OBJECTIVE To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness. METHODS From the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a widely adopted standard of 1-3 (red) as "not usually appropriate," 4-6 (yellow) "may or may not be appropriate," and 7-9 (green) "usually appropriate." Clinicians reviewed patient records to assess compliance with appropriate use criteria (AUC). RESULTS 9.6% of patients in our series were with non-malignant conditions and 1.4% with age ≤ 40 years. CDS scores (rounded) were 2% red, 38% yellow, 27% green, and 33% unscored CTs. Clinical society guidelines for CT exams, wherever available, were followed in 87.5 to 100% of cases. AUCs were not available for several clinical indications as also referral guidelines for serial CT imaging. More than half of CT exams were unrelated to follow-up of a primary chronic disease. CONCLUSIONS We are faced with a situation wherein patients in age ≤ 40 years require or are thought to require many CT exams over the course of a few years but the radiation risk creates concern. There is a fair number of conditions for which AUC are not available. Suggested solutions include development of CT scanners with lesser radiation dose and further development of appropriateness criteria. KEY POINTS We are faced with a situation wherein patients in age group 0-40 years and with non-malignant diagnosis require or are thought to require many CT exams over the course of a few years. More than half of CT exams were unrelated to follow-up of a primary chronic disease. Imaging guidelines and appropriateness use criteria are not available for many conditions. Wherever available, they are for initial work-up and diagnosis and there is a lack of guidance on serial CT imaging.

中文翻译：

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接受反复 CT 检查的患者：非恶性疾病患者的评估、成像原因和成像适当性。

目的 通过反复 CT 检查确定无恶性肿瘤且年龄 ≤ 40 岁且累积辐射剂量高的患者的百分比，并评估影像学检查的适用性。方法 从 5 年期间接受 ≥ 100 mSv 累积有效剂量 (CED) 的患者队列中，确定了一个非恶性疾病亚组。确定了导致多次 CT 的前 50 个临床适应症。临床决策支持 (CDS) 系统评分使用广泛采用的标准进行分析，1-3（红色）表示“通常不合适”，4-6（黄色）“可能合适也可能不合适”，7-9（绿色） ) “通常是合适的。” 临床医生审查患者记录以评估是否符合适当使用标准 (AUC)。结果 我们系列中 9.6% 的患者患有非恶性疾病，并且 1. 4% 年龄≤ 40 岁。CDS 评分（四舍五入）为 2% 红色、38% 黄色、27% 绿色和 33% 未评分 CT。87.5% 到 100% 的病例都遵循了 CT 检查的临床协会指南（如果有的话）。AUC 不适用于多种临床适应症，也不适用于连续 CT 成像的转介指南。超过一半的 CT 检查与原发性慢性疾病的随访无关。结论 我们面临这样一种情况，年龄≤ 40 岁的患者在几年内需要或被认为需要多次 CT 检查，但辐射风险引起了人们的关注。有相当多的条件是 AUC 不可用的。建议的解决方案包括开发辐射剂量较小的 CT 扫描仪和进一步制定适用性标准。要点 我们面临这样一种情况，即 0-40 岁年龄组的非恶性诊断患者需要或被认为需要在几年内进行多次 CT 检查。超过一半的 CT 检查与原发性慢性疾病的随访无关。影像学指南和适用性使用标准不适用于许多情况。只要可用，它们都用于初步检查和诊断，并且缺乏连续 CT 成像的指导。