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Alsubaie FH, Abujamea AH. Knowledge and Perception of Radiation Risk From Computed Tomography Scans Among Patients Attending an Emergency Department. Cureus 2024; 16:e52687. [PMID: 38384636 PMCID: PMC10879657 DOI: 10.7759/cureus.52687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
To evaluate the level of knowledge about radiation dose and possible risks related to computed tomography (CT) scans among patients visiting emergency departments (EDs), a survey was conducted over a two-month period. A total of 357 adult patients (44% men and 56% women) presenting for diagnostic imaging in the ED answered a survey consisting of 15 questions. The survey included questions about the participants' demographics and knowledge of radiation. Most of the respondents (58.5%) reported that the physician did not explain the potential risk of radiation before the procedure. In addition, more than half of the respondents (58.1%) expressed feeling anxious about the potential risk of radiation. Most respondents (84.9%) stated that the potential radiation risk did not affect their decision to proceed with the procedure. Overall, the findings highlight a lack of information about radiation and its potential risks provided to patients prior to the diagnostic procedure. Increasing awareness and understanding of the risks associated with these imaging modalities should be considered essential in modern communities. Efforts should be made to ensure that patients undergoing diagnostic imaging are aware of the radiation risks they may encounter.
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Affiliation(s)
- Faisal H Alsubaie
- Department of Family and Community Medicine, King Saud University/College of Medicine, Riyadh, SAU
| | - Abdullah H Abujamea
- Department of Radiology and Medical Imaging, King Saud University/College of Medicine, Riyadh, SAU
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2
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The why, who, how, and what of communicating CT radiation risks to patients and healthcare providers. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1514-1525. [PMID: 36799998 DOI: 10.1007/s00261-022-03778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 02/18/2023]
Abstract
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.
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Oakley PA, Harrison DE. Death of the ALARA Radiation Protection Principle as Used in the Medical Sector. Dose Response 2020; 18:1559325820921641. [PMID: 32425724 PMCID: PMC7218317 DOI: 10.1177/1559325820921641] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
ALARA is the acronym for "As Low As Reasonably Achievable." It is a radiation protection concept borne from the linear no-threshold (LNT) hypothesis. There are no valid data today supporting the use of LNT in the low-dose range, so dose as a surrogate for risk in radiological imaging is not appropriate, and therefore, the use of the ALARA concept is obsolete. Continued use of an outdated and erroneous principle unnecessarily constrains medical professionals attempting to deliver high-quality care to patients by leading to a reluctance by doctors to order images, a resistance from patients/parents to receive images, subquality images, repeated imaging, increased radiation exposures, the stifling of low-dose radiation research and treatment, and the propagation of radiophobia and continued endorsement of ALARA by regulatory bodies. All these factors result from the fear of radiogenic cancer, many years in the future, that will not occur. It has been established that the dose threshold for leukemia is higher than previously thought. A low-dose radiation exposure from medical imaging will likely upregulate the body's adaptive protection systems leading to the prevention of future cancers. The ALARA principle, as used as a radiation protection principle throughout medicine, is scientifically defunct and should be abandoned.
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Ukkola L, Oikarinen H, Henner A, Haapea M, Tervonen O. Patient information regarding medical radiation exposure is inadequate: Patients' experience in a university hospital. Radiography (Lond) 2017; 23:e114-e119. [DOI: 10.1016/j.radi.2017.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/31/2017] [Accepted: 04/01/2017] [Indexed: 11/30/2022]
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5
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A snapshot of patients' awareness of radiation dose and risks associated with medical imaging examinations at an Australian radiology clinic. Radiography (Lond) 2017; 23:94-102. [DOI: 10.1016/j.radi.2016.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/18/2016] [Accepted: 10/31/2016] [Indexed: 11/18/2022]
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Duty to Inform and Informed Consent in Diagnostic Radiology: How Ethics and Law can Better Guide Practice. HEC Forum 2017; 28:75-94. [PMID: 25749428 DOI: 10.1007/s10730-015-9275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although there is consensus on the fact that ionizing radiation used in radiological examinations can affect health, the stochastic (random) nature of risk makes it difficult to anticipate and assess specific health implications for patients. The issue of radiation protection is peculiar as any dosage received in life is cumulative, the sensitivity to radiation is highly variable from one person to another, and between 20 % and 50 % of radiological examinations appear not to be necessary. In this context, one might reasonably assume that information and patient consent would play an important role in regulating radiological practice. However, there is to date no clear consensus regarding the nature and content of-or even need for-consent by patients exposed to ionizing radiation. While law and ethics support the same principles for respecting the dignity of the person (inviolability and integrity), in the context of radiology practice, they do not provide a consistent message to guide clinical decision-making. This article analyzes the issue of healthcare professionals' duty to inform and obtain patient consent for radiological examinations. Considering that both law and ethics have as one of their aims to protect vulnerable populations, it is important that they begin to give greater attention to issues raised by the use of ionizing radiation in medicine. While the situation in Canada serves as a backdrop for a reflective analysis of the problem, the conclusions are pertinent for professional practice in other jurisdictions because the principles underlying health law and jurisprudence are fairly general.
