Article

Parental knowledge and attitudes towards dental radiography for children

School of Dentistry, The University of Western Australia, Perth.
Australian Dental Journal (Impact Factor: 1.1). 06/2013; 58(2):163-169. DOI: 10.1111/adj.12041
Source: PubMed

ABSTRACT

Background:
Radiographs are an essential part of most clinical dental examinations and diagnoses. The aim of the study was to assess the knowledge and attitudes of parents towards dental radiographs for their children.

Methods:
A 21-item questionnaire, covering parental level of radiation knowledge and socio-demographics was applied. Sliding scales were used to assess attitude towards dental radiographs.

Results:
There were 1467 questionnaires distributed between five primary schools in the Perth (Western Australia) metropolitan area, with 309 surveys (21%) returned for collection. Most parents displayed a low level of knowledge, but had a positive attitude towards dental radiographs. Parents with children who have previously had dental radiographs perceived dental radiographs as 'good', 'useful' and 'pleasant'. A higher level of education and parents with children who have previously had radiographs were significantly associated with a higher level of knowledge about dental radiography. Parents who had higher scores on questions assessing radiation knowledge were more likely to perceive dental radiographs as 'safe' and 'beneficial'.

Conclusions:
Most parents have a positive attitude towards dental radiographs on their children. However, the majority of parents lack knowledge regarding dental radiography, especially regarding the risks involved.

Full-text

Available from: Paul Vincent Abbott
Parental knowledge and attitudes towards dental
radiography for children
R Chiri,* S Awan,* S Archibald,* PV Abbott*
*School of Dentistry, The University of Western Australia, Perth.
ABSTRACT
Background: Radiographs are an essential part of most clinical dental examinations and diagnoses. The aim of the study
was to assess the knowledge and attitudes of parents towards dental radiographs for their children.
Methods: A 21-item questionnaire, covering parental level of radiation knowledge and socio-demographics was applied.
Sliding scales were used to assess attitude towards dental radiographs.
Results: There were 1467 questionnaires distributed between five primary schools in the Perth (Western Australia) metro-
politan area, with 309 surveys (21%) returned for collection. Most parents displayed a low level of knowledge, but had
a positive attitude towards dental radiographs. Parents with children who have previously had dental radiographs
perceived dental radiographs as ‘good’, ‘useful’ and ‘pleasant’. A higher level of education and parents with children
who have previously had radiographs were significantly associated with a higher level of knowledge about dental radiog-
raphy. Parents who had higher scores on questions assessing radiation knowledge were more likely to perceive dental
radiographs as ‘safe’ and ‘beneficial’.
Conclusions: Most parents have a positive attitude towards dental radiographs on their children. However, the majority
of parents lack knowledge regarding dental radiography, especially regarding the risks involved.
Keywords: Attitude, education, dental, knowledge, radiography.
Abbreviations and acronyms: ICRP = International Commission on Radiological Protection.
(Accepted for publication 1 August 2012.)
INTRODUCTION
Dental radiographs play an important role in the
detection and management of oral diseases.
1,2
While
radiation exposure in the dental setting is relatively
low, it is one of the most frequently undertaken radio-
graphic procedures, and is often repeated several times
during childhood and adolescence.
3
In today’s medico-legal minefield, informed consent
to undertake radiographs is an often overlooked issue
in dental treatment. It is unknown whether clinicians
are providing information about radiation safety a nd
if this information is understood and retained by the
public. When visiting the dentist, parents entrust the
dentist with the care of their children and therefore
they have the right to understand the often complex
risks and benefits of a procedure, including the taking
of radiographs.
Radiographs often add critical information to the
clinical examination,
4
revealing developmental and
eruption problems
4,5
in addition to caries, pulp and
periapical pathoses.
6
Radiographic guidelines exist to
avoid unnecessary exposure, as well as to identify
individuals for whom radiographic examination will
be beneficial.
2,4
However, the 2007 International
Commission on Radiological Protection (ICRP) guide-
lines suggest that the cancer risk associated with den-
tal radiography is 32% to 42% higher than
previously estimated in the 1990 ICRP guidelines.
6,7
In particular, several studies have alluded to an
increased risk of thyroid cancer, meningioma and sali-
vary tumours.
