Cumulative Radiation Exposure and Cancer Risk Estimates in Emergency Department Patients Undergoing Repeat or Multiple CT
Cumulative Radiation Exposure and Cancer Risk Estimates in Emergency Department Patients Undergoing Repeat or Multiple CT
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DOI：
10.2214/ajr.08.1351
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发表时间：
2009-04-01
影响因子：
5
通讯作者：
Sodickson, Aaron
中科院分区：
文献类型：
--
作者：
Griffey, Richard T.;Sodickson, Aaron
OBJECTIVE.我们研究的目的是确定一个保守的估计，接受重复或多次急诊科CT检查的患者人数，并量化他们的累积CT辐射剂量和终身归因于发展cancer.Materials和方法的风险。我们确定了在三级护理成人学术医疗中心的所有患者，这些患者在1年内至少有3次急诊就诊，包括颈部、胸部、腹部或骨盆的CT。对于该队列，我们确定了过去7.7年中的所有诊断性CT研究。根据第七次电离辐射生物效应（BEIR VII）报告，我们通过对扫描的解剖区域的典型有效剂量求和来计算累积辐射剂量，并使用每1,000名接受10 mSv剂量的患者中一例癌症的人群平均剂量-风险转换因子来计算终身归因风险。130例急诊科患者符合入选标准。在7.7年期间，研究计数的中位数、平均值和最大值分别为10、13和70，累积CT剂量分别为91、122和579 mSv，终生归因风险分别为1/110、1/82和1/17。急诊科研究占捕获的55%。相同研究类型的重复成像至少占队列成像的一半，占12%。一小部分（1.9%）急诊科接受颈部、胸部、腹部或骨盆CT检查的患者多次或重复成像的累积率较高。总体而言，该患者亚组可能因累积CT辐射暴露而发生癌症的风险增加。
OBJECTIVE. The purpose of our study was to define a conservative estimate of the number of patients undergoing repeat or multiple emergency department CT studies and to quantify their cumulative CT radiation doses and lifetime attributable risk of developing cancer.MATERIALS AND METHODS. We identified all patients at a tertiary care adult academic medical center with at least three emergency department visits within a 1-year period that included CT of the neck, chest, abdomen, or pelvis. For this cohort, we identified all diagnostic CT studies over the previous 7.7 years. We calculated cumulative radiation doses by summing typical effective doses of the anatomic regions scanned, and we calculated lifetime attributable risk using the population-averaged dose-to-risk conversion factor of one cancer per 1,000 patients receiving a 10-mSv dose, in accordance with the seventh Biologic Effects of Ionizing Radiation (BEIR VII) report.RESULTS. One hundred thirty emergency department patients met the inclusion criteria. Over the 7.7-year period, median, mean, and maximum values for the study count were 10, 13, and 70 with cumulative CT doses of 91, 122, and 579 mSv and lifetime attributable risk of one in 110, one in 82, and one in 17, respectively. Emergency department studies comprised 55% of those captured. Repeat imaging of the same study type represented at least half of the imaging for 72% of the cohort and all of the imaging for 12%.CONCLUSION. A small proportion (1.9%) of emergency department patients undergoing CT of the neck, chest, abdomen, or pelvis have high cumulative rates of multiple or repeat imaging. Collectively, this patient subgroup may have a heightened risk of developing cancer from cumulative CT radiation exposure.