Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging

Kasraie, Nima; Jordan, David W.; Keup, Christopher; Westra, Sjirk J.

doi:10.1016/j.jacr.2018.01.032

Cited by 14 publications

(15 citation statements)

References 70 publications

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“…Currently, the burden of communicating the risks and benefits to the patient falls on the front line doctors and radiologists who engage with patients face-to-face. 87 A great challenge Figure 4. Example of a radiation safety statement in a generated patient X-ray report by the Posture Ray X-ray analysis EMR software system used to assess spinal alignment (PostureCo Inc., Trinity, FL).…”

Section: Discussionmentioning

confidence: 99%

“…Kasraie et al have discussed many radiation risk communication strategies that are useful for alleviating patient concerns over medical radiation exposures ( Table 2). 87…”

Section: Discussionmentioning

confidence: 99%

“…We concur with Wagner who states “diagnostic radiology has an image problem.” 86 Of course, this refers to the widespread radiophobia propagated by medical radiation reduction campaigns including ALARA (“As Low As Reasonably Achievable”) that exclusively focuses on the risks from medical X-rays without adequately addressing the benefits experienced by patients. 86 - 90 The evidence as presented indicates that, in reality, patients only receive a benefit from receiving radiological imaging as part of their healthcare because when there are no risks, there are only benefits in a risk-to-benefit ratio. 91 Patient benefits are, in fact, orders of magnitude larger than the feared dangers of X-rays, and this is true even if the LNT model was appropriate for low-dose risk assessment.…”

Section: Discussionmentioning

confidence: 99%

“…teaches spine rehabilitation methods and sells products to physicians for patient care that require radiography for biomechanical analysis. 87…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

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X-Ray Hesitancy: Patients’ Radiophobic Concerns Over Medical X-rays

Oakley

Harrison²

2020

Dose-Response

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All too often the family physician, orthopedic surgeon, dentist or chiropractor is met with radiophobic concerns about X-ray imaging in the clinical setting. These concerns, however, are unwarranted fears based on common but ill-informed and perpetuated ideology versus current understanding of the effects of low-dose radiation exposures. Themes of X-ray hesitancy come in 3 forms: 1. All radiation exposures are harmful (i.e. carcinogenic); 2. Radiation exposures are cumulative; 3. Children are more susceptible to radiation. Herein we address these concerns and find that low-dose radiation activates the body’s adaptive responses and leads to reduced cancers. Low-dose radiation is not cumulative as long as enough time (e.g. 24 hrs) passes prior to a repeated exposure, and any damage is repaired, removed, or eliminated. Children have more active immune systems; the literature shows children are no more affected than adults by radiation exposures. Medical X-rays present a small, insignificant addition to background radiation exposure that is not likely to cause harm. Doctors and patients alike should be better informed of the lack of risks from diagnostic radiation and the decision to image should rely on the best evidence, unique needs of the patient, and the expertise of the physician—not radiophobia.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Kasraie et al have discussed many radiation risk communication strategies that are useful for alleviating patient concerns over medical radiation exposures ( Table 2). 87…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…teaches spine rehabilitation methods and sells products to physicians for patient care that require radiography for biomechanical analysis. 87…”

Section: Declaration Of Conflicting Interestsmentioning

confidence: 99%

See 2 more Smart Citations

X-Ray Hesitancy: Patients’ Radiophobic Concerns Over Medical X-rays

Oakley

Harrison²

2020

Dose-Response

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“…Indeed, I believe many radiology professionals including myself feel under pressure to apply this "business model" to earn our keep. I have referred to this issue as "the hidden financial conflict of interest of our profession" [39,40]. In his recent opinion article on CT risk communication, Dr. Mervyn Cohen [41] expressed his belief that the radiation risk from CT "if any, is minute" and cannot be discussed in a meaningful way with parents.…”

mentioning

confidence: 99%

High-pitch CT, decreasing need for sedation and its potential side effects: some practical considerations and future directions

Westra

2018

Pediatr Radiol

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The Accuracy of Incident Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches

Siminoski

Wang

Jaremko

et al. 2020

Journal of Bone and Mineral Research

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Vertebral fractures are clinically important sequelae of a wide array of pediatric diseases. In this study, we examined the accuracy of case-finding strategies for detecting incident vertebral fractures (IVF) over 2 years in glucocorticoid-treated children (n = 343) with leukemia, rheumatic disorders, or nephrotic syndrome. Two clinical situations were addressed: the prevalent vertebral fracture (PVF) scenario (when baseline PVF status was known), which assessed the utility of PVF and low lumbar spine bone mineral density (LS BMD; Z-score <−1.4), and the non-PVF scenario (when PVF status was unknown), which evaluated low LS BMD and back pain. LS BMD was measured by dual-energy X-ray absorptiometry, vertebral fractures were quantified on spine radiographs using the modified Genant semiquantitative method, and back pain was assessed by patient report. Forty-four patients (12.8%) had IVF. In the PVF scenario, both low LS BMD and PVF were significant predictors of IVF. Using PVF to determine which patients should have radiographs, 11% would undergo radiography (95% confidence interval [CI] 8-15) with 46% of IVF (95% CI 30-61) detected. Sensitivity would be higher with a strategy of PVF or low LS BMD at baseline (73%; 95% CI 57-85) but would require radiographs in 37% of children (95% CI 32-42). In the non-PVF scenario, the strategy of low LS BMD and back pain produced the highest specificity of any non-PVF model at 87% (95% CI 83-91), the greatest overall accuracy at 82% (95% CI 78-86), and the lowest radiography rate at 17% (95% CI 14-22). Low LS BMD or back pain in the non-PVF scenario produced the highest sensitivity at 82% (95% CI 67-92), but required radiographs in 65% (95% CI 60-70). These results provide guidance for targeting spine radiography in children at risk for IVF.

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Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging

Cited by 14 publications

References 70 publications

X-Ray Hesitancy: Patients’ Radiophobic Concerns Over Medical X-rays

X-Ray Hesitancy: Patients’ Radiophobic Concerns Over Medical X-rays

High-pitch CT, decreasing need for sedation and its potential side effects: some practical considerations and future directions

The Accuracy of Incident Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches

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