811
Furthermore, the cumulative nature
of radiation exposure over a patient’s lifetime and
increased radio-sensitivity of children
6
increases the
importance of explaining radiation risks to parents.
While several studies have either examined physi-
cians’ and other allied health professionals’ knowledge
and attitudes on radiation risks
12,13
or patients’
perception of CT and SPECT imaging,
1315
there is no
information in the literature regarding the knowledge
and attitude that parents have regarding dental radi-
ography for their children. It is thus unknown
whether radiation fears are exaggerated, or whether
parents recognize and accept the associated risks.
© 2013 Australian Dental Association 163
Australian Dental Journal 2013; 58: 163169
doi: 10.1111/adj.12041
Australian Dental Journal
The official journal of the Australian Dental Association
Page 1
The purpose of this study was to assess the know-
ledge and attitudes of parents towards dental radio-
graphs for children and other associated factors.
MATERIALS AND METHODS
Ethical approval of the project was granted by the
Human Research Ethics Committee of The University
of Western Aust ralia.
Study population
The research project was a cross-sectional design
and involved the development of a questionnaire.
Eight primary schools in the Perth metropolitan area
were approached and five were willing to participate
on a voluntary basis. The schools were chosen
based on convenience. A total of 1467 question-
naires were distributed to parents with the regular
school newsletters. Parents were asked to return the
completed questionnaires to the school for collection
by members of the research team. Questionnaires
were sent with a cover letter outlining the aims of
the project and explaining that participati on was
voluntary. A return of the questionnaire indicated
consent and all questionnaires were anonymous.
After collection of responses, an information bro-
chure was designed and distributed to the parents
highlighting the risks and benefits of dental radio-
graphs.
Questionnaire
The testing instrument was a 21-item questionnaire,
which assessed the parental level of knowledge and
attitude of dental radiography for children. Questions
were designed to elicit information about the depen-
dent variables (know ledge and attitude) and a series of
independent variables, as follows: (1) postcode; (2)
level of parental education; (3) regularity of the par-
ents’ and child’s dental visits; (4) whether the parent
accompanies the child to the dentist; (5) whether the
child attends the school dental service, private dentist or
both; (6) whether the child has previously had radio-
graphs taken; and (7) parental education by the dentist
regarding risks of and reasons for requiring dental
radiographs.
Measuring attitude
Attitude was measured using Ajzen’s theory of
planned behavi our,
16
where a series of sliding scales
with bipolar adjectives were used. Markings along the
sliding scal es were measured, then subsequently
categorized into three equal groups, namely agree, dis-
agree and undecided.
The sliding scales used were: (1) valuableworthless
(measuring parents’ perception of usefulness); (2)
harmfulbeneficial (measuring parents’ perception of
safety); (3) pleasantunpleasant; and (4) badgood.
An additional question of ‘do you believe the benefits
from dental radiographs outweigh the risks’ was also
included.
The adjectives chosen cover the two separable com-
ponents that Ajzen discusses as being required to
accurately measure attitude. The first component is
instrumental in nature representing adjectives such as
valuableworthless and harmfulbeneficial. The sec-
ond component is experiential in nature and was
reflected in the pleasantunpleasant scale. The bad
good scale was also included as this tends to capture
the overall attitude well.
17
Measuring level of radiation knowledge
Knowledge was measured by assessing whether
respondents answered a series of statements correctly,
incorrectly or did not know. The statements were: (1)
the exposure from a dental X-ray is too small to put
my child at any significant risk or harm; (2) children
are at a higher risk of harm from X-rays than adults;
(3) exposure to radiation from the environment (e.g.
the sun) is higher than radiation from dental X-rays;
(4) exposure to radiation for other medical purposes
(e.g. chest X-ray) is higher than radiation from dental
X-rays; and (5) children wearing a lead apron when
dental X-rays are being taken will be totally protected
against possible radiation damage.
The ‘I do not know’ option was included to allow
participants to acknowledge that they were lacking
information and to prevent guessing of answers. An
overall radiation knowledge score was produced by
summing the total number of correct answers.
Statistical methods
Questionnaire responses were analysed using the Sta-
tistical Package for Social Sciences (SPSS) 15.0
(Chicago, IL, USA). The relationship between the
dependant variables (knowledge and attitude) and the
independent variables was calculated with cross tabs
and the Pearson’s chi-squared test. Postcodes were
used to estimate the socioeconomic status of respon-
dents by using the Australian Bureau of Statistics
Index of Relative Socioeconomic Advantage and
Disadvantage.
