Physicians’ and Midlevel Providers’ Awareness of Lifetime Radiation–Attributable Cancer Risk Associated With Commonly Performed CT Studies: Relationship to Practice Behavior

Abstract

Objectives The purpose of this study is to investigate emergency department (ED) providers’ knowledge of the life-time cancer risk attributable to radiation (LAR) from commonly performed CT scans and its association with the ordering providers’ risk/benefit analysis prior to ordering the exam. It further explores factors that may influence provider selection of a particular diagnostic imaging study in an ED setting. Materials and Methods Sixty-seven ED providers at the University of Rochester Medical Center completed a multiple choice questionnaire. The questions were derived to assess individual provider’s awareness of LAR from a diagnostic CT scan of the abdomen/pelvis and their behavior towards risk/benefit analysis before ordering the exam. The association between the questions and years since completion of clinical training was determined using the Spearman correlation test. Univariate logistic regression analysis was employed for the same questions to predict the knowledge of LAR. Results Less than 30% of ED providers possessed accurate knowledge of LAR (p-value .025). Providers with greater clinical experience, although lacking in the knowledge of LAR, were more likely to consider patients’ radiation dose history, conduct risk/benefit analysis, and less likely to order a CT scan unnecessarily. Clinical experience was negatively correlated with perceived unnecessary use of CT scans (p-value .01). Conclusion A large proportion of ED providers are unaware of the life-time risk of carcinogenesis from commonly performed CT scans. The clinical experience, not the knowledge of LAR, is significantly associated with beneficial behavior toward the use of CT scanning.

High positive computed tomography yields in the emergency department might not be a positive finding

“…[5,6] In the ED setting, providers may tend to overutilise CT scans. [2,7] Other factors contributing to CT over-utilisation may include fear of a missed or incorrect diagnosis, the potential for malpractice lawsuits, as well as inadequate knowledge and awareness of radiation exposure and potential risk of inducing cancer. [7] There is an abundance of studies evaluating trends in CT scan use in EDs, with growing pressure to measure and reduce unnecessary imaging in that environment.…”

Communicating Potential Radiation-Induced Cancer Risks From Medical Imaging Directly to Patients

“…A total of 12 studies evaluated the understanding of radiation and cancer risk among patients and physicians [12][13][14][15][16][17][18][19][20][21][22][23] (Table 1). …”

“…Five studies further evaluated this awareness by giving stratified probabilities of the estimated lifetime risk of cancer for a CT examination [14,16,17,20,21]. In one study, only the correct estimation was reported and this was used for data analysis [12].…”

Awareness of medical radiation exposure among patients: A patient survey as a first step for effective communication of ionizing radiation risks

“…Medical radiologists themselves underestimate the radiation doses associated with a CT scan by 50-500 times [14] use ionizing radiation [15]. Such faulty knowledge is transferred directly onto patients when they discuss the reasons for having a medical imaging test and its related risks with medical specialists [16][17][18][19][20]. Nonetheless, no one knows the real level of awareness and perception of the risk arising from ionizing radiation in patients receiving diagnostic radiological procedures.…”