Communicating Radiation Risk Research Articles

Communicating radiation risk: the role of public engagement in reaching ALARA

The ALARA (an acronym for ‘as low as reasonably achievable’) principle, keeping the likelihood of incurring exposure, the number of people exposed and the magnitude of their individual doses ‘as low as reasonably achievable, taking into account economic and societal factors’, is at the core of radiation protection. For many decades the principle has been an area of continuous development, with recent work highlighting the importance of engaging not only with the decision-makers in the ALARA process but all stakeholders who may incur an exposure. This paper considers a particular case study in which the dredging of non-hazardous sediment in the United Kingdom near a now decommissioned nuclear power station raised substantial public concern about radiological exposure. This turned what was a straightforward construction activity into a complex public engagement and reassurance task, at a significant cost disproportionate to the level of radiological risk. This paper highlights the key lessons learnt from the case study, including not only the importance of engaging the public as part of the ALARA process but also of considering the societal impact arising from stress and concerns if misinformation is allowed to promulgate. A discussion is included on the need to underpin any engagement with a clear plan, including pre-engagement, implementation and reinforcement of messages. In addition, the role of the radiation protection professional is considered in ensuring that all stakeholders are informed, so that ultimately they can come to their own decision on what is safe.

Communicating Radiation Risk to Patients: Experiences Among Radiographers in Norway

IntroductionRisk communication related to radiation has become more important during the last decade. Informing patients of benefits, risks, and alternative imaging methods is necessary to make informed decisions. The purpose of this study was to investigate radiographers’ knowledge of radiation dose and risk, and their experiences with radiation risk communication. MethodsThis study used a qualitative approach using semi-structured interviews with clinical radiographers. The participants were presented with three authentic cases describing situations where risk communication is necessary. The interviews were audio-recorded, transcribed, and analyzed in four steps before the transcript interviews were coded and collected in meaningful themes. Participation was voluntary and participants signed an informed consent form. ResultsSix radiographers from two hospitals took part in the study. The mean age was 34 years, their work experiences as radiographers varied from 3.5 to 30 years and with an equal number of women and men. The participants provided reflections on the cases, how they managed the patients’ need for information, and how they dealt with concerned patients. They also reflected on the knowledge and skills needed to be confident with risk communication. DiscussionThe participants were insecure of their knowledge of radiation dose and risk. They expressed difficulties with informing patients of radiation risk, without raising unnecessary concerns among the patients. When informing patients of the amount of radiation dose, they compared the dose in the examination to flights, background radiation, and the number of chest x-rays. The participants expressed challenges around radiation risk communication. All participants used the principle of justification in radiation risk communication. ConclusionThis study shows that risk communication among radiographers is challenging, and the key challenge is the lack of knowledge of radiation doses and lack of experience in risk communication. There is a need for increased focus to and knowledge of radiation dose and risk, and radiation risk communication among radiographers working in clinical practice. This should be amplified in the education of radiographers, focusing on theoretical knowledge and skills such as reflection and critical thinking. This could cause radiographers to be confident and able to offer adequate information of doses and risks to the patients, so the patients can make an informed decision.

SRP workshop on ‘communication of radiation risk in the modern world’

Communicating radiation risk is an important part of radiation protection. However, achieving effective risk communication is challenging given the negative public perception of radiation and conflicting views presented by both the media and social media. Noting the importance of building capacity amongst radiation protection professionals to communicate radiation risk effectively, the Society for Radiological Protection (SRP) ran a half-day workshop at its Annual Conference on the 22nd May 2019 in Scarborough Spa, UK. A number of key factors were identified that should be considered when communicating with the public, post a nuclear or radiological incident, communicating with government and local authorities, and communicating with the public as part of public outreach. The following memorandum provides a summary of the points presented and discussed. It also outlines proposed future activities of the SRP, focused on further developing the communications aspect of radiation professionals’ practice.

Communicating Radiation Risk: The Power of Planned, Persuasive Messaging.

