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Karavas E, Ece B, Aydın S, Kocak M, Cosgun Z, Bostanci IE, Kantarci M. Are we aware of radiation: A study about necessity of diagnostic X-ray exposure. World J Methodol 2022; 12:264-273. [PMID: 36159099 PMCID: PMC9350723 DOI: 10.5662/wjm.v12.i4.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/27/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total exposure to ionizing radiation has nearly doubled in the last two decades. This increase is primarily due to increased computed tomography (CT) exposure. Concerns have been raised about the risks associated with patients' exposure to medical imaging radiation, which can increase a person's lifetime risk of developing cancer. Preventing unnecessary examinations becomes critical at this point. To avoid unnecessary examinations, it is necessary to understand the demanding process.
AIM To ascertain clinicians' awareness of and reasons for requesting a CT examination.
METHODS We developed an online questionnaire that included 20 questions about clinicians' awareness of radiation safety and their reasons for requesting a CT examination, as well as demographic information such as age, gender, and year of medical practice experience. Additionally, we asked participants the number of CT scans requested in a month, the patients' questions and approaches about the imaging method, the effect of the patient's previous imaging history on the current imaging request, whether they believed that they had sufficient information about radiation doses, and whether they requested CT without an indication. We administered the questionnaire to clinicians from a variety of different professions in four different cities.
RESULTS A total of 195 clinicians participated. Internal medicine specialists were the most crowded group (38/195, 19.5%). Mean age of the population was 33.66 ± 5.92 years. Mean year of experience was 9.01 ± 5.96. Mean number of requested CT scans in a month was 36.88 ± 5.86. Forty-five (23.1%) participants stated that they requested CT scans without clinical indication. The most common reasons for CT scan requests were work load, fear of malpractice, and patient demand/insistence.
CONCLUSION CT scan requests are influenced by a variety of factors, both internal and external to the doctors and patients. Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.
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Affiliation(s)
- Erdal Karavas
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
| | - Bunyamin Ece
- Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey
| | - Sonay Aydın
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
| | - Mehmet Kocak
- Department of Radiology, Bolu İzzet Baysal State Hospital, Bolu 14300, Turkey
| | - Zeliha Cosgun
- Department of Radiology, Bolu Abant Izzet Baysal University, Bolu 14030, Turkey
| | - Isil Esen Bostanci
- Department of Radiology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara 06200, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
- Department of Radiology, Atatürk University, Erzurum 25240, Turkey
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Vassileva J, Zewde NT, Reim M, Holmberg O, Rehani MM. Communication of radiation risk from imaging studies: an IAEA-coordinated international survey. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021524. [PMID: 35320786 DOI: 10.1088/1361-6498/ac6047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this IAEA-coordinated international study was to understand aspects related to the communication of radiation risk from imaging studies, such as how often imaging department personnel and referring physicians are asked about radiation risks in diagnostic imaging, who asks about these risks, how often professionals are able to provide satisfactory answers using qualitative metrics and how often quantitative risk estimates are needed. A web-based questionnaire with ten questions was completed by 386 healthcare professionals from 63 countries from all four continents, including clinicians/referring physicians (42.5%), radiologists or nuclear medicine physicians (26.7%), medical physicists (23.1%), radiographers/radiological technologists (6.2%) and others (1.6%). The results indicate that radiation risk-related questions are largely asked by patients (73.1%) and parents of child patients (38.6%), and 78% of the professionals believe they are able to answer those questions using qualitative metrics such as very small/minimal, small, medium rather than number of cancers likely occurring. The vast majority, with over three times higher frequency, indicated the purpose of knowing previous radiological exams as 'both clinical information and radiation exposure history' rather than 'only clinical information'. Nearly two-thirds of the clinicians/referring physicians indicated that knowing the radiation exposure history of the patient will affect their decision-making for the next exam, as against only about one-fifth who said 'no, it will not affect their decision-making'. The same question, when addressed to radiologists, resulted in a slightly larger fraction of about three-quarters who said 'yes', as opposed to a smaller fraction of about 12% who said 'no, it will not affect their decision-making'. Mapping the present situation of communication of benefits and risks for patients is important and may be the basis of further analysis, regular monitoring and possibly a target for clinical audits. Further studies focused on specific professional groups might help in obtaining á deeper understanding of the need for practical communication tools.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Madan M Rehani
