Patient perspectives and preferences for communication of medical imaging risks in a cancer care setting

People do not have high levels of knowledge of low dose ionizing radiation (LDIR)

Through survey and focus groups in two provinces in Canada misunderstanding and confusion surrounding Low-Dose Ionizing Radiation (LDIR) is explored specifically surrounding medical procedures, risk, and benefits. Generally people associated the word radiation with harm, but when asked participants were not concerned about LDIR. Approximately equal numbers (40%) thought LDIR was 'difficult' as those that thought it was 'easy' but research results reveal confusion about the definition of and sources of LDIR. Most people believed the benefits of LDIR outweighed the risks. Further, many had inaccurate views of 'high' dose radiation. Scientists and the Canadian regulator were determined to be the most trusted sources of information while elected officials and industry representatives the least trusted. Participants wanted more information on whether LDIR was a problem in Canada, what the risks were associated with it, as well as the applicable protections, rules and regulations. Focus group participants expressed a preference for face-to-face exchange of information, but mass media remains an important source of information as the first-place people check for answers. Future research surrounding behavioural science and LDIR communications, and deep LDIR science communication will be important in addressing this issue.

Patient's knowledge regarding radiation exposure from various imaging modalities: a pilot study

To determine patients' knowledge about ionising radiation used in diagnostic imaging and whether they were adequately informed about the procedure they were referred to. A cross-sectional study was conducted at the University Hospital Merkur, Zagreb, Croatia during 2019-20. A questionnaire with 14 questions was given to patients in waiting rooms for imaging examinations. Statistical analysis was conducted using the standard software package. Chi-square with Yates correction was used to determine differences in patients' answers between those who received the explanation about the procedure and those who did not. The differences depending on the educational level were also evaluated. The survey was completed by 374 participants (200 women, 174 men) with a mean age of 55.45 ± 15.92 y. Of all patients, 8.63% had no formal education or only finished elementary school, 52.83% had finished high school and 38.55% had a college or a higher degree. The referring physicians informed 63.66% of participants about the radiological exam they were being referred to, and 226 thought that the given explanation was sufficient. Most patients knew that some radiological procedures use ionising radiation. Only 47.37% of respondents correctly identified MRI as a non-ionising method, whereas 37.40% of participants recognised chest X-ray as the modality with the lowest radiation dose. Higher-educated patients had better knowledge of radiological procedures and the potential risks. The study demonstrated suboptimal patients' knowledge about ionising radiation, and additional efforts in their education are needed.

Radiographers' perceptions on the quality of managing general radiographic paediatric examinations through the use of a reflective tool

INTRODUCTION

Paediatric patients are a vulnerable population that require additional care by healthcare professionals. Quality managing these examinations ensures that effective and quality care is provided to individual patients, whilst encouraging consistency within the medical imaging department. This study explored radiographers' perspectives on quality management strategies of general radiographic paediatric examinations using a paediatric imaging reflective checklist.

METHODS

A quantitative descriptive research design with qualitative questions was used through a purposive sampling method from both public and private Australian diagnostic imaging qualified radiographers who had experience in paediatric imaging examinations. The paediatric imaging service reflective tool consisted of 65 items in total. Data analysis entailed Microsoft Excel version 16.16.6 and Jamovi version 2.3.21 for the closed-ended questions and for the open-ended responses a thematic analysis.

RESULTS

The participation rate was 13.2% and the most significant findings were: lead shielding was still being used at their organisation, despite recent recommendations to suspend its use; access to paediatric patient related information resources is limited; there was no involvement of families and communities regarding policy development or quality improvement measures as advocated in literature; and there was a need for enhanced specialised paediatric education, training and protocols.

CONCLUSION

Using the paediatric patient-centred imaging reflective checklist, radiographers had an opportunity to identify quality improvement indicators as well as issues that could further enhance best practice principles. Further studies could inform on the validity of this reflective tool.

Radiation protection measures used in Portuguese interventional radiology departments: A national survey

INTRODUCTION

This study aimed to characterise radiation protection (RP) measures used in interventional radiology (IR) departments in Portugal with respect to European and national recommendations.

METHODS

An online national survey was created to characterise the fluoroscopy technology as well as analyse the frequency of body fluoroscopy-guided intervention procedures (FGIP), RP education and training of the staff, and RP measures used daily.

RESULTS

In Portugal, most equipment for FGIP are single-sourced and have a flat panel detector (70%). The most commonly FGIP are percutaneous biliary drainage, percutaneous arterial and venous thrombolysis/thrombectomy, arteriovenous malformations embolization, and percutaneous transluminal balloon angioplasty for arteriovenous fistulas. Only a few staff members had received postgraduate education and training in RP (30%), with most nurses having not received RP education and training (40%). Some of the recommended RP measures lacked harmonisation. Additionally, >50% of the IR departments do not consider examination dose values to identify patients eligible for tissue reactions follow-up.

CONCLUSION

This is the first study to examine the characteristics of IR departments in Portugal. We observed a lack of RP education and training among staff members; further, there was a need to update some RP measures in some IR departments according to the recommendations.

