Total Cumulative Effective Dose Research Articles

Replacing Plain Radiograph with ultra-low dose CT thorax in cystic fibrosis (CF) in the era of CFTR modulation and its impact on cumulative effective dose

BackgroundMedical radiation exposure is of increasing concern in patients with cystic fibrosis (PWCF) due to improving life expectancy. We aimed to assess and quantify the cumulative effective dose (CED) in PWCF in the context of CFTR-modulator therapy and the advancement of dose reduction techniques. MethodsWe performed a retrospective observational study in a single University CF centre over a 11-year period. We included PWCF, aged over 18 years who exclusively attended our institution. Relevant clinical data (demographics, transplantation history and modulator status) and radiological data (modality, quantity, and radiation exposure measured as CED) were collected. For those on modulator therapy the quantified imaging and radiation data was dichotomised into pre-and-post therapy periods. ResultsThe study included 181 patients: 139 on CFTR modulator therapy, 15 transplant recipients and 27 with neither exposure. 82% of patients received <25 mSv over the study period. Mean study duration was 6.9 ± 2.6 years pre-modulation and 4.2 ± 2.6 years post-modulation. Pre-modulation CT contributed 9.6% of total chest imaging (n = 139/1453) and 70.9% of the total CED. Post-modulation CT use increased contributing 42.7% of chest imaging (n = 444/1039) and comprised 75.8% of CED. Annual CED was 1.55 mSv pre and 1.36 mSv post modulation (p = 0.41). Transplant recipients had an annual CED of 64 ± 36.1mSv. ConclusionChest CT utilisation for PWCF is rising in our institution, replacing chest radiography amidst CFTR-modulation. Despite the increasing use of CT, no significant radiation dose penalty was observed with a reduction in mean annual CED, primarily due to the influence of CT dose reduction strategies.

Are We Overradiating Patients with Irritable Bowel Syndrome?

Introduction: Protracted exposures to small doses of radiation, even cumulative effective doses (CED) as low as 50–100 mSv, may increase the risk for malignancy. Medical radiation exposure has not been rigorously examined for patients with irritable bowel syndrome (IBS). We examined medical radiation exposure in patients with IBS at a tertiary care center in the USA. Methods: Patients diagnosed with IBS at our institute from 2009 to 2018 were included in a retrospective cohort study. Medical charts were examined to calculate total and annual CED. Results: 221 patients were included; mean CED was 40.32 mSv (SD: 54.36). Fifty-nine participants (26.7%) received >50 mSv of CED with 27 participants (12.2%) exceeding 100 mSv. Conventional imaging, nuclear medicine, and fluoroscopy accounted for 74.08, 12.93, and 12.98% of total CED, respectively. CT scans contributed to 66.61% of total CED. Outpatient orders accounted for 37.96% of total CED, while 31.4% of total CED was ordered in the emergency department. Population-specific high total CED was calculated as 105.65 mSv. Multivariable binomial logistic regression model found that comorbid anxiety, chronic pain medication use, and diarrhea-predominant IBS were independently positively associated with population-specific high CED exposure. No significant temporal trend in peri-diagnostic mean CED was found. Conclusion: Patients with IBS receive high amounts of medical radiation, with 1 in 4 patients reaching at-risk levels of 50 mSv or more. Usage of pain medication at home, comorbid anxiety, and IBS-D are independently linked to an increased risk of high CED.

Cumulative effective dose caused by diagnostic imaging and its associated risk for cancer development in trauma patients referred to the emergency department