- Massachusetts General Hospital, Boston, MA, United States of America
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Armao D, Hartman TS, Katz L, Shea CM, Koschnitzky J, Yang R, Smith JK, Quinsey C. Radiation safety education and diagnostic imaging in pediatric patients with surgically treated hydrocephalus: the patient and family perspective. Childs Nerv Syst 2021; 37:491-497. [PMID: 32710252 DOI: 10.1007/s00381-020-04822-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgically treated hydrocephalus patients are frequently imaged with head computed tomography (CT), and risk/benefit communication with families is inconsistent and unknown. We aimed to educate patients and caregivers about radiation safety in CT and explore their communication preferences. METHODS We conducted a pediatric CT radiation safety and diagnostic imaging educational workshop for patients and caregivers at a national conference on hydrocephalus to characterize current practice and desired communication about CT imaging. Our workshop consisted of an interactive educational intervention with pre-/post-session surveys followed by feedback from participants. RESULTS Our session included 34 participants (100% response rate for surveys) with 28 being parents of individuals with hydrocephalus. A total of 76% (n = 26) participants showed an increase in knowledge after the session (p < 0.01). All participants (N = 34) uniformly desired risk/benefit discussions before CT scans. However, 71% stated that they were not informed of risks/benefits of CT scans by a medical professional. Following the session, the number of participants indicating that informed consent should be obtained before CT scans increased from 30 to 33. Respondents also revealed that 14% of children and young adults had received > 100 CT scans for shunt evaluation with the median being 25 scans (IQR 20). CONCLUSIONS Caregivers desire and deserve to be empowered through education and social support, and continuously engaged through sharing decisions and co-designing care plans. The neurosurgical community is in an ideal position to collaborate with radiologists, primary care providers, and parents in the development and testing of credible, high-quality online and social media resources.
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Affiliation(s)
- Diane Armao
- Department of Radiology, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA. .,Department of Pathology and Laboratory Medicine, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA.
| | - Terry S Hartman
- Department of Radiology, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA.,Department of Health Informatics, School of Health Professionals, Rutgers University, Newark, NJ, USA
| | - Laurence Katz
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Richard Yang
- School of Osteopathic Medicine, Campbell University, Buies Creek, NC, USA
| | - J Keith Smith
- Department of Radiology, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA
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Armao D, Hartman TS, Shea CM, Katz L, Thurnes T, Smith JK. Maximizing Benefit and Minimizing Risk in Medical Imaging Use: An Educational Primer for Health Care Professions Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518798812. [PMID: 30211315 PMCID: PMC6131289 DOI: 10.1177/2382120518798812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
"I am not young enough to know everything."Oscar Wilde. BACKGROUND There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students' training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics. MATERIALS AND METHODS The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance. RESULTS A total of 301 students were enrolled in the study. There was 58% (P < .01) and 85% (P < .01) improvement in attitude and knowledge regarding appropriateness of imaging, respectively. The authors also found an 8% increase (P < .01) in students who thought informed consent should be obtained prior to pediatric computed tomographic imaging. Physical assistant students were more likely than medical students to prefer obtaining informed consent at baseline (P = .03). CONCLUSIONS A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.
