Prevalence and correlates of patient-centred preparatory information provision to computed tomography and magnetic resonance imaging outpatients: A cross-sectional study

Exploring Patient Preferences for Information About CT Radiation Exposure: Bridging the Gap Between Patient Preference and Physician Practice

Background

CT scan utilizes ionizing radiation poses a danger to the patient's health. Thus, telling the patient about ionizing radiation would be critical in promoting shared decision-making and improving patient-doctor communication. However, few studies have examined this topic broadly.

Objective

The study was conducted to identify the frequency of physicians informing patients about the radiation risk before ordering a CT scan, as well as to examine the association between patients' demographic characteristics and their awareness of the radiation risks associated with CT scans.

Methods

A cross-sectional study was conducted among 387 patients who had undergone CT scans at a tertiary hospital in Riyadh, Saudi Arabia. Data were collected via phone interviews using a structured questionnaire. Chi-squared tests were employed to assess associations between patients' demographic characteristics and their awareness of CT scan radiation risks.

Results

When examining knowledge, 58% of patients knew that CT involves harmful radiation. This knowledge was significantly associated with higher education level and previous experience with CT scans. Regarding doctors' practice of providing information to patients about the scan, 344 (88.9%) patients indicated that their doctor had explained to them why they needed the scan. Only 28 (7.2%) patients stated that their doctor had mentioned the amount of radiation, and 74 (19.1%) patients indicated that doctors mentioned the risks associated with the radiation of the scan. Almost all patients (96.9%) preferred to be told about why they needed a CT scan.

Conclusion

The vast majority of patients who underwent CT scans did not receive enough information about the harm of the scans. However, most of them preferred to know about this harm.

Patient satisfaction with ultrasound, whole-body CT and whole-body diffusion-weighted MRI for pre-operative ovarian cancer staging: a multicenter prospective cross-sectional survey

BACKGROUND

In addition to the diagnostic accuracy of imaging methods, patient-reported satisfaction with imaging methods is important.

OBJECTIVE

To report a secondary outcome of the prospective international multicenter Imaging Study in Advanced ovArian Cancer (ISAAC Study), detailing patients' experience with abdomino-pelvic ultrasound, whole-body contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) for pre-operative ovarian cancer work-up.

METHODS

In total, 144 patients with suspected ovarian cancer at four institutions in two countries (Italy, Czech Republic) underwent ultrasound, CT, and WB-DWI/MRI for pre-operative work-up between January 2020 and November 2022. After having undergone all three examinations, the patients filled in a questionnaire evaluating their overall experience and experience in five domains: preparation before the examination, duration of examination, noise during the procedure, radiation load of CT, and surrounding space. Pain perception, examination-related patient-perceived unexpected, unpleasant, or dangerous events ('adverse events'), and preferred method were also noted.

RESULTS

Ultrasound was the preferred method by 49% (70/144) of responders, followed by CT (38%, 55/144), and WB-DWI/MRI (13%, 19/144) (p<0.001). The poorest experience in all domains was reported for WB-DWI/MRI, which was also associated with the largest number of patients who reported adverse events (eg, dyspnea). Patients reported higher levels of pain during the ultrasound examination than during CT and WB-DWI/MRI (p<0.001): 78% (112/144) reported no pain or mild pain, 19% (27/144) moderate pain, and 3% (5/144) reported severe pain (pain score >7 of 10) during the ultrasound examination. We did not identify any factors related to patients' preferred method.

CONCLUSION

Ultrasound was the imaging method preferred by most patients despite being associated with more pain during the examination in comparison with CT and WB-DWI/MRI.

TRIAL REGISTRATION NUMBER

NCT03808792.

Five-minute knee MRI: An AI-based super resolution reconstruction approach for compressed sensing. A validation study on healthy volunteers

PURPOSE

To investigate the potential of combining Compressed Sensing (CS) and a newly developed AI-based super resolution reconstruction prototype consisting of a series of convolutional neural networks (CNN) for a complete five-minute 2D knee MRI protocol.

