EXAMENES RADIOLOGICOS Y RIESGO CARCINOGENICO EN PACIENTES:

SDSDFSD

RESUMEN DE ALGUNOS ESTUDIOS Y PERSPECTIVAS ACTUALES

Jess Aponte Ortiz Mdico Residente de primer ao Radiologa Hospital Vctor Lazarte Julio 2012

Effective Doses of X ray exams

Effective Doses of X ray exams

Radiation exposures of X ray exams

RadioGraphics 2001; 21:10331045

Radiation exposures of X ray exams

RadioGraphics 2001; 21:10331045

American Association of Physicists in Medicine.

http://www.aapm.org/org/policies/details.asp?id=318&type

=PP AAPM POSITION STATEMENT ON RADIATION RISKS FROM MEDICAL IMAGING PROCEDURES

Policy text
The American Association of Physicists in Medicine (AAPM) acknowledges that

medical imaging procedures should be appropriate and conducted at the lowest radiation dose consistent with acquisition of the desired information.
Discussion of risks related to radiation dose from medical imaging procedures

should be accompanied by acknowledgement of the benefits of the procedures. Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable and may be nonexistent.
Predictions of hypothetical cancer incidence and deaths in patient populations

exposed to such low doses are highly speculative and should be discouraged. These predictions are harmful because they lead to sensationalistic articles in the public media that cause some patients and parents to refuse medical imaging procedures, placing them at substantial risk by not receiving the clinical benefits of the prescribed procedures.
AAPM members continually strive to improve medical imaging by lowering

radiation levels and maximizing benefits of imaging procedures involving ionizing radiation.
AAPM POSITION STATEMENT ON RADIATION RISKS FROM MEDICAL IMAGING PROCEDURES

Radiation exposure and cancer what is already known?

First, in most cases it is difficult to predict who will be harmed,

because many negative effects of exposure to ionizing radiation, such as cancer, are stochastic in nature (i.e., randomly occurring). However, although the severity of such effects does not vary by magnitude of exposure, the probability does increase with dose.
Second, the appearance or diagnosis of radiation-induced cancers

can occur many years after exposure. Thus, it is difficult to attribute the cancer to a specific exposure.

 Finally, much of what we know regarding cancer risk from

ionizing radiation comes from large observational studies involving workers in the nuclear industry and atomic bomb survivors. Exposure in these groups is by and large much higher than those typically seen in clinical populations. Risks to individuals exposed to radiation at doses used in most medical imaging procedures must be extrapolated from epidemiologic data for high-dose populations (e.g., atomic bomb survivors) using a linear no threshold

 However, there are no epidemiologic data to support the

validity of this model for low dose exposures (< 10 millisieverts [mSv]) and thus no direct data regarding the risk to individuals undergoing typical medical imaging procedures. It is likely for these reasons that health care providers have difficulty quantifying the risks associated with many imaging procedures, because they have little or no epidemiologic data suitable to their patients or direct clinical experience with known radiation-induced injuries.

 Are pre- or postnatal diagnostic X-rays a risk

factor for childhood cancer? A systematic review

Heterogeneous results were found for postnatal

exposures and leukemia in four studies. No significant effect of pre- and postnatal X-ray exposure was observed for other cancer sites (non-Hodgkin lymphomas, solid tumors and brain tumors). Most studies have limitations in study design, study size, or exposure measurement. Computed tomography is not covered in the studies and needs to be investigated in the future.

Objective To examine childhood cancer risks associated with exposure to diagnostic radiation and ultrasound scans in utero and in early infancy (age 0-100 days). Design Case-control study. Setting England and Wales. Participants 2690 childhood cancer cases and 4858 age, sex, and region matched controls from the United Kingdom Childhood Cancer Study (UKCCS), born 197696.

 Exposure to diagnostic radiography in early infancy (0-

100 days) was associated with a small increase in risk of all childhood cancer and leukaemia and a statistically significant increase in lymphoma. Exposure to diagnostic radiography in early infancy was associated with small, non-significant excess risks for all cancers and leukaemia, as well as increased risk of lymphoma (odds ratio 5.14, 1.27 to 20.78) on the basis of small numbers.

Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction.
Using an administrative database, we selected a cohort of

patients who had an acute myocardial infarction between April 1996 and March 2006 and no history of cancer. We documented all cardiac imaging and Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction. therapeutic procedures involving low-dose ionizing radiation. The primary outcome was risk of cancer. Statistical analyses were performed using a timedependent Cox model adjusted for age, sex and exposure to lowdose ionizing radiation from noncardiac imaging to account for work-up of cancer.

Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction.
Of the 82 861 patients included in the cohort, 77%

underwent at least one cardiac imaging or therapeutic procedure involving low-dose ionizing radiation in the first year after acute myocardial infarction. The cumulative exposure to radiation from cardiac procedures was 5.3 milli Sieverts (mSv) per patient-year, of which 84% occurred during the first year after acute myocardial infarction. A total of 12 020 incident cancers were diagnosed during the follow-up period.

Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction.
There was a dose-dependent relation between exposure

to radiation from cardiac procedures and subsequent risk of cancer. For every 10 mSv of low-dose ionizing radiation, there was a 3% increase in the risk of age- and sex-adjusted cancer over a mean follow-up period of five years (hazard ratio 1.003 per milliSievert, 95% confidence interval 1.0021.004). Interpretation: Exposure to low-dose ionizing radiation from cardiac imaging and therapeutic procedures after acute myocardial infarction is associated with an increased risk of cancer.

 Radiation exposure from CT scans in childhood and

subsequent risk of leukaemia and brain tumours: a retrospective cohort study.

Lancet 2012 4;380(9840):499-505.

 Assess the excess risk of leukaemia and brain tumours

after CT scans in a cohort of children and young adults. Methods In our retrospective cohort study, we included patients without previous cancer diagnoses who were first examined with CT in National Health Service (NHS) centres in England, Wales, or Scotland (Great Britain) between 1985 and 2002, when they were younger than 22 years of age. We obtained data for cancer incidence, mortality, and loss to follow-up from the NHS Central Registry from Jan 1, 1985, to Dec 31, 2008.

Lancet 2012 4;380(9840):499-505.

 We estimated absorbed brain and red bone marrow doses

per CT scan in mGy and assessed excess incidence of leukaemia and brain tumours cancer with Poisson relative risk models. To avoid inclusion of CT scans related to cancer diagnosis, follow-up for leukaemia began 2 years after the fi rst CT and for brain tumours 5 years after the first CT.

Lancet 2012 4;380(9840):499-505.

Findings During follow-up, 74 of 178 604 patients were diagnosed with leukaemia and 135 of 176 587 patients were diagnosed with brain tumours. We noted a positive association between radiation dose from CT scans and leukaemia (excess relative risk [ERR] per mGy 0036, 95% CI 00050120; p=00097) and brain tumours (0023, 00100049; p<00001). Compared with patients who received a dose of less than 5 mGy, the relative risk of leukaemia for patients who received a cumulative dose of at least 30 mGy (mean dose 5113 mGy) was 318 (95% CI 146694) and the relative risk of brain cancer for patients who received a cumulative dose of 5074 mGy (mean dose 6042 mGy) was 282 (133603). Lancet 2012 4;380(9840):499-505.

 Interpretation Use of CT scans in children to deliver

cumulative doses of about 50 mGy might almost triple the risk of leukaemia and doses of about 60 mGy might triple the risk of brain cancer. Because these cancers are relatively rare, the cumulative absolute risks are small: in the 10 years after the fi rst scan for patients younger than 10 years, one excess case of leukaemia and one excess case of brain tumour per 10 000 head CT scans is estimated to occur. Nevertheless, although clinical benefi ts should outweigh the small absolute risks, radiation doses from CT scans ought to be kept as low as possible and alternative procedures, which do not involve ionising radiation, should be considered if appropriate.
Lancet 2012 4;380(9840):499-505.

Lancet 2012 4;380(9840):499-505.

Lancet 2012 4;380(9840):499-505.

 Cancer

incidence risks to patients due to hysterosalpingography. Of all the cancers considered, the incidence of cancer of the bladder for patients undergoing HSG procedures is more probable.

J Med Phys 2012;37:112-6

 The study was carried out at five rural hospitals (Hospital

B-F) performing HSG procedure without screening and an urban hospital (Hospital A) with screening using II-TV for the HSG procedure. For the study, 120 patients selected at random were used, with 100 patients undergoing HSG procedure without screening and the remaining 20 patients undergoing HSG procedure with screening using II-TV. All the procedures were performed by a radiologist with the assistance of radiographers using a film size of 24 cm x 30 cm for all cases. The radiographic images generated were passed by a radiologist.
J Med Phys 2012;37:112-6

 Empirical risk models developed by the Biological

Effects of Ionizing Radiation (BEIR) Committee Report VII phase two were used to estimate excess relative cancer risk to patients due to radiation exposure. The empirical risk models used in this study are based on the Japanese Atomic bomb survivors.

J Med Phys 2012;37:112-6