Informed Consent for Radiologic Procedures

Brink, James A.; Goske, Marilyn J.; Patti, John A.

doi:10.1001/jama.2011.222

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…Those in favor of formal disclosure of risk argue that ionizing radiation is a known carcinogen and that major regulatory agencies accept the assumption that even small increases in ionizing radiation exposure, such as the low doses associated with medical imaging tests, may increase risk (21). Opponents have countered that the alleged risk represents “conjecture and unproven projections and extrapolations” (22,23), with no definite relationship to the low doses administered for imaging (24,25). …”

Section: Discussionmentioning

confidence: 99%

Patient Perspectives and Preferences for Communication of Medical Imaging Risks in a Cancer Care Setting

Thornton¹,

Dauer

Shuk³

et al. 2015

Radiology

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Purpose To identify opportunities for improving patient-centered communication about diagnostic imaging tests that involve the use of radiation in a cancer care setting. Materials and Methods Institutional review board approval and informed consent were obtained for this HIPAA–compliant study. Patient knowledge, information sources, and communication preferences were assessed in six focus groups during 2012. The groups consisted of patients undergoing treatment for metastatic colorectal carcinoma, women treated within the past 6 months for early-stage breast carcinoma, men undergoing surveillance after testicular cancer treatment, parents of patients treated for stage I–III neuroblastoma, patients in a thoracic oncology survivorship program, and participants in a lung cancer screening program. A multidisciplinary research team performed thematic content analysis of focus group transcripts. High-level findings were summarized during consensus conferences. Results Although they were aware of the long-term risk of cancer from exposure to ionizing radiation, most participants reported that their health care provider did not initiate discussion about benefits and risks of radiation from imaging tests. Most patients obtained information by means of self-directed internet searches. Participants expressed gratitude for tests (“That CT saved my daughter’s life,” “I’d rather have the radiation dosage than being opened up”), yet they expressed concern about having to initiate discussions (“If you don’t ask, nobody is going to tell you anything”) and the desire to be offered information concerning the rationale for ordering specific imaging examinations, intervals for follow-up imaging, and testing alternatives. Participants believed that such information should be available routinely and that conversation with their personal physician or endorsed, readily available reference materials were ideal methods for information exchange. Understanding imaging radiation risks and active participation in decision making about imaging were especially important to cancer survivors. Conclusion A substantial gap exists between patient expectations and current practices for providing information about medical imaging tests that involve the use of radiation.

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Section: Discussionmentioning

confidence: 99%

Patient Perspectives and Preferences for Communication of Medical Imaging Risks in a Cancer Care Setting

Thornton¹,

Dauer

Shuk³

et al. 2015

Radiology

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“…By using these methods, the uncertainty of each projected outcome was informed by the composite uncertainty of testicular cancer survival estimates derived from the Surveillance Epidemiology and End Results cancer registry (13) and most 11,29). This effect was expected; with increasing age at exposure and shorter life expectancy, both radiation-induced cancer risks and issues of timing decrease substantially in importance.…”

Section: Markov Chain Monte Carlo Uncertainty Analysismentioning

confidence: 99%

“…risks overwhelm radiation-induced cancer risks (28)(29)(30). Pitfalls associated with the use of lifetime attributable risk estimates in clinical decision making have received less attention (31,32).…”

Section: Special Report: Timing Paradox: Limitation Of Cancer Risk Esmentioning

confidence: 99%

Patients with Testicular Cancer Undergoing CT Surveillance Demonstrate a Pitfall of Radiation-induced Cancer Risk Estimates: The Timing Paradox