18
RESULTS
A total of 309 of the 1467 surveys (21%) were
returned during the collection period. Of the 309 par-
ticipants, 70 failed to complete all survey items. Given
164 © 2013 Australian Dental Association
R Chiri et al.
Page 2
the independent nature of the questions, analysis on
the remainder of the responses was still possible.
Demographics
The highest level of education of the participants was
a bachelor degree (34%), followed by TAFE/appren-
ticeship (27%). The percentage of children attending
the dentist 12 times per year was 97% and only 6%
of parents did not accompany their child/ren to the
dental appointment. Most children attended the
School Dental Service (SDS) (42%) or a private den-
tist (36%) and the remainder attended both. There
were 61% of parents who stated that their children
had received radiographs before. Table 1 summarizes
the demographic data.
Socioeconomic status
Postcodes were used to gauge the socioeconomic sta-
tus of the respondents. Over 90% of respondents
were from higher socioeconomic backgrounds, fal ling
among the top four deciles of the Index of Relative
Socioeconomic Advantage and Disadvantage.
18
This
made analysis unreliable and hence the influence of
socioeconomic status was not further investigated.
Attitude
Several elements of attitude were measured, namely
the perception of how good, pleasant, useful and safe
radiographs are. Responses recorded an overall posi-
tive opinion of dental radiographs with over 90% of
respondents agreeing that radiographs are ‘useful’ and
over half the parents perceiving dental radiographs as
‘good’ and ‘safe’ (Fig. 1).
Radiation knowledge
The majority of respondents (44%) answered ‘I do
not know’ to knowledge based questions and 41%
responded correctly. Only a small proportion of
respondents (15%) answered incorrectly. The majority
of respondents were aware that exposure from a den-
tal radiograph was too small to put their child/ren at
any significant harm (58.6%), whereas most were not
aware that radiation exposure from the environment
is higher than radiation from dental radiographs
(75.6%) (Fig. 2).
Parental education by dentist regarding risks and
importance of dental radiographs
Of those respond ents where parents accompanied
their child and radiographs had been taken, 63.6%
felt that the risks of dental radiographs were not
explained to them, but 90.3% said that the dentist
explained the reasons for taking dental radiographs.
Associations
Parents with children who have had previous dental
radiographs were more likely to perce ive dental radio-
graphs as ‘useful’ (p = 0.026), ‘pleasant’ (p = 0.003)
and ‘good’ (p = 0.001). Parents with children who
visited the dentist regularly (every six months) were
also more likely to perceive that the benefits out-
weighed the risks (p = 0.025) (Table 2).
A higher level of parental radiographic knowledge
was associated with a higher level of formal education
and having children who have had previous dental
radiographs (p = 0.000, p = 0.028) (Table 3).
Parents with high levels of knowledge about radio-
graphs stated that they thought dental radiographs
were safe (p = 0.011) and beneficial (p = 0.000). Con-
versely, parents who answered the knowledge-based
questions incorrectly perceived radiographs as being
‘harmful’ (p = 0.002), ‘useless’ (p = 0.02) and ‘bad’
(p = 0.002) (Table 4). Interestingly, parents who
admitted to lacking knowledge about radiographs (i.e.
answered ‘don’t know’) perceived them as safe (p =
0.003) and beneficial (p = 0.000) (Table 4).
Table 1. Demographic data
Highest level of education Regularity of dental visits Type of dentist Accompany
child/ren to
dentist
Child/ren have
had radiographs
before
Parent Child/ren
n% n%n% n% n% n%
Primary school 6 2.0 Every 6 months 101 33.0 126 41.4 SDS 128 42.0 Yes 288 93.8 Yes 186 60.6
High school 48 15.6 Once a year 113 36.9 170 55.9 Private
dentist
109 35.7 No 19 6.2 No 121 39.4
TAFE, vocational
training or
apprenticeship
83 27.0 2 yearly or < 92 30.1 8 2.6 Both 68 22.3
Bachelor degree 103 33.6
Postgraduate
degree
67 21.8
© 2013 Australian Dental Association 165
Knowledge and attitudes towards dental radiography
Page 3
Having the risks and reasons for dental radiographs
explained by the dentist positively influenced knowl-
edge (p = 0.005, p = 0.005), and encouraged parents
to view radiographs as beneficial (p = 0.007, p =
0.000). In addition, an explanation of the reasons for
dental radiographs was also statistically associated
0%
Safe Useful Pleasant Good
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
16.5
29.5
54
90.2
5.9
3.9
13.9
50.3
35.8
66.7
28
5.3
Disagree
Undecided
Agree
I believe dental X-rays on my child/ren are:
Fig. 1 Attitudes of parents towards dental radiographs on their child/ren.
