When you see these kinds of numbers
you realize the amount of man-made ionizing radiation being produce and the number of
radiographic images physicians are using to diagnose, treat and cure medical
conditions and diseases. But with all the good outcomes that come from
diagnostic imaging/x-ray many healthcare professional and patients do not full
understand the risks involved in radiologic procedures because the benefits tend to far
outweigh the risks. Does this mean that since a particular radiologic exam can
produce such beneficial outcomes should we be complacent about the risks of the
ionizing radiation produced by x-ray imaging systems? The real question is how we
raise awareness in radiation protection for not only the patients but the healthcare
professionals as well.
Most people have little or no
education on the biological effects of ionizing radiation and when they come in
for a physician ordered x-ray the medical staff (Doctors, nurses, etc.) may not fully provide the
patient with enough if any information on the negative effects the procedure
they are about to undergo. I believe that because of this lack of understanding
about radiation protection by many healthcare professionals in general and with the advancements of imaging
technologies over the past 20 years the healthcare community outside of
radiology departments loses the proper respect for radiation protection and
properly informing patients of those risks.
Would better informing the general public bring unnecessary fear of these potential risks of ionizing radation from ragraphic porcedures? Does the obvious benefit radiographic imaging has on the diagnosis, treatment, cure of illness and disease create a culture of limiting what we say about x-rays and the risks to the patients? Is it better to do all we can to alleviate the fear and anxiety patients have when coming in for x-rays in order to get more patient cooperation, build patient confidence, and produce the best quality diagnostic image for the radiologist and primary physician to give the best diagnosis possible? Or do we have a resposiblity as healthcare professionals to strive to provide inform consent about the risks and benfits?
Would better informing the general public bring unnecessary fear of these potential risks of ionizing radation from ragraphic porcedures? Does the obvious benefit radiographic imaging has on the diagnosis, treatment, cure of illness and disease create a culture of limiting what we say about x-rays and the risks to the patients? Is it better to do all we can to alleviate the fear and anxiety patients have when coming in for x-rays in order to get more patient cooperation, build patient confidence, and produce the best quality diagnostic image for the radiologist and primary physician to give the best diagnosis possible? Or do we have a resposiblity as healthcare professionals to strive to provide inform consent about the risks and benfits?
Informing patients of the potential risks involved with x-rays may create unwanted fear or
anxiety for the patients who are often fearful and anxiousanyways. Patient anxiety from the fact the
doctor has ordered the radiograph in the first place and what the images might
reveal. This fear can result in difficulties in acquiring a good quality image
due to issues with patient movement (i.e. tremors, nervous shaking or unwillingness to
cooperate). This is where building awareness about
radiation protection and true informed consent of patients has its
challenges not only to radiography but the medical community in general.
Many doctors do not provide enough information about the risks, benefits, and the actual radiation dose the patient will recieve. An example of this was shown by a research article published by the Radiologic Society of North America's monthly journal "Radiology" in 2004 assessing patients, physician, and radiologist awareness of radiation doses and possible risks associated with CT scans. The study reveals that "patients are not given information about the risks, benefits, and radiation dose for a CT scan(1). Patients, ED physicians, and radiologists alike are unable to provide accurate estimates of CT doses regardless of their experience level. Although this study used a small sample of patients and doctors it shows a general lack of understanding by both patient and doctors on the risks and the importance of providing information to patients to strive for informed consent. The study showed that only 7% of patients reported being told about the risks and benefits of their CT scans while 22% of ED physicians reported giving the patients such information (1). Does this show a lack of understanding about radiation or just complacency by the doctors so to not "freak out" the patient as to the actual radiation dose they will receive?
In my opinion most doctors havent the unerstanding necessary to provide that information to the patient. Here is where the Registered Technologist (RT) comes in. RT's are trained to understand not only radiation dose, how x-radiation is produced but the biological effects and possible risks of ionizing radiation and the need for consistent radiation protection of patient and medical personnel.
Many doctors do not provide enough information about the risks, benefits, and the actual radiation dose the patient will recieve. An example of this was shown by a research article published by the Radiologic Society of North America's monthly journal "Radiology" in 2004 assessing patients, physician, and radiologist awareness of radiation doses and possible risks associated with CT scans. The study reveals that "patients are not given information about the risks, benefits, and radiation dose for a CT scan(1). Patients, ED physicians, and radiologists alike are unable to provide accurate estimates of CT doses regardless of their experience level. Although this study used a small sample of patients and doctors it shows a general lack of understanding by both patient and doctors on the risks and the importance of providing information to patients to strive for informed consent. The study showed that only 7% of patients reported being told about the risks and benefits of their CT scans while 22% of ED physicians reported giving the patients such information (1). Does this show a lack of understanding about radiation or just complacency by the doctors so to not "freak out" the patient as to the actual radiation dose they will receive?
