Original article
Leadership
Optimizing Communication With Parents on Benefits and Radiation Risks in Pediatric Imaging

https://doi.org/10.1016/j.jacr.2018.01.032Get rights and content

Abstract

Effective radiation risk communication is a core competency for radiology care providers and can prevent and resolve potential conflicts while helping achieve effective public health safeguards. The authors present a synopsis of the challenges to holding such dialogue and review published methods for strengthening and maintaining this discourse. Twelve strategies are discussed in this article that can help alleviate concerns about the iatrogenic risk associated with medical imaging using radiation exposure.

Introduction

Despite improvements in protocol optimization and scanner technology to reduce exposure to children, there remains public concern about iatrogenic effects of radiation exposure. If patients or their parents are fearful of radiation exposure and have concerns reinforced by inaccurate information, there is risk for compromised patient care as access or image quality is diminished through efforts to reduce radiation dose 1, 2, 3, 4. Worse, patients may refuse appropriate diagnostic imaging tests, leading to suboptimal quality of care 3, 5.

Effective communication of benefits and risks from diagnostic imaging of adult and pediatric patients alike remains a serious concern 6, 7. Without effective dialogue between patients or their guardians and imaging professionals, patient dissatisfaction (at best) or medical errors (at worst) can ensue, leading to potential consequences as severe as litigation 8, 9 and negative publicity for the facility and providers involved 10, 11. According to a recent survey [6], patients routinely receive very little information about the pros and cons of diagnostic scans: only 21% of patients had discussed the benefits and risks of their most recent imaging studies with physicians [12].

In this article we build on previous foundations 13, 14 that enumerate several traits of effective risk communication aimed at optimizing the outcomes of communication between medical imaging providers and patients, expanding on these notions by presenting 12 strategies to facilitate this. For the purpose of this discussion, we use the linear no-threshold model as a conservative basis for radiation protection, with the provision that in the range of dose of a single typical CT scan, the radiation risk for an individual can be estimated only with large uncertainty in part because of individual differences in the efficacy of repair mechanisms of radiogenic genetic damage.

Section snippets

Addressing the Clinical Appropriateness of the Examination

Radiologists frequently encounter examination orders with vague or prepopulated but uninformative clinical indications, many of which likely contribute to overutilization of imaging 15, 16, 17, 18, 19. A substantial number of CT scans are ordered to reduce the medicolegal malpractice risk of the ordering physician (defensive medicine) 20, 21. In some instances, parents may insist on their children undergoing scans that are not clinically indicated and/or are expected to add little value to the

Take-Home Points

  • Pediatric imaging professionals and providers continue to sometimes face negative public perceptions of medical imaging radiation risks that are often disproportionate to the medical benefits.

  • Simplifying the concept of risk and enhancing efficient dialogue with the parents or guardians of a patient can help establish open, effective, and trusting communication, which if conveyed properly should help subside potential apprehension or unwillingness to undergo the needed radiologic diagnostic test.

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    The authors have no conflicts of interest related to the material discussed in this article.

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