Assessment of radiation dose awareness among pediatricians

Examining proficiency in radiation safetyamong pediatric residents in Palestine: a multicenter cross-sectional survey

BACKGROUND

Safe radiological practices are essential in pediatric healthcare because of children's vulnerability to the chronic impacts of radiation exposure. Having sufficient knowledge is crucial for adopting radiological safety and effective communication with patients. This study aimed to assess the level of knowledge about radiation safety among pediatric residents.

METHODS

This multicenter cross-sectional study was conducted from January 2022 to May 2022 in 15 Palestinian hospitals. All pediatric residents registered in the national pediatric residency program were eligible for inclusion. Convenience sampling was used to invite the participants. The questionnaire was based on a literature review and consisted of questions on demographic characteristics and sources of knowledge, in addition to 10 questions assessing knowledge about radiation safety. The proposed questions were reviewed by a panel of experts, and a pilot study was then conducted among 20 pediatric residents to improve linguistic accuracy and clarity. Descriptive and inferential statistics were used to analyze the data. The Mann‒Whitney and Kruskal‒Wallis tests were used to assess potential associations between knowledge scores and other categorical variables.

RESULTS

The final sample comprised 108 pediatric residents, for a response rate of 93.1%. Of those, 55.6% were females, and 44.4% were males. Most participants cited either personal study (36.1%) or medical school (36.1%) as the main sources of information about radiation safety. Approximately half had attended a conference related to radiological safety (47.2%), and over half said that they think the workplace was prepared for radiation safety (57.4%). The median knowledge score of the participants was 6.0/10.0. Years of pediatric training (p = 0.001) and source of information (p = 0.037) were significantly associated with higher knowledge scores. Most of the participants correctly identified the imaging modalities that use X-ray (97.2%) and cause the highest radiation dose (89.8%). The majority said they were familiar with the ALARA principle (60.2%). However, only 19.4% correctly chose the number of CXRs equivalent to an abdominal MDCT (19.4%), and less than a third correctly labeled orthopantomography as safe during pregnancy (28.7%).

CONCLUSIONS

This study identified knowledge gaps in radiation safety among pediatric residents, which could be addressed through tailored educational integration into pediatric training programs, emphasizing the risks pertinent to pediatric age groups. Moreover, the formulation of national guidelines is crucial for applying radiation knowledge in the field.

Insights into Testicular Radiation Exposure in the Orthopedic Surgeon

ABSTRACT

Testicular radiation exposure has been linked to diminished spermatogenesis, male infertility, and potentially testicular cancer. Despite this, the risk of testicular exposure from intraoperative fluoroscopy to the male orthopedic surgeon has yet to be studied. The purpose of this study is to determine factors associated with unnecessary testicular radiation exposure in male orthopedic surgeons. The study was designed to answer the following questions: (1) Do the designs of lead apron protection result in any differential testicular radiation exposure? (2) Does the position of the surgeon (standing, sitting, and knee position while sitting) alter the amount of testicular radiation exposure? (3) Does any combination of lead apron design and surgeon positioning increase the degree of testicular radiation exposure? A life-sized, whole-body, anthropomorphic phantom simulating an orthopedic surgeon was positioned adjacent to a hand table attached to a standard radiolucent operating table. A digital dosimeter was attached to the groin region beneath a lead apron. Scatter radiation dose equivalent rates were measured during continuous anteroposterior C-arm fluoroscopy of a forearm/hand phantom. Four trials were conducted using three different types of protective lead aprons (cross-back, full-skirt, and half-skirt) in three different positions (standing, sitting with knees 10 cm apart, and sitting with knees 25 cm apart). Radiation dose-equivalent rates were compared using the Student's t-test and analysis of variance. No scatter radiation (measured value of 0.0 mrem min-1 [0.0 Sv min-1]; below minimum detectability of dosimeter) was detected underneath the lead aprons in the standing position and when sitting with the knees 25 cm apart, using all three types of lead. When sitting with the knees 10 cm apart, the mean dose equivalent rate of scatter radiation was higher using the half-skirt (0.01 mrem min-1 [0.000001 Sv min-1]) than the cross-back (below minimum detectability of dosimeter) and skirt aprons (below minimum detectability of dosimeter), but this did not reach statistical significance (p = 0.44). For all apron types and all positions, the use of an apron resulted in significantly less scatter radiation exposure when compared to no protection (p < 0.001). Protective lead aprons are effective at preventing testicular radiation exposure in both the standing and sitting positions. As the only detectable radiation exposure occurred with use of a half-skirt apron when sitting with the knees spread 10 cm apart, cross-back and full-skirt aprons may provide slightly enhanced protection over half-skirt aprons in the sitting position.

Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting

Point-of-care thoracic ultrasound at the patient's bedside has increased significantly recently, especially in pediatric settings. Its low cost, rapidity, simplicity, and repeatability make it a practical examination to guide diagnosis and treatment choices, especially in pediatric emergency departments. The fields of application of this innovative imaging method are many and include primarily the study of lungs but also that of the heart, diaphragm, and vessels. This manuscript aims to describe the most important evidence for using thoracic ultrasound in the pediatric emergency setting.

A follow-up questionnaire survey 2022 on radiation protection among 464 medical staff from 34 endoscopy-fluoroscopy departments in Japan

OBJECTIVES

We surveyed and reported low protective equipment usage and insufficient knowledge among endoscopy-fluoroscopy departments in Japan in 2020. Two years later, we conducted a follow-up survey of doctors, nurses, and technologists in Japan.

METHODS

We conducted a questionnaire survey on radiation protection from May to June 2022. The participants were medical staff, including doctors, nurses, and radiological and endoscopy technicians in endoscopy-fluoroscopy departments. The questionnaire included 17 multiple-choice questions divided into three parts: background, equipment, and knowledge.

RESULTS

We surveyed 464 subjects from 34 institutions. There were 267 doctors (58%), 153 nurses (33%), and 44 technologists (9%). The rate of wearing a lead apron was 98% in this study. The rates of wearing a thyroid collar, lead glasses, and radiation dosimeter were 27%, 35%, and 74%, respectively. The trend of the protective equipment rate was similar to that of our previous study; however, radiation dosimetry among doctors was still low at 58%. The percentage of subjects who knew the radiation exposure (REX) dose of each procedure was low at 18%. Seventy-six percent of the subjects attended lectures on radiation protection, and 73% knew about the three principles of radiation protection; however, the concept of diagnostic reference levels was not well known (18%). Approximately 60% of the subjects knew about the exposure dose increasing cancer mortality (63%) and the 5-year lens REX limit (56%).

CONCLUSIONS

There was some improvement in radiation protection equipment or education, but relatively little compared to the 2020 survey of endoscopy departments.