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Coppolino M, Avins AL, Callen A, Sumner W. Quantifying Worry in the Face of Uncertainty: Radiation Exposure from Medical Imaging. J Med Imaging Radiat Sci 2017; 48:16-21. [PMID: 31047204 DOI: 10.1016/j.jmir.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The degree to which people worry about radiation exposure from medical imaging has not been quantified. Such concern is important for clinical decision making and policy generation. OBJECTIVE The aim of this study was to quantify the degree of worry as a consequence of radiation exposure. DESIGN A time trade-off methodology was used to estimate health state utilities associated with radiation exposure from computed tomography scans in an inclusive sample of physicians. Health state utilities were elicited from in-person interviews using a software-guided, hypothetical scenario in which the subject is exposed to two separate computed tomography scans. RESULTS One hundred and eighteen interviews were conducted. The overall mean and median utility values for the health state of concern due to radiation exposure were 0.95 (95% confidence interval: 0.94-0.96) and 0.98 (interquartile range: 0.91-1.00), respectively. The utility score distribution was highly skewed toward higher values. Five respondents (4.3%) recorded a utility score of ≤0.8 and 17 respondents (14.5%) were willing to sacrifice at least 5 or more years of life to live free of the radiation-exposure worry. CONCLUSIONS AND RELEVANCE The physician respondents generally demonstrated low levels of disutility; however, a subset of physicians expressed much greater disutility for the future risk of malignancy. Given the potential for physicians to influence health care decisions and policies, further study of radiation-related concerns seems warranted. Physicians, patients, and the general public should be aware of the potential impact such differing views held by physicians may have on their clinical recommendations.
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Affiliation(s)
- Michael Coppolino
- Department of Critical Care Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
| | - Andrew L Avins
- Northern California Kaiser-Permanente Division of Research, Oakland, California, USA; Department of Medicine, University of California, San Francisco, California, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA; Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Andrew Callen
- Department of Radiology, University of California, San Francisco, California, USA
| | - Walton Sumner
- Department of Medicine, Washington University School of Medicine St. Louis, Missouri, USA
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Mellado J. Autonomy, consent and responsibility. Part II. Informed consent in medical care and in the law. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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The radiographers' role in information giving prior to consent for computed tomography scans: A cross-sectional survey. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mellado JM. Autonomy, consent and responsibility. Part II. Informed consent in medical care and in the law. RADIOLOGIA 2016; 58:427-434. [PMID: 27554038 DOI: 10.1016/j.rx.2016.06.010] [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: 03/05/2016] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
Abstract
Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.
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Affiliation(s)
- J M Mellado
- Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España.
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11
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Shyu JY, Sodickson AD. Communicating radiation risk to patients and referring physicians in the emergency department setting. Br J Radiol 2016; 89:20150868. [PMID: 26647958 DOI: 10.1259/bjr.20150868] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Heightened awareness about the radiation risks associated with CT imaging has increased patients' wishes to be informed of these risks, and has motivated efforts to reduce radiation dose and eliminate unnecessary imaging. However, many ordering providers, including emergency physicians, are ill prepared to have an informed discussion with patients about the cancer risks related to medical imaging. Radiologists, who generally have greater training in radiation biology and the risks of radiation, often do not have a face-to-face relationship with the patients who are being imaged. A collaborative approach between emergency physicians and radiologists is suggested to help explain these risks to patients who may have concerns about getting medical imaging.
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Affiliation(s)
- Jeffrey Y Shyu
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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12
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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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Weigner MB, Basham HF, Dewar KM, Rupp VA, Cornelius L, Greenberg MR. Patient attitudes regarding consent for emergency department computed tomographies. West J Emerg Med 2015; 15:14-9. [PMID: 24578764 PMCID: PMC3935784 DOI: 10.5811/westjem.2013.5.15893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 05/24/2013] [Accepted: 05/24/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction Little is known about patient attitudes towards informed consent for computed tomography (CT) in the emergency department (ED). We set out to determine ED patient attitudes about providing informed consent for CTs. Methods In this cross-sectional questionnaire-based survey study, we evaluated a convenience sample of patients’ attitudes about providing informed consent for having a CT at 2 institutional sites. Historically, at our institutional network, patients received a CT at approximately 25% of their ED visits. The survey consisted of 17 “yes/no” or multiple-choice questions. The primary outcome question was “which type of informed consent do you feel is appropriate for a CT in the Emergency Department?” Results We analyzed 300 survey responses, which represented a 90% return rate of surveys distributed. Seventy-seven percent thought they should give their consent prior to receiving a CT, and 95% were either comfortable or very comfortable with their physician making the decision regarding whether they needed a CT. Forty percent of the patients felt that a general consent was appropriate before receiving a CT in the ED, while 34% thought a verbal consent was appropriate and 15% percent thought a written consent was appropriate. Seventy-two percent of the ED patients didn’t expect to receive a CT during their ED visit and 30% of the ED patients had previously provided consent prior to receiving a CT. Conclusion Most patients feel comfortable letting the doctor make the decision regarding the need for a CT. Most ED patients feel informed consent should occur before receiving a CT but only a minority feel the consent should be written and specific to the test.
