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European Radiology

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02.12.2019 | Computed Tomography

Patients undergoing recurrent CT scans: assessing the magnitude

verfasst von: Madan M. Rehani, Kai Yang, Emily R. Melick, John Heil, Dušan Šalát, William F. Sensakovic, Bob Liu

Erschienen in: European Radiology | Ausgabe 4/2020

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Abstract

Objectives

To assess percent of patients undergoing multiple CT exams that leads to cumulative effective dose (CED) of ≥ 100 mSv and determine their age distribution.

Methods

Data was retrieved retrospectively from established radiation dose monitoring systems by setting the threshold value of 100 mSv at four institutions covering 324 hospitals. The number of patients with CED ≥ 100 mSv only from recurrent CT exams during a feasible time period between 1 and 5 years was identified. Age and gender distribution of these patients were assessed to identify the magnitude of patients in the relatively lower age group of ≤ 50 years.

Results

Of the 2.5 million (2,504,585) patients who underwent 4.8 million (4,819,661) CT exams during the period of between 1 and 5 years, a total of 33,407 (1.33%) patients received a CED of ≥ 100 mSv with an overall median CED of 130.3 mSv and maximum of 1185 mSv. Although the vast majority (72–86%) of patients are > 50 years of age, nearly 20% (13.4 to 28%) are ≤ 50 years. The minimum time to accrue 100 mSv was a single day at all four institutions, an unreported finding to date.

Conclusions

We are in an unprecedented era, where patients undergoing multiple CT exams and receiving CED ≥ 100 mSv are not uncommon. While underscoring the need for imaging appropriateness, the consideration of the number and percent of patients with high exposures and related clinical necessities creates an urgent need for the industry to develop CT scanners and protocols with sub-mSv radiation dose, a goal that has been lingering.

Key Points

• We are in an era where patients undergoing multiple CT exams during a short span of 1 to 5 years are not uncommon and a sizable fraction among them are below 50 years of age.

• This leads to cumulative radiation dose to individual patients at which radiation effects are of real concern.

• There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering.

United Nations Scientific Committee on the Effects of Atomic Radiation (2010) Sources and Effects of Ionizing Radiation. United Nations Scientific Committee on the Effects of Atomic Radiation. UNSCEAR 2008 Report. Volume I: Sources: Report to the General Assembly, Scientific Annexes A and B. New York. Accessed June 18, 2019

Holmberg O, Malone J, Rehani M, Mclean D, Czarwinski R (2010) Current issues and actions in radiation protection of patients. Eur J Radiol 76(1):15–19. https://doi.org/10.1016/j.ejrad.2010.06.033 CrossRefPubMed

National Council on Radiation Protection and Measurements (2009) Ionizing radiation exposure of the population of the United States. NCRP Report 160. NCRP Bethesda, MD

Rehani MM (2015) What makes and keeps radiation risks associated with CT a hot topic? AJR Am J Roentgenol 204(3). https://doi.org/10.2214/ajr.14.12860

Rogers LF (2001) Taking care of children. AJR Am J Roentgenol 176(2):287. https://doi.org/10.2214/ajr.176.2.1760287 CrossRefPubMed

Sternberg S (2001) CT scans in children linked to cancer. USA Today 2001 Jun 19. https://usatoday30.usatoday.com/news/nation/2001-01-22-scans.htm Published January 19, 2001. Accessed August 7, 2018

Richwine L (2009) U.S. probing more cases of CT radiation overexposure. Reuters Dec 7. https://www.reuters.com/article/us-scans-fda/u-s-probing-more-cases-of-ct-radiation-overexposure-idUSTRE5B638O20091207. Published December 7, 2009. Accessed August 7, 2018

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(1013):523–538. https://doi.org/10.1259/bjr/42893576 CrossRefPubMedPubMedCentral

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. https://doi.org/10.1016/S0140-6736(12)60815-0 CrossRefPubMedPubMedCentral

10.

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 of 11 million Australians. BMJ 346:f2360. https://doi.org/10.1136/bmj.f2360 CrossRefPubMedPubMedCentral

11.

