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Cumulative Radiation Exposure and Cancer Risk Estimates in Emergency Department Patients Undergoing Repeat or Multiple CT

¹ Division of Emergency Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
² Department of Radiology, Division of Emergency Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA 02115.

OBJECTIVE. The purpose of our study was to define a conservative estimate of the number of patients undergoing repeat or multiple emergency department CT studies and to quantify their cumulative CT radiation doses and lifetime attributable risk of developing cancer.

MATERIALS AND METHODS. We identified all patients at a tertiary care adult academic medical center with at least three emergency department visits within a 1-year period that included CT of the neck, chest, abdomen, or pelvis. For this cohort, we identified all diagnostic CT studies over the previous 7.7 years. We calculated cumulative radiation doses by summing typical effective doses of the anatomic regions scanned, and we calculated lifetime attributable risk using the population-averaged dose-to-risk conversion factor of one cancer per 1,000 patients receiving a 10-mSv dose, in accordance with the seventh Biologic Effects of Ionizing Radiation (BEIR VII) report.

RESULTS. One hundred thirty emergency department patients met the inclusion criteria. Over the 7.7-year period, median, mean, and maximum values for the study count were 10, 13, and 70 with cumulative CT doses of 91, 122, and 579 mSv and lifetime attributable risk of one in 110, one in 82, and one in 17, respectively. Emergency department studies comprised 55% of those captured. Repeat imaging of the same study type represented at least half of the imaging for 72% of the cohort and all of the imaging for 12%.

CONCLUSION. A small proportion (1.9%) of emergency department patients undergoing CT of the neck, chest, abdomen, or pelvis have high cumulative rates of multiple or repeat imaging. Collectively, this patient subgroup may have a heightened risk of developing cancer from cumulative CT radiation exposure.

Keywords: CT radiation exposure • emergency department • radiation risks • repeat imaging

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