PURPOSE: Evaluate the cumulative effective whole body radiation dose (WBRD) in critically-ill surgical intensive care unit (SICU) patients. A method was developed to both track and report WBRD.
METHODS: Following IRB approval, patients admitted into 15 predesignated SICU beds in a level 1 trauma center during a 30 day consecutive period were prospectively observed. Calculations of effective dose were determined using Huda’s method for all X-ray, CT, and fluoroscopic examinations. Radiographic equipment was tested for standard output. Data was analyzed with SAS 9.2 using the REG procedure. A multi-variable linear regression analysis was performed using forward and backward analysis.
RESULTS: Data from 74 patients was analyzed. Mean length of stay was 7.4 days (1-56 days). 36.5% were trauma patients. The remainder were non-trauma surgical patients. Mean WBRD was 16.82mSv (0-120.23mSv). 6.76% of patients received >50mSv. CT contributed 79.5% of the populations' dose but accounted for only 20.1% of imaging studies. Number of CT studies (p<0.0001) and number of non-CT radiographic studies (p=0.0016) were predictive of WBRD. SICU admission to the trauma service was predictive of elevated WBRD (p=0.006). SICU length of stay was not predictive of elevated WBRD (p=0.257).
CONCLUSIONS: Medical radiation exposure and overutilization is an important healthcare quality issue as increasing dosage increases lifetime cancer risk. The BEIR VII report estimates a population of individuals exposed to 100 mSv has a 1% increased cancer risk. Fifty mSv is the highest US EPA annual occupational exposure dose allowed, and nearly 7% of the patients studied exceeded this dose. One patient received > 100mSv during their SICU stay. This study did not analyze appropriateness of each study performed however it highlights the need for healthcare workers to monitor the number and type of radiologic procedure performed on their critically-ill patients as EPA standards are frequently exceeded.
CLINICAL IMPLICATIONS: Healthcare providers must employ efficient stewardship of radiologic imaging in the critically-ill and injured patients so as to not exceed the maximum allowable EPA annual WBRD during routine SICU admissions.
DISCLOSURE: The following authors have nothing to disclose: Deborah Rohner, Suzanne Bennett, Ranasinghage Samaratunga, Jeffrey Smith, Mary Gaskill-Shipley, Steven Lisco
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