Informing Patients About the Cancer Induction Risk of Undergoing Computed Tomography Imaging: The Radiographers' Perspective

Radiation risk-benefit communication during paediatric CT imaging: Experiences of radiographers at two public hospitals

INTRODUCTION

Radiation dose knowledge and effective communication skills are essential for both radiographers and radiologists to be able to appropriately fulfil their legal responsibilities to justify each medical exposure. Furthermore, they enable the optimisation of imaging protocols and techniques according to the child's characteristics and underlying clinical conditions. Previous studies have shown that radiographers do not provide paediatric patients and their parents/guardians with adequate information about doses and risks before a procedure. However, they have a legal responsibility to explain the radiation risk associated with performing the procedure as well as the associated risk of not performing the same procedure. There are several obstacles to describing ionizing radiation risk, including the ionizing radiation language that is not readily understood by non-imaging personnel. This study aimed to explore and describe the radiographers' experiences of radiation risk-benefit communication during paediatric CT imaging at two public hospitals. This is important to understand the effectiveness of the communication process and institute corrective action where shortcomings are evident.

METHODS

A qualitative, exploratory, descriptive research design was applied. The sample consisted of 12 purposively selected radiographers who were trained and working in the CT imaging department. Data were collected using face-to-face individual interviews. Tesch's 8 steps were used to analyse the data collected and generate themes and subthemes.

RESULTS

Two themes emerged from the data collected: (1)Positive experiences with two sub-themes (job satisfaction and mutual benefit) and (2) negative experiences with three sub-themes (.professional deprecation, ineffectual outcomes and communication impediments).

CONCLUSION

Positive experiences boosted radiographers' confidence and enhanced their participation in radiation risk-benefit communication with paediatric patients' parents and guardians while negative experiences hindered patient-centred care in the process of risk-benefit communication.

IMPLICATIONS FOR PRACTICE

Continuous education of radiographers and doctors on radiation risk-benefit communication before paediatric CT procedures is recommended, in line with their scope of practice, to improve patient-centred care.

Survey of the publics' preferences for communication of medical radiation risk. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022;42:021506. [PMID: 35042199 DOI: 10.1088/1361-6498/ac4c93]

To comply with the Ionising Radiations (Medical Exposures) Regulations 2017, patients need to be adequately informed of medical radiation risks prior to exposure. This study used a survey developed in partnership with patients and members of the public to explore patient preferences for radiation risk communication. It was distributed through social media between 28/4/2020 and 18/7/2020. All respondents (N= 376) wanted to be informed about radiation risk, though the threshold at which they wished to be informed varied. The current practice of displaying posters in waiting areas does not meet the expressed preference of the patients if used in isolation. Only 6% of respondents were satisfied with the commonly used statement that the 'risk is low' if used in isolation. The majority of respondents (73%) said they would not be concerned about an increase in the risk of cancer of less than 1 in 10 000. The level of risk at which patients express a concern and the methodology for risk communication has been evaluated and based on these findings, and pre-existing literature, a graded approach to radiation risk communication based on modality is proposed. Patients must be involved throughout the evolution of this practice.

Communicating Radiation Risk to Patients: Experiences Among Radiographers in Norway

INTRODUCTION

Risk communication related to radiation has become more important during the last decade. Informing patients of benefits, risks, and alternative imaging methods is necessary to make informed decisions. The purpose of this study was to investigate radiographers' knowledge of radiation dose and risk, and their experiences with radiation risk communication.

METHODS

This study used a qualitative approach using semi-structured interviews with clinical radiographers. The participants were presented with three authentic cases describing situations where risk communication is necessary. The interviews were audio-recorded, transcribed, and analyzed in four steps before the transcript interviews were coded and collected in meaningful themes. Participation was voluntary and participants signed an informed consent form.

RESULTS

Six radiographers from two hospitals took part in the study. The mean age was 34 years, their work experiences as radiographers varied from 3.5 to 30 years and with an equal number of women and men. The participants provided reflections on the cases, how they managed the patients' need for information, and how they dealt with concerned patients. They also reflected on the knowledge and skills needed to be confident with risk communication.

