Medical Radiation Risk Research Articles

Survey of the publics’ preferences for communication of medical radiation risk * * Funding provided from Health Education England as part of the Higher Specialist Scientist Training programme.

To comply with the Ionising Radiations (Medical Exposures) Regulations 2017, patients need to be adequately informed of medical radiation risks prior to exposure. This study used a survey developed in partnership with patients and members of the public to explore patient preferences for radiation risk communication. It was distributed through social media between 28/4/2020 and 18/7/2020. All respondents (N = 376) wanted to be informed about radiation risk, though the threshold at which they wished to be informed varied. The current practice of displaying posters in waiting areas does not meet the expressed preference of the patients if used in isolation. Only 6% of respondents were satisfied with the commonly used statement that the ‘risk is low’ if used in isolation. The majority of respondents (73%) said they would not be concerned about an increase in the risk of cancer of less than 1 in 10 000. The level of risk at which patients express a concern and the methodology for risk communication has been evaluated and based on these findings, and pre-existing literature, a graded approach to radiation risk communication based on modality is proposed. Patients must be involved throughout the evolution of this practice.

Perception of medical radiation risk in Ireland: Results of a public survey

The Basic Safety Standards (BSS) directive 2013/59/EURATOM places a new emphasis on the practitioner and/or referrer to inform the patient of the benefits and risks associated with radiation dose. To communicate effectively, a prior knowledge of what a person comprehends is beneficial. The aim of this study was to evaluate the Irish public’s current level of understanding of ionising radiation and its associated risks. We designed a survey consisting of ten multiple choice questions and asked members of the public to respond. There were 326 responses to the public survey. All survey data was collected anonymously using snowball sampling. Overall, the data collected from this survey indicates that the respondents do not have a clear understanding of radiation risks. In particular there was a misunderstanding in which modalities use ionising radiation and there was a perceived limit in the number of X-rays a person can have in a year, implying that the public have not been informed of the principle of justification. Patients must be presented with the benefits of an exam involving ionising radiation together with a clear explanation of the risks.

Patient Perspectives on Dialogue and Shared Decision Making.

The fear of radiation on the part of patients and/or clinical staff can hamper adequate shared medical decision making. Typically, one-sided medical radiation risk communication methods with limited effectiveness are employed, such as paternalistic, risk numerology, and quality "assurance" approaches. More study is needed to determine patient preferences and potential fears associated with medical imaging radiation, and the results can provide insights for such discussions. Worry about the potential risks associated with medical imaging radiation has been shown to be substantial in the US population. The level of concern differs by sex, race/ethnicity, education, nationality, and overall health, suggesting that more care and individualized communication and discussion methods need to be employed by clinical staff. The opportunities for improved dialogue with patients (and parents of patients) and the public in general are plentiful.

