Patient information regarding medical radiation exposure is inadequate: Patients' experience in a university hospital

Automated Measurement of Effective Radiation Dose by 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

BACKGROUND/OBJECTIVES

Calculating the radiation dose from CT in 18F-PET/CT examinations poses a significant challenge. The objective of this study is to develop a deep learning-based automated program that standardizes the measurement of radiation doses.

METHODS

The torso CT was segmented into six distinct regions using TotalSegmentator. An automated program was employed to extract the necessary information and calculate the effective dose (ED) of PET/CT. The accuracy of our automated program was verified by comparing the EDs calculated by the program with those determined by a nuclear medicine physician (n = 30). Additionally, we compared the EDs obtained from an older PET/CT scanner with those from a newer PET/CT scanner (n = 42).

RESULTS

The CT ED calculated by the automated program was not significantly different from that calculated by the nuclear medicine physician (3.67 ± 0.61 mSv and 3.62 ± 0.60 mSv, respectively, p = 0.7623). Similarly, the total ED showed no significant difference between the two calculation methods (8.10 ± 1.40 mSv and 8.05 ± 1.39 mSv, respectively, p = 0.8957). A very strong correlation was observed in both the CT ED and total ED between the two measurements (r2 = 0.9981 and 0.9996, respectively). The automated program showed excellent repeatability and reproducibility. When comparing the older and newer PET/CT scanners, the PET ED was significantly lower in the newer scanner than in the older scanner (4.39 ± 0.91 mSv and 6.00 ± 1.17 mSv, respectively, p < 0.0001). Consequently, the total ED was significantly lower in the newer scanner than in the older scanner (8.22 ± 1.53 mSv and 9.65 ± 1.34 mSv, respectively, p < 0.0001).

CONCLUSIONS

We successfully developed an automated program for calculating the ED of torso 18F-PET/CT. By integrating a deep learning model, the program effectively eliminated inter-operator variability.

Risk management of radioiodine treatment in differentiated thyroid cancer

INTRODUCTION

Patient safety is paramount in providing quality healthcare and constitutes a global concern for healthcare systems. Radioiodine treatment to patients with well-differentiated thyroid cancer is not without risks. The aim of this study is to identify, evaluate and mitigate the risks associated with this procedure.

MATERIALS AND METHODS

A single-centre descriptive study was conducted in which risk management was carried out by establishing a risk map using FMEA methodology.

RESULTS

Based on the process map 6 sub-processes and 23 failure modes in the three phases of the treatment process were analysed. According to risk priority number (RPN), the sub-process with the highest risk was administrative management (RPN 82), followed by treatment per se and post-treatment imaging (both with RPN 70). An overall process RPN of 300 (156 pre-treatment, 74 treatment and 70 post-treatment) was obtained. Failures directly related to the patient pose a high risk. The implementation of verification systems, performing tasks earlier and providing quality medical information are the most relevant preventive measures to be implemented.

CONCLUSIONS

The application of the FMEA methodology in the risk management for radioiodine treatment is a valuable tool for improving the quality and safety of this process. The risk map has been able to identify failures at different stages, assess their causes and effects, prioritise the risks identified and implement preventive and corrective measures that can be monitored, ensuring the effectiveness of the actions taken.

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.

Emerging Issues Questioning the Current Treatment Strategies for Lumbar Disc Herniation

Lumbar disc herniation is among the common phenotypes of degenerative lumbar spine diseases, significantly affecting patients' quality of life. The practice pattern is diverse. Choosing conservative measures or surgical treatments is still controversial in some areas. For those who have failed conservative treatment, surgery with or without instrumentation is recommended, causing significant expenditures and frustrating complications, that should not be ignored. In the article, we performed a literature review and summarized the evidence by subheadings to unravel the cons of surgical intervention for lumbar disc herniation. There are tetrad critical issues about surgical treatment of lumbar disc herniation, i.e., favorable natural history, insufficient evidence in a recommendation of fusion surgery for patients, metallosis, and implant removal. Firstly, accumulating evidence reveals immune privilege and auto-immunity hallmarks of human lumbar discs within the closed niche. Progenitor cells within human discs further expand the capacity with the endogenous repair. Clinical watchful follow-up studies with repeated diagnostic imaging reveal spontaneous resolution for lumbar disc herniation, even calcified tissues. Secondly, emerging evidence indicates long-term complications of lumbar fusion, such as adjacent segment disease, pseudarthrosis, implant failure, and sagittal spinal imbalance, which get increasing attention. Thirdly, systemic and local reactions (metallosis) for metal instrumentation have been noted with long-term health concerns and toxicity. Fourthly, the indications and timing for spinal implant removal have not reached a consensus. Other challenging issues include postoperative lumbar stiffness. The review provided evidence from a negative perspective for surgeons and patients who attempt to choose surgical treatment. Collectively, the emerging underlying evidence questions the benefits of traditional surgery for patients with lumbar disc herniation. Therefore, the long-term effects of surgery should be closely observed. Surgical decisions should be made prudently for each patient.

