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Z Dalah E, B Mohamed A, M Al Bastaki U, A Khan S. Incidence and Mortality Life-Attributable Risks for Patients Subjected to Recurrent CT Examinations and Cumulative Effective Dose Exceeding 100 mSv. Clin Pract 2024; 14:1550-1561. [PMID: 39194929 DOI: 10.3390/clinpract14040125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/24/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
Computed tomography (CT) multi-detector array has been heavily utilized over the past decade. While transforming an individual's diagnosis, the risk of developing pathogenesis as a result remains a concern. The main aim of this institutional cumulative effective dose (CED) review is to highlight the number of adult individuals with a record of CED ≥ 100 mSv over a time span of 5 years. Further, we aim to roughly estimate both incidence and mortality life-attributable risks (LARs) for the shortlisted individuals. CT studies performed over one year, in one dedicated trauma and emergency facility, were retrospectively retrieved and analyzed. Individuals with historical radiological CED ≥ 100 mSv were short-listed. LARs were defined and established based on organ, age and gender. Out of the 4406 CT studies reviewed, 22 individuals were found with CED ≥ 100 mSv. CED varied amongst the short-listed individuals, with the highest CED registered being 223.0 mSv, for a 57-year-old male, cumulated over an average study interval of 46.3 days. The highest median mortality risk was for females, 214 per 100,000 registered for the age group 51-60 years. While certain clinical indications and diseases require close follow-up using radiological examinations, the benefit-to-risk ratio should be carefully considered, particularly when CT is requested.
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Affiliation(s)
- Entesar Z Dalah
- HQ Diagnostic Imaging Department, Dubai Health, Dubai, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University, Dubai Health, Dubai, United Arab Emirates
| | - Ahmed B Mohamed
- Medical Imaging Department, Rashid Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Usama M Al Bastaki
- HQ Diagnostic Imaging Department, Dubai Health, Dubai, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University, Dubai Health, Dubai, United Arab Emirates
- Medical Imaging Department, Rashid Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Sabaa A Khan
- Medical Imaging Department, Latifa Hospital, Dubai Health, Dubai, United Arab Emirates
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Kamarova S, Youens D, Ha NT, Bulsara M, Doust J, Fox R, Kritz M, McRobbie D, O'Leary P, Parizel PM, Slavotinek J, Wright C, Moorin R. Demonstrating the use of population level data to investigate trends in the rate, radiation dose and cost of Computed Tomography across clinical groups: Are there any areas of concern? J Med Radiat Sci 2024. [PMID: 38982690 DOI: 10.1002/jmrs.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION Increases in computed tomography (CT) use may not always reflect clinical need or improve outcomes. This study aimed to demonstrate how population level data can be used to identify variations in care between patient groups, by analysing system-level changes in CT use around the diagnosis of new conditions. METHODS Retrospective repeated cross-sectional observational study using West Australian linked administrative records, including 504,723 adults diagnosed with different conditions in 2006, 2012 and 2015. For 90 days pre/post diagnosis, CT use (any and 2+ scans), effective dose (mSv), lifetime attributable risk (LAR) of cancer incidence and mortality from CT, and costs were assessed. RESULTS CT use increased from 209.4 per 1000 new diagnoses in 2006 to 258.0 in 2015; increases were observed for all conditions except neoplasms. Healthcare system costs increased for all conditions but neoplasms and mental disorders. Effective dose increased substantially for respiratory (+2.5 mSv, +23.1%, P < 0.001) and circulatory conditions (+2.1 mSv, +15.4%, P < 0.001). The LAR of cancer incidence and mortality from CT increased for endocrine (incidence +23.4%, mortality +18.0%) and respiratory disorders (+21.7%, +23.3%). Mortality LAR increased for circulatory (+12.1%) and nervous system (+11.0%) disorders. The LAR of cancer incidence and mortality reduced for musculoskeletal system disorders, despite an increase in repeated CT in this group. CONCLUSIONS Use and costs increased for most conditions except neoplasms and mental and behavioural disorders. More strategic CT use may have occurred in musculoskeletal conditions, while use and radiation burden increased for respiratory, circulatory and nervous system conditions. Using this high-level approach we flag areas requiring deeper investigation into appropriateness and value of care.