Cumulative Radiation Dose from Medical Imaging in Children with Congenital Heart Disease: A Systematic Review

Children with congenital heart disease are exposed to repeated medical imaging throughout their lifetime. Although the imaging contributes to their care and treatment, exposure to ionising radiation is known to increase one's lifetime attributable risk of malignancy. A systematic search of multiple databases was performed. Inclusion and exclusion criteria were applied to all relevant papers and seven were deemed acceptable for quality assessment and risk of bias assessment. The cumulative effective dose (CED) varied widely across the patient cohorts, ranging from 0.96 mSv to 53.5 mSv. However, it was evident across many of the included studies that a significant number of patients were exposed to a CED >20 mSv, the current annual occupational exposure limit. Many factors affected the dose which patients received, including age and clinical demographics. The imaging modality which contributed the most radiation dose to patients was cardiology interventional procedures. Paediatric patients with congenital heart disease are at an increased risk of receiving an elevated cumulative radiation dose across their lifetime. Further research should focus on identifying risk factors for receiving higher radiation doses, keeping track of doses, and dose optimisation where possible.

Effective radiation dose of skeletal surveys performed for suspected physical abuse

BACKGROUND

A skeletal survey is an important diagnostic tool for patients presenting with suspected physical abuse. A relatively recent change in guidelines for skeletal surveys by the Royal College of Radiologists (RCR) in 2017 has led to more initial and follow-up images for these patients, which would be expected to have led to an increase in effective radiation dose.

OBJECTIVE

To estimate the effective dose following the change in guidelines and to ascertain the difference between doses before and after the change in guidelines.

MATERIALS AND METHODS

Data were collected retrospectively on children younger than 3 years old referred for skeletal surveys for suspected physical abuse at a tertiary paediatric centre. A Monte Carlo radiation patient dose simulation software, PCXMC v 2.0.1, was used to estimate the effective dose, expressed in millisieverts (mSv).

RESULTS

Sixty-eight children underwent skeletal surveys for suspected physical abuse. The total estimated effective dose for skeletal surveys with the previous RCR guidelines was found to be 0.19 mSv. For initial skeletal surveys with the current RCR guidelines, the estimated effective radiation dose was 0.19 mSv. Eighteen children had both initial and follow-up skeletal surveys as indicated by the current RCR guidelines, with an estimated effective total radiation dose of 0.26 mSv.

CONCLUSION

Skeletal surveys deliver a relatively low estimated effective radiation dose equivalent to 1 month of United Kingdom background radiation, with no significant change in dose following the change in guidelines. Therefore, the benefits of having a skeletal survey outweigh the main radiation risk. However, accurate data regarding the radiation dose are important for clinicians consenting parents/guardians for imaging in suspected physical abuse.

Unnecessary radiation exposure during diagnostic radiography in infants in a neonatal intensive care unit: a retrospective cohort study

Unnecessary radiation exposure (URE) during radiographic examination is an issue among infants in neonatal intensive care units (NICUs). The causes of URE have not been fully explored. This study investigated the incidence and identified the causes of URE in infants during diagnostic radiography in a NICU. This was a retrospective cohort study. We retrieved and analysed requests and radiographs taken at a tertiary NICU between September and November 2018. URE was defined as the rate of discordance between requests and images taken (DisBRI) and unnecessary radiation exposure in irrelevant regions (UREIR) during radiography. We compared the rates of URE between very low-birth-weight (VLBW, birth weight < 1500 g) infants and non-VLBW infants. A total of 306 radiographs from 88 infants were taken. The means ± standard deviations (SDs) of gestational age and birth weight were 35.7 ± 3.6 weeks and 2471 ± 816 g, respectively. Each infant underwent an average of 3.5 radiographs. The DisBRI rate was 1.3% and was mostly related to poor adherence to requests. The UREIR rates in thoraco-abdominal babygrams were 89.6% for the head, 14.8% for the elbows and 18.4% for the knee and were mainly related to improper positioning of and collimation in infants while performing radiography. The UREIR rates for the head, knee and ankle were higher in VLBW infants than in non-VLBW infants (94.6% vs. 85.6%, 27.0% vs. 11.5% and 5.4% vs. 0.7%, respectively, p < 0.05).

CONCLUSIONS

URE during diagnostic radiography is common in sick infants and is mainly related to improper positioning and collimation during examinations. Adherence to protocols when performing radiographic examination or using ultrasonography may be a solution to reduce URE in infants in NICUs.

WHAT IS KNOWN

• The risk of unnecessary radiation exposure (URE) during radiography has been a common and important issue in sick infants in neonatal intensive care units (NICUs). • The new point-of-care ultrasound (POCUS) technique decreases the need for chest films and prevents radiation exposure in neonates.

WHAT IS NEW

• In the NICU, URE is still a common issue in critically ill infants during radiographic examinations. The causes of URE during diagnostic radiography are mainly due to improper positioning and collimation during examinations. • The incidence of URE in irrelevant regions is higher in very low-birth-weight (VLBW) infants than in non-VLBW infants.

A Survey of Awareness of Parents and Caretakers on Diagnostic Radiological Examination Related Radiation Exposure in a Tertiary Hospital in Malaysia

BACKGROUND

With the advancement in medical imaging, radiological application in the paediatric population has also increased. Children, generally more radiosensitive, have a higher risk of developing certain malignancies. Therefore, this may result in uneasiness among parents and caretakers when their children need to undergo medical imaging examination. Hence, this study aims to assess the awareness of parents' and caretakers' awareness of medical imaging-related radiation exposure in our institution and their opinion of a medical radiation exposure-tracking programme for the paediatric population.

METHODOLOGY

A cross-sectional survey was conducted for 6 months duration among parents and caretakers, who brought their children (under 12 years old) for imaging. The questionnaire booklet had eleven knowledge-based questions to assess respondents on ionising radiation-associated medical imaging, the radiation-related risk and radiation safety precaution.

RESULTS

Two hundred and fifteen respondents participated in this survey. More than 40% of the respondents failed to identify various dose-saving and ionising radiation-related imaging methods. Only 87 participants (40.5%) could correctly answer at least six out of eleven knowledge-based questions. Moreover, 88.4% of the respondents support a medical radiation exposure-tracking programme for their children.

CONCLUSION

Parents and caretakers who visited our institution had inadequate awareness of medical radiation exposure. Appropriate measures need to be taken to address this promptly. Implementation of a medical radiation exposure-tracking programme for the paediatric population is considered timely as most respondents agree with this programme.

Lung Ultrasound: Its Findings and New Applications in Neonatology and Pediatric Diseases

Lung ultrasound has become increasingly used in both adult and pediatric populations, allowing the rapid evaluation of many lung and pleura diseases. This popularity is due to several advantages of the method such as the low cost, rapidity, lack of ionizing radiation, availability of bedside and repeatability of the method. These features are even more important after the outbreak of the SARS-CoV-2 pandemic, given the possibility of recognizing through ultrasound the signs of interstitial lung syndrome typical of pneumonia caused by the virus. The purpose of this paper is to review the available evidence of lung ultrasound (LUS) in children and its main applications in pediatric diseases.

