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. 2023;14(4):294-301.
doi: 10.5847/wjem.j.1920-8642.2023.055.

Knowledge of radiation exposure associated with common trauma imaging modalities among orthopaedic surgeons, emergency medicine physicians, and general surgeons in the United States

Fady Y Hijji  1 , Andrew D Schneider  1 , Matthew D Thomas  1 , Joseph G Lyons  1 , Daniel D Bohl  2 , Jennifer L Jerele  1 , Michael J Prayson  1
Affiliations

Knowledge of radiation exposure associated with common trauma imaging modalities among orthopaedic surgeons, emergency medicine physicians, and general surgeons in the United States

Fady Y Hijji et al. World J Emerg Med. 2023.

Abstract

Background: Few contemporary studies have assessed physicians' knowledge of radiation exposure associated with common imaging studies, especially in trauma care. The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal (MSK) imaging studies routinely utilized in the trauma setting.

Methods: An electronic survey was distributed to United States orthopaedic surgery, general surgery, and emergency medicine (EM) residency programs. Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis, lumbar spine, and lower extremity, in terms of chest X-ray (CXR) equivalents. Physician estimates were compared to the true effective radiation doses. Additionally, participants were asked to report the frequency of discussing radiation risk with patients.

Results: A total of 218 physicians completed the survey; 102 (46.8%) were EM physicians, 88 (40.4%) were orthopaedic surgeons, and 28 (12.8%) were general surgeons. Physicians underestimated the effective radiation doses of nearly all imaging modalities, most notably for pelvic computed tomaography (CT) (median 50 CXR estimation vs. 162 CXR actual) and lumbar CT (median 50 CXR estimation vs. 638 CXR actual). There was no difference between physician specialties regarding estimation accuracy (P=0.133). Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure (P=0.007).

Conclusion: The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking. Further investigation with larger scale studies is warranted, and additional education in this area may improve care.

Keywords: Emergency department; Radiation dosage; Radiation exposure; Radiation protection; X-ray.

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Conflict of interest statement

Conflicts of interest: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Box plots of physician estimates of effective radiation dose from pelvic imaging compared with actual values from the literature. The black circles represent the actual values. Median and interquartile range (IQR) values for each imaging study are reported below the respective graph. A: pelvic X-ray (AP); B: hip X-ray (cross-table lateral); C: pelvic CT scan.
Figure 2
Figure 2
Box plots of physician estimates of effective radiation dose from lumbar spine imaging compared with actual values from the literature. The black circles represent the actual values. Median and interquartile range (IQR) values for each imaging study are reported below the respective graph. A: lumbar X-rays (two views); B: lumbar CT scan.
Figure 3
Figure 3
Box plots of physician estimates of effective radiation dose from lower extremity imaging compared with actual values from the literature. The black circles represent the actual values. Median and interquartile range (IQR) values for each imaging study are reported below the respective graph. A: femur X-ray (AP); B: ankle X-ray (AP); C: lower extremity CT scan.
See this image and copyright information in PMC

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