Rehani MM (2015) Looking into future: challenges in radiation protection in medicine. Radiat Prot Dosimetry 165(1–4):3–6. https://doi.org/10.1093/rpd/ncv071 CrossRefPubMed

12.

Canellas R, Ackman JB, Digumarthy SR et al (2018) Submillisievert chest dual energy computed tomography: a pilot study. Br J Radiol 91(1082):20170735. https://doi.org/10.1259/bjr.20170735 CrossRefPubMedPubMedCentral

13.

Rehani MM, Berris T (2012) International Atomic Energy Agency study with referring physicians on patient radiation exposure and its tracking: a prospective survey using a web-based questionnaire. BMJ Open 2(5). https://doi.org/10.1136/bmjopen-2012-001425

14.

International Atomic Energy Agency (IAEA) (2012) Radiation Protection of Patients (RPOP), Bonn Call for Action platform (https://www.iaea.org/resources/rpop/resources/bonn-call-for-action-platform). Published 2012. Updated 2019. Accessed August 7, 2018

15.

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):175–184. https://doi.org/10.1148/radiol.2511081296 CrossRefPubMed

16.

Brenner DJ (2010) Medical imaging in the 21st century — getting the best bang for the rad. N Eng J Med 362(10):943–945. https://doi.org/10.1056/nejme1000802 CrossRef

17.

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):887–892. https://doi.org/10.2214/ajr.08.1351 CrossRefPubMed

18.

Desmond AN, O'Regan K, Curran C et al (2008) Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut 57(11):1524–1529. https://doi.org/10.1136/gut.2008.151415

19.

Smith-Bindman R, Moghadassi M, Wilson N et al (2015) Radiation doses in consecutive CT examinations from five university of California Medical Centers. Radiology 77(1):134–141. https://doi.org/10.1148/radiol.2015142728 CrossRef

20.

Fazel R, Krumholtz HM, Wang Y et al (2009) Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 361(9):849–857CrossRef

21.

Chen J, Einstein AJ, Fazel R et al (2010) Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures. A population-based analysis. J Am Coll Cardiol 56:702–711CrossRef

22.

Einstein AJ, Weiner SD, Berheim A et al (2010) Multiple testing, cumulative radiation dose, and clinical indications in patients undergoing myocardial perfusion imaging. JAMA 304:2137–2144CrossRef

23.

Hendee WR, Becker GJ, Borgstede JP et al (2010) Addressing overutilization in medical imaging. Radiology 257(1):240–245. https://doi.org/10.1148/radiol.10100063 CrossRefPubMed

24.

Stein EG, Haramati LB, Bellin E et al (2010) Radiation exposure form medical imaging in patients with chronic and recurrent conditions. J Am Coll Radiol 7:351–359. https://doi.org/10.1016/j.jacr.2009.12.015

25.

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. https://doi.org/10.1681/ASN.2010070784 CrossRefPubMedPubMedCentral

26.

(2007) The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 37(2–4):1–332. https://doi.org/10.1016/j.icrp.2007.10.003

27.

United Nations Scientific Committee on the Effects of Atomic Radiation (2018) Sources, effects and risks of ionizing radiation UNSCEAR 2017 Report New York, NY: UNSCEAR http://wwwunscearorg/docs/publications/2017/UNSCEAR_2017_Annex-Bpdf Published March 2018. Accessed 10 February 2019

28.

National Council of Radiation Protection and Measurements (2018) NCRP Commentary No. 27: Implications of recent epidemiologic studies for the linear-non threshold model and radiation protection. Bethesda, Maryland. Accessed August 7, 2018

29.

National Research Council (2006) Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. The National Academies Press, Washington, DC. https://doi.org/10.17226/11340

30.

European Commission (2008) European guidance on estimating population doses from medical X-ray procedures. Radiation protection No 154. EC Brussels. Accessed August 7, 2018

31.

