Do physicians abuse radiation in the emergency department?

Background: The use of radiological investigation is an accepted part of medical practice. However, there is no known safe radiation dose. Man-made radiation accounts for 13% of total radiation burden, 90% of it is due to diagnostic medical exposure. The most significant studies of the effects of radiation came from the lifetime study of the approximately 90,000 survivors of the atomic bombs dropped over Hiroshima and Nagasaki in 1945. These studies considered survivors who received whole-body doses from photons and neutrons in excess of 2.5 mSv as population liable for excess cancers. These survivors include those who were 900 to 1,500 meters away from the "hypocenter," just below the exploding bomb. Objectives: The aim of this study is to make a comparison between the whole-body doses of radiation received by the survivors of Hiroshima and Nagasaki and the dose received by patients from diagnostic radiological examinations in the first day of admission to the ER department. Materials and methods: In the period 19^th October 2008 to 25 ^th November 2008, 273 blunt trauma patients with a revised trauma score of <10 were studied prospectively in the emergency department of Al Basher Teaching Hospital, Amman, Jordan. 188 patients (68.87%) were male, 85 (31.13%) were female. Age range was from < 1year to 95 years (mean age 18.06 years). On admission, a detailed history and physical examination were undertaken. The doses of radiation in millisieverts (mSv) received by patients from radiological examination performed during the first day of admission were calculated. Results: Range of radiological examinations per patient was 1-14 (mean 4.63). Positive findings in these examinations were found in 27.83% (76 patients), the findings were negative in 72.17% (197 patients). Dose of radiation received by patients ranged between 0.1 and 18.5 millisieverts (mean 3.52 millisieverts). 41.76% of patients (114) received >2.5 millisieverts (similar to the dose of radiation received by survivors of the atomic bombs dropped over Hiroshima and Nagasaki), and are considered as liable for excess cancers. 58.24% of them (159 patients) received <2.5 millisieverts. The additional risk for cancer ranges between 0.001% and 0.731% (a mean of 0.060%). Conclusion: Patients are receiving an unusually high dose of radiation for diagnostic purposes. This brings an unacceptable additional risk of cancer for the patients.