title: Radiation dose from computed tomography in patients with necrotizing pancreatitis: how much is too much?
abstract: OBJECTIVE
  Low-dose ionizing radiation from medical imaging has been indirectly linked with subsequent cancer. Computed tomography (CT) is the gold standard for defining pancreatic necrosis. The primary goal was to identify the frequency and effective radiation dose of CT imaging for patients with necrotizing pancreatitis.
  
  
  METHODS
  All patients with necrotizing pancreatitis (2003-2007) were retrospectively analyzed for CT-related radiation exposure.
  
  
  RESULTS
  Necrosis was identified in 18% (238/1290) of patients with acute pancreatitis (mean age = 53 years; hospital/ICU length of stay = 23/7 days; mortality = 9%). A median of five CTs/patient [interquartile range (IQR) = 4] were performed during a median 2.6-month interval. The average effective dose was 40 mSv per patient (equivalent to 2,000 chest X-rays; 13.2 years of background radiation; one out of 250 increased risk of fatal cancer). The actual effective dose was 63 mSv considering various scanner technologies. CTs were infrequently (20%) followed by direct intervention (199 interventional radiology, 118 operative, 12 endoscopic) (median = 1; IQR = 2). Magnetic resonance imaging did not have a CT-sparing effect. Mean direct hospital costs increased linearly with CT number (R = 0.7).
  
  
  CONCLUSIONS
  The effective radiation dose received by patients with necrotizing pancreatitis is significant. Management changes infrequently follow CT imaging. The ubiquitous use of CT in necrotizing pancreatitis raises substantial public health concerns and mandates a careful reassessment of its utility.
authors.affiliation: Department of Surgery, Indiana University, 545 Barnhill Drive, Emerson Hall 203, Indianapolis, IN 46202, USA. ball.chad@gmail.com
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Camilo
authors.initials: C
authors.lastname: Correa-Gallego
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Atilla
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Christian M
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Fatih
authors.initials: F
authors.lastname: Akisik
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
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