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Original Research: Critical Care |

Cumulative Total Effective Whole-Body Radiation Dose in Critically Ill PatientsRadiation Dose in Critically Ill Patients

Deborah J. Rohner, MD; Suzanne Bennett, MD; Chandrasiri Samaratunga, PhD; Elizabeth S. Jewell, MS; Jeffrey P. Smith, MS; Mary Gaskill-Shipley, MD; Steven J. Lisco, MD, FCCP
Author and Funding Information

From the Department of Anesthesiology (Dr Rohner), University of Kentucky, Lexington, KY; Department of Anesthesiology (Dr Bennett) and Department of Radiology (Drs Samaratunga and Gaskill-Shipley and Mr Smith), University of Cincinnati, Cincinnati, OH; Department of Anesthesiology (Ms Jewell), University of Michigan, Ann Arbor, MI; and the Department of Anesthesiology (Dr Lisco), University of Nebraska Medical Center, Omaha, NE.

Correspondence to: Deborah J. Rohner, MD, Department of Anesthesiology, University of Kentucky, 800 Rose St, N263, Lexington, KY 40536; e-mail: Deborah.rohner@uky.edu


For editorial comment see page 1431

Part of this article was presented in abstract form at CHEST 2011, October 22-26, 2011, in Honolulu, HI.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1481-1486. doi:10.1378/chest.12-2222
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Background:  Uncertainty exists about a safe dose limit to minimize radiation-induced cancer. Maximum occupational exposure is 20 mSv/y averaged over 5 years with no more than 50 mSv in any single year. Radiation exposure to the general population is less, but the average dose in the United States has doubled in the past 30 years, largely from medical radiation exposure. We hypothesized that patients in a mixed-use surgical ICU (SICU) approach or exceed this limit and that trauma patients were more likely to exceed 50 mSv because of frequent diagnostic imaging.

Methods:  Patients admitted into 15 predesignated SICU beds in a level I trauma center during a 30-day consecutive period were prospectively observed. Effective dose was determined using Huda’s method for all radiography, CT imaging, and fluoroscopic examinations. Univariate and multivariable linear regressions were used to analyze the relationships between observed values and outcomes.

Results:  Five of 74 patients (6.8%) exceeded exposures of 50 mSv. Univariate analysis showed trauma designation, length of stay, number of CT scans, fluoroscopy minutes, and number of general radiographs were all associated with increased doses, leading to exceeding occupational exposure limits. In a multivariable analysis, only the number of CT scans and fluoroscopy minutes remained significantly associated with increased whole-body radiation dose.

Conclusions:  Radiation levels frequently exceeded occupational exposure standards. CT imaging contributed the most exposure. Health-care providers must practice efficient stewardship of radiologic imaging in all critically ill and injured patients. Diagnostic benefit must always be weighed against the risk of cumulative radiation dose.


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