Radiation Exposure in Imaging Scans, Capstone Project Example

There are a number of potential theories to help ameliorate the problem of overusing radiation equipment (CT scans) as a key diagnostic tool. Indeed, while many theories propose solutions that either work on reducing supply from the health  provider side or reducing demand on the consumer side, there is one theory that attempts to change the behavior of both parties: education initiatives that outline the risks and benefits of CT scans.  One might posit that education efforts are already robust, and thus, would not likely improve this problem.  However, the medical literature paints a dramatically different picture.

Lee et al. conducted a survey of clinicians and patients  regarding the potential risks and benefits of CT scans.  The study found that only seven percent of patients were given an explanation of potential risks associated with CT scans; in addition, all patients and most emergency department (ED) physicians and radiologists were unable to accurately estimate the dose for one CT scan compared with that for one chest radiograph  (Lee, Haims, Monico, Brink, & Forman, 2004). While the study had a limited sample size, it indicates that a problem might currently exist not only in clinicians understanding of potential dangers associated with CT scans, but also in what information they give to patients on the subject.  Baumann et al. conduct a study that shows a similar picture: The authors conduct a cross-sectional study of acute abdominal patients aged 18 and older asking them several questions related to radiation exposure and cancer risks emanating from CT scans.  The study found that while patients were more confident when CT scans were used in diagnosis, they had a poor understanding of radiation exposure and difficulty in remembering previous exposure (Baumann, Chen, Mills, Glaspey, Thompson, Jones & Farner, 2011).   These two studies indicate that general knowledge regarding CT scans and their impact could be improved in both the doctor and patient population.

With this point in mind, some clinicians have stated that CT scans are indispensible in certain conditions, particularly in emergency department diagnosis. There is inevitably truth in that statement, however, even in patients with higher risk for cancer or who have cancer, educational efforts could be expanded.  Hassan et al. conduct a cost-benefit analysis of using whole body CT scans, a common practice, in the detection of colon cancer (Hassan, Pickhardt, Laghi, Zullo, Kim, Iafrate, Di Giulo, & Morini, 2009).  The study found that whole-body scans offer little benefit to patients, while putting them at risk for greater radiation exposure in an already at-risk population.  The study shows how comparative effectiveness research can be a powerful educational tool to educate doctors regarding the economic and clinical tradeoffs.

While many theories have been proposed to help reduce unnecessary use of CT scans, education of patients and doctors would likely have a palpable impact on the problem.  Indeed, not only would more informed doctors be able to give patients clear explanations regarding the risks involved, but patients could, in many circumstances, be more proactive in making decisions about their care.

References

Baumann, B.M., Chen, E.H., Mills, A.M., Glaspey, L.G., Thompson, N.M., Jones, M.J., Farner, M.C. (2011).  Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure.  Annals of Emergency Medicine. 58(1), 1-7.

Hassan, C., Pickhardt, P.J., Laghi, A., Zullo, A., Kim, D.H., Iafrate, F., Di Giulo, L.D. & Morini, S. (2009).  Impact of Whole-Body CT Screening on the Cost-effectiveness of CT Colongraphy.  Radiology.  251(1), 156-165.

Lee, C.I., Haims, A.H., Monico, E.P., Brink, J.A. & Forman, H.A. (2004). Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks.  231 (2), 393-398.