IMPLICATIONS FOR PRACTICE

Our findings will be presented to the participating IR departments in order to update and promote RP best practices. Moreover, our findings will be presented to the national societies of the different professional groups in order to inform strategies for harmonising RP education and training of the staff.

The why, who, how, and what of communicating CT radiation risks to patients and healthcare providers

Computed tomography (CT) has witnessed tremendous growth in utilization. Despite its immense benefits, there is a growing concern from the general public and the medical community about the detrimental consequences of ionizing radiation from CT. Anxiety from the perceived risks associated with CT can deter referring physicians from ordering clinically indicated CT scans and patients from undergoing medically necessary exams. This article discusses various strategies for educating patients and healthcare providers on the benefits and risks of CT scanning and salient techniques for effective communication.

A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools

US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.

Exploring determinants and regional variation of diagnostic imaging utilization rates in German inpatient care

INTRODUCTION

Germany ranks high concerning the per capita supply of computer tomographs (CT) and positron emission tomographs (PET) which may incentivize supply-induced use. Beyond that, international comparison shows high per capita examinations. However, misuse of diagnostic imaging may cause harm to patients and the health care system. The use of diagnostic imaging in Germany has been insufficiently studied so far. Therefore, the study aimed to determine the extent of regional differences as well as supply and demand side factors of per capita CT and PET examinations in German inpatient care.

METHODS

Cartographic visualizations and a random intercept model controlling for the regional disease burden, ambulatory provided supply and demand, and population deprivation between 2010 and 2017 for CT and between 2016 and 2017 for PET were applied. For this purpose, the Nationwide hospital discharge data (DRG statistics), hospital structured quality reports, the National Association of Statutory Health Insurance Physicians, the Central Research Institute of Ambulatory Health Care in Germany, and the German Index of Socioeconomic Deprivation were used.

RESULTS

We found a substantial regional variation of examination rates (-63 to +108% for CT and from -94 up to +847% for PET). Regarding PET, the supply structures have a significant impact on examinations per 1,000 inhabitants (28.46, p < .000). Both devices were used in correlation with the regional disease burden. Ambulatory and inpatient CT examination rates were positively associated.

DISCUSSION

The regional differences identified are to some extent attributable to the regional burden of disease and thus warranted. Although the inpatient PET supply influences utilization rates, the direction of the effect should be investigated more closely for valid statements. The findings in terms of CT should be treated with caution. The cartographic distribution and examination rates indicate global overuse. The clear separation of inpatient and ambulatory sectors leads to misallocation of scarce resources, medically unnecessary multiple examinations, and capacity utilization problems.

CONCLUSION

The results obtained have great potential for assessing and analyzing the adoption and rapid expansion of imaging technologies. Capacity utilization figures should be the focus of further research to assess utilization rates both economically and medically. Policy makers should address ongoing issues of operational and organizational separation of inpatient and ambulatory sectors in the German health care system.

A Survey of Awareness of Parents and Caretakers on Diagnostic Radiological Examination Related Radiation Exposure in a Tertiary Hospital in Malaysia

BACKGROUND

With the advancement in medical imaging, radiological application in the paediatric population has also increased. Children, generally more radiosensitive, have a higher risk of developing certain malignancies. Therefore, this may result in uneasiness among parents and caretakers when their children need to undergo medical imaging examination. Hence, this study aims to assess the awareness of parents' and caretakers' awareness of medical imaging-related radiation exposure in our institution and their opinion of a medical radiation exposure-tracking programme for the paediatric population.

METHODOLOGY

A cross-sectional survey was conducted for 6 months duration among parents and caretakers, who brought their children (under 12 years old) for imaging. The questionnaire booklet had eleven knowledge-based questions to assess respondents on ionising radiation-associated medical imaging, the radiation-related risk and radiation safety precaution.

RESULTS

Two hundred and fifteen respondents participated in this survey. More than 40% of the respondents failed to identify various dose-saving and ionising radiation-related imaging methods. Only 87 participants (40.5%) could correctly answer at least six out of eleven knowledge-based questions. Moreover, 88.4% of the respondents support a medical radiation exposure-tracking programme for their children.

CONCLUSION

Parents and caretakers who visited our institution had inadequate awareness of medical radiation exposure. Appropriate measures need to be taken to address this promptly. Implementation of a medical radiation exposure-tracking programme for the paediatric population is considered timely as most respondents agree with this programme.

The cumulative radiation dose paradigm in pediatric imaging

Medical imaging professionals have an accountability for both quality and safety in the care of patients that have unexpected or anticipated repeated imaging examinations that use ionizing radiation. One measure in the safety realm for repeated imaging is cumulative effective dose (CED). CED has been increasingly scrutinized in patient populations, including adults and children. Recognizing the challenges with effective dose, including the cumulative nature, effective dose is still the most prevalent exposure currency for recurrent imaging examinations. While the responsibility for dose monitoring incorporates an element of tracking an individual patient cumulative radiation record, a more complex aspect is what should be done with this information. This challenge also differs between the pediatric and adult population, including the fact that high cumulative doses (e.g.,>100 mSv) are reported to occur much less frequently in children than in the adult population. It is worthwhile, then, to review the general construct of CED, including the comparison between the relative percentage occurrence in adult and pediatric populations, the relevant pediatric medical settings in which high CED occurs, the advances in medical care that may affect CED determinations in the future, and offer proposals for the application of the CED paradigm, considering the unique aspects of pediatric care.