Background: The current study aimed to determine the cumulative effective dose caused by diagnostic imaging and its associated risk for cancer development in trauma patients referred to an emergency department. Methods: This study was carried out retrospectively in an emergency department (Kashan, Iran) from April 2015 to October 2015. Then, the types of diagnostic radiologic studies performed on adult trauma patients in their first 24 h upon presentation were recorded. Finally, the cumulative effective dose of trauma patients and its associated risk for cancer development were obtained. Results: In total, the patients received 3323 radiologic examinations including 2169 radiographs and 1154 computed tomography (CT)-scans. The most common type of plain radiographic and CT-scan examinations included anterior posterior and posterior anterior chest as well as head, respectively. The mean cumulative effective dose received by trauma patients referred to the emergency department was 2.47 ± 4.29 mSv. Most of the effective dose was from CT-scan examinations (90.65% of total cumulative effective dose; 2181.91 mSv). The majority of patients (83.40%) received between 0.00 and 5.00 mSv cumulative effective dose. Moreover, the cancer risk per average cumulative effective dose received by trauma patients was 1.01 × 10−4. Conclusions: In current study, the mean cumulative effective dose per each trauma patient (2.47 mSv) was relatively less than that of the other evaluated studies. It was also found that although the number of CT-scans was relatively few compared to plain radiographs, most of the cumulative effective dose of patients resulted from CT-scans; hence, using unnecessary CT-scan examinations should be avoided.

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

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

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

ObjectivesTo calculate each patient’s cumulative radiation exposure and the recurrent tests during a 12-year study period, according to sex and age, in routine practice.DesignRetrospective cohort study.SettingA general hospital with a...

Ionizing diagnostic radiation exposure in patients with Crohn's disease: A retrospective study in a medium hospital and its predictive factors

Abstract Introduction It is estimated that diagnostic medical radiation exposure may be responsible for 0.5–2% of cancers worldwide. Because of the relapsing course of Crohn's disease (CD), these patients usually require multiple ionising radiation test. Objective Stimulating the total cumulative effective dose received by our CD patients and identifying the risk factors associated with the exposure to a cumulative effective dose due to the disease (CEED) ≥50 mSv. Materials and methods Retrospective cohort study (2001–2014). Population: patients with CD. Risk dose ≥50 mSv. For calculating de cumulative effective dose and the CEED, all the ionising test done were taken. For identifying predictive factors for receiving a CEDD ≥50 mSv, an univariate and a multivariate logistic regression analyses were performed using a ≥50 mSv dose as dependent variable. Results Of the 267 patients analysed the 24.6% of them received a cumulative effective dose ≥50 mSv and the 15.2% a CEED ≥50 mSv. In the multivariate analysis, the following variables were identified as independent predictors associated with a CEDD ≥50 mSv: major surgery (OR = 2.1; IC95% [1.1–3.8]; p = 0.019) and severity (OR = 20.6; IC95% [4.5–94.8]; p Conclusions Patients with CD are more at risk of receiving risk CEED, so it would be advisable to monitor the cumulative effective dose received to anticipate our intervention in order to avoid reaching that dose. The ultrasounds and abdominal resonance enterography are alternatives in these cases, although their accessibility is limited in some centres.

Variability in Imaging Practices and Comparative Cumulative Effective Dose for Neuroblastoma and Nephroblastoma Patients at 6 Pediatric Oncology Centers.

The purpose of this study was to estimate the cumulative effective dose (CED) from diagnosis and posttherapy computed tomographic (CT) scans performed on children treated for neuroblastoma or nephroblastoma (Wilms tumor) and to examine the different imaging practices used in 6 regional pediatric oncology centers between January 2010 and December 2013. We analyzed retrospectively the CT scan acquisition data in children aged 10 years or younger at diagnosis. The use of nonionizing imaging modalities was reported. The CT examinations of 129 children, with a mean age at diagnosis of 36 months, treated for 66 neuroblastomas and 63 nephroblastomas, were analyzed. The mean follow-up period was 28 months (minimum, 8 months, maximum, 41 mo). There were 600 CT scans, with a total of 1039 acquisitions. The mean CED from CT scans was 27 mSv (minimum=18.25, maximum=45). Abdominal CT examinations contributed 85% of the total CED. A median of 4.6 CT scans, 10.3 sonograms, and 0.4 magnetic resonance imaging examinations per child were performed. Our results suggest a reduction in radiation exposure but variability in the imaging modality choice and acquisition protocols. We emphasize the need for consensus and standardization in oncologic pediatric imaging procedures. When feasible, we encourage the substitution of nonionizing examinations for CT.

