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Radiation dose from medical imaging in end stage renal disease patients: a Nationwide Italian Survey

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Abstract

Background and objectives

End stage renal disease (ESRD) patients are exposed to the risk of ionizing radiation during repeated imaging studies. The variability in diagnostic imaging policies and the accompanying radiation doses across various renal units is still unknown. We studied this variability at the centre level and quantified the associated radiation doses at the patient level.

Methods

Fourteen Italian nephrology departments enrolled 739 patients on haemodialysis and 486 kidney transplant patients. The details of the radiological procedures performed over one year were recorded. The effective doses and organ doses of radiation were estimated for each patient using standardized methods to convert exposure parameters into effective and organ doses

Results

Computed tomography (CT) was the major contributor (> 77%) to ionizing radiation exposure. Among the haemodialysis and kidney transplant patients, 15% and 6% were in the high (≥ 20 mSv per year) radiation dose groups, respectively. In haemodialysis patients, the most exposed organs were the liver (16 mSv), the kidney (15 mSv) and the stomach (14 mSv), while the uterus (6.2 mSv), the lung (5.7 mSv) and the liver (5.5 mSv) were the most exposed in kidney transplant patients. The average cumulative effective dose (CED) of ionizing radiation among centres in this study was highly variable both in haemodialysis (from 6.4 to 18.8 mSv per patient-year; p = 0.018) and even more so in kidney transplant (from 0.6 to 13.7 mSv per patient-year; p = 0.002) patients.

Conclusions

Radiation exposure attributable to medical imaging is high in distinct subgroups of haemodialysis and transplant patients. Furthermore, there is high inter-centre variability in radiation exposure, suggesting that nephrology units have substantially different clinical policies for the application of diagnostic imaging studies.

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References

  1. de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomedas LM, Ansell D et al (2009) Cardiovascular and non-cardiovascular mortality among patients starting dialysis. JAMA 302:1782–1789

    Article  Google Scholar 

  2. Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB et al (1999) Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 354:93–99

    Article  CAS  Google Scholar 

  3. Kinsella SM, Coyle JP, Long EB, McWilliams SR, Maher MM, Clarkson MR et al (2010) Maintenance hemodialysis patients have high cumulative radiation exposure. Kidney Int 78:789–793

    Article  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. Nguyen KN, Patel AM, Weng FL (2013) Ionizing radiation exposure among kidney transplant recipients due to medical imaging during the pretransplant evaluation. Clin J Am Soc Nephrol 8:833–839

    Article  Google Scholar 

  6. De Mauri A, Brambilla M, Izzo C, Matheoud R, Chiarinotti D, Carriero A et al (2012) Cumulative radiation dose from medical imaging in kidney transplant patients. Nephrol Dial Transplant 27:3645–4365

    Article  Google Scholar 

  7. 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

    Article  Google Scholar 

  8. Mettler FA, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263

    Article  Google Scholar 

  9. Compagnone G, Ortolani P, Domenichelli S, Ovi V, Califano G, Dall’Ara G et al (2011) Effective and equivalent organ doses in patients undergoing coronary angiography and percutaneous coronary intervention. Med Phys 38:2168–2175

    Article  Google Scholar 

  10. The 2007 recommendations of the International Commission on Radiological Protection: ICRP publication 103. Ann ICRP 2007

  11. Miglioretti ADL (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086

    Article  Google Scholar 

  12. 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

    Google Scholar 

  13. Milliken GA, Johnson DE (2009) Analysis of messy data, volume I: designed experiments. Chapman and Hall/CRC, New York

    Book  Google Scholar 

  14. Fazel R, Krumholtz HM, Wang Y, Ross JS, Chen J, Ting HH, Shah ND, Nasir K, Einstein AJ, Nallamothu BK (2009) Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 361:849–857

    Article  CAS  Google Scholar 

  15. Little MP, Wakeford R, Tawn EJ, Bouffler SD, de Gonzalez BA (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

    Article  Google Scholar 

  16. 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

    Google Scholar 

  17. 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

    Article  Google Scholar 

  18. Lee YJ, Chung YE, Lim JS, Kim JH, Kim YJ, Lee HJ et al (2012) Cumulative radiation exposure during follow-up after curative surgery for gastric cancer. Korean J Radiol 13:144–151

    Article  CAS  Google Scholar 

  19. Stiles BM, Mirza F, Towe CW, Ho VP, Port JL, Lee PC et al (2011) Cumulative radiation dose from medical imaging procedures in patients undergoing resection for lung cancer. Ann Thorac Surg 92:1170–1178

    Article  Google Scholar 

  20. Martin CJ (2007) Effective dose: how should it be applied to medical exposures. Br J Radiol 80:639–647

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was presented in abstract form at the ERA-EDTA Congress–Wien 2016 and the ECMP Congress–Athens 2016.

