辐射暴露估算器：追踪您的医疗影像辐射负担 | WellAlly康心伴

interface ImagingStudy {
  id: string;
  studyType: ImagingType;
  bodyRegion: BodyRegion;
  datePerformed: Date;
  facilityName: string;
  indication: string;
  wasJustified: boolean;
  alternativeConsidered: boolean;
}

type ImagingType =
  | 'xray'
  | 'mammogram'
  | 'ct'
  | 'fluoroscopy'
  | 'nuclear_medicine'
  | 'pet_scan'
  | 'cardiac_cath'
  | 'interventional_fluoro';

type BodyRegion =
  | 'chest'
  | 'abdomen'
  | 'pelvis'
  | 'spine'
  | 'extremity'
  | 'head'
  | 'neck'
  | 'whole_body';

interface RadiationDoseData {
  effectiveDoseMsv: number;
  backgroundEquivalentDays: number;
  organDoses: {
    breast?: number;
    thyroid?: number;
    boneMarrow?: number;
    gonads?: number;
    lung?: number;
    colon?: number;
  };
}

// 辐射剂量参考值（典型有效剂量，单位mSv）
const RADIATION_DOSE_REFERENCES: Record<ImagingType, Partial<Record<BodyRegion, RadiationDoseData>>> = {
  xray: {
    chest: { effectiveDoseMsv: 0.1, backgroundEquivalentDays: 10, organDoses: { breast: 0.01, lung: 0.02, boneMarrow: 0.01 } },
    abdomen: { effectiveDoseMsv: 0.7, backgroundEquivalentDays: 70, organDoses: { colon: 0.3, gonads: 0.2, boneMarrow: 0.05 } },
    pelvis: { effectiveDoseMsv: 0.6, backgroundEquivalentDays: 60, organDoses: { gonads: 0.3, colon: 0.1, boneMarrow: 0.04 } },
    spine: { effectiveDoseMsv: 1.5, backgroundEquivalentDays: 150, organDoses: { boneMarrow: 0.2, thyroid: 0.01, breast: 0.05 } },
    extremity: { effectiveDoseMsv: 0.01, backgroundEquivalentDays: 1, organDoses: { boneMarrow: 0.002 } },
  },
  mammogram: {
    chest: { effectiveDoseMsv: 0.4, backgroundEquivalentDays: 50, organDoses: { breast: 0.3, lung: 0.02 } },
  },
  ct: {
    head: { effectiveDoseMsv: 2, backgroundEquivalentDays: 250, organDoses: { boneMarrow: 0.05, thyroid: 0.03 } },
    chest: { effectiveDoseMsv: 7, backgroundEquivalentDays: 875, organDoses: { breast: 3, lung: 7, boneMarrow: 0.2, thyroid: 0.05 } },
    abdomen: { effectiveDoseMsv: 8, backgroundEquivalentDays: 1000, organDoses: { colon: 4, stomach: 6, liver: 6, boneMarrow: 0.3, gonads: 0.5 } },
    pelvis: { effectiveDoseMsv: 6, backgroundEquivalentDays: 750, organDoses: { gonads: 3, colon: 5, bladder: 5, boneMarrow: 0.2 } },
    spine: { effectiveDoseMsv: 6, backgroundEquivalentDays: 750, organDoses: { boneMarrow: 0.5, thyroid: 0.05 } },
  },
  nuclear_medicine: {
    bone: { effectiveDoseMsv: 6, backgroundEquivalentDays: 750, organDoses: { boneMarrow: 3, bone: 20 } },
    thyroid: { effectiveDoseMsv: 13, backgroundEquivalentDays: 1600, organDoses: { thyroid: 150 } },
    cardiac_stress: { effectiveDoseMsv: 12, backgroundEquivalentDays: 1500, organDoses: { colon: 12, lung: 8, boneMarrow: 3 } },
  },
  pet_scan: {
    whole_body: { effectiveDoseMsv: 14, backgroundEquivalentDays: 1750, organDoses: { bladder: 20, boneMarrow: 4, colon: 7 } },
  },
  cardiac_cath: {
    chest: { effectiveDoseMsv: 7, backgroundEquivalentDays: 875, organDoses: { lung: 15, boneMarrow: 0.3, breast: 2 } },
  },
  fluoroscopy: {
    abdomen: { effectiveDoseMsv: 15, backgroundEquivalentDays: 1900, organDoses: { colon: 20, stomach: 15, boneMarrow: 0.4, gonads: 5 } },
  },
};

export class RadiationExposureCalculator {
  // 计算总累积辐射暴露
  calculateCumulativeExposure(studies: ImagingStudy[]): RadiationExposureReport {
    let totalDose = 0;
    let annualDose = 0;
    const organCumulativeDoses: Record<string, number> = {};
    const doseByYear: Record<number, number> = {};

    studies.forEach(study => {
      const doseData = this.getDoseData(study.studyType, study.bodyRegion);
      if (doseData) {
        totalDose += doseData.effectiveDoseMsv;

        // 计算年剂量
        const year = study.datePerformed.getFullYear();
        doseByYear[year] = (doseByYear[year] || 0) + doseData.effectiveDoseMsv;

        // 追踪器官特定剂量
        Object.entries(doseData.organDoses).forEach(([organ, dose]) => {
          organCumulativeDoses[organ] = (organCumulativeDoses[organ] || 0) + dose;
        });
      }
    });

