Emergency Radiology

, Volume 20, Issue 6, pp 485–491 | Cite as

Radiation exposure among patients with the highest CT scan utilization in the emergency department

  • Kaushal H. Shah
  • Benjamin H. Slovis
  • Dan Runde
  • Brandon Godbout
  • David H. Newman
  • Jarone Lee
Original Article

Abstract

The risk of cancer from computed tomography (CT) scan radiation is a rising concern in the medical field. Our objectives were to determine how many patients received more than ten CT scans in an academic emergency department (ED) over the course of 7 years and to quantify their radiation exposure and lifetime attributable risk of cancer. An electronic chart review was performed at our urban academic institution with an annual census of 110,000 patients. All patients who underwent a CT scan performed during ED management between the dates of January 2001 and December 2007 were identified. Specific predetermined data elements (e.g., subject demographics, type of CT scan) were extracted by two researchers blinded to hypothesis, using a preformatted data form. After identifying patients with more than ten CTs performed during the study period, radiation exposure was calculated based on accepted and reported radiation doses for the respective anatomic CTs, and lifetime attributable cancer risk was calculated based on the seventh report of the Biological Effects of Ionizing Radiation (BEIR VII) projections. Over the 7-year study period, 24,393 patients received 34,671 CT scans. The vast majority of patients (17,909) received a single CT. Twenty-six (0.1 %) patients received more than ten CTs totaling 374 scans with an average radiation exposure of 83.4 mSv. The maximum lifetime attributable risk for any individual in this cohort was 1.7 % above the baseline cancer risk. Among those undergoing CT imaging in our ED, high-exposure patients (greater than ten scans) constituted a significant minority, while more than one in four patients underwent more than one CT scan during the study period. While the presumed overall risk of radiation-induced cancer continues to be low, it is important for the emergency physician to use clinical knowledge as well as concern for the patient when utilizing radiographic imaging. Increasing attributable cancer risk may have important public health implications in the future, regardless of the low individual risk.

Keywords

Radiation exposure Computed tomography Emergency department Lifetime attributable risk 

