Patients place considerable confidence in CT scans, but they fail to understand the risks they may be taking, researchers say. Patients may be confident in the evaluations the scans allow, but they substantially underestimate the amount of radiation involved in the process.
The study, published in the January issue of the Annals of Emergency Medicine, highlights the need for increased patient awareness about the appropriate use of, and the risks inherent in, CT imaging. Patients with abdominal pain are four times more confident in an evaluation that included CT than one did not; however, they substantially underestimated the amount of radiation involved and the attendant peril.
“Given the increasing concerns about unnecessary radiation exposure from medical imaging, our findings suggest that efforts to reduce unnecessary medical imaging will need to not only address health care provider practices but also include patient education and awareness,” the authors note.
Researchers surveyed 1,168 patients with non-traumatic abdominal pain.
Twenty percent reported confidence in a medical evaluation that included patient history and physical exam only. Ninety percent reported confidence in a medical evaluation that included patient history, physical exam, blood work and CT scan.
Abdomen-pelvis CT scans have been demonstrated to increase certainty of diagnosis, decrease the need for emergency surgery, and avert up to a quarter of hospital admissions, explains Brigitte M. Baumann, MD, MSCE, of the department of emergency medicine at the University of Medicine and Dentistry of New Jersey in Camden. “At the same time, there is growing concern about the long-term consequences of CT scans, particularly in patients who receive many of these scans over the course of their lifetime.”
In fact, 75 percent of the patients underestimated the amount of radiation delivered by a CT scan, and only 3 percent understood CT scans increased a person’s lifetime risk of cancer.
A recent FDA initiative aimed at reducing unnecessary radiation exposure from medical imaging primarily focused on physician practices and providing patients with a record of their imaging history. It’s commendable, Baumann says, but it fails to address patient expectations. “We need to do a better job of educating our patients about the risks associated with CT scans.”
There are many opportunities to do just that, Baumann tells HealthLeaders Media. “Each time an imaging study is ordered, the risks should be mentioned, whether the discussion takes place in the ED or the primary care doctor's office.”
The point isn’t to dissuade patients, but to inform them. “In some situations, the need for CT outweighs the risks and in these cases, the discussion will be brief,” she says. An older patient with poorly controlled blood pressure and a tearing pain in his abdomen and back needs an emergent CT to assess for an aortic dissection, a life-threatening condition, she explains.
In contrast, a young patient who has had some nausea and vomiting for less than 24 hours, has no fever, and a GI ‘bug’ is making its rounds, probably does not urgently need a CT.
“Perhaps we could employ ‘watchful waiting’ and if things get worse or change, then the patient should return…for additional testing, which may include a CT. If things improve, then we've avoided an unnecessary test and radiation exposure,” she says.
In each case, the doctor uses his or her training and expertise to weigh the risks and benefits, she says. “Physicians do this all the time, but we often do not verbalize what we are thinking. Perhaps now is the time to try and verbalize a bit more so that patients can become more informed and involved in their own health care.”
The paper calls for further education and research. “We suggest that future efforts to curtail unnecessary medical imaging consider these findings and use them to guide investigations aimed at determining patient understanding of radiation risk and exposure in other patient populations. These future findings, in conjunction with ours, should guide patient education and awareness efforts.”