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Affiliation(s)
- Michael B Weigner
- Lehigh Valley Hospital and Health Network, Department of Emergency Medicine Research, Allentown, Pennsylvania
| | - Hilary F Basham
- Lehigh Valley Hospital and Health Network, Department of Emergency Medicine Research, Allentown, Pennsylvania
| | - Kate M Dewar
- Lehigh Valley Hospital and Health Network, Department of Emergency Medicine Research, Allentown, Pennsylvania
| | - Valerie A Rupp
- Lehigh Valley Hospital and Health Network, Department of Emergency Medicine Research, Allentown, Pennsylvania
| | - Llewellyn Cornelius
- Lehigh Valley Hospital and Health Network, Department of Emergency Medicine Research, Allentown, Pennsylvania
| | - Marna Rayl Greenberg
- Lehigh Valley Hospital and Health Network, Department of Emergency Medicine Research, Allentown, Pennsylvania
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Armao DM, Smith JK, Semelka RC. Debriefing the Brief: It is Time for the Provision of Informed Consent before Pediatric CT. Radiology 2015; 275:326-30. [DOI: 10.1148/radiol.2015142860] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Mills AM, Raja AS, Marin JR. Optimizing diagnostic imaging in the emergency department. Acad Emerg Med 2015; 22:625-31. [PMID: 25731864 DOI: 10.1111/acem.12640] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/09/2015] [Accepted: 02/03/2015] [Indexed: 12/15/2022]
Abstract
While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use.
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Affiliation(s)
- Angela M. Mills
- The Department of Emergency Medicine; University of Pennsylvania; Philadelphia PA
| | - Ali S. Raja
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
- Center for Evidence Based Imaging and Department of Radiology; Brigham and Women's Hospital; Boston MA
| | - Jennifer R. Marin
- The Departments of Pediatrics and Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
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Daramola OO, Lidder AK, Ramli R, Chandra RK, Shintani-Smith S, Conley DB, Kern RC, Tan BK. Patient knowledge and perception of computed tomography scan in the management of chronic rhinosinusitis symptoms. Laryngoscope 2015; 125:791-5. [PMID: 25346013 PMCID: PMC4376556 DOI: 10.1002/lary.24992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/23/2014] [Accepted: 09/30/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to report patients' knowledge and comfort level with computed tomography (CT) imaging for sinus disease and evaluate patient willingness to undergo empiric medical therapy (EMT) versus CT-directed therapy (CTDT). STUDY DESIGN Prospective survey study. METHODS A 22-item survey was administered to patients with nasal/sinus symptoms in a tertiary care rhinology clinic. Questions elicited patient demographics, imaging history, and knowledge/comfort regarding imaging-related radiation exposure. Patients were presented with the theoretical choice of EMT versus CTDT, given the expected positive predictive value, in chronic rhinosinusitis (CRS) management. RESULTS Two hundred patients (52% female, age range 18-83 years) participated. Of these, 85% had symptoms for over 3 months. Only 91 patients (45.5%) were aware that CT imaging involved radiation exposure. Prior CT experience and past sinus surgery (P < .05), but not sex or education level, were associated with increased comfort with CT imaging. Most patients (78%) preferred CTDT over EMT. If a CT sinus was recommended, 77 patients (38.5%) had concerns, of which 26% identified radiation exposure as the leading concern. The majority (70%) were unsure about the relative radiation dose of a conventional CT. CONCLUSIONS Patients with CRS symptoms prefer CTDT over EMT if a diagnosis cannot be established definitively using exam findings. Although most patients deferred to the physician regarding the decision to utilize CT imaging, there is low awareness of CT-related radiation exposure, and a significant minority of patients have radiation-related concerns with regard to medical imaging for nasal and sinus symptoms.
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Affiliation(s)
- Opeyemi O. Daramola
- Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ramiza Ramli
- Department of Otorhinolaryngology, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Rakesh K. Chandra
- Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stephanie Shintani-Smith
- Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David B. Conley
- Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert C. Kern
- Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bruce K. Tan
- Department of Otolaryngology-Head and Neck Surgery Northwestern University Feinberg School of Medicine, Chicago, IL
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Ashurst JV, Cherney AR, Evans EM, Kennedy Hall M, Hess EP, Kline JA, Mitchell AM, Mills AM, Weigner MB, Moore CL. Research priorities for the influence of gender on diagnostic imaging choices in the emergency department setting. Acad Emerg Med 2014; 21:1431-7. [PMID: 25420885 DOI: 10.1111/acem.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 12/14/2022]
Abstract
Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised.