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Affiliation(s)
- Diane Armao
- Department of Radiology, School of
Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
- Department of Pathology and Laboratory
Medicine, School of Medicine, The University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
- Department of Physician Assistant
Studies, Elon University, Elon, NC, USA
| | - Terry S Hartman
- Department of Radiology, School of
Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Christopher M Shea
- Department of Health Policy and
Management, UNC Gillings School of Global Public Health, The University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laurence Katz
- Department of Emergency Medicine, School
of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Tracey Thurnes
- Department of Physician Assistant
Studies, Elon University, Elon, NC, USA
| | - J Keith Smith
- Department of Radiology, School of
Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
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Frush DP, Perez MDR. Children, medical radiation and the environment: An important dialogue. ENVIRONMENTAL RESEARCH 2017; 156:358-363. [PMID: 28391175 DOI: 10.1016/j.envres.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/27/2017] [Accepted: 04/02/2017] [Indexed: 06/07/2023]
Abstract
There are unique considerations in the medical care of children, which includes the use of medical imaging. Medical imaging is frequently necessary and is essential in diagnosis and management of children with illness and injury. Much of medical imaging requires ionizing radiation. While virtually all diagnostic imaging radiation is considered low-dose level, there is still a broad misperception about what modalities use ionizing radiation and how much radiation risk exists in the medical environment. A discussion of radiation exposure is especially relevant in children due to their increased vulnerability, including to radiation-induced cancer. Ionizing radiation is both naturally occurring and man-made, including medical sources that have been increasing over the past few decades and can vary in radiation dose both between different modalities and for similar examinations. Perspectives vary regarding cancer risk and levels of radiation resulting from diagnostic imaging, however most medical and scientific organization support the perspective that the risk of cancer at these levels is uncertain. It is important to have balanced and informed resources for the use of ionizing radiation in the care of children, and it is equally important to assure that the delivery of this content is appropriate to the audience to which it is intended. For these reasons, it is valuable to review the issues related to use of ionizing radiation in medical imaging in children.
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Affiliation(s)
- Donald P Frush
- Department of Radiology, Duke University Medical Center, 1905 McGovern-Davison Children's Health Center, Durham, NC 27710, USA.
| | - Maria Del Rosario Perez
- Department of Public Health, Environmental and Social Determinants of Health (PHE), Cluster of Family, Women's and Children's Health (FWC), World Health Organization (WHO), Geneva, Switzerland
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Armao D, Hartman T, Shea CM, Sams C, Ivanovic M, Fordham LA, Smith JK. A Toolkit for Pediatric CT Dose Reduction in Community Hospitals. J Am Coll Radiol 2016; 13:1337-1342.e11. [PMID: 27289341 DOI: 10.1016/j.jacr.2016.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
Pediatric CT radiation dose optimization is a challenging process for pediatric-focused facilities and community hospitals alike. Ongoing experience and trial-and-error approaches to dose reduction in the large academic hospital setting may position these centers to help community hospitals that strive for CT quality improvement. We describe our hands-on approach in a pilot project to create a partnership between an academic medical center and a community hospital to develop a toolkit for implementing CT dose reduction. Our aims were to (1) assess the acceptability of an interactive educational program and electronic toolkit booklet, (2) conduct a limited test of the efficacy of the toolkit in promoting knowledge and readiness to change, and (3) assess the acceptability and practicality of a collaborative approach to implementing dose reduction protocols in community hospitals. In partnering with the community hospital, we found that they had size-specific radiation doses two to three times higher than those at our center. Survey results after a site visit with interactive educational presentations revealed an increase in knowledge, stronger opinions about the health risks of radiation from CT scans, and willingness and perceived ability to reduce pediatric CT doses.
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Affiliation(s)
- Diane Armao
- Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina; Department of Pathology and Laboratory Medicine, UNC School of Medicine, Chapel Hill, North Carolina; Department of Physician Assistant Studies, Elon University, Elon, North Carolina.
| | - Terry Hartman
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Christopher M Shea
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Cassandra Sams
- Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Marija Ivanovic
- Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Lynn Ansley Fordham
- Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina
| | - J Keith Smith
- Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina
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Communicating Potential Radiation-Induced Cancer Risks From Medical Imaging Directly to Patients. AJR Am J Roentgenol 2015; 205:962-70. [DOI: 10.2214/ajr.15.15057] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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