Most major trauma patients are transported to the trauma center on a backboard. And nearly all of them get at least a chest x-ray, and possibly a pelvis x-ray. But do the backboard and x-rays mix?
There seems to be a debate in our ED about the quality of x-rays obtained through a backboard. This has led to a push to hold the x-ray until the patient has been rolled and the board removed. Unfortunately, since we must wait and actually view the image before transporting the patient, this can lead to a delay in leaving the resuscitation room.
So what’s the problem? Most backboards are made of plastic these days, with very few metal parts. Even the strap buckles are usually plastic. And plastic is, for the most part, transparent to x-rays. Yes, if the board is thick it may lighten the image a bit. And if there are cutouts in it, they may show as darker areas. However, they tend to have smooth and regular borders that are easily distinguished from structures in the human body.
Bottom line: The densities and irregularities in backboards do not significantly degrade x-ray images. Remember, you are looking for large collections of air (pneumothorax) or fluid (hemothorax) in the chest, and major bony disruption in the pelvis. These are easily seen through a backboard, or even if parts of the body are off the edge of the image. Don’t wait to get those x-rays, have them done as early as possible so you can view them and move on to the next phase of care.