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Kearns M, Brennan P, Buckley T. Nurse practitioners' use of diagnostic imaging: A scoping review. J Clin Nurs 2024; 33:432-453. [PMID: 37953490 DOI: 10.1111/jocn.16874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/08/2023] [Accepted: 08/23/2023] [Indexed: 11/14/2023]
Abstract
AIM To explore the nature and extent of peer-reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research. BACKGROUND Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years. DESIGN A scoping review based on the steps suggested by the Joanna Briggs Institute. METHODS A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms 'nurse practitioner', 'medical imaging', 'diagnostic imaging', 'scan' and 'radiography'. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021. RESULTS Eight themes were identified-country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image-guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging. CONCLUSION There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this. RELEVANCE TO CLINICAL PRACTICE Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x-rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Mary Kearns
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrick Brennan
- Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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2
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Thind GS, Hussein A, Mishra V, Ramachandran V, Lohia M, Ennala S, Guduguntla N, Dugar S, Martin C, Moghekar A, Sadana DS, Krishnan S. Characteristics of Cumulative Annual Radiation Exposure in Young Intensive Care Unit Survivors. J Patient Saf 2022; 18:e985-e991. [PMID: 35617610 DOI: 10.1097/pts.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients admitted to the intensive care unit (ICU) are at high risk for hazardous medical radiation exposure. However, the cumulative annual radiation exposure in ICU survivors remains unknown. METHODS This was a single-center retrospective study of all critically ill adult patients admitted to the 64-bed adult medical ICU at a quaternary medical center. The study included patients aged 18 to 39 years admitted through the year 2013 (January 1, 2013-December 31, 2013) who survived their respective ICU admission. RESULTS A total of 353 patients were included in the study. The median cumulative effective dose (CED) for the calendar year was 9.14 mSv (interquartile range, 1.74-27 mSv). In 11.6% of the patients (n = 41), CED was more than 50 mSv, while 5.1% of the patients (n = 18) exceeded annual CED of 100 mSv. Overall, radiation exposure from ICU-related imaging studies was lower than those from other medical settings (mean difference, -9.2 ± 83.6; P < 0.05). However, there was no statistically significant difference in exposure (ICU versus non-ICU) when restricting the analysis to patients with a CED of greater than 50 and greater than 100 mSv. Eighty-seven percent of the original cohort was alive at the end of the year. CONCLUSIONS Young ICU survivors are at risk for high annual radiation exposure from both ICU and non-ICU sources. A subset is exposed to hazardous annual radiation exposure in excess of 100 mSv.
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Affiliation(s)
| | - Ahmed Hussein
- From the Department of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Mehul Lohia
- From the Department of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Siddharth Dugar
- From the Department of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Ajit Moghekar
- From the Department of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Sudhir Krishnan
- From the Department of Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
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3
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Karavas E, Ece B, Aydın S, Kocak M, Cosgun Z, Bostanci IE, Kantarci M. Are we aware of radiation: A study about necessity of diagnostic X-ray exposure. World J Methodol 2022; 12:264-273. [PMID: 36159099 PMCID: PMC9350723 DOI: 10.5662/wjm.v12.i4.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/27/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total exposure to ionizing radiation has nearly doubled in the last two decades. This increase is primarily due to increased computed tomography (CT) exposure. Concerns have been raised about the risks associated with patients' exposure to medical imaging radiation, which can increase a person's lifetime risk of developing cancer. Preventing unnecessary examinations becomes critical at this point. To avoid unnecessary examinations, it is necessary to understand the demanding process.
AIM To ascertain clinicians' awareness of and reasons for requesting a CT examination.
METHODS We developed an online questionnaire that included 20 questions about clinicians' awareness of radiation safety and their reasons for requesting a CT examination, as well as demographic information such as age, gender, and year of medical practice experience. Additionally, we asked participants the number of CT scans requested in a month, the patients' questions and approaches about the imaging method, the effect of the patient's previous imaging history on the current imaging request, whether they believed that they had sufficient information about radiation doses, and whether they requested CT without an indication. We administered the questionnaire to clinicians from a variety of different professions in four different cities.
RESULTS A total of 195 clinicians participated. Internal medicine specialists were the most crowded group (38/195, 19.5%). Mean age of the population was 33.66 ± 5.92 years. Mean year of experience was 9.01 ± 5.96. Mean number of requested CT scans in a month was 36.88 ± 5.86. Forty-five (23.1%) participants stated that they requested CT scans without clinical indication. The most common reasons for CT scan requests were work load, fear of malpractice, and patient demand/insistence.
CONCLUSION CT scan requests are influenced by a variety of factors, both internal and external to the doctors and patients. Raising awareness of radiation safety and reducing fear of malpractice by limiting the number of patients per physician may result in a reduction in unnecessary CT examinations and ionizing radiation exposure.