A questionnaire survey on radiation protection among 282 medical staff from 26 endoscopy-fluoroscopy departments in Japan

BACKGROUND AND AIMS

It is essential for endoscopists, technologists, and nurses to understand radiation protection. However, protective equipment usage is still low, and there is little awareness of radiation protection in practice.

METHODS

We conducted a questionnaire survey on radiation protection from January to February 2020. The participants were medical staff, including medical doctors, nurses, and radiological and endoscopy technician in endoscopy-fluoroscopy departments. The questionnaire included 14 multiple-choice questions divided among three parts: background, equipment, and knowledge.

RESULTS

We surveyed a total of 282 subjects from 26 institutions. There were 168 medical doctors (60%), 90 nurses (32%), and 24 technologists (9%). Although almost all staff members (99%) always wore a lead apron, only a few wore a thyroid collar (32%) and lead glasses (21%). The rate of wearing a radiation dosimeter was insufficient (69%), especially among doctors (52%). A few subjects knew the radiation exposure dose of each procedure (15%), and slightly over half had attended lectures on radiation protection (64%) and knew about the three principles of radiation protection (59%). Protection adherence did not differ by years of experience, knowledge of fluoroscopy, awareness of radiation exposure doses, or attendance at basic lectures on radiation protection. However, medical doctors who were aware of the radiation exposure dose of each procedure were significantly more likely to wear dosimeters than those who were not (p = 0.0008).

CONCLUSION

Medical staff in endoscopy departments in Japan do not have enough radiation protection equipment or education.

Time Trend of the Radiation Exposure Dose in Endoscopic Retrograde Cholangiopancreatography Over an 8-Year Period: A Single-Center Retrospective Study

INTRODUCTION

The global needs for a reduction in radiation exposure (RE) are increasing. Endoscopic retrograde cholangiopancreatography (ERCP) is a significant fluoroscopic procedure in the gastrointestinal field. However, the actual RE in ERCP and its annual trend are still unclear. Therefore, we examined the yearly trend of RE in ERCP.

METHODS

This retrospective, single-center cohort study included consecutive cases of ERCP from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm2), and fluoroscopy time (FT, min). We also evaluated the annual trend of the RE before and after the fluoroscopy device update.

RESULTS

In total, 2,174 patients receiving ERCP were enrolled. Among these, the mean age was 74.3 years, and 913 patients were women (42.0%). The median/third quartile values of AK (mGy), DAP (Gycm2), and FT (min) were 109/234 mGy, 13.3/25.8 Gycm2, and 18.2/27.7 minutes. The annual AK, DAP, and FT from 2012 to 2019 were 138, 207, 173, 177, 106, 71.0, 45.0, and 33.3 mGy; 23, 21.4, 19, 18.3, 11.9, 9.0, 6.8, and 6.4 Gycm2; and 12.5, 12.1, 9.7, 9.8, 8.2, 10.8, 9.4, and 10.3 minutes, respectively. The corresponding values before and after the update in July 2016 were 177 and 52 mGy (P < 0.0001), 19.2 and 7.6 Gycm2 (P < 0.0001), and 10.2, and 9.9 minutes (P = 0.05), respectively.

DISCUSSION

The RE from ERCP tended to decrease every year, especially after fluoroscopy device updates.

Increased and unjustified CT usage in paediatric C-spine clearance in a level 2 trauma centre

PURPOSE

Cervical spine injury after blunt trauma in children is rare but can have severe consequences. Clear protocols for diagnostic workup are, therefore, needed, but currently not available. As a step in developing such a protocol, we determined the incidence of cervical spine injury and the degree of protocol adherence at our level 2 trauma centre.

METHODS

We analysed data from all patients aged < 16 years suspected of cervical spine injury after blunt trauma who had presented to our hospital during two periods: January 2010 to June 2012, and January 2017 to June 2019. In the intervening period, the imaging protocol for diagnostic workup was updated. Outcomes were the incidence of cervical spine injury and protocol adherence in terms of the indication for imaging and the type of imaging.

RESULTS

We included 170 children in the first study period and 83 in the second. One patient was diagnosed with cervical spine injury. Protocol adherence regarding the indication for imaging was > 80% in both periods. Adherence regarding the imaging type decreased over time, with 45.8% of the patients receiving a primary CT scan in the second study period versus 2.9% in the first.

CONCLUSION

Radiographic imaging is frequently performed when clearing the paediatric cervical spine, although cervical spine injury is rare. Particularly CT scan usage has wrongly been emerging over time. Stricter adherence to current protocols could limit overuse of radiographic imaging, but ultimately there is a need for an accurate rule predicting which children really are at risk of injury.

Radiologists' Knowledge and Attitudes towards CT Radiation Dose and Exposure in Saudi Arabia-A Survey Study

Computed tomography (CT) is a key imaging technique in diagnostic radiology, providing highly sensitive and specific information. While its use has increased dramatically in recent years, the quantity and associated risks of radiation from CT scans present major challenges, particularly in paediatrics. The fundamental principles of radiation protection require that radiation quantities be as low as reasonably achievable and CT use must be justified, particularly for paediatric patients. CT radiation knowledge is a key factor in optimising and minimising radiation risk. The objective of this study was to analyse knowledge level, expertise, and competency regarding CT radiation dose and its hazards in paediatrics among radiologists in Saudi Arabian hospitals. A self-reported, multiple-choice questionnaire assessed the attitudes and opinions of radiologists involved in imaging studies using ionising radiation. Among the total respondents, 65% ± 13.5% had a good comprehension of the dangers of carcinogenicity to the patient resulting from CT scans, with 80% presuming that cancer risks were elevated. However, only 48.5%, 56.5%, and 65% of the respondents were aware of specific radiation risks in head, chest, and abdominal paediatric examinations, respectively. Regular, frequent, and specific training courses are suggested to improve the fundamental knowledge of CT radiation among radiologists and other physicians.

Chest Radiography in Children Hospitalized with Bronchiolitis

In uncomplicated bronchiolitis, chest radiography (CR) is not routinely recommended, yet it is still frequently made. This study seeks to evaluate the use of CR in children with bronchiolitis due to a lower respiratory tract infection (RSV-RTI) with respiratory syncytial virus (RSV) and the influence of CR on patient treatment during the 2010-2017 seasons. There were 581 children included into the study: 459 with bronchiolitis (390 RSV-RTI and 69 non-RSV), 65 with RSV pneumonia and 57 with RSV bronchitis. We found that CR was performed in 28.6% (166/581) patients. CR was much more frequent in patients with RSV than non-RSV infections (61% vs. 31%). CR prognostic sensitivity and specificity in guiding antibiotic treatment was low, 78% and 58%, respectively. Positive and negative predicted values of CR were 78% and 58%, respectively and the number needed to diagnose was 2.777. Children in whom CR was performed (irrespective of the result) were at 22.9-fold higher risk of antibiotic therapy (95%CI: 14.1-37.1; p < 0.01), while those with a positive CR were only at 4.4-fold higher risk of antibiotic therapy (95%CI: 2.2-8.9; p < 0.01). Children with CR required a longer hospital stay than those without it (10 vs. 8 days, respectively; p < 0.01). The percentage of CR decreased from 78% in 2010 to 33% in 2017, with the lowest value of 11% in 2015. The additional cost of CR, which had no influence on treatment, would have been €381 had it been performed in each patient, which amounts to 1% of the total hospitalization cost. We conclude that CR is overused and in most cases it has no influence on the patient management. The recognition of practical meaning of CR is essential to avoid unnecessary radiation of children.

