Novo estudo destaca a exposição à radiação de imagens médicas para crianças com síndrome de Down
Crianças com síndrome de Down geralmente são submetidas a exames médicos extensos, incluindo exames de imagem, que podem utilizar radiação ionizante. Ao mesmo tempo, doenças genéticas como a síndrome de Down têm um risco aumentado...
![](data:image/jpeg;base64,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)
Domínio público
Crianças com síndrome de Down geralmente são submetidas a exames médicos extensos, incluindo exames de imagem, que podem utilizar radiação ionizante. Ao mesmo tempo, doenças genéticas como a síndrome de Down têm um risco aumentado estabelecido de certos tipos de cancro, tornando a exposição à radiação no início da vida menos do que ideal. Até recentemente, pouca pesquisa tinha sido feita para medir as taxas típicas de exposição à radiação por imagem em crianças com síndrome de Down.
Um estudo recente realizado por pesquisadores da UC Davis Health quantifica essas taxas de exposição. O artigo é baseado no trabalho de Emily C. Marlow, ex-aluna de doutorado em epidemiologia na UC Davis e atual pós-doutoranda na American Cancer Society.
O artigo da revista PLOS ONE, "Utilização de imagens médicas e exposição associada à radiação em crianças com síndrome de Down", detalha a análise de sua equipe de pesquisa de dados de uma década de mais de 4 milhões de registros médicos de crianças em seis sistemas de saúde dos EUA . Eles descobriram que as crianças com síndrome de Down passaram por quase 10 vezes mais exames de imagens médicas do que outras crianças, com implicações nos riscos de câncer ao longo da vida.
Diana Miglioretti, pesquisadora do centro de câncer, professora e chefe da divisão de bioestatística da Escola de Medicina da UC Davis, é a autora sênior do estudo. Ela disse que este é o primeiro estudo desse tipo a utilizar um grande e abrangente conjunto de dados para medir a exposição à radiação de imagens médicas em crianças com síndrome de Down.
Radiação ionizante e síndrome de Down
A radiação ionizante está presente em muitos tipos de exames médicos, como radiografias de tórax e medicina nuclear. As pessoas também são apresentadas a pequenas quantidades de radiação de fundo através da exposição ao sol, à atmosfera e a outras fontes. Ressonâncias magnéticas e ultrassonografias, outros exames comumente usados, não usam radiação.
Embora a radiação ionizante possa ajudar os médicos a identificar doenças no corpo, a exposição repetida à radiação de qualquer fonte pode aumentar a risco de câncer . O risco de câncer devido à exposição à radiação em imagens médicas é extremamente pequeno, portanto os exames médicos necessários não devem ser evitados.
Os investigadores viram motivos de preocupação para as crianças com síndrome de Down, que podem ter maior susceptibilidade à radiação porque já têm um risco aumentado de desenvolver cancro. Por exemplo, a investigação de Marlow estabeleceu ainda mais a forte relação entre o risco de leucemia e a síndrome de Down.
Porque as pessoas com síndrome de Down geralmente apresentam outras condições, como doenças cardíacas congênitas e distúrbios musculoesqueléticos, elas podem ser submetidas a uma quantidade substancial de exames de imagem em tenra idade. Além disso, as taxas de imagens médicas para todas as crianças nos EUA aumentaram ao longo do tempo. Embora os exames de imagem sejam úteis para diagnosticar problemas médicos, a equipe queria compreender as disparidades na exposição à radiação entre crianças com e sem síndrome de Down.
“Para crianças com síndrome de Down, especificamente, estamos vendo um aumento na tomografia computadorizada e na angiografia, ambas com uma dose relativamente alta de radiação – muitas vezes mais do que as radiografias padrão”, explicou Marlow.
O interesse de Miglioretti é minimizar os danos das imagens médicas e sua maior preocupação com as crianças com síndrome de Down são as tomografias computadorizadas (TC). A leucemia é um dos cânceres mais sensíveis à radiação, com um dos tempos mais curtos para desenvolvê-la. “Estamos preocupados que as crianças com síndrome de Down possam ser mais sensíveis ao desenvolvimento de leucemia devido à exposição à radiação”, disse ela.
Considerando opções para pacientes com síndrome de Down
O estudo de coorte retrospectivo utilizou dados médicos de seis sistemas de saúde dos EUA entre 1996 e 2016. Incluiu 4.348.226 pacientes, dos quais 3.095 crianças foram identificadas com síndrome de Down.
Os pesquisadores analisaram a dose de radiação absorvida pela medula óssea vermelha de uma criança, que estimaram a partir de dados de pacientes em exames médicos, como o principal risco de exposição à radiação . devido à sua associação com a leucemia.
Eles descobriram que as crianças com síndrome de Down foram expostas à radiação ionizante em taxas significativamente mais elevadas do que outras crianças. Em média, eles receberam exames de imagem 9,5 vezes mais rápido que outras crianças antes de completarem um ano de idade e 2,3 vezes mais que outras crianças entre 1 e 18 anos de idade.
Embora os riscos de desenvolver câncer a partir de imagens médicas sejam pequenos, os pesquisadores sugerem cautela. “Sempre há prós e contras nas imagens médicas”, disse Marlow.
Por exemplo, usar uma tomografia computadorizada para uma criança não comunicativa pode ser muito mais fácil do que esperar que ela fique imóvel para fazer uma ressonância magnética. “Os médicos e os pais só precisam levar em conta a frequência com que a criança está sendo exposta”, acrescentou ela.
“A mensagem que queremos transmitir é que as imagens médicas devem ser usadas criteriosamente”, disse a coautora sênior do estudo, Rebecca Smith-Bindman, professora de epidemiologia e bioestatística e diretora do Laboratório de Pesquisa de Resultados de Radiologia da UC San Francisco. “Médicos e pais devem trabalhar juntos para garantir que os exames de imagem sejam usados ??apenas quando houver uma clara necessidade de informações adicionais que os exames de imagem possam fornecer, e que o benefício potencial justifique o risco adicional”.
Mais informações: Emily C. Marlow et al, Utilização de imagens médicas e exposição à radiação associada em crianças com síndrome de down, PLOS ONE (2023). DOI: 10.1371/journal.pone.0289957
Informações do periódico: PLoS ONE