[Risk Communication of Radiation Exposure for Diagnosis: A Questionnaire Survey]

PURPOSE

We investigated how a radiologic technologist explains to a patient about the risk of radiation exposure involved by the radiological examination.

METHODS

In this institutional review board-approved, cross-sectional study, an online questionnaire link was emailed to 650 radiological technologists who are members of the National Hospital Kanto Koshinetsu Radiological Technologist Association. The questions to survey risk communication included the ideal and reality explanation for radiation exposure to patients, the respondent's educational background, and years of experience. Statistical analysis was performed using the Kruskal-Wallis test and Bonferroni correction as a multiple comparison test.

RESULTS

Among the 650 radiological technologists, 245 (37.7%) completed the online questionnaire. The most common response was to compare and convey the doses of radiation during examination and background radiation when asked by a patient about risk. In the cross-analysis, the Kruskal-Wallis test showed no significant difference in what was explained according to educational background. According to years of experience, a significant difference in the content was found about explanation of the risk to patients.

CONCLUSIONS

We clarified the actual condition of risk communication related to the exposure in radiological examinations. In the future, development of risk communication is expected by improving the knowledge and information of "risk" and giving explanations requested by patients.

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.

Predictors of patient preference for either whole body magnetic resonance imaging (WB-MRI) or CT/ PET-CT for staging colorectal or lung cancer

INTRODUCTION

Whole body magnetic resonance imaging (WB-MRI) may be more efficient in staging cancers, but can be harder for patients to tolerate. We examined predictors of patient preference for WB-MRI vs. CT/ PET-CT for staging colorectal or lung cancer.

METHODS

Patients recruited prospectively to two multicentre trials comparing diagnostic accuracy of WB-MRI with standard staging scans were sent two questionnaires: the first, administered at trial registration, captured demographics, educational level and comorbidities; the second, administered after staging completion, measured emotional distress (GHQ-12), positive mood (PANAS), perceived scan burden, patients' beliefs about WB-MRI, and preference for either WB-MRI or CT (colorectal trial), WB-MRI or PET-CT (lung trial). Preference for WB-MRI or CT/ PET-CT was analysed using logistic regression.

RESULTS

Baseline and post-staging questionnaires were completed by 97 and 107 patients, respectively. Overall, 56/107 (52%) preferred WB-MRI over standard scans and were more likely to have no additional comorbidities, higher positive mood, greater awareness of potential benefits of WB-MRI and lower levels of perceived WB-MRI scan burden. In adjusted analyses, only awareness of potential WB-MRI benefits remained a significant predictor (OR: 1.516, 95% CIs 1.006-2.284, P = 0.047). Knowledge that WB-MRI does not use radiation predicted preference (adjusted OR: 3.018, 95% CIs 1.099-8.288, P = 0.032), although only 45/107 (42%) patients were aware of this attribute.

CONCLUSIONS

A small majority of patients undergoing staging of colorectal or lung cancer prefer WB-MRI to CT/ PET-CT. Raising awareness of the potential benefits of WB-MRI, notably lack of ionizing radiation, could influence preference.

"I Wish Someone Had Told Me That Could Happen": A Thematic Analysis of Patients' Unexpected Experiences With End-Stage Kidney Disease Treatment

BACKGROUND

Preparedness regarding prognosis and treatment options enables patients to cope with uncertainties, make value-based treatment decisions, and set treatment goals. Yet, little is known about the expectedness of end-stage kidney disease (ESKD) patients' treatment experiences beyond their desire for better treatment education.

OBJECTIVE

To describe unexpected adverse treatment experiences among ESKD patients.

METHOD

The authors conducted 7 focus groups with 55 dialysis patients and living-donor kidney transplantation recipients receiving medical care in Baltimore, Maryland. Data were analyzed thematically. Themes present in different treatment groups were highlighted to provide insight into common experiences.

RESULTS

The authors identified 5 themes: (1) psychological reactions, (2) constrained freedom of choice, (3) treatment delivery and logistics, (4) morbidity, and (5) finances.

CONCLUSION

Patients were unprepared for nonclinical, logistical, and clinical aspects of ESKD treatment. The need for providers' use of tailored preparatory techniques and the development of pretreatment interventions to help patients know what to expect from and feel psychologically prepared for treatment, particularly with respect to nonclinical implications, is critical. These efforts have great potential to improve patients' treatment experiences.

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.

Imaging in clinical trials: a patient-led questionnaire study to assess impact of imaging regimes on patient participation

BACKGROUND

Cancer trials often incorporate intensive imaging with Magnetic Resonance Imaging (MRI) and Positron Emission Tomography with Computerised Tomography (PET/CT), which can be physically and mentally exhausting for patients. This questionnaire study aimed to determine the aspects of imaging that affect a patient's decision to participate in clinical trials in order to inform the design of future trials that utilise imaging. This should achieve greater patient compliance and improve the patient experience.

