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Published in: European Journal of Trauma and Emergency Surgery 1/2018

01-02-2018 | Original Article

Cumulative radiation exposure and estimated lifetime cancer risk in multiple-injury adult patients undergoing repeated or multiple CTs

Authors: S. Kritsaneepaiboon, A. Jutiyon, A. Krisanachinda

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2018

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Abstract

Purpose

To estimate the cumulative radiation exposure and lifetime attributable risk (LAR) of radiation-induced cancer from computed tomographic (CT) scanning of adult patients with multiple-injury traumas.

Methods

The study comprises 328 multiple-injury adult patients who underwent diagnostic CT during 2013. Each patient’s cumulative CT radiation exposure was calculated and the biological effects of ionizing radiation VII methodology was used to estimate the LAR of cancer incidence on the basis of sex and age at each exposure.

Results

The average cumulative dose per patient was 19.4 mSv. One point five percent (5/328) of the patients received a cumulative effective dose ≥100 mSv and 63.7 % of patients received a cumulative effective dose ≤20 mSv. The average LAR of cancer incidence was 0.14 % or 1 in 714 patients. Only one patient had an LAR >1 %, a man <30 years of age. The group of major injuries [injury severity score (ISS) >15] had a statistically significantly greater accumulative effective dose and slightly greater LAR than the group of minor injuries (ISS ≤15).

