis of epidemiological findings regarding circulatory disease following exposure to low-level ionizing radiation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Modelos Lineares , Radiação Ionizante , Risco , Humanos , Exposição à Radiação/efeitos adversos
8.
J Radiol Prot ; 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32668420

RESUMO

The HARMONIC project (Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Paediatrics) is a European study aiming to improve our understanding of the long-term health risks from radiation exposures in childhood and early adulthood. Here, we present the study design for the cardiac component of HARMONIC. A pooled cohort of approximately 100,000 patients who underwent cardiac fluoroscopy procedures in Belgium, France, Germany, Italy, Norway, Spain or the UK, while aged under 22 years, will be established from hospital records and/or insurance claims data. Doses to individual organs will be estimated from dose indicators recorded at the time of examination, using a lookup-table-based dosimetry system produced using Monte Carlo radiation transport simulations and anatomically realistic computational phantom models. Information on beam geometry and x-ray energy spectra will be obtained from a representative sample of radiation dose structured reports (RDSRs). Uncertainties in dose estimates will be modelled using 2-dimensional Monte Carlo methods. The cohort will be followed up using national registries and insurance records (Germany) to determine vital status and cancer incidence. Information on organ transplantation (a major risk factor for cancer development) and/or other conditions predisposing to cancer will be obtained from national or local registries and health insurance data, depending on country. The relationship between estimated radiation dose and cancer risk will be investigated using regression modelling. Results will improve information for patients and parents and aid clinicians in managing and implementing changes to reduce radiation risks without compromising medical benefits.

9.
J Neurooncol ; 148(2): 335-342, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32415644

RESUMO

INTRODUCTION: Cognitive impairment is frequent in patients with high-grade glioma and requires cognitive follow-up. Cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) have been used to assess cognition in these patients. Here we assessed the sensitivity of the MoCA in screening for cognitive impairment in a cohort of 156 patients with newly-diagnosed high-grade glioma, after surgery and before radiochemotherapy. METHODS: We assessed cognitive performance with the MoCA and a neuropsychological battery. Cognitive scores were analyzed in terms of a previously validated framework designed to control false positives and data for 1003 control participants from the GRECOGVASC study. After comparison of performance on the tests, we used stepwise logistic regression to produce a cognitive summary score from the neuropsychological battery. Then we analyzed sensitivity and specificity of the MoCA with receiver operator characteristic (ROC) curve analysis. RESULTS: Both raw and adjusted MoCA scores showed only moderate sensitivity. The area under the ROC curve was 0.759 (95% CI 0.703-0.815) for the raw score and 0.788 (95% CI 0.734-0.842) for the adjusted score. Optimal discrimination was obtained with a raw score ≤ 25 (sensitivity: 0.526; specificity: 0.832; positive predictive value: 0.2; negative predictive value: 0.96) and an adjusted score - 0.603 (sensitivity: 0.716; specificity: 0.768; positive predictive value: 0.24; negative predictive value: 0.96). CONCLUSION: The moderate sensitivity of MoCA indicates that it is not a suitable screening tool for detecting cognitive impairment in patients with newly-diagnosed high-grade glioma.


Assuntos
Neoplasias Encefálicas/complicações , Disfunção Cognitiva/diagnóstico , Glioma/complicações , Testes de Estado Mental e Demência , Adulto , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Disfunção Cognitiva/etiologia , Feminino , Glioma/patologia , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Sensibilidade e Especificidade , Adulto Jovem
10.
Radiat Oncol ; 14(1): 204, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727075

