Increasing Patient Purray In Trauma

At a level one trauma center multiple patients come in each day either unstable or unable to communicate what has happened to them. Doctors are forced to treat these patients and potentially save their lives based on what they can see in front of them. Since the doctors have limited information, they have to base the patient’s treatment off their physical exam, blood pressure, oxygen saturation, pulse, breath sounds and numerous other medical practices. But that still leaves them with limited information about this patient’s condition, so what do they rely on? Diagnostic imaging, to quickly see the patient’s status and are able to provide lifesaving care. Radiography plays a critical role in the patients care, and it allows doctors to view
inside the patient’s body. With the fear of missing an injury, doctors put patients through extensive exams, but an increased risk of patient dose.
Do the benefits from these exams outweigh the potential hazardous effects of increased patient dose? In a typical trauma procedure the patient is brought in and assessed. Then we immediately do an x-ray of their chest and pelvis while they are still in the trauma bay. The chest x-ray is the standard test for diagnosis of trauma patients in the emergency department. A chest x-ray can show pneumothorax, pleural effusion, atelectasis, and many other pathologies that would need attention right away. A pelvis x-ray in trauma patients is needed to prevent a delay in recognition of major pelvic fractures, dislocations, and potential pelvic bleeding. Once the patient is stabilized they are then taken to CT for trauma imaging. Your typical trauma scans for CT are of the head, neck, chest, abdomen, and pelvis.1 After the patient is brought back to the trauma bay from CT, we immediately begin imaging of their extremities. It is not uncommon for a trauma patient to have an entire leg
or arm examined (Ex. Hip, femur, knee, tib-fib, ankle, and foot) if there is an abrasion or suspected fracture. In polytrauma patients there is often suspected fractures in more than one location. If a major fracture is present, the bone must be reduced and casted. The patient is then examined again to verify that the bone is aligned. Typically within a couple of hours after a trauma patient’s arrival to the emergency room they have already been through numerous exams. We also have to account for the fact that these patients will require repeat images throughout their hospitalization to check the progress of their recovery. This then raises the concern of what kind of dose is the patient receiving and is this necessary for the patient care. “The most crucial point is the early identification of patients with suspicion of severe injuries that will benefit from CT scanning as the indiscriminate use for patients with minor injuries can cause serious radiation overdose and is not justified”2 Dose is a general term used to express how much radiation exposure a person receives.
Although there is no specific dose limits set for patient dose, we will compare the recommend occupational doses to the average dose from each exam. According to the National Council on Radiation Protection and Measurements (NCRP) the annual occupational dose should not exceed 50 milisievert (mSv.) To help put in perspective how much a milisievert is we receive approximately 3 mSv each year from natural radiation such as the sun and radon. The average dose for a typical chest x-ray is .08 mSv, pelvis- .7 mSv , CT head- 2 mSv , CT chest 8 mSv, CT Abdomen and Pelvis- 10 mSv , extremities and joints- 7days).3 As stated before doctors use diagnostic imaging to help tell the story of the patient and to check for injures that require immediate care. For example, patient X comes into the ER as a MVC and is complaining of serve chest pain and difficulty breathing. The doctors request a chest x-ray immediately after assessing the patient. The x-ray is taken and doctors can see that the patient has several broken ribs and a pneumothorax requiring a chest tube. Within minutes the patients care is accelerated. With the current advances in mobile radiology the technologist can come to the patient in the trauma bay, which will require less movement of the patient. Doctors can see the images seconds after the x-ray is taken and without leaving the patients side. In extreme cases it can be the difference
in getting additional imaging from CT or immediately taking the patient to the operating room.
Because there is always a risk when being exposed to radiation technologist must be fast, accurate, and still produce good quality images. While following ALARA, as low as reasonably achievable. Technologists must reduce the exposure to the lowest amount possible while still providing quality images. Technologist undergo special training for trauma radiography. A suspected fracture still requires quality images, even for a trauma patient. For example, if humerus films are needed, but there is a suspected fracture, technologist are trained to do special trauma views (transthoracic, cross-table lateral, etc.,).
In conclusion, when you’re a trauma patient time is life. The benefits of knowing what is happening inside a patient’s body for immediate care far outweighs the risk from the radiation. Even when knowing that multiple images will be taken due to casting or later manipulation. That is why it is so important for technologist to have proper training in trauma radiography and ALARA. Diagnostic imaging is the best way to see the patient’s status and be able to provide live saving care.