8 trends in orthopedic trauma imaging

The retrospective multicenter study includes two level 1 trauma centers were 500 patients per year were reviewed in 2002, 2005 and 2008. The researchers found:

1. Most images were performed within 23 hours of the initial injury.

2. Patients who underwent CT scans increased over the years. In 2002, just 15 percent of all radiographic studies were CT scans, compared with 33 percent in 2008.

3. Musculoskeletal CTs also increased over time. In 2002, 26 percent were musculoskeletal CTs, compared with 49 percent in 2008. At the same time, there was no change in patient acuity.

4. Average effective dose per patient through the years was:

•    2002: 17.3 millisieverts
•    2005: 30 mSv
•    2008: 34.1 mSv

At the same time, the percentage of the total doses attributable to musculoskeletal studies increased throughout the years:

•    2002: 25 percent
•    2005: 29 percent
•    2008: 31 percent

5. The average total charges per patient increased significantly over time. In 2002, the average charge was $4,529 per patient; in 2005 the average charge increased to $6,922. By 2008, the average charge was up again to $7,750.

6. The surgeons at one center ordered more CT scans in 2008, and that center had higher charges than the other: $8,694 per patient compared with $6,806. Although the cases at both centers were similar acuity, the variation in CT scans "suggests opportunity for discussion about indications for utilization which could result in lower radiation doses and fewer expenses," concluded the study authors.

7. Both centers had a shift toward more advanced imaging from the conventional projection radiography.

8. Previous studies suggest increased cancer risk when patients are exposed to 20 mSv to 40 mSv, which makes the high mSv levels since 2005 concerning.

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