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Distribution of radiation exposure in patients with partially stable and unstable pelvic ring fractures: first-time use of highly accurate assessment by Monte Carlo calculations

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Abstract

Purpose

Radiological examinations including X-ray and CT play a critical role in the assessment and treatment of trauma patients. The ionizing radiation used is known to be carcinogenic. However, little is known about the total radiation exposure in trauma patients. The objective of this study was to accurately estimate radiation exposure of patients with severe pelvic ring fractures.

Methods

In this retrospective dynamic cohort study, adult patients with partially stable and unstable pelvic ring fractures were included. For each patient, data concerning demography and injury characteristics were collected. Subsequently, the total effective radiation dose due to all trauma-related X-rays and CT scans during initial assessment, treatment and follow-up was calculated using Monte Carlo software.

Results

A total of 114 patients were included. The median total effective dose was 49.7 millisievert (mSv). 57 patients (50.0%) received more than 50 mSv and 13 patients (11.4%) received more than 100 mSv. 62.4% of the total effective dose was received within the 24 h after admission. The median total effective dose for survivors (n = 95) was 52.0 mSv. Polytrauma patients received a significantly higher total effective dose than non-polytrauma patients.

Conclusions

This study showed that a substantial number of patients with partially stable and unstable pelvic ring fractures have an increased cancer risk due to trauma-related medical imaging. Physicians should be aware of the amount of radiation their patients are exposed to, and minimize imaging related increase of cancer risks during initial assessment, treatment and follow-up.

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References

  1. Huber-Wagner S, Lefering R, Qvick L-M, et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373:1455–61. https://doi.org/10.1016/S0140-6736(09)60232-4.

    Article  PubMed  Google Scholar 

  2. Chan O. Primary computed tomography survey for major trauma. Br J Surg. 2009;96:1377–8. https://doi.org/10.1002/bjs.6881.

    Article  CAS  PubMed  Google Scholar 

  3. Wurmb TE, Frühwald P, Hopfner W, et al. Whole-body multislice computed tomography as the first line diagnostic tool in patients with multiple injuries: the focus on time. J Trauma. 2009;66:658–65. https://doi.org/10.1097/TA.0b013e31817de3f4.

    Article  PubMed  Google Scholar 

  4. Mohseni S, Talving P, Kobayashi L, Lam L, Inaba K, Branco BC, Oliver M, Demetriades D. The diagnostic accuracy of 64-slice computed tomography in detecting clinically significant arterial bleeding after pelvic fractures. Am Surg. 2011;77:1176–82.

    Article  Google Scholar 

  5. Dormagen JB, Tötterman A, Røise O, et al. Efficacy of plain radiography and computer tomography in localizing the site of pelvic arterial bleeding in trauma patients. Acta Radiol. 2010;51:107–16. https://doi.org/10.3109/02841850903286703.

    Article  PubMed  Google Scholar 

  6. National Clinical Guideline Centre (UK). Fractures (complex): assessment and management. London: National Clinical Guideline Centre; 2016.

    Google Scholar 

  7. American College of Surgeons (ACS), Trauma Quality Improvement Program (TQIP) best practices guidelines in imaging. 2018. p. 1–116. https://www.facs.org/quality-programs/trauma/tqp/center-programs/tqip/best-practice.

  8. Brenner DJ. Should we be concerned about the rapid increase in CT usage? Rev Environ Health. 2010;25:63–8.

    Article  Google Scholar 

  9. Lam DL, Larson DB, Eisenberg JD, et al. Communicating potential radiation-induced cancer risks from medical imaging directly to patients. Am J Roentgenol. 2015;205:962–70. https://doi.org/10.2214/AJR.15.15057.

    Article  Google Scholar 

  10. Mettler FA, Thomadsen BR, Bhargavan M, et al. Medical radiation exposure in the US in 2006: preliminary results. Health Phys. 2008;95:502–7. https://doi.org/10.1097/01.HP.0000326333.42287.a2.

    Article  CAS  PubMed  Google Scholar 

  11. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84. https://doi.org/10.1056/NEJMra072149.

    Article  CAS  PubMed  Google Scholar 

  12. Giannakopoulos GF, Saltzherr TP, Beenen LFM, et al. Radiological findings and radiation exposure during trauma workup in a cohort of 1124 level 1 trauma patients. Langenbecks Arch Surg. 2017;402:159–65. https://doi.org/10.1007/s00423-016-1515-z.

    Article  CAS  PubMed  Google Scholar 

  13. Tejwani NC, Raskolnikov D, McLaurin T, Takemoto R. The role of computed tomography for postoperative evaluation of percutaneous sacroiliac screw fixation and description of a “safe zone”. Am J Orthop. 2014;43:513–6.

    PubMed  Google Scholar 

  14. Gill K, Bucholz RW. The role of computerized tomographic scanning in the evaluation of major pelvic fractures. J Bone Jt Surg Am. 1984;66:34–9.