Exposición a radiación diagnóstica en pacientes con enfermedad de Crohn: estudio retrospectivo en un hospital medio y sus factores predictivos

IntroductionIt is estimated that diagnostic medical radiation exposure may be responsable for 0.5-2% of cancers worldwide. Because of the relapsing course of Crohn's disease (CD), these patients usually requiere multiple ionizing radiation test. ObjectiveStimating the total cumulative effective dose received by our CD patients and identifying the risk factors associated with the exposure to a cumulative effective dose due to the disease (CEED) > 50mSv. Materials and methodsRetrospective cohort study (2001-2014). Population: patients with CD. Risk dose >50mSv. For calculating de cumulative effective dose and the CEED, all the ionizing test done were taken. For identifying predictive factors for receiving a CEDD >50mSv, an univariate and a multivariate logistic regression analyses were performed using a >50mSv dose as dependent variable. ResultsOf the 267 patients analyzed the 24.6% of them received a cumulative effective dose > 50mSv and the 15.2% a CEED>50mSv. In the multivariate analysis, the following variables were identified as independent predictors associated with a CEDD >50mSv: major surgery (OR= 2.1; IC95% [1.1-3.8]; p=.019) and severity (OR= 20.6; IC95% [4.5-94.8]; p<.01). ConclusionsPatients with CD are more at risk of receiving risk CEED, so it would be advisable to monitor the cumulative effective dose received to anticipate our intervention in order to avoid reaching that dose. The ultrasounds and abdominal resonance enterography are alternatives in these cases, although their accessibility is limited in some centers.

Radiation Exposure in Patients with Inflammatory Bowel Disease: a Fourteen-Year Review at a Tertiary Care Centre in Malaysia

Background and Aims:Patients with inflammatory bowel disease (IBD) are subjected to a large amount of ionizing radiation during the course of their illness. This may increase their risk of malignancy to a greater level than that due to the disease itself. In Caucasian patients with Crohn’s disease, this has been well documented and recommendations are in place to avoid high radiation imaging protocols. However, there are limited data available on radiation exposure in Asian IBD patients. We therefore sought to identify total radiation exposure and any differences between ethnically diverse ulcerative colitis (UC) and Crohn’s disease (CD) patients at our centre along with determining factors that may contribute to any variation.Methods:The cumulative effective dose (CED) was calculated retrospectively from 2000 to 2014 using data from our online radiology database and patients’ medical records. Total CED in the IBD population was measured. High exposure was defined as a radiation dose of greater than 0.2mSv (equivalent to slightly less than ½ a year of background radiation).Results:A total of 112 cases of IBD (36 CD and 76 UC) were reviewed. Our CD patients were diagnosed at an earlier age than our UC cases (mean age 26.1 vs 45.7). The total CED in our IBD population was 8.53 (95% CI: 4.53-12.52). Patients with CD were exposed to significantly higher radiation compared to those with UC. The mean CED was 18.6 (7.30-29.87) and 3.65 (1.74-5.56, p=0.01) for CD and UC patients respectively. 2 patients were diagnosed as having a malignancy during follow up with respective CED values of 1.76mSv and 10mSv.Conclusions:CD patients, particularly those with complicated disease, received a higher frequency of diagnostic imaging over a shorter period when compared to UC patients. Usage of low radiation imaging protocols should be encouraged in IBD patients to reduce their risk of consequent malignancy.

Radiation exposure from medical imaging in dialyzed patients undergoing renal pre-transplant evaluation.

