Imagers, patients agree on best practice for radiation risk disclosure—but is it clinically practical?

Imagers and patients agree fundamentally on risk communication strategies when it comes to radiation exposure in medical imaging. Actually implementing those beliefs, though, could be a clinical challenge, new research out of Australia suggests.

“For radiographers, gaining informed consent with our patients represents a challenging undertaking,” first author Cameron W.E. Younger, a lecturer in the School of Health Sciences at the University of Newcastle, and colleagues wrote in Radiography. “Reconciling the need to gain meaningful consent with time pressures represents one challenge, as does differing expectations of how risk communication should be undertaken.”

Though the idea of informed consent has existed for decades, the authors said, an Australian High Court ruling in 1992 mandated doctors were obligated to disclose all possible material risks for a proposed course of treatment. Risks were considered material if, in the circumstances of the case, a reasonable person in the patient’s position would likely attach significance to it.

Imaging exams “represent an unusual case in risk disclosure,” Younger et al. wrote, since the majority involve ionizing radiation and carry with them the stigma of cancer risk, even if it’s small. And, because the risk can be minimal, many physicians gloss over the conversation altogether for times’ sake.

“When recommending a medical imaging examination using ionizing radiation, in the majority of cases, referring physicians do not disclose the radiation risk and are often unaware that a risk even exists,” the authors said. “Lack of awareness of the risks associated with higher-dose examinations such as CT scanning is particularly concerning, as CT has sustained rapid growth for over two decades, often at a much higher rate than population growth, with ‘no sign of reaching a plateau.’”

In an effort to assess and harmonize imaging professionals’ and patients’ expectations for risk disclosure, Younger and the research team distributed a survey to a total of 293 participants—121 radiology technologists and 172 members of the public. Respondents were asked about their preferences for receiving ionizing radiation risk information, who they’d like to deliver that information and how they’d like it delivered. They were also asked about the threshold of ionizing radiation cancer risk they’d consider “material.”

Both population groups answered the survey similarly, the authors reported—all respondents showed a clear majority in wanting to know every risk possible and desired human interaction as their preferred method of communication. The average acceptance of human interaction was 90 percent among participants; other popular modes of delivery were information pamphlets, websites and phone apps.

The authors also found all technologists and patients preferred to hear about risks from radiologists, then technologists, radiology registrars, general practitioners or emergency department physicians, in that order. They also discovered patients preferred to be told about their chances of recovery in the form of simple odds or a graph rather than descriptive or fractional comparisons. 

Younger and colleagues said it’s ideal that patients and practitioners agree on methods of communication when it comes to the informed consent, but agreement itself doesn’t ensure sustainable practice.

“The practice must also be practicable,” they wrote. “In discussing material risks, this research found that both respondent groups reached agreement on disclosing a level of risk which may be impractical in the clinical setting.”

Conducting business the way both groups indicated would likely result in increasingly long exam times, the researchers said—time hospital staff just don’t have. The system will have to grapple with ensuring quality care, managing time and conserving money to strike a favorable balance. 

In the meantime, they said, practices might want to consider a shared model of informed consent where the referring physician and technologist administering the exam divide risk disclosure among themselves. 

“Generally, the views of radiographers on informed consent are well-aligned with the views of members of the public,” Younger et al. said. “However, this level of risk disclosure comes at the cost of a potentially substantial time commitment, and this may not be practical.”