Optimisation of protection in the medical exposure of recurrent adult patients due to computed tomography procedures: development of recurrent exposures reference levels.

Autor: Bramilla M; Medical Physics Department, University Hospital 'Maggiore Della Carità', Novara, Italy. marco.brambilla@maggioreosp.novara.it., Berton L; Medical Physics Department, A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy., Balzano RF; Radiology Department, ASL BT Ospedale Dimiccoli, Barletta, Italy., Cannillo B; Medical Physics Department, University Hospital 'Maggiore Della Carità', Novara, Italy., Carriero A; Radiology Department, University Hospital 'Maggiore Della Carità', Novara, Italy., Chauvie S; Medical Physics Department, A.O. Santa Croce e Carle, Cuneo, Italy., Gallo T; Radiology Department, A.O. Ordine Mauriziano, Turin, Italy., Cornacchia S; Medical Physics Department, ASL BT Ospedale Dimiccoli, Barletta, Italy., Cutaia C; Medical Physics Department, A.O. Ordine Mauriziano, Turin, Italy., D'Alessio A; Medical Physics Department, University Hospital 'Maggiore Della Carità', Novara, Italy., Emanuele R; Medical Physics Department, A.O. Santa Croce e Carle, Cuneo, Italy., Fonio P; Radiology Department, A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy., Matheoud R; Medical Physics Department, University Hospital 'Maggiore Della Carità', Novara, Italy., Stasi M; Medical Physics Department, A.O. Ordine Mauriziano, Turin, Italy., Talenti A; Radiology Department, A.O. Santa Croce e Carle, Cuneo, Italy., Rampado O; Medical Physics Department, A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Jul; Vol. 34 (7), pp. 4475-4483. Date of Electronic Publication: 2023 Dec 21.
DOI: 10.1007/s00330-023-10520-7
Abstrakt: Objectives: To assess the incidence (1 year) and the cumulative incidence (3 years) of the condition of patients accruing cumulative effective doses (CED) of ≥ 100 mSv and their variability among different hospitals. To establish and validate a reference level for the CED in patients with recurrent exposures (RERL) and provide a RERL value.
Methods: Data of CT exposure was collected in 9 similar hospitals. The database included 294,222 patient*years who underwent 442,278 CT exams in 3 years. The incidence proportion of patients with CED ≥ 100 mSv in a given year (I 100;1 ) and the 3-year cumulative incidence of patients with CED ≥ 100 mSv over 3 consecutive years (I 100;3 ) were calculated and compared among different institutions.
Results: I 100;1 ranged from a minimum of 0.1% to a maximum of 5.1%. The percentage of recurrent patients was quite uniform among centres ranging from 23 to 38%. The I 100;3 ranged from a minimum of 1.1 to 11.4%. There was a strong positive correlation between the third quartile values of yearly CED and yearly incidence (r = 0.90; R 2  = 0.81; p < 0.0001). RERL value in our study was found at 34.0 mSv.
Conclusion: The management of patients with recurrent exposures is highly variable among hospitals leading to a 50-fold variation in I 100;1 and to a tenfold variation in I 100;3 . RERL could be established and used by taking as a RERL quantity the CED and as a RERL value the 75th percentile of the third quartiles of the distribution of the yearly CED obtained by surveying different hospitals.
Clinical Relevance Statement: This is the first ever multicentre study that quantifies recurrent exposures in terms of incidence and cumulative incidence of patients with CED ≥ 100 mSv. RERL establishment and use could benefit the optimisation of radioprotection of patients with recurrent exposures.
Key Points: This is the first multicentre study estimating yearly incidence and 3-year cumulative incidence of patients with cumulative effective doses ≥ 100 mSv. In this study, a 50-fold inter centre variation between the maximum (5.1%) and the minimum value (0.1%) of yearly incidence of patients with cumulative effective doses ≥ 100 mSv was reported. The range of the 3-year cumulative incidence extended from 1.1 to 11.4% (a tenfold variation) The third quartile of the yearly cumulative effective doses in a centre showed a strong positive correlation with the yearly incidence of patients with cumulative effective doses ≥ 100 mSv, with a potential of being used to set reference levels for recurrent exposures.
(© 2023. The Author(s), under exclusive licence to European Society of Radiology.)
Databáze: MEDLINE
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