World Journal of Surgery

, Volume 34, Issue 9, pp 2009–2016 | Cite as

Single-Centre Experience of Radiation Exposure in Acute Surgical Patients: Assessment of Therapeutic Impact and Future Recommendations

  • Gerard J. Fitzmaurice
  • Robin Brown
  • Brian Cranley
  • Enda F. Conlon
  • R. Alan J. Todd
  • Mark E. O’Donnell



Radiological investigations have become a key adjunct in patient management and consequently radiation exposure to patients is increasing. The study objectives were to examine the use of radiological investigations in the management of acute surgical patients and to assess whether a guideline-based radiation exposure risk/benefit analysis can aid in the choice of radiological investigation used.


A prospective observational study was completed over a 12-week period from April to July 2008 for all acute surgical admissions. Data recorded included demographics, clinical presentation, differential diagnosis, investigations, surgical interventions, and final clinical outcome. The use of radiological investigative modalities as an adjunct to clinical assessment was then evaluated against The Royal College of Radiologists (RCR) guidelines.


A total of 380 acute surgical admissions (M = 174, F = 185, children = 21) were assessed during the study period. Seven hundred thirty-four radiological investigations were performed with a mean of 1.93 investigations per patient. Based on the RCR guidelines, 680 (92.6%) radiological investigations were warranted and included 142 CT scans (19.3%), 129 chest X-rays (17.6%), and 85 abdominal X-rays (11.6%). Clinically, radiological imaging complemented surgical management in 326 patients (85.8%) and the management plan remained unchanged for the remaining 54 patients (14.2%). This accounted for an average radiation dose of 4.18 millisievert (mSv) per patient or 626 days of background radiation exposure. CT imaging was responsible for the majority of the radiation exposure, with a total of 1310 mSv (82.6%) of the total radiation exposure being attributed to CT imaging in 20.8% of acute admissions. Subgroup analysis demonstrated that 92.8% of the CT scans performed were appropriate.


Radiation exposure was generally low for the majority of acute surgical admissions. However, it is recommended that CT imaging requests be evaluated carefully, particularly for patients with clinically confirmed pathologies and in younger women.



The authors acknowledge Dr. Fionnuala Mone from the Department of Surgery in Daisy Hill Hospital for her assistance with data collection and collation.


