Children undergoing radiofrequency ablation (RFA) are believed to be at increased risk of developing malignancy caused by radiation, although the magnitude of this risk is incompletely understood. We previously reported a strategy to reduce radiation exposure during pediatric RFA. In a cohort of 15 subjects (median age 12 years, range 9 to 17), radiation was measured using dosimeters at 5 sites. The risk of malignancy using measured radiation absorbed dose was calculated. International Council for Radiation Protection 60 risk estimates were applied to calculate absorbed organ doses. Median duration of combined biplane fluoroscopy was 14.4 minutes. Of the 5 dosimeter locations, the right scapular location had the highest median radiation exposure (43 mGy). Incorporating data from the 5 dosimeters, the risk model calculated that the organ with the greatest absorbed dose and at greatest risk of malignancy was the lung, followed by bone marrow, then breast. Thyroid and ovary exposures were negligible. The increased lifetime risk of fatal malignancy was 0.02% per single RFA procedure. In conclusion, with appropriate measures to reduce radiation exposure, the increased risk of malignancy after a single RFA procedure in children is low. These data should be of help counseling families and will contribute to analysis of the relative risk reduction benefits of such novel imaging approaches as a magnetic resonance imaging-based catheterization laboratory.

译文

尽管尚未完全了解这种风险的大小,但接受射频消融 (RFA) 的儿童被认为发展由辐射引起的恶性肿瘤的风险增加。我们之前报道了一种减少儿科RFA期间辐射暴露的策略。在15名受试者 (中位年龄12岁,范围9至17) 的队列中,使用剂量计在5个部位测量了辐射。使用测量的辐射吸收剂量计算了恶性肿瘤的风险。国际辐射防护理事会60风险估计值用于计算吸收器官剂量。联合双平面荧光透视的中位持续时间为14.4分钟。在5个剂量计位置中,右肩胛骨位置的中位辐射暴露量最高 (43 mGy)。结合5个剂量计的数据,风险模型计算出吸收剂量最大且恶性肿瘤风险最大的器官是肺,其次是骨髓,然后是乳房。甲状腺和卵巢暴露可以忽略不计。致命恶性肿瘤的终生风险增加的0.02% 是每个单一的RFA程序。总之,通过采取适当措施减少辐射暴露,儿童单次RFA手术后发生恶性肿瘤的风险较低。这些数据应有助于辅导家庭,并有助于分析基于磁共振成像的导管实验室等新型成像方法的相对风险降低益处。

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