METHODS

In this prospective study, 20 volunteers were examined using a 3T-MRI-scanner (Ingenia Elition X, Philips). Similar to clinical practice, the protocol consists of a fat-saturated 2D-proton-density-sequence in coronal, sagittal and transversal orientation as well as a sagittal T1-weighted sequence. The sequences were acquired with two different resolutions (standard and low resolution) and the raw data reconstructed with two different reconstruction algorithms: a conventional Compressed SENSE (CS) and a new CNN-based algorithm for denoising and subsequently to interpolate and therewith increase the sharpness of the image (CS-SuperRes). Subjective image quality was evaluated by two blinded radiologists reviewing 8 criteria on a 5-point Likert scale and signal-to-noise ratio calculated as an objective parameter.

RESULTS

The protocol reconstructed with CS-SuperRes received higher ratings than the time-equivalent CS reconstructions, statistically significant especially for low resolution acquisitions (e.g., overall image impression: 4.3 ± 0.4 vs. 3.4 ± 0.4, p < 0.05). CS-SuperRes reconstructions for the low resolution acquisition were comparable to traditional CS reconstructions with standard resolution for all parameters, achieving a scan time reduction from 11:01 min to 4:46 min (57 %) for the complete protocol (e.g. overall image impression: 4.3 ± 0.4 vs. 4.0 ± 0.5, p < 0.05).

CONCLUSION

The newly-developed AI-based reconstruction algorithm CS-SuperRes allows to reduce scan time by 57% while maintaining unchanged image quality compared to the conventional CS reconstruction.

Effects of a 360° virtual counselling environment on patient anxiety and CCTA process time: A randomised controlled trial

INTRODUCTION

This study investigated whether a 360° virtual counselling environment (360°VCE) was more effective at decreasing patients' anxiety than routine standard of care counselling for patients undergoing coronary computed tomography angiography (CCTA), and if there was any difference in the process times for both of these groups.

METHODS

A total of 86 patients underwent CCTA in this randomised controlled trial. Patients were randomly assigned to intervention and control groups. The 360°VCE was developed using spherical panoramic images and non-immersive 360° technology. The primary outcome, anxiety, was measured using the State-Trait Anxiety Inventory (STAI). The secondary outcome, CCTA process time, was measured from the time of arrival in the department until end of examination.

RESULTS

Pre-scan anxiety was lower among patients in the 360°VCE group immediately before CCTA in comparison to patients in the control group (p = 0.015). Women demonstrated higher levels of anxiety than men in both groups. No between-group differences were discerned in CCTA process time.

CONCLUSION

Access to 360°VCE can reduce patients' pre-CCTA anxiety levels.

IMPLICATIONS FOR PRACTICE

The presented results can be used to improve patient counselling and care, reduce anxiety among patients undergoing CCTA, and optimise the CCTA examination procedure.

Understanding Magnetic Resonance Imaging in Multiple Sclerosis (UMIMS): Development and Piloting of an Online Education Program About Magnetic Resonance Imaging for People With Multiple Sclerosis

Background

People with multiple sclerosis (pwMS) lack sufficient magnetic resonance imaging (MRI) knowledge to truly participate in frequently occurring MRI-related therapy decisions. An evidence-based patient information (EBPI) about MRI is currently lacking.

Objective

The aim of this study was to develop an evidence-based online education program about limitations and benefits of MRI for pwMS. Ultimately, our goal was to improve MRI risk-knowledge, empower pwMS, and promote shared decision-making.

Methods

The program's contents were based on literature research and a previous pilot study. It was revised following 2 evaluation rounds with pwMS, MRI experts and expert patients. In a pilot study, n = 92 pwMS received access to the program for 4 weeks. User experiences and acceptance, MRI knowledge (MRI-RIKNO 2.0 questionnaire) and emotions and attitudes toward MRI (MRI-EMA questionnaire) were assessed. Results were compared to a previous survey population of n = 508 pwMS without access to the program.

Results

Participants rated the program as easy to understand, interesting, relevant, recommendable, and encouraging. In comparison to pwMS without access to the program, MRI risk-knowledge and perceived MRI competence were higher.

Conclusion

Satisfaction with the program and good MRI-risk knowledge after usage demonstrates the need and applicability of EBPI about MRI in MS.

