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; Andrew D Schneider; Matthew D Thomas; Joseph G Lyons; Daniel D Bohl; Jennifer L Jerele; Michael J Prayson

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

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

Authors

Fady Y Hijji¹, Andrew D Schneider¹, Matthew D Thomas¹, Joseph G Lyons¹, Daniel D Bohl², Jennifer L Jerele¹, Michael J Prayson¹

Affiliations

¹ Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton OH 45409, USA.
² Department of Orthopaedic Surgery, Rush University Medical Center, Chicago IL 60612, USA.

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.