The purpose of this study was to assess knowledge and attitudes about radiation from CT among emergency department patients with symptoms prompting CT who were stratified on the basis of demographic variables, pain, and perceived illness.
This survey study was based on three knowledge and three attitude questions asked of patients who underwent any CT examination from June 23 through July 31, 2008. Data were analyzed with chi-square for categoric data and the Student's t test or analysis of variance for continuous data.
The survey was completed by 383 patients (mean age, 48 ± 18 years; 60% women; 40% black; 52% white; 8% other race). In answering the three knowledge-based questions, 79% and 83% of patients correctly estimated their risk of cancer from chest radiography and CT, respectively, as none, small, or very small. Patients who were white, more educated, and had lower pain scores were more likely to be correct. Only 34% of all patients correctly thought that CT gave more radiation than chest radiography; the more educated patients were more likely to be correct. In answering the three attitude questions, 74% of patients believed having their condition diagnosed with CT was more important than worrying about radiation. Patients preferred a better test with more radiation, although 68% wanted their physician to take the time to discuss the risk and benefits rather than using their judgment to order the best test. Privately insured patients preferred to have their condition diagnosed with CT rather than worry about radiation. Blacks and patients with less pain wanted the risks and benefits explained at the expense of time. Whites preferred a more definitive test at the expense of more radiation.
Patients did not estimate the risk of development of cancer from their imaging examinations as high and were more concerned about having their condition diagnosed with CT than about the risk of future cancer. Knowledge and attitudes differed by age, race, education, insurance status, and pain level but not by sex, body mass index, or perceived seriousness of condition.
"Concerns that patients will refuse necessary examinations because of irrational fear of developing cancer have not been borne out in practice. In fact, patients may prefer to confirm their diagnosis with CT despite the radiation risks involved.96 Larson et al92 found that providing radiation-induced cancer risk information to parents of pediatric patients did not cause parents to refuse studies recommended by the referring physician. "
[Show abstract][Hide abstract] ABSTRACT: Medical imaging now accounts for most of the US population's exposure to ionizing radiation. A substantial proportion of this medical imaging is ordered in the emergency setting. We aim to provide a general overview of radiation dose from medical imaging with a focus on computed tomography, as well as a literature review of recent efforts to decrease unnecessary radiation exposure to patients in the emergency department setting.
We conducted a literature review through calendar year 2010 for all published articles pertaining to the emergency department and radiation exposure.
The benefits of imaging usually outweigh the risks of eventual radiation-induced cancer in most clinical scenarios encountered by emergency physicians. However, our literature review identified 3 specific clinical situations in the general adult population in which the lifetime risks of cancer may outweigh the benefits to the patient: rule out pulmonary embolism, flank pain, and recurrent abdominal pain in inflammatory bowel disease. For these specific clinical scenarios, a physician-patient discussion about such risks and benefits may be warranted.
Emergency physicians, now at the front line of patients' exposure to ionizing radiation, should have a general understanding of the magnitude of radiation dose from advanced medical imaging procedures and their associated risks. Future areas of research should include the development of protocols and guidelines that limit unnecessary patient radiation exposure.
The western journal of emergency medicine 05/2012; 13(2):202-10. DOI:10.5811/westjem.2011.11.6804
[Show abstract][Hide abstract] ABSTRACT: An increasing number of publications and international reports on computed tomography (CT) have addressed important issues on optimised imaging practice and patient dose. This is partially due to recent technological developments as well as to the striking rise in the number of CT scans being requested. CT imaging has extended its role to newer applications, such as cardiac CT, CT colonography, angiography and urology. The proportion of paediatric patients undergoing CT scans has also increased. The published scientific literature was reviewed to collect information regarding effective dose levels during the most common CT examinations in adults and paediatrics. Large dose variations were observed (up to 32-fold) with some individual sites exceeding the recommended dose reference levels, indicating a large potential to reduce dose. Current estimates on radiation-related cancer risks are alarming. CT doses account for about 70% of collective dose in the UK and are amongst the highest in diagnostic radiology, however the majority of physicians underestimate the risk, demonstrating a decreased level of awareness. Exposure parameters are not always adjusted appropriately to the clinical question or to patient size, especially for children. Dose reduction techniques, such as tube-current modulation, low-tube voltage protocols, prospective echocardiography-triggered coronary angiography and iterative reconstruction algorithms can substantially decrease doses. An overview of optimisation studies is provided. The justification principle is discussed along with tools that assist clinicians in the decision-making process. There is the potential to eliminate clinically non-indicated CT scans by replacing them with alternative examinations especially for children or patients receiving multiple CT scans.
European journal of radiology 06/2011; 81(4):e665-83. DOI:10.1016/j.ejrad.2011.05.025 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The role of computed tomography (CT) in acute illnesses has increased substantially in recent years; however, little is known about how CT use in the emergency department (ED) has changed over time.
A retrospective study was performed with the 1996 to 2007 National Hospital Ambulatory Medical Care Survey, a large nationwide survey of ED services. We assessed changes during this period in CT use during an ED visit, CT use for specific ED presenting complaints, and disposition after CT use. Main outcomes were presented as adjusted risk ratios (RRs).
Data from 368,680 patient visits during the 12-year period yielded results for an estimated 1.29 billion weighted ED encounters, among which an estimated 97.1 million (7.5%) patients received at least one CT. Overall, CT use during ED visits increased 330%, from 3.2% of encounters (95% confidence interval [CI] 2.9% to 3.6%) in 1996 to 13.9% (95% CI 12.8% to 14.9%) in 2007. Among the 20 most common complaints presenting to the ED, there was universal increase in CT use. Rates of growth were highest for abdominal pain (adjusted RR comparing 2007 to 1996=9.97; 95% CI 7.47 to 12.02), flank pain (adjusted RR 9.24; 95% CI 6.22 to 11.51), chest pain (adjusted RR 5.54; 95% CI 3.75 to 7.53), and shortness of breath (adjusted RR 5.28; 95% CI 2.76 to 8.34). In multivariable modeling, the likelihood of admission or transfer after a CT scan decreased over the years but has leveled off more recently (adjusted RR comparing admission or transfer after CT in 2007 to 1996=0.42; 95% CI 0.32 to 0.55).
CT use in the ED has increased significantly in recent years across a broad range of presenting complaints. The increase has been associated with a decline in admissions or transfers after CT use, although this effect has stabilized more recently.
Annals of emergency medicine 08/2011; 58(5):452-62.e3. DOI:10.1016/j.annemergmed.2011.05.020 · 4.68 Impact Factor
Note: This list is based on the publications in our database and might not be exhaustive.
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