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Affiliation(s)
- Sviatlana Kamarova
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Nepean Blue Mountains Local Health District, New South Wales Health, Kingswood, New South Wales, Australia
| | - David Youens
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Ninh T Ha
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Notre Dame, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Richard Fox
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Marlene Kritz
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Donald McRobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Leary
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia
| | - Paul M Parizel
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cameron Wright
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Kutaiba N, Varcoe JG, Barnes P, Succar N, Lau E, Patwala K, Low E, Ardalan Z, Gow P, Goodwin M. Radiation exposure from radiological procedures in liver transplant candidates with hepatocellular carcinoma. Eur J Radiol 2023; 158:110656. [PMID: 36542933 DOI: 10.1016/j.ejrad.2022.110656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Candidates for liver transplantation (LT) with hepatocellular carcinoma (HCC) undergo a large number of diagnostic and interventional radiology procedures. A significant proportion of such procedures involve ionizing radiation with increased lifetime risk of cancer. The objective of our study was to review LT candidates with HCC to quantify ionizing radiation doses from different radiology procedures performed at a single transplant center. METHOD We retrospectively reviewed 179 adult patients with HCC (median age 58.6 years [IQR, 55-62]; 155 [86.6%] males) who were accepted for LT between April 2010 and Dec 2018. Radiology procedures and radiation doses were retrieved and the total and median radiation effective dose in millisieverts (mSv) were calculated for different procedures. Exposure to ionizing radiation was categorized based on previously reported thresholds. RESULTS We assessed 9,986 radiology procedures for our cohort. Patients had a median effective dose prior to transplantation of 254 mSv (IQR, 130-421) with an annualized rate of 152 mSv (IQR, 92-266). Patient median dose increased to 316 mSv (IQR, 159-478) when including exposures post-LT within the study period. 85% of overall exposure was in the extremely high exposure category (>100 mSv). Interventional procedures represented 13% of procedures with substantial radiation and contributed to 45% of radiation exposure while abdominal CTs represented 39% of total procedures and contributed to 45% of radiation exposure. CONCLUSIONS Patients with HCC considered for LT undergo radiology procedures with significant cumulative radiation exposure. Attempts to reduce radiation exposure are suggested by minimizing unnecessary procedures and utilizing ones without ionizing radiation. Improving interventional techniques to reduce radiation doses is needed without compromising treatment delivery.
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Affiliation(s)
- Numan Kutaiba
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia.
| | - Joshua G Varcoe
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia; Medical Physics, Austin Health, Melbourne, Victoria, Australia
| | - Peter Barnes
- Medical Physics, Austin Health, Melbourne, Victoria, Australia
| | - Natalie Succar
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Eddie Lau
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia; Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Kurvi Patwala
- Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Elizabeth Low
- Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Zaid Ardalan
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Paul Gow
- The University of Melbourne, Victoria, Australia; Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Mark Goodwin
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia
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Martin CJ, Barnard M. How much should we be concerned about cumulative effective doses in medical imaging? JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:011514. [PMID: 34673564 DOI: 10.1088/1361-6498/ac31c1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
The International Atomic Energy Agency issued a statement calling for action to strengthen the radiation protection of patients undergoing recurrent imaging. This followed reports of patients receiving cumulative effective doses over 100 mSv from multiple computed tomography examinations. In order to evaluate excess risks of cancer incidence among UK patients, data from an exposure management system covering three hospitals within one trust have been studied over 5½ years. Cumulative effective doses for 105 757 patients, from whom 719 (0.68%) received effective dose over 100 mSv, have been analysed using age and sex specific risk factors for stochastic effects. Two cancers might be expected to be initiated in the patients receiving over 100 mSv, while five might be expected to develop cancer among patients receiving 50-100 mSv. However, the calculations ignore health conditions for which the patients are being treated that may shorten their lives, and rely on the linear-no-threshold dose-effect model which is a subject of debate, so they are likely to overestimate cancer incidence. If health of the patients receiving >100 mSv is taken into account, the risk of mortality from cancer initiated by medical exposure might be the order of 1 in 2000. Recommendations on further strengthening of optimisation should be applied to imaging procedures for all patients with special focus on those performed on children and adolescents.