    Article  CAS  Google Scholar 

  15. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160:445–51. https://doi.org/10.1148/radiology.160.2.3726125.

    Article  CAS  PubMed  Google Scholar 

  16. Schmidt R, Wulff J, Kästner B, et al. Monte Carlo based calculation of patient exposure in X-ray CT-examinations. Curr Radiol Rep. 2009. https://doi.org/10.1007/978-3-540-89208-3_596.

    Article  Google Scholar 

  17. Long DJ, Lee C, Tien C, et al. Monte Carlo simulations of adult and pediatric computed tomography exams: validation studies of organ doses with physical phantoms. Med Phys. 2013;40:013901. https://doi.org/10.1118/1.4771934.

    Article  PubMed  Google Scholar 

  18. Kara U, Tekin HO. Estimatıon of absorbed dose distribution in different organs durıng the CT scan: Monte Carlo study. Austin J Radiol. 2017. https://doi.org/10.26420/austinjradiol.2017.1063.

    Article  Google Scholar 

  19. Hart D, Hillier MC, Wall BF. National reference doses for common radiographic, fluoroscopic and dental X-ray examinations in the UK. Br J Radiol. 2009;82:1–12.

    Article  CAS  Google Scholar 

  20. Hart B, Wall BF. Radiation exposure of the UK population from the medical and dental X-ray examinations. NRPB, March 2002. NRPB. Document W4 pp. 1–41. National Oxford

  21. Biswas D, Bible JE, Bohan M, et al. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Jt Surg. 2009;91:1882–9. https://doi.org/10.2106/JBJS.H.01199.

    Article  Google Scholar 

  22. Richards PJ, Summerfield R, George J, et al. Major trauma and cervical clearance radiation doses and cancer induction. Injury. 2008;39:347–56. https://doi.org/10.1016/j.injury.2007.06.013.

    Article  PubMed  Google Scholar 

  23. Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA. 2003;100:13761–6. https://doi.org/10.1073/pnas.2235592100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360. https://doi.org/10.1136/bmj.f2360.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Behnampour N, Hajizadeh E, Journal FZAP. Modeling of influential predictors of gastric cancer incidence rates in Golestan Province North Iran. Eprintsgoumsacir. 2014. https://doi.org/10.7314/APJCP.2014.15.3.1111.

    Article  Google Scholar 

  26. Huang W-Y, Muo C-H, Lin C-Y, et al. Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nation-wide population-based cohort study. Br J Cancer. 2014;110:2354–60. https://doi.org/10.1038/bjc.2014.103.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Berrington de González A, Mahesh M, Kim K-P, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071–7. https://doi.org/10.1001/archinternmed.2009.440.

    Article  PubMed  Google Scholar 

  28. Wrixon AD. New ICRP recommendations. J Radiol Prot. 2008;28:161–8. https://doi.org/10.1088/0952-4746/28/2/R02.

    Article  CAS  PubMed  Google Scholar 

  29. Lell MM, Wildberger JE, Alkadhi H, et al. Evolution in computed tomography: the battle for speed and dose. Invest Radiol. 2015;50:629–44. https://doi.org/10.1097/RLI.0000000000000172.

    Article  PubMed  Google Scholar 

  30. Ozdoba C, Slotboom J, Schroth G, et al. Dose reduction in standard head CT: first results from a new scanner using iterative reconstruction and a new detector type in comparison with two previous generations of multi-slice CT. Clin Neuroradiol. 2014;24:23–8. https://doi.org/10.1007/s00062-013-0263-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Chen MY, Shanbhag SM, Arai AE. Submillisievert median radiation dose for coronary angiography with a second-generation 320-detector row CT scanner in 107 consecutive patients. Radiology. 2013;267:76–85. https://doi.org/10.1148/radiol.13122621.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Maxfield MW, Schuster KM, McGillicuddy EA, et al. Impact of adaptive statistical iterative reconstruction on radiation dose in evaluation of trauma patients. J Trauma Acute Care Surg. 2012;73:1406–11. https://doi.org/10.1097/TA.0b013e318270d2fb.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Jakob C. F. Gunneweg.

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All authors (Jakob C.F. Gunneweg, Georgios F. Giannakopoulos, Wietse P. Zuidema, Niels A.A. Matheijssen, Ferco H. Berger) declare that they have no conflict of interest.

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Gunneweg, J.C.F., Giannakopoulos, G.F., Zuidema, W.P. et al. Distribution of radiation exposure in patients with partially stable and unstable pelvic ring fractures: first-time use of highly accurate assessment by Monte Carlo calculations. Eur J Trauma Emerg Surg 47, 1201–1209 (2021). https://doi.org/10.1007/s00068-019-01297-w

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  • DOI: https://doi.org/10.1007/s00068-019-01297-w

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