Cumulative total effective whole-body radiation dose in critically ill patients

Deborah J. Rohner, Suzanne Bennett, Chandrasiri Samaratunga, Elizabeth S. Jewell, Jeffrey P. Smith, Mary Gaskill-Shipley, Steven J Lisco

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Uncertainty exists about a safe dose limit to minimize radiation-induced cancer. Maximum occupational exposure is 20 mSv/y averaged over 5 years with no more than 50 mSv in any single year. Radiation exposure to the general population is less, but the average dose in the United States has doubled in the past 30 years, largely from medical radiation exposure. We hypothesized that patients in a mixed-use surgical ICU (SICU) approach or exceed this limit and that trauma patients were more likely to exceed 50 mSv because of frequent diagnostic imaging. Methods: Patients admitted into 15 predesignated SICU beds in a level I trauma center during a 30-day consecutive period were prospectively observed. Effective dose was determined using Huda's method for all radiography, CT imaging, and fluoroscopic examinations. Univariate and multivariable linear regressions were used to analyze the relationships between observed values and outcomes. Results: Five of 74 patients (6.8%) exceeded exposures of 50 mSv. Univariate analysis showed trauma designation, length of stay, number of CT scans, fluoroscopy minutes, and number of general radiographs were all associated with increased doses, leading to exceeding occupational exposure limits. In a multivariable analysis, only the number of CT scans and fluoroscopy minutes remained significantly associated with increased whole-body radiation dose. Conclusions: Radiation levels frequently exceeded occupational exposure standards. CT imaging contributed the most exposure. Health-care providers must practice efficient stewardship of radiologic imaging in all critically ill and injured patients. Diagnostic benefit must always be weighed against the risk of cumulative radiation dose.

Original languageEnglish (US)
Pages (from-to)1481-1486
Number of pages6
JournalChest
Volume144
Issue number5
DOIs
StatePublished - Nov 2013

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Whole-Body Irradiation
Critical Illness
Occupational Exposure
Fluoroscopy
Radiation-Induced Neoplasms
Radiation
Trauma Centers
Wounds and Injuries
Diagnostic Imaging
Radiography
Health Personnel
Uncertainty
Linear Models
Length of Stay
Population
Radiation Exposure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Rohner, D. J., Bennett, S., Samaratunga, C., Jewell, E. S., Smith, J. P., Gaskill-Shipley, M., & Lisco, S. J. (2013). Cumulative total effective whole-body radiation dose in critically ill patients. Chest, 144(5), 1481-1486. https://doi.org/10.1378/chest.12-2222

Cumulative total effective whole-body radiation dose in critically ill patients. / Rohner, Deborah J.; Bennett, Suzanne; Samaratunga, Chandrasiri; Jewell, Elizabeth S.; Smith, Jeffrey P.; Gaskill-Shipley, Mary; Lisco, Steven J.

In: Chest, Vol. 144, No. 5, 11.2013, p. 1481-1486.

Research output: Contribution to journalArticle

Rohner, DJ, Bennett, S, Samaratunga, C, Jewell, ES, Smith, JP, Gaskill-Shipley, M & Lisco, SJ 2013, 'Cumulative total effective whole-body radiation dose in critically ill patients', Chest, vol. 144, no. 5, pp. 1481-1486. https://doi.org/10.1378/chest.12-2222
Rohner DJ, Bennett S, Samaratunga C, Jewell ES, Smith JP, Gaskill-Shipley M et al. Cumulative total effective whole-body radiation dose in critically ill patients. Chest. 2013 Nov;144(5):1481-1486. https://doi.org/10.1378/chest.12-2222
Rohner, Deborah J. ; Bennett, Suzanne ; Samaratunga, Chandrasiri ; Jewell, Elizabeth S. ; Smith, Jeffrey P. ; Gaskill-Shipley, Mary ; Lisco, Steven J. / Cumulative total effective whole-body radiation dose in critically ill patients. In: Chest. 2013 ; Vol. 144, No. 5. pp. 1481-1486.
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