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Affiliation(s)
- Colin J Martin
- Department of Clinical Physics and Bioengineering, University of Glasgow, Gartnaval Royal Hospital, Glasgow, United Kingdom
| | - Michael Barnard
- Department of Radiation Physics and Protection, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Brower C, Rehani MM. Radiation risk issues in recurrent imaging. Br J Radiol 2021; 94:20210389. [PMID: 34161140 PMCID: PMC9328055 DOI: 10.1259/bjr.20210389] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
Millions of patients benefit from medical imaging every single day. However, we have entered an unprecedented era in imaging practices wherein 1 out of 125 patients can be exposed to effective dose >50 mSv from a single CT exam and 3 out of 10,000 patients undergoing CT exams could potentially receive cumulative effective doses > 100 mSv in a single day. Recurrent imaging with CT, fluoroscopically guided interventions, and hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) is more prevalent today than ever before. Presently, we do not know the cumulative doses that patients may be receiving across all imaging modalities combined. Furthermore, patients with diseases with longer life expectancies are being exposed to high doses of radiation enabling radiation effects to manifest over a longer time period. The emphasis in the past on improving justification of imaging and optimization of technique and practice has proved useful. While that must continue, the current situation requires imaging device manufacturers to urgently develop imaging technologies that are safer for patients as high doses have been observed in patients where imaging has been justified through clinical decision-support and optimized by keeping doses below the national benchmark doses. There is a need to have a critical look at the fundamental principles of radiation protection as cumulative doses are likely to increase in the coming years.
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Yurdaisik I, Nurili F, Aksoy SH, Agirman AG, Aktan A. IONIZING RADIATION EXPOSURE IN PATIENTS WITH COVID-19: MORE THAN NEEDED. RADIATION PROTECTION DOSIMETRY 2021; 194:135-143. [PMID: 34151376 PMCID: PMC8344538 DOI: 10.1093/rpd/ncab092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the ionizing radiation exposure in patients with Coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS This was a retrospective study in which all patients presented with suggestive symptoms of COVID-19 were included. The study was carried out in a university-affiliated private hospital in Istanbul, Turkey. Biological radiation dose exposure (cumulative effective dose: CED) was evaluated in millisievert (mSv) units. RESULTS A total of 1410 patients were included in the study. Of all study subjects, 804 patients (57%) underwent only one chest computed tomography (CT) procedure. Six hundred and six patients (43%) had two or more chest CT procedures. Median CED was 6.02 (min-max:1.67-16.27) mSv. The number of patients who were exposed to ≤ 5 mSv were 149 (24.6%), whereas 457 patients (75.4%) were exposed to >5 mSv. CONCLUSION The radiation exposure in COVID-19 patients seems unjustifiably high. Awareness should be increased as to the proper use of chest CT in COVID-19 as per to the society recommendations.
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Affiliation(s)
- Isil Yurdaisik
- Department of Radiology, Istinye University, Gaziosmanpasa Medical Park Hospital, 34250 Istanbul, Turkey
| | - Fuat Nurili
- Department of Radiology, Memorial Sloan Ketteting Cancer Center, Interventional Radiology, New York, NY 10065, USA
| | - Suleyman Hilmi Aksoy
- Department of Radiology, Galata University, Hisar Intercontinental Hospital, 34768 Istanbul, Turkey
| | - Ayse Gul Agirman
- Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668 Istanbul, Turkey
| | - Ahmet Aktan
- Department of Radiology, Yalova Private Hospital, 77100 Yalova, Turkey
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Bo YMD, Peng HMD, Yukun LMD, Mingbo ZMD. Feasibility and Efficacy of the Segmental Localization of Lumbar Vertebrae by Ultrasound vs X-ray Examination: A Prospective Comparative Study. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.200062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Rehani MM, Nacouzi D. Higher patient doses through X-ray imaging procedures. Phys Med 2020; 79:80-86. [PMID: 33189060 DOI: 10.1016/j.ejmp.2020.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023] Open
Abstract
Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of X-rays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators- but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.
