TY - JOUR
T1 - Radiation Exposure in the Medical ICU
T2 - Predictors and Characteristics
AU - Krishnan, Sudhir
AU - Moghekar, Ajit
AU - Duggal, Abhijit
AU - Yella, Jagadeesh
AU - Narechania, Shraddha
AU - Ramachandran, Vidhya
AU - Mehta, Atul
AU - Adhi, Fatima
AU - Vijayan, Anil Kumar Changarath
AU - Han, Xiaozhen
AU - Wang, Xiaofeng
AU - Dong, Frank
AU - Martin, Charles
AU - Guzman, Jorge
N1 - Publisher Copyright:
© 2018 American College of Chest Physicians
PY - 2018/5
Y1 - 2018/5
N2 - Background: Patients admitted to the medical ICU (MICU) are often subjected to multiple radiologic studies. We hypothesized that some endure radiation dose exposure (cumulative effective dose [CED]) in excess of annual US federal occupational health standard limits (CED ≥ 50 mSv) and 5-year cumulative limit (CED ≥ 100 mSv). We also evaluated the correlation of CED with Acute Physiology and Chronic Health Evaluation (APACHE) III score and other clinical variables. Methods: Retrospective observational study conducted in an academic medical center involving all adult admissions (N = 4,155) to the MICU between January 2013 and December 2013. Radiation doses from ionizing radiologic studies were calculated from reference values to determine the CED. Results: Three percent of admissions (n = 131) accrued CED ≥ 50 mSv (1% [n = 47] accrued CED ≥ 100 mSv). The median CED was 0.72 mSv (interquartile range, 0.02-5.23 mSv), with a range of 0.00 to 323 mSv. Higher APACHE III scores (P =.003), longer length of MICU stay (P <.0001), sepsis (P =.03), and gastrointestinal disorders and bleeding (P <.0001) predicted higher CED in a multivariable linear regression model. Patients with gastrointestinal bleeding and disorders had an odds ratio of 21.05 (95% CI, 13.54-32.72; P <.0001) and 6.94 (95% CI, 3.88-12.38; P <.0001), respectively, of accruing CED ≥ 50 mSv in a multivariable logistic regression model. CT scan and interventional radiology accounted for 49% and 38% of the total CED, respectively. Conclusions: Patients in the MICU are exposed to radiation doses that can be substantial, exceeding federal annual occupational limits, and in a select subset, are > 100 mSv. Efforts to justify, restrict, and optimize the use of radiologic resources when feasible are warranted.
AB - Background: Patients admitted to the medical ICU (MICU) are often subjected to multiple radiologic studies. We hypothesized that some endure radiation dose exposure (cumulative effective dose [CED]) in excess of annual US federal occupational health standard limits (CED ≥ 50 mSv) and 5-year cumulative limit (CED ≥ 100 mSv). We also evaluated the correlation of CED with Acute Physiology and Chronic Health Evaluation (APACHE) III score and other clinical variables. Methods: Retrospective observational study conducted in an academic medical center involving all adult admissions (N = 4,155) to the MICU between January 2013 and December 2013. Radiation doses from ionizing radiologic studies were calculated from reference values to determine the CED. Results: Three percent of admissions (n = 131) accrued CED ≥ 50 mSv (1% [n = 47] accrued CED ≥ 100 mSv). The median CED was 0.72 mSv (interquartile range, 0.02-5.23 mSv), with a range of 0.00 to 323 mSv. Higher APACHE III scores (P =.003), longer length of MICU stay (P <.0001), sepsis (P =.03), and gastrointestinal disorders and bleeding (P <.0001) predicted higher CED in a multivariable linear regression model. Patients with gastrointestinal bleeding and disorders had an odds ratio of 21.05 (95% CI, 13.54-32.72; P <.0001) and 6.94 (95% CI, 3.88-12.38; P <.0001), respectively, of accruing CED ≥ 50 mSv in a multivariable logistic regression model. CT scan and interventional radiology accounted for 49% and 38% of the total CED, respectively. Conclusions: Patients in the MICU are exposed to radiation doses that can be substantial, exceeding federal annual occupational limits, and in a select subset, are > 100 mSv. Efforts to justify, restrict, and optimize the use of radiologic resources when feasible are warranted.
KW - cumulative effective dose
KW - medical ICU
KW - radiation exposure
UR - http://www.scopus.com/inward/record.url?scp=85044598164&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044598164&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2018.01.019
DO - 10.1016/j.chest.2018.01.019
M3 - Article
C2 - 29391140
AN - SCOPUS:85044598164
SN - 0012-3692
VL - 153
SP - 1160
EP - 1168
JO - Chest
JF - Chest
IS - 5
ER -