Are ICU Patients Overexposed to Radiation? via MedPage Today

Clinicians “trigger happy” when it comes to CT scans in the ICU, investigator says

by Salynn Boyles

NEW ORLEANS — A week in the intensive care unit (ICU) can expose critically ill patients to radiation levels that exceed yearly or even 5-year cumulative limits set by federal officials for occupational exposure, a researcher reported here.

In a retrospective observational review of data on 21,108 patients treated at an academic medical center ICU over a 5-year period, 4% of patients received cumulative effective doses (CED) of radiation ≥50 mSv, which is the yearly limit set by the Occupational Safety and Health Administration (OSHA), according to Sudhir Krishnan, MD, of the Cleveland Clinic in Ohio.

The 5-year cumulative limit of 100 mSv was met or exceeded by 1% of patients, even though the average length of stay in the ICU was around 5 days, he reported at CHEST 2019, the annual meeting of the American College of Chest Physicians.


He said much of the radiation exposure among patients in ICUs comes from CT scans.


The median radiation dose among the patients included in the analysis was 0.72 mSv (IQR 0.02-4.08 mSv) over a 5-year period. Higher APACHE 3 scores (P<0.001), hepatic failure (P=0.03), and gastrointestinal (GI) disorders were all predictive of higher CED in multiple linear regression modeling.

The odds of receiving a radiation dose of ≥50 mSv was highest in patients with GI bleeding (OR 8.90, 95% CI 6.84-11.59), followed by GI disorders (OR 2.60, 95% CI 2.17-4.04) and hematological disorders (OR 3.58, 95% CI 2.69-4.78).

Krishnan said while the radiation exposures may not be a cause for concern in older, sicker patients, younger patients who survive the ICU may have a greatly elevated risk for cancer from repeated imaging performed during their stay.

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