Radiation-free CMR diagnostic heart catheterization in children

BackgroundChildren with heart disease may require repeated X-Ray cardiac catheterization procedures, are more radiosensitive, and more likely to survive to experience oncologic risks of medical radiation. Cardiovascular magnetic resonance (CMR) is radiation-free and offers information about structure, function, and perfusion but not hemodynamics. We intend to perform complete radiation-free diagnostic right heart catheterization entirely using CMR fluoroscopy guidance in an unselected cohort of pediatric patients; we report the feasibility and safety.MethodsWe performed 50 CMR fluoroscopy guided comprehensive transfemoral right heart catheterizations in 39 pediatric (12.7 ± 4.7 years) subjects referred for clinically indicated cardiac catheterization. CMR guided catheterizations were assessed by completion (success/failure), procedure time, and safety events (catheterization, anesthesia). Pre and post CMR body temperature was recorded. Concurrent invasive hemodynamic and diagnostic CMR data were collected.ResultsDuring a twenty-two month period (3/2015 – 12/2016), enrolled subjects had the following clinical indications: post-heart transplant 33%, shunt 28%, pulmonary hypertension 18%, cardiomyopathy 15%, valvular heart disease 3%, and other 3%. Radiation-free CMR guided right heart catheterization attempts were all successful using passive catheters. In two subjects with septal defects, right and left heart catheterization were performed. There were no complications. One subject had six such procedures. Most subjects (51%) had undergone multiple (5.5 ± 5) previous X-Ray cardiac catheterizations. Retained thoracic surgical or transcatheter implants (36%) did not preclude successful CMR fluoroscopy heart catheterization. During the procedure, two subjects were receiving vasopressor infusions at baseline because of poor cardiac function, and in ten procedures, multiple hemodynamic conditions were tested.ConclusionsComprehensive CMR fluoroscopy guided right heart catheterization was feasible and safe in this small cohort of pediatric subjects. This includes subjects with previous metallic implants, those requiring continuous vasopressor medication infusions, and those requiring pharmacologic provocation. Children requiring multiple, serial X-Ray cardiac catheterizations may benefit most from radiation sparing. This is a step toward wholly CMR guided diagnostic (right and left heart) cardiac catheterization and future CMR guided cardiac intervention.Trial registrationClinicalTrials.gov NCT02739087 registered February 17, 2016

Examinees’ perception of medical radiation risk information disclosure

Examinees’ perception of medical radiation risk information disclosure

Arming the Bayesian physician to rule out pulmonary embolism: using evidence-based diagnostics to combat overtesting.

Arming the Bayesian physician to rule out pulmonary embolism: using evidence-based diagnostics to combat overtesting.

CT Radiation Dose: Current Controversies and Dose Reduction Strategies

The purpose of this article is to use clinical scenarios to explore aspects of ionizing radiation imparted to patients undergoing CT examinations. Examination appropriateness, effective doses, cancer risks, and pertinent dose reduction strategies are reviewed. CT accounts for the majority of radiation exposure related to medical imaging. Medical professionals should have a working knowledge of the benefits and risks of medical radiation and an understanding of strategies for reducing CT radiation dose.

College students’ perception of medical radiation risk information disclosure

College students’ perception of medical radiation risk information disclosure

Dose reduction methods for CT colonography

Patients, referring physicians, the media, and government agencies have all expressed concern over the risks of medical radiation, particularly as it relates to CT. This concern is particularly paramount when associated with a screening examination such as CT colonography. These theoretical risks must be weighed realistically against the substantial benefits of colon cancer screening as well as against the risks inherent in the major alternative screening option, optical colonoscopy. When put into perspective, the risk-benefit ratio is highly in favor of the performance of CT colonography. Nevertheless, in following the ALARA principle, there is an ever increasing armamentarium of options that can be employed in the pursuit of CT radiation dose reduction, all of which can be used in many synergistic combinations allowing for dose reduction while simultaneously preserving image quality and minimizing image noise. After a brief tutorial on estimating radiation dose, various strategies will be discussed including reductions in tube current and tube voltage as well as the use of automatic dose modulation and iterative reconstruction. Other practical considerations will also be reviewed including proper patient isocentering, optimization of colonic insufflation to minimize additional decubitus scans, proper choice of scan volumes to avoid overranging, and variation of slice thickness and window width to minimize perceived image noise. Finally, a strategy for how to incrementally introduce these methods as well as a way to compare dose reduction efforts across institutions throughout the country will be offered.

Abstract No. 296: Development of a radiation dose chart listing commonly performed interventional radiology procedures to support the interventionalist while consulting a patient population aware of the risks of medical radiation

