心脏辐射暴露和事件癌症：挑战和机遇
Cardiac radiation exposure and incident cancer: challenges and opportunities
影响因子:6.60000
分区:医学1区 Top / 心脏和心血管系统2区 核医学2区
发表日期:2024 Nov 27
作者:
Eugenio Picano, Eliseo Vano, Robert P Gale, Patrick Serruys
摘要
放射程序的使用具有极大的心脏病学。患有心脏病的人暴露于电离辐射。根据用于放射保护目的的线性无阈值模型，暴露于电离辐射会增加终生癌症风险。在美国，截至2016年放射学年，平均公民每年每年的年度医疗辐射暴露量为每年2.29毫米，对应于115张胸部X射线的剂量暴露。心脏病学研究通常涉及每次手术的高暴露，约占累积医疗辐射暴露的30-50％。恶性肿瘤更多的是从心脏干预和心血管成像测试（例如肺，骨髓和雌性乳房）接受最大的器官剂量的最大器官剂量的最大入射。人们认为，辐射暴露和癌症之间的潜伏期至少为2年，对于所有固体癌症而言，辐射暴露和癌症的潜伏期至少为5年，并且在心脏病学研究中更有可能出现差异，随访较长，随访和包括癌症发生率等非心血管终点。在心脏病学研究中，暴露后3 - 2年观察到过多的癌症，随访时间更长，显示出更大的癌症发生率差异。假定相关的多余癌症风险需要更大的研究。这些暴露提供了一个独特的机会，可以扩大我们对暴露于电离辐射和癌症风险之间关系的了解。比较介入性透视镜与最佳医疗疗法或开放手术的未来试验应包括癌症发生终点。版权所有。有关商业重复使用，请联系reprints@oup.com，以获取转载和翻译权以进行转载。所有其他权限都可以通过我们的restrimlink服务通过我们网站上文章页面上的“权限链接”获得 - 有关更多信息，请联系journals.permissions.permissions@oup.com。
Abstract
The use of radiological procedures has enormously advanced cardiology. People with heart disease are exposed to ionizing radiation. Exposure to ionizing radiation increases lifetime cancer risk with a dose-proportional hazard according to the linear no-threshold model adopted for radioprotection purposes. In the USA, the average citizen accumulates a median annual medical radiation exposure of 2.29 millisievert per year per capita as of the radiologic year 2016, corresponding to the dose exposure of 115 chest X-rays. Cardiology studies often involve high exposures per procedure accounting for ∼30-50% of cumulative medical radiation exposures. Malignancy is more incident in the most radiosensitive organs receiving the largest organ dose from cardiac interventions and cardiovascular imaging testing, such as the lung, bone marrow, and female breast. The latency period between radiation exposure and cancer is thought to be at least 2 years for leukaemia and 5 years for all solid cancers, and differences are more likely to emerge in cardiology studies with longer follow-up and inclusion of non-cardiovascular endpoints such as cancer incidence. In cardiological studies, excess cancers are observed 3-12 years following exposure, with longer follow-up times showing greater differences in cancer incidence. The presumed associated excess cancer risk needs greater study. These exposures provide a unique opportunity to expand our knowledge of the relationship between exposure to ionizing radiation and cancer risk. Future trials comparing interventional fluoroscopy vs. optimal medical therapy or open surgery should include a cancer incidence endpoint.© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.