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Affiliation(s)
- Erdal Karavas
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
| | - Bunyamin Ece
- Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey
| | - Sonay Aydın
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
| | - Mehmet Kocak
- Department of Radiology, Bolu İzzet Baysal State Hospital, Bolu 14300, Turkey
| | - Zeliha Cosgun
- Department of Radiology, Bolu Abant Izzet Baysal University, Bolu 14030, Turkey
| | - Isil Esen Bostanci
- Department of Radiology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara 06200, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
- Department of Radiology, Atatürk University, Erzurum 25240, Turkey
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4
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Armao D, Hartman TS, Katz L, Shea CM, Koschnitzky J, Yang R, Smith JK, Quinsey C. Radiation safety education and diagnostic imaging in pediatric patients with surgically treated hydrocephalus: the patient and family perspective. Childs Nerv Syst 2021; 37:491-497. [PMID: 32710252 DOI: 10.1007/s00381-020-04822-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgically treated hydrocephalus patients are frequently imaged with head computed tomography (CT), and risk/benefit communication with families is inconsistent and unknown. We aimed to educate patients and caregivers about radiation safety in CT and explore their communication preferences. METHODS We conducted a pediatric CT radiation safety and diagnostic imaging educational workshop for patients and caregivers at a national conference on hydrocephalus to characterize current practice and desired communication about CT imaging. Our workshop consisted of an interactive educational intervention with pre-/post-session surveys followed by feedback from participants. RESULTS Our session included 34 participants (100% response rate for surveys) with 28 being parents of individuals with hydrocephalus. A total of 76% (n = 26) participants showed an increase in knowledge after the session (p < 0.01). All participants (N = 34) uniformly desired risk/benefit discussions before CT scans. However, 71% stated that they were not informed of risks/benefits of CT scans by a medical professional. Following the session, the number of participants indicating that informed consent should be obtained before CT scans increased from 30 to 33. Respondents also revealed that 14% of children and young adults had received > 100 CT scans for shunt evaluation with the median being 25 scans (IQR 20). CONCLUSIONS Caregivers desire and deserve to be empowered through education and social support, and continuously engaged through sharing decisions and co-designing care plans. The neurosurgical community is in an ideal position to collaborate with radiologists, primary care providers, and parents in the development and testing of credible, high-quality online and social media resources.
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Affiliation(s)
- Diane Armao
- Department of Radiology, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA. .,Department of Pathology and Laboratory Medicine, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA.
| | - Terry S Hartman
- Department of Radiology, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA.,Department of Health Informatics, School of Health Professionals, Rutgers University, Newark, NJ, USA
| | - Laurence Katz
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Richard Yang
- School of Osteopathic Medicine, Campbell University, Buies Creek, NC, USA
| | - J Keith Smith
- Department of Radiology, University of North Carolina, Campus Box 7510, Chapel Hill, NC, 27599-7510, USA
| | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA
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5
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Radiation Emergency Readiness Among US Medical Toxicologists: A Survey. Disaster Med Public Health Prep 2020; 15:292-297. [PMID: 31955717 DOI: 10.1017/dmp.2019.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Large scale radiologic and nuclear disasters are rare; however, recent events such as the Fukushima Daiichi nuclear reactor emergency in Japan and current global political tensions have highlighted the need for health-care providers with expertise in managing radiation injuries. Medical Toxicologists have the ability to collaborate with other specialists in filling this critical role. METHODS We conducted a cross-sectional survey to assess the attitudes, experiences, and knowledge of medical toxicologists through the assistance of the American College of Medical Toxicology. RESULTS The survey was completed by 114 medical toxicologists during the enrollment period. Medical toxicologists who had a willingness to participate in radiologic or nuclear emergencies or who had taken care of patients contaminated with radioactive material were more likely to perform well on the knowledge assessment. CONCLUSION We identified that there is a group of medical toxicologists who have the willingness, experience, and knowledge to help manage patients in the event of a radiologic or nuclear emergency.
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6
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Azman RR, Shah MNM, Ng KH. Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks. Korean J Radiol 2019; 20:399-404. [PMID: 30799570 PMCID: PMC6389812 DOI: 10.3348/kjr.2018.0416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/09/2018] [Indexed: 01/01/2023] Open
Abstract
The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.