0%
Medical radiaƟon
exposure (e.g. chest X-ray)
is higher than radiaƟon
from dental X-rays
A lead apron will totally
protect children against
possible radiaƟon damage
Exposure from a dental
X-ray is too small to put
my child at any signicant
harm
Children are at a higher
risk of harm from X-rays
than adults
Environment radiaƟon
exposure (e.g. the sun) is
higher than radiaƟon from
dental X-rays
10%
39.4
48.9
11.7
20%
30%
40%
50%
60%
70%
80%
90%
100%
39.9
41.9
18.2
10.4
30.9
58.6
41.5
44.4
14.1
24.4
52.1
Answered
incorrectly
Answered
correctly
Didn’t know
23.5
Fig. 2 Responses to questions assessing radiation knowledge.
Table 2. Association between each component of attitude and associated factors using the Pe arsons chi-squared
test
Level of parental education Regularity of dental
visits
Accompany child/ren
to dentist
Type of dentist
(sds or pvt)
Child/ren have
had X-rays before
Parent Child
Safe 0.534 0.256 0.127 0.379 0.882 0.332
Useful 0.118 0.379 0.113 0.52 0.378 0.026*
Pleasant 0.861 0.781 0.961 0.092 0.993 0.003*
Good 0.073 0.314 0.437 0.531 0.308 0.001*
Benefits 0.376 0.289 0.025* 0.239 0.578 0.07
*p 0.05 indicates signicance.
166 © 2013 Australian Dental Association
R Chiri et al.
Page 4
with the perception of radiographs as ‘useful’
(p = 0.004) and ‘good’ (p = 0.001) (Table 5).
Regularity of dental visits by the parent, type of
dental service, and whether parent accompanied their
child/ren during the dental visit were found to have
no significant associations with attitude or knowledge
(Tables 23).
DISCUSSION
A key insight gained from this study is that while
knowledge about dental radiographs is low, parents
have a positive attitude towards radiographs. This
suggests that attitude is not primarily derived from
knowledge. Attitudes develop over time and are orga-
nized around three main types of beliefs:
19
(1) descrip-
tive beliefs these are based on direct experiences and
are of most value; (2) infe rential beliefs beliefs based
on an inference process, whereby a belief is inferred
from other beliefs; (3) infor mational beliefs these are
based on information derived from an outside
source.
19
This study found that descriptive belief s, based on
parents’ experiences with radiographs taken for their
children, may have shaped parental attitudes. Fishbein
and Ajzen found that the more positive a person’s
experience is, the more positive beliefs he or she will
hold.
19
Furthermore, as a person forms a belief
around something, an attitude is simultaneously
formed.
19
This study indicated that parents who participated
in the survey have had positive experiences when
radiographs have been taken, and these previous expe-
riences have impacted on the parental attitudes. For
example, parents with children who have had previ-
ous dental radiographs and parents who have the per-
ception that radiographs are ‘good’ and ‘useful’ were
significantly associated with each other. However, this
raises the question of how else does the dentist impact
on parental attitudes? One can infer that the discus-
sion the dentist has with the parents may have influ-
enced their attitude. This is supported by the results,
whereby parents who believed the importance of den-
tal radiographs were explained to them were signifi-
cantly associated with the perception that radiographs
were ‘useful’ and ‘good’ (p = 0.004, p = 0.001), and
they believed the benefits of the radiographs outweigh
the risks (p = 0.000). This implies that the dentist had
a large role to play in shaping parental attitudes.
