随着癌症筛查和治疗的进步不断降低癌症死亡率，降低心脏风险是改善癌症幸存者预后的首要任务。超过一半的成年癌症患者将接受放射治疗（RT）；因此，开发一个评估和预测辐射诱发心脏病（RICD）的框架至关重要。从历史上看，RICD 仅使用平均心脏剂量等整体心脏指标进行建模。然而，过去十年的数据已经确定了心脏亚结构在预测重大心脏事件方面优于整个心脏指标。此外，非放疗因素（例如先前存在的心血管危险因素和其他疗法的毒性）也会增加未来心脏事件的风险。在这篇综述中，我们的目的是讨论当前预测 RICD 的证据和知识差距，并为开发基于三个相互关联的组成部分的综合模型提供路线图：(1) 基线心血管风险评估，(2) 与心脏特异性结果和 (3) 新型生物标志物开发。© 2024 澳大利亚和新西兰皇家放射科医生学院。

Cardiac risk mitigation is a major priority in improving outcomes for cancer survivors as advances in cancer screening and treatments continue to decrease cancer mortality. More than half of adult cancer patients will be treated with radiotherapy (RT); therefore it is crucial to develop a framework for how to assess and predict radiation-induced cardiac disease (RICD). Historically, RICD was modelled solely using whole heart metrics such as mean heart dose. However, data over the past decade has identified cardiac substructures which outperform whole heart metrics in predicting for significant cardiac events. Additionally, non-RT factors such as pre-existing cardiovascular risk factors and toxicity from other therapies contribute to risk of future cardiac events. In this review, we aim to discuss the current evidence and knowledge gaps in predicting RICD and provide a roadmap for the development of comprehensive models based on three interrelated components, (1) baseline CV risk assessment, (2) cardiac substructure radiation dosimetry linked with cardiac-specific outcomes and (3) novel biomarker development.© 2024 The Royal Australian and New Zealand College of Radiologists.