Radiation doses in diagnostic imaging for suspected physical abuse

OBJECTIVE

To measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families.

METHODS

Data were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children's Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose.

RESULTS

Seventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43).

CONCLUSIONS

In a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.

An Investigation of Procedural Radiation Dose Level Awareness and Personal Training Experience in Communicating Ionizing Radiation Examinations Benefits and Risks to Patients in Two European Cardiac Centers

PURPOSE

Cardiac interventional practitioners need to be appropriately informed regarding radiation dose quantities and risks. Communicating benefit-risk information to patients requires attention as specified in Basic Safety Standards Directive 2013/59/Eurotom. This study investigated the awareness of procedural radiation dose levels and the impact of personal training experience in communicating ionizing radiation benefit-risks to patients.

METHODOLOGY

A questionnaire, consisting of 28 questions, was distributed directly to adult and pediatric interventional cardiology specialists at specialized cardiovascular imaging centers in Dublin, Ireland and Milan, Italy.

RESULTS

A total of 18 interventional cardiologists (senior registrar to consultant grades with between 2 y to over 21 y experience in cardiac imaging) participated. The majority of participants (n = 17) stated that parents of pediatric and adult patients should be informed of the potential benefits and risk. All participants indicated they had radiation safety training; however, 50% had not received training in radiation examination benefit-risk communication. Despite this, 77.8% (n = 14) participants indicated a high confidence level in successfully explaining risks and/or benefits of cardiac imaging procedures. When asked to estimate effective dose (ED) values for common cardiac imaging procedures less than 50% identified appropriate dose ranges. All participants underestimated procedural dose values based on recent European data. 50% (n = 9) participants answered all questions correctly for a number of true or false radiation risk statements.

CONCLUSION

Benefit-risk communication training deficits and inaccurate understanding of radiation dose levels was identified. Further research and training to support clinicians using radiation on a daily basis is required.

Parents' received and expected information about their child's radiation exposure during radiographic examinations

BACKGROUND

Despite regulations, insufficient information is provided to adult patients prior to their radiologic examinations. Information regarding paediatric patients has not been systematically studied.

OBJECTIVE

To survey parents' experience and wishes for information in connection with their child's radiographic examination.

MATERIALS AND METHODS

We provided a questionnaire to consenting parents of children younger than 12 years old at a university hospital. The questionnaire asked parents about the information obtained from the referrer prior to the radiograph, the chance to discuss with the referrer and their wishes regarding future information. Forty-one parents responded to the survey. Twenty-five children were referred for radiography of extremities, the others for dental, body and skull examinations.

RESULTS

Altogether 34/41 (83%, 95% confidence interval [CI] 69-91%) parents said they received adequate information on the purpose of the examination, 8/35 (23%, 95% CI 12-39%) on other options and 3/41 (7%, 95% CI 3-19%) on radiation dose. Ten of 41 parents (24%, 95% CI 12-40%) said they were aware of radiation exposure. The number of previous radiology examinations was not sufficiently discussed. The communication was scored as mean 6.5 (95% CI 5.8-7.1) on a scale from 4 (poor) to 10 (excellent). Thirty-eight of 40 (95%, 95% CI 84-99%) of parents expected information on the purpose, 35/40 (88%, 95% CI 74-95%) on radiation dose and 31/40 (78%, 95% CI 63-88%) on other options. Symbols of radiation and corresponding period of natural background radiation are preferred to convey the dose. A referrer is the preferred source of information.

CONCLUSION

Parents did not feel adequately informed prior to their child's radiographic examination. Parents expect more information about the purpose, dose and alternative tests.

CT utilization abruptly increases at age 18 among patients with inflammatory bowel diseases in the hospital

Objectives

Patients with inflammatory bowel disease(IBD) are frequently exposed to computed tomography (CT). Each CT exposes patients to radiation that cumulatively could increase the risk of malignancy, particularly in younger patients. We aim to study the effect of age on CT use in IBD patients seen in the Emergency Department (ED) or the hospital.

Methods

We conducted a retrospective cohort study of IBD patients identified in Truven Health Marketscan databases between 2009–2013. The main outcome was use of CT during an ED or inpatient visit. Effect of age on CT use was characterized using logistic regression accounting for important covariables.

Results

There were 66,731 patients with IBD with 144,147 ED or inpatient visits in this cohort with a diagnosis code of IBD. At first visit, 5.8% percent were below age 18. CT was utilized in 26.6% of visits. In multivariable analysis, adjusting for medications, recent surgery, and gender, patients 18–35 were more likely to undergo CT (OR 2.35, 95%CI: 2.20–2.52) compared to those <18. Examining patients only between 16 and 19, the odds of an 18 or 19-year-old undergoing CT is significantly higher than a 16 or 17-year-old (OR 1.96, 95%CI: 1.71–2.24).

Conclusions

Patients with IBD undergo CT more than a quarter of the time in the ED or inpatient setting. Pediatric providers limit radiation exposure among those <18 while adult providers are not as cautious with radiation exposure for the young adult population. Increased awareness of the risks of cumulative radiation exposure in the young adult population is needed.

Informed Consent for Radiation in Interventional Radiology Procedures

Purpose

To explore the patient perception on radiation-related cancer risk from interventional radiology (IR) procedures and whether informed radiation consent is warranted.

Methods

A multiple-choice survey was prospectively administered to 68 adults undergoing a body or neuro-IR procedure with ionizing radiation exposure. Subgroup analysis with chi-square or Fisher exact test was performed based on patient past IR history ( P < .05).

Results

A total of 81% of patients wanted to be informed if there was a radiation-related 3% increased cancer risk over 5 years. Although 55% considered 3% a small risk, 28% wanted to further discuss the risks and alternate options, and 15% would have only proceeded if it were a life-saving procedure: 89%, 80%, and 67% of patients wanted to be informed with exposure risks of 1 in 100, 1 in 1000, and 1 in 10,000, respectively. Only 53% were aware they were going to be exposed to radiation, irrespective of past IR history ( P = .15). Most patients believed radiation consent should include radiation-related cancer risks (85%). No past IR history was significantly associated with wanting consent to include cancer-related risk (100% vs 76%; P = .01) and deterministic risks (70% vs 41%; P = .04). A majority (69%) believed both the referring physician and the interventional radiologist were responsible for obtaining radiation consent, and 65% of patients wanted verbal consent followed by signed written consent, regardless of past IR history.

Conclusions

Many patients want to discuss cancer-related radiation risks with both radiologists and physicians. Informed radiation consent should be considered for procedures with high anticipated radiation doses.

Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults

OBJECTIVES

To analyse CT use in recent years in a high-density Italian area (±10 million inhabitants, including 1 million children), focusing on developing age.

METHODS

Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004-2014 in emergency and outpatient care and assessment of radiation exposure trend.

RESULTS

Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased ±19 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72-1.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16-48 %.

CONCLUSIONS

The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations.

KEY POINTS

• Literature highlights a remarkable increase in CT use over the last decades. • The paediatric age had higher exposure to X-ray risk. • A detailed retrospective analysis of more than 9 million scans was performed. • Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range. • This study raises concern about exposure for teenagers and young adults.

Pediatric providers and radiology examinations: knowledge and comfort levels regarding ionizing radiation and potential complications of imaging

BACKGROUND

Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers.

OBJECTIVE

To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging.

MATERIALS AND METHODS

A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies.

RESULTS

One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, P<0.001) knew that nuclear medicine utilizes ionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis.

CONCLUSION

Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost.

Physician Knowledge of Radiation Exposure and Risk in Medical Imaging

PURPOSE

Medical imaging is an increasingly important source of radiation exposure for the general population, and there are risks associated with such exposure; however, recent studies have demonstrated poor understanding of medical radiation among various groups of health care providers. This study had two aims: (1) analyze physicians' knowledge of radiation exposure and risk in diagnostic imaging across multiple specialties and levels of training, and (2) assess the effectiveness of a brief educational presentation on improving physicians' knowledge.

METHODS

From 2014 to 2016, 232 health care providers from multiple departments participated in an educational presentation and pre- and postpresentation tests evaluating knowledge of radiation exposure and risk at a large academic institution.

RESULTS

Knowledge of radiation exposure and risk was relatively low on the prepresentation test, including particularly poor understanding of different imaging modalities, with 26% of participants unable to correctly identify which modalities expose patients to ionizing radiation. Test scores significantly increased after the educational presentation. Radiologists had higher prepresentation test scores than other specialties, and therefore less opportunity for improvement, but also demonstrated improvement in radiation safety knowledge after education. Aside from radiology, there was no significant difference in initial knowledge of radiation exposure and risk among the other specialties.

CONCLUSIONS

Providers' knowledge of radiation exposure and risk was low at baseline but significantly increased after a brief educational presentation. Efforts to educate ordering providers about radiation exposure and risk are needed to ensure that providers are appropriately weighing the risks and benefits of medical imaging and to ensure high-quality, patient-centered care.

Knowledge on Irradiation, Medical Imaging Prescriptions, and Clinical Imaging Referral Guidelines among Physicians in a Sub-Saharan African Country (Cameroon)

Background

Clinical imaging guidelines (CIGs) are suitable tools to enhance justification of imaging procedures.

Objective

To assess physicians' knowledge on irradiation, their self-perception of imaging prescriptions, and the use of CIGs.

Materials and Methods

A questionnaire of 21 items was self-administered between July and August 2016 to 155 referring physicians working in seven university-affiliated hospitals in Yaoundé and Douala (Cameroon). This pretested questionnaire based on imaging referral practices, the use and the need of CIGs, knowledge on radiation doses of 11 specific radiologic procedures, and knowledge of injurious effects of radiation was completed in the presence of the investigator. Scores were allocated for each question.

Results

155 questionnaires were completed out of 180 administered (86.1%). Participants were 90 (58%) females, 63 (40.64%) specialists, 53 (34.20%) residents/interns, and 39 (25.16%) general practitioners. The average professional experience was 7.4 years (1–25 years). The mean knowledge score was 11.5/59 with no influence of sex, years of experience, and professional category. CIGs users' score was better than nonusers (means 14.2 versus 10.6; p < 0.01). 80% of physicians (124/155) underrated radiation doses of routine imaging exams. Seventy-eight (50.3%) participants have knowledge on CIGs and half of them made use of them. “Impact on diagnosis” was the highest justification criteria follow by “impact on treatment decision.” Unjustified requests were mainly for “patient expectation or will” or for “research motivations.” 96% of interviewees believed that making available national CIGs will improve justification.

Conclusion

Most physicians did not have appropriate awareness about radiation doses for routine imaging procedures. A small number of physicians have knowledge on CIGs but they believe that making available CIGs will improve justification of imaging procedures. Continuous trainings on radiation protection and implementation of national CIGs are therefore recommended.

Duty to Inform and Informed Consent in Diagnostic Radiology: How Ethics and Law can Better Guide Practice

Although there is consensus on the fact that ionizing radiation used in radiological examinations can affect health, the stochastic (random) nature of risk makes it difficult to anticipate and assess specific health implications for patients. The issue of radiation protection is peculiar as any dosage received in life is cumulative, the sensitivity to radiation is highly variable from one person to another, and between 20 % and 50 % of radiological examinations appear not to be necessary. In this context, one might reasonably assume that information and patient consent would play an important role in regulating radiological practice. However, there is to date no clear consensus regarding the nature and content of-or even need for-consent by patients exposed to ionizing radiation. While law and ethics support the same principles for respecting the dignity of the person (inviolability and integrity), in the context of radiology practice, they do not provide a consistent message to guide clinical decision-making. This article analyzes the issue of healthcare professionals' duty to inform and obtain patient consent for radiological examinations. Considering that both law and ethics have as one of their aims to protect vulnerable populations, it is important that they begin to give greater attention to issues raised by the use of ionizing radiation in medicine. While the situation in Canada serves as a backdrop for a reflective analysis of the problem, the conclusions are pertinent for professional practice in other jurisdictions because the principles underlying health law and jurisprudence are fairly general.

Physicians' Knowledge about Radiation Dose in Radiological Investigation in Iran

BACKGROUND

Although ionizing radiation is very important in diagnostic and treatment of many diseases, the hazards of this radiation are considerable and irrefutable. One of the main stages in radiation protection is knowledge about radiation dose in radiological investigation. The aim of this study was to determine the physicians' knowledge in radiological examinations.

MATERIAL AND METHODS

The data collected by questionnaire were designed and the most commonly requested radiological investigations were listed. The questionnaire was distributed among 106 consultant physicians. The survey was conducted on the awareness about the radiation dose and risks among health professionals in Iran.

RESULTS

The results indicated that the majority of physicians did not know about ionizing radiation and evaluation of absorbed dose in patients. Many of these physicians were not aware of radiations risks and the most important aspects of radiation protection; although, they have passed some courses in radiobiology and medical physics.

CONCLUSION

Since radiological examinations play an indispensable role in medicine, knowledge about radiation doses and hazards is very important. Generally, this study showed that knowledge of radiation doses is inadequate among physicians.