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Affiliation(s)
| | - David Nacouzi
- Duke University Medical Center, Durham, NC 27708, USA
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Trinh E, Bargman JM. Utility of Abdominal Imaging in Peritoneal Dialysis Patients Presenting With Peritonitis. Can J Kidney Health Dis 2020; 7:2054358120964115. [PMID: 33101700 PMCID: PMC7549170 DOI: 10.1177/2054358120964115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/08/2020] [Indexed: 12/27/2022] Open
Abstract
Background Peritonitis remains a major complication in peritoneal dialysis (PD). Abdominal imaging is often performed in the setting of peritonitis to evaluate for concomitant intra-abdominal processes. However, the usefulness of this procedure is unknown. Objective The aim of this study was to assess the prevalence of abdominal imaging performed in the setting of PD peritonitis and to evaluate clinical parameters associated with abnormal imaging results to identify clinical situations in which radiographic examinations are informative. Design This is a retrospective cohort study. Setting The study was conducted at the Toronto General Hospital, Ontario, Canada. Patients We studied 166 episodes of PD peritonitis in 114 patients between January 1, 2011, and June 30, 2016. Measurements Baseline demographics, characteristics of PD peritonitis, and characteristics of abdominal imaging performed. Methods The association between relevant clinical parameters and abnormal abdominal imaging was examined using a univariate and multivariate logistic regression model. Results Abdominal imaging (computed tomography [CT] scan or ultrasound) was performed in 68 cases (41%). Patients were more likely to undergo imaging if they required hospitalization, were admitted to the intensive care unit (ICU), had polymicrobial or fungal organisms causing peritonitis, had relapsing/recurrent/refractory peritonitis, had an indication for hemodialysis or PD catheter removal, or presented with hypotension, tachycardia, or an elevated serum lactate. Of the imaging performed, abnormalities were found in 32 cases (47%). The most common findings were bowel obstruction, intra-abdominal collection, and biliary abnormalities. In the univariate analysis, ICU admission (43.3% vs 14.3%, P < .01) and need for temporary or permanent hemodialysis (62.5% vs 30.6%, P < .01) were associated with imaging abnormalities. Importantly, the peritonitis organism was not associated with abnormal imaging results. In a multivariate analysis, ICU admission was the only significant clinical parameter associated with imaging abnormalities with an odds ratio (OR) of 4.4 (95% confidence interval [CI]: 1.1-17.4, P = .04). Limitations Single-center study, small sample size, and lack of detailed information on the exact indications leading to abdominal imaging. Conclusions Abdominal imaging is commonly performed in the setting of PD peritonitis. Abnormalities are not infrequent and are present in almost half of the cases, with need for ICU admission being the most significant clinical parameter associated with abnormal findings. Therefore, abdominal imaging should be performed in carefully selected patients with PD peritonitis, especially if there is evidence of hemodynamic instability. While the finding of fungal or polymicrobial peritonitis was a driver for abdominal imaging, the presence of these organisms did not predict radiologic abnormalities.
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Joanne M Bargman
- Division of Nephrology, University Health Network, Toronto, ON, Canada
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Joyce S, O'Connor OJ, Maher MM, McEntee MF. Strategies for dose reduction with specific clinical indications during computed tomography. Radiography (Lond) 2020; 26 Suppl 2:S62-S68. [PMID: 32682731 DOI: 10.1016/j.radi.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
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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Affiliation(s)
- S Joyce
- Department of Radiology, University College Cork, Cork, Ireland.
| | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Discipline of Diagnostic Radiography, University College Cork, Cork, Ireland
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Brambilla M, Vassileva J, Kuchcinska A, Rehani MM. Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action. Eur Radiol 2019; 30:2493-2501. [PMID: 31792583 DOI: 10.1007/s00330-019-06528-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/15/2019] [Accepted: 10/17/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To have a global picture of the recurrent use of CT imaging to a level where cumulative effective dose (CED) to individual patients may be exceeding 100 mSv at which organ doses typically are in a range at which radiation effects are of concern METHODS: The IAEA convened a meeting in 2019 with participants from 26 countries, representatives of various organizations, and experts in radiology, medical physics, radiation biology, and epidemiology. Participants were asked to collect data prior to the meeting on cumulative radiation doses to assess the magnitude of patients above a defined level of CED. RESULTS It was observed that the number of patients with CED ≥ 100 mSv is much larger than previously known or anticipated. Studies were presented in the meeting with data from about 3.2 million patients who underwent imaging procedures over periods of between 1 and 5 years in different hospitals. It is probable that an additional 0.9 million patients reach the CED ≥ 100 mSv every year globally. CONCLUSIONS There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients. The actions include development of appropriateness criteria/referral guidelines by professional societies for patients who require recurrent imaging studies, development of CT machines with lower radiation dose than today by manufacturers, and development of policies by risk management organizations to enhance patient radiation safety. Alert values for cumulative radiation exposures of patients should be set up and introduced in dose monitoring systems. KEY POINTS • Recurrent radiological imaging procedures leading to high radiation dose to patients are more common than ever before. • Tracking of radiation exposure of individual patients provides useful information on cumulative radiation dose. • There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients.
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Affiliation(s)
- Marco Brambilla
- Medical Physics Department, University Hospital "Maggiore della Carità", C.so Mazzini 18, 28100, Novara, Italy.