While the majority of parents had the importance
of dental radiographs explained to them (90.3%), sig-
nificantly fewer parents reported that they had been
informed of the radiation risks (39.7%). This finding
is consistent with other studies, as both Ludwi g and
Table 3. Association between knowledge and associated factors using the Pearsons chi-squared test
Level of parental
education
Regularity of
dental visits
Accompany child/ren
to dentist
Type of dentist
(school dental service
or private)
Child/ren have
had X-rays before
Parent Child
Correct 0.000* 0.178 0.097 0.74 0.368 0.028*
Not correct 0.073 0.855 0.185 0.804 0.067 0.307
Don’t know 0.000* 0.204 0.151 0.605 0.515 0.205
*p 0.05 indicates signicance.
Table 4. Associations between knowledge and each
component of attitude using the Pearsons chi-squared
test
Safe Useful Pleasant Good Benefits
Correct 0.011* 0.406 0.446 0.22 0.000*
Not correct 0.002* 0.02* 0.772 0.002* 0.335
Don’t know 0.003* 0.444 0.739 0.786 0.000*
*p 0.05 indicates signicance.
Table 5. Association between knowledge and attitude with whether the dentist explains the risks and importance
(using the Pearsons chi-squared test)
Attitude Knowledge
Safe Useful Pleasant Good Benefits Correct Not correct Don’t know
Dentist explains the risks of dental
radiographs for children
0.32 0.104 0.104 0.16 0.007* 0.005* 0.213 0.000*
Dentist explains the importance of
dental radiographs for children
0.236 0.004* 0.48 0.001* 0.000* 0.005* 0.667 0.002*
*p 0.05 indicates signicance.
© 2013 Australian Dental Association 167
Knowledge and attitudes towards dental radiography
Page 5
Turner
13
and Lee et al.
20
reported that most people
are uninformed about the hazards of radiation before
medical imaging. This may be due to either the lack
of an explanation or poor information retention and
it does not explicitly imply that the information on
radiography was not being provided. Reassuringly
however, parents who believed the risks were
explained to them also agreed that the benefits of the
radiographs outweig h the risks (p = 0.007).
There are several methods to eff ectively communi-
cate radiation risk and address parents’ concerns. One
such method is to compare radiation exposure from
radiographic procedures with the background equiva-
lent rad iation time.
21
Given that natural background
radiation in Australia is 2 mSv annually, routine non-
digital bitewing radiographs give an effective dose of
0.002 mSv which is equivalent to 8.8 hours of radia-
tion exposure from nature.
22,23
Other approaches
include comparison with typical doses from air travel,
doses from other medical imaging procedures such as
a chest radiograph or by comparison with safety levels
prescribed for occupational exposures.
24
The above methods provide a comparison only and
they do not reflect radiation risk per se. However,
these risks are theoretic; epidemiological research has
been unable to establish that there are effects of statis-
tical significance at doses below a few tens of millisie-
verts.
23
Dentists need to assure patients that they are
committed to obtaining excellent clinical results with
the lowest possible radiation risk, and that the poten-
tial benefits of modern medical imaging procedur es
almost always far outweigh the associated risks.
With regards to parental knowledge of radiography,
many parents were uns ure of the answers (44%), with
a much lower percentage of respondents answering
questions incorrectly (16%). This suggests a lack of
provision of information rather than misinformation
about dental radiography. Ludwig and Turner found
similar findings and they concluded that while the
public understand the harmful effects from the sun,
knowledge on the effects of radiation from medical
testing is very limited.
20
Baumann et al.
14
and Larson
et al.
25
also found that with regards to CT scans,
knowledge of radiation exposure and risks was
poor.
14,25
Over half of the respondents (58.6%) knew that
‘exposure from a dental X-ray is too small to put their
child at any significant harm’. This is closely compara-
ble to Ludwig and Turner’s findings that 63% of
responders seldom or never worried about radiation
exposure when having imaging procedures,
20
and
Busey’s et al. findings whereby 98% of respondents
were not worried about the radiation from a CT scan.