Conclusions

More than half of the multiple-injury trauma patients were classified as low risk cumulative effective dose (≤20 mSv) and almost all patients had a low LAR risk of cancer incidence from CT studies. Patients who were at the highest risk of cancer from CT scans were those aged under 30 years who had multiple or repeated scans, particularly in the trunk.
Literature
1.
go back to reference Smith-Bindman R, Lipson J, Marcus R, Kim K-P, Mahesh M, Gould R, Berrington de González A, Miglioretti DL. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–86.CrossRefPubMedPubMedCentral Smith-Bindman R, Lipson J, Marcus R, Kim K-P, Mahesh M, Gould R, Berrington de González A, Miglioretti DL. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–86.CrossRefPubMedPubMedCentral
2.
go back to reference Laack TA, Thompson KM, Kofler JM, Bellolio MF, Sawyer MD, Laack NN. Comparison of trauma mortality and estimated cancer mortality from computed tomography during initial evaluation of intermediate-risk trauma patients. J Trauma. 2011;70:1362–5.CrossRefPubMed Laack TA, Thompson KM, Kofler JM, Bellolio MF, Sawyer MD, Laack NN. Comparison of trauma mortality and estimated cancer mortality from computed tomography during initial evaluation of intermediate-risk trauma patients. J Trauma. 2011;70:1362–5.CrossRefPubMed
3.
go back to reference Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.CrossRefPubMed Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.CrossRefPubMed
4.
go back to reference Linton OW, Mettler FA Jr, National Council on Radiation Protection and Measurements. National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol. 2003;181:321–9.CrossRefPubMed Linton OW, Mettler FA Jr, National Council on Radiation Protection and Measurements. National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol. 2003;181:321–9.CrossRefPubMed
5.
go back to reference Griffey RT, Sodickson A. Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol. 2009;192:887–92.CrossRefPubMed Griffey RT, Sodickson A. Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol. 2009;192:887–92.CrossRefPubMed
7.
go back to reference Tien HC, Tremblay LN, Rizoli SB, Gelberg J, Spencer F, Caldwell C, Brenneman FD. Radiation exposure from diagnostic imaging in severely injured trauma patients. J Trauma. 2007;62:151–6.CrossRefPubMed Tien HC, Tremblay LN, Rizoli SB, Gelberg J, Spencer F, Caldwell C, Brenneman FD. Radiation exposure from diagnostic imaging in severely injured trauma patients. J Trauma. 2007;62:151–6.CrossRefPubMed
8.
go back to reference Shrimpton PC, Hillier MC, Lewis MA, Dunn M. National survey of doses from CT in the UK: 2003. Br J Radiol. 2006;79:968–80.CrossRefPubMed Shrimpton PC, Hillier MC, Lewis MA, Dunn M. National survey of doses from CT in the UK: 2003. Br J Radiol. 2006;79:968–80.CrossRefPubMed
9.
go back to reference Thomas KE, Wang B. Age-specific effective doses for pediatric MSCT examinations at a large children’s hospital using DLP conversion coefficients: a simple estimation method. Pediatr Radiol. 2008;38:645–56.CrossRefPubMed Thomas KE, Wang B. Age-specific effective doses for pediatric MSCT examinations at a large children’s hospital using DLP conversion coefficients: a simple estimation method. Pediatr Radiol. 2008;38:645–56.CrossRefPubMed
10.
go back to reference Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A. Dose optimization and reduction if musculoskeletal CT including the spine. In: Tack D, Kalra MK, Gevenois PA, editors. Radiation dose from multidetector CT. 2nd ed. Heidelberg: Springer; 2012. p. 369–88.CrossRef Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A. Dose optimization and reduction if musculoskeletal CT including the spine. In: Tack D, Kalra MK, Gevenois PA, editors. Radiation dose from multidetector CT. 2nd ed. Heidelberg: Springer; 2012. p. 369–88.CrossRef
11.
go back to reference Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Jt Surg Am. 2009;91:1882–9.CrossRef Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Jt Surg Am. 2009;91:1882–9.CrossRef
12.
go back to reference Asha S, Curtis KA, Grant N, Taylor C, Lo S, Smart R, Compagnoni K. Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol. Emerg Med Australas. 2012;24:43–51.CrossRefPubMed Asha S, Curtis KA, Grant N, Taylor C, Lo S, Smart R, Compagnoni K. Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol. Emerg Med Australas. 2012;24:43–51.CrossRefPubMed
14.
go back to reference Salibi PN, Agarwal V, Panczykowski DM, Puccio AM, Sheetz MA, Okonkwo DO. Lifetime attributable risk of cancer from CT among patients surviving severe traumatic brain injury. AJR Am J Roentgenol. 2014;202:397–400.CrossRefPubMed Salibi PN, Agarwal V, Panczykowski DM, Puccio AM, Sheetz MA, Okonkwo DO. Lifetime attributable risk of cancer from CT among patients surviving severe traumatic brain injury. AJR Am J Roentgenol. 2014;202:397–400.CrossRefPubMed
15.
go back to reference Wen JC, Sai V, Straatsma BR, McCannel TA. Radiation-related cancer risk associated with surveillance imaging for metastasis from choroidal melanoma. JAMA Ophthalmol. 2013;131:56–61.CrossRefPubMed Wen JC, Sai V, Straatsma BR, McCannel TA. Radiation-related cancer risk associated with surveillance imaging for metastasis from choroidal melanoma. JAMA Ophthalmol. 2013;131:56–61.CrossRefPubMed
16.
go back to reference Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMed Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMed
17.
go back to reference Linn S. Sorting variables for each case: a new algorithm to calculate injury severity score (ISS) using SPSS-PC. Stat Med. 1996;15:933–7.CrossRefPubMed Linn S. Sorting variables for each case: a new algorithm to calculate injury severity score (ISS) using SPSS-PC. Stat Med. 1996;15:933–7.CrossRefPubMed
