Analysis of radiation exposure to the orthopaedic trauma patient during their inpatient hospitalisation

Purpose: There has been considerable concern regarding radiation exposure to both the patient and treating surgeon and the possible risk of resulting malignancy. We sought to analyse the total effective dose of radiation that a cohort of orthopaedic trauma patients are exposed to during their inpatient hospitalisation and determine risk factors for greater exposure levels.

Methods: Following approval from the Institution Review Board, a search was conducted of a level I trauma centre database for radiation exposures to patients over a 1 year period. Patients were included if they had an ICD-9 code from 805 to 828, indicating a fracture involving the trunk (805-811) or extremities (812-828). We compared the total effective radiation dose in various injury patterns as well as those considered to be polytrauma patients to those who were not according to their injury severity score (ISS).

Results: The records of 1357 trauma patients were available for review. The average patient age was 40.6 years and the mean ISS was 14.1. The average effective radiation dose for all patients during their hospitalisation was 31.6 mSv. There was a statistically significant difference in radiation exposure between patients with an ISS greater than 16 (48.6 mSv) versus those with an ISS equal to or less than 16 (23.5 mSv), p<0.001. Patients with spine trauma can be expected to get more than 15 mSv more radiation than non-spine patients, p<0.001. Extremity injuries received the least amount of radiation, spine only patients were next, then finally spine and extremity injury patients had the greatest exposures. Having a spine fracture, a pelvic fracture, a chest wall injury, or a long bone fracture were all risk factors for having more than 20 mSv of effective dose exposure. Patients under the age of 18 years did receive less radiation than the remainder of the cohort, p<0.001.

Conclusions: The average orthopaedic patient receives a total effective radiation dose of more than 30 mSv, much greater than is considered acceptable as a recommended permissible annual dose by the International Commission on Radiological Protection (20 mSv). These findings indicate that the average trauma patient (in particular those with polytrauma or fractures involving the spine, pelvis, chest wall, or long bones) is exposed to high levels of radiation during their inpatient hospitalisation. The treating physicians of such patients should take into consideration the large amounts of radiation their patients receive just during their initial hospitalisation, and be prudent with the ordering of imaging studies involving radiation exposure.