Aetiological diagnosis of child deafness: CODEPEH recommendations

Important progress in the fields of molecular genetics (principally) and diagnostic imaging, together with the lack of a consensus protocol for guiding the diagnostic process after confirming deafness by neonatal screening, have led to this new work document drafted by the Spanish Commission for the Early Detection of Child Deafness (Spanish acronym: CODEPEH). This 2015 Recommendations Document, which is based on the most recent scientific evidence, provides guidance to professionals to support them in making decisions regarding aetiological diagnosis. Such diagnosis should be performed without delay and without impeding early intervention. Early identification of the causes of deafness offers many advantages: it prevents unnecessary trouble for the families, reduces health system expenses caused by performing different tests, and provides prognostic information that may guide therapeutic actions.

Knowing the Enemy: Health Care Provider Knowledge of Computed Tomography Radiation Dose and Associated Risks

BACKGROUND

There is ionizing radiation and associated risk from many medical imaging examinations, especially computed tomography (CT). Unfortunately, health care providers often have limited knowledge regarding radiation dose levels and potential risk.

RESEARCH OBJECTIVES

To assess knowledge of dose levels and risk among referring physicians, imaging technologists, and radiologists in Saskatoon, Saskatchewan, and to identify potential differences between and within those groups.

MATERIALS AND METHODS

A survey was designed and administered to health care professionals.

RESULTS

A total of 308 of 328 surveys were completed (91% response rate). Overall 73% of physicians, 97% of radiologists, and 76% of technologists correctly believed that there is a risk for cancer from an abdomen-pelvic CT scan. Although only 18% of physicians, 28% of radiologists, and 22% of technologists selected the most appropriate estimate of abdominal-pelvic CT dose in terms of chest x-ray equivalents, this is similar to other reported studies. Physicians and technologists who use CT were more likely to select the correct dose than those who do not. Most respondents (91% of physicians, 100% of radiologists, and 100% of technologists) felt that pregnant patients should always be informed about radiation dose as a risk. Although frequency of discussing risk decreased with increasing patient age, technologists were more likely to discuss risk at any age. A total of 93% of respondents expressed interest in receiving dose feedback from medical imaging procedures.

CONCLUSIONS

Radiologists and technologists generally showed better knowledge than referring physicians. Among physicians and technologists, knowledge was better in those who use CT than those who do not.

CT radiation dose awareness among paediatricians

BACKGROUND

The radiation dose delivered from computed tomography (CT) scanning and the risks associated with ionising radiation are major concerns in paediatric imaging. Compared to adults, children have increased organ sensitivity and a longer expected lifetime in which cancer may develop. Therefore, it is important to investigate the awareness of paediatricians (referring physicians) regarding radiation doses and the associated risks.

METHODS

A multiple-choice survey was distributed among paediatricians in 8 hospitals in Riyadh, the capital of Saudi Arabia.

RESULTS

Among the 162 respondents, only 24 (15 %) were aware of the As Low As Reasonably Achievable (ALARA) principle. Approximately half (54 %) of the respondents believed that multi-slice CT delivered a low radiation dose, and 100 (62 %) of the respondents were not aware that radiation is considered carcinogenic by the Food and Drug Administration in the United States. Among the respondents, 110 (68 %) did not have any specific education regarding radiation during their training. There was an overall underestimation (83 %) of the CT radiation dose, and 70 % thought that magnetic resonance imaging (MRI) delivered some level of ionising radiation.

CONCLUSIONS

Among paediatricians in Saudi Arabian hospitals, there was a wide underestimation of the CT radiation dose and the associated risks for children. We should improve paediatricians' knowledge about radiation doses. Radiologists, paediatricians, radiation technologists and medical physicists should work together to optimise CT guidelines and protocols to reduce the radiation risks for children.

Physicians' Perceptions of Radiation Dose Quantity Depend on the Language in Which It Is Expressed

PURPOSE

Radiation dose information is increasingly requested by nonradiology providers, but there are no standard methods for communicating dose. The aim of this study was to compare physicians' perceptions of the amount of radiation associated with similar dose quantities expressed using different dose terms to evaluate the impact of word choice on physicians' understanding of radiation dose.

METHODS

Internal medicine and pediatric residents were surveyed online for 42 days. After obtaining demographics and training levels, respondents were asked to rank five different radiation dose quantities, each corresponding to one of the five ACR relative radiation levels (RRLs) expressed using different dose terms. Respondents ranked the choices from least to greatest (ie, from 1 to 5) or indicated if all five were equal. For the final question, the same dose quantity was expressed five different ways.

RESULTS

Fifty-one medicine and 45 pediatric residents responded (a 44% response rate). Mean differences in rankings were as follows: for chest x-rays, 0.109 (95% confidence interval [CI], -0.018 to 0.236); for cross-country flights, 0.462 (95% CI, 0.338 to 0.585); for natural background radiation, -0.672 (95% CI, -0.793 to -0.551); for cancer risk, -0.294 (95% CI, -0.409 to -0.178); and for ACR RRL, 0.239 (95% CI, 0.148 to 0.329). Statistically significant differences were found in the distributions of rankings (P < .001) and percentage of correct rankings across each radiation dose term (P < .001), with the ACR RRL having the highest percentage of correct rankings (61.2%).

CONCLUSIONS

Adult and pediatric physicians consistently over- or underestimated radiation dose quantities using different terms to express radiation dose. These results suggest that radiation dose information should be communicated using standard terminology such as the ACR RRL scale to foster consistency and improve the accuracy of physicians' radiation risk perceptions.

The radiology informed consent form: recommendations from the European Society of Cardiology position paper

Every radiological and nuclear medicine examination confers a definite long-term risk of cancer, but most patients undergoing such examinations receive no or inaccurate information about radiation dose and corresponding risk related to the dose received. Informed consent is a procedure to support (not substitute) the physician/patient dialogue and relationship, facilitating a free, informed and aware expression of the patient's will in the principle of patient autonomy. Physicians are responsible for providing patients with all the information on risks, benefits and alternatives useful to the patient to make the decision. In current radiological practice the information on the radiation dose and long-term cancer risks is difficult to find and not easy to understand. The form using plain language should spell-out the type of examination, the effective dose (mSv), the effective dose expressed in number of chest radiographs and the risk of cancer. The current practice clashes against the guidelines and the law.

Ionizing Radiation Knowledge Among Emergency Department Providers

PURPOSE

The aim of this study was to assess knowledge of ionizing radiation exposure from diagnostic imaging examinations among emergency department (ED) providers.

METHODS

An electronic questionnaire was distributed to ED providers in a five-hospital university-affiliated health care system. Providers included attending emergency medicine (EM) physicians, EM residents, and midlevel providers (MLPs) (nurse practitioners and physicians assistants). Data were collected and analyzed.

RESULTS

One hundred six of 210 providers (41 attending physicians, 32 residents, and 31 MLPs) completed the survey, for a response rate of 50.5%. More than two in five providers (44.6%) could not correctly identify which of six common imaging modalities used ionizing radiation. MLPs were more likely to incorrectly identify radiography (25%) and fluoroscopy (29%) as modalities that did not use ionizing radiation (P = .01 and P = .25 respectively). Fewer attending physicians (14.6%) than residents (37.5%) were not very comfortable or were uncomfortable explaining the risks of radiation to patients. Nearly half of attending physicians (47.5%) and nearly three-quarters of residents (71.9%) were not very comfortable, were uncomfortable, or were extremely uncomfortable explaining the amount of radiation in certain imaging tests to patients. MLPs were more likely to incorrectly rank a selection of imaging tests by radiation exposure (P = .002). MLPs were more likely to incorrectly answer a question on the effects of ionizing radiation on patients (P = .01).