18.
19.
go back to reference Palmer C. Major trauma and the injury severity score—where should we set the bar? Annu Proc Assoc Adv Automot Med. 2007;51:13–29.PubMedPubMedCentral Palmer C. Major trauma and the injury severity score—where should we set the bar? Annu Proc Assoc Adv Automot Med. 2007;51:13–29.PubMedPubMedCentral
21.
go back to reference Klingenbeck-Regn K, Schaller S, Flohr T, Ohnesorge B, Kopp AF, Baum U. Subsecond multi-slice computed tomography: basics and applications. Eur J Radiol. 1999;31:110–24.CrossRefPubMed Klingenbeck-Regn K, Schaller S, Flohr T, Ohnesorge B, Kopp AF, Baum U. Subsecond multi-slice computed tomography: basics and applications. Eur J Radiol. 1999;31:110–24.CrossRefPubMed
22.
go back to reference Deunk J, Brink M, Dekker HM, Kool DR, Blickman JG, van Vugt AB, Edwards MJ. Routine versus selective multidetector-row computed tomography (MDCT) in blunt trauma patients: level of agreement on the influence of additional findings on management. J Trauma. 2009;67:1080–6.CrossRefPubMed Deunk J, Brink M, Dekker HM, Kool DR, Blickman JG, van Vugt AB, Edwards MJ. Routine versus selective multidetector-row computed tomography (MDCT) in blunt trauma patients: level of agreement on the influence of additional findings on management. J Trauma. 2009;67:1080–6.CrossRefPubMed
23.
go back to reference Hui CM, MacGregor JH, Tien HC, Kortbeek JB. Radiation dose from initial trauma assessment and resuscitation: review of the literature. Can J Surg. 2009;52:147–52.PubMedPubMedCentral Hui CM, MacGregor JH, Tien HC, Kortbeek JB. Radiation dose from initial trauma assessment and resuscitation: review of the literature. Can J Surg. 2009;52:147–52.PubMedPubMedCentral
24.
go back to reference Wu D. Radiation exposure in trauma patients. J Lanc Gen Hosp. 2012;7. Wu D. Radiation exposure in trauma patients. J Lanc Gen Hosp. 2012;7.
25.
go back to reference Salottolo K, Bar-Or R, Fleishman M, Maruyama G, Slone DS, Mains CW, Bar-Or D. Current utilization and radiation dose from computed tomography in patients with trauma. Crit Care Med. 2009;37:1336–40.CrossRefPubMed Salottolo K, Bar-Or R, Fleishman M, Maruyama G, Slone DS, Mains CW, Bar-Or D. Current utilization and radiation dose from computed tomography in patients with trauma. Crit Care Med. 2009;37:1336–40.CrossRefPubMed
26.
go back to reference Kim PK, Zhu X, Houseknecht E, Nickolaus D, Mahboubi S, Nance ML. Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg. 2005;29:1557–62.CrossRefPubMed Kim PK, Zhu X, Houseknecht E, Nickolaus D, Mahboubi S, Nance ML. Effective radiation dose from radiologic studies in pediatric trauma patients. World J Surg. 2005;29:1557–62.CrossRefPubMed
27.
go back to reference Lemburg SP, Peters SA, Roggenland D, Nicolas V, Heyer CM. Cumulative effective dose associated with radiography and CT of adolescents with spinal injuries. AJR Am J Roentgenol. 2010;195:1411–7.CrossRefPubMed Lemburg SP, Peters SA, Roggenland D, Nicolas V, Heyer CM. Cumulative effective dose associated with radiography and CT of adolescents with spinal injuries. AJR Am J Roentgenol. 2010;195:1411–7.CrossRefPubMed
28.
go back to reference Winslow JE, Hinshaw JW, Hughes MJ, Williams RC, Bozeman WP. Quantitative assessment of diagnostic radiation doses in adult blunt trauma patients. Ann Emerg Med. 2008;52:93–7.CrossRefPubMed Winslow JE, Hinshaw JW, Hughes MJ, Williams RC, Bozeman WP. Quantitative assessment of diagnostic radiation doses in adult blunt trauma patients. Ann Emerg Med. 2008;52:93–7.CrossRefPubMed
30.
go back to reference Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R, Khorasani R. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology. 2009;251:175–84.CrossRefPubMed Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R, Khorasani R. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology. 2009;251:175–84.CrossRefPubMed
31.
go back to reference MacLeod J, Lynn M, McKenney MG, Jeroukhimov I, Cohn SM. Predictors of mortality in trauma patients. Am Surg. 2004;70:805–10.PubMed MacLeod J, Lynn M, McKenney MG, Jeroukhimov I, Cohn SM. Predictors of mortality in trauma patients. Am Surg. 2004;70:805–10.PubMed
32.
go back to reference Sogut O, Sayhan MB, Gokdemir MT, Boleken ME, Al B, Kose R, Ozgonul A, Kara HP. Analysis of hospital mortality and epidemiology in trauma patients: a multi-center study. J Curr Surg. 2011;1:19–24. Sogut O, Sayhan MB, Gokdemir MT, Boleken ME, Al B, Kose R, Ozgonul A, Kara HP. Analysis of hospital mortality and epidemiology in trauma patients: a multi-center study. J Curr Surg. 2011;1:19–24.
33.
34.
go back to reference Mettler FA, Thomadsen BR, Bhargavan M, Gilley DB, Gray JE, Lipoti JA, McCrohan J, Yoshizumi TT, Mahesh M. Medical radiation exposure in the U.S. in 2006: preliminary results. Health Phys. 2008;95:502–7.CrossRefPubMed Mettler FA, Thomadsen BR, Bhargavan M, Gilley DB, Gray JE, Lipoti JA, McCrohan J, Yoshizumi TT, Mahesh M. Medical radiation exposure in the U.S. in 2006: preliminary results. Health Phys. 2008;95:502–7.CrossRefPubMed
35.
go back to reference Martin CJ. Effective dose: how should it be applied to medical exposures? Br J Radiol. 2007;80:639–47.CrossRefPubMed Martin CJ. Effective dose: how should it be applied to medical exposures? Br J Radiol. 2007;80:639–47.CrossRefPubMed
Metadata
Title
Cumulative radiation exposure and estimated lifetime cancer risk in multiple-injury adult patients undergoing repeated or multiple CTs
Authors
S. Kritsaneepaiboon
A. Jutiyon
A. Krisanachinda
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2018
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-016-0665-6

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