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Communicating Radiation Risk to Patients
Posted on Thursday, April 18th, 2013, under Radiation Safety
By Greg Sackett, M.S., CHP
Responding to patient concerns and questions about radiation risk can be one of the most challenging duties facing technologists and physicians. Patients often arrive with preconceived notions of risk based on misinformation they have seen in the media or read on the internet. They may be scared or even hostile towards the caregiver attempting to complete a prescribed procedure.
When discussing risk, perception equals reality, regardless of scientific or technical evidence to the contrary. Therefore it is necessary to discuss risk within the patient’s perception of the hazard. The keys to remember when discussing risk with the patient are:
- Tell the truth.
- Use positive or neutral terms and no jargon.
- Use examples to help the patient understand.
- Don’t speculate, discuss only the procedure being performed.
- Do not attack the patient’s beliefs or a source of misinformation.
- Ask if you are being understood.
Ensure the patient that the procedure will be performed using good radiation safety practices that are designed to keep the doses as low as possible while still generating the diagnostic results required. Be careful generalizing risks, as future cancer risk is highly age dependent. Many radiation induced cancers have latency periods of 10 to 20 years. While individuals over 60 have minimal cancer risks from radiation exposure, children have a lifetime risk of 10-15% simply due to the length of time available for cancer to appear.
One aspect often overlooked when discussing radiation risks is the BENEFIT to the patient of the procedure being performed. The risks of NOT performing an exam include missing a diagnosis and/or initiating treatment too late to improve the medical outcome. This risk must be considered in conjunction with the latency period for radiation-induced cancer and the age of the patient. The use of radiation in healthcare saves thousands of actual lives every year, while the entirely theoretical risks predicted by risk models are orders of magnitude smaller. Ensure that the patient understands why the procedure is being performed and the benefit to their immediate health.
If the patient has questions that you cannot answer, they may be referred to the Radiologist or Radiation Safety Officer of your institution. You may also refer them to trusted websites like RadiologyInfo.org that are designed to answer patient questions about Radiology and Radiation Safety.
References:
- How to Understand and Communicate Radiation Risk, Peck and Samei, Imagewisely.org
- Benefits of Medical Radiation Exposures, Zanzonico and Stabin, HPS.org
Radiographic Technique Still Matters For Image Quality and Patient Dose
Posted on Saturday, March 23rd, 2013, under Radiography
Shirley Bartley, M.B.A., RT (R)(N)
The new technologist at the hospital radiology department went to do a portable in the ICU. The patient looked average size. She looked for the technique chart to set the correct exposure factors. There was no chart to be found. She guessed at the technique based on what she could remember from the last place she worked. When the new tech returned to the department the supervisor was reviewing the image. “You are going to have to repeat this portable chest. There is an image quality problem. You didn’t penetrate the mediastinum.” The supervisor told the new tech.
If the kVp is too low the anatomy will not be properly penetrated. The fine detail in dense areas of the body will just not be there. This will jeopardize the radiologist ability to make a correct interpretation of the patient’s condition.
A few minutes later the new tech was working in room 2 with a seasoned employee. The new tech selected the radiographic technique from the anatomic programing feature on the operator’s consol. “Don’t use that. It doesn’t work. I have my own technique.” The new technologist made a mental note to try to remember the technique.
Without standard technique systems that are used by everyone image quality will be inconsistent. It is difficult for the radiologist to see changes in the patient’s condition when totally different radiographic technique is used. Technologist that just “remember” their own techniques are frequently wrong.
After lunch the new tech was working with a radiology student. They did an abdomen using automatic exposure control (AEC). Viewing the image, the new tech pointed out that the exposure indicator value was well above the acceptable range. The students said, “They don’t pay any attention to the number here.”
With digital systems the image that is over exposed no longer comes out black. The only way we can determine that the patient was over exposed is with the exposure indicator value. The AEC unit that is not properly calibrated will not produce the correct quantity of radiation for the image. When the exposure indicator value is ignored the patients may be overexposed unnecessarily.
These three situations describe common problems for image quality and patient dose. ISS, Inc. can assist you in maximizing image quality while keeping patient dose as low as reasonably achievable (ALARA). For more information access our recent white paper.