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Affiliation(s)
- John V. Ashurst
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Alan R. Cherney
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Elizabeth M. Evans
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Michael Kennedy Hall
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Erik P. Hess
- Department of Emergency Medicine; Mayo Clinic; Rochester MN
| | - Jeffrey A. Kline
- Department of Emergency Medicine; Indiana University School of Medicine; Indianapolis IN
| | - Alice M. Mitchell
- Department of Emergency Medicine; Indiana University School of Medicine; Indianapolis IN
| | - Angela M. Mills
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - Michael B. Weigner
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Christopher L. Moore
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
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Griffey RT, Jeffe DB, Bailey T. Emergency physicians' attitudes and preferences regarding computed tomography, radiation exposure, and imaging decision support. Acad Emerg Med 2014; 21:768-77. [PMID: 25125272 DOI: 10.1111/acem.12410] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/31/2013] [Accepted: 02/01/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although computerized decision support for imaging is often recommended for optimizing computed tomography (CT) use, no studies have evaluated emergency physicians' (EPs') preferences regarding computerized decision support in the emergency department (ED). In this needs assessment, the authors sought to determine if EPs view overutilization as a problem, if they want decision support, and if so, the kinds of support they prefer. METHODS A 42-item, Web-based survey of EPs was developed and used to measure EPs' attitudes, preferences, and knowledge. Key contacts at local EDs sent letters describing the study to their physicians. Exploratory principal components analysis (PCA) was used to determine the underlying factor structure of multi-item scales, Cronbach's alpha was used to measure internal consistency of items on a scale, Spearman correlations were used to describe bivariate associations, and multivariable linear regression analysis was used to identify variables independently associated with physician interest in decision support. RESULTS Of 235 surveys sent, 155 (66%) EPs responded. Five factors emerged from the PCA. EPs felt that: 1) CT overutilization is a problem in the ED (α = 0.75); 2) a patient's cumulative CT study count affects decisions of whether and what type of imaging study to order only some of the time (α = 0.75); 3) knowledge that a patient has had prior CT imaging for the same indication makes EPs less likely to order a CT (α = 0.42); 4) concerns about malpractice, patient satisfaction, or insistence on CTs affect CT ordering decisions (α = 0.62); and 5) EPs want decision support before ordering CTs (α = 0.85). Performance on knowledge questions was poor, with only 18% to 39% correctly responding to each of the three multiple-choice items about effective radiation doses of chest radiograph and single-pass abdominopelvic CT, as well as estimated increased risk of cancer from a 10-mSv exposure. Although EPs wanted information on patients' cumulative exposures, they feel inadequately familiar with this information to make use of it clinically. If provided with patients' cumulative radiation exposures from CT, 87% of EPs said that they would use this information to discuss imaging options with their patients. In the multiple regression model, which included all variables associated with interest in decision support at p < 0.10 in bivariate tests, items independently associated with EPs' greater interest in all types of decision support proposed included lower total knowledge scores, greater frequency that cumulative CT study count affects EP's decision to order CTs, and greater agreement that overutilization of CT is a problem and that awareness of multiple prior CTs for a given indication affects CT ordering decisions. CONCLUSIONS Emergency physicians view overutilization of CT scans as a problem with potential for improvement in the ED and would like to have more information to discuss risks with their patients. EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients. Findings reveal several opportunities that could potentially affect CT utilization.
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Affiliation(s)
- Richard T. Griffey
- The Division of Emergency Medicine; The Department of Internal Medicine; Washington University School of Medicine; St. Louis MO
- The Washington University Institute for Public Health; St. Louis MO
| | - Donna B. Jeffe
- The Division of Health Behavior Research; The Department of Internal Medicine; Washington University School of Medicine; St. Louis MO
- The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital; St. Louis MO
| | - Thomas Bailey
- The Division of Infectious Diseases; The Department of Internal Medicine; Washington University School of Medicine; St. Louis MO
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Robey TE, Edwards K, Murphy MK. Barriers to computed tomography radiation risk communication in the emergency department: a qualitative analysis of patient and physician perspectives. Acad Emerg Med 2014; 21:122-9. [PMID: 24673667 DOI: 10.1111/acem.12311] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/02/2013] [Accepted: 09/04/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This qualitative study aimed to characterize the barriers to informed discussions between patients and emergency physicians (EPs) about radiation risk from computed tomography (CT) and to identify future interventions to improve patient understanding of CT radiation risk. METHODS This study used a focus group approach to collect concepts about radiation risk exposure from a national sample of EPs and a local sample of emergency department (ED) patients. A directed content analysis used an a priori medical ethics framework to explore themes from the focus groups while a subsequent normative ethics analysis compared these results with existing perceptions about discussing CT radiation risk. RESULTS Focus groups (three each for a total of 19 EPs and 27 patients) identified concepts consistent with core medical ethics principles: patients emphasized autonomy and nonmaleficence more than physicians, while physicians emphasized beneficence. Subjects' knowledge of radiation dose and risk were equivalent to previously published reports. When asked about whether they should talk about radiation with patients, 74% of EPs reported that radiation exposure should be discussed, but the study EPs self-reported doing so with only an average of 24% of patients. Patients reported wanting to hear about radiation from their physicians the next time they need CT scans and thought that a written handout would work better than any other method. When presented with options for how to discuss risk with patients, EPs reported needing easy access to risk information and preferred discussion over other communications approaches, but had mixed support of distributing patient handouts. CONCLUSIONS The normative view that radiation from diagnostic CT should be discussed in the ED is shared by patients and physicians, but is challenged by the lack of a structured method to communicate CT radiation risk to ED patients. Our analysis identifies promising interest among physicians and patients to use information guides and electronic order prompts as potential informational tools to overcome this barrier.
