관상동맥조영술과 경피적관상동맥중재술에서 환자 선량과 암 발생 생애귀속위험 평가
Radiation Dose and Estimate of Lifetime Attributable Risk of Cancer from Coronary Angiography and Percutaneous Coronary Intervention
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초록
관상동맥질환의 진단과 치료를 위한 관상동맥조영술(Coronary Angiography, CA)과 경피적관상동맥중재술(Percutaneous Coronary Intervention, PCI) 과정에서 환자에 대한 유효선량을 알아보고, 이 선량으로 인한 암 발생위험을 CA와 PCI를 구분하여 평가해 보고자 하였다. CA를 시행한 환자 60명과 PCI 시술을 받은 환자 58명을 대상으로 DAP(dose-area product)를 측정하였고, 몬테카를로 시뮬레이션(Monte Carlo simulations) 프로그램(PCXMC 1.5)을 이용하여 유효선량과 장기선량을 산출하였다. 암 발생의 생애귀속위험의 평가는 전리방사선 생물학적 효과 위원회의 7차 보고서(BEIR Ⅶ)를 활용하였다. 그 결과 대상자의 DAP 값 평균은 CA군에서 53.76Gy․cm2이었고, PCI군에서는 165.82Gy․cm2이었다. 유효선량은 CA군에서 평균 1.28mSv이었고, PCI군에서는 3.94mSv이었다. 장기선량은 폐에서 CA군 2.17mSv, PCI군 6.71mSv이었고, 여성 유방선량은 CA에서 5.45mSv, PCI에서 16.82mSv이었다. 암 발생 생애귀속위험은 CA에서 남성은 1,508명 중 1명, 여성은 1,357명 중 1명이었고, PCI에서는 남성 553 중 1명, 여성은 482명 중 1명이었다. DAP 값은 몬테 카를로 시뮬레이션을 기본으로 하여 장기선량과 유효선량을 계산할 수 있는 지표가 되었다. CA와 PCI 과정에서 환자에게 노출되는 방사선량은 무시할 수 없는 암 발생의 생애귀속위험이 된다. 또한 암 발생 위험은 PCI군에서 더 높았고, 남성보다는 여성이 더 높았다.
Abstract
The Purpose of this study was to determine the effective dose to an average patient from Coronary Angiography (CA) and Percutaneous Coronary Intervention (PCI). And to estimate the lifetime attributable risk (LAR) of cancer associated with radiation exposure from CA and PCI. The dose-area product (DAP) values to the patient were recorded from 60CA and 58PCI. A Monte Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Lifetime attributable risks were estimated with models developed in the National Academies' Biological Effects of Ionizing Radiation Ⅶ report. The mean DAP values was 53.76Gy․cm2 for CA and 165.82Gy․cm2 for PCI. Mean effective dose were 1.28mSv in CA, 3.94mSv in PCI. Results of Calculate organ dose, lung doses was 2.17mSv in CA and 6.71mSv in PCI. Female breast doses was 5.45mSv in CA and 16.82mSv in PCI. LAR estimates for CA varied from 1 in 1,508 for man to 1 in 1,357 for women. In PCI procedure varied from 1 in 553 for man to 1 in 482 for women. DAP can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. These dose estimates derived from our simulation models suggest that CA and PCI are associated with a nonnegligible LAR of cancer. This risk varies markedly and is considerably greater for women, PCI than for man, CA.
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