Joseph R. Steele MD, Presenter: Consultant, INTIO, Inc Stockholder, INTIO, Inc Stockholder, Intelliject, Inc Stockholder, MedicaSafe, Inc Consultant, Adient Medical Inc Stockholder, Adient Medical Inc Consultant, Edumedics LLC Stockholder, Edumedics LLC

A. Kyle Jones PhD, Abstract Co-Author: Nothing to Disclose

Stowe Shoemaker PhD, Abstract Co-Author: Nothing to Disclose

We were interested in developing tools and processes for educating patients about radiation exposure and the risks and benefits of medical imaging. Developing these tools and processes requires an understanding of the knowledge of patients regarding ionizing radiation. We designed a survey to measure patients' knowledge about the use of ionizing radiation in medical imaging.

5462 patients completed the initial survey, having undergone a mean of 6.4 imaging studies in the last year at our institution. Over 2,000 competed the non-responder survey. Reasons provided for visits included to check for disease recurrence (41%) and evaluate treatment response (23%). Only 22% of patients could define ionizing radiation. 27% of patients responded that radiography did not involve exposure to ionizing radiation while 30% responded that MRI did. Only 36% of patients believed that CT exposed them to ionizing radiation, and no more than 36% of those surveyed responded affirmatively to any modality that uses ionizing radiation. When asked to identify the medical imaging exam that delivered the highest radiation dose from a list of exams (chest x-ray, chest CT, whole body PET, NM bone scan, abdomen MRI, none), only 50% responded but the highest fraction correctly identified whole body PET. 22% of patients reported that they were "Not concerned at all" about radiation exposure, while 13% reported being "Very concerned". Most patients answered that the risks from medical imaging were small. Most agreed with the statement "I am willing to accept the risks associated with radiation exposure because I want a less invasive test that provides quick answers," and most perceived the studies they received to be valuable in treating their condition (95%). Only 3% of patients were informed of the radiation dose from their most recent imaging study, however, only 55% of patients wanted to be informed. Only 21% of patients reported that a doctor had discussed the risks and benefits of their most recent imaging study, and 40% said they would have the exam regardless of the risk/benefit ratio. Patients did not understand the risks of imaging, believing risks from CT included heritable mutations (12.2%), sterility (23.5%), and acute radiation sickness (12%).  When asked how they would behvae if another hospital nearby began advertising "low dose" CT scans at the same cost as our institution, only 7% of patients reported that they would have their imaging performed at the outside facility, 57% would continue to have their imaging performed at our institution, and 36% would ask their doctor what they should do.

Most patients do not know what ionizing radiation is, and therefore poorly understand radiation risks. Patients believe that the studies they undergo offer a benefit that is large compared to the risk, and as providers we owe it to them to ensure this is the case. We cannot hope to effectively educate patients about radiation without understanding their current knowledge level. Our survey, the largest of its kind, indicates that we currently overestimate the knowledge of our patients about radiation. Using the information learned in this survey, we can target our educational efforts to have the highest impact on patient education. Better education leads to more accurate expectations, which translates into better decisions and a better patient experience.

We developed a 25 question survey that was distributed to patients who had recently undergone diagnostic imaging at our institution. Participants were first asked if they could define ionizing radiation, if not, they were provided with the definition. Participants were then questioned about which types of diagnostic imaging use ionizing radiation, the relative associated radiation doses, doses in imaging relative to other activities, risks from radiation exposure, information that had been provided to them about their exam, and their desire for information related to the risks and benefits of medical imaging. A shorter non-responder survey was distributed to patients who did not respond to the original survey.

Steele, J, Jones, A, Shoemaker, S, Patient Perception and Understanding of Radiation in Diagnostic Imaging.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018038.html