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Affiliation(s)
- Raja Rizal Azman
- Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, University Malaya Research Imaging Centre (UMRIC), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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7
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Ihle IR, Neibling E, Albrecht K, Treston H, Sholapurkar A. Investigation of radiation-protection knowledge, attitudes, and practices of North Queensland dentists. ACTA ACUST UNITED AC 2018; 10:e12374. [PMID: 30548457 DOI: 10.1111/jicd.12374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
Abstract
AIM Queensland has current radiation-protection guidelines; however, with the absence of data exploring compliance and implementation, the efficacy is unknown. The aim of the present study was to investigate the knowledge and attitudes on radiation protection among private North Queensland (NQ) dentists. METHODS A quantitative methodology was employed in an observational and descriptive study using questionnaires for data collection. RESULTS Of the 154 questionnaires distributed, 63 were completed and returned. The respondents' knowledge concerning the technical details of their equipment was limited, with 31.5% and 47% not knowing the tube voltage and current utilized for their machines, respectively. In total, 23.8% of dentists had limited knowledge about the speed of the conventional film they used, 90.5% of respondents agreed that the role of imaging in dentistry is important, and 75.8% dentists reported the thyroid as the most important organ to protect during dental radiography. Their knowledge regarding position-distance rule was reasonably adequate; 80.3% of the dental practices appeared to follow the Australian Radiation Protection and Nuclear Safety Agency guidelines, 95.2% preferred taking radiographs if it was only urgent, and 69.8% identified a need for spreading awareness regarding radiation protection. CONCLUSIONS An opportunity and need for further continuing education was identified among NQ dentists to ensure safety of patients.
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Affiliation(s)
- Isabella R Ihle
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Emma Neibling
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Katia Albrecht
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Hannah Treston
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Amar Sholapurkar
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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8
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Emergency department imaging superusers. Emerg Radiol 2018; 26:161-168. [DOI: 10.1007/s10140-018-1659-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/09/2018] [Indexed: 11/27/2022]
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9
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Zener R, Johnson P, Wiseman D, Pandey S, Mujoomdar A. Informed Consent for Radiation in Interventional Radiology Procedures. Can Assoc Radiol J 2018; 69:30-37. [DOI: 10.1016/j.carj.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/05/2017] [Accepted: 07/19/2017] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Rebecca Zener
- Victoria Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Peter Johnson
- University Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Daniele Wiseman
- Victoria Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Sachin Pandey
- University Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Amol Mujoomdar
- Victoria Hospital, London Health Sciences Centre, Department of Medical Imaging, Western University, London, Ontario, Canada
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10
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Rigsby CK, McKenney SE, Hill KD, Chelliah A, Einstein AJ, Han BK, Robinson JD, Sammet CL, Slesnick TC, Frush DP. Radiation dose management for pediatric cardiac computed tomography: a report from the Image Gently 'Have-A-Heart' campaign. Pediatr Radiol 2018; 48:5-20. [PMID: 29292481 PMCID: PMC6230472 DOI: 10.1007/s00247-017-3991-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022]
Abstract
Children with congenital or acquired heart disease can be exposed to relatively high lifetime cumulative doses of ionizing radiation from necessary medical imaging procedures including radiography, fluoroscopic procedures including diagnostic and interventional cardiac catheterizations, electrophysiology examinations, cardiac computed tomography (CT) studies, and nuclear cardiology examinations. Despite the clinical necessity of these imaging studies, the related ionizing radiation exposure could pose an increased lifetime attributable cancer risk. The Image Gently "Have-A-Heart" campaign is promoting the appropriate use of medical imaging studies in children with congenital or acquired heart disease while minimizing radiation exposure. The focus of this manuscript is to provide a comprehensive review of radiation dose management and CT performance in children with congenital or acquired heart disease.
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Affiliation(s)
- Cynthia K Rigsby
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
| | - Sarah E McKenney
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA
| | - Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Anjali Chelliah
- Division of Pediatric Cardiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew J Einstein
- Division of Cardiology, Departments of Medicine and Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - B Kelly Han
- Department of Pediatrics, Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Joshua D Robinson
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Sammet
- Department of Medical Imaging #9, Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Radiology and Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Timothy C Slesnick
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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11
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Armao D, Hartman TS, Shea CM, Katz L, Thurnes T, Smith JK. Maximizing Benefit and Minimizing Risk in Medical Imaging Use: An Educational Primer for Health Care Professions Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518798812. [PMID: 30211315 PMCID: PMC6131289 DOI: 10.1177/2382120518798812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
"I am not young enough to know everything."Oscar Wilde. BACKGROUND There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students' training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics. MATERIALS AND METHODS The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance. RESULTS A total of 301 students were enrolled in the study. There was 58% (P < .01) and 85% (P < .01) improvement in attitude and knowledge regarding appropriateness of imaging, respectively. The authors also found an 8% increase (P < .01) in students who thought informed consent should be obtained prior to pediatric computed tomographic imaging. Physical assistant students were more likely than medical students to prefer obtaining informed consent at baseline (P = .03). CONCLUSIONS A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.