The need to increase patient awareness of radiation exposure in imaging modalities: A study on the awareness and attitude of patients

BACKGROUND

A decline in requests for unnecessary imaging can be achieved through increased patient awareness about imaging modalities and can thus reduce radiation exposure. This study aimed to evaluate patient awareness and attitude about radiation exposure in various imaging modalities.

METHODS

This cross-sectional study was performed on 900 patients and used a 12-item questionnaire, of which 824 were fulfilled and analyzed. Statistical analysis was done using SPSS software version 18.

RESULTS

The age of respondents ranged from 18-82; most participants were male (71.5%). The highest patient-estimated radiation exposures were for radiology, CT scans, and mammography. More than 20% of individuals believed that ionizing radiation (IR) is used in MRI, and 60% stated that IR is not used in mammography. Results show a significant statistical difference between attitude and behavior of respondents on the question about knowing who to address questions to in regard to amount of radiation, but they asked the person who is more accessible such as a radiology technologist instead of a medical physicist (P < 0.05). In addition, there was significant statistical difference between question 3 (X-ray is used in which method of radiation?) and question 4 (scoring of radiation exposure in each of the imaging modalities; Score one means no radiation, score has more than one meaning of rays), which indicates accuracy of responses of referees (P <0.05). 73.4% of individuals agree about the importance of reduction of radiation during imaging, and most of the individuals (87%) tended to be aware of radiation exposure in each of imaging modalities.

CONCLUSION

Given the low patient awareness about imaging modalities and radiation dose, it is recommended to prepare brochures and guidance about radiation exposure and absorbed doses in each modality, to be provided and displayed in imaging clinics.

What information did pregnant women want related to risks and benefits attending X-ray examinations?

BACKGROUND

In connection with X-ray examinations of pregnant patients, good communication of benefit and risk is important to provide adequate patient care. Pregnant women often become concerned about the foetus and are unsure of the risk of malformations and the development of cancer. Health professionals who are involved in imaging pregnant women require specif knowledge about risks and benefits so they can convey information without creating unnecessary fear.

PURPOSE

This study identifies the information needs of pregnant women in connection with X-ray examinations and how they prefer to have the information communicated.

METHOD

A qualitative study using semi-structured interviews of seven pregnant women aged 28-36 in weeks 16-33 of their pregnancy. The interviews were analysed using interpretive phenomenological analysis.

RESULTS

The participants had expectations regarding the information provided about X-ray examinations during pregnancy. They needed concrete information on radiation doses, risks and any effects on the foetus. The risk was thought to be low, but several of the participants would still have been concerned when undergoing an X-ray examination.

CONCLUSION

To provide adequate care of pregnant women in connection with X-ray examinations, healthcare professionals must have knowledge of pregnancy and radiation and have expertise in risk communication. This will prevent unnecessary concern in the pregnant woman, ensure that justified necessary examinations are carried out, and avoid adverse decisions such as termination of pregnancy based on erroneous grounds.

Low Radiation X-rays: Benefiting People Globally by Reducing Cancer Risks

Modern medical imaging facilitates the diagnosis and treatment of human diseases. However, few people are aware of the cons of radiation exposure from medical imaging. Emerging evidence reveals that cumulative doses of radiation exposure will increase the morbidity and mortality of pertaining cancer. As a special young population, patients with adolescent idiopathic scoliosis (AIS) suffer more radiation harms from repeated diagnostic imaging, most of which can be avoided in clinical practice. Accumulating evidence highlights reduced cancer risks of radiation exposure for AIS patients with low/zero radiation imaging modalities proposed, amongst which easy conversion from anterior-posterior (AP) to posterior-anterior (PA) projection for whole-spine radiographs should be stressed. It can greatly reduce radiation doses without compromising the quality of diagnostic imaging. Tight collimation combined with PA projection can further reduce radiation harms, and need to be spread to benefit people globally.

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.

Individuals with back and neck pain on medical forums: What do they mention? What do they fear?

BACKGROUND

The use of online medical forums is on the rise globally. Data scraping is a method of extracting website content using an automated computer program. We scraped users' questions regarding back and neck pain (BNP) from popular Israeli online medical forums. We aimed to identify the sort of questions being asked about BNP, and to analyse explicit themes that characterize their questions.