American Association of Physicists in Medicine (AAPM) (2008) Task Group 23 on the Diagnostic Imaging Council CT Committee. The Measurement, Reporting, and Management of Radiation Dose in CT. AAPM Report No. 96. Maryland: AAPM [cited 2019 Mar 16]. https://www.aapm.org/pubs/reports/RPT_96.pdf

32.

Brambilla M, Vassileva J, Kuchcinskac A, Rehani MM (2019) Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action. Eur Radiol. https://doi.org/10.1007/s00330-019-06528-7

33.

OECD Organization for Economic Co-operation and Development(2017) Health at a glance 2017: OECD indicators. OECD Publishing, Paris. https://doi.org/10.1787/health_glance-2017-en

34.

Rosenthal DI, Weilburg JB, Schultz T et al (2006) Radiology order entry with decision support: initial clinical experience. J Am Coll Radiol 3:799–806CrossRef

35.

Sistrom CL, Dreyer KJ, Dang PP et al (2009) Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations. Radiology 253(2):453–461. https://doi.org/10.1148/radiol.2532090200 CrossRefPubMed

36.

Weilburg JB, Sistrom CL, Rosenthal DI et al (2017) Utilization management of high-cost imaging in an outpatient setting in a large stable patient and provider cohort over 7 years. Radiology 284(3):766–776. https://doi.org/10.1148/radiol.2017160968 CrossRefPubMed

37.

Rehani MM, Melick ER, Alvi RM et al (2019) Patients undergoing recurrent CT exams: Assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness. Eur Radiol. https://doi.org/10.1007/s00330-019-06551-8

38.

Rehani M, Frush D (2010) Tracking radiation exposure of patients. Lancet 376(9743):754–755. https://doi.org/10.1016/S0140-6736(10)60657-5 CrossRefPubMed

39.

Seuri R, Rehani MM, Kortesniemi M (2013) How tracking radiologic procedures and dose helps: experience from Finland. AJR Am J Roentgenol 200(4):771–775. https://doi.org/10.2214/AJR.12.10112 CrossRefPubMed

40.

Rehani MM, Berris T (2014) Templates and existing elements and models for implementation of patient exposure tracking. Radiat Prot Dosimetry 158(1):36–42. https://doi.org/10.1093/rpd/nct185 CrossRefPubMed

41.

Akagi M, Nakamura Y, Higaki T et al (2019) Deep learning reconstruction improves image quality of abdominal ultra-high-resolution CT. Eur Radiol. https://doi.org/10.1007/s00330-019-06170-3

42.

American Association of Physicists in Medicine (AAPM) (2019) Estimating patient organ dose with computed tomography: a review of present methodology and required DICOM information: a Joint Report of AAPM Task Group 246 and the European Federation of Organizations for Medical Physics (EFOMP). https://www.aapm.org/pubs/reports/RPT_246.pdf

43.

Guberina N, Suntharalingam S, Naßenstein K et al (2018) Verification of organ doses calculated by a dose monitoring software tool based on Monte Carlo simulation in thoracic CT protocols. Acta Radiol 59(3):322–326. https://doi.org/10.1177/0284185117716199 CrossRefPubMed

44.

Guberina N, Forsting M, Suntharalingam S et al (2017) Radiation dose monitoring in the clinical routine. Rofo 189(4):356–360. https://doi.org/10.1055/s-0042-116684 CrossRefPubMed

45.

Iriuchijima A, Fukushima Y, Ogura A (2018) Comparison of organ dose calculation using Monte Carlo simulation and in-phantom dosimetry in CT examination. Nihon Hoshasen Gijutsu Gakkai Zasshi 74(2):166–171. https://doi.org/10.6009/jjrt.2018_JSRT_74.2.16 CrossRefPubMed

Titel: Patients undergoing recurrent CT scans: assessing the magnitude
verfasst von: Madan M. Rehani
Kai Yang
Emily R. Melick
John Heil
Dušan Šalát
William F. Sensakovic
Bob Liu
Publikationsdatum: 02.12.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 4/2020
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06523-y

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Patients undergoing recurrent CT scans: assessing the magnitude