to 猎人: 我现在觉得协和医生的行为是医闹了


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送交者: whatistruth 于 2013-03-12, 23:27:48:

看了那几个科普贴以后。

我开始的怀疑不是在医闹这点,也不是在多人同发这点,而是到底那个所谓的泄漏剂量有没有可能引发这个甲癌。多人同发似乎是个很真实的证据,虽然真正的原因不清楚。

那几个科普贴都是针对牙科X光检查的担心。但是人家很干脆的说了,不担心这个,唯一有担心的是CT检查,因为剂量高。特别是那个CNN的读者问答(http://www.cnn.com/2011/HEALTH/expert.q.a/03/30/thyroid.cancer.radiation.brawley/index.html)。提到甲癌虽然发病增加,但是相比其他肺癌、肠癌、乳腺癌等等,其人数提高部分还要归功于现在的cat mri 和甲状腺超声等手段把很小尺寸的都能查出来。而且甲癌是存活率最高的之一。 More than 97% of patients do very well.

接着狗了一下剂量,CT大概相当于3年的自然辐射量。(参见fda http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095505.htm)而牙医的剂量并不比别的胸透剂量小。(参见 http://www.doh.wa.gov/CommunityandEnvironment/Radiation/XRay/TypicalPatientExposures.aspx

引用:
Compare Exposure Measurements

The national average of natural, unavoidable (often referred to as background) radiation dose to each of us is about 620 millirem per year (228 of that is estimated to come from radon exposure).

300 millirem is the average received from all medical exposures. 300 mrem represents a six fold increase in average medical exposures over the past 25 years. Half of the average background medical exposure (147 mrem) is from computed tomography (CT) exams, a relatively new technology that has significantly improved diagnostic imaging.

The occupational dose limit to a radiation worker, such as a dental hygienist or assistant, medical X-ray technologist, radiologist, or therapy technologist is 5000 millirem per year.

The established dose limit to a member of the public from non-medical or dental X-ray sources (such as airport X-ray machines) is 100 millirem per year.

There is NO LIMIT for exposure to properly prescribed diagnostic and therapeutic sources for a patient. These exposures can be whatever is necessary based on the patient's medical and dental needs.

就是说正常检查的量人家并不觉得有联系,CT是由于一次性剂量大,才被提出来 (题外话,国外是CT量大增,国内更是大大增加吧?这个做CT的时候有没有提醒?)。

在NIH的网页介绍甲癌的时候,(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002193/),人家确实提了:

引用:
hyroid cancer can occur in all age groups.

Radiation increases the risk of developing thyroid cancer. Exposure may occur from:

Radiation therapy to the neck (especially in childhood)

Radiation exposure from nuclear plant disasters

Other risk factors are a family history of thyroid cancer and chronic goiter.


放射可能增加甲癌的风险,但是列的这两个一个特别强调了针对脖子部位的放射治疗(特别是儿童期),另一个是核工厂事故。这个剂量都是远远大于医疗仪器通过楼板的辐射剂量的 (这个没有人科普,但是我觉得这个量级恐怕不需要人科普了)。
另外的因素包括家庭史和慢性甲状腺肿

在甲状腺肿的介绍里面 (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002161/),原因就包括不明原因:

引用:
There are different kinds of goiters.

A simple goiter can occur for no known reason, or when the thyroid gland is not able to produce enough thyroid hormone to meet the body's needs. The thyroid gland makes up for this by becoming larger.

Toxic nodular goiter involves an enlarged thyroid gland that contains a small, rounded growth or growths called nodules. These nodules produce too much thyroid hormone.

引用:
In most cases of simple goiter the cause is unknown. Sometimes, certain medications such as lithium or aminoglutethimide can cause a simple goiter.

Simple goiters are also more common in:

Anyone over age 40

People with a family history of goiter

Females


可能不明原因引起,在单纯性甲状腺肿大 (Simple goiters)在:
40岁以上;有甲肿家庭史;女性里面更常见。

俺作为一个普通读者,能不能推断:有可能40岁以上;有甲种家庭史;女性有甲癌的风险更大?

如果非要从辐射致病来讲,如果单次的高剂量(CT检查)都没有显著提高甲癌的风险,那么低剂量的辐射(可能的潜在泄漏,)能不能导致显著差别?俺学一下钟院士拍拍脑门--不过是和他习惯性夸大相反--感觉可能性很小吧?如果有的话,是不是楼上手术室里面的人风险更高?


到了这里,我感觉不管什么原因,那个辐射致癌可能性很小了。他们本身作为医务工作者,对甲癌的看法和普通人表现的没有什么区别,天塌地陷。而根据纪小龙医生的观点(http://wjjixiaolong.blog.sohu.com/255665853.html),1毫米的甲癌是可以忽略的。根据网友asasasa翻译摘自日文wiki:

引用:
所以早期手术摘除的话,百分之八九十可以治愈,但是需要终生服用甲状腺激素药物。关于手术摘除,日本欧洲主张部分摘除,而美国主张全部甲状腺摘除。患者的追踪调查表明部分摘除和全摘除的生存率没有区别。另外,因为肿瘤成长缓慢,对于1cm以下的微小甲癌,不进行手术只定期观察也可以。如果发现肿瘤增大,或者发生向淋巴转移的情况再实施手术,10年生存率为85%。

当医生的况且如此反应,普通人“医闹”多也不是很奇怪了。关键还是愿意出来科普的人是太少。光靠方舟子是mission impossible。

再次呼吁专业人士就放射剂量及防护,以及甲癌的发病诊治康复出来科普。




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