RADIATION DOSE TRENDS AND CANCER RISK ACCRUED FROM RADIATION EXPOSURE IN THE MEDICAL ICU: A 5-YEAR PERSPECTIVE

Abstract

SESSION TITLE: Tuesday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Patients admitted to Medical Intensive care unit (MICU) are subjected to multiple radiological studies.Some endure radiation dose exposure [Cumulative Effective dose (CED) ] in excess of annual federal occupational health standard limits (CED≥50 mSv) and those statistically linked with cancer induction (CED≥100 mSv). We evaluated the cancer risk( life time attributable risk) from the CED accrued during a single admission and radiation dose trends over a 5 year period METHODS: This is a retrospective observational study conducted in an academic medical center involving all adult admissions (N=21,108) admitted to the MICU between January 2013 and December 2017. Clinical and radiologic data were obtained from the electronic medical records and the picture archiving & communication system. Radiation doses from ionizing radiological studies were calculated from reference values to determine CED. RESULTS: Four percent of the patients (n=562) accrued CED ≥50%, 1 % (n=195) accrued CED ≥100 mSv. The median CED was 0.72 mSv (IQR, 0.02-4.08 mSv)over a five year period with a range of 0.00 mSv to 1607 mSv . The mean MICU length of stay(LOS ) was 4.7(+/-6.7 )days and APACHE score was 65.8(+/-29.6) over a 5 year period . Higher APACHE 3 scores (p< 0.001), hepatic failure (p=0.03 ), and gastrointestinal disorders (0.0001) predicted higher CED in a multivariable linear regression model. Odds ratio of accruing CED≥ 50mSv was noted at 8.9 (CI 6.84-11.59, P< 0.0001) in gastrointestinal bleeding, 2.6 (CI 2.17-4.04, p < 0.0001) in gastrointestinal disorders ,3.58 (CI 2.69-4.78 P<0.001) in hematological disorders and 1.38 (CI 0.99-1.92 p<0.001) in Cirrhosis. CT scan and interventional radiology accounted for 59% and 29% of the total CED, respectively. The median increase in cancer risk from CED accrued was 0.36(IQR, 0.23-0.58).The Median CED remained constant across 5 years without an uptrend. CONCLUSIONS: MICU patients are exposed to radiation doses that can be substantial, exceeding federal annual occupational limits and in a select subset, exceeds >100 mSv resulting in an increased cancer risk from baseline among ICU survivors. Median CED remained constant across the study period without an uptrend. Efforts to justify, restrict & optimize the use of radiological resources when feasible, are warranted. CLINICAL IMPLICATIONS: Younger MICU survivors could be at substantial cancer risk from CED accrued in the MICU within a relatively short span of time. Those discharged could be subjected to even more medical radiation as a part of ongoing medical care, adding to the annual CED and increasing the radiogenic risk further. Attempts to mitigate radiation burden by optimizing the utilization of fluoroscopically guided interventional procedures and computerized tomography merits further discussion and research. DISCLOSURES: No relevant relationships by Sinan Abdul-Wahab, source=Web Response No relevant relationships by Anirban Bhattacharyya, source=Web Response No relevant relationships by Abhijit Duggal, source=Web Response No relevant relationships by Sravanthi Ennala, source=Web Response No relevant relationships by Nagamani Guduguntla, source=Web Response no disclosure on file for Jorge Guzman; No relevant relationships by Xiaozhen Han, source=Web Response No relevant relationships by Tarik Hanane, source=Web Response no disclosure on file for Ali Khwaja; No relevant relationships by Sudhir Krishnan, source=Web Response Advisory Committee Member relationship with Boston Scientific Corp. Please note: $1001 - $5000 Added 03/14/2019 by CHARLES MARTIN, source=Web Response, value=Consulting fee Consultant relationship with Terumo Interventional Corp. Please note: $1001 - $5000 Added 03/14/2019 by CHARLES MARTIN, source=Web Response, value=Consulting fee Advisory Committee Member relationship with BTG Inc. Please note: $1001 - $5000 Added 03/14/2019 by CHARLES MARTIN, source=Web Response, value=Consulting fee No relevant relationships by Xiaofeng Wang, source=Web Response