Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure - 13/07/13

Doi : 10.1016/j.annemergmed.2010.10.018

Brigitte M. Baumann, MD, MSCE ^a,^⁎ , Esther H. Chen, MD ^b,^c, Angela M. Mills, MD ^c, Lindsey Glaspey, BA ^a, Nicole M. Thompson, MS ^a, Molly K. Jones, BA ^a, Michael C. Farner, MD ^d
^a Department of Emergency Medicine, UMDNJ–RWJMS, Camden, NJ
^b Department of Emergency Medicine, University of California San Francisco, San Francisco, CA
^c Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
^d South Jersey Radiology Associates, Voorhees, NJ

Address for correspondence: Brigitte M. Baumann, MD, MSCE, Department of Emergency Medicine, One Cooper Plaza, Camden, NJ 08103; 856-968-7347, fax 856-968-8426

Résumé

Study objective

We describe patient perceptions of computed tomography (CT) and their understanding of radiation exposure and risk.

Methods

This was a cross-sectional study of acute abdominal pain patients aged 18 years or older. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point visual analog scale. Knowledge of radiation exposure was ascertained when participants compared the radiation dose of one abdomen-pelvis CT with 2-view chest radiography. To assess cancer risk knowledge, participants rated their agreement with these factual statements: “Approximately 2 to 3 abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors” and “2 to 3 abdominal CTs over a person's lifetime can increase cancer risk.” Previous CT was also assessed.

Results

There were 1,168 participants, 67% women and mean age 40.7 years (SD 15.9 years). Median confidence in a medical evaluation without ancillary testing was 20 (95% confidence interval [CI] 16 to 25) compared with 90 (95% CI 88 to 91) when laboratory testing and CT were included. More than 70% of participants underestimated the radiation dose of CT relative to chest radiography, and cancer risk comprehension was poor. Median agreement with the Hiroshima statement was 13 (95% CI 10 to 16) and 45 (95% CI 40 to 45) with the increased lifetime cancer risk statement. Seven hundred ninety-five patients reported receiving a previous CT. Of 365 patients who reported no previous CT, 142 (39%) had one documented in our electronic medical record.

Conclusion

Patients are more confident when CT imaging is part of their medical evaluation but have a poor understanding of the concomitant radiation exposure and risk and underestimate their previous imaging experience.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design

Setting

Selection of Participants

Methods of Measurement

Data Collection and Processing and Primary Data Analysis

Results

Characteristics of Study Subjects

Limitations

Discussion

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	Supervising editor: David T. Overton, MD, MBA
	Author contributions: BMB, EHC, AMM, and MCF were responsible for study design and data collection. LG, NMT and MKJ assisted with data collection. BMB conducted the statistical analyses. All authors contributed to data interpretation and article preparation. BMB takes responsibility for the paper as a whole.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.
	Please see page 2 for the Editor's Capsule Summary of this article.
	Publication date: Available online December 13, 2010.