title: Roux-en-Y gastric bypass is associated with an increased exposure to ionizing radiation.
abstract: BACKGROUND
  Bariatric surgery provides for a reliable and sustainable solution to the obesity epidemic. The gold standard bariatric surgical procedure is the Roux-en-Y gastric bypass (RYGB). Assessment of this population preoperatively and work-up of postoperative complications often includes radiographic evaluation. Repeated exposure to radiation is not without complication.
  
  
  OBJECTIVE
  Assess the association between the RYGB and exposure to ionizing radiation.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Patients were identified by their ICD-9 code as having had a RYGB at the Massachusetts General Hospital (MGH) from 2002 to 2012. The number of abdominal and pelvis (A/P) computed tomography (CT) scans performed was determined and converted into an effective dose (ED) and expressed as milliSeiverts (mSv) to illustrate the biologic effects of radiation.
  
  
  RESULTS
  From 2002 to 2012, 1789 primary laparoscopic RYGBs were completed. Fifty-five revisional operations were completed on 51 patients. Of these, 38 had both their index and second operation at the MGH. A total of 1065 A/P CTs were completed in the laparoscopic RYGB population (mean = .6), and 106 A/P CTs were done in the revisional surgery cohort (mean = 2.8). The mean ED of radiation was 56.1 mSv and 19.5 mSv for the index and revisional populations, respectively.
  
  
  CONCLUSIONS
  This study demonstrated the significant cumulative radiation exposure attributable to A/P CTs. This exposes the patient to a potential increased risk of malignancy as well as imposing a financial burden on the healthcare system. The findings of this study raise the awareness of an increased risk of radiation exposure for this population and the necessity of creation of a dedicated algorithm for the mindful utilization of CT imaging.
authors.affiliation: The University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: peter-nau@uiowa.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Nau
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: George
authors.initials: G
authors.lastname: Molina
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Aran
authors.initials: A
authors.lastname: Shima
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Abujudeh
authors.initials: A
authors.lastname: Hani
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ozanan
authors.initials: O
authors.lastname: Meireles
mesh_terms: D005471:Fluoroscopy / Q000009:adverse effects*; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D016343:Monitoring, Intraoperative / Q000009:adverse effects* / Q000379:methods; D009767:Obesity, Morbid / Q000601:surgery*; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D015431:Weight Loss
keywords: Ionizing radiation; Radiation exposure; Roux-en-Y gastric bypass; Weight loss surgery