Preventing Patient Death or Serious Injury Associated With Radiation Exposure From Fluoroscopy and Computed Tomography: Brief Review (NEW)

Introduction Fluoroscopicallyand computed tomography (CT)-guided diagnostic and interventional procedures are being performed with increasing frequency worldwide. From 1980 to 2007, annual performance of CT in the U.S. increased from 3 million to 80 million. With this rapid increase in the use of imaging techniques, there has been a concurrent increase in patient exposure to ionizing radiation. Effects associated with radiation can be categorized as either deterministic or stochastic. Deterministic effects manifest themselves in a relatively short time after a high-intensity exposure to radiation (e.g., 1 or more sieverts). In 1994, approximately 50 radiation-induced burns were reported to the U.S. Food and Drug Administration (FDA). In 2000, a review of 73 reports of radiation-induced skin injuries identified fluoroscopically-guided procedures as the cause of 38 severe skin injuries (e.g., chronic ulceration); 18 requiring skin grafts. Radiationinduced burns have also been reported after extended radiation exposure during CT brain perfusion scans. Stochastic effects are increased risks of various conditions (e.g., cancer, heart disease) that manifest themselves over a longer time period. Recent estimates indicate that CT scans performed in the U.S. in 2007 will be related to approximately 29,000 future cancers; killing nearly 15,000. Almost one half of the projected cancers will be due to scans of the abdomen and pelvis. Experts indicate that more than 400 patients (across eight U.S. hospitals) who recently received “higher-than-expected” radiation doses while undergoing CT brain perfusion scans may now face long-term risks of cancer and brain damage.