Analysis of radiation exposure to the orthopaedic trauma patient during their inpatient hospitalisation

Prasarn, Mark L.; Martin, Elizabeth; Schreck, Michael J.; Wright, John W.; Westesson, Per‐Lennart; Morgan, Thomas L.; Rechtine, Glenn R.

doi:10.1016/j.injury.2011.08.026

Cited by 19 publications

(17 citation statements)

References 29 publications

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“…However, these additional images are costly, painful, and increase patient radiation exposure. Image quality can be compromised by suboptimal positioning, obesity, bowel gas, and bowel or bladder contrast [1][2][3][4]. Computed tomography (CT) scans are also performed for a more detailed assessment of the injury pattern [3,[5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Conventional versus virtual radiographs of the injured pelvis and acetabulum

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Conventional versus virtual radiographs of the injured pelvis and acetabulum

et al. 2015

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“…2,4,7,10,[12][13][14][15] The associated high doses of radiation and related medical costs have received attention. 2,4,8,9,11,12,27,28 Furthermore, debate exists over the time taken to perform advanced imaging tests, which could delay emergent procedures. 10,29,30 Higher-order tests also increase the potential for incidental findings, which may generate more evaluation, including imaging or procedures and their related risks and costs.…”

Section: Discussionmentioning

confidence: 99%

“…Several other reports have been recently published, which also show dramatic increases in the number of CT scans in trauma patients, with large associated doses of radiation. 2,4,8,9,11,13,26,[33][34][35] Inaba et al 4 reviewed 500 trauma patients from 2002 and 2007 and noted significant increases in the number of CT scans and associated radiation, rising to a mean effective dose of 20.7 mSv in blunt trauma patients. During that time, no changes in hospital length of stay, mortality, or the number of missed injuries were seen.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported significant increases over time in the number of CT scans within the 24 hours of admission in trauma patients, despite no change in patient acuity as measured by Injury Severity Score (ISS), hospital length of stay, or mortality rates. 4,8,9 Radiography contributes substantially to current medical costs. Large radiation doses with CT scans have also been recently questioned, because CT scans account for .70% of radiation in a medical setting.…”

Section: Introductionmentioning

confidence: 99%

“…Large radiation doses with CT scans have also been recently questioned, because CT scans account for .70% of radiation in a medical setting. 2,4,[9][10][11][12][13][14][15] Although the diagnostic capabilities with advanced imaging are excellent, and the ease of availability of such tests has rapidly improved, consideration for balancing these benefits with the risks of radiation and monetary costs to the patient is warranted.…”

Section: Introductionmentioning

confidence: 99%

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Trends in Musculoskeletal Imaging in Trauma Patients

Vallier

Ahmadinia

Forde

et al. 2014

Journal of Orthopaedic Trauma

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The number of diagnostic imaging tests, radiation dose, and related charges in trauma patients increased over time at both trauma centers, with CT scans accounting for most of the radiation dose and costs. A shift toward more advanced imaging from conventional projection radiography was noted at both trauma centers. Effective dose per patient more than doubled over the course of study at center 1. By 2008, half of all radiographic studies were for musculoskeletal purposes. Previous studies have suggested an increased risk of cancer with exposures of 20-40 mSv, making the mean total radiation doses in excess of 30.0 mSv since 2005 of great concern. Variability in ordering patterns between the 2 centers with similar patient acuity suggests opportunity for discussion about indications for utilization, which could result in lower radiation doses and fewer expenses.

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Radiation exposure before and after the introductionof a dedicated total-body CT protocolin multitrauma patients

et al. 2013

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Total-body CT (TBCT) scanning in trauma patients is being increasingly used in trauma assessment. One of the major disadvantages of CT scanning is the amount of radiation exposure involved. The aim of this study was to assess the number of radiological investigations and their associated radiation exposure in multitrauma patients before and after the introduction of a total-body CT protocol as a primary diagnostic tool. The Trauma Registry was used to identify trauma patients admitted to our Level 1 trauma centre in 2008 (pre-TBCT protocol) and 2010 (post-TBCT protocol). Consecutive patients with an Injury Severity Score of ≥16 were included. Patients aged 16 or under, referrals from other hospitals and patients with specific low-energy injury mechanisms were excluded. Subsequent effective doses were estimated from literature and from dose calculations. Three hundred one patients were included, 150 patients pre- and 151 post-introduction of the TBCT protocol. Demographics were comparable. In 2008, 20 % of severely injured patients underwent total-body CT scan, compared with 46 % of the patients in 2010. Trauma room radiation doses for conventional radiographs were significantly higher in 2008, while doses for CT scans were significantly lower. The total effective dose of trauma room radiological investigations was 16 milliSieverts (mSv) in 2008 vs. 24 mSv in 2010 (P = 0.223). The overall effective dose during the total hospital admission was not significantly different between 2008 and 2010 (20 vs. 24 mSv, P = 0.509).In conlusion, after the introduction of a dedicated TBCT protocol, the TBCT rate was more than doubled. Although this increased the CT-induced trauma room radiation dose, the overall radiation dose throughout hospital admission was comparable between patients in 2008 and 2010.

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Analysis of radiation exposure to the orthopaedic trauma patient during their inpatient hospitalisation

Cited by 19 publications

References 29 publications

Conventional versus virtual radiographs of the injured pelvis and acetabulum

Conventional versus virtual radiographs of the injured pelvis and acetabulum

Trends in Musculoskeletal Imaging in Trauma Patients

Radiation exposure before and after the introductionof a dedicated total-body CT protocolin multitrauma patients

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