METHOD

A detailed questionnaire assessing patient expectation and acceptability of imaging within clinical trials was developed in collaboration with two patient representatives. The questionnaire addressed the influence of scan type, length, frequency, scheduling, invasiveness and staff support on acceptability of imaging. It was applied to three patient groups. Group 1 consisted of patients newly recruited to studies with imaging, Group 2 consisted of previous participants in studies with imaging and Group 3 consisted of patients having imaging for clinical care.

RESULTS

One hundred ninety six patients completed the questionnaires (Group 1:47; Group 2: 50 and Group 3: 99). The use of ionising radiation and number of scans required were identified as negative influences on decision to participate by 25% of Group 3 but only by 6% of Groups 1 and 2. Scan duration >30mins was perceived as a negative factor for decision to participate by all Groups (12-22%). Good communication provided by researchers in terms of discussing the study before and after reading study materials was a key factor in influencing decision to participate (> 50% in Groups 1 and 2 and > 20% in Group 3).

CONCLUSION

Factors relating to imaging procedures within clinical trials that affect participation have been identified with communication around study materials as the key determinant. These data will be used to influence the development of future research protocols. Modification of imaging requirements within clinical trials will improve patient tolerance and acceptability and is likely to raise recruitment.

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.

Defining the information needs of lung cancer screening participants: a qualitative study

Introduction

Lung cancer screening (LCS) by low-dose CT has been shown to improve mortality, but individuals must consider the potential benefits and harms before making an informed decision about taking part. Shared decision-making is required for LCS in USA, though screening-eligible individuals' specific views of these harms, and their preferences for accessing this information, are not well described.

Methods

In this qualitative study, we aimed to explore knowledge and perceptions around lung cancer and LCS with a focus on harms. We carried out seven focus groups with screening-eligible individuals, which were divided into current versus former smokers and lower versus higher educational backgrounds; and 16 interviews with health professionals including general practitioners, respiratory physicians, lung cancer nurse specialists and public health consultants. Interviews and focus groups were audio-recorded and transcribed. Data were coded inductively and analysed using the framework method.

Results

Fatalistic views about lung cancer as an incurable disease dominated, particularly among current smokers, and participants were often unaware of curative treatment options. Despite this, beliefs that screening is sensible and worthwhile were expressed. Generally participants felt they had the 'right' to an informed decision, though some cautioned against information overload. The potential harms of LCS were poorly understood, particularly overdiagnosis and radiation exposure, but participants were unlikely to be deterred by them. Strong concerns about false-negative results were expressed, while false-positive results and indeterminate nodules were also reported as concerning.

Conclusions

These findings demonstrate the need for LCS information materials to highlight information on the benefits of early detection and options for curative treatment, while accurately presenting the possible harms. Information needs are likely to vary between individuals and we recommend simple information materials to be made available to all individuals considering participating in LCS, with signposting to more detailed information for those who require it.

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.

An Investigation of Procedural Radiation Dose Level Awareness and Personal Training Experience in Communicating Ionizing Radiation Examinations Benefits and Risks to Patients in Two European Cardiac Centers

PURPOSE

Cardiac interventional practitioners need to be appropriately informed regarding radiation dose quantities and risks. Communicating benefit-risk information to patients requires attention as specified in Basic Safety Standards Directive 2013/59/Eurotom. This study investigated the awareness of procedural radiation dose levels and the impact of personal training experience in communicating ionizing radiation benefit-risks to patients.

METHODOLOGY

A questionnaire, consisting of 28 questions, was distributed directly to adult and pediatric interventional cardiology specialists at specialized cardiovascular imaging centers in Dublin, Ireland and Milan, Italy.

RESULTS

A total of 18 interventional cardiologists (senior registrar to consultant grades with between 2 y to over 21 y experience in cardiac imaging) participated. The majority of participants (n = 17) stated that parents of pediatric and adult patients should be informed of the potential benefits and risk. All participants indicated they had radiation safety training; however, 50% had not received training in radiation examination benefit-risk communication. Despite this, 77.8% (n = 14) participants indicated a high confidence level in successfully explaining risks and/or benefits of cardiac imaging procedures. When asked to estimate effective dose (ED) values for common cardiac imaging procedures less than 50% identified appropriate dose ranges. All participants underestimated procedural dose values based on recent European data. 50% (n = 9) participants answered all questions correctly for a number of true or false radiation risk statements.

CONCLUSION

Benefit-risk communication training deficits and inaccurate understanding of radiation dose levels was identified. Further research and training to support clinicians using radiation on a daily basis is required.