Every day, health physicists and physicians are expected to communicate effectively with concerned people, but rarely (if ever) are they given training on how to effectively communicate. In an age of social media, this paper presents the relevance of teachings from an ancient Greek philosopher. Aristotle's Rhetoric is still considered one of the most influential works on persuasive messaging. He puts the onus of effective communications on the people with the "true" and "just" information to communicate that information clearly to the audience. By communicating with intention-using the persuasive appeals of ethos, pathos, logos, and storytelling-radiation professionals can speak to their expertise in radiation science, while adapting their instructions, presentations, and communication styles to meet the needs of each type of audience: from scientists to concerned citizens, from doctors to first responders, and beyond.

Uses of Effective Dose: The Good, the Bad, and the Future.

Effective dose (E) is a risk-adjusted dosimetric quantity developed by the International Commission on Radiological Protection. It is a key metric for practical management of the risk of stochastic health effects in a comprehensive radiation protection program. The International Commission on Radiological Protection and others have emphasized repeatedly that E is not intended to represent an actual radiation dose and should not be used as a risk-related metric for a specific person or population. The cancer risk uncertainties in the low-dose range and the underlying approximations, simplifications, and sex- and age-averaging used in generating E make it unsuitable for this purpose. However, in practice, medical imaging professionals and authors of peer-reviewed medical publications frequently and incorrectly use E as a surrogate for whole-body dose in order to calculate cancer risk estimates for specific patients or patient populations. This frequent misuse has popularized E for uses for which it was neither designed nor intended. Alternatives to E have been proposed that attempt to account for known age and sex differences in radiation sensitivity. E has also been proposed as a general indicator for communicating radiation risk to patients, if its limitations are kept in mind. Forthcoming guidance from the International Commission on Radiological Protection will likely clarify if, when, and how some form of E may be used as a rough indicator of the risk of a stochastic effect, possibly with some modifications for the substantial variations in risk known to exist with respect to age, sex, and population group.

NCRP Program Area Committee 7: Radiation Education, Risk Communication, Outreach, and Policy.

In 2013, the National Council on Radiation Protection and Measurements (NCRP) established Program Area Committee 7 (PAC 7) to develop projects and provide guidance on "Radiation Education, Risk Communication, Outreach, and Policy." In 2017, the Committee transitioned to new leadership, the membership was updated, and the purpose, goals, and near-term objectives for PAC 7 were reviewed. Building on the foundation created when the PAC was founded, three near-term action items were identified: (1) to include an NCRP communication strategy and checklist for each report, (2) to apply this strategy to an existing report and the imminent Council Committee 1 report on Radiation Protection in the United States, and (3) to conduct an evaluation and user-friendly cataloging of guides for communicating radiation risk. Other potential products and activities, including some previously identified efforts, were also discussed. Finally, the liaison role with other NCRP committees was further developed with specific identification of a liaison on each of the other PACs to help better incorporate communication, education, outreach, and policy into NCRP activities.

Communicating Radiation Risk to the Population of Fukushima.

Radiological specialists from Nagasaki University have served on the medical relief team organized at Fukushima Medical University Hospital (Fukushima City) ever since the accident at the Fukushima Dai-ichi nuclear power plant. Furthermore, we have conducted the radiation crisis communication efforts by spreading correct information on the health effects of radiation as 'advisors on radiation health risk control'. Nagasaki University has been assisting the reconstruction efforts of Kawauchi Village in Fukushima Prefecture, which was the first village to declare that residents could safely return to their homes because radiation doses were found to be at comparatively low levels. In April 2013, Nagasaki University and the Kawauchi government office concluded an agreement concerning comprehensive cooperation toward reconstruction of the village. As a result, we established a satellite facility of the university in the village. In conclusion, training of specialists who can take responsibility for long-term risk communication regarding the health effects of radiation as well as crisis communication in the initial phase of the accident is an essential component of all such recovery efforts. Establishment of a training system for such specialists will be very important both for Japan and other countries worldwide.

Communicating radiation risk to patients and referring physicians in the emergency department setting.

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.