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, Radiation Safety and Monitoring Section, NSRW, International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400, Vienna, Austria
| | - Agnieszka Kuchcinska
- Medical Physics Department, Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Madan M Rehani
- Massachusetts General Hospital, 175 Cambridge Street, Suite 244, Boston, MA, 02114, USA
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M A S, Delma CR, Manickam K, Mohan S, Habib SL, Natarajan M. Heterozygous Tsc2 (Tsc2+/–) mouse model to study induced renal cancer in response to ionizing radiation at low doses. Carcinogenesis 2019; 40:782-790. [DOI: 10.1093/carcin/bgy172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Kidneys are one of the main dose-limiting organs in radiotherapeutic procedures of lower abdomen. Likewise, the threat of exposure of radiosensitive organs such as kidneys in warfare or radiation accidents among military personal or due to terrorist activities in general public is of increasing concern. These events warrant the need for appropriate animal models to study the acute and chronic effects of low- and high-dose rate radiation exposures. In this study, for the first time, we validated Tsc2+/– mouse model to study whether radiation accelerates carcinogenesis in kidneys. Tsc2+/– mice at increasing age groups at 8 and 10 months were exposed to repeated doses of gamma radiation (0.4 Gy × 5) and assessed for aggravated kidney tumor formation at 2 months post-irradiation. Animals from irradiated group showed a significant increase in numbers of bilateral, multifocal tumors compared with mock-irradiated animals. Intra-glomerular reactive oxygen species (ROS) levels measured by dihydroethidium florescence showed significant increases in ROS production in irradiated Tsc2+/– mice compared with non-irradiated animals. Similarly, selective hematological parameters and glomerular filtration rate were further reduced significantly in irradiated Tsc2+/– mice. Tsc2 protein, tuberin in irradiated mice, however, remains at the same reduced levels as that of the mock-irradiated heterozygous Tsc2 mice. The results indicate that radiation alters kidney homeostatic function and influences high spontaneous incidence of renal cell carcinoma in this rodent model. Repurposing of Tsc2+/– mice model will, therefore, provide a unique opportunity to study acute and delayed effects of radiation in the development of kidney cancers.
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Affiliation(s)
- Sureshkumar M A
- Department of Pathology, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Caroline R Delma
- Department of Pathology, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Krishnan Manickam
- Department of Pathology, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Sumathy Mohan
- Department of Pathology, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Samy L Habib
- Department of Cell System and Anatomy, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Mohan Natarajan
- Department of Pathology, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
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Zhang MB, Yan LT, Li SP, Li YY, Huang P. Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report. World J Clin Cases 2019; 7:1161-1168. [PMID: 31183348 PMCID: PMC6547327 DOI: 10.12998/wjcc.v7.i10.1161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/01/2019] [Accepted: 03/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). Repeated fluoroscopy, with more than 30 shots on average, is inevitable to ensure its accuracy and safety. However, exposure to X-rays may pose a threat to human health. We herein report a case of ultrasound (US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.
CASE SUMMARY A 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic, his symptoms had aggravated for 1 month, and he was diagnosed with L3-4 and L4-5 disc herniations. He received US-guided PELD with good results: His straight leg elevation increased from 40 to 90 degrees after PELD, and his visual analog scale (VAS) and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD. With the guidance of US, he received only two shots of fluoroscopy (fluoroscopic time: 4.4 s; radiation dose: 3.98 mGy). To our knowledge, this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.
CONCLUSION US could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.
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Affiliation(s)
- Ming-Bo Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, China
| | - Long-Tao Yan
- Department of Pain, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shou-Peng Li
- Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, China
| | - Ying-Ying Li
- Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, China
| | - Peng Huang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
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Ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy: a new guidance method that reduces radiation doses. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2543-2550. [DOI: 10.1007/s00586-019-05980-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
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Aguiar Torres L, Dos Santos Rodrigues A, Linhares D, Camarinho R, Nunes Páscoa Soares Rego ZM, Ventura Garcia P. Buccal epithelial cell micronuclei: Sensitive, non-invasive biomarkers of occupational exposure to low doses of ionizing radiation. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2018; 838:54-58. [PMID: 30678828 DOI: 10.1016/j.mrgentox.2018.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 01/18/2023]
Abstract
We have evaluated buccal epithelial cell micronucleus formation as a biomarker of genotoxic damage following occupational exposure to low doses of ionizing radiation. Buccal epithelial cells were collected from 42 occupationally exposed medical personnel and 39 non-exposed individuals (reference group). Each individual in the exposed group was routinely monitored with a personal radiation badge. The frequency of micronucleated cells (MNC) was significantly higher in the exposed group (5.26 vs. 1.33 MNC/2000 cells) and correlated strongly with accumulated radiation dose (Annual Deep Dose, mSv). Occupational exposure to low doses of ionizing radiation was associated with an 80% relative increase in the frequency of MNC (MRR = 1.8; 95% CI: 1.1-2.8), suggesting that such exposures cause DNA damage. This non-invasive biomonitoring method should be generally applicable to studies of workers who are exposed occupationally to low doses of IR.
