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Radiation doses to emergency department patients undergoing computed tomography

Published online by Cambridge University Press:  04 March 2015

James C. Worrall ,
Sadia Jama  and
Ian G. Stiell
James C. Worrall*
Affiliation:
Departments of Emergency Medicine
Sadia Jama
Affiliation:
Departments of Emergency Medicine
Ian G. Stiell
Affiliation:
Departments of Emergency Medicine Departments of Epidemiology and Community Medicine, University of Ottawa Departments of Ottawa Hospital Research Institute, Ottawa, ON
*
Correspondence to: Dr. James Worrall, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, 6th Floor, Room F662, Ottawa, ON K1Y 4E9, jaworrall@toh.on.ca.

Abstract

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Objectives:

Computed tomography (CT) use is increasing in the emergency department (ED). Many physicians are concerned about exposing patients to radiation from CT scanning, but estimates of radiation doses vary. This study’s objective was to determine the radiation doses from CT scanning for common indications in a Canadian ED using modern multidetector CT scanners.

Methods:

We conducted a health records review of consecutive adult patients seen at two busy tertiary care EDs over a 2-month period who underwent CT scanning ordered by emergency physicians. Cases were identified by searching an imaging database. Data collected included patient age and sex, study indication, scanner model, body area, and reported dose-length product. Effective dose per scan was calculated from reported dose-length product. Data were collected on a standardized form, entered into an electronic database, and analyzed with descriptive statistics and 95% CIs. Results: During the study period, emergency physicians assessed 19,880 patients. Overall, 2,720 (13.7%) underwent CT scanning, and of these, 144 (5.3%) patients had more than one scan. Patients had a mean age of 59.0 years, and 45.3% were men. Mean doses for the most common indications were as follows: simple head, 2.9 mSv; cervical spine, 5.7 mSv; complex head, 9.3 mSv; CT pulmonary angiogram, 11.2 mSv; abdomen (nontraumatic abdominal pain), 15.4 mSv; and abdomen (renal colic), 9.8 mSv.

Conclusions:

Approximately one in seven ED patients had a CT scan. Emergency physicians should be aware of typical radiation doses for the studies they order and how the dose varies by protocol and indication.