Patient Perspectives on Dialogue and Shared Decision Making

The fear of radiation on the part of patients and/or clinical staff can hamper adequate shared medical decision making. Typically, one-sided medical radiation risk communication methods with limited effectiveness are employed, such as paternalistic, risk numerology, and quality "assurance" approaches. More study is needed to determine patient preferences and potential fears associated with medical imaging radiation, and the results can provide insights for such discussions. Worry about the potential risks associated with medical imaging radiation has been shown to be substantial in the US population. The level of concern differs by sex, race/ethnicity, education, nationality, and overall health, suggesting that more care and individualized communication and discussion methods need to be employed by clinical staff. The opportunities for improved dialogue with patients (and parents of patients) and the public in general are plentiful.

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.

Parental preferences on diagnostic imaging tests for paediatric appendicitis

Objectives

To determine parental preferences for diagnostic imaging tests (DITs) for paediatric appendicitis, to rank the attributes impacting the DIT selection and to identify DIT attributes that would cause parents to switch their DIT.

Methods

Parents of children who had an abdominal ultrasound (US) for right lower quadrant pain were interviewed. Two DITs were compared at a time, parents were asked to indicate their preferred test and to rank its attributes according to the impact each attribute had on their selection. The strength of their preference for the chosen DIT was measured by systematically adjusting attributes of the chosen DIT until the parent changed their choice.

Results

Fifty parents were interviewed. For US versus CT, more parents preferred US (68%, P=0.02) with higher importance ranks for cancer risk (P<0.0001), test accuracy (P=0.04), pain during test (P=0.3), and scan length (P<0.0001); and lower ranks for sedation (P=0.02), intravenous (IV) (P<0.02), and oral contrast (P=0.06). For US versus MRI, parents preferred MRI (78%, P<0.0001) with higher importance ranks for accuracy (P=0.2), pain during test (P=0.06), and scan length (P=0.06); and lower for noise (P<0.0001), claustrophobia (P<0.0001), use of IV contrast (P=0.06), and sedation (P=0.2).

Conclusion

US and MRI were the DIT preferred by parents for the investigation of acute paediatric appendicitis.

Medical Imaging Outpatients' Experiences With Receiving Information Required for Informed Consent and Preparation: A Cross-Sectional Study

BACKGROUND

Medical imaging outpatients often experience inadequate information provision and report high levels of anxiety. However, no studies have assessed patients' receipt of preparatory information in this setting.

OBJECTIVE

To examine medical imaging outpatients' perceived receipt or non-receipt of preparatory information from health professionals and imaging department staff prior to their procedure.

METHOD

Computed tomography and magnetic resonance imaging outpatients at one Australian hospital self-completed a touchscreen computer survey assessing their perceived receipt of 33 guideline-recommended preparatory information items.

RESULTS

Of 317 eligible patients, 280 (88%) consented to participate. Eight percent (95% confidence interval: 5%-12%) of participants reported receiving all information items. The median number of information items not received was 18 (interquartile range: 8-25). Items most frequently endorsed as "not received" were: how to manage anxiety after (74%) and during the scan (69%). Items most commonly endorsed as "received" were: reason for referral (85%) and how to find the imaging department (74%).

CONCLUSION

Few medical imaging outpatients recalled receiving recommended preparatory information. Preparatory communication needs to be improved to better meet patient-centered service imperatives.

Patient-Centered Outcomes Related to Imaging Testing in US Primary Care

BACKGROUND

Imaging tests are one of the most sophisticated types of diagnostic tools used in health care, yet there are concerns that imaging is overused. Currently, tests are typically evaluated and implemented based on their accuracy, and there is limited knowledge about the range of patient-centered outcomes (PCOs) that imaging tests may lead to. This study explores patients' experiences and subsequent outcomes of imaging tests most notable to patients.

METHODS

Adult patients from four primary care clinics who had an x-ray, CT, MRI, or ultrasound in the 12 months before recruitment participated in a single semistructured interview to recount their imaging experience. Interview transcripts were analyzed thematically.

RESULTS

Four themes related to PCOs were identified from 45 interviews. Participants' mean age was 53 years (25-83 years), 30 had undergone a diagnostic imaging test, and 15 underwent imaging for screening or monitoring. Themes included knowledge gained from the imaging test, its contribution to their overall health care journey, physical experiences during the test procedure, and impacts of the testing process on emotions.

CONCLUSIONS

Patients identified various imaging test outcomes that were important to them. Measurement and reporting these outcomes should be considered more often in diagnostic research. Tools for providers and patients to discuss and utilize these outcomes may help promote shared decision making around the use and impact of imaging tests.

Prevalence and correlates of patient-centred preparatory information provision to computed tomography and magnetic resonance imaging outpatients: A cross-sectional study

OBJECTIVE

Responsiveness to information preferences is key to high-quality, patient-centred care. This study examined the top ten preparatory information items not delivered in accordance with medical imaging outpatients' preferences, and patient characteristics associated with reporting a greater number of unmet information preferences.

METHODS

Magnetic resonance imaging and computed tomography outpatients were recruited consecutively in one major public hospital waiting room. Participants self-administered a touchscreen computer questionnaire assessing their sociodemographic and scan characteristics, and unmet preferences for 33 guideline-endorsed preparatory information items.