TU-F-9A-01: Balancing Image Quality and Dose in Radiography

Emphasis is often placed on minimizing radiation dose in diagnostic imaging without a complete consideration of the effect on image quality, especially those that affect diagnostic accuracy. This session will include a patient image-based review of diagnostic quantities important to radiologists in conventional radiography, including the effects of body habitus, age, positioning, and the clinical indication of the exam. The relationships between image quality, radiation dose, and radiation risk will be discussed, specifically addressing how these factors are affected by image protocols and acquisition parameters and techniques. This session will also discuss some of the actual and perceived radiation risk associated with diagnostic imaging. Regardless if the probability for radiation-induced cancer is small, the fear associated with radiation persists. Also when a risk has a benefit to an individual or to society, the risk may be justified with respect to the benefit. But how do you convey the risks and the benefits to people? This requires knowledge of how people perceive risk and how to communicate the risk and the benefit to different populations. In this presentation the sources of errors in estimating risk from radiation and some methods used to convey risks are reviewed. Learning Objectives: 1. Understand the image quality metrics that are clinically relevant to radiologists. 2. Understand how acquisition parameters and techniques affect image quality and radiation dose in conventional radiology. 3. Understand the uncertainties in estimates of radiation risk from imaging exams. 4. Learn some methods for effectively communicating radiation risk to the public.

Communication of radiation risk in nuclear medicine: Are we saying the right thing?

The radiation risk arising from nuclear medicine investigations represents a small but manageable risk to patients and it needs to be effectively communicated to them. Frequently in the culture of "doctor knows best," patients trust their doctors to do whatever is right and appropriate and leave it to them to worry about any attendant risks associated with any tests involving the use of radiation. The benefit to the patient of having a speedier diagnosis and a further guide to management may not be effectively communicated in a comprehensive, timely and professional manner. In this article, we address the issue of communication of radiation risk and benefits to patients and the basis for such information. While there are different ways of communicating radiation risk, we recognize that certain basic parameters are absolutely essential for patients to enable them to make an informed choice about undergoing a nuclear medicine investigation under the direction of a well-trained and qualified individual.

Minimizing and Communicating Radiation Risk in Pediatric Nuclear Medicine

The value of pediatric nuclear medicine is well established. Pediatric patients are referred to nuclear medicine from nearly all pediatric specialties including urology, oncology, cardiology, gastroenterology, and orthopedics. Radiation exposure is associated with a potential, small, risk of inducing cancer in the patient later in life and is higher in younger patients. Recently, there has been enhanced interest in exposure to radiation from medical imaging. Thus, it is incumbent on practitioners of pediatric nuclear medicine to have an understanding of dosimetry and radiation risk to communicate effectively with their patients and their families. This article reviews radiation dosimetry for radiopharmaceuticals and also CT given the recent proliferation of PET/CT and SPECT/CT. It also describes the scientific basis for radiation risk estimation in the context of pediatric nuclear medicine. Approaches for effective communication of risk to patients' families are discussed. Lastly, radiation dose reduction in pediatric nuclear medicine is explicated.

Fears, feelings, and facts: interactively communicating benefits and risks of medical radiation with patients.

As public awareness of medical radiation exposure increases, there has been heightened awareness among patients and physicians of the importance of holistic benefit-and-risk discussions in shared medical decision making. We examine the rationale for informed consent and risk communication, draw on the literature on the psychology of radiation risk communication to increase understanding, examine methods commonly used to communicate radiation risk, and suggest strategies for improving communication about medical radiation benefits and risk.

SRP Meeting: Social and Political Implications of CommunicatingRadiation Risk Daresbury, Warrington, 20 June 2001

The SRP held a very interesting meeting in June at the Daresbury Laboratory in Warrington on the social and political implications of communicating radiation risk. In today's risk-aware society, effective communication is just as important as the control measures introduced to prevent or restrict exposure.

Development of a system to evaluate and communicate radiation risk.

Review of research protocols involving positron emission tomography studies on healthy volunteers focused attention on the radiation exposure disclosure statements contained in the informed consent form. Of particular concern was the observation that breast doses from positron emission tomography studies are greater than breast doses from other research uses of radioisotopes, as well as routine nuclear medicine and radiographic procedures. Disclosure of individual organ doses is not normally provided on informed consent forms. A worksheet was developed to aid research investigators in the determination of effective dose equivalents and organ dose equivalents from all sources of radiation to which a volunteer is exposed. Three standardized risk statements are discussed. The final selection and use of these statements are determined by worksheet calculations of effective dose equivalents and organ dose equivalents.