Published online Apr 28, 2016. doi: 10.4329/wjr.v8.i4.419
Peer-review started: October 6, 2015
First decision: November 24, 2015
Revised: December 3, 2015
Accepted: January 29, 2016
Article in press: January 31, 2016
Published online: April 28, 2016
Processing time: 206 Days and 20.2 Hours
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.
Core tip: We hypothesized that intensive care unit (ICU) patients, especially pediatric patients, are potentially vulnerable to increased cumulative effective doses (CED) from ionizing radiation. We found a relatively low CED in the majority of ICU patients, during their stay in the ICU. Nevertheless, physicians are beholden to keep radiation exposures from diagnostic imaging as low as reasonably practical and CED should be minimized where feasible, especially in young patients. Physicians should be aware that trauma patients and patients with extended ICU admission times are at an increased risk of high CEDs.