Strahlenexposition durch Röntgenthoraxaufnahmen auf der Intensivstation
Dosiskumulation und Strahlenkrebsrisiko bei Langzeittherapie

Leppek, R.; Bertrams, S. S.; Höltermann, W.; Klose, K. J.

doi:10.1007/s001170050417

Cited by 11 publications

(4 citation statements)

References 12 publications

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“…[16] • COVID-19 ICU patients received more radiological exams and had a higher CED of radiation than non-COVID-19 patients, indicating a need for radiation reduction strategies. Radiologe 1998 [17] • The risk from repeated chest X-rays in ICU patients with ARDS is minimal.…”

Section: Discussionmentioning

confidence: 99%

“…[16] The Risk of Repetitive Imaging in ICU Patients Recent studies have examined radiation exposure risks in ICU patients. Leppek et al [17] evaluated the morbidity risk associated with repeated bedside chest radiography in ICU patients, particularly those undergoing long-term ventilation for Adult Respiratory Distress Syndrome (ARDS). [9] Surface and gonadal doses were measured for each patient, revealing that the mean surface dose per patient ranged from 0.31 mGy to 0.56 mGy.…”

Section: Radiation Exposure During the Covid-19 Pandemicmentioning

confidence: 99%

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Radiation Overuse in Intensive Care Units: A Cause for Concern

Zanon,

Bini,

Toniolo

et al. 2023

Preprint

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Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in intensive care unit (ICU) settings, highlighting its rise during the COVID-19 pandemic and repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed annual occupational limits, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median Cumulative Effective Dose (CED) in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICU units, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates rigorous radiation management protocols to safeguard patient health, while ensuring the continuity of high-quality medical care.

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Section: Discussionmentioning

confidence: 99%

Section: Radiation Exposure During the Covid-19 Pandemicmentioning

confidence: 99%

Radiation Overuse in Intensive Care Units: A Cause for Concern

Zanon,

Bini,

Toniolo

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Recent studies have examined radiation exposure risks in ICU patients. Leppek et al [ 23 ] evaluated the morbidity risk associated with repeated bedside chest radiography in ICU patients, particularly those undergoing long-term ventilation for Adult Respiratory Distress Syndrome (ARDS) [ 13 ].…”

Section: Radiation Dose Assessment In Icu Patients Amidst Covid-19 An...mentioning

confidence: 99%

Radiation Overuse in Intensive Care Units

Zanon,

Bini,

Toniolo

et al. 2024

Tomography

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Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in ICU settings, highlighting its rise during the COVID-19 pandemic and the rise in repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed the diagnostic reference level, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median cumulative effective dose in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICUs, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates for rigorous radiation management protocols to safeguard patient health while ensuring the continuity of high-quality medical care.

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“…In contrast, a restrictive strategy limits CXRs to specific clinical indications, such as a change in clinical status or following certain procedures. Arguments for adopting a restrictive approach include variable interpretation of CXRs depending on clinician and patient factors, low incidence of clinically unsuspected abnormalities, potential harm arising from unnecessary treatment of minor or false positive findings, cost, radiation exposure and adverse events arising from repositioning of the patient to obtain the CXR [5,6]. …”

Section: Introductionmentioning

confidence: 99%

Routine chest x-rays in intensive care units: a systematic review and meta-analysis

et al. 2012

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IntroductionChest x-rays (CXRs) are the most frequent radiological tests performed in the intensive care unit (ICU). However, the utility of performing daily routine CXRs is unclear.MethodsWe searched Medline and Embase (1948 to March 2011) for randomized and quasi-randomized controlled trials (RCTs) and before-after observational studies comparing a strategy of routine CXRs to a more restrictive approach with CXRs performed to investigate clinical changes among critically ill adults or children. In duplicate, we extracted data on the CXR strategy, study quality and clinical outcomes (ICU and hospital mortality; duration of mechanical ventilation and ICU and hospital stay).ResultsNine studies (39,358 CXRs; 9,611 patients) were included in the meta-analysis. Three trials (N = 870) of moderate to good quality provided information on the safety of a restrictive routine CXR strategy; only one trial systematically assessed for missed findings. Pooled data from trials showed no evidence of effect of a restrictive approach on ICU mortality (risk ratio [RR] 1.04, 95% confidence interval [CI] 0.84 to 1.28, P = 0.72; two trials, N = 776), hospital mortality (RR 0.98, 95% CI 0.68 to 1.41, P = 0.91; two trials, N = 259), ICU length of stay (weighted mean difference [WMD] -0.86 days, 95% CI -2.38 to 0.66 days, P = 0.27; three trials, N = 870), hospital length of stay (WMD -2.50 days, 95% CI -6.62 to 1.61 days, P = 0.23; two trials, N = 259), or duration of mechanical ventilation (WMD -0.30 days, 95% CI -1.48 to 0.89 days, P = 0.62; three trials, N = 705). Adding data from six observational studies, one of which systematically screened for missed findings, gave similar results.ConclusionsThis meta-analysis did not detect any harm associated with a restrictive chest radiograph strategy. However, confidence intervals were wide and harm was not rigorously assessed. Therefore, the safety of abandoning routine CXRs in patients admitted to the ICU remains uncertain.

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Strahlenexposition durch Röntgenthoraxaufnahmen auf der Intensivstation Dosiskumulation und Strahlenkrebsrisiko bei Langzeittherapie

Abstract: In comparison with the decreased prognosis of severely ill long-term ventilated patients the additional morbidity risk due to chest radiographs is a negligible quantity.

Cited by 11 publications

References 12 publications

Radiation Overuse in Intensive Care Units: A Cause for Concern

Radiation Overuse in Intensive Care Units: A Cause for Concern

Radiation Overuse in Intensive Care Units

Routine chest x-rays in intensive care units: a systematic review and meta-analysis

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