Ionizing radiation exposure from medical procedures is rising sharply-the per-capita annual effective dose in the US is 3.0 millisieverts (mSv). Hemodialyzed and kidney transplanted patients receive still higher doses of ionizing radiation due to the presence of multiple comorbidities. The aim of this study was to assess the cumulative effective dose (CED) among dialyzed patients undergoing renal pre-transplant evaluation. We evaluated 70 hemodialysis patients between June 2009 and December 2014, aged 46.4±12.0years. The number and type of radiologic procedures were collected through the Radiology Information System. CED was expressed as total mSv/patient and annual CED (mSv/patient/year). A total of 744 radiologic procedures were performed, accounting for 3869mSv of ionizing radiation: conventional radiology, computed tomography and nuclear medicine accounted for 78, 14 and 8% of the procedures, but they represented, respectively, 8, 83 and 9% of the total CED. The mean (median) annual CED was 35 (7) mSv/patient/year, while total CED was 72 (32) mSv/patient. Thirty-seven patients were active waitlisted and received 47 (10) mSv during the pre-transplant evaluation and 36 (5) mSv during the waiting phase to maintain active status. Concerning cancer risk, 4 (7%) patients were classified at low risk (<3mSv/year), 19 (35%) at moderate risk (3 to <20mSv/year), 8 (15%) at high risk (20 to <50mSv/year), and 23 (43%) at very high risk (≥50mSv/year). Our study demonstrated that during renal pre-transplant evaluation, dialyzed patients receive a high dose of ionizing radiation. Considering that transplanted individuals have a high incidence of cancer due to multifactorial etiology, it is mandatory to reduce the ionizing radiation imaging.

Ionizing radiation exposure as a result of diagnostic imaging in patients with lymphoma

Survival rates among patients with lymphoma continue to improve. Strategies aimed at reducing potential treatment-related toxicity are increasingly prioritized. While radiological procedures play an important role, ionizing radiation exposure has been linked to an increased risk of malignancy, particularly among individuals whose cumulative radiation exposure exceeds a specific threshold (75 millisieverts). Within this retrospective study, the cumulative radiation exposure dose was quantified for 486 consecutive patients with lymphoma. The median estimated total cumulative effective dose (CED) of ionizing radiation per subject was 69 mSv (42-118). However, younger patients (under 40 years) had a median CED of 89 mSv (55-124). This study highlights the considerable radiation exposure occurring among patients with lymphoma as a result of diagnostic imaging. To limit the risk of secondary carcinogenesis, consideration should be given to monitoring cumulative radiation exposure in individual patients as well as considering imaging modalities, which do not impart an ionizing radiation dose.

Cumulative radiation dose and radiation risk from medical imaging in patients subjected to endovascular aortic aneurysm repair.

This study was undertaken to quantify the cumulative effective dose (CED) of radiation and the dose to relevant organs in endovascular aortic repair (EVAR) patients, to assess radiation risks and to evaluate the clinical usefulness of multi-detector computed tomography (MDCT) follow-up. The radiation exposures were obtained from 71 consecutive EVAR patients with a follow-up duration ≥1year. Dose calculations were performed on an individual basis and expressed as effective doses and organ doses. Radiation risk was expressed as risk of exposure-induced death (%), using the biological effects of ionising radiation model. Two radiologists independently assessed the images for abdominal aortic aneurysm expansion without endoleaks, thrombotic occlusion, endoleaks and device migration. They first reviewed arterial imaging alone and subsequently added non-contrast and delayed phases to determine the overall performance. The median total CED and annual CED were 224 and 104mSv per patient-year. The median cumulative organ doses were 191, 205, 230, 269 and 271mSv for lung, bone marrow, liver, colon and stomach, respectively. The average risk of exposure-induced death was 0.8% (i.e., odds 1 in 130). All the findings related to EVAR outcome and leading to a change in patient management were visible during the arterial phase of the MDCT angiography. Omission of the unenhanced scan and the venous phase of the MDCT angiography would have led to a significant reduction of about 60% of the associated MDCT radiation exposure in a single patient. EVAR patients received high radiation doses and the excess cancer risk attributable to radiation exposure is not negligible. The unenhanced scan and the venous phase of the MDCT angiography could have been omitted without compromising the utility of the examination and with a significant reduction of doses and associated risks.

