Inpatient radiation exposure in patients with spinal trauma

Abstract

Context/objective: Radiation exposure from medical imaging is an important patient safety consideration; however, patient exposure guidelines and information on cumulative inpatient exposure are lacking. Design/setting: Trauma patients undergo numerous imaging studies, and spinal imaging confers a high effective dose; therefore, we examined cumulative effective radiation dose in patients hospitalized with spinal trauma. We hypothesized that people with spinal cord injury (SCI) would have higher exposures than those with spine fractures due to injury severity. Particpants/interventions: Retrospective data were compiled for all patients with spine injuries admitted to a level I trauma center over a 2-year period. Outcome measures: Injury severity score (ISS) and cumulative radiation exposure were then determined for these patients, including 406 patients with spinal fractures and 59 patients with SCI. Results: Cumulative effective dose was 45 millisieverts (mSv) in SCI patients, compared to 38 mSv in spinal fracture patients (P = 0.01). Exposure was higher in patients with an ISS over 16 (P = 0.001). Mean exposure in both groups far exceeded the European annual occupational exposure maximum of 20 mSv. More than one-third of patients with SCI exceeded the US occupational maximum of 50 mSv. Conclusion: Patients with SCI had significantly higher radiation exposure and ISS than those with spine fracture, but the effective dose was globally high. Dose did not correlate with injury severity for patients with SCI. While the benefits of imaging are clear, radiation exposure does involve risk and we urge practitioners to consider cumulative exposure when ordering diagnostic tests.

Tables for effective dose assessment from diagnostic radiology (period 1946–1995) in epidemiologic studies

“…The ICRP declares that the effective dose is somewhat limited for individual risk measurements [ 21 ]. Nevertheless, it is often used to calculate the radiation risk of subjects in prospective as well as retrospective studies [ 34 – 37 ]. A more precise way would be considering the organ doses, but often it is impossible to get the dose values of the respective organs for the particular examinations.…”

Radiation Exposure in Patients with Isolated Limb Trauma: Acceptable or Are We Imaging Too Much?

“…Similar CED for spinal trauma was described by Martin et al (2013), who investigated the CED of 406 patients with spinal fractures, of whom 59 had a spinal cord injury (SCI). Patients’ with SCI had a mean CED of 45 mSv compared to 38 mSv in those with spinal fractures [ 10 ].…”

“…Current literature reports that patients are being exposed to levels greater than 20 mSv. These studies include all trauma involving the axial skeleton, thereby including the most radiosensitive tissues [ 10 , 11 , 12 ]. There is limited research investigating radiation exposure of patients with orthopaedic extremity trauma.…”

Multi-detector CT imaging: impact of virtual tube current reduction and sparse sampling on detection of vertebral fractures

“…However, clearly higher estimated effective doses of 5.6 mSv for the lumbar and 10.0 mSv for the whole dorsal spine in CT compared with radiography result in a considerably increased risk of developing cancer later in life [ 7 – 9 ]. Importantly, cancer risks are summative, and radiography or CT performed for initial diagnostics are not the only sources of radiation exposure, with a patient suffering from an acute traumatic vertebral fracture being exposed to a cumulative effective dose of about 38 mSv only during inpatient stay and without taking into account later follow-up imaging [ 32 ]. Consequently, reduction of CT-related radiation exposure is necessary, but should ideally be achieved without loss of image quality or diagnostic accuracy.…”