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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.

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

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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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