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目的针对行体部CT扫描的年轻人,量化其预后情况、预测癌症风险并确定一般检查适应证。材料与方法本项多中心回顾性研究符合HIPAA标准,经3个机构的审查委员会批准,并免除知情同意书。通过对18～35岁有社会保障记录并在2003年—2007年间行胸/腹盆部CT检查的病人的问卷调查,填写病人在一个城市内3家大学附属医院的就诊和缴费记录。根据扫描部位及扫描频率对病人进行分析。记录死亡情况和随访间隔时间。应用电离辐射生物效应的第7条法则计算预期癌症发生率和死亡率。根据ICD-9疾病编码确定检查适应证,计算95%置信区间百分比,应用二项检验比较百分比间的差异。结果在21945例病人中,进行16851次胸部CT扫描,24112次腹盆部CT扫描。在平均(5.5±0.1)年的随访期内,7.1%(575/8057)行胸部CT检查的病人和3.9%(546/13888)行腹部CT检查的病人已死亡。相比之下,死于CT诱导癌症的预期风险分别为0.1%(5/8057,P<0.01)和0.1%(8/12472,P<0.01)。胸部CT最常见的检查指征包括癌症和创伤,而腹盆部CT为腹痛、创伤和癌症。在那些只行1～2次CT扫描的非癌症病人中,胸部CT和腹盆部CT辐射诱导癌症的死亡率和预期风险分别为3.6%(215/5914)、0.05%(3/5914,P<0.01)和1.9%(219/11291)、0.1%(6/11291,P<0.01)。结论在行体部CT扫描的年轻人中,由基础疾病所致死亡的风险高于长期辐射诱导癌症所致死亡的风险。
Objective To assess the prognosis of young people who underwent CT scan of their body parts, predict the risk of cancer and determine the general indications. Materials and Methods This multicenter retrospective study was conducted in accordance with the HIPAA standards and was approved by the review bodies of the three institutions and exempted from informed consent. Through the questionnaire survey of patients aged 18-35 with social security records and performing thoracic / abdominal pelvic CT examinations between 2003 and 2007, fill in the records of patients’ attendance and payment in 3 university affiliated hospitals in one city. According to the scan site and scan frequency of the patient analysis. Record the death and follow-up interval. Rule 7, applying biological effects of ionizing radiation, calculates expected cancer incidence and mortality. Identify indications based on ICD-9 disease codes, calculate 95% confidence intervals, and apply two tests to compare the percent differences. Results Of 21 495 patients, 16 851 chest CT scans and 241 12 abdominal abdomen CT scans were performed. In a mean follow-up of 5.5 ± 0.1 years, 7.1% (575/8057) of patients undergoing chest CT and 3.9% (546/13888) undergoing abdominal CT had died. In contrast, the expected risks of dying from CT-induced cancer were 0.1% (5/8057, P <0.01) and 0.1% (8/12472, P <0.01), respectively. The most common indications for chest CT include cancer and trauma, while the pelvic CT is abdominal pain, trauma and cancer. Among non-cancer patients who underwent CT scans on 1 or 2 occasions, the mortality and expected risk of CT radiation-induced cancer in the chest and abdomen were 3.6% (215/5914), 0.05% (3/5914, P <0.01) and 1.9% (219/11291), 0.1% (6/11291, P <0.01). Conclusion The risk of death from underlying disease is higher in young people undergoing CT scan of the body than the risk of death from long-term radiation-induced cancer.