Radiographers' and radiology practitioners' opinion, experience and practice of benefit-risk communication and consent in paediatric imaging
Introduction
Since there is still much scientific uncertainty relating to the risks of low radiation dose exposures commonly associated with most medical imaging examinations (<100 mSv),1, 2 it is not surprising that any study, report or opinion suggesting any increased risk will generate substantial interest. This was evident recently when large population studies in the United Kingdom, Australia and Taiwan similarly reported a very small, albeit increased, risk in the number of observed brain cancers and/or leukaemia in patients who had undergone a computed tomography (CT) scan when they were younger.3, 4, 5 Indeed, despite significant limitations noted in such studies,6, 7 considerable media attention was drawn to these findings, with some choosing to over dramatise the reported findings so as to raise safety concerns about the use of CT scans in children.8, 9, 10
In times where information is so easily accessible, such coverage can raise alarm and concern amongst those who are referred for any medical imaging examination. Similarly, it may raise concern amongst parents of children being referred for medical imaging examinations, particularly since they might already be overwhelmed, confused and worried about the wellbeing of their child.8 It is in this context that radiographers and radiologists have an important responsibility to fulfil when meeting with patients and/or their representatives: to provide adequate benefit-risk information relating to the medical imaging examination to be performed. This responsibility is now reflected in Council Directive 2013/59/EURATOM, which lays down revised basic safety standards for the protection against dangers arising from exposure to ionising radiation, and which needs to be transposed into national legislation of each Member State by February 2018.11 In fact, Article 57 (1d) specifies that ‘wherever practicable and prior to the exposure taking place, the practitioner or the referrer, as specified by Member States, ensures that the patient or their representative is provided with adequate information relating to the benefits and risks associated with the radiation dose from the medical exposure.’ Consequently, the provision of benefit-risk information is essential as it helps fulfil the patients' right to information; it respects their autonomy; it empowers them to provide informed consent and allows them to become more involved in a shared decision making process relating to what is best for them or for their child.12, 13, 14, 15
For this reason the authors of this study deemed it was opportune to attain an insight into current benefit-risk communication practices at a large general teaching hospital in Malta, and which also serves as the primary paediatric referral centre where thousands of medical imaging examinations are performed on paediatric patients each year.16 Consequently the authors sought and obtained ethical approval from the governing institution to conduct a prospective cross-sectional survey with radiographers, as well as with radiologists, nuclear medicine physicians and radiology residents (hereafter collectively referred to as ‘radiology practitioners’) at this hospital. Furthermore, since the provision of benefit-risk information may be influenced by radiation knowledge, the survey also sought to assess the level of radiation dose awareness amongst potential participants, with some initial findings being provided in a previous publication.17 Therefore the aims of this article were to investigate radiographers' and radiology practitioners' opinion and practice of providing benefit-risk information and seeking consent for paediatric imaging examinations; as well as attain an insight into their experience of situations where parents choose to refuse a medical imaging examination for their child.
Section snippets
Materials and methods
The study consisted of a prospective cross-sectional survey conducted among radiographers and radiology practitioners at a large general hospital in Malta. Since a comprehensive literature review revealed that no standardised tool existed to investigate the aspects being considered in this study, the authors specifically developed a questionnaire for this purpose.17 Overall the questionnaire contained 20 questions, the majority of which were close ended, although it was also possible for
Results
A total of 112 questionnaires were returned from the 168 distributed, resulting in an overall response rate of 66.7%. These comprised of 100 radiographers and 12 radiology practitioners (consultant/specialist radiologists/nuclear medicine physicians {n = 7}, trainee radiology residents {n = 5}). The characteristics of the study participants are summarised in Table 1, with the majority being female (58.0%), aged 35 years or younger (77.7%) and having a maximum of 10 years working experience
Discussion
Benefit-risk communication has recently been recognised as an aspect of radiography and radiology practice that merits specific attention and importance. In fact, one of the recommended 10 ‘Actions’ put forward by the International Atomic Energy Agency (IAEA) and World Health Organization (WHO) following the ‘International Conference on Radiation Protection in Medicine; setting the scene for the next decade’ in Bonn, Germany, was to foster an improved benefit-risk dialogue amongst health
Conclusion
The main findings revealed varied practice with respect to the communication of benefit-risk information to paediatric patients and/or their parents/guardians. Indeed, it appears that information relating to the benefits and risks of paediatric imaging examinations are not always communicated, despite the fact that most radiographers and radiologists seek parental consent. Apart from encouraging more studies to investigate benefit-risk communication practice in imaging departments across
Conflict of interest statement
None.
Acknowledgements
The authors would like to thank all radiographers, radiologists, nuclear medicine physicians, and radiology resident trainees for their time and contribution to this study, as well as to Prof. Liberato Camilleri for his statistical advice and support.
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