5 ways to communicate the benefits, risks of radiation in pediatric radiology

Radiologists can provide significant value by communicating the benefits and risks associated with radiation to the parents or guardians of pediatric patients, and a group of researchers provided numerous strategies for such communication in a new analysis for the Journal of the American College of Radiology. These are five of the team’s suggestions:

1. Address the clinical appropriateness of the exam

Appropriateness criteria can be an effective resource for radiologists looking to communicate with patients and the families of pediatric patients. It promotes transparency, the authors note, as well as consistency. By discussing that an imaging examination is required for specific reasons connected to specific appropriateness criteria, the radiologists can show that a plan has been put in place for these types of exams and they are closely following that plan.

“Effective communication with patients, families, and referrers requires that both the content of the appropriateness guidelines and their source be conveyed and understood,” wrote lead author Nima Kasraie, PhD, of Children’s Mercy Hospital in Kansas City, Missouri, and colleagues. “Radiologists can use the discussion to qualify the source of the guidelines and explain the process used to create them, as well as sharing the content of the guideline and the recommendation for the current clinical scenario. Such discussions can help quell concerns that radiologists are placing financial self-interest ahead of patient safety and establish radiologists as authorities on evidence-based care to their referring colleagues.”

2. Describe risks associated with an exam in the context of its benefits

“Studies of risk perception show that individuals judge the risk of an activity to be lower when they clearly understand the benefits they will receive as a result,” the authors wrote. “Small risks presented in isolation tend to be overestimated by laypersons and scientists alike.”

In radiology, Kasraie et al. noted, specialists don’t focus on the benefits nearly enough when discussing various risks. The examination, of course, is designed to help the patient—and sometimes, that means radiation must be used. The famous ALARA principle, which stands for as low as reasonably achievable, does not help radiologists in these situations.

“In medical imaging, radiation risk should always be discussed in the context of the associated benefit, never in isolation,” the authors wrote.

3. Limit technical jargon

When speaking with the parents or guardians of pediatric patients, radiologists should simplify risk and avoid terms such as size-specific dose estimate, air kerma, and so on. And effective dose (ED) should also be avoided, though it might seem acceptable to use at first. “Despite common practice, ED was never intended to be used as a measure of risk to an individual patient but rather was designed as a quality improvement tool and to determine risk on the basis of a generic or standard reference phantom for purposes of radiation protection,” the authors wrote.

4. Describe familiar comparisons to convey risk

Comparing radiation from a medical imaging procedure to the radiation from, say, “the amount of radiation one would receive during a common commercial flight,” can help the parents or guardians of pediatric patients better understand the situation and potentially feel less anxiety.

5. Use technology as a supplement to face-to-face communication

The parents or guardians of pediatric patients are sure to turn to various websites, social media resources and smartphone applications for more information about radiation in medical imaging. If radiologists research such resources, they can discuss them as needed when examinations are being discussed.

“Patients may trust physicians more if their statements are confirmed by the patients’ own research, and patients or parents using their own technology may feel a greater sense of control,” the authors wrote. “Radiologists can research available tools and ask their patients which tools they use and enjoy; in turn, future patients can be provided with recommendations for sites, apps, and other resources to learn more about their examinations.”