RESUMO

BACKGROUND: Breast cancer (BC) radiotherapy (RT) can induce cardiotoxicity, with adverse events often observed many years after BC RT. Subclinical left ventricular (LV) dysfunction can be detected early after BC RT with global longitudinal strain (GLS) measurement based on 2D speckle-tracking echocardiography. This 6-month follow-up analysis from the BACCARAT prospective study aimed to investigate the association between cardiac radiation doses and subclinical LV dysfunction based on GLS reduction. METHODS: The patient study group consisted of 79 BC patients (64 left-sided BC, 15 right-sided BC) treated with RT without chemotherapy. Echocardiographic parameters, including GLS, were measured before RT and 6 months post-RT. The association between subclinical LV dysfunction, defined as GLS reduction > 10%, and radiation doses to whole heart and the LV were performed based on logistic regressions. Non-radiation factors associated with subclinical LV dysfunction including age, BMI, hypertension, hypercholesterolemia and endocrine therapy were considered for multivariate analyses. RESULTS: A mean decrease of 6% in GLS was observed (- 15.1% ± 3.2% at 6 months vs. - 16.1% ± 2.7% before RT, p = 0.01). For left-sided patients, mean heart and LV doses were 3.1 ± 1.3 Gy and 6.7 ± 3.4 Gy respectively. For right-sided patients, mean heart dose was 0.7 ± 0.5 Gy and median LV dose was 0.1 Gy. Associations between GLS reduction > 10% (37 patients) and mean doses to the heart and the LV as well as the V20 were observed in univariate analysis (Odds Ratio = 1.37[1.01-1.86], p = 0.04 for Dmean Heart; OR = 1.14 [1.01-1.28], p = 0.03 for Dmean LV; OR = 1.08 [1.01-1.14], p = 0.02 for LV V20). In multivariate analysis, these associations did not remain significant after adjustment for non-radiation factors. Further exploratory analysis allowed identifying a subgroup of patients (LV V20 > 15%) for whom a significant association with subclinical LV dysfunction was found (adjusted OR = 3.97 [1.01-15.70], p = 0.048). CONCLUSIONS: This analysis indicated that subclinical LV dysfunction defined as a GLS decrease > 10% is associated with cardiac doses, but adjustment for non-radiation factors such as endocrine therapy lead to no longer statistically significant relationships. However, LV dosimetry may be promising to identify high-risk subpopulations. Larger and longer follow-up studies are required to further investigate these associations. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02605512, Registered 6 November 2015 - Retrospectively registered.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Coração/efeitos da radiação , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico , Adulto , Idoso , Índice de Massa Corporal , Cardiotoxicidade , Diagnóstico Precoce , Ecocardiografia , Feminino , Seguimentos , Humanos , Hipercolesterolemia/complicações , Hipertensão/complicações , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Radiometria , Radioterapia Conformacional , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco
12.
Cancer ; 125(14): 2497-2505, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31012956

RESUMO

BACKGROUND: Pediatric differentiated thyroid cancer (DTC) rates have increased over time in the United States and worldwide. Improvements in imaging for the diagnosis of DTC have been hypothesized as a potential driver of these increases. This study stratifies temporal trends in pediatric DTC by stage and tumor size to assess whether rates of large, late-stage cancers, which are likely to be clinically meaningful, are increasing over time. METHODS: Age-standardized incidence rates (ASRs) of DTC and annual percent changes (APCs) in primary DTC rates were estimated for 0- to 19-year-olds with data from 39 US cancer registries during 1998-2013. RESULTS: During 1998-2013, 7296 cases of DTC were diagnosed (6652 papillary cases and 644 follicular cases). APCs of pediatric DTCs significantly increased by 4.43%/y [95% CI, 3.74%/y-5.13%/y], primarily because of increases in papillary histologies. Increasing trends were observed for children aged 10 to 19 years for both sexes and for non-Hispanic whites, non-Hispanic blacks, and Hispanics. Rates increased significantly over the time period for all tumor stages (APClocalized , +4.06%/y [95% CI, 2.84%/y-5.29%/y]; APCregional , +5.68%/y [95% CI, 4.64%/y-6.73%/y]; APCdistant , +8.55%/y [95% CI, 5.03%/y-12.19%/y]) and across tumor sizes (APC<1 cm , +9.46%/y [95% CI, 6.13%/y-12.90%/y]; APC1-2 cm , +6.92%/y [95% CI, 4.31%/y-9.60%/y]; APC>2 cm , +4.69%/y [95% CI, 2.75%/y-6.67%/y]). CONCLUSIONS: Significantly increasing rates of DTC over time among 10- to 19-year-olds in the United States are unlikely to be entirely explained by increases in medical surveillance during childhood because rates of large and late-stage DTC are increasing over time. Future studies should examine environmental and other factors that may be contributing to rising DTC rates.


Assuntos
Saúde da Criança/tendências , Neoplasias da Glândula Tireoide/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estadiamento de Neoplasias , Sistema de Registros , Fatores de Risco , Neoplasias da Glândula Tireoide/etnologia , Neoplasias da Glândula Tireoide/etiologia , Carga Tumoral , Estados Unidos/epidemiologia , Adulto Jovem
13.
Radiat Oncol ; 14(1): 29, 2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30732640