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Affiliation(s)
- Diane Armao
- Department of Radiology, School of
Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
- Department of Pathology and Laboratory
Medicine, School of Medicine, The University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
- Department of Physician Assistant
Studies, Elon University, Elon, NC, USA
| | - Terry S Hartman
- Department of Radiology, School of
Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Christopher M Shea
- Department of Health Policy and
Management, UNC Gillings School of Global Public Health, The University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laurence Katz
- Department of Emergency Medicine, School
of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Tracey Thurnes
- Department of Physician Assistant
Studies, Elon University, Elon, NC, USA
| | - J Keith Smith
- Department of Radiology, School of
Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
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12
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Wildman-Tobriner B, Parente VM, Maxfield CM. Pediatric providers and radiology examinations: knowledge and comfort levels regarding ionizing radiation and potential complications of imaging. Pediatr Radiol 2017; 47:1730-1736. [PMID: 28852812 DOI: 10.1007/s00247-017-3969-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
| | | | - Charles M Maxfield
- Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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13
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Hobbs JB, Goldstein N, Lind KE, Elder D, Dodd GD, Borgstede JP. Physician Knowledge of Radiation Exposure and Risk in Medical Imaging. J Am Coll Radiol 2017; 15:34-43. [PMID: 29100884 DOI: 10.1016/j.jacr.2017.08.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Jason B Hobbs
- University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Noah Goldstein
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kimberly E Lind
- University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Deirdre Elder
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gerald D Dodd
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
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14
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Hill KD, Frush DP, Han BK, Abbott BG, Armstrong AK, DeKemp RA, Glatz AC, Greenberg SB, Herbert AS, Justino H, Mah D, Mahesh M, Rigsby CK, Slesnick TC, Strauss KJ, Trattner S, Viswanathan MN, Einstein AJ. Radiation Safety in Children With Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimization From the Image Gently Alliance. JACC Cardiovasc Imaging 2017; 10:797-818. [PMID: 28514670 PMCID: PMC5542588 DOI: 10.1016/j.jcmg.2017.04.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 02/07/2023]
Abstract
There is a need for consensus recommendations for ionizing radiation dose optimization during multimodality medical imaging in children with congenital and acquired heart disease (CAHD). These children often have complex diseases and may be exposed to a relatively high cumulative burden of ionizing radiation from medical imaging procedures, including cardiac computed tomography, nuclear cardiology studies, and fluoroscopically guided diagnostic and interventional catheterization and electrophysiology procedures. Although these imaging procedures are all essential to the care of children with CAHD and have contributed to meaningfully improved outcomes in these patients, exposure to ionizing radiation is associated with potential risks, including an increased lifetime attributable risk of cancer. The goal of these recommendations is to encourage informed imaging to achieve appropriate study quality at the lowest achievable dose. Other strategies to improve care include a patient-centered approach to imaging, emphasizing education and informed decision making and programmatic approaches to ensure appropriate dose monitoring. Looking ahead, there is a need for standardization of dose metrics across imaging modalities, so as to encourage comparative effectiveness studies across the spectrum of CAHD in children.
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Affiliation(s)
- Kevin D Hill
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina (Image Gently Alliance representative)
| | - Donald P Frush
- Department of Radiology, Duke University Medical Center, Durham, North Carolina (Image Gently Alliance and SPR representative)
| | - B Kelly Han
- Department of Pediatric Cardiology, Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota (SCCT representative)
| | - Brian G Abbott
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (ASNC representative)
| | - Aimee K Armstrong
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio (ACC representative)
| | - Robert A DeKemp
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (SNMMI representative)
| | - Andrew C Glatz
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (Image Gently Alliance representative)
| | - S Bruce Greenberg
- Department of Radiology, Arkansas Children's Hospital, Little Rock, Arkansas (NASCI representative)
| | - Alexander Sheldon Herbert
- Department of Radiology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York (ASRT representative)
| | - Henri Justino
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (SCAI representative)
| | - Douglas Mah
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts (PACES representative)
| | - Mahadevappa Mahesh
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland (AAPM representative)
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (ACR representative)
| | - Timothy C Slesnick
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia (AAP representative)
| | - Keith J Strauss
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Image Gently Alliance Representative)
| | - Sigal Trattner
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York (Image Gently Alliance representative)
| | - Mohan N Viswanathan
- Department of Internal Medicine, Stanford University, Stanford, California (HRS representative)
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York (Image Gently Alliance representative).
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15
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Bibbo G. Effective doses and standardised risk factors from paediatric diagnostic medical radiation exposures: Information for radiation risk communication. J Med Imaging Radiat Oncol 2017; 62:43-50. [DOI: 10.1111/1754-9485.12628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Giovanni Bibbo
- SA Medical Imaging; Women's and Children's Hospital; North Adelaide South Australia Australia
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16
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The Think A-Head campaign: an introduction to ImageGently 2.0. Pediatr Radiol 2016; 46:1774-1779. [PMID: 27812745 DOI: 10.1007/s00247-016-3739-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 12/13/2022]
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