Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010.
Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010.
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DOI：
10.1001/jama.2012.5960
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发表时间：
2012-06-13
影响因子：
120.7
通讯作者：
Williams, Andrew E.
中科院分区：
文献类型：
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作者：
Smith-Bindman, Rebecca;Miglioretti, Diana L.;Johnson, Eric;Lee, Choonsik;Feigelson, Heather Spencer;Flynn, Michael;Greenlee, Robert T.;Kruger, Randell L.;Hornbrook, Mark C.;Roblin, Douglas;Solberg, Leif I.;Vanneman, Nicholas;Weinmann, Sheila;Williams, Andrew E.
在付费服务模式下，诊断性成像的使用显著增加。人们对综合医疗保健系统成员的成像模式知之甚少。评估综合医疗保健系统成员在成像使用和相关辐射暴露方面的趋势。对来自该国不同地区的六个大型综合卫生系统成员的电子记录进行了回顾分析。通过审查医疗记录，可以从选定的测试中直接估计辐射暴露。从1996年到2010年，每年纳入100-200万名成员患者。先进的诊断成像率和医学成像的年度累积辐射暴露。在15年的研究期间，参与者总共接受了3090万次成像检查(超过2590万人年)，反映了每人每年1.18次(95%可信区间1.17-1.19)的检查，其中35%是高级诊断成像(CT、MRI、核医学和超声波)。从1996年到2010年，先进诊断成像的使用有所增加；计算机断层扫描检查从1996年的52/1000登记人数增加到2010年的149/1000登记人数，年增长7.8%(95%可信区间5.8%，9.8%)；核磁共振检查从17/1000增加到65/1000，年增长10%(95%可信区间3.3%，16.5%)；超声检查从134/1000增加到230/1000，年增长3.9%(95%可信区间3.0%到4.9%)。核医学从32/1000下降到21/1000，年下降3%(95%可信区间下降7.7%，上升1.3%)，2004年后，PET显像率从2.2/万上升到23.5/万，年增长15.2%。虽然所有卫生系统的成像都有所增加，但对解剖面积评估采用的不同方式各不相同。CT使用的增加导致参与者的辐射暴露增加，人均有效剂量翻了一番，接受高(>；20-50mSv)或非常高(>；50mSv)年辐射暴露的参与者的比例增加了一倍。到2010年，接受成像的参与者中，近7%的人每年受到高辐射照射(>；20-50mSv)，4%的人接受非常高的年度辐射暴露(>；50mSv)。在综合保健系统内，在1996至2010年间，高级诊断成像和相关辐射暴露的比率大幅增加。
Diagnostic imaging use increased significantly within fee-for-service models of care. Little is known about patterns of imaging among members of integrated health care systems. To estimate trends in imaging utilization and associated radiation exposure among members of integrated healthcare systems. Retrospective analysis of electronic records of members of six large integrated health systems from diverse regions of the country. Review of medical records allowed direct estimation of radiation exposure from selected tests. Between 1–2 million member-patients were included each year from 1996 to 2010. Advanced diagnostic imaging rates, and cumulative annual radiation exposure from medical imaging. During the 15 year study period, enrollees underwent a total of 30.9 million imaging examinations (over 25.9 million person-years), reflecting 1.18 (95% CI 1.17–1.19) tests per person per year, of which 35% were for advanced diagnostic imaging (CT, MRI, nuclear medicine, and ultrasound). Use of advanced diagnostic imaging increased from 1996 to 2010; computed tomography examinations increased from 52/1000 enrollees in 1996 to 149/1000 in 2010, 7.8% annual growth (95% CI 5.8%, 9.8%); MRI increased from 17/1000 to 65/1000, 10% annual growth (95% CI 3.3%, 16.5%); and ultrasound increased from 134/1000 to 230/1000, 3.9% annual growth (95% CI 3.0% to 4.9%). While nuclear medicine decreased from 32/1000 to 21/1000, 3% annual decline (95% CI 7.7% decline to 1.3% increase), after 2004, PET imaging rates increased from 2.2/10 000 to 23.5/10 000, 15.2% annual growth. While imaging increased within all health systems, the adoption of different modalities for anatomic area assessment varied. Increased use of CT resulted in increased radiation exposure for enrollees, with a doubling in the mean per capita effective dose and in the proportion of enrollees who received high (>20–50 mSv) or very high (>50mSv) annual radiation exposure. By 2010, nearly 7% of enrollees who underwent imaging received a high annual radiation exposure (>20–50 mSv) and 4% received a very high annual exposure (>50 mSv). Within integrated health care systems there was a large increase in the rate of advanced diagnostic imaging and associated radiation exposure between 1996 and 2010.
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影响因子：
--
作者：
Berrington de González A;Mahesh M;Kim KP;Bhargavan M;Lewis R;Mettler F;Land C
通讯作者：
Land C
DOI：
10.1056/nejmoa0901249
发表时间：
2009-08-27
期刊：
The New England journal of medicine
影响因子：
--
作者：
Fazel R;Krumholz HM;Wang Y;Ross JS;Chen J;Ting HH;Shah ND;Nasir K;Einstein AJ;Nallamothu BK
通讯作者：
Nallamothu BK
影响因子：
5
作者：
Hendrick, R. Edward;Pisano, Etta D.;Gatsonis, Constantine
通讯作者：
Gatsonis, Constantine
影响因子：
5
作者：
Parker, Laurence;Levin, David C.;Rao, Vijay M.
通讯作者：
Rao, Vijay M.
影响因子：
9.7
作者：
Levin, David C.;Rao, Vijay M.;Parker, Laurence
通讯作者：
Parker, Laurence