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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 (
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.
3 mSv), moderate (>3 to 20 mSv), high (>20 to 50 mSv), or very high (>50 mSv).
Source Information
From the Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta (R.F.); the Section of Cardiovascular Medicine, Department of Medicine (H.M.K., Y.W., J.C.), the Robert Wood Johnson Clinical Scholars Program, Department of Medicine (H.M.K.), and the Section of Health Policy and Administration, School of Public Health (H.M.K.), Yale University School of Medicine; and the Center for Outcomes Research and Evaluation, Yale–New Haven Hospital (H.M.K.) — both in New Haven, CT; the Mount Sinai School of Medicine and the James J. Peters Veterans Affairs Medical Center (J.S.R.); and the Department of Medicine, Cardiology Division, and the Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital (A.J.E.) — all in New York; the Divisions of Cardiovascular Diseases (H.H.T.) and Health Care Policy and Research (N.D.S.), Mayo Clinic, Rochester, MN; the Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore (K.N.); the Department of Internal Medicine, Boston Medical Center, Boston (K.N.); and the Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and the University of Michigan, Division of Cardiovascular Medicine (B.K.N.) — both in Ann Arbor.
Address reprint requests to Dr. Fazel at Emory University, Division of Cardiology, Bldg. A, Suite 1-North, 1256 Briarcliff Rd. NE, Atlanta, GA 30306, or at rfazel{at}emory.edu.
Related Letters:
Radiation Exposure from Medical Imaging Procedures
Applegate K. E., Amis E. S. Jr., Schauer D. A., Becker G. J., Bosma J., Hendee W., Mezrich R. S., Budhraja V., Diamond B. F., Fazel R., Krumholz H. M., Nallamothu B. K., Lauer M. S.
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N Engl J Med 2009;
361:2289-2292, Dec 3, 2009.
Correspondence
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