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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 10/2010

01-10-2010 | 2010 SSAT Plenary Presentation

Radiation Dose from Computed Tomography in Patients with Necrotizing Pancreatitis: How Much Is Too Much?

Authors: Chad G. Ball, Camilo Correa-Gallego, Thomas J. Howard, Nicholas J. Zyromski, Michael G. House, Henry A. Pitt, Atilla Nakeeb, Christian M. Schmidt, Fatih Akisik, Keith D. Lillemoe

Published in: Journal of Gastrointestinal Surgery | Issue 10/2010

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Abstract

Objectives

Low-dose ionizing radiation from medical imaging has been indirectly linked with subsequent cancer. Computed tomography (CT) is the gold standard for defining pancreatic necrosis. The primary goal was to identify the frequency and effective radiation dose of CT imaging for patients with necrotizing pancreatitis.

Methods

All patients with necrotizing pancreatitis (2003–2007) were retrospectively analyzed for CT-related radiation exposure.

Results

Necrosis was identified in 18% (238/1290) of patients with acute pancreatitis (mean age = 53 years; hospital/ICU length of stay = 23/7 days; mortality = 9%). A median of five CTs/patient [interquartile range (IQR) = 4] were performed during a median 2.6-month interval. The average effective dose was 40 mSv per patient (equivalent to 2,000 chest X-rays; 13.2 years of background radiation; one out of 250 increased risk of fatal cancer). The actual effective dose was 63 mSv considering various scanner technologies. CTs were infrequently (20%) followed by direct intervention (199 interventional radiology, 118 operative, 12 endoscopic) (median = 1; IQR = 2). Magnetic resonance imaging did not have a CT-sparing effect. Mean direct hospital costs increased linearly with CT number (R = 0.7).

Conclusions

The effective radiation dose received by patients with necrotizing pancreatitis is significant. Management changes infrequently follow CT imaging. The ubiquitous use of CT in necrotizing pancreatitis raises substantial public health concerns and mandates a careful reassessment of its utility.
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Metadata
Title
Radiation Dose from Computed Tomography in Patients with Necrotizing Pancreatitis: How Much Is Too Much?
Authors
Chad G. Ball
Camilo Correa-Gallego
Thomas J. Howard
Nicholas J. Zyromski
Michael G. House
Henry A. Pitt
Atilla Nakeeb
Christian M. Schmidt
Fatih Akisik
Keith D. Lillemoe
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 10/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-010-1314-8

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