Abstract
Objectives
To analyse CT use in recent years in a high-density Italian area (±10 million inhabitants, including 1 million children), focusing on developing age.
Methods
Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004–2014 in emergency and outpatient care and assessment of radiation exposure trend.
Results
Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased ±19 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72–1.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16–48 %.
Conclusions
The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations.
Key Points
• Literature highlights a remarkable increase in CT use over the last decades.
• The paediatric age had higher exposure to X-ray risk.
• A detailed retrospective analysis of more than 9 million scans was performed.
• Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range.
• This study raises concern about exposure for teenagers and young adults.
Similar content being viewed by others
Abbreviations
- CBCT:
-
Cone beam computed tomography
- CT:
-
Computed tomography
- DLP:
-
Dose length product
- RHCS:
-
Regional Health Care System
References
Shannoun F, Zheeb H, Back C, Blettner M (2006) Medical exposure of the population from diagnostic use of ionizing radiation in Luxembourg between 1994 and 2002. Health Phys 91:154–162
Brenner DJ, Hall EJ (2007) Computed tomography – An increasing source of radiation exposure. N Engl J Med 357:2277–2284
Borretzen I, Lysdahl KB, Olerud HM (2007) Diagnostic radiology in Norway trends in examination frequency and collective effective dose. Radiat Prot Dosim 124:339–347
Fazel R, Krumholz HM, Wang Y et al (2009) Exposure to low dose ionizing radiation from medical imaging procedures. N Engl J Med 361:849–857
Catuzzo P, Aimonetto S, Zenone F et al (2010) Population exposure to ionizing radiation from CT examinations in Aosta Valley between 2001 and 2008. Br J Radiol 83:1042–1051
Muhogora WE, Ahmed NA, Alsuwaidi JS et al (2010) Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosim 140:49–58
Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK (2011) National trends in use of computed tomography in the emergency department. Ann Emerg Med 58:452–462
Pearce MS, Salotti JA, McHugh K et al (2011) CT scans in young people in Northern England: trends and patterns 1993-2002. Pediatr Radiol 41:832–838
Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee FT Jr (2011) Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 8:756–761
Bernier M-O, Rehel JL, Brisse HJ et al (2012) Radiation exposure from CT in early childhood: a French large-scale multicenter study. Br J Radiol 85:53–60
Samara ET, Aroua A, Bochud FO et al (2012) Exposure of the Swiss population by medical x-rays: 2008 review. Health Phys 102(3):263–270
Smith-Bindman R, Miglioretti DL, Johnson E et al (2012) Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA 307:2400–2409
Aroua A, Samara ET, Bochud FO, Meuli R, Verdun FR (2013) Exposure of the Swiss population to computed tomography. BMC Med Imaging 13:22
Hayton A, Wallace A, Marks P, Edmonds K, Tingey D, Johnston P (2013) Australian per caput dose from diagnostic imaging and nuclear medicine. Radiat Prot Dosim 156:445–450
Etard C, Aubert B, Mezzarobba M, Bernier MO (2014) Exposure of the French paediatric population to ionizing radiation from diagnostic medical procedures in 2010. Pediatr radiol 44:1588–1594
Le Coultre R, Bize J, Champendal M et al (2015) Exposure of the Swiss population by radiodiagnostics: 2013 review. Radiat Prot Dosim. https://doi.org/10.1186/1471-2342-13-22
HPA-CRCE-012 (2008) Frequency and collective dose for medical and dental X-ray examinations in the UK. HPA-CRCE-012. Available via https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/340154/HPA-CRCE-012_for_website.pdf
Institut de Radioprotection et de Sureté Nucléaire (2014). Exposition de la population française aux rayonnements ionisants liée aux actes de diagnostic médical en 2012. Institut de Radioprotection et de Sureté Nucléaire, Fontenay-aux-Roses. Available via http://www.eurosafeimaging.org/wp/wp-content/uploads/2015/05/IRSN-PRP-HOM-2014-6_Exposition-France-rayonnements-diagnostic-medical-2012.pdf
United Nations Scientific Committee on the Effects of Atomic Radiation (2010) UNSCEAR 2008 report Vol 1: Sources of ionizing radiation. United Nations, New York Available via http://www.unscear.org/docs/reports/2008/09-86753_Report_2008_Annex_B.pdf
International Commission on Radiological Protection (2007) Radiological protection in medicine, 105. Annals of the ICRP 37(6):1–332
Committee on the Biological Effects of Ionizing Radiation (2006) Health Risks from Exposure to low Levels of Ionizing Radiation (BEIR VII), National Academy of Sciences, National Research Council. National Academy Press, Washington
Pearce MS, Salotti JA, Little MP 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
Mathews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680.000 people exposed to computed tomography scans in childhood or adolescence: data linkage study in 11 million Australians. BMJ. https://doi.org/10.1136/bmj.f2360
Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for UK and 14 other countries. Lancet 363:345–351
Brenner DJ, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296
Krille L, Zeeb H, Jahnen A et al (2012) Computed tomographies and cancer risk in children: a literature overwiev of CT practices, risk estimations and an epidemiologic cohort study proposal. Radiat Environ Biophys 51:103–111
Brady Z, Cain TM, Johnston PN (2011) Paediatric CT imaging trends in Australia. J Med Imaging Radiat Oncol 55:132–142