RESULTS

Of 317 eligible patients, 280 (88%) consented to participate. Given equal rankings, the top ten unmet information preferences included 13 items which were endorsed by at least 25% of participants, and commonly related to receiving 'too little' information. One item related to the pre-scan period, seven items to the scan period and five items to the post-scan period. None of the patient characteristics examined were significantly associated with reporting a greater number of unmet information preferences.

CONCLUSION

There is room to improve responsiveness to medical imaging outpatients' preparatory information preferences. Improvements should be targeted at individuals, rather than groups defined by sociodemographic or scan characteristics.

PRACTICE IMPLICATIONS

A standardised approach to addressing individual patient's information preferences is needed.

Project Transform: engaging patient advocates to share their perspectives on improving research, treatment and policy

OBJECTIVE

Incorporating the patient perspective into lung cancer research, policy and treatment is becoming increasingly recognized as important. This project sought to create an engagement partnership with lung cancer patient advocates and to explore their views on transforming lung cancer healthcare systems, treatment and policy to be more patient centered.

METHODS

A patient action committee (PAC) of patient advocates living with lung cancer was engaged through group meetings, in-person and phone interviews, and email correspondence. Group meetings (two 1 hour meetings, one 3 hour meeting) served to discuss engagement strategies and project goals, while individual interviews (n = 19) (30-75 minutes) provided in-depth exploration of individuals' perspectives. Meetings and interviews were recorded to identify priorities for addressing issues within lung cancer research, treatment and policy. PAC members corroborated the results through email and in-person meetings.

RESULTS

PAC members identified three general objectives: (i) for healthcare systems, increasing access to care through accessible, coordinated and affordable care, (ii) for treatment, addressing patient needs in treatment and research through patient education, shared decisions and clinical trials, and (iii) for policy, shining a light on lung cancer through screening policies, public awareness and research funding.

CONCLUSION

Patient advocates expressed their views that lung cancer is a neglected disease that is not highly prioritized in healthcare systems, treatment approaches and public perceptions. This project represents an integral step in developing an ongoing partnership between researchers and these advocates.

Prevalence and Correlates of Worry About Medical Imaging Radiation Among United States Cancer Survivors

PURPOSE

Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for survivors. The aims of this paper are to describe cancer survivors' level of worry about medical imaging radiation (MIR) and to identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust.

METHOD

This cross-sectional study used the 2012-2013 Health Information National Trends Survey of US adults conducted by the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic regression analysis was used to evaluate factors associated with higher MIR worry (reporting "some" or "a lot" of MIR worry).

RESULTS

Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in unadjusted analysis.

CONCLUSION

Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns of worry could aid efforts to improve these individuals' survivorship care and education.

Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging

Effective radiation risk communication is a core competency for radiology care providers and can prevent and resolve potential conflicts while helping achieve effective public health safeguards. The authors present a synopsis of the challenges to holding such dialogue and review published methods for strengthening and maintaining this discourse. Twelve strategies are discussed in this article that can help alleviate concerns about the iatrogenic risk associated with medical imaging using radiation exposure.

Clinical Outcomes After Cardiac Stress Testing Among US Patients Younger Than 65 Years

Background

Scientific statements have championed the measurement of clinical outcomes after cardiac stress testing to better define their value. Using contemporary national data, we sought to describe the characteristics of patients who experience outcomes after stress testing.

Methods and Results

Using administrative claims from a large national private insurer, we conducted an observational cohort study of patients without cardiovascular disease aged 25 to 64 years who underwent stress testing from 2006 to 2011 and had at least 1 year of membership in the insurance company before and after testing. We used Kaplan–Meier time‐to‐event analyses to determine rates of acute myocardial infarction (AMI), elective coronary revascularization, and coronary angiography without revascularization in the year following testing. We used logistic regression to determine factors associated with outcomes, and stratified the cohort into quintiles based on likelihood of experiencing AMI and/or revascularization to describe the characteristics of patients at highest and lowest risk. Among 553 027 patients who underwent stress testing (mean age 50 years, 49% women, 73% white), 0.8% were hospitalized for AMI, 1.8% underwent elective coronary revascularization, and 2.5% underwent coronary angiography without revascularization within 1 year. Patients who were older, male, and white were more likely to undergo subsequent revascularization. Patients in the lowest likelihood quintile were young (mean age 40 years), frequently women (84.7%), had a low incidence of coexisting conditions (5.2% with diabetes mellitus), and had a 0.5% rate of AMI and/or revascularization.

Conclusions

The proportion of US patients younger than 65 who had AMI and/or coronary revascularization after stress testing was low. Assessing risk of subsequent outcomes may be useful in improving patient referrals for stress testing.

Informed Consent for Radiation in Interventional Radiology Procedures

Purpose

To explore the patient perception on radiation-related cancer risk from interventional radiology (IR) procedures and whether informed radiation consent is warranted.

Methods

A multiple-choice survey was prospectively administered to 68 adults undergoing a body or neuro-IR procedure with ionizing radiation exposure. Subgroup analysis with chi-square or Fisher exact test was performed based on patient past IR history ( P < .05).

