臺灣博碩士論文加值系統

在現代醫學的各個面向中，電腦斷層掃描皆有著廣泛的應用。電腦斷層使用放射線照射人體組織來產生影像資料，然而輻射帶來的潛在致癌風險也引發許多顧慮，尤其在兒童族群當中。我們進行一基於全國人口的重疊病例對照研究來評估孩童經過電腦斷層檢查後產生的後續腦瘤、白血病及淋巴瘤風險。在2000至2013年間，我們於臺灣健保研究資料庫中辨識出7826位診斷腦瘤、白血病或淋巴瘤的小於25歲兒童及青年人，每位利用發病密度抽樣法與不超過10位之健康對照組進行配對後，使用條件邏輯迴歸計算罹患勝算比。經過配對後，我們找出7826位癌症個案。相較於無暴露過電腦斷層的參加者，接受過四次以上斷層掃描者有較高罹患腦瘤(勝算比9.68；95%信賴區間，3.12-30.02)、白血病(勝算比4.79；95信賴區間，1.79-12.81)與非何金氏淋巴瘤的風險(勝算比6.65；95%信賴區間，1.88-23.56)；何金氏淋巴瘤與兒童期電腦斷層無顯著關聯。而在六歲前累積受過三次以上斷層掃描者，日後罹癌風險最高(勝算比11.73；95%信賴區間，4.44-30.99)。接著分別是介於六到十二歲(勝算比3.89；95%信賴區間，1.39-10.91)與十二到十八歲者勝算比2.40；95%信賴區間，1.11-5.19)。本研究顯示多次的斷層掃描的會增加後續癌症的風險，且年齡越小風險越高(Cochran-Armitage趨勢檢驗p<0.001)。本研究顯示兒童期電腦斷層輻射暴露會增加25歲前的癌症風險，且越年幼的孩童影響越大。我們應在施作電腦斷層時對受檢查者，尤其是年齡前兒童，執行輻射的減量與防護。

To evaluate the subsequent risks of intracranial tumor, leukemia, non-Hodgkin lymphoma, and Hodgkin lymphoma diagnosed at ≤25 years of age after exposure to radiation from CT scans in childhood, we conducted a population-based, nested case-control study using the National Health Insurance Research Database in Taiwan. Cases were those aged less than 25 and were newly diagnosed with interested cancers during 2000 to 2013. Controls were randomly selected from the non-malignant individuals at the same age with their matched cases. People with cancer-predisposing conditions were excluded from both groups. Up to 10 controls were allocated to each case with matched sex, birthday, date of cohort entry, and exposure period. The childhood CT scans occurred beyond the lag period (3 years before cancer diagnosis) were extracted from the database. The adjusted odds ratio (aOR) was calculated using conditional logistic regression to estimate the cancer risk associated with CT-related radiation. After matching, 7826 cancer cases were identified. Compared to participants without exposure, the risk significantly elevated for intracranial tumor (aOR:9.68; 95% CI, 3.12-30.02), leukemia (aOR:4.79; 95% CI, 1.79-12.81), and non-Hodgkin lymphoma (aOR:6.65; 95% CI, 1.88-23.56) in patients received ≥4 CT scans. CT radiation exposure was not associated with Hodgkin lymphoma risk. Children who cumulatively received ≥3 CT scans before the age of 6 had the highest subsequent cancer risk (aOR: 11.73; 95% CI, 4.44-30.99), followed by those between 6 and12 years (aOR: 3.89; 95% CI, 1.39-10.91) and those between 12 and 18 years (aOR: 2.40; 95% CI, 1.11-5.19). The negative correlation was statistically significant. (p for trend <0.001). Our results demonstrate exposure to the childhood CT scans associated with an increased risk of intracranial tumor, leukemia, and non-Hodgkin lymphoma into early adulthood. Young children showed a pronounced effect. Adopting advanced radiation-protective techniques during CT-scan is imperative, especially in younger children.

Graduate Thesis Certification i
Table of Contents ii
List of Tables iv
List of Figures v
Chinese Abstract vi
Abstract viii
Chapter 1 Introduction
1.1 Background 1
1.2 Hypothesis 3
Chapter 2 Literature review
2.1 Basic principles and indications of CT 4
2.2 CT radiation dose estimation 4
2.3 The following risk of malignant diseases after CT scans in children 6
Chapter 3 Method and material
3.1 Data source 12
3.2 Study design and matching of participants 12
3.3 Definition of CT exposure and radiation dose estimation 13
3.4 Statistical analysis 14
Chapter 4 Results
4.1 Basic characteristics 16
4.2 Cancer risk and the total number of CT scans and cumulative organ-absorbed radiation dose 16
4.3 Cancer risk and the cumulative number of CT scans at different ages 17
4.4 Sensitivity analyses 17
Chapter 5 Discussion 19
Chapter 6 Conclusion 24
Reference 43
Supplementary: The ICD-9 code used for excluding patients with previous malignant diseases or cancer-predisposing conditions. 47

List of Tables
Table 1. Reference of organ-absorbed radiation dose from different computed tomographic scan types, modified from Gao et al., 2018. 25
Table 2. Reference of organ-absorbed radiation dose from different computed tomographic scan types, modified from Kim et al., 2012. 27
Table 3. Demographic data of patients in the case group and the matched controls 32
Table 4. The adjusted odds ratio for intracranial tumor, leukemia and lymphomas relating to the number of total CT scans (lag period: 3-year) 34
Table 5. The adjusted odds ratio for intracranial tumor, leukemia and lymphomas relating to the organ-specific cumulative dose from CT scans (estimated using data by Gao et al., 2018) 35
Table 6. The adjusted odds ratio for intracranial tumors, leukemias and lymphomas relating to the number of CT scans using different lag periods 36
Table 7. The adjusted odds ratio for intracranial tumor, leukemia and lymphomas relating to the organ-specific cumulative dose from CT scans (estimated using data by Kim et al., 2018) 38
Table 8. Exposure status of other radiology and nuclear medicine procedures in our cohort 39

List of Figures
Figure 1: NCICT software interface 40
Figure 2: Flow chart of the case and control group selection and the matching procedure 41
Figure 3: Forest plots for adjusted odds ratios of intracranial tumor, leukemia, or lymphoma by cumulative number of computed tomography radiation exposure in different age children 42

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