Patients', radiographers' and radiography students' experiences of 360° virtual counselling environment for the coronary computed tomography angiography: A qualitative study

INTRODUCTION

The aim of this study was to describe patients', radiographers' and radiography students' experiences of the developed 360° virtual counselling environment (360°VCE) for the coronary computed tomography angiography (cCTA).

METHODS

A descriptive qualitative approach was used. The participants were cCTA patients (n = 10), radiographers (n = 10) and radiography students (n = 10) who used the 360°VCE and visited or worked at a university hospital in Finland. The 360°VCE, resembling the authentic environments of a CT imaging unit, included digital counselling materials in text, image, animation and video formats. Data were gathered through thematic interviews individually to obtain an understanding of participants' perspectives and analyzed by inductive content analysis.

RESULTS

Five main categories and 15 categories were identified. Identified benefits of the 360°VCE for patients included improvements in knowledge, spatial and environmental orientation, and senses of security and self-efficacy, with reductions in fear and nervousness. Patients found the counselling materials engaging, and that the 360° technology conveniently provided reassuring familiarity with the environment before their visit. Identified benefits for radiographers and radiography students included improvements in patients' mental preparedness, knowledge, spatial and environmental orientation, and reductions in patients' fear, which eased procedures and enhanced diagnostic success. The 360°VCE also provided useful information and familiarization with the cCTA unit for students during clinical practice and staff of referring units.  CONCLUSION: It seems that patients', radiographers' and radiography students' experiences of 360°VCE respond to patients' needs by improved knowledge and reduced fears. Thus, current counselling practices can be usefully complemented with spherical panoramic imaging technology and online information delivery.

IMPLICATIONS FOR PRACTICE

The results may be used to improve patient counselling and care, thereby optimizing the cCTA examination procedure and reducing fear. However, further research is needed to characterize experiences of the 360° VCE more comprehensively.

Patient preferences for development in MRI scanner design: a survey of claustrophobic patients in a randomized study

OBJECTIVE

To investigate which magnetic resonance imaging (MRI) scanner designs claustrophobic patients prefer.

MATERIAL/METHODS

We analyzed questionnaires completed by 160 patients at high risk for claustrophobia directly after a scan in either a short-bore or open panoramic scanner as part of a prospective randomized trial Enders et al (BMC Med Imaging 11:4, 2011). Scanner preferences were judged based on schematic drawings of four scanners. Information on the diagnostic performance of the depicted scanners was provided, too.

RESULTS

A majority of patients suggested upright open (59/160, 36.9%) and open panoramic (53/160, 33.1%) before short-bore designs (26/160, 16.3%, for all p < 0.001) for future development. When asked about patients' preferred scanner choice for an upcoming examination, information about a better diagnostic performance of a short-bore scanner significantly improved its preference rates (from 6/160 to 49/160 or 3.8 to 30.5%, p < 0.001). Patients with a claustrophobic event preferred open designs significantly more often than patients without a claustrophobic event (p = 0.047). Patients scanned in a short-bore scanner in our trial preferred this design significantly more often (p = 0.003). Noise reduction (51/160, 31.9%), more space over the head (44/160, 27.5%), and overall more space (33/160, 20.6%) were the commonest suggested areas of improvement.

CONCLUSION

Patients at high risk for claustrophobia visually prefer open- over short-bore MRI designs for further development. Education about a better diagnostic performance of a visually less-attractive scanner can increase its acceptance. Noise and space were of most concern for claustrophobic patients. This information can guide individual referral of claustrophobic patients to scanners and future scanner development.

KEY POINTS

• Patients at high risk for claustrophobia visually favor the further development of open scanners as opposed to short- and closed-bore scanner designs. • Educating claustrophobic patients about a higher diagnostic performance of a short-bore scanner can significantly increase their acceptance of this otherwise visually less-attractive design. • A medical history of earlier claustrophobic events in a given MRI scanner type and focusing on the features "more space" and "noise reduction" can help to guide referral of patients who are at high risk for claustrophobia.

Electronic Health Literacy Among Magnetic Resonance Imaging and Computed Tomography Medical Imaging Outpatients: Cluster Analysis

Background

Variations in an individual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points.

Objective

The aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership.

Methods

Medical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership.

Results

Of the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007).

Conclusions

The identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals’ internet use frequency and health information amount preferences.