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Affiliation(s)
| | - Armindo Dos Santos Rodrigues
- Faculty of Sciences and Technology, University of the Azores, 9501-801 Ponta Delgada, Portugal; IVAR, Institute of Volcanology and Risks Assessment, University of the Azores, 9501-801 Ponta Delgada, Portugal
| | - Diana Linhares
- Faculty of Sciences and Technology, University of the Azores, 9501-801 Ponta Delgada, Portugal; IVAR, Institute of Volcanology and Risks Assessment, University of the Azores, 9501-801 Ponta Delgada, Portugal
| | - Ricardo Camarinho
- Faculty of Sciences and Technology, University of the Azores, 9501-801 Ponta Delgada, Portugal; IVAR, Institute of Volcanology and Risks Assessment, University of the Azores, 9501-801 Ponta Delgada, Portugal
| | | | - Patrícia Ventura Garcia
- Faculty of Sciences and Technology, University of the Azores, 9501-801 Ponta Delgada, Portugal; cE3c-ABG, Centre for Ecology, Evolution and Environmental Changes /Azorean Biodiversity Group, University of the Azores, 9501-801 Ponta Delgada, Azores, Portugal.
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Wu R, Liao X, Xia H. Radiation Exposure to the Surgeon During Ultrasound-Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study. World Neurosurg 2017; 101:658-665.e1. [PMID: 28342919 DOI: 10.1016/j.wneu.2017.03.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the radiation dose to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation, and to investigate whether the usage of ultrasonography could reduce the radiation exposure to the surgeon. METHODS The stages of needle insertion and foraminal plasty for transforaminal PELD were performed under ultrasound guidance and confirmed by fluoroscopy according to the standard technique by 2 spinal surgeons separately in 25 transforaminal PELDs (25 levels). The radiation exposure dose of the surgeons' chest above and below the shielding and the fluoroscopy time were recorded. The effective dose and number of possible levels per year within the yearly occupational exposure limit (OEL) were calculated. The radiation dose per level and fluoroscopy time between ultrasound-assisted PELD and fluoroscopy-assisted PELD were compared. RESULTS The mean operation time and fluoroscopy time were 67.6 ± 14.6 minutes and 2.9 ± 0.7 seconds, respectively. The mean effective dose to the surgeons per level was 1.3 ± 0.6 μSv. One surgeon could perform PELDs at 38,462 levels per year without exceeding the OEL for whole-body radiation wearing a lead apron, and 1938 levels per year without using any shielding devices. Ultrasound-assisted PELD had significantly less radiation dose per level at the chest below and above apron, effective dose per level, and fluoroscopy time, compared with fluoroscopy-assisted PELD (all P < 0.05). CONCLUSIONS The method of ultrasound-assisted needle insertion and foraminal plasty in transforaminal PELD can reduce radiation exposure to the surgeons compared with fluoroscopy-assisted PELD.
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Affiliation(s)
- Ruihui Wu
- Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China
| | - Xuqiang Liao
- Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China
| | - Hong Xia
- Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China.
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Moloney F, Fama D, Twomey M, O’Leary R, Houlihane C, Murphy KP, O’Neill SB, O’Connor OJ, Breen D, Maher MM. Cumulative radiation exposure from diagnostic imaging in intensive care unit patients. World J Radiol 2016; 8:419-427. [PMID: 27158429 PMCID: PMC4840200 DOI: 10.4329/wjr.v8.i4.419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/03/2015] [Accepted: 01/31/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To quantify cumulative effective dose of intensive care unit (ICU) patients attributable to diagnostic imaging.
METHODS: This was a prospective, interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center. Demographic and clinical data including age, gender, date of ICU admission, primary reason for ICU admission, APACHE II score, length of stay, number of days intubated, date of death or discharge, and re-admission data was collected on all patients admitted over a 1-year period. The overall radiation exposure was quantified by the cumulative effective radiation dose (CED) in millisieverts (mSv) and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board. Pediatric patients were selected for subgroup-analysis.
