Survey of CT scan examinations of an emergency department on young patients from the perspective of radiation protection - Justification of examinations

Document Type : Conference Paper

Authors

1 Medical Physics Department, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Radiology Department, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Medical Physics Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

4 Department of Nuclear Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

5 Birjand Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran

Abstract

Background: In term of annual collective effective dose, computed tomography (CT) has the highest radiation risks among the other imaging modality and its utilization is increasing every year. Accordingly, due to the high sensitivity of children to radiation exposure, radiation protection has to be considered especially in young patients.
Objective: The aim of this study was to determine the justifiability and alternative modality of brain CT scans that performed on patients aged fewer than 20.
Methods: CT scan results were evaluated for 145 patients who entered an emergency department in Yazd, Iran, over six month period. Patients were categorized in four different age groups and the justification of CT examinations, based on reliable references was evaluated for them.
Results: About seventy percent of scans did not show any specific clinical complication. Also, based on the referral guidelines for recommended imaging modality, about 12% of scans could alternate with MRI and 18% of them are justified.
Conclusions: According to the high percentage of scans with normal results, it may be important to pay attention to the availability, retraining and consideration to a comprehensive CT scan prescribing protocols, especially for children. In order to reduce the prescribing of CT Scans in unjustified cases, the increasing capacity of MRI equipment, in terms of device operation hours during the day, can be helpful.

Keywords

References

  1. P. R. Sierzenski, et al. Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine. Annal. Emergency Med. 63 (1) )2014( p. 25-32.
  2. H. Oikarinen, et al. Unjustified CT examinations in young patients. European Radiology 19 (5) (2009) 1161-1165.
  3. A. Sodickson, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 251 (1) (2009) 175-184.
  4. E. Dougeni, K. Faulkner, G. Panayiotakis. A review of patient dose and optimisation methods in adult and paediatric CT scanning. European J. Radiology 81(4) (2012) e665-e683.
  5. D. J. Brenner, E. J. Hall, Computed tomography—an increasing source of radiation exposure. New England J. Med. 357 (22) (2007) 2277-2284.
  6. A. Al-Tell, M. Hjouj, M. S. Ahmad, H. Mohammad. Justification of urgent brain CT examinations at medium size hospital, jerusalem. Atlas J. Bio. (2019) 655-660.
  7. S. -Y. Hu, et al. Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study. BMJ Open 6 (6) (2016) e010973.
  8. D. L. Miglioretti, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatrics 167 (8) (2013) 700-707.
  9. A. L. Hryhorczuk, R. C. Mannix, G. A. Taylor. Pediatric abdominal pain: use of imaging in the emergency department in the United States from 1999 to 2007. Radiology 263 (3) (2012) 778-785.
  10. T. D. Kirsch, et al. Computed tomography scan utilization in emergency departments: a multi-state analysis. J. Emergency Med. 41 (3) (2011) 302-309.
  11. K. E. Thomas, et al. Assessment of radiation dose awareness among pediatricians. Pediatric Radiology 36(8) (2006) 823-832.
  12. G. Stanescu, G. Rosca-Fartat, D. Stanescu, Justification of CT scans using referral guidelines for imaging. Radiation Protection Dosimetry 165 (1-4) (2015) 43-46.
  13. W. K. Jeong, et al. Imaging guidelines for enhancing justifications for radiologic studies. J. Korean Med. Sci. 31 (Suppl 1) (2016) S38-S44.
  14. O. Linton, et al. Summary of workshop on CT in emergency medicine: ensuring appropriate use. J. Amer. College Radiology 8 (5) (2011) 325-329.
  15. D. J. Brenner, Slowing the increase in the population dose resulting from CT scans. Radiat. Res. 174 (6b) (2010) 809-815.
  16. E. P. Hess, et al. Trends in computed tomography utilization rates: a longitudinal practice-based study. J. Patient Safety 10(1) (2014) 52-58.
  17. A. Pola, et al. Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults. European Radiology 28(6) (2018) 2308-2318.
  18. P. Tahvonen, et al. Justification of CT examinations in young adults and children can be improved by education, guideline implementation and increased MRI capacity. British J. Radiology 86 (1029) (2013) 20130337.
  19. M. S. Pearce, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet 380 (9840) (2012) 499-505.
  20. S. Skinner. MRI brain imaging. Australian Family Phys. 42 (11) (2013) 794-797.
  21. J. Roth, et al. The added value of magnetic resonance imaging cisternography and ventriculography as a diagnostic aid in pediatric hydrocephalus. Pediatric Neurosurgery 54(3) (2019) 165-172.
  22. T. Bosemani, et al. Congenital abnormalities of the posterior fossa. Radiographics 35 (1) (2015) 200-220.
  23. M. G. Lansberg, et al. Comparison of diffusion-weighted MRI and CT in acute stroke. Neurology 54 (8) (2000) 1557-1561.
  24. P. Armstrong, M. Wastie, A. G. Rockall, Diagnostic Imaging. John Wiley & Sons, 2010.
  25. D. J. Brenner, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. Amer. J. Roentgenology 176 (2) (2001) 289-296.
  26. K. S. Sodhi, et al. Clinical application of ‘Justification’and ‘Optimization’principle of ALARA in pediatric CT imaging: “How many children can be protected from unnecessary radiation?”. European J. Radiology 84 (9) (2015) 1752-1757.
  27. J. Clarke, et al. Provision of MRI can significantly reduce CT collective dose. British J. Radiology 74 (886) (2001) 926-931.
  28. V. Beir. Health effects of exposure to low levels of ionizing radiation. Biol. Effects Ionizing Radiations (1990) 22-45.
  29. D. Zinsser, R. Marcus, A. E. Othman, F. Bamberg, K. Nikolaou, T. Flohr, M. Notohamiprodjo. Dose Reduction and Dose Management in Computed Tomography - State of the Art. Rofo.190 (6) (2018) 531-541.
  30. F. G. Blankenberg, et al. Sonography, CT, and MR imaging: a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage. Amer. J. Neuroradiology 21 (1) (2000) 213-218.

 

Files

Share

How to cite

Statistics