Abstract
Background
The National Institute of Environmental Health Sciences, a subsidiary of the Food and Drug Administration, has declared that X-ray radiation at low doses is a human carcinogen.
Objective
The purpose of our study was to determine if informed consent should be obtained for communicating the risk of radiation-induced cancer from radiation-based imaging.
Materials and methods
Institutional review board approval was obtained for the prospective survey of 456 physicians affiliated with three tertiary hospitals by means of a written questionnaire. Physicians were asked to state their subspecialty, number of years in practice, frequency of referral for CT scanning, level of awareness about the risk of radiation-induced cancer associated with CT, knowledge of whether such information is provided to patients undergoing CT, and opinions about the need for obtaining informed consent as well as who should provide information about the radiation-induced cancer risk to patients. Physicians were also asked to specify their preference among different formats of informed consent for communicating the potential risk of radiation-induced cancer. Statistical analyses were performed using the chi-squared test.
Results
Most physicians stated that informed consent should be obtained from patients undergoing radiation-based imaging (71.3%, 325/456) and the radiology department should provide information about the risk of radiation-induced cancer to these patients (54.6%, 249/456). The informed consent format that most physicians agreed with included modifications to the National Institute of Environmental Health Services report on cancer risk from low-dose radiation (20.2%, 92/456) or included information on the risk of cancer from background radiation compared to that from low-dose radiation (39.5%, 180/456).
Conclusion
Most physicians do not know if patients are informed about cancer risk from radiation-based imaging in their institutions. However, they believe that informed consent for communicating the risk of radiation-induced cancer should be obtained from patients undergoing radiation-based imaging.
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References
United Nations Scientific Committee on the Effects of Atomic Radiation (2009) UNSCEAR 2000 report, vol I. Annex D: Medical radiation exposures. United Nations, New York. http://www.unscear.org/unscear/en/publications/2000_1.html. Accessed 19 May 2009
Stern S, Kaczmarek R, Spelic D et al (2002) Nationwide evaluation of X-ray trends (NEXT) 2000–2001 survey of patient radiation exposure from computed tomographic (CT) examinations in the United States. Radiology 221:161
Brenner DJ, Georgsson MA (2005) Mass screening with CT colonography: should the radiation exposure be of concern? Gastroenterology 129:328–337
NCRP (1989) Exposure of the U.S. population from diagnostic medical radiation. NCRP Report No. 100. National Council on Radiation Protection and Measurements, Bethesda, MD
Mettler FA, Wiest PW, Locken JA et al (2000) CT scanning: patterns of use and dose. J Radiol Prot 20:353–359
Scott BR (2006) Low-dose radiation-induced protective process and implications for risk assessment, cancer prevention, and cancer therapy. Dose Response 5:131–149
Regulla DF, Eder H (2005) Patient exposure in medical X-ray imaging in Europe. Radiat Prot Dosimetry 114:11–25
National Institute of Environmental Health Sciences (2009) The eleventh report on carcinogens. http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s097zird.pdf. Accessed 21 May 2009
Gilbert ES, Koshurnikova NA, Sokolnikov M et al (2000) Liver cancers in Mayak workers. Radiat Res 154:246–252
Cologne JB, Tokuoka S, Beebe GW et al (1999) Effects of radiation on incidence of primary liver cancer among atomic bomb survivors. Radiat Res 152:364–373
Brenner DJ, Doll R, Goodhead DT et al (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 100:13761–13766
Ries LA, Harkins D, Krapcho M et al (eds) (1975) SEER Cancer Statistics Review, 1975–2003, National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/csr/1975_2003/. Accessed 20 May 2009
Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR 176:289–296
Picano E (2004) Education and debate. BMJ 329:849–851
Barnett GC, Charman SC, Sizer B et al (2004) Information given to patients about adverse effects of radiotherapy: a survey of patients’ views. Clin Oncol 16:479–484
Lee CI, Haims AH, Monico EP et al (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398
Larson DB, Rader SB, Forman HP et al (2007) Informing parents about CT radiation exposure in children: it's OK to tell them. AJR 189:271–275
Lee CI, Flaster HV, Haims AH et al (2006) Diagnostic CT scans: institutional informed consent guidelines and practices at academic medical centers. AJR 187:282–287
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A commentary on this article is available at doi:10.1007/s00247-009-1322-6
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Karsli, T., Kalra, M.K., Self, J.L. et al. What physicians think about the need for informed consent for communicating the risk of cancer from low-dose radiation. Pediatr Radiol 39, 917–925 (2009). https://doi.org/10.1007/s00247-009-1307-5
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DOI: https://doi.org/10.1007/s00247-009-1307-5