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Beyond the Data: The Human Side of Radiation Dose Monitoring. Part II - Communication

Olav Christianson

In our last blog we discussed the radiation dose monitoring dream team. In this blog, which is the second in a six part series, we’ll discuss the team’s communications with patients. communication is often the key to the success of any initiative so be sure to consider how it is being handled.

Have you ever asked yourself “what do patients really know about radiation?” There are a lot of movies with a story line indicating that radiation can turn you in a super being with spider powers, or a huge dinosaur like monster, or even perhaps life-sized turtles with special ninja capabilities.

And more likely, patients are fearful of radiation because that have no experience with it and our senses cannot perceive it.  Therefore, part of proper patient communication is getting them to understand what is real and what isn’t, as it helps control their fear and discomfort with the process in general. According to one study here are patients’ perception of radiation risk:

  • 92% were not informed of the radiation risks1
  • 56% of patients believed MRI increased their risk of cancer1
  • 42% of patients believed radiologic exams did not use radiation

Source: Ricketts, Perception of Radiation Exposure and Risk Among Patients, Medical Students, and Referring Physicians at a Tertiary Care Community Hospital., Canadian Association of Radiologists Journal, 2013

To provide some perspective on radiation risk perception see this diagram:

radiation risk chart
Source: Morgan 1993.

The chart above may help you effectively use plain language and analogies to explain to patients:

  • Information on radiation risks
  • Information of the benefits of the procedure (more on this next)
  • The risks of not performing the study
  • What has been or will be done to ensure their safety

We encourage you to be patient and empathetic, because while you are familiar with the risks from procedures, the patients are not. The key messages you’re sharing should be:

  • About how the study is recommended by their physician to aid in diagnosis and guiding their treatment
  • How the patient is given the lowest possible radiation dose without compromising the diagnostic quality of the study
  • How the study is medically indicated and will be properly done, therefore the benefits outweigh the risks

Here is an example of communication about a scan. Ask yourself which you’d rather hear if you were a patient:

Bad Good
The CT exam you had two weeks ago has doubled the risk that your child will develop cancer from 15 per 100,000 to 30 per 100,000 children The CT scan was an important exam that allowed the physician to rapidly diagnose and treat your child's inquiries, which otherwise could have placed your health and the health of your child at risk. the increased risk of an adverse outcome is very small, and the likelihood of normal development is virtually the same as it is for any child.

Communication Informed consent and radiation risks - What you need to know:

  • “As the severity of a potential harm becomes greater, the need to disclose improbable risks grows, though courts have yet to assign a threshold for the probability of a grave harm beyond which it must be disclosed.”
  • “…the benefits and risks must be clearly stated, unequivocal, and easily measured.”
  • Informed consent includes:
    • The purpose of the procedure
    • How it will be performed
    • The risks and benefits of the procedure
    • The risk of not performing the procedure
    • Reasonable alternatives
  • Informed consent is only recommended for studies that may be associated with deterministic effects. 

    • Brink et al., Informed Decision Making Trumps Informed Consent for Medical Imaging with Ionizing Radiation, Radiology, 2012

Read the first blog in this series, and watch for upcoming ones. A webinar going into deeper detail on this information is posted on AHRA.com for members, and another will be appearing on LANDAUER.com soon.