RESULTS: A total of 2737 studies were performed in 421 patients. The total CED was 1704 mSv with a median CED of 1.5 mSv (IQR 0.04-6.6 mSv). Total CED in pediatric patients was 74.6 mSv with a median CED of 0.07 mSv (IQR 0.01-4.7 mSv). Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED. Computed tomography (CT) accounted for 16% of all studies performed and contributed 97% of total CED. Trauma patients received a statistically significant higher dose [median CED 7.7 mSv (IQR 3.5-13.8 mSv)] than medical [median CED 1.4 mSv (IQR 0.05-5.4 mSv)] and surgical [median CED 1.6 mSv (IQR 0.04-7.5 mSv)] patients. Length of stay in ICU [OR = 1.12 (95%CI: 1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mSv.
CONCLUSION: Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs. CED should be minimized where feasible, especially in young patients.
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De Mauri A, Matheoud R, Carriero A, Lizio D, Chiarinotti D, Brambilla M. Radiation exposure from medical imaging in dialyzed patients undergoing renal pre-transplant evaluation. J Nephrol 2016; 30:141-146. [DOI: 10.1007/s40620-016-0275-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/30/2016] [Indexed: 11/28/2022]
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Murphy KP, Crush L, O’Neill SB, Foody J, Breen M, Brady A, Kelly PJ, Power DG, Sweeney P, Bye J, O’Connor OJ, Maher MM, O’Regan KN. Feasibility of low-dose CT with model-based iterative image reconstruction in follow-up of patients with testicular cancer. Eur J Radiol Open 2016; 3:38-45. [PMID: 27069978 PMCID: PMC4811850 DOI: 10.1016/j.ejro.2016.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We examine the performance of pure model-based iterative reconstruction with reduced-dose CT in follow-up of patients with early-stage testicular cancer. METHODS Sixteen patients (mean age 35.6 ± 7.4 years) with stage I or II testicular cancer underwent conventional dose (CD) and low-dose (LD) CT acquisition during CT surveillance. LD data was reconstructed with model-based iterative reconstruction (LD-MBIR). Datasets were objectively and subjectively analysed at 8 anatomical levels. Two blinded clinical reads were compared to gold-standard assessment for diagnostic accuracy. RESULTS Mean radiation dose reduction of 67.1% was recorded. Mean dose measurements for LD-MBIR were: thorax - 66 ± 11 mGy cm (DLP), 1.0 ± 0.2 mSv (ED), 2.0 ± 0.4 mGy (SSDE); abdominopelvic - 128 ± 38 mGy cm (DLP), 1.9 ± 0.6 mSv (ED), 3.0 ± 0.6 mGy (SSDE). Objective noise and signal-to-noise ratio values were comparable between the CD and LD-MBIR images. LD-MBIR images were superior (p < 0.001) with regard to subjective noise, streak artefact, 2-plane contrast resolution, 2-plane spatial resolution and diagnostic acceptability. All patients were correctly categorised as positive, indeterminate or negative for metastatic disease by 2 readers on LD-MBIR and CD datasets. CONCLUSIONS MBIR facilitated a 67% reduction in radiation dose whilst producing images that were comparable or superior to conventional dose studies without loss of diagnostic utility.
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Affiliation(s)
- Kevin P. Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Lee Crush
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Siobhan B. O’Neill
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - James Foody
- Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Micheál Breen
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Adrian Brady
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Paul J. Kelly
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Derek G. Power
- Department of Medical Oncology, Cork and Mercy University Hospitals, Cork, Ireland
| | - Paul Sweeney
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Jackie Bye
- General Electric Healthcare Technologies, Herdfordshire, UK
| | - Owen J. O’Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Kevin N. O’Regan
- Department of Radiology, Cork University Hospital, Cork, Ireland
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20
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Sullivan CJ, Murphy KP, McLaughlin PD, Twomey M, O'Regan KN, Power DG, Maher MM, O'Connor OJ. Radiation exposure from diagnostic imaging in young patients with testicular cancer. Eur Radiol 2014; 25:1005-13. [PMID: 25500962 DOI: 10.1007/s00330-014-3507-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/30/2014] [Accepted: 11/13/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Risks associated with high cumulative effective dose (CED) from radiation are greater when imaging is performed on younger patients. Testicular cancer affects young patients and has a good prognosis. Regular imaging is standard for follow-up. This study quantifies CED from diagnostic imaging in these patients. METHODS Radiological imaging of patients aged 18-39 years, diagnosed with testicular cancer between 2001 and 2011 in two tertiary care centres was examined. Age at diagnosis, cancer type, dose-length product (DLP), imaging type, and frequency were recorded. CED was calculated from DLP using conversion factors. Statistical analysis was performed with SPSS. RESULTS In total, 120 patients with a mean age of 30.7 ± 5.2 years at diagnosis had 1,410 radiological investigations. Median (IQR) surveillance was 4.37 years (2.0-5.5). Median (IQR) CED was 125.1 mSv (81.3-177.5). Computed tomography accounted for 65.3 % of imaging studies and 98.3 % of CED. We found that 77.5 % (93/120) of patients received high CED (>75 mSv). Surveillance time was associated with high CED (OR 2.1, CI 1.5-2.8). CONCLUSIONS Survivors of testicular cancer frequently receive high CED from diagnostic imaging, mainly CT. Dose management software for accurate real-time monitoring of CED and low-dose CT protocols with maintained image quality should be used by specialist centres for surveillance imaging. KEY POINTS • CT accounted for 98.3 % of CED in patients with testicular cancer. • Median CED in patients with testicular cancer was 125.1 mSv • High CED (>75 mSv) was observed in 77.5 % (93/120) of patients. • Dose tracking and development of low-dose CT protocols are recommended.
