Shokoohi Hamid, Meeker Melissa, Montoya Kristofer, Mataac Maria, Li Xinhua, Rehani Madan M
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Emerg Med. 2025 Aug;75:118-124. doi: 10.1016/j.jemermed.2025.05.024. Epub 2025 Jun 11.
Advances in computed tomography (CT) technology have reduced radiation exposure, with head CTs delivering around 2 mSv. However, some examinations still deliver doses of ≥50 mSv, increasing the risk of radiation-induced cancers.
This study examines the incidence of high-dose CT scans (≥50 mSv) in the emergency department (ED) over a four-year period, exploring trends and potential contributing factors.
This retrospective cohort study examined CT scans from the ED of a tertiary care hospital from 2019 to 2022. Adult patients (≥18 years) who received a single CT scan with a dose ≥50 mSv were included. We analyzed the data by age, sex, scan type, scanner model, use of contrast, and examination year using descriptive statistics and Kruskal-Wallis testing to identify significant variations in radiation dose.
Out of over 166,000 CT scans performed during the study period, we identified 1357 (0.81% of examinations) examinations with radiation doses ≥ 50 mSv, 58% of which were performed on females and 61% <65 years old. Aorta CTs were most common (62%), followed by chest/abdomen/pelvis (14%). Most of these scans were aorta studies (62%), followed by chest/abdomen/pelvis scans (14%) and trauma-related examinations. The highest doses were seen in extremity CTs (median 67 mSv), aorta scans (median 60 mSv), and chest/abdomen/pelvis studies (median 59 mSv). Use of IV contrast was associated with 89% of high-dose scans. The overall percentage of high-dose CTs increased over time, from 0.50% in 2019 to 0.92% in 2022, with a rise in median dose from 57 mSv to 60 mSv. Dose variations were statistically significant across scan type, patient age, contrast use, and year, but not by gender or scanner model.
Although high-dose CT examinations are relatively uncommon, their occurrence in the ED has increased in recent years despite newer CT technology. These scans are most often linked to specific protocols like aortic imaging and multiphase extremity studies. Our findings point to the need for review of CT protocols and better awareness of radiation risks.
计算机断层扫描（CT）技术的进步降低了辐射暴露，头部CT的辐射剂量约为2毫希沃特（mSv）。然而，一些检查的辐射剂量仍≥50 mSv，增加了辐射诱发癌症的风险。
本研究调查了四年期间急诊科（ED）高剂量CT扫描（≥50 mSv）的发生率，探讨其趋势和潜在影响因素。
这项回顾性队列研究分析了一家三级护理医院急诊科2019年至2022年期间的CT扫描数据。纳入接受单次剂量≥50 mSv CT扫描的成年患者（≥18岁）。我们通过年龄、性别、扫描类型、扫描仪型号、是否使用对比剂以及检查年份对数据进行分析，采用描述性统计和Kruskal-Wallis检验来确定辐射剂量的显著差异。
在研究期间进行的超过166,000次CT扫描中，我们识别出1357次（占检查的0.81%）辐射剂量≥50 mSv的检查，其中58%是对女性进行的，61%的患者年龄<65岁。主动脉CT最为常见（62%），其次是胸部/腹部/骨盆CT（14%）。这些扫描大多数是主动脉检查（62%），其次是胸部/腹部/骨盆扫描（14%）以及与创伤相关的检查。四肢CT的辐射剂量最高（中位数67 mSv），其次是主动脉扫描（中位数60 mSv）和胸部/腹部/骨盆检查（中位数59 mSv）。89%的高剂量扫描使用了静脉对比剂。高剂量CT的总体百分比随时间增加，从2019年的0.50%增至2022年的0.92%，中位数剂量从57 mSv上升至60 mSv。不同扫描类型、患者年龄、对比剂使用情况和年份之间的剂量差异具有统计学意义，但在性别或扫描仪型号方面无差异。
尽管高剂量CT检查相对不常见，但尽管有更新的CT技术，近年来其在急诊科的出现频率有所增加。这些扫描大多与主动脉成像和多期四肢检查等特定方案相关。我们的研究结果表明需要审查CT方案并提高对辐射风险的认识。
