Diagnostic Yields, Charges, and Radiation Dose of Chest Imaging in Blunt Trauma Evaluations

Rodriguez, Robert M.; Baumann, Brigitte M.; Raja, Ali S.; Langdorf, Mark I.; Anglin, Deirdre; Bradley, Richard N; Medak, Anthony J.; Mower, William R.; Hendey, Gregory W.

doi:10.1111/acem.12396

Cited by 28 publications

(32 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even though CXR misses most SF, our findings do not necessarily advocate for increased chest CT utilization in blunt trauma-at least not for the purposes of solely identifying SF. Chest CT is much more expensive than CXR and delivers nearly a thousandfold the effective radiation dose to radiosensitive organs, with quantifiable resultant higher cancer risk [7,17]. SF diagnosis will continue to rise with increasing chest CT use.…”

Section: Discussionmentioning

confidence: 99%

“…Widely available, rapid CT has transformed diagnostic trauma evaluation with many centres adopting routine head-to-pelvis CT (pan-scan) for victims of major trauma [5][6][7][8]. Computed tomography has replaced X-ray as the imaging modality of choice for evaluation of patients with trauma.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have demonstrated that cervical spine CT diagnoses many more injuries than plain cervical spine radiographs, and recent literature suggests that chest CT similarly detects many more thoracic injuries, such as rib fractures and pulmonary contusions, than plain CXR. Given that sternal fracture is not readily seen on the single anterior-posterior view radiographs primarily used in trauma patients and the upsurge in chest CT use with much greater sensitivity for injury, it is likely that more sternal fractures -especially minor ones -are now being diagnosed [7][8][9][10][11][12][13]. Traditional teachings regarding diagnosis and management may therefore no longer apply with these minor SF diagnoses.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sternal fracture in the age of pan-scan

Perez¹,

Rodriguez²,

Baumann³

et al. 2015

Injury

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sternal fracture in the age of pan-scan

Perez¹,

Rodriguez²,

Baumann³

et al. 2015

Injury

Self Cite

View full text Add to dashboard Cite

“…20 The study found that only 6.9% (6.2%-7.7%) of chest CTs found a clinically significant injury. After calculating the effective dose of chest imaging, the authors determined that only one significant injury was found per 129 (101.4-217.4) mSv of radiation, suggesting that a substantial number of trauma investigations find no clinically significant injury.…”

Section: Discussionmentioning

confidence: 91%

Radiation Exposure From CT Scanning in the Resuscitative Phase of Trauma Care: A Level One Trauma Centre Experience

Beatty

Furey

Daniels

et al. 2015

CJEM

View full text Add to dashboard Cite

ObjectivesThe initial management of a trauma patient often involves imaging in the form of x-rays, computed tomography (CT) and other radiographic studies, which expose the patient to ionizing radiation, an entity known to cause tissue injury and malignancy at high doses. The purpose of this study was to use a calculation-based method to determine the radiation exposure of trauma patients undergoing trauma team activation in a Canadian tertiary-care trauma centre.MethodsA retrospective chart review was conducted using the Nova Scotia Provincial Trauma Registry. All patients age 16 years old and over who underwent trauma team activation between March 1, 2008 and March 1, 2009 were included. Patients who died prior to imaging tests were excluded. Dose reports for each CT were used to calculate a whole-body radiation dose for each patient.ResultsThere were 230 trauma team activations during the study period, of which 206 had CT imaging. Data were available for 162 patients. The mean whole-body radiation exposure for all patients was 24.4±10.3 mSv, which may correlate to one additional cancer death for every 100 trauma patients scanned.ConclusionsTrauma patients are exposed to significant amounts of radiation during their initial trauma work-up, which may increase the risk of fatal cancer. Clinicians who care for these patients must be aware of the radiation exposure, and take measures to limit radiation exposure of trauma patients.

show abstract

“…For instance, when performing after a normal chest radiograph, CT diagnoses only one major injury for every 67 studies (5). Rodriguez et al have designed a cohesive summary algorithm so-named NEXUS Chest X-ray, which consists of seven criteria (age >60 years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% [95% confidence interval (CI), 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6-14.0%) for detecting clinically significant injuries, reinforcing the efficacy of X-ray chest imaging in the evaluation of all blunt trauma patients (6).…”

Section: Review Articlementioning

confidence: 99%

Thoracic wall trauma—misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging

Tomás¹,

Facenda²,

Vaz³

et al. 2017

Quant. Imaging Med. Surg.

View full text Add to dashboard Cite

Blunt injuries to the chest wall are an important chapter on emergency room (ER) departments, being the third most common injuries in trauma patients which ominous complications could appear. This article describes different types of traumatic events affecting the chest wall, which maybe misdiagnosed with conventional X-ray. Special emphasis has been done in computed tomography (CT) and multidetector CT (MDCT) imaging. This technique is considered the "gold-standard" for those traumatic patients, due to its fast acquisition covering the whole area of interest in axial plane, reconstructing multiplanar (2D, 3D) volume-rendered images with a superb quality and angiographic CT capabilities for evaluating vascular damage. Complementary techniques such as ultrasonography (US) and magnetic resonance imaging (MRI) may improve the diagnostic accuracy due to its great capacity in visualising soft-tissue trauma (muscletendinous tears) and subtle fractures. All these imaging methods have an important role in quantifying the severity of chest wall trauma. The findings of this study have been exposed with cases of our archives in a didactic way.

show abstract

Diagnostic Yields, Charges, and Radiation Dose of Chest Imaging in Blunt Trauma Evaluations

Abstract: Background: Chest radiography (CXR) is the most common imaging in adult blunt trauma patient evaluation. Knowledge of the yields, attendant costs, and radiation doses delivered may guide effective chest imaging utilization.

Cited by 28 publications

References 26 publications

Sternal fracture in the age of pan-scan

Sternal fracture in the age of pan-scan

Radiation Exposure From CT Scanning in the Resuscitative Phase of Trauma Care: A Level One Trauma Centre Experience

Thoracic wall trauma—misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging

Contact Info

Product

Resources

About