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Affiliation(s)
- Thomas E. Robey
- Waterbury Hospital Emergency Department; Waterbury CT
- Yale University Department of Emergency Medicine; New Haven CT
| | - Kelly Edwards
- University of Washington Department of Bioethics and Humanities; Seattle WA
| | - Mary K. Murphy
- Yale University Department of Emergency Medicine; New Haven CT
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Marin JR, Grudzen CR. Emergency physician radiation risk communication: a role for shared decision-making. Acad Emerg Med 2014; 21:211-3. [PMID: 24438041 DOI: 10.1111/acem.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jennifer R. Marin
- Departments of Pediatrics and Emergency Medicine; Children's Hospital of Pittsburgh; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Corita R. Grudzen
- Brookdale Department of Geriatrics and Palliative Medicine; Mount Sinai School of Medicine; New York NY
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21
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Incidental Findings and the Need for a Revised Informed Consent Process. AJR Am J Roentgenol 2013; 201:1064-8. [DOI: 10.2214/ajr.13.11138] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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22
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Vock P. Invited Commentary: "Event-based versus process-based informed consent to address scientific evidence and uncertainties in ionising medical imaging" by Recchia et al. Insights Imaging 2013; 4:655-7. [PMID: 24018753 PMCID: PMC3781241 DOI: 10.1007/s13244-013-0283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peter Vock
- University of Bern, Ahornweg 58, 3095, Spiegel, Switzerland,
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Ma S, Kong B, Liu B, Liu X. Biological effects of low-dose radiation from computed tomography scanning. Int J Radiat Biol 2013; 89:326-33. [PMID: 23216318 DOI: 10.3109/09553002.2013.756595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE With the widespread use of computed tomography (CT), the risks of low-dose radiation from CT have been increasingly highlighted. This study aims to illustrate the CT-induced biological effects and analyze the potential beneficial or harmful outcomes so as to provide radiologists with reasonable advice on CT usage. MATERIALS AND METHODS The related literature was analyzed according to the topics of stochastic effect, hereditary effect, deterministic effect, accumulative injuries, hormesis and adaptive response; population epidemiology data were also analyzed. RESULTS CT accounts for 9% of X-ray examinations and approximately 40-67% of medical-related radiation, the dose is within the range of low-dose radiation (LDR). Two opposite viewpoints exist nowadays regarding the biological effects of CT scanning: They are either harmful or harmless. Approximately 0.6% and 1.5% of the cumulative cancer risk could be attributed to diagnostic X-rays in the UK and Germany, respectively. The probability of CT scans induced-cancer is about 0.7% and CT angiography's risk is around 0.13%. It is estimated that approximately 29,000 cancers could be related to CT scans in the USA every year. Meanwhile, another investigation of 25,104 patients who underwent 45,632 CT scans in 4 years showed that the majority of CT-induced cancers were accidents rather than certainties of frequent CT scans. CONCLUSION Although the LDR effects of CT are still controversial, the current problems include the high frequency-use and abuse of CT scans, the increase of radiation dose and accumulative dose in high-accuracy CT, and the poor understanding of carcinogenic risks. The underlying biological basis needs further exploring and the ratio of risks and benefits should be considered.
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Affiliation(s)
- Shumei Ma
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, China
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24
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Weigner MB, Dewar KM, Basham HF, Rupp VA, Greenberg MR. Impact of Education on Physician Attitudes toward Computed Tomography Utilization and Consent. J Emerg Med 2012; 43:e349-53. [DOI: 10.1016/j.jemermed.2011.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/17/2011] [Accepted: 09/18/2011] [Indexed: 11/17/2022]
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Paterick TE, Jan MF, Paterick ZR, Tajik AJ, Gerber TC. Cardiac imaging modalities with ionizing radiation: the role of informed consent. JACC Cardiovasc Imaging 2012; 5:634-40. [PMID: 22698534 DOI: 10.1016/j.jcmg.2011.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 11/10/2011] [Accepted: 11/21/2011] [Indexed: 11/16/2022]
Abstract
Informed consent ideally results in patient autonomy and rational health care decisions. Frequently, patients face complex medical decisions that require a delicate balancing of anticipated benefits and potential risks, which is the concept of informed consent. This balancing process requires an understanding of available medical evidence and alternative medical options, and input from experienced physicians. The informed consent doctrine places a positive obligation on physicians to partner with patients as they try to make the best decision for their specific medical situation. The high prevalence and mortality related to heart disease in our society has led to increased cardiac imaging with modalities that use ionizing radiation. This paper reviews how physicians can meet the ideals of informed consent when considering cardiac imaging with ionizing radiation, given the limited evidence for risks and benefits. The goal is an informed patient making rational choices based on available medical information.
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Affiliation(s)
- Timothy E Paterick
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin 53215, USA.
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Divrik Gökçe S, Gökçe E, Coşkun M. Radiology residents' awareness about ionizing radiation doses in imaging studies and their cancer risk during radiological examinations. Korean J Radiol 2012; 13:202-9. [PMID: 22438688 PMCID: PMC3303904 DOI: 10.3348/kjr.2012.13.2.202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 09/16/2011] [Indexed: 12/21/2022] Open
Abstract
Objective Imaging methods that use ionizing radiation have been more frequent in various medical fields with advances in imaging technology. The aim of our study was to make residents be aware of the radiation dose they are subjected to when they conduct radiological imaging methods, and of cancer risk. Materials and Methods A total of 364 residents participated in this descriptive study which was conducted during the period between October, 2008 and January, 2009. The questionnaires were completed under strict control on a one-to-one basis from each department. A χ2-test was used for the evaluation of data obtained. Results Only 7% of residents correctly answered to the question about the ionizing radiation dose of a posteroanterior (PA) chest X-ray. The question asking about the equivalent number of PA chest X-rays to the ionizing dose of a brain CT was answered correctly by 24% of residents; the same question regarding abdominal CT was answered correctly by 16% of residents, thorax CT by 16%, thyroid scintigraphy by 15%, intravenous pyelography by 9%, and lumbar spine radiography by 2%. The risk of developing a cancer throughout lifetime by a brain and abdominal CT were 33% and 28%, respectively. Conclusion Radiologic residents should have updated knowledge about radiation dose content and attendant cancer risks of various radiological imaging methods during both basic medical training period and following practice period.
