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      Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks

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          Abstract

          The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.

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          Exposure to low-dose ionizing radiation from medical imaging procedures.

          Reza Fazel, Harlan M. Krumholz, Yongfei Wang … (2009)
          The growing use of imaging procedures in the United States has raised concerns about exposure to low-dose ionizing radiation in the general population. We identified 952,420 nonelderly adults (between 18 and 64 years of age) in five health care markets across the United States between January 1, 2005, and December 31, 2007. Utilization data were used to estimate cumulative effective doses of radiation from imaging procedures and to calculate population-based rates of exposure, with annual effective doses defined as low ( 3 to 20 mSv), high (> 20 to 50 mSv), or very high (> 50 mSv). During the study period, 655,613 enrollees (68.8%) underwent at least one imaging procedure associated with radiation exposure. The mean (+/-SD) cumulative effective dose from imaging procedures was 2.4+/-6.0 mSv per enrollee per year; however, a wide distribution was noted, with a median effective dose of 0.1 mSv per enrollee per year (interquartile range, 0.0 to 1.7). Overall, moderate effective doses of radiation were incurred in 193.8 enrollees per 1000 per year, whereas high and very high doses were incurred in 18.6 and 1.9 enrollees per 1000 per year, respectively. In general, cumulative effective doses of radiation from imaging procedures increased with advancing age and were higher in women than in men. Computed tomographic and nuclear imaging accounted for 75.4% of the cumulative effective dose, with 81.8% of the total administered in outpatient settings. Imaging procedures are an important source of exposure to ionizing radiation in the United States and can result in high cumulative effective doses of radiation. 2009 Massachusetts Medical Society
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            Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study.

            Stefan Huber-Wagner, Rolf Lefering, Lars-Mikael Qvick … (2009)
            The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing. There is no evidence to suggest that use of whole-body CT has any effect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not. In a retrospective, multicentre study, we used the data recorded in the trauma registry of the German Trauma Society to calculate the probability of survival according to the trauma and injury severity score (TRISS), revised injury severity classification (RISC) score, and standardised mortality ratio (SMR, ratio of recorded to expected mortality) for 4621 patients with blunt trauma given whole-body or non-whole-body CT. 1494 (32%) of 4621 patients were given whole-body CT. Mean age was 42.6 years (SD 20.7), 3364 (73%) were men, and mean injury-severity score was 29.7 (13.0). SMR based on TRISS was 0.745 (95% CI 0.633-0.859) for patients given whole-body CT versus 1.023 (0.909-1.137) for those given non-whole-body CT (p<0.001). SMR based on the RISC score was 0.865 (0.774-0.956) for patients given whole-body CT versus 1.034 (0.959-1.109) for those given non-whole-body CT (p=0.017). The relative reduction in mortality based on TRISS was 25% (14-37) versus 13% (4-23) based on RISC score. Multivariate adjustment for hospital level, year of trauma, and potential centre effects confirmed that whole-body CT is an independent predictor for survival (p
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              Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks.

              Edward Monico, Kimberly Brink, Andrew Haims … (2004)
              To determine the awareness level concerning radiation dose and possible risks associated with computed tomographic (CT) scans among patients, emergency department (ED) physicians, and radiologists. Adult patients seen in the ED of a U.S. academic medical center during a 2-week period with mild to moderate abdominopelvic or flank pain and who underwent CT were surveyed after acquisition of the CT scan. Patients were asked whether or not they were informed about the risks, benefits, and radiation dose of the CT scan and if they believed that the scan increased their lifetime cancer risk. Patients were also asked to estimate the radiation dose for the CT scan compared with that for one chest radiograph. ED physicians who requested CT scans and radiologists who reviewed the CT scans were surveyed with similar questions and an additional question regarding the number of years in practice. The chi(2) test of independence was used to compare the three respondent groups regarding perceived increased cancer risk from one abdominopelvic CT scan. Seven percent (five of 76) of patients reported that they were told about risks and benefits of their CT scan, while 22% (10 of 45) of ED physicians reported that they had provided such information. Forty-seven percent (18 of 38) of radiologists believed that there was increased cancer risk, whereas only 9% (four of 45) of ED physicians and 3% (two of 76) of patients believed that there was increased risk (chi(2)(2) = 41.45, P <.001). All patients and most ED physicians and radiologists were unable to accurately estimate the dose for one CT scan compared with that for one chest radiograph. Patients are not given information about the risks, benefits, and radiation dose for a CT scan. Patients, ED physicians, and radiologists alike are unable to provide accurate estimates of CT doses regardless of their experience level.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Radiol
                Journal ID (iso-abbrev): Korean J Radiol
                Journal ID (publisher-id): KJR
                Title: Korean Journal of Radiology
                Publisher: The Korean Society of Radiology
                ISSN (Print): 1229-6929
                ISSN (Electronic): 2005-8330
                Publication date (Print): March 2019
                Publication date (Electronic): 30 January 2019
                Volume: 20
                Issue: 3
                Pages: 399-404
                Affiliations
                Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
                Author notes
                Corresponding author: Raja Rizal Azman, FRCR, Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. Tel: (603) 79492091, Fax: (603) 79562253, rizalazman@ 123456ummc.edu.my
                Author information
                https://orcid.org/0000-0001-8153-7798
                Article
                DOI: 10.3348/kjr.2018.0416
                PMC ID: 6389812
                PubMed ID: 30799570
                SO-VID: 003614b2-2c6e-45d7-8bfc-b34338c2f302
                Copyright © Copyright © 2019 The Korean Society of Radiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 02 July 2018
                Date accepted : 09 October 2018
                Categories
                Subject: Technology, Experiment, and Physics
                Subject: Review Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ionizing radiation,medical technology,cumulative radiation dose,decision-making process,private practice
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ionizing radiation, medical technology, cumulative radiation dose, decision-making process, private practice

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