title: Exposure to low-dose ionizing radiation from medical imaging procedures.
abstract: BACKGROUND
  The growing use of imaging procedures in the United States has raised concerns about exposure to low-dose ionizing radiation in the general population.
  
  
  METHODS
  We identified 952,420 nonelderly adults (between 18 and 64 years of age) in five health care markets across the United States between January 1, 2005, and December 31, 2007. Utilization data were used to estimate cumulative effective doses of radiation from imaging procedures and to calculate population-based rates of exposure, with annual effective doses defined as low (< or = 3 mSv), moderate (> 3 to 20 mSv), high (> 20 to 50 mSv), or very high (> 50 mSv).
  
  
  RESULTS
  During the study period, 655,613 enrollees (68.8%) underwent at least one imaging procedure associated with radiation exposure. The mean (+/-SD) cumulative effective dose from imaging procedures was 2.4+/-6.0 mSv per enrollee per year; however, a wide distribution was noted, with a median effective dose of 0.1 mSv per enrollee per year (interquartile range, 0.0 to 1.7). Overall, moderate effective doses of radiation were incurred in 193.8 enrollees per 1000 per year, whereas high and very high doses were incurred in 18.6 and 1.9 enrollees per 1000 per year, respectively. In general, cumulative effective doses of radiation from imaging procedures increased with advancing age and were higher in women than in men. Computed tomographic and nuclear imaging accounted for 75.4% of the cumulative effective dose, with 81.8% of the total administered in outpatient settings.
  
  
  CONCLUSIONS
  Imaging procedures are an important source of exposure to ionizing radiation in the United States and can result in high cumulative effective doses of radiation.
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30306, USA. rfazel@emory.edu
authors.forename: Reza
authors.initials: R
authors.lastname: Fazel
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011839:Radiation, Ionizing; D011859:Radiography / Q000706:statistics & numerical data*; D011877:Radionuclide Imaging / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States; D055815:Young Adult