  1. 1.
    Frenz MB, Mee AS (2005) Diagnostic radiation exposure and cancer risk. Gut 54(6):889–890CrossRefPubMedGoogle Scholar
  2. 2.
    Rosen MP, Siewert B, Sands DZ et al (2003) Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 13(2):418–424PubMedGoogle Scholar
  3. 3.
    Van Dam J, Cotton P, Johnson CD et al (2004) AGA future trends report: CT colonography. Gastroenterology 127(3):970–984CrossRefPubMedGoogle Scholar
  4. 4.
    Kalra MK, Maher MM, Saini S (2003) Multislice CT: update on radiation and screening. Eur Radiol 13:M129–M133PubMedGoogle Scholar
  5. 5.
    Winslow JE, Hinshaw JW, Hughes MJ et al (2008) Quantitative assessment of diagnostic radiation doses in adult blunt trauma patients. Ann Emerg Med 52(2):93–97CrossRefPubMedGoogle Scholar
  6. 6.
    International Commission on Radiological Protection (2000) Avoidance of radiation injuries from medical interventional procedures, ICRP Publications 85. Pergamon Press, OxfordGoogle Scholar
  7. 7.
    De Gonzalez A, Darby S (2004) Risk of cancer from diagnostic x-rays: estimates for the UK and 14 other countries. Lancet 363:345–351CrossRefGoogle Scholar
  8. 8.
    Andreassi MG, Cioppa A, Manfredi S et al (2007) Acute chromosomal DNA damage in human lymphocytes after radiation exposure in invasive cardiovascular procedures. Eur Heart J 28:2195–2199CrossRefPubMedGoogle Scholar
  9. 9.
    The Royal College of Radiologists (2007) Making the best use of clinical radiology services, 6th edn. The Royal College of Radiologists, LondonGoogle Scholar
  10. 10.
    Strzelcyzk JJ, Damilakis J, Marx MV et al (2006) Facts and controversies about radiation exposure, part 1: controlling unnecessary radiation exposure. J Am Coll Radiol 3(12):924–931CrossRefGoogle Scholar
  11. 11.
    Church CA, Kuhn FA, Mikhail J et al (2008) Patient and surgeon radiation exposure in balloon catheter sinus ostial dilation. Otolaryngol Head Neck Surg 138:187–191CrossRefPubMedGoogle Scholar
  12. 12.
    Shiralkar S, Rennie A, Snow M et al (2003) Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 327(7411):371–372CrossRefPubMedGoogle Scholar
  13. 13.
    Hart D, Wall BF (2002) Radiation exposure of the UK population from medical and dental X-ray examinations. National Radiological Protection Board, DidcotGoogle Scholar
  14. 14.
    Mettler FA Jr, Thomadsen BR, Bhargavan M et al (2008) Medical radiation exposure in the US in 2006: preliminary results. Health Phys 95(5):502–507CrossRefPubMedGoogle Scholar
  15. 15.
    The Health Protection Agency, Ionising radiation exposure of the UK population: 2005 review. Accessed 17 Apr 2009
  16. 16.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284CrossRefPubMedGoogle Scholar
  17. 17.
    Tubiana M, Nagataki S (2008) Computed tomography and radiation exposure. N Engl J Med 358:850CrossRefPubMedGoogle Scholar
  18. 18.
    Wakeford R (2008) Childhood leukaemia following medical diagnostic exposure to ionising radiation in utero or after birth. Radiat Prot Dosimetry 132(2):166–174CrossRefPubMedGoogle Scholar
  19. 19.
    Weerakkody RA, Walsh SR, Cousins C et al (2008) Radiation exposure during endovascular aneurysm repair. Br J Surg 95:699–702CrossRefPubMedGoogle Scholar
  20. 20.
    Solomon SB, Patriciu A, Bohlman ME et al (2002) Robotically driven interventions: a method of using CT fluoroscopy without radiation exposure to the physician. Radiology 225:277–282CrossRefPubMedGoogle Scholar
  21. 21.
    Malek S, Davies E, Malek IA et al (2007) Radiation exposure to patients in power limb trauma surgery. Eur J Orthop Surg Traumatol 17:17–21CrossRefGoogle Scholar
  22. 22.
    Morris-Stiff G, Stiff RE, Morris-Stiff H (2006) Abdominal radiograph requesting in the setting of acute abdominal pain: temporal trends and appropriateness of requesting. Ann R Coll Surg Engl 88:270–274CrossRefPubMedGoogle Scholar
  23. 23.
    Hall EJ, Brenner DJ (2008) Cancer risks from diagnostic radiology. Br J Radiol 81:362–378CrossRefPubMedGoogle Scholar
  24. 24.
    Hansen J, Jurik AG (2009) Analysis of current practice of CT examinations. Acta Oncol 48(2):295–301CrossRefPubMedGoogle Scholar
  25. 25.
    National Research Council of the National Academies (2006) Health risks from exposure to low levels of ionising radiation: BEIR VII Phase 2. National Academies Press, Washington DCGoogle Scholar
  26. 26.
    Sodickson A, Baeyens PF, Andriole KP et al (2009) Recurrent CT cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 251(1):175–184CrossRefPubMedGoogle Scholar
  27. 27.
    Gaitini D, Beck-Rasi N, Mor-Yosef D et al (2008) Diagnosing acute appendicitis in adults: accuracy of colour Doppler sonography and MDCT compared with surgery and clinical follow-up. AJR Am J Roentgenol 190:1300–1306CrossRefPubMedGoogle Scholar
  28. 28.
    Mayo JR (2008) Radiation dose issues in longitudinal studies involving computed tomography. Proc Am Thorac Soc 5(9):934–939CrossRefPubMedGoogle Scholar
  29. 29.
    Fazel R, Krumholz HM, Wang Y et al (2009) Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 361(9):849–857CrossRefPubMedGoogle Scholar
  30. 30.
    Pedrosa I, Lafornara M, Pandharipande PV et al (2009) Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology 250:749–757CrossRefPubMedGoogle Scholar
  31. 31.
    Hernandez JA, Swischuk LE, Angel CA et al (2005) Imaging of acute appendicitis: US as the primary imaging modality. Pediatr Radiol 35:392–395CrossRefPubMedGoogle Scholar
  32. 32.
    Peloquin JM, Pardi DS, Sandborn WJ et al (2008) Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 103(8):2015–2022CrossRefPubMedGoogle Scholar
  33. 33.
    Lysdahl KB, Hofmann BM (2009) What causes increasing and unnecessary use of radiological investigations? A survey of radiologists’ perceptions. BMC Health Serv Res 9:155CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Gerard J. Fitzmaurice
    • 1
  • Robin Brown
    • 1
  • Brian Cranley
    • 1
  • Enda F. Conlon
    • 2
  • R. Alan J. Todd
    • 2
  • Mark E. O’Donnell
    • 1
    • 3
    • 4
  1. 1.Department of General SurgeryDaisy Hill HospitalNewryNorthern Ireland, UK
  2. 2.Department of RadiologyDaisy Hill HospitalNewryNorthern Ireland, UK
  3. 3.Faculty of Life and Health SciencesUniversity of UlsterNewtonabbeyNorthern Ireland, UK
  4. 4.SaintfieldNorthern Ireland, UK

Personalised recommendations