Temporal trends in the use of diagnostic imaging for inpatients with pancreatic conditions: How much ionizing radiation are we using?

Abstract

Background: Low-dose ionizing radiation from medical imaging has been indirectly linked with subsequent cancer and increased costs. Computed tomography (CT) is the gold standard for defining pancreatic anatomy and complications. Our primary goal was to identify the temporal trends associated with diagnostic imaging for inpatients with pancreatic diseases. Methods: Data were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database from 2000 to 2008. Pancreas-related ICD-9 diagnostic codes were matched to all relevant imaging modalities. Results: Between 2000 and 2008, a significant increase in admissions (p < 0.001), but decrease in overall imaging procedures (p = 0.032), for all pancreatic disorders was observed. This was primarily a result of a reduction in the number of CT and endoscopic retrograde cholangiopancreatography examinations (i.e., reduced radiation exposure, p = 0.008). A concurrent increase in the number of inpatient magnetic resonance cholangiopancreatography/magnetic resonance imaging performed was observed (p = 0.040). Intraoperative cholangiography and CT remained the dominant imaging modality of choice overall (p = 0.027). Conclusion: Inpatients with pancreatic diseases often require diagnostic imaging during their stay. This results in substantial exposure to ionizing radiation. The observed decrease in the use of CT may reflect an improved awareness of potential stochastic risks.