CONCLUSIONS

Among ED providers, there are knowledge gaps regarding the presence and effect of ionizing radiation in diagnostic imaging tests. MLPs were more likely to make factual errors, while EM residents were least comfortable counseling patients about radiation risks.

First-line diagnosis of paediatric pneumonia in emergency: lung ultrasound (LUS) in addition to chest-X-ray (CXR) and its role in follow-up

OBJECTIVE

The role of lung ultrasound (LUS) integrated with chest X-ray (CXR) for the first-line diagnosis of paediatric pneumonia; to define its role during the follow-up to exclude complications.

METHODS

We performed a retrospective review of a cohort including 84 consecutive children (age range: 3-16 years; mean age: 6 years; 44 males, 40 females) with clinical signs of cough and fever. All the patients underwent CXR at admission integrated with LUS. Those positive at LUS were followed up with LUS until the complete resolution of the disease.

RESULTS

CXR showed 47/84 pneumonic findings. LUS showed 60/84 pneumonic findings; 34/60 pneumonic findings had a typical pattern of lung consolidation; 26/60 pneumonic findings showed association of multiple B-lines, findings consistent with interstitial involvement, and small and hidden consolidations not achievable by CXR. One case was negative at LUS because of retroscapular location. 60 patients were followed up with LUS; 28/60 patients showed a complete regression of the disease; 23/60 patients had a significant decrease in size of consolidation; 9/60 patients showed disease stability or insignificant decrease in size, thus requiring adjunctive LUS examinations.

CONCLUSION

LUS, integrated with CXR, revealed to be an accurate first-line technique to identify small pneumonic consolidations, especially for "CXR-occult" findings, and for early diagnosis of pleural effusion; furthermore, LUS follow-up allows complications to be verified and additional radiation exposures to be avoided.

ADVANCES IN KNOWLEDGE

The effective role of LUS in the diagnosis and follow-up of lung consolidations and pleural effusions in paediatric patients in an emergency setting.

Awareness of radiation dose associated with common diagnostic procedures in emergency departments: A pilot study

BACKGROUND

The large number of diagnostic procedures undertaken in emergency departments (ED) is vital to the early diagnosis and treatment of patients. The use of ionising radiation in diagnosis adds a lifetime attributable risk (LAR) of cancer depending on the region imaged, the frequency of imaging, and dose per exposure.

AIMS

This pilot study aims to assess the degree of radiation awareness amongst ED doctors at major metropolitan and regional health services in Australia, in terms of the dose and risks associated with common imaging. Secondary aims were to provide a template to practically evaluate ED doctor radiation awareness, identify factors impacting upon radiation awareness (e.g., location, seniority of doctor), and to suggest practical means to improve radiation awareness.

METHODS

Physicians in the EDs of two major health services (one regional and one metropolitan) in Australia were surveyed and asked to compare the radiation dose from each procedure to what the general population is exposed to naturally from background radiation. Additionally, the physicians were asked to estimate the LAR of cancer from each diagnostic procedure. These estimates were compared to literature-sourced values to assess the accuracy of physician responses.

RESULTS

Results showed that there was significant variance with regard to knowledge of dose and risk, and that respondents tended to greatly overexaggerate the radiation levels and risk associated with diagnostic imaging. Despite failing to attribute correct values, in many cases, respondents ranked scans correctly. Responses comparing differences amongst the two health services and amongst different levels of medical hierarchy largely overlapped with no clear difference between these factors.

CONCLUSION

Physicians reported low confidence in their knowledge of radiation awareness and indicated the need for additional education, which would assist them in communicating the risks to patients. Furthermore, such education would assist physicians in tailoring their diagnostic imaging requests so as to minimise radiation levels in patients.

Assessment of radiation protection awareness and knowledge about radiological examination doses among Italian radiographers

Objectives

To evaluate radiation protection basic knowledge and dose assessment for radiological procedures among Italian radiographers

Methods

A validated questionnaire was distributed to 780 participants with balanced demographic characteristics and geographic distribution.

Results

Only 12.1 % of participants attended radiation protection courses on a regular basis. Despite 90 % of radiographers stating to have sufficient awareness of radiation protection issues, most of them underestimated the radiation dose of almost all radiological procedures. About 5 % and 4 % of the participants, respectively, claimed that pelvis magnetic resonance imaging and abdominal ultrasound exposed patients to radiation. On the contrary, 7.0 % of the radiographers stated that mammography does not use ionising radiation. About half of participants believed that radiation-induced cancer is not dependent on age or gender and were not able to differentiate between deterministic and stochastic effects. Young radiographers (with less than 3 years of experience) showed a higher level of knowledge compared with the more experienced radiographers.

Conclusions

There is a substantial need for radiographers to improve their awareness of radiation protection issues and their knowledge of radiological procedures. Specific actions such as regular training courses for both undergraduate and postgraduate students as well as for working radiographers must be considered in order to assure patient safety during radiological examinations.

Main messages

• Radiographers should improve their knowledge on radiation protection issues.

• Only 12.1 % of participants attended radiation protection courses on a regular basis.

• Specific actions must be considered in order to increase knowledge and awareness.

Paediatric imaging radiation dose awareness and use of referral guidelines amongst radiology practitioners and radiographers

Objectives

The objectives are to investigate radiology practitioners’ and radiographers’ radiation dose awareness and use of referral guidelines for paediatric imaging examinations.

Methods

A prospective cross-sectional survey was conducted amongst radiology practitioners and radiographers working at a primary paediatric referral centre in Malta. Part of the survey asked participants to indicate the typical effective dose (ED) for several commonly performed paediatric imaging examinations, answer five true-false statements about radiation protection principles, and specify their use of referral guidelines for paediatric imaging.

Results

The return of 112 questionnaires provided a response rate of 66.7 %. Overall, imaging practitioners demonstrated poor awareness of radiation doses associated with several paediatric imaging examinations, with only 20 % providing the correct ED estimate for radiation-based examinations. Nearly all participants had undertaken radiation protection training, but the type and duration of training undertaken varied. When asked about the use of referral guidelines for paediatric imaging, 77.3 % claimed that they ‘did not’ or ‘were not sure’ if they made use of them.

Conclusions

Poor awareness of radiation doses associated with paediatric imaging examinations and the non-use of referral guidelines may impede imaging practitioners’ role in the justification and optimisation of paediatric imaging examinations. Education and training activities to address such shortcomings are recommended.

Key Points

• Imaging practitioners demonstrated poor radiation dose awareness for 5 paediatric imaging examinations.

• Most radiology practitioners and radiographers were ‘not sure’ or ‘did not’ use referral guidelines.