Pandharipande

Eisenberg²,

Lee³

et al. 2013

Radiology

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Purpose:To demonstrate a limitation of lifetime radiation-induced cancer risk metrics in the setting of testicular cancer surveillance-in particular, their failure to capture the delayed timing of radiation-induced cancers over the course of a patient's lifetime. Materials and Methods:Institutional review board approval was obtained for the use of computed tomographic (CT) dosimetry data in this study. Informed consent was waived. This study was HIPAA compliant. A Markov model was developed to project outcomes in patients with testicular cancer who were undergoing CT surveillance in the decade after orchiectomy. To quantify effects of early versus delayed risks, life expectancy losses and lifetime mortality risks due to testicular cancer were compared with life expectancy losses and lifetime mortality risks due to radiation-induced cancers from CT. Projections of life expectancy loss, unlike lifetime risk estimates, account for the timing of risks over the course of a lifetime, which enabled evaluation of the described limitation of lifetime risk estimates. Markov chain Monte Carlo methods were used to estimate the uncertainty of the results. Results:As an example of evidence yielded, 33-year-old men with stage I seminoma who were undergoing CT surveillance were projected to incur a slightly higher lifetime mortality risk from testicular cancer (598 per 100 000; 95% uncertainty interval [UI]: 302, 894) than from radiation-induced cancers (505 per 100 000; 95% UI: 280, 730). However, life expectancy loss attributable to testicular cancer (83 days; 95% UI: 42, 124) was more than three times greater than life expectancy loss attributable to radiationinduced cancers (24 days; 95% UI: 13, 35). Trends were consistent across modeled scenarios. Conclusion:Lifetime radiation risk estimates, when used for decision making, may overemphasize radiation-induced cancer risks relative to short-term health risks.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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“…1 There is substantial uncertainty concerning the actual risks associated with medical imaging radiation (MIR). [2][3][4][5][6][7][8] In this context, the mass media has devoted increasing coverage to patient safety in the context of tests that use MIR. For example, in January 2014, the Op-Ed section of The New York Times 9 featured an essay written by a cardiologist and a radiologist that was headlined, "We are Giving Ourselves Cancer" and dramatically described perceived population harms of MIR.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Worry About the Health Harms of Medical Imaging Radiation in the General Population

Hay

Gold

Baser

et al. 2016

J Prim Care Community Health

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Background In recent years, there have been dramatic increases in medical imaging use and increasing media attention to increased exposure to ionizing radiation in the United States. Patient perspectives on medical imaging radiation (MIR) use understudied, but could guide primary care discussions. This study examines prevalence of worry about the health harms from MIR in the United States general population. Methods This cross-sectional study used the 2012–2013 Health Information National Trends Survey conducted by the National Cancer Institute. A nationally representative sample (N=3532) was drawn from the United States general population to observe prevalence of worry about MIR as well as potential covariates including demographic, medical and psychological factors, health information-seeking, physician trust in providing cancer information, and cancer fatalism. Results About 65% of the sample population reported experiencing at least some worry about MIR. Univariable and multivariable logistic regressions indicate higher rates of MIR worry among women, racial/ethnic minorities, those with lower educational attainment, foreign-born Americans, those who self-report poorer health, and those with a personal history of cancer. Lower trust in cancer information from physicians and greater attention to cancer information from popular media were each associated with higher rates of worry about health harms of MIR. Conclusions An accurate assessment of public worry about MIR will aid primary care providers’ efforts to understand patient responses to medical imaging and identify addressable knowledge gaps regarding benefits and risks of medical imaging. These data may improve risk communication regarding medical imaging among referring primary care physicians, radiologists and patients.

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Informed Consent for Radiologic Procedures

Cited by 9 publications

References 4 publications

Patient Perspectives and Preferences for Communication of Medical Imaging Risks in a Cancer Care Setting

Patient Perspectives and Preferences for Communication of Medical Imaging Risks in a Cancer Care Setting

Patients with Testicular Cancer Undergoing CT Surveillance Demonstrate a Pitfall of Radiation-induced Cancer Risk Estimates: The Timing Paradox

Prevalence and Correlates of Worry About the Health Harms of Medical Imaging Radiation in the General Population

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