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Safety investigation of CT brain perfusion scans


8 October, 2009  

The US Food and Drug Administration (FDA) has become aware of radiation overexposures during perfusion CT imaging to aid in the diagnosis and treatment of stroke.

Over an 18-month period, 206 patients at a particular facility received radiation doses that were approximately eight times the expected level. Instead of receiving the expected dose of 0.5 Gy (maximum) to the head, these patients received 3-4 Gy. In some cases, this excessive dose resulted in hair loss and erythema. The facility has notified all patients who received the overexposure and provided resources for additional information.

While this event involved a single kind of diagnostic test at one facility, the magnitude of these overdoses and their impact on the affected patients were significant. This situation may reflect more widespread problems with CT quality assurance programs and may not be isolated to this particular facility or this imaging procedure (CT brain perfusion). If patient doses are higher than the expected level, but not high enough to produce obvious signs of radiation injury, the problem may go undetected and unreported, putting patients at increased risk for long-term radiation effects.

Patients should follow their doctor’s recommendations for receiving CT scans. While unnecessary radiation exposure should be avoided, a medically-needed CT scan has benefits that outweigh the radiation risks.

To find out more, please click on the link below:

US FDA