Temporal trends in imaging and associated radiation exposure in inflammatory bowel disease

Increasing use of diagnostic imaging in inflammatory bowel disease (IBD) has led to concerns about the malignant potential of ionising radiation in a cohort that have an increased lifetime risk of gastrointestinal malignancy. The aim was to quantify radiation exposure in IBD patients referred from primary care, determine predictors of high exposure and evaluate temporal trends in diagnostic imaging over a 20-year period. This was a retrospective cohort study whereby IBD patients were recruited from the outpatient clinic and evaluated retrospectively. The total cumulative effective dose (CED) received from tests was calculated for each subject. Cox regression was performed to assess factors associated with potentially harmful levels of ionising radiation defined as total CED > 50 milli-sieverts (mSv; equivalent to five CT abdomen scans). The cohort included 415 patients. Median total CED was 7.2 mSv (IQR: 3.0-22.7) in Crohn's disease and 2.8 mSv (IQR: 0.8-8.9) in ulcerative colitis patients, respectively. A total of 32 patients (8%) received a CED > 50 mSv. A history of IBD-related surgery was associated with high exposure (HR 7.7). During the study period, usage of abdominal CT increased by 310%. Approximately 1 in 13 patients in the study cohort were exposed to potentially harmful levels of ionising radiation. Strategies to minimise exposure to diagnostic medical radiation in IBD patients are required.

Cumulative Radiation Dose in Patients With Hereditary Hemorrhagic Telangiectasia and Pulmonary Arteriovenous Malformations

PurposeTo determine the cumulative effective dose (CED) of radiation from medical imaging and intervention in patients with hereditary hemorrhagic telangiectasia (HHT) who have pulmonary arteriovenous malformations and to identify clinical factors associated with exposure to high levels of radiation. MethodsAll patients with at least 1 pulmonary arteriovenous malformation were identified from the dedicated patient database of a tertiary HHT referral centre. Computerized imaging and electronic patient records were systematically examined to identify all imaging studies performed from 1989-2010. The effective dose was determined for each study, and CED was calculated retrospectively. ResultsAmong 246 patients (mean age, 53 years; 62.2% women) with a total of 2065 patient-years, 3309 procedures that involved ionizing radiation were performed. CED ranged from 0.2-307.6 mSv, with a mean of 51.7 mSv. CED exceeded 100 mSv in 26 patients (11%). Interventional procedures and computed tomography (CT) were the greatest contributors, which accounted for 51% and 46% of the total CED, respectively. Factors associated with high cumulative exposure were epistaxis (odds ratio 2.7 [95% confidence interval, 1.1-6.3]; P = .02), HHT-related gastrointestinal bleeding (odds ratio 2.0 [95% confidence interval, 1.0-3.8]; P = .04) and number of patient-years (P < .0001). ConclusionsPatients with HHT are exposed to a significant cumulative radiation dose from diagnostic and therapeutic interventions. Identifiable subsets of patients are at increased risk. A proportion of patients receive doses at levels that are associated with harm. Imaging indications and doses should be optimized to reduce radiation exposure in this population.

Diagnostic radiation exposure in children with spinal dysraphism: an estimation of the cumulative effective dose in a cohort of 135 children from The Netherlands

ObjectiveBased on the assumption that children with spinal dysraphism are exposed to a large amount of ionising radiation for diagnostic purposes, our objective was to estimate this exposure, expressed in...

PWE-199 Diagnostic Radiation Exposure in Patients with Crohn’S Disease Treated with Infliximab

IntroductionExposure to radiation from diagnostic imaging is thought to be associated with an increase in cancer risk. Patients with Crohn’s Disease (CD) frequently require x-ray exposure throughout the course of...