RESUMO

BACKGROUND: Intra-individual heterogeneity of cardiac exposure is an issue in breast cancer (BC) radiotherapy that was poorly considered in previous cardiotoxicity studies mainly based on mean heart dose (MHD). This dosimetric study analyzes the distribution of individually-determined radiation doses to the heart and its substructures including coronary arteries and evaluate whether MHD is a relevant surrogate parameter of dose for these substructures. METHODS: Data were collected from the BACCARAT prospective study that included left or right unilateral BC patients treated with 3D-Conformal Radiotherapy (RT) between 2015 and 2017 and followed-up for 2 years with repeated cardiac imaging examinations. A coronary computed tomography angiography (CCTA) was performed before RT for all patients. Registration of the planning CT and CCTA images allowed delineation of the coronary arteries on the planning CT images. Using the 3D dose matrix generated during treatment planning and the added coronary contours, dose distributions were generated for whole heart and the following substructures: left ventricle (LV), left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). A descriptive analysis of the physical doses in Gray (Gy) was performed, Dmean was the volume-weighted mean dose. RESULTS: Dose distributions were generated for 89 left-sided BC patients (MHD = 2.9 ± 1.5 Gy, Dmean_LAD = 15.7 ± 3.1 Gy) and 15 right-sided BC patients (MHD = 0.5 ± 0.1 Gy; Dmean_RCA = 1.2 ± 0.4 Gy). For left-sided BC patients, the ratio Dmean_LAD/MHD was around 5. Pearson correlation coefficients between MHD and Dmean for delineated substructures were all statistically significant. However, for all substructures, the coefficient of determination R2 indicated that the proportion of the variance in Dmean of the substructure predictable from MHD was moderate to low (in particular R2 = 0.45 for LAD). Among left-sided BC patients with MHD < 3Gy, 56% of patients could nevertheless receive LAD doses above 40Gy (V40 > 0). CONCLUSION: Our study illustrates that MHD is not enough to predict with confidence individual patient dose to the LV and coronary arteries, in particular the LAD. For precise radiotherapy-induced cardiotoxicity studies it would be necessary to consider the distribution of doses within these cardiac substructures rather than just the MHD. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02605512 , Registered 6 November 2015 - Retrospectively registered.


Assuntos
Biomarcadores , Neoplasias da Mama/radioterapia , Vasos Coronários/efeitos da radiação , Ventrículos do Coração/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Dosagem Radioterapêutica
15.
Circ Cardiovasc Interv ; 11(11): e006765, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30571202

RESUMO

Background Children treated with cardiac catheterization procedures have now a long life expectancy and consequently potential long-term radiation-induced risks. We projected lifetime attributable risks (LARs) of cancer incidence from the most frequent procedures in pediatrics: atrial septal defect closure, patent ductus arteriosus occlusion, or pulmonary valvuloplasty. Methods and Results Organ equivalent doses were estimated for 1251 procedures performed in children aged ≤15 years at 2 reference catheterization centers in France from 2009 to 2013. Sex-specific LARs were projected in lifelong nonsmokers using extended Committee on Biological Effects of Ionizing Radiation VII risk models and considering various sources of risk projection uncertainties and dose variability (Radiation Risk Assessment Tool software). Median LARs ranged between 0.3 and 1.4 (atrial septal defect closure), 0.6 and 5.0 (patent ductus arteriosus occlusion), and 1.0 and 12.0 (pulmonary valvuloplasty) per 1000 procedures, depending on patient sex and age at treatment. These radiation-related risks would represent 0.4% to 6.0% of children's total lifetime cancer risk. For the 10% of procedures (all types combined) with highest exposures, LARs reached 4.2 per 1000 (95% uncertainty interval, 0.8-13.1) in boys and 22.2 per 1000 (95% uncertainty interval, 7.4-45.6) in girls. In boys, lung cancer accounted for 70% to 80% of the projected LARs, whereas in girls it accounted for 20% to 60% and breast cancer for 30% to 80% of the excess risks, depending on the type of procedure and patient age. Conclusions Radiation exposure may lead to substantial radiation doses and increased cancer risks in some cases. This suggests the need for dose reporting to support recommendations for long-term surveillance and prevention strategies when it is necessary.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/terapia , Neoplasias Induzidas por Radiação/epidemiologia , Exposição à Radiação/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Adolescente , Idade de Início , Feminino , Fluoroscopia/efeitos adversos , França/epidemiologia , Cardiopatias Congênitas/epidemiologia , Humanos , Incidência , Masculino , Neoplasias Induzidas por Radiação/diagnóstico , Doses de Radiação , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Eur J Epidemiol ; 33(12): 1179-1191, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30151727

