“The reality is that very few people walk around with a lifetime exposure number to let us know how much radiation they’ve had medically,” said Paul Sierzenski, MD, MS-HQS, RDMS, FAAEM, FACEP, in an interview with Clinical Pain Advisor.

Dr. Sierzenski is a professor of emergency medicine at Thomas Jefferson University Sidney Kimmel Medical College in Philadelphia, and director of emergency, trauma, and critical care ultrasound for Christiana Care Health System in Wilmington, Delaware.


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TRENDING ON CPA: How to Overcome Pain Resource Challenges: Part 1 

Much concern exists regarding unnecessary exposure of patients to radiation. “In the long term, you’re getting a lot of exposure to radiation with the number of CT scans that we’re giving,” Dr. Goldstein warned. “I believe you’ll see a serious trend upwards in cancer than what we’ve had in the past — especially in the younger population. One CT scan in a child less than 2 significantly increases their risks for developing kidney cancers.”

“We’ve been looking for ways to minimize radiation and exposure, as CT scans have become very popular,” Goldstein continued. “There’s a radiographic study (ultrasound, CT scan, etc.) done on almost every patient coming through ER. Orally exposing them to contrast increases their time in the ER by 3 hours. No contrast dye means no exposure and expedited timeframes. From the aspects of expedited care and safety, you are changing the world of emergency medicine and the efficiency of care. Still, exposing them to the radiation from the CT scan is a serious dilemma going forward because we’re doing so many more of the CT scans [than ever before].”

Lowering the CT dose may be one alternative — a recent study published in the New England Journal of Medicine found low-dose CT scans to be noninferior to those performed utilizing the standard dose, while reducing exposure to ionizing radiation by 25%.2    

Study Limited by Sample Size

While patient follow-up was key in determining efficacy of NCCT in this patient population, one of the challenges was lack of work-up failures, Dr. Goldstein said.