DISCUSSION

The participants were insecure of their knowledge of radiation dose and risk. They expressed difficulties with informing patients of radiation risk, without raising unnecessary concerns among the patients. When informing patients of the amount of radiation dose, they compared the dose in the examination to flights, background radiation, and the number of chest x-rays. The participants expressed challenges around radiation risk communication. All participants used the principle of justification in radiation risk communication.

CONCLUSION

This study shows that risk communication among radiographers is challenging, and the key challenge is the lack of knowledge of radiation doses and lack of experience in risk communication. There is a need for increased focus to and knowledge of radiation dose and risk, and radiation risk communication among radiographers working in clinical practice. This should be amplified in the education of radiographers, focusing on theoretical knowledge and skills such as reflection and critical thinking. This could cause radiographers to be confident and able to offer adequate information of doses and risks to the patients, so the patients can make an informed decision.

Radiation exposure awareness from patients undergoing nuclear medicine diagnostic 99mTc-MDP bone scans and 2-deoxy-2-(18F) fluoro-D-glucose PET/computed tomography scans

INTRODUCTION

Medical imaging is on average the largest source of artificial radiation exposure worldwide. This study seeks to understand patient's awareness of radiation exposure derived from nuclear medicine diagnostic scans and assess if current information provided by leaflets is adequate.

METHODS

Single-centre cross-sectional questionnaire study applied to bone scan and FDG PET/computed tomography patients, at a nuclear medicine and PET/computed tomography department over a 15-week period in 2018. Questionnaires on dose comparators were designed in collaboration with patients, public, and experts in radiation exposure. Qualitative data were analysed using thematic analysis and quantitative data using SPSS (V. 24).

RESULTS

A total of 102 questionnaires were completed (bone scan = 50; FDG PET/computed tomography = 52). Across both groups, 33/102 (32.4%) patients reported having a reasonable understanding of nuclear medicine and 21/102 (20.6%) reported a reasonable knowledge of ionising radiations. When asked to compare the exposure dose of respective scans with common comparators 8/50 (16%) of bone scan patients and 11/52 (21.2%) FDG PET/computed tomography answered correctly. On leaflet information, 15/85 (17.6%) patients reported the leaflets do not provide enough information on radiation exposure and of these 10/15 (66.7%) commented the leaflets should incorporate more information on radiation exposure dose.

CONCLUSION

More observational and qualitative studies in collaboration with patients are warranted to evaluate patients' understanding and preferences in communication of radiation exposure from nuclear medicine imaging. This will ensure communication tools and guidelines developed to comply with ionising radiation (medical exposure) regulation 2017 are according to patients needs and preferences.

Barriers to not informing patients about radiation in connection with radiological examinations: Radiographers' opinion

INTRODUCTION

In some instances, little knowledge regarding radiological examinations is provided to patients. The purpose was to investigate whether radiographers inform patients about radiation, and if not, the reasons for it.

METHODS

A questionnaire was sent to radiographers working in the public sector in Northern Finland. Radiographers were asked whether they had informed patients about the radiation dose and risks during the last year. If information was not provided, the reasons for it were investigated using multiple-answer type multiple-choice questions with the option for free text responses. The results were compared between a University Hospital and other departments and between different lengths of work experience. Altogether 174/272 (64%) radiographers responded to the questionnaire; 50% were from the University Hospital and 50% from other departments.

RESULTS

Altogether 103/174 (59%) respondents did not inform patients about the radiation dose and 93/174 (53%) did not inform them about the associated risks. Regarding a passive approach to dose information, respondents thought that the referrer had already informed the patient (49/103, 48%), information was not needed (51/103, 50%), or it might cause unnecessary fear (47/103, 46%). Reasons for a passive approach to risk information were similar (66/93, 71%; 33/93, 36%; 47/93, 51%, respectively). Regarding the results, there were no differences between the institutions or work experience levels. According to the open question, some radiographers expected patients to ask questions before informing them. Lack of time was rarely mentioned as a reason.

CONCLUSION

The main reasons for inadequate information were ignorance regarding responsibilities, assumption that information is not needed, and concern about causing unnecessary fear.

IMPLICATIONS FOR PRACTICE

Education, guidelines specifying responsibilities and contents for information, and easy-access digital educational material for public and professionals are needed.