Pearce MS, Salotti JA, Howe NL et al (2012) CT scans in young people in Great Britain: temporal and descriptive patterns, 1993-2002. Radiol Res Pract 2012:1–8
Menoch MJ, Hirsh ADA, Khan NS, Simon HK, Sturm JJ (2012) Trends in computed tomography utilization in the pediatric emergency department. Pediatrics 129:e690–e697
Palorini F, Origgi D, Granata C, Matranga D, Salerno S (2013) Adult exposures from MDCT including multiphase studies: first Italian nationwide survey. Eur Radiol. 44:469–483
European Commission (1999) European guidelines on quality criteria for Computed Tomography. EUR 16262. European Commission, Bruxelles Available via http://www.drs.dk/guidelines/ct/quality/htmlindex.htm
International Commission on Radiological Protection (2008) Radiological Protection in Medicine. Pubblication 105. Elsevier, Oxford
International Commission on Radiological Protection (2008) Recommendations of the ICRP, Publication 103. Elsevier, Oxford
European Commission (2001) Referral Guidelines for Imaging, Radiation Protection 118. Office for Official Publications of the European Communities, Luxembourg
EURATOM (2014) Council Directive 2013/59/EURATOM. EURATOM, Bruxelles Available via http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=OJ%3AL%3A2014%3A013%3ATOC
Malone J, Guleria R, Craven C et al (2012) Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency Consultation. Br J Radiol 85:523–538
Rehani MM, Berris T (2012) International Atomic Energy Agency study with referral physicians on patient radiation exposure and its tracking: a prospective survey using a web-based questionnaire. BMJ Open. https://doi.org/10.1136/bmjopen-2012
Mola E, Visentin G, Elli P, Orlando T (2012) Valutazione dei Bisogni Formativi dei Medici Prescrittori in Merito al Rischio da Radiazioni Ionizzanti. Available via http://www.occhioclinico.it/cms/node/1375
Borgen L, Stranden E, Espeland A (2010) Clinicians’ justification of imaging: do radiation issues play a role? Insights Imaging 1:193–200
O’Sullivan J, O’Connor OJ, O’Regan K et al (2010) An assessment of medical students awareness of radiation exposures associated with diagnostic imaging investigations. Insights Imaging 1:86–92
Lee C, Haims AH, Monico EP, Brink JA, Forman HP (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398
Thomas KE, Parnell-Parmley JE, Haidar S et al (2006) Assessment of radiation dose awareness among pediatricians. Paediatr Radiol 36:823–832
Heyer CM, Hansmann J, Peters SA, Lemburg SP (2010) Paediatricians awareness of radiation dose and inherent risk in chest imaging studies- A questionnaire study. Eur J Radiol 76:288–293
Shiralkar S, Rennie A, Snow M, Galland RB, Lewis MH, Gower-Thomas K (2003) Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 327:371–372
Jacob K, Vivian G, Steel JR (2004) X-ray dose training: are we exposed to enough? Clin Radiol 59:928–934
Arslanoglu A, Bilgin S, Kubal Z, Ceyhan MN, Ilhan MN, Maral I (2007) Doctors and intern doctors’ knowledge about patients’ ionizing radiation exposure doses during common radiological examinations. Diagn Interv Radiol 13:53–55
Bautista AB, Burgos A, Nickel BJ et al (2009) Do clinicians use the American College of Radiology Appropriateness Criteria in the Management of their patients? AJR Am J Roentgenol 192:1581–1585
Soye JA, Paterson A (2008) A survey of awareness of radiation dose among health professionals in Northern Ireland. Br J Radiol 81:725–729
Picano E (2004) Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. BMJ 329:849–851
Picano E (2004) Sustainability of medical imaging. BMJ 328:578–580
Bornstein MM, Scarfe WC, Vaughn VM, Jacobs R (2014) Cone beam computed tomography in implant dentistry: a systematic review focusing on guidelines, indications, and radiation dose risks. Int J Oral Maxillofac. Implants. https://doi.org/10.11607/jomi.2014suppl.g1.4
European Commission (2004) European guidelines on radiation protection in dental radiology. Rp 136, European Commission, Publication Office, Luxembourg. Available via https://ec.europa.eu/energy/sites/ener/files/documents/136.pdf
European Commission (2011) SEDENTEXCT project Radiation protection n. 172: Cone Beam CT for dental and maxillofacial radiology (Evidence based guidelines). European Commission, Publication Office, Luxembourg Available via http://www.sedentexct.eu/files/radiation_protection_172.pdf
Acknowledgements
We thank Dr. Maurizio Bersani from Direzione Generale Sanità, Regione Lombardia, who kindly helped and supported us during the data selection and collection.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
The scientific guarantor of this publication is Andrea Pola.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Funding
This study has received funding by Direzione Generale Sanità, Regione Lombardia, Call per la ricerca indipendente 2010-2013.
Statistics and biometry
One of the authors has significant statistical expertise.
Informed consent
Written informed consent was not required for this study because no human subjects were involved in this study.
Ethical approval
Institutional Review Board approval was not required for this study because no human subjects were involved in this study.
Methodology
• retrospective
• multicentre study
Electronic supplementary material
ESM 1
(DOCX 63 kb)
Rights and permissions
About this article
Cite this article
Pola, A., Corbella, D., Righini, A. et al. Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults. Eur Radiol 28, 2308–2318 (2018). https://doi.org/10.1007/s00330-017-5225-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-017-5225-x