MIRA-ESRD study Investigators and participating centres: Emilio Balestra (Ancona), Diego Bellino (Genova), Roberta Benevento (Bologna), Cristina Bregant (Trieste), Paola Bregant (Trieste), Barbara Cannillo (Novara), Giuseppe Casto (Pisa), Doriana Chiarinotti (Novara), Sara Cimolai (Mestre), Giacomo Colussi (Milano), Antonio De Agostini (Brescia), Fausto Declich (Lecco), Maria Grazia Facchini (Bologna), Maria Alessandra Galione (Lecco), Cesare Gavotti (Genova), Ugo Gerini (Trieste), Paola Isoardi (Torino), Cristina Izzo (Novara), Fabrizio Levrero (Genova), Eric Lorenzon (Trieste), Stefano Maffei (Torino), Stefania Maggi (Ancona), Alberto Mari (Ancona), Federico Mattana (Genova), Alberto Menegotto (Milano), Ophelia Meniconi (Pisa), Nicoletta Paruccini (Monza), Luisa Pierotti (Bologna), Federico Pieruzzi (Monza), Giuseppe Pontoriero (Lecco), Adele Postorino (Reggio Calabria), Marco Quaglia (Novara), Osvaldo Rampado (Torino), Andrea Ranghino (Torino), Sonia Reccanello (Mestre), Stefania Sabatino (Udine), Giulia Sangalli (Lecco), Chiara Sottocornola (Pisa), Marina Sutto (Milano), Salvatore Tata (Mestre), Alberto Torresin (Milano), Antonio Traino (Pisa), Annalisa Trianni (Udine), Letizia Zeni (Brescia).

Author information

Authors and Affiliations

  1. Nephrology, Dialysis and Transplantation Unit, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli” di Reggio Calabria, Reggio Calabria, Italy

    Maurizio Postorino

  2. Medical Physics Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Domenico Lizio

  3. Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy

    Andreana De Mauri

  4. Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy

    Carmela Marino, Giovanni Luigi Tripepi & Carmine Zoccali

  5. Fisica Sanitaria, AOU Maggiore Della Carità, Novara, Italy

    Marco Brambilla

Authors
  1. Maurizio Postorino
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  2. Domenico Lizio
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  3. Andreana De Mauri
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  4. Carmela Marino
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  5. Giovanni Luigi Tripepi
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  6. Carmine Zoccali
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  7. Marco Brambilla
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Consortia

On behalf of the MIRA-ESRD Study Investigators

  • Emilio Balestra
  • , Diego Bellino
  • , Roberta Benevento
  • , Cristina Bregant
  • , Paola Bregant
  • , Barbara Cannillo
  • , Giuseppe Casto
  • , Doriana Chiarinotti
  • , Sara Cimolai
  • , Giacomo Colussi
  • , Antonio De Agostini
  • , Fausto Declich
  • , Maria Grazia Facchini
  • , Maria Alessandra Galione
  • , Cesare Gavotti
  • , Ugo Gerini
  • , Paola Isoardi
  • , Cristina Izzo
  • , Fabrizio Levrero
  • , Eric Lorenzon
  • , Stefano Maffei
  • , Stefania Maggi
  • , Alberto Mari
  • , Federico Mattana
  • , Alberto Menegotto
  • , Ophelia Meniconi
  • , Nicoletta Paruccini
  • , Luisa Pierotti
  • , Federico Pieruzzi
  • , Giuseppe Pontoriero
  • , Adele Postorino
  • , Marco Quaglia
  • , Osvaldo Rampado
  • , Andrea Ranghino
  • , Sonia Reccanello
  • , Stefania Sabatino
  • , Giulia Sangalli
  • , Chiara Sottocornola
  • , Marina Sutto
  • , Salvatore Tata
  • , Alberto Torresin
  • , Antonio Traino
  • , Annalisa Trianni
  •  & Letizia Zeni

Corresponding author

Correspondence to Maurizio Postorino.

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The authors have no conflicts of interest and no funding to declare.

Ethical approval

The Institutional Review Board approved the study of each participating centre.

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The members of the MIRA-ESRD Study Investigators are mentioned "Acknowledgements" section.

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Postorino, M., Lizio, D., De Mauri, A. et al. Radiation dose from medical imaging in end stage renal disease patients: a Nationwide Italian Survey. J Nephrol 34, 791–799 (2021). https://doi.org/10.1007/s40620-020-00911-0

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  • DOI: https://doi.org/10.1007/s40620-020-00911-0

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