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

doi:10.5847/wjem.j.1920-8642.2023.055

Abstract

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.

Key words: Radiation dosage, Radiation exposure, Radiation protection, X-ray, Emergency department

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.

Figures/Tables 6

Table 1.

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Table 2.

Table 3.

References 33

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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%

Variables	Error index* (Mean/Median)	P-value^a
Specialty		0.133
Orthopedic surgery	997.3/1,007.6
Non-orthopedic surgery^b	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 decline^c		0.982
No	1,098.9/927.4
Yes	1,022.4/968.9

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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