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Sheikhtaheri A, Farzandipour M. Factors Associated with Quality of Informed Consent in Patients Admitted for Surgery: An Iranian Study. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/21507716.2010.528507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Scaife ER, Rollins MD. Managing radiation risk in the evaluation of the pediatric trauma patient. Semin Pediatr Surg 2010; 19:252-6. [PMID: 20889080 DOI: 10.1053/j.sempedsurg.2010.06.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric trauma is usually a nonoperative experience for the pediatric general surgeon. The pediatric trauma surgeon resuscitates the child and then evaluates and triages the identified injuries. A common diagnostic tool is the computed tomography (CT) scan. Most children who require evaluation for significant trauma will get a CT scan, but there are no national guidelines directing the assessment. Injuries to the head, cervical spine, chest, and abdomen can all be imaged with a CT scan; the question is whether the liberal approach to imaging children is appropriate. Over the past decade, concern has arisen about the radiation dose delivered by CT. This concern has generated a national campaign to "image gently." This article reviews the data involving the risk of medical radiation exposure and discusses strategies for managing the risk.
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Affiliation(s)
- Eric R Scaife
- Division of Pediatric Surgery, University of Utah, 100 N. Mario Capecchi, Salt Lake City, UT 84113, USA.
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Knowledge and Attitudes of Emergency Department Patients Regarding Radiation Risk of CT: Effects of Age, Sex, Race, Education, Insurance, Body Mass Index, Pain, and Seriousness of Illness. AJR Am J Roentgenol 2010; 195:1151-8. [DOI: 10.2214/ajr.09.3847] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tsapaki V, Rehani M, Saini S. Radiation safety in abdominal computed tomography. Semin Ultrasound CT MR 2010; 31:29-38. [PMID: 20102693 DOI: 10.1053/j.sult.2009.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The rapid technological developments in computed tomography (CT) have enabled many new clinical applications in the abdominal region. Abdomen CT is considered as a high radiation dose examination due to the large number of radiosensitive organs in the field of view. CT radiation dose has received a lot of attention not only by the medical specialties and researchers, but also by patients and media. This article reviews the situation on radiation dose and risk and provides practical guidelines to effectively manage the radiation dose without losing the benefits and maintaining diagnostic confidence in CT procedures.
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Karsli T, Kalra MK, Self JL, Rosenfeld JA, Butler S, Simoneaux S. What physicians think about the need for informed consent for communicating the risk of cancer from low-dose radiation. Pediatr Radiol 2009; 39:917-25. [PMID: 19557405 DOI: 10.1007/s00247-009-1307-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/17/2009] [Accepted: 05/08/2009] [Indexed: 10/24/2022]
Abstract
BACKGROUND The National Institute of Environmental Health Sciences, a subsidiary of the Food and Drug Administration, has declared that X-ray radiation at low doses is a human carcinogen. OBJECTIVE The purpose of our study was to determine if informed consent should be obtained for communicating the risk of radiation-induced cancer from radiation-based imaging. MATERIALS AND METHODS Institutional review board approval was obtained for the prospective survey of 456 physicians affiliated with three tertiary hospitals by means of a written questionnaire. Physicians were asked to state their subspecialty, number of years in practice, frequency of referral for CT scanning, level of awareness about the risk of radiation-induced cancer associated with CT, knowledge of whether such information is provided to patients undergoing CT, and opinions about the need for obtaining informed consent as well as who should provide information about the radiation-induced cancer risk to patients. Physicians were also asked to specify their preference among different formats of informed consent for communicating the potential risk of radiation-induced cancer. Statistical analyses were performed using the chi-squared test. RESULTS Most physicians stated that informed consent should be obtained from patients undergoing radiation-based imaging (71.3%, 325/456) and the radiology department should provide information about the risk of radiation-induced cancer to these patients (54.6%, 249/456). The informed consent format that most physicians agreed with included modifications to the National Institute of Environmental Health Services report on cancer risk from low-dose radiation (20.2%, 92/456) or included information on the risk of cancer from background radiation compared to that from low-dose radiation (39.5%, 180/456). CONCLUSION Most physicians do not know if patients are informed about cancer risk from radiation-based imaging in their institutions. However, they believe that informed consent for communicating the risk of radiation-induced cancer should be obtained from patients undergoing radiation-based imaging.