    // 计算当前年剂量（过去12个月）
    const oneYearAgo = new Date();
    oneYearAgo.setFullYear(oneYearAgo.getFullYear() - 1);
    const recentStudies = studies.filter(s => s.datePerformed >= oneYearAgo);
    annualDose = recentStudies.reduce((sum, study) => {
      const doseData = this.getDoseData(study.studyType, study.bodyRegion);
      return sum + (doseData?.effectiveDoseMsv || 0);
    }, 0);

    return {
      totalCumulativeDoseMsv: totalDose,
      annualDoseMsv: annualDose,
      backgroundEquivalentYears: totalDose / 3, // 3 mSv = 1年背景辐射
      riskCategory: this.categorizeRisk(totalDose),
      organCumulativeDoses,
      doseByYear,
      recommendations: this.generateRecommendations(studies, totalDose, annualDose)
    };
  }

  private getDoseData(type: ImagingType, region: BodyRegion): RadiationDoseData | null {
    return RADIATION_DOSE_REFERENCES[type]?.[region] || null;
  }

  private categorizeRisk(totalDoseMsv: number): RiskCategory {
    if (totalDoseMsv ＜ 20) return { level: 'minimal', description: '相当于1-7年的自然背景辐射' };
    if (totalDoseMsv ＜ 50) return { level: 'low', description: '在辐射工作者的职业暴露限值内' };
    if (totalDoseMsv ＜ 100) return { level: 'moderate', description: '接近职业暴露限值上限' };
    return { level: 'elevated', description: '流行病学研究显示可测量的癌症风险增加' };
  }

  private generateRecommendations(
    studies: ImagingStudy[],
    totalDose: number,
    annualDose: number
  ): Recommendation[] {
    const recommendations: Recommendation[] = [];

    // 高年剂量建议
    if (annualDose > 20) {
      recommendations.push({
        priority: 'high',
        title: '检测到高年度辐射剂量',
        action: '与您的主治医生或频繁开具影像检查的医生讨论累积辐射暴露',
        rationale: `您的年度医学辐射剂量 ${annualDose.toFixed(1)} mSv 显著超过平均背景暴露量3 mSv/年`
      });
    }

    // 检查潜在的重复影像
    const duplicates = this.findPotentialDuplicates(studies);
    if (duplicates.length > 0) {
      recommendations.push({
        priority: 'medium',
        title: '检测到可能的重复影像检查',
        action: '询问您的医生是否可以使用最近一家机构的影像，而非重复检查',
        rationale: `${duplicates.length} 项类似的影像检查可能在不同机构间重复了`
      });
    }

    // 高剂量检查的替代方案
    const highDoseStudies = studies.filter(s => {
      const dose = this.getDoseData(s.studyType, s.bodyRegion);
      return dose && dose.effectiveDoseMsv >= 10;
    });

    if (highDoseStudies.length > 2) {
      recommendations.push({
        priority: 'medium',
        title: '多次高剂量影像检查',
        action: '对于未来的影像检查，在临床适当时询问无辐射替代方案，如MRI或超声',
        rationale: 'MRI和超声在不使用电离辐射的情况下提供出色的诊断信息'
      });
    }

    // 儿科考虑
    const pediatricStudies = studies.filter(s => {
      const ageAtStudy = this.calculateAgeAtStudy(s.datePerformed);
      return ageAtStudy ＜ 18;
    });

    if (pediatricStudies.length > 0) {
      recommendations.push({
        priority: 'high',
        title: '检测到儿科影像检查',
        action: '确保所有影像机构使用儿科专用低剂量方案。儿童对辐射的敏感性是成人的2-3倍',
        rationale: `${pediatricStudies.length} 项影像检查在儿童时期进行，此时辐射敏感性最高`
      });
    }

    return recommendations;
  }

  private findPotentialDuplicates(studies: ImagingStudy[]): ImagingStudy[] {
    const duplicates: ImagingStudy[] = [];
    const studyGroups = new Map<string, ImagingStudy[]>();

    // 按类型和部位分组
    studies.forEach(study => {
      const key = `${study.studyType}_${study.bodyRegion}`;
      if (!studyGroups.has(key)) {
        studyGroups.set(key, []);
      }
      studyGroups.get(key)!.push(study);
    });

    // 查找30天内的重复检查
    studyGroups.forEach(groupStudies => {
      if (groupStudies.length > 1) {
        for (let i = 0; i < groupStudies.length - 1; i++) {
          const daysDiff = this.daysBetween(groupStudies[i].datePerformed, groupStudies[i + 1].datePerformed);
          if (daysDiff <= 30) {
            duplicates.push(groupStudies[i + 1]);
          }
        }
      }
    });

    return duplicates;
  }
}

interface RadiationExposureReport {
  totalCumulativeDoseMsv: number;
  annualDoseMsv: number;
  backgroundEquivalentYears: number;
  riskCategory: RiskCategory;
  organCumulativeDoses: Record<string, number>;
  doseByYear: Record<number, number>;
  recommendations: Recommendation[];
}

interface RiskCategory {
  level: 'minimal' | 'low' | 'moderate' | 'elevated';
  description: string;
}

interface Recommendation {
  priority: 'low' | 'medium' | 'high';
  title: string;
  action: string;
  rationale: string;
}