Cumulative radiation exposure from diagnostic imaging in intensive care unit patients

Moloney, Fiachra; Fama, Daniel; Twomey, Maria; O'Leary, Ruth Aoibheann; Houlihane, Conor; Murphy, Kevin P.; O’Neill, Siobhán; O’Connor, Owen J.; Breen, Dorothy; Maher, Michael M.

doi:10.4329/wjr.v8.i4.419

Cited by 23 publications

(18 citation statements)

References 30 publications

(21 reference statements)

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“…Lutterman et al identified 200 inpatients receiving a mean dose of 14.8 mSV, with significantly higher doses in those spending time in the ICU [ 11 ]. Moloney et al identified 421 ICU patients receiving a median CED of 1.5 mSV, with the highest median CED found in trauma patients (7.7 mSv) [ 10 ]. Krishnan et al identified 4155 medical ICU patients reporting a median CED of 0.72 mSV, of note, within their population, three percent did receive > 50 mSv [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Globally speaking, the medical field has moved towards minimizing radiation exposure to patients as reasonable in order to provide adequate care, as most believe there is increased risk of carcinoma with increased exposure to ionizing radiation [ 3 ]. As a result of these concerns, attention has been called to radiation during medical care in certain populations, including trauma patients [ 4 , 5 ], children [ 6 – 8 ], ICU care [ 9 , 10 ], and general hospital care [ 11 ]. However, lack of awareness and guidelines related to radiation exposure during CPSI management has the potential for significant practice variation and subsequent differences in radiographic study use and radiation exposure.…”

Section: Introductionmentioning

confidence: 99%

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Cumulative radiation dose incurred during the management of complex pleural space infection

et al. 2021

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Background Complex pleural space infections are commonly managed with antibiotics, pleural drainage, intrapleural fibrinolytic therapy, and surgery. These strategies often utilize radiographic imaging during management, however little data is available on cumulative radiation exposure received during inpatient management. We aimed to identify the type and quantity of radiographic studies along with the resultant radiation exposure during the management of complex pleural space infections. Methods Retrospective review of community network healthcare system from January 2015 to July 2018. Patients were identified through billing databases as receiving intrapleural fibrinolytic therapy and/or surgical intervention. Patient demographics, clinical outcomes, and inpatient radiographic imaging was collected to calculate cumulative effective dose. Results A total of 566 patients were identified with 7275 total radiographic studies performed and a median cumulative effective dose of 16.9 (IQR 9.9–26.3) mSv. Multivariable linear regression analysis revealed computed tomography use was associated with increased cumulative dose, whereas increased age was associated with lower cumulative dose. Over 74% of patients received more than 10 mSv, with 7.4% receiving more than 40 mSv. Conclusions The number of radiographic studies and overall cumulative effective dose in patients hospitalized for complex pleural space infection was high with the median cumulative effective dose > 5 times normal yearly exposure. Ionizing radiation and modern radiology techniques have revolutionized medical care, but are likely not without risk. Additional study is warranted to identify the frequency and imaging type needed during complex pleural space infection management, attempting to keep ionizing radiation exposure as low as reasonably possible.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cumulative radiation dose incurred during the management of complex pleural space infection

et al. 2021

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“…In a study of adult and pediatric ICU patients, Moloney et al found the median radiation exposure for pediatric patients (n = 23) to be 0.07 mSv. 24 Using a cutoff of 15 mSv for high radiation, they identified pediatric subgroup, trauma patients, and longer duration of stay as risk factors. In PICU patients exclusively, we have also identified increasing age as a risk factor for higher exposure.…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure in Pediatric Intensive Care Unit Patients: How Much Is Too Much?

Kapileshwarkar

Smith

Szpunar

et al. 2018

Clin Pediatr (Phila)

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We aimed to determine median cumulative radiation exposure in pediatric intensive care unit (PICU) patients, proportion of patients with high radiation exposure (above annual average radiation per person of 6.2 mSv), and determine risk factors for high exposure. This was a retrospective chart review of PICU patients up to 18 years of age admitted to a large community hospital over 2 years. Radiologic studies and radiation exposure were determined for each patient, and total hospital radiation exposure was classified as high (>6.2 mSv) or not (≤6.2 mSv). Median radiation exposure per patient was 0.2 mSv (interquartile range = 2.1) and 11.7% of patients received >6.2 mSv radiation during their hospitalization. Factors associated with high radiation exposure included admission for trauma or surgery, number of computed tomography scans, age, and PICU length of stay (all P < .0001). We concluded that subsets of PICU patients are at risk of high radiation exposure. Policies and protocols may help minimize radiation exposure among PICU patients.

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“…These include patients with testicular cancer, 16 cystic fibrosis (CF), 17 inflammatory bowel disease (in particular Crohn's disease (CD) patients), 18 lymphoma 19 and endstage kidney disease, 20 in addition to trauma patients, and patients admitted within intensive care facilities for extended periods of time. 21 Of heightened significance is that age at the time of first radiation exposure is now accepted as an independent risk factor for subsequent cancer mortality. For patients with CF and CD, this is of particular relevance as first clinical presentation typically occurs within the paediatric setting.…”

Section: Health Informationmentioning

confidence: 99%

Strategies for dose reduction with specific clinical indications during computed tomography

et al. 2020

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Increasing integration of computed tomography (CT) into routine patient care has escalated concerns regarding associated radiation exposure. Specific patient cohorts, particularly those with cystic fibrosis (CF) and Crohn's disease, have repeat exposures and thus have an increased risk of high lifetime cumulative effective dose exposures.Thoracic CT is the gold standard imaging method in the diagnosis, assessment and management of pulmonary disease. In the setting of CF, CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography. Furthermore, in specific cases of Crohn's disease, CT demonstrates diagnostic superiority over magnetic resonance imaging (MRI) for radiological evaluation.Low dose CT protocols have proven beneficial in the evaluation of CF, Crohn's disease and renal calculi, and in the follow up of testicular cancer patients. For individuals with chronic conditions warranting frequent radiological follow up, the focus must continue to be the incorporation of appropriate CT use into patient care. This is of particular importance for the paediatric population who are most susceptible to potential radiation induced malignancy.CT technological developments continue to focus on radiation dose optimisation. This article aims to highlight these advancements, which prioritise the acquisition of diagnostically satisfactory images with the least amount of radiation possible.

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Cumulative radiation exposure from diagnostic imaging in intensive care unit patients

Cited by 23 publications

References 30 publications

Cumulative radiation dose incurred during the management of complex pleural space infection

Cumulative radiation dose incurred during the management of complex pleural space infection

Radiation Exposure in Pediatric Intensive Care Unit Patients: How Much Is Too Much?

Strategies for dose reduction with specific clinical indications during computed tomography

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