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Affiliation(s)
- Tijen Karsli
- Children's Healthcare of Atlanta, Atlanta, GA, USA
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Olumide Olufowote J. A structurational analysis of informed consent to treatment: (re)productions of contradictory sociohistorical structures in practitioners' interpretive schemes. QUALITATIVE HEALTH RESEARCH 2009; 19:802-814. [PMID: 19365100 DOI: 10.1177/1049732309335605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Informed consent (IC) to treatment honors patient autonomy and bodily integrity. Yet, it is a leading reason for patient litigation, it has not been examined from discursive or theoretical perspectives, and its sociohistorical context is ignored. In a previous analysis of American IC law and the IC literature, structuration theory guided a reconceptualization of IC as unfolding amid contradictory sociohistorical structures or discursive formations-traditionalism, liability, and decision making-representing interests favoring a group's (physicians, states and administrative entities, and patients, respectively) control of IC. This study's focus groups with radiologists found them (re)producing these structures in their interpretive schemes of patients' reactions to IC, IC as protective paperwork, and IC as a patient- and relationship-centered process.
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Bulas DI, Goske MJ, Applegate KE, Wood BP. Image Gently: Why We Should Talk to Parents About CT in Children. AJR Am J Roentgenol 2009; 192:1176-1178. [DOI: 10.2214/ajr.08.2218] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Dorothy I. Bulas
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, 111 Michigan Ave., NW, Washington, DC 20010
| | - Marilyn J. Goske
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH
| | | | - Beverly P. Wood
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Morin RL. Research involving human subjects. HEALTH PHYSICS 2008; 95:547-50. [PMID: 18849688 DOI: 10.1097/01.hp.0000327649.87259.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This paper will discuss the history of human subjects in research and the subsequent regulations and requirements that now govern human subject research. Also presented are the requirements and definitions of the oversight bodies which govern human use research in the United States.
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Affiliation(s)
- Richard L Morin
- Department of Radiology, Mayo Clinic, Jacksonville, FL 32224, USA.
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35
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Caon M. Radiation information and informed consent for clinical trials. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2008; 28:415-422. [PMID: 18714137 DOI: 10.1088/0952-4746/28/3/m02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Examples of the statements about the radiation from medical imaging in the information for participants provided to the Human Research Ethics Committee (HREC) for approval are presented and discussed. There is considerable scope for improvement in the information about radiation that is presented to potential participants in clinical trials. Many radiation statements seem only intended to allay fear and anxiety about radiation rather than providing accurate information. This situation cannot be said to be conducive to allowing the participant to give informed consent to their involvement in a clinical trial in which ionising radiation is used. As many clinical trials are international and conducted at many sites (sometimes over 100), we would expect the same statements to have been seen by members of HRECs in many countries. Few HRECs include a member who is an expert in radiation. Hence, to ensure that the information is sound, those sections of the participant information that refer to radiation should be written or reviewed by a specialist in radiation protection such as a medical physicist, a health physicist or a radiation safety officer.
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Affiliation(s)
- Martin Caon
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia.
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Thomas J, Rideau AM, Paulson EK, Bisset GS. Emergency department imaging: current practice. J Am Coll Radiol 2008; 5:811-816e2. [PMID: 18585658 DOI: 10.1016/j.jacr.2008.02.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE To provide a snapshot of the demographics of radiologists providing coverage for emergency departments (EDs) and current imaging practices in EDs in the United States. METHODS An online survey was created with Views Flash 3 software (Cogix, Monterey, California). Random e-mail addresses from a variety of databases were chosen. A total of 678 surveys were sent over a 9-month period. RESULTS One hundred ninety-two radiology groups (28%) responded to the survey. Forty-one groups (21%) had designated emergency radiology divisions. Sixty-three groups (33%) were using computed tomographic (CT) coronary angiography in the ED workup of chest-pain. Thirty-five groups (18%) were using "triple-rule-out scans" (ie, a single CT scan to rule out coronary artery disease, pulmonary embolism, and aortic dissection). Multiplanar reconstructions of chest, abdominal, and pelvic CT images were routinely performed by 95 groups (49%). Forty-four percent used reformatted CT images instead of conventional radiographs in the workup of cervical spine trauma, and 68 groups (35%) used reformations in thoracic and lumbar spine trauma. Ninety groups (47%) did not use oral contrast for blunt abdominal trauma CT scanning. Sixty-seven respondents (35%) preferred computed tomography to evaluate for acute appendicitis in the setting of pregnancy. Forty percent of imaging equipment located within the EDs was CT scanners. The majority of the groups still communicated unexpected findings via telephone (49%). CONCLUSION New imaging practices for the evaluation of entities such as chest pain, spine trauma, and abdominal pain and trauma are emerging in EDs. As one plans ED development, these trends should be considered.
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Affiliation(s)
- John Thomas
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Abstract
In recent years, there has been a rapid increase in the number of CT scans performed, both in the US and the UK, which has fuelled concern about the long-term consequences of these exposures, particularly in terms of cancer induction. Statistics from the US and the UK indicate a 20-fold and 12-fold increase, respectively, in CT usage over the past two decades, with per caput CT usage in the US being about five times that in the UK. In both countries, most of the collective dose from diagnostic radiology comes from high-dose (in the radiological context) procedures such as CT, interventional radiology and barium enemas; for these procedures, the relevant organ doses are in the range for which there is now direct credible epidemiological evidence of an excess risk of cancer, without the need to extrapolate risks from higher doses. Even for high-dose radiological procedures, the risk to the individual patient is small, so that the benefit/risk balance is generally in the patients' favour. Concerns arise when CT examinations are used without a proven clinical rationale, when alternative modalities could be used with equal efficacy, or when CT scans are repeated unnecessarily. It has been estimated, at least in the US, that these scenarios account for up to one-third of all CT scans. A further issue is the increasing use of CT scans as a screening procedure in asymptomatic patients; at this time, the benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established.
