JOURNAL CLUB: How Radiation Exposure Histories Influence Physician Imaging Decisions: A Multicenter Radiologist Survey Study

Abstract

Purpose To evaluate the influence of patient-level radiation exposure histories on radiologists’ imaging decisions. Materials and Methods We conducted an IRB exempt, HIPAA compliant, physician survey study in three academic medical centers. Radiologists were asked to make a prospective imaging recommendation for a hypothetical patient with a history of multiple CT scans. We queried radiologists’ decision-making, evaluating whether they: incorporated cancer risks from previous imaging; reported acceptance (or rejection) of the linear no-threshold (LNT) model; and understood LNT model implications in this setting. Consistency between radiologists’ decisions and their LNT model beliefs was evaluated – those acting in accordance with the LNT model were expected to disregard previously incurred cancer risks. Fisher’s exact test was used to verify the generalizability of results across institutions and training levels (residents, fellows, and attendings). Results Fifty-six percent (322/578) of radiologists completed the survey. Most (92% (295/322)) incorporated risks from the patient’s exposure history during decision-making. Most (61% (196/322) also reported acceptance of the LNT model. Fewer (25% (79/322)) rejected the LNT model, and 15% (47/322) could not judge. Among radiologists reporting LNT model acceptance or rejection, the minority (36% (98/275)) made decisions in a manner consistent with their LNT model beliefs. This finding was not statistically different across institutions (p=0.070) or training levels (p=0.183). Few radiologists (4% (13/322)) demonstrated an accurate understanding of LNT model implications. Conclusion Most radiologists, when faced with patient exposure histories, make decisions that contradict their self-reported acceptance of the LNT model and the LNT model itself. These findings underscore a need for related educational initiatives.

Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study

“…While it is an important step to improve clinicians’ awareness of the risks of radiation exposure from advanced medical imaging, a more nuanced approach or the provision of information about the relevant clinical impact may be more useful to inform clinical decisions. The cancer risk associated with cumulative radiation exposure from multiple imaging tests is not well understood by the radiology and medical community 37 38. Whether cumulative radiation exposure information would be clinically relevant warrants further investigation.…”

Radiation Exposure From CT-Guided Ablation of Renal Masses: Effects on Life Expectancy

“…In this study, we used decision-analytic (Markov) modeling techniques to quanti-I n recent years, there have been increasing concerns about cancer risks associated with CT, particularly in clinical settings where patients are scanned multiple times [1][2][3][4][5][6][7][8][9][10][11][12]. CTguided renal mass ablation represents one such circumstance and is perceived to be associated with a high burden of radiation exposure [10,11].…”

The Cumulative Risk of Multiple CT Exposures Using Two Different Methods

“…The inclusion of this information in the radiology department is primarily useful for population-based data gathering and not in the care of individual patients (Durand 2011). Another study reported, however, that at present, most radiologists incorporate risks from past exposures to guide prospective imaging decisions (Pandharipande et al 2013). From another perspective, offering the patient and health care professional information such as cumulative dose estimates compared to natural background radiation and associated LAR compared to natural risks can also decrease the probability that irrational radiation fears will prevent a medically necessary examination from taking place in the future (Durand and Mahesh 2012;Eisenberg et al 2012).…”