Abstract
Background and aim
Ionizing radiation exposure from medical procedures is rising sharply—the per-capita annual effective dose in the US is 3.0 millisieverts (mSv). Hemodialyzed and kidney transplanted patients receive still higher doses of ionizing radiation due to the presence of multiple comorbidities. The aim of this study was to assess the cumulative effective dose (CED) among dialyzed patients undergoing renal pre-transplant evaluation.
Patients and methods
We evaluated 70 hemodialysis patients between June 2009 and December 2014, aged 46.4 ± 12.0 years. The number and type of radiologic procedures were collected through the Radiology Information System. CED was expressed as total mSv/patient and annual CED (mSv/patient/year).
Results
A total of 744 radiologic procedures were performed, accounting for 3869 mSv of ionizing radiation: conventional radiology, computed tomography and nuclear medicine accounted for 78, 14 and 8 % of the procedures, but they represented, respectively, 8, 83 and 9 % of the total CED. The mean (median) annual CED was 35 (7) mSv/patient/year, while total CED was 72 (32) mSv/patient. Thirty-seven patients were active waitlisted and received 47 (10) mSv during the pre-transplant evaluation and 36 (5) mSv during the waiting phase to maintain active status. Concerning cancer risk, 4 (7 %) patients were classified at low risk (<3 mSv/year), 19 (35 %) at moderate risk (3 to <20 mSv/year), 8 (15 %) at high risk (20 to <50 mSv/year), and 23 (43 %) at very high risk (≥50 mSv/year).
Conclusions
Our study demonstrated that during renal pre-transplant evaluation, dialyzed patients receive a high dose of ionizing radiation. Considering that transplanted individuals have a high incidence of cancer due to multifactorial etiology, it is mandatory to reduce the ionizing radiation imaging.
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References
Mettler FA, Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS, Lipoti JA, Mahesh M, McCrohan JL, Stabin MG, Thomadsen BR, Yoshizumi TT (2009) Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources—1950–2007. Radiology 253:520–531
Brambilla M, De Mauri A, Leva L, Carriero A, Picano E (2013) Cumulative radiation dose from medical imaging in chronic adult patients. Am J Med 126:480–486
Brambilla M, De Mauri A, Lizio D, Leva L, Carriero A, Carpeggiani C, Picano E (2014) Cumulative radiation dose estimates from medical imaging in paediatric patients with non-oncologic chronic illnesses. A systematic review. Phys Med 30:403–412
Committee to assess health risks from exposure to low levels of ionizing radiation, National Research Council (2005) Health risks from exposure to low levels of ionizing radiation: BEIR VII-phase 2. National Academies Press, Washington, DC
Board of Radiation Effects Research Division on Earth and Life Sciences National Research Council of the National Academies (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. National Academies Press, Washington, DC
De Mauri A, Brambilla M, Chiarinotti D, Matheoud R, Carriero A, De Leo M (2011) Estimated radiation exposure from medical imaging in hemodialysis patients. J Am Soc Nephrol 22:571–578
Kinsella SM, Coyle JP, Long EB, McWilliams SR, Maher MM, Clarkson MR, Eustace JA (2010) Maintenance hemodialysis patients have high cumulative radiation exposure. Kidney Int 78:789–793
Coyle J, Kinsella S, McCarthy S, MacWilliams S, McLaughlin P, Eustace J, Maher MM (2012) Cumulative ionizing radiation exposure in patients with end stage kidney disease: a 6-year retrospective analysis. Abdom Imaging 3:632–638
De Mauri A, Brambilla M, Izzo C, Matheoud R, Chiarinotti D, Carriero A, Stratta P, De Leo M (2012) Cumulative radiation dose from medical imaging in kidney transplant patients. Nephrol Dial Transplant 27:3645–3651
Stewart JH, Vajdic CM, van Leeuwen MT et al (2009) The pattern of excess cancer in dialysis and transplantation. Nephrol Dial Transplant 24:3225–3231