In my opinion most doctors havent the unerstanding necessary to provide that information to the patient. Here is where the Registered Technologist (RT) comes in. RT's are trained to understand not only radiation dose, how x-radiation is produced but the biological effects and possible risks of ionizing radiation and the need for consistent radiation protection of patient and medical personnel.
How much radiation dose one recieve from a typical radiographic procedure? From a CT scan? In coming up with an overall dose of an x-ray procedure on the patient the term effective dose is used when referring to the radiation risk averaged over the entire body. The effective dose accounts for the relative sensitivities of the different tissues exposed. More importantly, it allows for quantification of risk and comparison to more familiar sources of exposure that range from natural sources of background radiation to radiographic medical procedures. the patient's effective dose from a CT scan of the abdomen-pelvis is 10 millisieverts. It takes
about 3 years of receiving background radiation (i.e. cosmic rays, radioactive
minerals in building/concrete, radon gas in homes, etc.) to equal the radiation dose received by one abdominal
pelvic CT scan. When put in these terms a CT scan may sound like a high
dose of radiation to the patient? But in terms of the amount of radiation received throughout a person’s
life from background radiation it is only a moderate dose. This is where
the Radiologic Technologist plays such a vital role in raising
awareness on the relative safety of Radiography if radiation protection is practiced and how the benefits really do outweigh the risks.
The fact is physicians do not received the level of training about x-ray radiation or how radiographic images are produced as are the radiologic technologists who actually perform the ordered procedures. The RT's have a ethical responsibility for explaining the procedure and informing the patient about the risks and benefits. Frequently RT's do not provide too much information about this topic so not to induce unecessary fear or anxiety by the patient which might inhibit their ability to complete the exam or may affect the compliance of the patient during the exposure which could then result in non-diagnotic quality images and repeated exams thus doubling the radiation dose to the patient. Often due to the complexity of the topic it becomes too time consuming trying to explain the risks vs. benefits to the patient so the technologists try to explain things in simple terms so to gain the confidence of the patient and thus a successful procedure. This could be considered an indirect effect on creating better radiation protection to the patient.
The fact is physicians do not received the level of training about x-ray radiation or how radiographic images are produced as are the radiologic technologists who actually perform the ordered procedures. The RT's have a ethical responsibility for explaining the procedure and informing the patient about the risks and benefits. Frequently RT's do not provide too much information about this topic so not to induce unecessary fear or anxiety by the patient which might inhibit their ability to complete the exam or may affect the compliance of the patient during the exposure which could then result in non-diagnotic quality images and repeated exams thus doubling the radiation dose to the patient. Often due to the complexity of the topic it becomes too time consuming trying to explain the risks vs. benefits to the patient so the technologists try to explain things in simple terms so to gain the confidence of the patient and thus a successful procedure. This could be considered an indirect effect on creating better radiation protection to the patient.
With the number of people needing diagnostic images on the
rise, radiation protection of patients and occupationally expose workers is needed more than ever. It
starts with the professionals who have the knowledge and skills to build that
awareness, the technologists. I feel the first step in building patient
awareness is to start with increasing awareness among the medical profession in
general. If the doctors who are ordering these exams don't fully understand the
risks and radiation dose to the patients or become complacent in their use of
radiation protection equipment for patients and staff we are not doing enough
to protection the public from unnecessary exposure to ionizing radiation.
It is my hope to build awareness through being an advocate for radiation protection education in the medical community. I believe increasing informed consent of the general population to the risks and benefits of radiographic imaging will not make it more difficult to get quality images but help patients have understanging of the importance of cooperation for radiation protection.Cited sources:
1) Lee, C. et al. "Diagnostic CT Scans: Assessment of Patient, Physician, and Radiologist Awareness of Radiation Dose and Possible Risks." March 18, 2004. doi: 10.1148/radiol.2312030767. Radiology. 231, 393-398. http://radiology.rsna.org/content/231/2/393.full
2) Prochaska, Gail. "General X-ray Procedures Growing at ~5% per year, as Installed X-ray Units Decline." February 10, 2011. IMV Medical Information Division. Des Plaines, IL. http://www.prweb.com/releases/2011/2/prweb8127064.htm
