Çocukluk Çağında Radyasyon Maruziyeti ve Duyarlılığı
Özet
Çocukluk çağındaki radyolojik görüntülemeler, tanı koymada klinisyenlere büyük kolaylık sağlasa da çocukların biyolojik yapıları gereği önemli riskleri beraberinde getirmektedir. Çocuklar, yetişkinlere kıyasla daha yüksek hücre döngüsüne, daha az hücre sayısına ve önlerinde daha uzun bir yaşam beklentisine sahip oldukları için iyonizan radyasyonun geç etkilerine karşı 2-3 kat daha duyarlıdırlar. Dokuların matürasyonuna bağlı olarak kök hücrelerin ve proliferasyon hızı yüksek organların (tiroid, meme, gonadlar) radyosensitivitesi oldukça fazladır. Son yıllarda hekimlerin bilgi yetersizliği, malpraktis endişeleri ve COVID-19 pandemisi gibi süreçler nedeniyle özellikle Bilgisayarlı Tomografi (BT) gibi yüksek dozlu gereksiz tetkik istemlerinde ciddi artışlar gözlenmiştir. Bu durum, çocuklarda ilerleyen yıllarda lösemi ve beyin tümörü gibi malignite risklerini artırmaktadır. Hücre hasarları, deterministik ve sitokastik etkiler olarak ikiye ayrılmakta; embriyo ve fetüs dönemi ise radyasyondan en en üst düzeyde etkilenmektedir. Bu riskleri en aza indirmek adına tıbbi uygulamalarda ALARA (mümkün olan en düşük doz) ve "nazikçe görüntüle" (image gently) protokolleri geliştirilmiştir. Hekimlerin görüntüleme kararlarını fizik muayene ve klinik öykü ile optimize etmesi, koruyucu ekipman kullanımı ve ultrasonografi ile MRG gibi alternatif non-iyonizan yöntemlerin önceliklendirilmesi büyük önem arz etmektedir.
Although radiological imaging in childhood facilitates diagnostic processes for clinicians, it entails significant health risks due to children's biological structures. Children are 2-3 times more sensitive to the late effects of ionizing radiation than adults because of their higher cell turnover rate, lower cell counts, and longer life expectancy. Depending on tissue maturation, the radiosensitivity of stem cells and organs with high proliferation rates (thyroid, breast, gonads) is substantially high. In recent years, due to insufficient knowledge among physicians, malpractice concerns, and periods like the COVID-19 pandemic, a substantial increase in unnecessary high-dose examinations, especially Computed Tomography (CT), has been observed. This upward trend increases the long-term risk of malignancies such as leukemia and brain tumors in children. Cellular damage is classified into deterministic and stochastic effects, with the embryo and fetus stages being the most vulnerable to radiation exposure. To minimize these risks, protocols such as ALARA (as low as reasonably achievable) and the "image gently" campaigns have been established. It is crucial for physicians to optimize imaging decisions with detailed physical examinations and medical histories, leverage protective shielding, and prioritize alternative non-ionizing methods like ultrasound and MRI.
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