Patient radiation safety in the intensive care unit

The aim of this commentary review was to summarize the main research evidences on radiation exposure and to underline the best clinical and radiological practices to limit radiation exposure in intensive care unit (ICU) patients. Radiological imaging is essential for management of patients in the ICU despite the risk of ionizing radiation exposure in monitoring critically ill patients, especially in those with prolonged hospitalization. In optimizing radiation exposure reduction for ICU patients, multiple parties and professionals must be considered, including hospital management, clinicians, radiographers, and radiologists. Modified diagnostic reference levels for ICU patients, based on UK guidance, may be proposed, especially considering the frequent repetition of X-ray diagnostic procedures in ICU patients. Best practices may reduce radiation exposure in ICU patients with particular emphasis on justification and radiation exposure optimization in conventional radiology, interventional radiology and fluoroscopy, CT, and nuclear medicine. CT contributes most predominately to radiation exposure in ICU patients. Low-dose (<1 mSv in effective dose) or even ultra-low-dose CT protocols, iterative reconstruction algorithms, and artificial intelligence-based innovative dose-reduction strategies could reduce radiation exposure and related oncogenic risks.