METHODS

Six leading Israeli BNP forums were identified. In phase 1, Python scripts scraped 12,418 questions into a data set. In phase 2 - five themes were identified: Surgery (n = 2,957); health care professions (n = 2,361); Sports (n = 2,304); drugs (n = 1,419) and interpretation of imaging (n = 845). Phase 3 - included the categorization of explicit fear-related words by the authors. Phase 4 - analysis of explicit fear-related themes yielded 402 questions.

RESULTS

Gender was identified for 394 users, and age was identified for 181 users. A total of 248 users (61.6%) were women and 146 men (36.3%). Mean age 36.3 ± 16.15 for women and 35.5 ± 16.1 for men. The most commonly expressed fears were related to: invasive procedures, 30.9% (131 questions); fear of serious condition or misdiagnosis, 17.0% (72 questions); General concerns, 13.7% (58 questions); fear of worsening or relapse, 12.3% (52 questions); adverse effects of oral drugs or radiation, 10.8% (46 questions) and concerns related to lifestyle, 9.7% (41 questions).

CONCLUSIONS

Web scraping is a feasible strategy with which to explore medical forums and the above-mentioned themes, all of which are of potential clinical significance.

SIGNIFICANCE

Using automated algorithms, a total of 12,369 questions from online back and neck medical forums were scraped and analysed. Secondary analysis categorized fear-related themes that were mentioned by users. Identifying and addressing patients' fear has potential to improve communication and therapeutic outcome. For example, questions regarding surgery were typically asked after the option was mentioned by a physician. This insight should encourage physicians to devote extra time explaining the possible implications of surgery, should they consider it as an option.

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.

Ionising radiation exposure from medical imaging - A review of Patient's (un) awareness

INTRODUCTION

Medical imaging is the main source of artificial radiation exposure. Evidence, however, suggests that patients are poorly informed about radiation exposure when attending diagnostic scans. This review provides an overview of published literature with a focus on nuclear medicine patients on the level of awareness of radiation exposure from diagnostic imaging.

METHODS

A review of available literature on awareness, knowledge and perception of ionising radiation in medical imaging was conducted. Articles that met the inclusion criteria were subjected to critical appraisal using the Mixed Methods Appraisal Tool.

RESULTS

140 articles identified and screened for eligibility, 24 critically assessed and 4 studies included in synthesis. All studies demonstrated that patients were generally lacking awareness about radiation exposure and highlighted a lack of communication between healthcare professionals and patients with respect to radiation exposure.

CONCLUSION

Studies demonstrate a need to better inform patients about their radiation exposure, and further studies focusing on nuclear medicine patients are particularly warranted.

IMPLICATIONS FOR PRACTICE

Adequate and accurate information is crucial to ensure the principle of informed consent is present.

Parents' received and expected information about their child's radiation exposure during radiographic examinations

BACKGROUND

Despite regulations, insufficient information is provided to adult patients prior to their radiologic examinations. Information regarding paediatric patients has not been systematically studied.

OBJECTIVE

To survey parents' experience and wishes for information in connection with their child's radiographic examination.

MATERIALS AND METHODS

We provided a questionnaire to consenting parents of children younger than 12 years old at a university hospital. The questionnaire asked parents about the information obtained from the referrer prior to the radiograph, the chance to discuss with the referrer and their wishes regarding future information. Forty-one parents responded to the survey. Twenty-five children were referred for radiography of extremities, the others for dental, body and skull examinations.

RESULTS

Altogether 34/41 (83%, 95% confidence interval [CI] 69-91%) parents said they received adequate information on the purpose of the examination, 8/35 (23%, 95% CI 12-39%) on other options and 3/41 (7%, 95% CI 3-19%) on radiation dose. Ten of 41 parents (24%, 95% CI 12-40%) said they were aware of radiation exposure. The number of previous radiology examinations was not sufficiently discussed. The communication was scored as mean 6.5 (95% CI 5.8-7.1) on a scale from 4 (poor) to 10 (excellent). Thirty-eight of 40 (95%, 95% CI 84-99%) of parents expected information on the purpose, 35/40 (88%, 95% CI 74-95%) on radiation dose and 31/40 (78%, 95% CI 63-88%) on other options. Symbols of radiation and corresponding period of natural background radiation are preferred to convey the dose. A referrer is the preferred source of information.

CONCLUSION

Parents did not feel adequately informed prior to their child's radiographic examination. Parents expect more information about the purpose, dose and alternative tests.