Consent For Imaging Research Articles

241. An interdisciplinary collaboration to enhance consent for imaging for VTE in pregnancy: A quality improvement project

Introduction Imaging for VTE in pregnancy is common, but the decision between VQ scan and CTPA often causes anxiety amongst women and health care professionals. Ensuring the patient is aware of the rationale, risks, and benefits requires a good understanding of the technicalities of each scan, as well as the ability to express relative risks in terms the patient can understand. We identified a need for an accurate patient information leaflet (PIL), as well as the need to improve staff education and confidence. We used an interdisciplinary approach, incorporating the recent updates to Ionising Radiation (Medical Exposure) Regulations and latest ARSAC research into our educational material and guidelines. Methods Multi-specialty survey: We designed and disseminated a short survey amongst health care professionals to assess their confidence about counselling women. 124 people completed this survey (obstetricians, physicians, midwives, and radiographers) and it was clear that staff were particularly underconfident about VQ scans. Over 99% of survey participants indicated they would find an education session useful in addition to a new PIL, with several expressing they were shocked how little they knew. Areas that revealed particular uncertainty included advice for pregnant staff caring for women having VQ scans, and the risks associated with both VQ and CTPA. Patient information leaflet: We designed a PIL to cover all the essential areas about the use of chest radiography, ultrasonography, VQ and CTPA in pregnancy and commonly asked questions associated with these investigations. Education session: These were introduced at both hospitals in our Trust. Conclusions The survey results, patient information leaflet and results of a post-implementation survey will be presented. As a result of this project, we hope to demonstrate that women are more informed when these tests are being performed, and that staff feel more confident.

354. Counselling and consenting for diagnostic imaging in pregnancy

Diagnostic imaging in pregnancy requires a detailed understanding of the risks and benefits of the imaging options. This will ensure the most appropriate and safest imaging modality is performed to provide maximal information for diagnosis and management. Counselling and obtaining informed consent for imaging that involves radiation requires the clinician to communicate with the woman and her family a realistic estimate of the potential radiation dose to herself and her fetus, to describe and quantitate the risks of this estimated dose, to outline the benefits of the imaging procedure and to respond to any questions or concerns. Although the “as low as reasonably achievable” (ALARA) should be applied, pregnant women should be imaged using the standard imaging protocols used for any other patients. If dose reduction strategies do not compromise image quality, then they should be used for all patients. The American College of Radiology particularly note that “It is best to create written protocols for all imaging of pregnant patients to avoid reactive, non-optimal protocol adjustments by physicians attempting to reduce radiation exposures.” All allied staff must also be well informed to ensure the patient receives a consistent message about the risks and benefits of the proposed test(s). In almost all diagnostic imaging,with or without contrast or nuclear isotopes, maternal and fetal risks are negligible and therefore the most sensitive and specific imaging should be performed at the most appropriate time whether during or after pregnancy. With adequate information and knowledge, the reflex “no radiation” approach to selection of diagnostic imaging modalities in pregnancy should be replaced with principle of ensuring that non-ionising radiation options are considered first, whether during or after pregnancy; but when X ray, CT, nuclear scan or PET are the most suitable modality; these should be applied with appropriate care and counselling.

Introducing virtopsy into a country religiously opposed to autopsy

Purpose To evaluate accomplishments and challenges in introducing virtopsy to the pediatric forensic post-mortem examination. This in a country (Israel) requiring family consent, with religious opposition from most of the population (Jewish, Muslim, Christian and Druze) to autopsies and even to shipping the body from one location to another before final interment. What lessons can be learnt applicable to similar communities. Materials and methods Data was collected from the National Center of Forensic Medicine in Israel during the 18 month period introducing post-mortem imaging (Group A) carried out in a medical center located miles away from the Forensic Center. There was limited daytime access to imaging devices, resulting in interment delay. The data was compared to the previous 18 months (Group B). The examined parameters were cases submitted, those examined, autopsied or imaged depending on family consent. Results Out of all cases consent to autopsy was similar (A=56% vs. B=54%). Of all cases in Group A, consent for imaging was 24%. Of those imaged, 77% underwent autopsy. Of those examined externally only, 16% consented to imaging. For 7% of total cases in Group A, estimation of cause of death was based on virtopsy alone. Conclusion In a country with high religious opposition to post-mortem forensic procedure, there are challenges to making virtopsy an integral part of the pediatric forensic post-mortem protocol. At this point those consenting to post-mortem imaging are more likely to agree to the performance of autopsies. Even with the difficulties, some we have identified, there was an immediate increase of 7% of cases where a possible cause of death would not otherwise be given. Virtopsy does not breach religious doctrine in Israel, and might partially substitute autopsy.