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Affiliation(s)
- C J Sullivan
- Department of Radiology, Cork and Mercy University Hospitals, Wilton, Cork, Ireland
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21
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Cumulative radiation dose from medical imaging in chronic adult patients. Am J Med 2013; 126:480-6. [PMID: 23541374 DOI: 10.1016/j.amjmed.2012.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/22/2022]
Abstract
Chronic patients require ongoing care that results in repeated imaging and exposure to ionizing radiation for both diagnostic and therapeutic purposes. This is of concern due to the long-term effects of radiation exposure, namely the association between radiation and increased cancer risk. In this study, the scientific literature on cumulated dose of radiation accrued from medical imaging by 4 cohorts of chronic patients (cardiac disease, end-stage kidney disease, inflammatory bowel disease, and patients undergoing endovascular aortic repair) was systematically reviewed. We found that the cumulative effective dose is moderate in cardiac and inflammatory bowel disease patients, high in end-stage kidney disease patients, and very high in endovascular aortic repair patients. We concluded that radiation burden of medical imaging is high in selected cohorts of chronic patients. Efforts should be implemented to reduce this cumulative dose and its potential attendant risks.
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Nguyen KN, Patel AM, Weng FL. Ionizing radiation exposure among kidney transplant recipients due to medical imaging during the pretransplant evaluation. Clin J Am Soc Nephrol 2013; 8:833-9. [PMID: 23393106 PMCID: PMC3641612 DOI: 10.2215/cjn.03990412] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 12/31/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney transplant recipients are at increased risk for malignancies. One recognized risk for malignancy is ionizing radiation. The purpose of this study was to determine, among kidney transplant recipients, the medical imaging procedures that contribute to radiation exposure and their cumulative radiation exposure, as a result of their pretransplant evaluation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Medical records of patients who received a first, kidney-alone transplant during 2008 at a single transplant center were examined. This study identified medical imaging procedures that were performed as prerequisites for deceased donor wait-listing or receipt of live donor kidney transplants and to maintain active status on the wait list. Frequencies of medical imaging procedures and cumulative effective doses of radiation were calculated. RESULTS Among the 172 kidney transplant recipients, 905 procedures were performed. Seventy patients (40.7%) were exposed to low dose (0-20 mSv), 51 (29.7%) were exposed to moderate dose (>20-50 mSv), 28 (16.3%) were exposed to high dose (>50-100 mSv), and 23 (13.4%) were exposed to very high dose (>100 mSv) cumulative effective radiation. Nuclear stress tests accounted for 82.9% of the total radiation exposure. In multivariate analysis, older age, diabetes, and black race were associated with exposure to >20 mSv radiation during the pretransplant evaluation. CONCLUSIONS Kidney transplant recipients are exposed to large amounts of ionizing radiation from medical imaging during the pretransplant evaluation. The effects of radiation upon malignancy risk and strategies to reduce this radiation exposure warrant further investigation.
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Affiliation(s)
- Kim N. Nguyen
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, New Jersey; and
| | - Anup M. Patel
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, New Jersey; and
| | - Francis L. Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, New Jersey; and
- Department of Epidemiology, School of Public Health, University of Medicine & Dentistry of New Jersey, Piscataway, New Jersey
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