Results

A total of 81% of patients wanted to be informed if there was a radiation-related 3% increased cancer risk over 5 years. Although 55% considered 3% a small risk, 28% wanted to further discuss the risks and alternate options, and 15% would have only proceeded if it were a life-saving procedure: 89%, 80%, and 67% of patients wanted to be informed with exposure risks of 1 in 100, 1 in 1000, and 1 in 10,000, respectively. Only 53% were aware they were going to be exposed to radiation, irrespective of past IR history ( P = .15). Most patients believed radiation consent should include radiation-related cancer risks (85%). No past IR history was significantly associated with wanting consent to include cancer-related risk (100% vs 76%; P = .01) and deterministic risks (70% vs 41%; P = .04). A majority (69%) believed both the referring physician and the interventional radiologist were responsible for obtaining radiation consent, and 65% of patients wanted verbal consent followed by signed written consent, regardless of past IR history.

Conclusions

Many patients want to discuss cancer-related radiation risks with both radiologists and physicians. Informed radiation consent should be considered for procedures with high anticipated radiation doses.

Thoracic surgeon and patient focus groups on decision-making in early-stage lung cancer surgery

AIM

To investigate medical decision-making from the thoracic surgeons' and patients' perspectives in early-stage lung cancer.

PATIENTS & METHODS

We conducted one focus group with thoracic surgeons (n = 15) and one with a group of early-stage lung cancer patients treated with surgery (n = 7). Focus groups were recorded, transcribed and coded for themes.

RESULTS

For surgeons, surgical procedure choice was a primary concern, followed by the surgical treatment plan decision-making process. Survivors focused primarily on the physical and mental health-related postsurgical burden for which they felt they were not well prepared and placed less emphasis on surgical decision-making.

CONCLUSION

As early-stage lung cancer mortality rates are improving, surgeons and patients can prioritize surgical approaches and postsurgical care that enhance quality of life.

Physicians' communication of risks from non-steroidal anti-inflammatory drugs and attitude towards providing adverse drug reaction information to patients

RATIONALE, AIMS, AND OBJECTIVES

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for orthopaedic conditions, therefore this study aimed to explore orthopaedic physicians' perceptions of their role in NSAID-risk communication, their attitudes towards the necessity of informing patients about adverse drug reactions (ADR), and factors associated with these.

METHODS

Self-administered questionnaires were mailed to all 206 orthopaedic physicians working at hospitals in Northeastern Thailand. Attitudes were assessed using 17 statements and total scores classed as poor, moderate and good attitude.

RESULTS

Sixty-six questionnaires were returned (32.04%). The responses showed that 75% of physicians claimed to communicate NSAID ADR information, more frequently about gastrointestinal (GI) complications, than about renal and cardiovascular (CVS) complications. ADR management (36%) and monitoring (30%) were not frequently communicated. The time spent with patients was associated with provision of ADR and monitoring advice. Renal function was the risk factor of greatest concern for prescribing any NSAID, followed by history of GI complications, and allergy for non-selective NSAIDs, and history of CVS diseases and age for selective COX-2 NSAIDs. Most physicians (41) had moderate attitude towards providing information and 24 good attitude. Fewer physicians working in tertiary hospitals than general and community hospital physicians considered that time limitations prevented counseling and that patient information leaflets offered easily accessible information. Additionally, more physicians who did not inform patients about ADRs agreed that ADR communication can lead to anxiety and discontinuing treatment.

CONCLUSION

The study indicates that, although orthopaedic physicians had positive attitudes towards providing ADR information to patients, improvement is needed in communicating NSAID risk information.

An Assessment of the Quality of CT Radiation Dose Information on the Internet

OBJECTIVES

Our goal was to ascertain the quality of health information related to CT radiation exposure using a simulated Internet search and from incident information that may be available during day-to-day Internet usage.

METHODS

We entered 14 terms relating to information on CT dose into the most commonly used Internet search engine and analyzed the first 100 web page results for each. A Rich Search Site (RSS) feed search was also used to evaluate incidental information over a 12-week period in 2014. Each web page was classified as being "completely accurate," "somewhat accurate," or "inaccurate."

RESULTS

Of 1,400 web pages, 290 were relevant and accessible. We deemed 12.8% of these pages as inaccurate and 67.2% of pages as completely accurate. The highest proportion of web pages was from media sources, which, along with discussion forums, commercial websites, and blogs, were found to have proportionally the largest amount of inaccurate information. Of 1,943 posts, 136 (7.0%) identified by the RSS were relevant, 9.6% were deemed inaccurate, and only 29.9% were deemed completely accurate. The results of our simulated query highlight the importance of public education regarding Internet usage when researching topics relating to radiation exposure associated with CT.

