Acute Pancreatitis: Computed Tomography Utilization and Radiation Exposure Are Related to Severity but Not Patient Age

Background & Aims

A goal of radiologists is to use computed tomography (CT) imaging less frequently in younger patients because of radiation exposure. We evaluated abdominal CT use among patients hospitalized for acute pancreatitis at a tertiary care hospital and compared estimated radiation doses with disease severity and patient age.

Methods

We performed a retrospective analysis of numbers and types of CTs performed on patients with acute pancreatitis (1036 admissions, 869 patients; mean age, 50.8 y); 566 had 1081 abdominopelvic CTs performed from October 1, 2001, to September 30, 2006. Effective dose estimates for abdominopelvic CTs were used to estimate exposure. Disease severities were stratified using Balthazar CT grades and severity indexes.

Results

The mean number of abdominopelvic CTs per patient, per hospitalization, was 1.9 (range, 1–12); the mean number was 3.0 over the 5-year period (range, 1–19). During hospitalization, each patient was exposed to a mean estimated radiation dose of 31.03 ± 26.4 mSv (range, 14.7–176.9 mSv). Patients with pancreatitis grades D or E (n = 233) compared with grades A through C (n = 333) had longer periods of hospitalization (mean, 23.3 vs 10.8 d; P < .001), more days as an inpatient (mean, 2.54 vs 1.45 d; P < .001), more total CT scans (mean, 4.02 vs 2.37; P < .001), and higher total effective radiation doses (mean, 53.5 vs 35 mSv; P < .0001). Linear regression revealed a relationship between dose and disease grade, but not patient age.

Conclusions

Regardless of age, patients with severe acute pancreatitis undergo more abdominopelvic CTs as inpatients and outpatients and are exposed to higher doses of radiation compared with patients with less severe disease. Awareness of CT ordering patterns for patients with acute pancreatitis may aid in the development of alternate imaging strategies to reduce radiation exposure in this population, especially for younger patients.

Keywords: Pancreatic Inflammation, Imaging Utilization, Tertiary Care

Abbreviations used in this paper: CECT, contrast-enhanced computed tomography, CTSI, computed tomography severity index, IV, intravenous, MRI, magnetic resonance imaging