Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study)

Abstract

ObjectivesTo assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients.DesignA quantitative and qualitative evaluation through a survey and focal groups.SettingSan Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies.ParticipantsThe surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey.Primary and secondary outcome measuresClinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients.ResultsNearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure.ConclusionsMedical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

Underestimation of Radiation Doses by Compliance of Wearing Dosimeters among Fluoroscopically-Guided Interventional Medical Workers in Korea

“…Workers who specialize in radiology and cardiology may have more radiation safety education than in other specialties because they are more frequently involved in the performance of fluoroscopically-guided interventional procedures. Radiologists have received more training and more knowledge on radiation exposure compared with doctors of other medical specialties in Spain [ 18 ] and the US [ 19 ], and radiologists reported a higher accuracy of radiation doses associated with a standard chest x-ray exposure than non-radiologists in Hong Kong [ 20 ]. However, orthopedic surgeons less frequently wore a dosimeter (29.2%) compared with doctors with other specialties and did not apply the standard rules for radiation safety in South Korea [ 21 ].…”

Patients’ perception of radiation safety of radiological investigations in urology

“…21 Wider availability and local modification of the National Radiological Protection Board patient information leaflet may go some way in redressing this knowledge deficit. Innovative approaches such as incorporating the radiation dose of the scan that patient is about to undergo on the appointment letter and medical report 22 will allow patients to track their radiation exposure due to radiological investigations personally. Further, explanation of radiation doses in terms of background radiation may go some way to improving patients' understanding of their radiation exposure with each scan, where each standard CT scan of the abdomen and pelvis exposes patients to a radiation dose equivalent to three years of background radiation.…”

“…23 Other than inadequate education of the patient, the current literature demonstrates that the patients' suboptimal knowledge could possibly be attributed to patients not being well informed. With only 50% of the patients inquiring about radiation exposure, 91% 19 and 68.3% 22 of patients were not informed about radiation exposure, demonstrating that there is a need to improve communication between patients and medical staff.…”

“…In an American study, only 22% of interviewed emergency department (ED) physicians and 13% of radiologists were correctly able to quantify the radiation exposure of a CT scan. 22,24 Only 2% of physicians were able to answer more than 50% of questions on approximate doses of radiation correctly, 21 with 19% of physicians 24 being unaware that diagnostic tests increase cancer likelihood. Although medical students – the future opinion shapers among patients – were aware of relative amounts of radiation exposure, they have also been identified to have poor knowledge on the quantification of radiation exposure 19 and incorrectly identified MRI as having radiation.…”

Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain

“…For instance, communication with patients regarding associated risk is essential to get a rational use of diagnostic imaging test, but there is a lack of knowledge in the general population regarding radiation exposure and the associated risks related to these tests 29 30. In addition, recent studies showed that most clinicians were unaware of radiation exposure associated with imaging tests31–33 and that less than 50% of the imaging tests carried out in clinical practice were considered appropriate according to the available recommendations and 29.1% of the total collective effective dose was associated with inappropriate imaging tests 34…”