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Affiliation(s)
- E J Hall
- Center for Radiological Research, Columbia University Medical Center, New York, NY 10032, USA.
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Nephrogenic system fibrosis: A radiologist's practical perspective. Eur J Radiol 2008; 66:220-4. [DOI: 10.1016/j.ejrad.2008.01.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 01/04/2008] [Accepted: 01/08/2008] [Indexed: 11/23/2022]
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, Stanford University School of Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5621, USA.
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Hujoel P, Hollender L, Bollen AM, Young JD, McGee M, Grosso A. Head-and-neck organ doses from an episode of orthodontic care. Am J Orthod Dentofacial Orthop 2008; 133:210-7. [PMID: 18249287 DOI: 10.1016/j.ajodo.2007.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 09/24/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The high prevalence of orthodontic treatment in young people makes the associated radiation to the head and neck of potential public-health significance. In this study, we estimated secular changes (1963-2003) in age-specific organ doses associated with orthodontic care and collective organ doses in the United States in 1999. METHODS A survey of radiographic records at 1 university clinic was combined with published estimates to provide organ-specific radiation doses. Collective organ doses were estimated from the 1999 US Nationwide Evaluation of X-ray Trends and published orthodontic utilization surveys. RESULTS Before 1992, orthodontic care in a university setting was associated with mean doses of 7.0 milligrays (mGy) to the thyroid, 0.8 mGy to the red bone marrow, 2.7 mGy to the brain, 13.2 mGy to the salivary glands, and 5.1 mGy to the bone. After 1992, the doses decreased to 2.8 mGy to the thyroid, 0.3 mGy to the red bone marrow, 0.7 mGy to the brain, 6.2 mGy to the saliva glands, and 2.4 mGy to the bone. Around 1999, the collective doses associated with orthodontic care in the United States in patients less than 19 years of age were 400 Gy to the red bone marrow and 3800 Gy to the thyroid. CONCLUSIONS Orthodontic care, in part due to its high prevalence, potentially contributes significantly to the diagnostic radiation burden in those less than 19 years old in the United States.
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Affiliation(s)
- Philippe Hujoel
- Department of Dental Public Health Sciences and Epidemiology, School of Dentistry, University of Washington, Seattle, WA 98195-7475, USA.
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Olufowote JO. A structurational analysis of informed consent to treatment: societal evolution, contradiction, and reproductions in medical practice. HEALTH COMMUNICATION 2008; 23:292-303. [PMID: 18569058 DOI: 10.1080/10410230802056404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Informed consent (IC) to treatment enables physician disclosures (e.g., risks, benefits) and shared decisions, and honors patient autonomy and bodily integrity. Unfortunately, litigation and rising physician malpractice insurance suggest a need to reexamine IC. To initiate this, problems plaguing prior studies of IC interaction--lack of discursive and theoretical perspectives, neglect of IC's sociohistorical context--must first be addressed. Structuration theory, which overcomes these problems, guided analyses of IC law, resulting in discovery of three sociohistorical systems of meaning or discourses representing interests that favor different groups' (physicians, states and administrative entities, patients) control of IC's meaning and ideal practice. The article then works toward blending IC's sociohistorical context with struggles in contemporary practice by reexamining the literature on IC interaction for (re)productions of these discourses.
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Ellenbogen PH, Hoffman TR, Short BW, Gonzalez A. The radiologist assistant: what radiologists need to know now. J Am Coll Radiol 2007; 4:461-70. [PMID: 17601588 DOI: 10.1016/j.jacr.2007.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Indexed: 11/18/2022]
Abstract
States are increasingly considering legislative and regulatory avenues to establish the role of radiologist assistants (RAs) under current state medical practice acts or state radiation control regulatory programs. It is critical that radiology practices be cautious to comply with federal and state laws and regulations to ensure that these advanced practice professionals provide the appropriate services under the appropriate level of supervision. For quality-of-care reasons, the ACR remains concerned about the scope of practice of radiology practitioner assistants and some misinformation that has spread to state officials about the assistants' role in radiology practice. Another potential source of confusion may be the fact that physician assistants and nurse practitioners are being increasingly used in many areas of health care (including radiology) and may derive delegated authority (from physicians) to perform services that physicians determine nurse practitioners or physician assistants to be qualified to perform. The authors in particular emphasize current federal and state legislative activities and describe possible exposure and risks associated with the extension of the scope of practice by radiologic technologists without commensurate changes in state statutes and regulations.
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Affiliation(s)
- Paul H Ellenbogen
- Department of Radiology, Presbyterian Hospital of Dallas, Dallas, Tex 75231, USA.
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Iserson KV. Is informed consent required for the administration of intravenous contrast and similar clinical procedures? Ann Emerg Med 2006; 49:231-3. [PMID: 17083998 DOI: 10.1016/j.annemergmed.2006.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 08/23/2006] [Accepted: 08/24/2006] [Indexed: 11/29/2022]
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