15
The limitations of this study were primarily con-
cerned with the population sampling method and the
low response rate. As the schools were chosen for
convenience from the Perth metropolitan area, the
sample is not an accurate representation of the general
population. A reasonable proportion of the Western
Australian population reside in rural and remote
areas
26
and this population was not sampled. There
was also a skewed distribution of socioeconomic sta-
tus within the study due to the sampling method and
this made correlation of this variable unreliable. Fur-
thermore, over half the respondents were university
educated and approximately 60% had experience of
dental radiographs. This skewed demographic may
have affected the results and therefore the relatively
positive attitudes towards dental radiographs found in
this population may not extend to the general popula-
tion. The low response rate may have been improved
if direct communication was made with the parents
(e.g. an anno uncement made at an assembly) and fol-
low-up reminders had been placed in newsletters. It is
unknown how many children were giving their par-
ents the newsletter or how many parents read the
school newsletter.
Furthermore, it would be useful for further research
to investigate parents’ sources of knowledge, or what
parents believe the risks are as these were not investi-
gated in this study. It is also unknown whether par-
ents are aware of the varying radiation exposure from
different types of images.
In conclusion, most parents had a positive attitude
towards dental radiographs although they had limited
knowledge about radiography. This study emphasizes
the importance of providing accurate and appropriate
information so patients and parents have a better
knowledge and understanding of dental radiographs.
It is imperative for den tal health professionals to
understand their role in shaping positive attitudes
towards dental radiographs.
ACKNOWLEDGEMENTS
The authors acknowledge Drs Alana Ang, Anabel
Chan, Damini Chawla, Khaled Chiri and Millicent
Taylor for their input in fabricating the questionnaire
and collecting the data, and Dr Lara Andrews for her
contribution towards the introduction. We would also
like to acknowledge Dr Bernard Koong and Dr Peter
Readman for their valuable contributions towards
reviewing the appropriateness of the questionnaire,
and the Perth metropolitan primary schools that par-
ticipated in this study on a voluntary basis.
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Address for correspondence:
Winthrop Professor Paul Abbott
School of Dentistry
The University of Western Australia
17 Monash Ave nue
Nedlands WA 6009
Email: paul.v.abbott@uwa.edu.au
© 2013 Australian Dental Association 169
Knowledge and attitudes towards dental radiography
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    [Show abstract] [Hide abstract] ABSTRACT: Dental patients are often aware that radiation has the potential to harm them but they do not usually understand how or why and what potential harmful effects may arise from dental radiographs. The potential for undesirable effects must be balanced against the benefits obtained from radiographs. Dentists should address the concerns of patients who question the need for radiographs and allow them to make an informed decision. Data are available that relate radiation exposure levels from medical and dental radiographs to normal background exposure levels and allow comparisons with everyday risks in life. Recognized radiation authorities publish guidelines to help dentists with their use of radiographs, although, due to the time lag associated with testing and the publication of results, some of the published data may not always be entirely relevant to currently used X-ray machines and techniques. Dentists also have professional obligations not only to limit the use of radiographs to potentially beneficial situations but also to take good quality diagnostic radiographs, to limit the doses used, to use good radiation safety measures and to use modern equipment to achieve the best possible films. Radiographs must then be properly developed and viewed under appropriate conditions to gain the maximum possible diagnostic information from each exposure.
    Full-text · Article · Aug 2000 · Australian Dental Journal
  • [Show abstract] [Hide abstract] ABSTRACT: Patients perceptions of risk for harm influence their decisions concerning medical procedures and feelings of satisfaction with medical care choices. Radiologic technologists, dental hygienists, and other allied health professionals frequently are asked by patients to explain the radiation exposure dose and health risk associated with an imaging procedure. The purpose of this study was to evaluate the radiation risk perceptions within the community to develop an effective patient education strategy for health professionals based on the responses of 200 participants in a cross-sectional survey. Less than half of the adults responding to the survey agreed with experts regarding the risk of radiation exposure from various sources, and 75% to 90% of the responders thought that imaging providers should be highly educated and highly regulated. With efficacious patient education, appropriate risk comparisons can be made in simple terminology by addressing the public's knowledge, beliefs, and attitudes toward sources of radiation exposure.