Cumulative Radiation Exposures during Diagnosis and Treatments with Diagnostic Radiology Tools: In Patient with Hepatocellular Carcinoma

This paper was supported by a research grant from the General Electric Healthcare, 2010. Purpose: To evaluate the cumulative radiation dose for diagnosis and treatment with diagnostic radiology tools for patients with hepatocellular carcinoma. Materials and Methods: Cumulative radiation dose of 98 patients with hepatocellular carcinoma were examined by diagnostic CT, CT for follow-up, once or repeated transarterial chemoembolization (TACE), and X-ray examinations. Thus, we calculated the total cumulative effective doses per patient. Results: The mean follow-up periods were 85 (51-102) weeks. A total of 565 CT scans, 262 TACEs, and 1679 X-ray examinations were enrolled. Cumulative effective dose values per person of 91.4 ± 50.6 (8.4-244.7) mSv, 49.2 ± 44.7 (5.3-247.6) mSv, and 3.6 ± 4.7 (0.02-22.04) mSv were measured for CT, TACE, and X-ray examinations. Total cumulative effective dose values per person were measured as 144.2 ± 87.4 (15.4-513.5) mSv. Conclusion: The patient who underwent TACE are exposed to pretty high dose radiations, thus, significant efforts to reduce the radiation dose are necessary.

Radiologic Imaging in Cystic Fibrosis: Cumulative Effective Dose and Changing Trends Over 2 Decades

With the increasing life expectancy for patients with cystic fibrosis (CF), and a known predisposition to certain cancers, cumulative radiation exposure from radiologic imaging is of increasing significance. This study explores the estimated cumulative effective radiation dose over a 17-year period from radiologic procedures and changing trends of imaging modalities over this period. Estimated cumulative effective dose (CED) from all thoracic and extrathoracic imaging modalities and interventional radiology procedures for both adult and pediatric patients with CF, exclusively attending a nationally designated CF center between 1992-2009 for > 1 year, was determined. The study period was divided into three equal tertiles, and estimated CED attributable to all radiologic procedures was estimated for each tertile. Two hundred thirty patients met inclusion criteria (2,240 person-years of follow-up; 5,596 radiologic procedures). CED was > 75 mSv for one patient (0.43%), 36 patients (15.6%) had a CED between 20 and 75 mSv, 56 patients (24.3%) had a CED between 5 and 20 mSv, and in 138 patients (60%) the CED was estimated to be between 0 and 5 mSv over the study period. The mean annual CED per patient increased consecutively from 0.39 mSv/y to 0.47 mSv/y to 1.67 mSv/y over the tertiles one to three of the study period, respectively (P < .001). Thoracic imaging accounted for 46.9% of the total CED and abdominopelvic imaging accounted for 42.9% of the CED, respectively. There was an associated 5.9-fold increase in the use of all CT scanning per patient (P < .001). This study highlights the increasing exposure to ionizing radiation to patients with CF as a result of diagnostic imaging, primarily attributable to CT scanning. Increased awareness of CED and strategies to reduce this exposure are needed.

PWE-252 Trends in imaging and impact of diagnostic medical radiation in inflammatory bowel disease

IntroductionIncreasing use of diagnostic imaging in inflammatory bowel disease has led to concerns about the malignant potential of ionising radiation in a cohort that is already predisposed to malignancy. The...

Cumulative radiation dose from medical imaging in kidney transplant patients

Although many patients undergoing kidney transplant are exposed to multiple examinations that increase cumulative effective doses (CEDs) of ionizing radiation, no data are available characterizing their total longitudinal radiation burden and relating radiation burden with risk factors for more exposure. We did a retrospective cohort study of 92 patients (mean age 52 years; range: 20-75 years) who underwent kidney transplant at University Hospital, Novara, Italy, that evaluated all following medical imaging procedures involving ionizing radiation undergone beginning June 2007, and all subsequent procedures through August 2011, at the centre. The mean and median annual CED were 17.2 and 4.9 millisieverts (mSv) per patient-year. The mean and median total CED per patient over the study period were 46.1 and 17.3 mSv, respectively. Twenty-eight and 12% of patients had total CED >50 and 100 mSv, values which are associated with a good or strong evidence of an increased cancer mortality risk, respectively. Computed tomography scanning accounted for 73% of the total CED. The annual CED was significantly higher in incident patients and in patients with ischaemic heart disease and cancer. In this institution, multiple testing of kidney transplant patients was common in many patients associated with high cumulative estimated doses of ionizing radiation.