Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness

@article{Rehani2019PatientsUR,
  title={Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness},
  author={Madan M. Rehani and Emily R. Melick and Raza M. Alvi and Ruhani Doda Khera and Salma Batool-Anwar and Tomas G. Neilan and Michael A. Bettmann},
  journal={European Radiology},
  year={2019},
  volume={30},
  pages={1839-1846}
}
Objective To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness. Methods From the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a… 

Patients undergoing recurrent CT scans: assessing the magnitude

The authors are in an unprecedented era, where patients undergoing multiple CT exams and receiving CED ≥ 100 mSv are not uncommon and a sizable fraction among them are below 50 years of age, which leads to cumulative radiation dose to individual patients at which radiation effects are of real concern.

Analysis of patients receiving ≥ 100 mSv during a computed tomography intervention

Awareness of the possibility of such high doses and potential for long-term deleterious effects, especially in younger patients, and consideration of alternative imaging guidance and/or further dose optimization should be strongly considered whenever feasible are strongly considered.

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A survey carried out in Europe aims to estimate the proportion of patients that undergo CT examinations and are exposed to a CED of more than 100 mSv and suggests some practical actions to support the management of cumulative effective dose and to refine or improve practice where recurrent examinations are required.

Multicentric study of patients receiving 50 or 100 mSv in a single day through CT imaging—frequency determination and imaging protocols involved

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Probability of receiving a high cumulative radiation dose and primary clinical indication of CT examinations: a 5-year observational cohort study

The probability of receiving a high radiation dose from CT examinations is small but not negligible and in the majority (80%) of high effective dose receiving patients, the indication for the initial CT scan was oncology related.

Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action

There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients, including development of appropriateness criteria/referral guidelines by professional societies for patients who require recurrent imaging studies, development of CT machines with lower radiation dose by manufacturers, and development of policies by risk management organizations to enhance patient radiation safety.

Cancer Morbidity and Computed Tomography: “After” and “Due to” Challenge

The study aimed to evaluate the possible long-term carcinogenic effects after the exposure to a low dose of diagnostic radiation, appeared within a decade after the 1st CT scan to assess the expected excess cancer morbidity in the OCTC study.

Recurrent imaging procedures with ionising radiation on the same patient. Should we pay more attention?

  • E. Vañó
  • Medicine
    Journal of radiological protection : official journal of the Society for Radiological Protection
  • 2020
Cumulative doses to individual patients from recurrent CT the ‘ total radiation ’ from other high dose imaging modalities such as interventional and PET-CT ( PET emission the) are reported, valuable for epidemiological studies on radiation effects on the group of patients.

Referring physician perspective on how to handle frequent use of CT imaging

  • Elliott WinfordA. Bharija
  • Medicine
    Journal of radiological protection : official journal of the Society for Radiological Protection
  • 2021
It is suggested that all body CT exams should be monitored at an individual, prescriber, and institution level for frequency of use and there should be radiation risk stratification of an individual patient based on the cumulative radiation burden in recent years.

References

SHOWING 1-10 OF 49 REFERENCES

Patients undergoing recurrent CT scans: assessing the magnitude

The authors are in an unprecedented era, where patients undergoing multiple CT exams and receiving CED ≥ 100 mSv are not uncommon and a sizable fraction among them are below 50 years of age, which leads to cumulative radiation dose to individual patients at which radiation effects are of real concern.

Assessment of appropriateness of indications for CT enterography in younger patients

A multidisciplinary expert panel concluded that the vast majority of young patients underwent clinically appropriate first‐time CTE exams, however, a shift in clinical practice to MRE appears warranted for approximately half of young Patients undergoing repeat CTE examinations.

Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action

There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients, including development of appropriateness criteria/referral guidelines by professional societies for patients who require recurrent imaging studies, development of CT machines with lower radiation dose by manufacturers, and development of policies by risk management organizations to enhance patient radiation safety.

Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation

Identifiable subsets of patients with Crohn’s disease are at risk of exposure to significant amounts of diagnostic radiation, and specialist centres should develop low-radiation imaging protocols.

Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations.

The likelihood of RAI increased by 15% for each decade of radiologist experience and roughly doubled over 13 years of study, with the unadjusted rate rising from roughly 6% to 12%.

Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults.

While most patients accrue low radiation-induced cancer risks, a subgroup is potentially at higher risk due to recurrent CT imaging, and Cumulative CT radiation exposure added incrementally to baseline cancer risk in the cohort.

Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT.

A small proportion of emergency department patients undergoing CT of the neck, chest, abdomen, or pelvis have high cumulative rates of multiple or repeat imaging and may have a heightened risk of developing cancer from cumulative CT radiation exposure.

Utilization Management of High-Cost Imaging in an Outpatient Setting in a Large Stable Patient and Provider Cohort over 7 Years.

Analysis of high-cost imaging utilization in a stable cohort of patients cared for by PCPs during a 7-year period showed that comprehensive UM can produce a significant and sustained reduction in risk-adjusted per-patient year outpatient high- cost imaging volume.

Predictors of CT Radiation Dose and Their Effect on Patient Care: A Comprehensive Analysis Using Automated Data.

Purpose To determine patient, vendor, and institutional factors that influence computed tomography (CT) radiation dose. Materials and Methods The relevant institutional review boards approved this