    No preview · Article · Feb 2002 · Journal of allied health
  • [Show abstract] [Hide abstract] ABSTRACT: To determine the awareness level concerning radiation dose and possible risks associated with computed tomographic (CT) scans among patients, emergency department (ED) physicians, and radiologists. Adult patients seen in the ED of a U.S. academic medical center during a 2-week period with mild to moderate abdominopelvic or flank pain and who underwent CT were surveyed after acquisition of the CT scan. Patients were asked whether or not they were informed about the risks, benefits, and radiation dose of the CT scan and if they believed that the scan increased their lifetime cancer risk. Patients were also asked to estimate the radiation dose for the CT scan compared with that for one chest radiograph. ED physicians who requested CT scans and radiologists who reviewed the CT scans were surveyed with similar questions and an additional question regarding the number of years in practice. The chi(2) test of independence was used to compare the three respondent groups regarding perceived increased cancer risk from one abdominopelvic CT scan. Seven percent (five of 76) of patients reported that they were told about risks and benefits of their CT scan, while 22% (10 of 45) of ED physicians reported that they had provided such information. Forty-seven percent (18 of 38) of radiologists believed that there was increased cancer risk, whereas only 9% (four of 45) of ED physicians and 3% (two of 76) of patients believed that there was increased risk (chi(2)(2) = 41.45, P <.001). All patients and most ED physicians and radiologists were unable to accurately estimate the dose for one CT scan compared with that for one chest radiograph. Patients are not given information about the risks, benefits, and radiation dose for a CT scan. Patients, ED physicians, and radiologists alike are unable to provide accurate estimates of CT doses regardless of their experience level.
    No preview · Article · May 2004 · Radiology
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    [Show abstract] [Hide abstract] ABSTRACT: In this study, dose area product (DAP) measurements have been performed aiming at establishing diagnostic reference levels (DRLs) in paediatric intraoral dental radiology. Measurements were carried out at 52 X-ray units for all types of intraoral examinations performed in clinical routine. Not all X-ray units have pre-set child exposure settings with reduced exposure time or in some cases lower tube voltage. Child examinations are carried out using adult exposure settings at these units, which increases the DAP third quartile values by up to 50%. For example, third quartile values for periapical examination ranges from 14.4 to 40.9 mGy cm(2) for child settings and 20.6 to 48.8 mGy cm(2) when the adult settings are included. The results show that there exists a large difference between the patient exposures among different dental facilities. It was also observed that clinics working with faster film type or higher tube voltage are not always associated with lower exposure.
    Full-text · Article · Feb 2006 · Radiation Protection Dosimetry
  • No preview · Article · Feb 2008 · American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics
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    [Show abstract] [Hide abstract] ABSTRACT: The thyroid gland is highly susceptible to radiation carcinogenesis and exposure to high-dose ionising radiation is the only established cause of thyroid cancer. Dental radiography, a common source of low-dose diagnostic radiation exposure in the general population, is often overlooked as a radiation hazard to the gland and may be associated with the risk of thyroid cancer. An increased risk of thyroid cancer has been reported in dentists, dental assistants, and x-ray workers; and exposure to dental x-rays has been associated with an increased risk of meningiomas and salivary tumours. To examine whether exposure to dental x-rays was associated with the risk of thyroid cancer, we conducted a population-based case-control interview study among 313 patients with thyroid cancer and a similar number of individually matched (year of birth +/- three years, gender, nationality, district of residence) control subjects in Kuwait. Conditional logistic regression analysis, adjusted for other upper-body x-rays, showed that exposure to dental x-rays was significantly associated with an increased risk of thyroid cancer (odds ratio = 2.1, 95% confidence interval: 1.4, 3.1) (p=0.001) with a dose-response pattern (p for trend <0.0001). The association did not vary appreciably by age, gender, nationality, level of education, or parity. These findings, based on self-report by cases/controls, provide some support to the hypothesis that exposure to dental x-rays, particularly multiple exposures, may be associated with an increased risk of thyroid cancer; and warrant further study in settings where historical dental x-ray records may be available.
    Full-text · Article · May 2010 · Acta oncologica (Stockholm, Sweden)
  • [Show abstract] [Hide abstract] ABSTRACT: OBJECTIVE: As public awareness of medical radiation exposure increases, there has been heightened awareness among patients and physicians of the importance of holistic benefit-and-risk discussions in shared medical decision making. CONCLUSION: We examine the rationale for informed consent and risk communication, draw on the literature on the psychology of radiation risk communication to increase understanding, examine methods commonly used to communicate radiation risk, and suggest strategies for improving communication about medical radiation benefits and risk.
    No preview · Article · Apr 2011 · American Journal of Roentgenology
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