Notes

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Brenner DJ, Elliston CD (2004) Estimated radiation risks potentially associated with full-body CT screening. Radiology 232(3):735–738PubMedCrossRefGoogle Scholar
  2. 2.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284PubMedCrossRefGoogle Scholar
  3. 3.
    Berrington de Gonzalez A, Mahesh M, Kim KP et al (2009) Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169(22):2071–2077PubMedCrossRefGoogle Scholar
  4. 4.
    Lee J, Kirschner J, Pawa S, Wiener DE, Newman DH, Shah K (2010) Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007. Ann Emerg Med 56(6):591–596PubMedCrossRefGoogle Scholar
  5. 5.
    Stern SH, Kaczmarek RV, Spelic DC, Suleiman OH (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 221:161Google Scholar
  6. 6.
    National Research Council (U.S.) and 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, Washington, D.CGoogle Scholar
  7. 7.
    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):887–892PubMedCrossRefGoogle Scholar
  8. 8.
    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):175–184PubMedCrossRefGoogle Scholar
  9. 9.
    Romano S, Romano L (2010) Utilization patterns of multidetector computed tomography in elective and emergency conditions: indications, exposure risk, and diagnostic gain. Semin Ultrasound CT MR 31(1):53–56PubMedCrossRefGoogle Scholar
  10. 10.
    Weiss CR, Scatarige JC, Diette GB, Haponik EF, Merriman B, Fishman EK (2006) CT pulmonary angiography is the first-line imaging test for acute pulmonary embolism: a survey of US clinicians. Acad Radiol 13(4):434–446PubMedCrossRefGoogle Scholar
  11. 11.
    Ahmed F, Zafar AM, Khan N, Haider Z, Ather MH (2010) A paradigm shift in imaging for renal colic—is it time to say good bye to an old trusted friend? Int J Surg 8(3):252–256PubMedCrossRefGoogle Scholar
  12. 12.
    Bailitz J, Starr F, Beecroft M et al (2009) CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma 66(6):1605–1609PubMedCrossRefGoogle Scholar
  13. 13.
    Mathen R, Inaba K, Munera F et al (2007) Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. J Trauma 62(6):1427–1431PubMedCrossRefGoogle Scholar
  14. 14.
    Broder J, Warshauer DM (2006) Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 13(1):25–30PubMedCrossRefGoogle Scholar
  15. 15.
    Boone JM, Brunberg JA (2008) Computed tomography use in a tertiary care university hospital. J Am Coll Radiol JACR 5(2):132–138CrossRefGoogle Scholar
  16. 16.
    Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248(1):254–263PubMedCrossRefGoogle Scholar
  17. 17.
    Preston DL, Pierce DA, Shimizu Y, Ron E, Mabuchi K (2003) Dose response and temporal patterns of radiation-associated solid cancer risks. Heal Phys 85(1):43–46CrossRefGoogle Scholar
  18. 18.
    Pierce DA, Preston DL (2000) Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 154(2):178–186PubMedCrossRefGoogle Scholar
  19. 19.
    Preston DL, Ron E, Tokuoka S et al (2007) Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res 168(1):1–64PubMedCrossRefGoogle Scholar
  20. 20.
    Cardis E, Vrijheid M, Blettner M et al (2005) Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries. BMJ 331(7508):77PubMedCrossRefGoogle Scholar
  21. 21.
    Cardis E, Vrijheid M, Blettner M 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):396–416PubMedCrossRefGoogle Scholar
  22. 22.
    Hendee WR, O'Connor MK (2012) Radiation risks of medical imaging: separating fact from fantasy. Radiology 264(2):312–321PubMedCrossRefGoogle Scholar
  23. 23.
    Tubiana M, Feinendegen LE, Yang C, Kaminski JM (2009) The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 251(1):13–22PubMedCrossRefGoogle Scholar
  24. 24.
    Scott BR (2008) Low-dose radiation risk extrapolation fallacy associated with the linear-no-threshold model. Hum Exp Toxicol 27(2):163–168PubMedCrossRefGoogle Scholar
  25. 25.
    Smith-Bindman R, Lipson J, Marcus 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):2078–2086PubMedCrossRefGoogle Scholar
  26. 26.
    Motaganahalli R, Martin A, Feliciano B, Murphy MP, Slaven J, Dalsing MC (2012) Estimating the risk of solid organ malignancy in patients undergoing routine computed tomography scans after endovascular aneurysm repair. J Vasc Surg 56(4):929–937PubMedCrossRefGoogle Scholar
  27. 27.
    Howlader N NA, 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) (2012) 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. Accessed 19 Apr 2013
  28. 28.
    Brenner DJ (2010) Slowing the increase in the population dose resulting from CT scans. Radiat Res 174(6):809–815PubMedCrossRefGoogle Scholar
  29. 29.
    United Nations (2010) Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation: United Nations Scientific Committee on the Effects of Atomic Radiation: UNSCEAR 2008 report to the General Assembly, with scientific annexes. United Nations, New YorkGoogle Scholar
  30. 30.
    ICRP (2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37(2–4):1–332Google Scholar
  31. 31.
    McNitt-Gray MF (2002) AAPM/RSNA Physics tutorial for residents: topics in CT. Radiation dose in CT. Radiographics RevPubl Radiol Soc N Am Inc 22(6):1541–1553Google Scholar
  32. 32.
    Baker KS, Shaikh MB, Gould ES, Yang J, Chen J, Bonvento M (2012) Evaluation of radiation dose among patients admitted through a university hospital emergency department. Emerg Radiol 19(6):505–512PubMedCrossRefGoogle Scholar
  33. 33.
    Martin CJ (2007) Effective dose: how should it be applied to medical exposures? Br J Radiol 80(956):639–647PubMedCrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2013

Authors and Affiliations

  • Kaushal H. Shah
    • 1
  • Benjamin H. Slovis
    • 1
    • 5
  • Dan Runde
    • 2
  • Brandon Godbout
    • 3
  • David H. Newman
    • 1
  • Jarone Lee
    • 4
  1. 1.Department of Emergency MedicineMount Sinai Medical CenterNew YorkUSA
  2. 2.Department of Emergency MedicineHarbor UCLALos AngelesUSA
  3. 3.Department of Emergency Medicine, Lenox Hill HospitalNorth Shore LIJNew YorkUSA
  4. 4.Division of Trauma, Emergency Surgery, Surgical Critical CareHarvard Medical SchoolBostonUSA
  5. 5.New YorkUSA

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