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Liver Transplant Recipients Are Exposed to High Levels of Ionizing Radiation

Summary and Comment |
March 3, 2014

Liver Transplant Recipients Are Exposed to High Levels of Ionizing Radiation

  1. Atif Zaman, MD, MPH

Replacing computed tomographic scans with magnetic resonance imaging is one approach that should be taken to reduce patients' exposure levels.

  1. Atif Zaman, MD, MPH

The association between exposure to medical-range radiation and radiation-induced cancer is documented in epidemiologic and experimental studies. Patients undergoing liver transplantation undergo a battery of tests from the evaluation process through posttransplantation, and many are radiation-based.

The objective of this retrospective study was to quantify the radiation exposure received by patients during transplant evaluation, waitlist time, and 60 days posttransplant at a single transplant center. The effective radiation exposure was obtained for 94% of the examinations; for others, standardized values were used to estimate exposure.

During a median observation period of 14 months, 74 patients underwent 1826 diagnostic imaging examinations and procedures, 73% of which involved radiation. One third of these involved considerable radiation exposure. Median annualized effective radiation exposure was 51 millisieverts (mSv). Patients with hepatoma received significantly higher amounts than patients without hepatoma (137 mSv vs. 32 mSv, P<0.00001). Computed tomography of the abdomen accounted for 46% of radiation exposure in the cohort.

Comment

This study highlights the high ionizing radiation exposure in patients undergoing evaluation and treatment for liver transplantation. Over half of study patients were exposed annually to >50 mSv of radiation. To put this result in perspective, annual radiation exposures in nuclear power plant workers are limited to 20 mSv in Europe and 50 mSv in the U.S. Measures should be taken to limit radiation exposure in this patient population, such as performing magnetic resonance imaging instead of computed tomography scans for abdominal imaging and choosing cardiac testing during evaluation that minimizes exposure.

  • Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex

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