Abstract
Admission to an intensive care unit (ICU) is associated with increased medical imaging and radiation exposure, yet few studies have estimated the risk of cancer associated with these examinations. The purpose of this study was to review computed tomography (CT) scans performed on patients admitted to two urban academic ICUs, predict their radiation exposure, and calculate their estimated lifetime attributable risk of cancer (LAR). An electronic chart review was performed on all CT scans performed between January 2007 and December 2011. The estimated effective dose of radiation was calculated for each CT, and the LAR for each patient was predicted. Mean radiation exposure was 22.2 ± 25.0 mSv with a mean LAR of 0.1 ± 0.2 % and a median of 0.6 % with a range of <0.001 to 3.4 %. Our cohort received radiation doses higher than recommended by guidelines; however, the critical nature of their admission may have warranted these imaging studies. Estimated risk of cancer in this population was overall low.
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References
Mettler FA Jr et al (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248(1):254–263
Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284
Pearce MS et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380(9840):499–505
Ventures IM (2012) 2012 CT Market Outlook Report, in International Marketing Ventures. Des Plaines, IL. Available at: http://www.imvinfo.com
Brenner DJ (2012) Minimising medically unwarranted computed tomography scans. Ann ICRP 41(3-4):161–169
Griffey RT, Sodickson A (2009) Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol 192(4):887–892
Smith-Bindman R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169(22):2078–2086
Rohner DJ et al (2013) Cumulative total effective whole-body radiation dose in critically ill patients. Chest 144(5):1481–1486
Lutterman AC et al (2014) Cumulative radiation exposure estimates of hospitalized patients from radiological imaging. J Am Coll Radiol 11(2):169–175
Stern SH et al (2001) Nationwide Evaluation of X-ray Trends (NEXT) 2000–2001 survey of patient radiation exposure from computed tomographic (CT) examinations in the United States. Radiology 221:161
National Research Council (U.S.) of the National Academies, Committee to Assess Health Risks from Exposure to Low Level of Ionizing Radiation (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. National Academies Press, Washington, DC
Shah KH et al (2013) Radiation exposure among patients with the highest CT scan utilization in the emergency department. Emerg Radiol 20(6):485–491
Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298(3):317–323
Mettler FA Jr et al (2009) Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources—1950-2007. Radiology 253(2):520–531
Baker LC, Atlas SW, Afendulis CC (2008) Expanded use of imaging technology and the challenge of measuring value. Health Aff (Millwood) 27(6):1467–1478
Preston DL et al (2007) Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res 168(1):1–64
Preston DL et al (2003) Dose response and temporal patterns of radiation-associated solid cancer risks. Health Phys 85(1):43–46
Cardis E et al (2007) The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: estimates of radiation-related cancer risks. Radiat Res 167(4):396–416
Roudsari B et al (2012) Falls, older adults, and the trend in utilization of CT in a level I trauma center. AJR Am J Roentgenol 198(5):985–991
Shinagare AB et al (2014) Inpatient imaging utilization: trends of the past decade. AJR Am J Roentgenol 202(3):W277–W283
Levin DC, Rao VM, Parker L (2012) The recent downturn in utilization of CT: the start of a new trend? J Am Coll Radiol 9(11):795–798
Lee J, Geyer B, Naraghi L, et al (2015) Advanced imaging use in intensive care units has decreased, resulting in lower charges without negative effects on patient outcomes. J Crit Care 30(3):460–464. doi:10.1016/j.jcrc.2014.12.012
The 2007 recommendations of the International Commission on radiological protection. ICRP publication 103. Ann ICRP 37(2-4):1-332. Available at: http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103
Tien HC et al (2007) Radiation exposure from diagnostic imaging in severely injured trauma patients. J Trauma 62(1):151–156
Howlader N, Noone A, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, April 2012
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Slovis, B.H., Shah, K.H., Yeh, D.D. et al. Significant but reasonable radiation exposure from computed tomography-related medical imaging in the ICU. Emerg Radiol 23, 141–146 (2016). https://doi.org/10.1007/s10140-015-1373-y
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DOI: https://doi.org/10.1007/s10140-015-1373-y