• Imaging practitioners generally considered previously undertaken paediatric imaging examinations.

• Some imaging practitioners had not undertaken training in radiation protection for 10 years.

• Training activities to address imaging practitioners’ poor radiation dose awareness are encouraged.

Cumulative doses analysis in young trauma patients: a single-centre experience

Multidetector computed tomography (MDCT) represents the main source of radiation exposure in trauma patients. The radiation exposure of young patients is a matter of considerable medical concern due to possible long-term effects. Multiple MDCT studies have been observed in the young trauma population with an increase in radiation exposure. We have identified 249 young adult patients (178 men and 71 women; age range 14-40 years) who had received more than one MDCT study between June 2010 and June 2014. According to the International Commission on Radiological Protection publication, we have calculated the cumulative organ dose tissue-weighting factors by using CT-EXPO software(®). We have observed a mean cumulative dose of about 27 mSv (range from 3 to 297 mSv). The distribution analysis is characterised by low effective dose, below 20 mSv, in the majority of the patients. However, in 29 patients, the effective dose was found to be higher than 20 mSv. Dose distribution for the various organs analysed (breasts, ovaries, testicles, heart and eye lenses) shows an intense peak for lower doses, but in some cases high doses were recorded. Even though cumulative doses may have long-term effects, which are still under debate, high doses are observed in this specific group of young patients.

Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children

BACKGROUND

Many studies have demonstrated a rise in computed tomography (CT) utilization in abstract children's hospitals. However, CT utilization may be declining, perhaps due to awareness of potential hazards of pediatric ionizing radiation, such as increased risk of malignancy. Th e objective is to assess the trend in CT utilization in hospitalized children at freestanding children's hospitals from 2004 to 2012 and we hypothesize decreases are associated with shifts to alternate imaging modalities.

METHODS

Multicenter cross-sectional study of children admitted to 33 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between January 1, 2004, and December 31, 2012. The rates of CT, ultrasound, and MRI for the top 10 All-Patient Refined Diagnosis Related Groups (APR-DRGs) for which CT was performed in 2004 were determined by billing data. Rates of each imaging modality for those top 10 APR-DRGs were followed through the study period. Odds ratios of imaging were adjusted for demographics and illness severity.

RESULTS

For all included APR-DRGs except ventricular shunt procedures and nonbacterial gastroenteritis, the number of children imaged with any modality increased. CT utilization decreased for all APR-DRGs (P values , .001). For each of the APR-DRGs except seizure and infections of upper respiratory tract, the decrease in CT was associated with a significant rise in an alternative imaging modality (P values # .005).

CONCLUSIONS

For the 10 most common APR-DRGs for which children received CT in 2004,a decrease in CT utilization was found in 2012. Alternative imaging modalities for 8 of the diagnoses were used.

A prospective study assessing clinicians attitude and knowledge on radiation exposure to patients during radiological investigations

Background:

Exposure to radiation during radiological investigations is of health concern, which referring physicians should rationalize. Hence, we assessed the clinician's awareness and concern of radiation exposure to patients, in relation to their referral practice.

Materials and Methods:

A prospective study was conducted involving specialists from Punjab (India), who were handed a standard set of questionnaire concerning knowledge of radiation hazards and doses from imaging procedures, consideration of radiation dose and age when referring, referrals not likely to affect treatment, and use of referral guidelines were included. Of the 150 medical doctors given the questionnaire, 106 returned it.

Results:

Majority of the clinicians underestimated radiation doses, while a few overestimated it. Almost half of the clinicians (55.5%) favored to select the rationale of asking about previous radiological examinations as clinical need only, which was surprising. Rates of referrals unlikely to affect treatment were more (66%) than reported rates in previous studies. Worryingly, only 30.1% of the clinicians had knowledge of referral guidelines and alarmingly only 10.5% had made use of it.

Conclusions:

Our study although in a small population size identifies inadequate knowledge on radiation and its guidelines among referral physicians, which warrants the immediate need for training programs to bridge this knowledge gap.

Perception of radiation dose and potential risks of computed tomography in emergency department medical personnel

Objective

Use of computed tomography (CT) continues to increase, but the relatively high radiation doses associated with CT have raised health concerns such as future risk of cancer. We investigated the level of awareness regarding radiation doses and possible risks associated with CT in medical personnel (MP).

Methods

This study was conducted from April to May 2012 and included physicians and nurses who worked in the emergency department of 17 training hospitals. The questionnaire included measurement of the effect of CT or radiography on health using a 10-point numerical rating scale, estimation of the radiation dose of one abdominal CT scan compared with one chest radiograph, and perception of the increased lifetime risk of cancer associated with CT.

Results

A total of 354 MP participated in this study: 142 nurses, 87 interns, 86 residents, and 39 specialists. Interns were less aware of the effects of CT or radiography on health than other physicians or nurses (mean±SD of 4.8±2.7, 5.9±2.7, 6.1±2.7, and 6.0±2.2 for interns, residents, specialists, and nurses, respectively; P<0.05). There was a significant difference in knowledge about the relative radiation dose of one abdominal CT scan compared with one chest radiograph between physicians and nurses (48.6% vs. 28.9% for physicians vs. nurses, P<0.05). MP perceived an increased risk of cancer from radiation associated with CT.

Conclusion

MP perceive the risk of radiation associated with CT, but their level of knowledge seems to be insufficient.

Patient perspectives and preferences for communication of medical imaging risks in a cancer care setting

PURPOSE

To identify opportunities for improving patient-centered communication about diagnostic imaging tests that involve the use of radiation in a cancer care setting.

MATERIALS AND METHODS

Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Patient knowledge, information sources, and communication preferences were assessed in six focus groups during 2012. The groups consisted of patients undergoing treatment for metastatic colorectal carcinoma, women treated within the past 6 months for early-stage breast carcinoma, men undergoing surveillance after testicular cancer treatment, parents of patients treated for stage I-III neuroblastoma, patients in a thoracic oncology survivorship program, and participants in a lung cancer screening program. A multidisciplinary research team performed thematic content analysis of focus group transcripts. High-level findings were summarized during consensus conferences.

RESULTS

Although they were aware of the long-term risk of cancer from exposure to ionizing radiation, most participants reported that their health care provider did not initiate discussion about benefits and risks of radiation from imaging tests. Most patients obtained information by means of self-directed internet searches. Participants expressed gratitude for tests ("That CT saved my daughter's life," "I'd rather have the radiation dosage than being opened up"), yet they expressed concern about having to initiate discussions ("If you don't ask, nobody is going to tell you anything") and the desire to be offered information concerning the rationale for ordering specific imaging examinations, intervals for follow-up imaging, and testing alternatives. Participants believed that such information should be available routinely and that conversation with their personal physician or endorsed, readily available reference materials were ideal methods for information exchange. Understanding imaging radiation risks and active participation in decision making about imaging were especially important to cancer survivors.

CONCLUSION

A substantial gap exists between patient expectations and current practices for providing information about medical imaging tests that involve the use of radiation.