Radiation Doses Among Blunt Trauma Patients: Assessing Risks and Benefits of Computed Tomographic Imaging
William R. Mower
Annals of Emergency Medicine - August 2008 (Vol. 52, Issue 2, Pages 99-100, DOI: 10.1016/j.annemergmed.2008.01.337)
Here's one:
Mower article link
Study objective: Many emergency departments and trauma centers utilize extensive radiologic studies during the assessment of trauma patients. A point of concern arises about the possible biological effects of these cumulative radiation doses. The objective of this study is to determine the amount of ionizing radiation received by adult blunt trauma patients at a Level I trauma center during the first 24 hours of their care.
Methods: This nonconcurrent case series reviewed the first 100 consecutive adult blunt trauma patients who presented to a Level I trauma center in 2006. All patients met hospital standards for the less acute major triage criteria. Individual radiation dose reports calculated by the computed tomography (CT) scanner were used to determine the radiation doses from each CT procedure. Standardized tables were used to determine radiation dose for plain radiographs. The median effective dose of radiation (millisieverts) was calculated for the first 24 hours of hospitalization.
Results: A total of 100 eligible patients presented between January 1, 2006, and March 20, 2006. Eighty-six patients had complete radiologic records available. The median age was 32 years, with an intraquartile range of 23 to 46 years; the median Injury Severity Score was 14, with an intraquartile range of 9 to 29; and the median number of CT scans was 3, with an intraquartile range of 3 to 4. The median effective total dose of ionized radiation was 40.2 mSv, with an intraquartile range of 30.5 to 47.2 mSv. A dose of 40.2 mSv is the equivalent of approximately 1,005 chest radiographs.
Conclusion: Trauma patients meeting the less acute major triage criteria are exposed to clinically important radiation doses from diagnostic radiographic imaging during the first 24 hours of their care. [Ann Emerg Med. 2008;52:93-97.]
What is already known on this topic
Computed tomography (CT) is increasingly used in the routine evaluation of trauma patients. Ionizing radiation from CT can increase lifetime cancer risk, especially in the very young.
What question this study addressed
The radiation exposure incurred during the first 24 hours by blunt trauma patients at a single trauma center.
What this study adds to our knowledge
The median number of CT scans was 3, and the median total dose was 40.2 mSv, equivalent to 1000 chest radiographs. CT of the chest-abdomen-pelvis contributed the greatest radiation doses of all scans and radiographs.
How this might change clinical practice Although radiographic studies are an important part of
the trauma evaluation, they should be used judiciously, with the goal of minimizing the patient's exposure to ionizing radiation.
Damned if you do and damned if you don't.