RESUMO

It has long been known that relatively high-dose ionising radiation exposure (> 1 Gy) can induce cataract, but there has been no evidence that this occurs at low doses (< 100 mGy). To assess low-dose risk, participants from the US Radiologic Technologists Study, a large, prospective cohort, were followed from date of mailed questionnaire survey completed during 1994-1998 to the earliest of self-reported diagnosis of cataract/cataract surgery, cancer other than non-melanoma skin, or date of last survey (up to end 2014). Cox proportional hazards models with age as timescale were used, adjusted for a priori selected cataract risk factors (diabetes, body mass index, smoking history, race, sex, birth year, cumulative UVB radiant exposure). 12,336 out of 67,246 eligible technologists reported a history of diagnosis of cataract during 832,479 person years of follow-up, and 5509 from 67,709 eligible technologists reported undergoing cataract surgery with 888,420 person years of follow-up. The mean cumulative estimated 5-year lagged eye-lens absorbed dose from occupational radiation exposures was 55.7 mGy (interquartile range 23.6-69.0 mGy). Five-year lagged occupational radiation exposure was strongly associated with self-reported cataract, with an excess hazard ratio/mGy of 0.69 × 10-3 (95% CI 0.27 × 10-3 to 1.16 × 10-3, p < 0.001). Cataract risk remained statistically significant (p = 0.030) when analysis was restricted to < 100 mGy cumulative occupational radiation exposure to the eye lens. A non-significantly increased excess hazard ratio/mGy of 0.34 × 10-3 (95% CI - 0.19 × 10-3 to 0.97 × 10-3, p = 0.221) was observed for cataract surgery. Our results suggest that there is excess risk for cataract associated with radiation exposure from low-dose and low dose-rate occupational exposures.


Assuntos
Pessoal Técnico de Saúde , Catarata/etiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Exposição à Radiação/efeitos adversos , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Catarata/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Exposição Ocupacional/análise , Exposição à Radiação/estatística & dados numéricos , Fatores de Risco , Tecnologia Radiológica/estatística & dados numéricos , Estados Unidos , Adulto Jovem
17.
Sci Rep ; 8(1): 10481, 2018 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-29992993

RESUMO

There are well-documented associations of glaucoma with high-dose radiation exposure, but only a single study suggesting risk of glaucoma, and less conclusively macular degeneration, associated with moderate-dose exposure. We assessed risk of glaucoma and macular degeneration associated with occupational eye-lens radiation dose, using participants from the US Radiologic Technologists Study, followed from the date of surveys in 1994-1998, 2003-2005 to the earliest of diagnosis of glaucoma or macular degeneration, cancer other than non-melanoma skin cancer, or date of last survey (2012-2014). We excluded those with baseline disease or previous radiotherapy history. Cox proportional hazards models with age as timescale were used. There were 1631 cases of newly self-reported doctor-diagnosed cases of glaucoma and 1331 of macular degeneration among 69,568 and 69,969 eligible subjects, respectively. Estimated mean cumulative eye-lens absorbed dose from occupational radiation exposures was 0.058 Gy. The excess relative risk/Gy for glaucoma was -0.57 (95% CI -1.46, 0.60, p = 0.304) and for macular degeneration was 0.32 (95% CI -0.32, 1.27, p = 0.381), suggesting that there is no appreciable risk for either endpoint associated with low-dose and low dose-rate radiation exposure. Since this is the first examination of glaucoma and macular degeneration associated with low-dose radiation exposure, this result needs to be replicated in other low-dose studies.


Assuntos
Glaucoma/etiologia , Degeneração Macular/etiologia , Exposição Ocupacional , Exposição à Radiação , Adulto , Idoso , Feminino , Glaucoma/epidemiologia , Humanos , Degeneração Macular/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Fatores de Risco , Autorrelato , Inquéritos e Questionários , Estados Unidos
18.
Occup Environ Med ; 75(8): 533-561, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29720482

RESUMO

INTRODUCTION: Technologists working in nuclear medicine (NM) are exposed to higher radiation doses than most other occupationally exposed populations. The aim of this study was to estimate the risk of cancer in NM technologists in relation to work history, procedures performed and radioprotection practices. METHODS: From the US Radiologic Technologists cohort study, 72 755 radiologic technologists who completed a 2003-2005 questionnaire were followed for cancer mortality through 31 December 2012 and for cancer incidence through completion of a questionnaire in 2012-2013. Multivariable-adjusted models were used to estimate HRs for total cancer incidence and mortality by history of ever performing NM procedures and frequency of performing specific diagnostic or therapeutic NM procedures and associated radiation protection measures by decade. RESULTS: During follow-up (mean=7.5 years), 960 incident cancers and 425 cancer deaths were reported among the 22 360 technologists who worked with NM procedures. We observed no increased risk of cancer incidence (HR 0.96, 95% CI 0.89 to 1.04) or death (HR 1.05, 95% CI 0.93 to 1.19) among workers who ever performed NM procedures. HRs for cancer incidence but not mortality were higher for technologists who began performing therapeutic procedures in 1960 and later compared with the 1950s. Frequency of performing diagnostic or therapeutic NM procedures and use of radioprotection measures were not consistently associated with cancer risk. No clear associations were observed for specific cancers, but results were based on small numbers. CONCLUSION: Cancer incidence and mortality were not associated with NM work history practices, including greater frequency of procedures performed.