Keywords

computed tomographyemergency departmenthealth recordsradiation
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 6 , November 2014 , pp. 477 - 484
Copyright
Copyright © Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1.Kocher, K, Meurer, W, Fazel, R, et al. National trends in use of computed tomography in the emergency department. Ann Emerg Med 2011;58:452-62.CrossRefGoogle ScholarPubMed
2.Brenner, D, Hall, E. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84, doi:10.1056/NEJMra072149.CrossRefGoogle ScholarPubMed
3.Berrington de, González A, Mahesh, M, Kim, K-P, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009;169:2071-7, doi:10.1001/archinternmed.2009.440.CrossRefGoogle Scholar
4.Krille, L, Hammer, G, Merzenich, H, et al. Systematic review on physician’s knowledge about radiation doses and radiation risks of computed tomography. Eur J Radiol 2010;76:36-41, doi:10.1016/j.ejrad.2010.08.025.CrossRefGoogle ScholarPubMed
5.Shrimpton, P, Hillier, M, Lewis, M, et al. National survey of doses from CT in the UK: 2003. Br J Radiol 2006;79:968-80, doi:10.1259/bjr/93277434.CrossRefGoogle ScholarPubMed
6.Smith-Bindman, R, Lipson, J, Marcus, R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009;169:2078-86, doi:10.1001/archinternmed.2009.427.CrossRefGoogle ScholarPubMed
7.Lee, C, Haims, A, Monico, E, et al. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 2004;231:393-8, doi:10.1148/radiol.2312030767.CrossRefGoogle ScholarPubMed
8.Huda, W, Ogden, K, Khorasani, M. Converting dose-length product to effective dose at CT. Radiology 2008;248:995–1003, doi:10.1148/radiol.2483071964.CrossRefGoogle ScholarPubMed
9.Huda, W, Mettler, F. Volume CT dose index and dose-length product displayed during CT: what good are they? Radiology 2011;258:236-42, doi:10.1148/radiol.10100297.CrossRefGoogle Scholar
10.Lee, J, Kirschner, J, Pawa, S, et al. Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007. Ann Emerg Med 2010;56:591-6.e1, doi:10.1016/j.annemergmed.2010.05.027.CrossRefGoogle ScholarPubMed
11.Raja, A, Walls, R, Schuur, J.Decreasing use of high-cost imaging: the danger of utilization-based performance measures. Ann Emerg Med 2010;56:597-9, doi:10.1016/j.annemergmed.2010.09.013.CrossRefGoogle ScholarPubMed
12.Sodickson, A, Baeyens, PF, Andriole, KP, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009;251: 175-84, doi:10.1148/radiol.2511081296.CrossRefGoogle ScholarPubMed
13.Fazel, R, Krumholz, H, Wang, Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009;361:849-57, doi:10.1056/NEJMoa0901249.CrossRefGoogle ScholarPubMed
14.Bendeck, S, Nino-Murcia, M, Berry, G, et al. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 2002;225:131-6, doi:10.1148/radiol. 2251011780.CrossRefGoogle ScholarPubMed
15.Frei, S, Bond, W, Bazuro, R, et al. Appendicitis outcomes with increasing computed tomographic scanning. Am J Emerg Med 2008;26:39-44, doi:10.1016/j.ajem.2007.06.027.CrossRefGoogle ScholarPubMed
16.Coursey, C, Nelson, R, Patel, M, et al. Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology 2010;254:460-8, doi:10.1148/radiol.09082298.CrossRefGoogle Scholar
17.Broder, J, Bowen, J, Lohr, J, et al. Cumulative CT exposures in emergency department patients evaluated for suspected renal colic. J Emerg Med 2007;33:161-8, doi:10.1016/j.jemermed.2006.12.035.CrossRefGoogle ScholarPubMed
18.Katz, SI, Saluja, S, Brink, JA, et al. Radiation dose associated with unenhanced CT for suspected renal colic: impact of repetitive studies. AJR Am J Roentgenol 2006;186:1120-4, doi:10.2214/AJR.04.1838.CrossRefGoogle ScholarPubMed
19.Goldstein, NM, Kollef, MH, Ward, S, et al. The impact of the introduction of a rapid D-dimer assay on the diagnostic evaluation of suspected pulmonary embolism. Arch Intern Med 2001;161:567-71, doi:10.1001/archinte.161.4.567.CrossRefGoogle ScholarPubMed
20.Pollack, CV. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department. J Am Coll Cardiol 2011;57:700-6, doi:10.1016/j.jacc.2010.05.071.CrossRefGoogle ScholarPubMed
21.Venkatesh, A, Kline, J, Courtney, D, et al. Evaluation of pulmonary embolism in the emergency department and consistency with a national quality measure. Arch Intern Med. [Epub ahead of print 2012 June 4]Google Scholar
22.Kline, JA, Courtney, DM, Beam, DM, et al. Incidence and predictors of repeated computed tomographic pulmonary angiography in emergency department patients. Ann Emerg Med 2009;54:41-8, doi:10.1016/j.annemergmed.2008.08.015.CrossRefGoogle ScholarPubMed
23.Anderson, DR, Kahn, SR, Rodger, MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 2007;298:2743-53, doi: 10.1001/jama.298.23.2743.CrossRefGoogle ScholarPubMed
24.Hadley, J, Agola, J, Wong, P. Potential impact of the American College of Radiology appropriateness criteria on CT for trauma. AJR Am J Roentgenol 2006;186:937-42, doi:10.2214/AJR.05.0041.CrossRefGoogle Scholar
25.Stiell, IG, Clement, CM, Grimshaw, JM, et al. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. CMAJ 2010;182: 1527-32, doi:10.1503/cmaj.091974.CrossRefGoogle ScholarPubMed
26.Macgregor, DM, McKie, L.CT or not CT – that is the question. Whether’tis better to evaluate clinically and x-ray than to undertake a CT head scan! Emerg Med J 2004;22: 541-3, doi:10.1136/emj.2004.017160.CrossRefGoogle Scholar
27.Bankier, A, Kressel, H. Through the Looking Glass revisited: the need for more meaning and less drama in the reporting of dose and dose reduction in CT. Radiology 2012;265:4–8, doi:10.1148/radiol.12121145.CrossRefGoogle ScholarPubMed
28.Israel, G, Cicchiello, L, Brink, J, et al. Patient size and radiation exposure in thoracic, pelvic, and abdominal ct examinations performed with automatic exposure control. AJR Am J Roentgenol 2010;195:1342-6, doi:10.2214/AJR.09.3331.CrossRefGoogle ScholarPubMed
29.Brenner, D. Is it time to retire the CTDI for CT quality assurance and dose optimization? Med Phys 2005;32:3225-6, doi:10.1118/1.2040747.CrossRefGoogle ScholarPubMed
30.Brenner, D, Elliston, C, Hall, E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289-96, doi:10.2214/ajr.176.2. 1760289.CrossRefGoogle ScholarPubMed
31.Brenner, D, Doll, R, Goodhead, D, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 2003;100:13761-6, doi:10.1073/pnas.2235592100.CrossRefGoogle ScholarPubMed
32.Little, M, Wakeford, R, Tawn, E, et al. Risks associated with low doses and low dose rates of ionizing radiation: why linearity may be (almost) the best we can do. Radiology 2009; 251:6–12, doi:10.1148/radiol.2511081686.CrossRefGoogle ScholarPubMed
33.Tubiana, M, Feinendegen, L, Yang, C, et al. The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 2009;251:13–22, doi:10. 1148/radiol.2511080671.CrossRefGoogle ScholarPubMed
34.Preston, DL, Ron, E, Tokuoaka, S, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res 2007;168:1–64, doi:10.1667/RR0763.1.CrossRefGoogle ScholarPubMed
35.Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, National Research Council. Estimating Cancer Risk. In: Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington (DC): The National Academies Press; 2006. p. 267–312.Google Scholar