Over the past two decades, there has been an increase in the number of fluoroscopically and CT guided procedures along with an increase in the medical radiation dose to the general public. Perceptive and concerned patients are now asking germane questions regarding radiation dose from interventional procedures. A single source of concise and rudimentary interventional radiation doses was not found. Thus, a chart was developed listing the average patient radiation doses for commonly performed interventional radiology procedures. This chart acts as a convenient reference source supporting the interventionalist when discussing these procedures with concerned patients. Succinct charts documenting radiation dose from diagnostic radiology examinations can be expeditiously found online with a straightforward search protocol. There are numerous articles regarding interventional radiology radiation doses, but a chart comparable to the diagnostic radiology doses was not found. Consequently, a concise reference chart was created listing average patient radiation doses of commonly performed interventional radiology procedures with comparison to routine diagnostic radiology, interventional cardiology and background radiation doses. A search of the recent literature for the average radiation doses for commonly performed fluoroscopically and CT guided procedures was performed. A chart was then created which clearly states the average aforementioned medical radiation doses. Natural sources of background radiation were also provided as reference. Medical radiation use and exposure has been reported more frequently in the media generating a concerned and informed patient population. While interventionalists are well trained in performing procedures limiting the amount of radiation, they might not be able to state the accurate average radiation dose of a particular procedure to an anxious and inquisitive patient. This unique chart provides the information necessary to address such questions and can be a valuable asset in the office, the consultation room or pre operative holding area. The chart could also easily be converted into a convenient iphone or ipad application.

The Information Imperative: Is It Time for an Informed Consent Process Explaining the Risks of Medical Radiation?

We believe that the radiology community should take the initiative to adopt guidelines and require that all imaging facilities use some form of active information process describing the risks of medical radiation.

Informing Patients About Risks and Benefits of Radiology Examinations: A Review Article

Communicating the risks, benefits, and alternatives to a planned medical intervention is integral to high-quality patient care. When effective, such communication promotes patient autonomy, alleviates unfounded patient apprehension, and mitigates medicolegal liability. The topic of medical radiation adds to the usual challenges of effective medical communication some special challenges of its own. Among these is a lack of understanding by the general population and health professionals of the benefits and risks of medical radiation, which is compounded by unfamiliar terminology and units of measure. This is further complicated by the fact that many patients have poor comprehension of risk data in general. In this article, the authors present a case, review the ethical basis and legal history of informed consent, and explore the current initiatives, available resources, and further opportunities related to this challenging topic.

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.

Risks of medical radiation: myths and misperceptions

Risks of medical radiation: myths and misperceptions

Communicating with the family: the risks of medical radiation to conceptuses in victims of major blunt-force torso trauma.

Trauma surgeons must balance the risk and benefits of diagnostic radiographic procedures on potentially pregnant patients and should know the range and likelihood of effects that radiation might have on pregnancy. We present guidelines for assessing such radiation risks. Knowledge of a patient's pregnancy status and an estimate of radiation dose to the conceptus (low, < 10 mGy [milligray]; intermediate, 10-250 mGy; high, > 250 mGy) allow provisional assessment of radiation-induced risks. Dose estimates may be estimated at 2 mGy per exposure (radiographs), 5 mGy per slice (computed tomography), and 10 mGy per minute of fluoroscopy, when the conceptus is within the x-ray field. A formal radiation exposure assessment is appropriate when provisional estimates exceed 10 mGy. A simple qualitative dose assessment can inform clinical decisions and guide appropriate triage to more formal quantitative assessment.

Genetics, Radiobiology and Radiology Proceedings, Mid-Western Conference.

The risks of medical radiation are insidious, yet its values are spectacular. The means by which these risks can be minimized are, therefore, of utmost importance. The whole medical profession needs the fullest possible understanding by which the risks can be evaluated and the benefits obtained with the least possible damage, especially to future generations. Such were the considerations discussed at the Mid-Western Conference on Genetics, Radiobiology, and Radiology, May 2, 1958, as one of three regional conferences requested by the Committee on Radiobiology and authorized by the National Academy of Sciences - National Research Council. The book under review presents a transcript of proceedings of the one-day conference. Participants included four professors of genetics, four professors of radiobiology, and twenty-one professors of radiology. The forenoon sessions were devoted to the viewpoints of geneticists and radiobiologists, with special attention to genetics and the mechanisms of mutational damage. In the afternoon, the