Radiation Brain Drain? The Impact of Demographic Change on U.S. Radiation Protection

The use of radiation has a substantial beneficial impact, particularly in the areas of medicine, energy production, basic science research, and industrial applications. Radiation protection knowledge and experience are required for acquiring and implementing scientific knowledge to protect workers, members of the public, and the environment from potential harmful effects of ionizing radiation while facilitating the beneficial use and development of radiation-based technologies. However, demographic changes are negatively impacting U.S. radiation protection and response capabilities. The number of radiation professionals continues to decrease even as the demand for such professionals is growing. These concerns are most pronounced in the medical, energy, research, and security arenas. Though the United States has been the world leader in radiation protection and radiation sciences for many years, the country has no strategic plan to ensure the maintenance of expertise in radiobiology, radiation physics, and radiation protection. Solving this problem will require a significant increase in federal and state funding as well as formal partnerships and initiatives among academia, professional societies, government, and the private sector.

Women's experiences and preferences regarding breast imaging after completing breast cancer treatment

BACKGROUND

After treatment for breast cancer, most women receive an annual surveillance mammography to look for subsequent breast cancers. Supplemental breast MRI is sometimes used in addition to mammography despite the lack of clinical evidence for it. Breast imaging after cancer treatment is an emotionally charged experience, an important part of survivorship care, and a topic about which limited patient information exists. We assessed women's experiences and preferences about breast cancer surveillance imaging with the goal of determining where gaps in care and knowledge could be filled.

PARTICIPANTS AND METHODS

We conducted six focus groups with a convenience sample of 41 women in California, North Carolina, and New Hampshire (USA). Participants were aged 38-75 years, had experienced stage 0-III breast cancer within the previous 5 years, and had completed initial treatment. We used inductive thematic analysis to identify key themes from verbatim transcripts.

RESULTS

Women reported various types and frequencies of surveillance imaging and a range of surveillance imaging experiences and preferences. Many women experienced discomfort during breast imaging and anxiety related to the examination, primarily because they feared subsequent cancer detection. Women reported trust in their providers and relied on providers for imaging decision-making. However, women wanted more information about the treatment surveillance transition to improve their care.

CONCLUSION

There is significant opportunity in breast cancer survivorship care to improve women's understanding about breast cancer surveillance imaging and to provide enhanced support to them at the time their initial treatment ends and at the time of surveillance imaging examinations.

Exploration of communication gaps among women with metastatic breast cancer, caregivers and oncologists

Aim: The Make Your Dialogue Count survey aimed to explore communication gaps between patients/caregivers and oncologists, and the needs of patients/caregivers at diagnosis and most recent treatment change. Methods: Three distinct sets of parallel questions were asked of 359 women with metastatic breast cancer, 234 caregivers and 252 oncologists. Survey respondents were not necessarily associated with each other. Results: Patients/caregivers considered themselves knowledgeable, yet many lacked basic disease information affecting treatment decisions. Patients/caregivers reported that oncologists do not discuss important topics at diagnosis. Patients failed to discuss side effects, but wanted their oncologist’s help to manage side effects. Conclusion: This survey provides additional insight on interactional dynamics to bridge gaps in understanding that affect quality of care.

Radiologic Professionalism in Modern Health Care

Modern radiology is at the forefront of technological progress in medicine, a position that often places unique challenges on its professional character. This article uses "Medical Professionalism in the New Millennium: A Physician Charter," a document published in 2002 and endorsed by several major radiology organizations, as a lens for exploring professional challenges in modern radiology. The three main tenets of the Charter emphasize patient welfare, patient autonomy, and the reduction of disparities in health care distribution. This article reviews the ways in which modern technology and financial structures potentially create stressors on professionalism in radiology, while highlighting the opportunities they provide for radiologists seeking to fulfill the professional goals articulated in the Charter. Picture archiving and communication systems (PACS) and voice recognition systems have transformed the speed of radiology and enhanced the ability of radiologists to improve patient care but also have brought new tensions to the workplace. Although teleradiology may improve global access to radiologists, it may also promote the commoditization of radiology, which diminishes the professional stature of radiologists. Social media and patient portals provide radiologists with new forums for interacting with the public and patients, potentially promoting patient welfare. However, patient privacy and autonomy are important considerations. Finally, modern financial structures provide radiologists with both entrepreneurial opportunities as well as the temptation for unprofessional conduct. Each of these advances carries the potential for professional growth while testing the professional stature of radiology. By considering the risks and benefits of emerging technologies in the modern radiology world, radiologists can chart an ethical and professional future path.

Internet-based ICRP resource for healthcare providers on the risks and benefits of medical imaging that uses ionising radiation

The purpose of the International Commission on Radiological Protection (ICRP) Committee 3 Working Party was to update the 2001 web-based module 'Radiation and your patient: a guide for medical practitioners' from ICRP. The key elements of this task were: to clearly identify the target audience (such as healthcare providers with an emphasis on primary care); to review other reputable sources of information; and to succinctly publish the contribution made by ICRP to the various topics. A 'question-and-answer' format addressing practical topics was adopted. These topics included benefits and risks of imaging using ionising radiation in common medical situations, as well as pertaining to specific populations such as pregnant, breast-feeding, and paediatric patients. In general, the benefits of medical imaging and related procedures far outweigh the potential risks associated with ionising radiation exposure. However, it is still important to ensure that the examinations are clinically justified, that the procedure is optimised to deliver the lowest dose commensurate with the medical purpose, and that consideration is given to diagnostic reference levels for particular classes of examinations.