Wong G, Hayen A, Chapman JR, Webster AC, Wang JJ, Mitchell P, Craig JC (2009) Association of CKD and cancer risk in older people. J Am Soc Nephrol 20:1341–1350
Stengel B (2010) Chronic kidney disease and cancer: a troubling connection. J Nephrol 23:253–262
Mandayam S, Shahinian VB (2008) Are chronic dialysis patients at increased risk for cancer? J Nephrol 21:166–174
Nguyen K, Patel AM, Weng FL (2013) Ionizing radiation exposure from medical imaging in kidney transplant recipients. Clin J Am Soc Nephrol 8:833–839
USRDS (2011) US Renal Data System 2011 Annual Data Report: Atlas of Chornic Kidney disease in the Unites States. National Institute of Health, National Institute of diabetes and Digestive and Kidney Disease, Bethesda
Mettler FA, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263
Hart D, Wall BF (2002) Effective radiation exposure of the UK population from medical and dental X-ray examinations. NRPN-W4, Oxon
(2007) The 2007 recommendations of the International Commission on Radiological Protection: ICRP publication 103. Ann ICRP 37:1–332
ICRP publication 80 (1998) Radiation dose to patients from radiopharmaceuticals. Addendum 2 to ICRP 53. Also includes addendum 1 to ICRP publication 72. Ann ICRP 28:1–130
Hart D, Wall BF (2005) A survey of nuclear medicine in the UK in 2003/04. HPA-RPD-003. Health Protection Agency, Chilton
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
Little MP, Wakeford R, Tawn EJ, Bouffler SD, Berrington de Gonzalez A (2009) Risks associated with low doses and low dose rates of ionizing radiation: why linearity may be (almost) the best we can do. Radiology 251:6–12
Tubiana M, Feinendegen LE, Yang C, Kaminski JM (2009) The linear no threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 251:13–22
Pierce DA, Shimizu Y, Preston DL, Vaeth M, Mabuchi K (1996) Studies of the mortality of atomic bomb survivors. Report 12, part I. Cancer: 1950–1990. Radiat Res 146:1–27
Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K (2003) Studies of mortality of atomic bomb survivors. Report 13: solid cancer and noncancer disease mortality: 1950–1997. Radiat Res 160:381–407
Pearce MS, Salotti JA, Little MP, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Craf AW, Parker L, Berrington de Gonzales A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukemia and brains tumors: a retrospective cohort study. Lancet 380:499–505
Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, Giles GG, Wallace AB, Anderson PR, Guiver TA, McGale P, Cain TC, Dowty JG, Bickerstaffe AC, Darby S (2013) Cancer risk in 680000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 346:2360–2378
French Academies Report (2005) La relation dose-effet et l’estimation des effets cancérogènes des faiblesdoses de rayonnements ionisants. http://www.academie-sciences.fr/publications/raports/pdf/doseeffect-070405gb.pdf
Vajdic CM, McDonald SP, McCredie MR, van Leeuwen MT, Stewart JH, Law M, Chapman JR, Webster AC, Kaldor JM, Grulich AE (2006) Cancer incidence before and after kidney transplantation. JAMA 296:2823–2831
Brambilla M, De Mauri A, Lizio D, Matheoud R, De Leo M, Carriero A (2014) Estimated radiation risk of cancer from medical imaging in haemodialysis patients. Nephrol Dial Transplant 29:1680–1686
Amis ES Jr, Butler PF, Applegate KE, Birnbaum SB, Brateman LF, Hevezi JM, Mettler FA, Morin RL, Pentecost MJ, Smith GG, Strauss KJ, Zeman RK (2007) American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 4:272–284
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De Mauri, A., Matheoud, R., Carriero, A. et al. Radiation exposure from medical imaging in dialyzed patients undergoing renal pre-transplant evaluation. J Nephrol 30, 141–146 (2017). https://doi.org/10.1007/s40620-016-0275-8
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DOI: https://doi.org/10.1007/s40620-016-0275-8