World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (4): 294-301.doi: 10.5847/wjem.j.1920-8642.2023.055
• Original Article • Previous Articles Next Articles
Fady Y. Hijji1, Andrew D. Schneider1, Matthew D. Thomas1, Joseph G. Lyons1(), Daniel D. Bohl2, Jennifer L. Jerele1, Michael J. Prayson1
Received:
2022-08-29
Accepted:
2023-02-02
Online:
2023-06-30
Published:
2023-07-01
Contact:
Joseph G. Lyons
E-mail:joseph.g.lyons@wright.edu
Fady Y. Hijji, Andrew D. Schneider, Matthew D. Thomas, Joseph G. Lyons, Daniel D. Bohl, Jennifer L. Jerele, Michael J. Prayson. Knowledge of radiation exposure associated with common trauma imaging modalities among orthopaedic surgeons, emergency medicine physicians, and general surgeons in the United States[J]. World Journal of Emergency Medicine, 2023, 14(4): 294-301.
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URL: http://wjem.com.cn/EN/10.5847/wjem.j.1920-8642.2023.055
Table 1.
Physician characteristics (n=218)
Variables | Number | Percent |
---|---|---|
Specialty | ||
Orthopaedic surgery | 88 | 40.4% |
Resident | 60 | |
Attending | 28 | |
Emergency medicine | 102 | 46.8% |
Resident | 80 | |
Attending | 22 | |
General surgery | 28 | 12.8% |
Resident | 27 | |
Attending | 1 | |
Years in practice | ||
≤5 | 164 | 75.2% |
6-10 | 11 | 5.1% |
>10 | 43 | 19.7% |
Fellowship trained | ||
No | 187 | 85.8% |
Yes | 31 | 14.2% |
Resident education* | ||
Not involved | 0 | 0.0% |
Involved | 51 | 100.0% |
Practice setting | ||
Academic | 118 | 54.1% |
Community | 32 | 14.7% |
Mixed | 68 | 31.2% |
Region | ||
East Coast | 83 | 38.1% |
Midwest | 94 | 43.1% |
West Coast | 41 | 18.8% |
Population | ||
Greater than 3 million | 17 | 7.8% |
1-3 million | 55 | 25.2% |
300,000-1 million | 84 | 38.5% |
100,000-300,000 | 49 | 22.5% |
20-100,000 | 13 | 6.0% |
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.
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.
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.
Table 2.
Accuracy of radiation dose estimates by physician characteristics (n=218)
Variables | Error index* (Mean/Median) | P-valuea |
---|---|---|
Specialty | 0.133 | |
Orthopedic surgery | 997.3/1,007.6 | |
Non-orthopedic surgeryb | 1,118.4/932.9 | |
Years in practice | 0.429 | |
≤10 | 1,035.1/954.9 | |
>10 | 1,093.3/995.6 | |
Fellowship trained | 0.109 | |
No | 1,028.8/950.4 | |
Yes | 1,151.9/1,009.4 | |
Practice setting | 0.526 | |
Academic | 1,027.6/952.6 | |
Community | 1,016.0/994.4 | |
Mixed | 1,093.0/1,000.8 | |
Region | 0.945 | |
East Coast | 1,009.2/952.5 | |
Midwest | 1,116.3/995.9 | |
West Coast | 960.4/952.9 | |
Population | 0.076 | |
>300,000 | 1,030.5/952.6 | |
≤300,000 | 1,086.1/1,011.4 | |
Radiation consideration | 0.928 | |
≤50% | 991.1/1,009.4 | |
>50% | 1,136.4/1,003.9 | |
Thyroid shield use | 0.179 | |
≤50% | 996.0/1,028.1 | |
>50% | 1,119.7/1,003.2 | |
Leaded eye wear use | 0.576 | |
≤50% | 1,116.8/1,005.1 | |
>50% | 1,057.7/1,013.9 | |
Discussion of radiation with imaging | 0.098 | |
≤50% | 1,060.8/977.5 | |
>50% | 911.6/903.9 | |
Discussion of radiation with procedures | 0.007 | |
≤50% | 1,076.3/992.4 | |
>50% | 896.0/852.4 | |
Patient declinec | 0.982 | |
No | 1,098.9/927.4 | |
Yes | 1,022.4/968.9 |
Table 3.
Physician radiation consideration and disclosure (n=218)
Questions | Number | Percent* |
---|---|---|
How frequently do you consider radiation exposure when using fluoroscopy? | ||
Always | 63 | 51.6% |
Most of the time | 35 | 28.7% |
About half of the time | 7 | 5.7% |
Sometimes | 16 | 13.1% |
Never | 1 | 0.8% |
N/A | 96 | |
How frequently do you wear a thyroid shield when using fluoroscopy? | ||
Always | 70 | 56.0% |
Most of the time | 41 | 32.8% |
About half of the time | 4 | 3.2% |
Sometimes | 5 | 4.0% |
Never | 5 | 4.0% |
N/A | 93 | |
How frequently do you wear leaded eye wear when using fluoroscopy? | ||
Always | 9 | 7.4% |
Most of the time | 8 | 6.6% |
About half of the time | 6 | 4.9% |
Sometimes | 14 | 11.5% |
Never | 85 | 69.7% |
N/A | 96 | |
How frequently is your ability to wear lead affected limited availability in the hospital? | ||
Always | 8 | 5.7% |
Most of the time | 15 | 10.6% |
About half of the time | 9 | 6.4% |
Sometimes | 56 | 39.7% |
Never | 53 | 37.6% |
N/A | 77 | |
When recommending a patient undergo imaging, how often do you discuss radiation with the patient? | ||
Always | 2 | 0.9% |
Most of the time | 19 | 8.7% |
About half of the time | 31 | 14.2% |
Sometimes | 125 | 57.3% |
Never | 41 | 18.8% |
N/A | 0 | |
When discussing risk/benefits of a procedure, how often do you discuss radiation risk with the patient? | ||
Always | 3 | 1.4% |
Most of the time | 33 | 15.1% |
About half of the time | 20 | 9.2% |
Sometimes | 96 | 44.0% |
Never | 66 | 30.3% |
N/A | 0 | |
Has a patient ever declined to undergo imaging because they did not want the radiation? | ||
No | 68 | 31.2% |
Yes | 150 | 68.8% |
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