Diagnostic Radiation Exposure of Injury Patients in the Emergency Department: A Cross-Sectional Large Scaled Study

Je Sung You,Yong Eun Chung,Hye Sun Lee,Sung Phil Chung,Hye-Jeong Lee,Myeong-Jin Kim,Incheol Park,Myo Jeong Kim,Ki Whang Kim,Suminori Akiba

doi:10.1371/journal.pone.0084870

Abstract

In contrast to patients with underlying cancer or chronic disease, injury patients are relatively young, and can be expected to live their natural lifespan if injuries are appropriately treated. Multiple and repeated diagnostic scans might be performed in these patients during admission. Nevertheless, radiation exposure in injury patients has been overlooked and underestimated because of the emergent nature of such situations. Therefore, we tried to assess the cumulative effective dose (cED) of injury patients in the emergency department. We included patients who visited the emergency department (ED) of a single tertiary hospital due to injury between February 2010 and February 2011. The cED for each patient was calculated and compared across age, sex and injury mechanism. A total of 11,676 visits (mean age: 28.0 years, M:F = 6,677:4,999) were identified. Although CT consisted of only 7.8% of total radiologic examinations (n=78,025), it accounted for 87.1% of the total cED. The mean cED per visit was 2.6 mSv. A significant difference in the cED among injury mechanisms was seen (p<0.001) and patients with traffic accidents and fall down injuries showed relatively high cED values. Hence, to reduce the cED of injury patients, an age-, sex- and injury mechanism-specific dose reduction strategy should be considered.

Highlights

Diagnostic X-ray imaging, including conventional radiography, computed tomography (CT) and nuclear medicine, have played major roles in screening, diagnosis and monitoring of treatment response in the evaluation of disease
The number of CT scans was relatively small compared to conventional radiography, most of the cumulative effective dose (cED) of injury patients resulted from CT
In patients who were less than 15 years old, the most common injury mechanism was slip down injury, and most of the cED resulted from head CT scanning

Summary

Introduction

Diagnostic X-ray imaging, including conventional radiography, computed tomography (CT) and nuclear medicine, have played major roles in screening, diagnosis and monitoring of treatment response in the evaluation of disease. A large-scale retrospective cohort study demonstrated an increased incidence of leukemia and brain tumors in patients who received low-dose radiation during childhood: cumulative dosages of 50 mGy and 60 mGy might triple the risk of leukemia and brain tumors, respectively [9]. Populations in these studies included a high proportion of relatively older patients or patients who had underlying cancer or chronic disease, and as a result, the expected residual lifespan was relatively short

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