title: Radiation exposure from medical imaging in dialyzed patients undergoing renal pre-transplant evaluation.
abstract: OBJECTIVE
  Ionizing radiation exposure from medical procedures is rising sharply-the per-capita annual effective dose in the US is 3.0 millisieverts (mSv). Hemodialyzed and kidney transplanted patients receive still higher doses of ionizing radiation due to the presence of multiple comorbidities. The aim of this study was to assess the cumulative effective dose (CED) among dialyzed patients undergoing renal pre-transplant evaluation.
  
  
  METHODS
  We evaluated 70 hemodialysis patients between June 2009 and December 2014, aged 46.4 ± 12.0 years. The number and type of radiologic procedures were collected through the Radiology Information System. CED was expressed as total mSv/patient and annual CED (mSv/patient/year).
  
  
  RESULTS
  A total of 744 radiologic procedures were performed, accounting for 3869 mSv of ionizing radiation: conventional radiology, computed tomography and nuclear medicine accounted for 78, 14 and 8 % of the procedures, but they represented, respectively, 8, 83 and 9 % of the total CED. The mean (median) annual CED was 35 (7) mSv/patient/year, while total CED was 72 (32) mSv/patient. Thirty-seven patients were active waitlisted and received 47 (10) mSv during the pre-transplant evaluation and 36 (5) mSv during the waiting phase to maintain active status. Concerning cancer risk, 4 (7 %) patients were classified at low risk (<3 mSv/year), 19 (35 %) at moderate risk (3 to <20 mSv/year), 8 (15 %) at high risk (20 to <50 mSv/year), and 23 (43 %) at very high risk (≥50 mSv/year).
  
  
  CONCLUSIONS
  Our study demonstrated that during renal pre-transplant evaluation, dialyzed patients receive a high dose of ionizing radiation. Considering that transplanted individuals have a high incidence of cancer due to multifactorial etiology, it is mandatory to reduce the ionizing radiation imaging.
authors.affiliation: Nephrology Department, University Hospital "Maggiore della Carità", Novara, Italy. andreanademauri@libero.it.
authors.forename: Andreana
authors.initials: A
authors.lastname: De Mauri
authors.affiliation: Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Matheoud
authors.affiliation: Radiology Department, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Carriero
authors.affiliation: Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Lizio
authors.affiliation: Nephrology Department, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Doriana
authors.initials: D
authors.lastname: Chiarinotti
authors.affiliation: Medical Physics Department, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Brambilla
mesh_terms: D000328:Adult; D000368:Aged; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D006435:Renal Dialysis; D012189:Retrospective Studies
keywords: Cumulative effective dose; Hemodialysis; Ionizing radiation exposure; Renal pre-transplant evaluation