Wednesday, March 05, 2008

1000 X-rays

I have got to get a Wii! reviewed a study published in the Annals of Emergency Medicine which I find rather disturbing. It seems that if you are so unfortunate as to experience trauma and fortunate enough to make it to a trauma center alive, you will be the likely recipient of a "pan-scan" of the head, neck, chest, abdomen, and pelvis. At our local trauma center, we call it a "man-scan" with no offense to the ladies, and it generally includes a scan or two of the extremities as well as regular old radiographs of all areas in question. There is a lot to be said for this approach, as the victim of polytrauma will most certainly have multiple injuries, and CT is very good at ferreting them out. The man-scans can be very tedious to read: "There are minimally displaced fractures of the 3rd, 4th, 7th, 9th,10th, and 12th ribs on the right and......"

But use of this powerful tool has its price, and that is in terms of radiation, as well as the final bill. it seems that the average trauma patient is exposed to radiation equivalent to 1,005 chest x-rays, which is enough to raise the individual's risk of developing a malignancy later in life. While the average person in the US receives a dose of about 3 millisieverts (mSv) from environmental sources (radon, cosmic rays, friends with glowing personalities, etc.), the star of the trauma imaging show receives an average dose of 40 mSv, and gets it all at once.

What to do? The study's author suggests:
Possible options for reducing radiation exposure may include ordering fewer repeated imaging studies, using lower dose radiological imaging techniques and using alternative imaging methods that do not use radiation, such as ultrasound and magnetic resonance imaging.
I think that there also has to be a little cerebral activity injected into the decision process. It is all too easy to order a shotgun battery of tests as a knee-jerk response to a trauma situation, without completely evaluating if some components are necessary. I realize that I'm not on the front line here, so to speak, and the folks that order the tests are. Still, I think they have to be made aware of the fact that the "man-scan" might not be quite as benign as we would like to think.

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