Assuntos
Pessoal de Saúde , Neoplasias Induzidas por Radiação , Medicina Nuclear , Doenças Profissionais , Exposição Ocupacional , Proteção Radiológica , Tecnologia Radiológica , Adulto , Idoso , Estudos de Coortes , Emprego , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Induzidas por Radiação/mortalidade , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Profissionais/mortalidade , Exposição Ocupacional/efeitos adversos , Utilização de Procedimentos e Técnicas , Medição de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia
19.
Radiology ; 287(2): 676-682, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29390195

RESUMO

Purpose To summarize occupational badge doses recorded for a sample of U.S. nuclear medicine technologists. Materials and Methods Nine large U.S. medical institutions identified 208 former and current nuclear medicine technologists certified after 1979 and linked these individuals to historic badge dose records maintained by a commercial dosimetry company (Landauer), yielding a total of 2618 annual dose records. The distributions of annual and cumulative occupational doses were described by using summary statistics. Results Between 1992 and 2015, the median annual personal dose equivalent per nuclear medicine technologist was 2.18 mSv (interquartile range [IQR], 1.25-3.47 mSv; mean, 2.69 mSv). Median annual personal dose equivalents remained relatively constant over this period (range, 1.40-3.30 mSv), while maximum values generally increased over time (from 8.00 mSv in 1992 to 13.9 mSv in 2015). The median cumulative personal dose equivalent was 32.9 mSv (IQR, 18.1-65.5 mSv; mean, 51.4 mSv) for 45 technologists who had complete information and remained employed through 2015. Conclusion Occupational radiation doses were well below the established occupational limits and were consistent with those observed for nuclear medicine technologists worldwide and were greater than those observed for nuclear and general medical workers in the United States These results should be informative for radiation monitoring and safety efforts in nuclear medicine departments. © RSNA, 2018 Online supplemental material is available for this article.


Assuntos
Medicina Nuclear , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Lesões por Radiação/epidemiologia , Monitoramento de Radiação , Proteção Radiológica/instrumentação , Adulto , Idoso , Carga Corporal (Radioterapia) , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Monitoramento de Radiação/instrumentação , Eficiência Biológica Relativa , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
20.
Eur Radiol ; 28(2): 630-641, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28836026

RESUMO

OBJECTIVES: To describe computed tomography (CT) scanning parameters, volume CT dose index (CTDIvol) and dose-length product (DLP) in paediatric practice and compare them to current diagnostic reference levels (DRLs). METHODS: The survey was conducted in radiology departments of six major university hospitals in France in 2010-2013. Data collection was automatised to extract and standardise information on scanning parameters from DICOM-header files. CTDIvol and DLP were estimated based on Monte Carlo transport simulation and computational reference phantoms. RESULTS: CTDIvol and DLP were derived for 4,300 studies, four age groups and 18 protocols. CTDIvol was lower in younger patients for non-head scans, but did not vary with age for routine head scans. Ratios of 95th to 5th percentile CTDIvol values were 2-4 for most body parts, but 5-7 for abdominal examinations and 4-14 for mediastinum CT with contrast, depending on age. The 75th percentile CTDIvol values were below the national DRLs for chest (all ages) and head and abdominal scans (≥10 years). CONCLUSION: The results suggest the need for a better optimisation of scanning parameters for routine head scans and infrequent protocols with patient age, enhanced standardisation of practices across departments and revision of current DRLs for children. KEY POINTS: • CTDIvol varied little with age for routine head scans. • CTDIvol was lowest in youngest children for chest or abdominal scans. • Individual and inter-department variability warrant enhanced standardisation of practices. • Recent surveys support the need for revised diagnostic reference levels. • More attention should be given to specific protocols (sinuses, neck, spine, mediastinum).


Assuntos
Hospitais Universitários , Imagens de Fantasmas , Exposição à Radiação/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Criança , Pré-Escolar , Relação Dose-Resposta à Radiação , Feminino , França , Humanos , Lactente , Recém-Nascido , Masculino , Doses de Radiação
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