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An exploration of Canadian emergency physicians' and residents' knowledge of computed tomography radiation dosing and risk

  • David Barbic (a1), Skye Barbic (a2) and Jerrald Dankoff (a3)

Abstract

Objective: The objective of this study was to measure the current knowledge of Canadian emergency physicians and emergency medicine residents regarding computed tomography (CT) radiation dosing and its associated risks.

Methods: Three focus groups were conducted as the qualitative element of this study. Cognitive debriefing was carried out to ensure the validity and reliability of the focus group findings and to aid with survey development. A 26-item electronic survey was developed and pilot tested for distribution to the membership of the Canadian Association of Emergency Physicians.

Results: Eighteen emergency medicine physicians and three emergency medicine residents participated in the focus groups. Four major themes emerged: 1) physician knowledge of risks associated with CT, 2) risk management strategies, 3) communication, and 4) knowledge translation. The survey response rate was 49.8% (638 of 1,281). The mean respondent age was 40.9±9.9 years, and 70.7% were male. Of all respondents, 82.5% were actively practicing attending physicians, 56.4% of all respondents practiced in urban academic emergency departments, and the average time practicing was 10.7±9.6 years. Radiography and CT were correctly identified by 92.2% and 95.1% of respondents, respectively, as sources of ionizing radiation, whereas magnetic resonance imaging and ultrasonography were selected by 1.0% and 0.5%, respectively. With respect to the lifetime attributable risk (LAR) of malignancy due to CT, 82.2% of participants correctly identified that abdominal CT increases the risk of cancer by 0.2 to 2%, whereas 51.3% correctly identified that the LAR increases twofold in a 7- year-old boy. When asked to identify populations at risk for potential harm due to ionizing radiation, 92.2% of respondents identified children, 80.3% identified pregnant women, and 71.4% identified women of reproductive age. A minority (37.2%) reported communicating the potential risks of CT to a majority of their patients. Electronic platforms were identified by 74.8% of respondents as their preferred method of knowledge translation on this topic.

Conclusions: Canadian emergency medicine physicians and emergency medicine residents demonstrated identifiable gaps in knowledge surrounding CT radiation dose and risk.

Objectif: L’étude visait à mesurer les connaissances actuelles des médecins d’urgence et des résidents en médecine d’urgence au Canada en ce qui concerne les doses de rayonnement émis par la tomodensitométrie (TDM) et les risques associés.

Méthode: Trois groupes de discussion ont été formés à titre d’élément qualitatif de l’étude. Nous avons procédé à un bilan cognitif afin de nous assurer de la validité et de la fiabilité des conclusions auxquelles en étaient arrivés les groupes de discussion, et de faciliter l’élaboration de l’enquête. Un questionnaire électronique en 26 points a été élaboré , puis soumis à un essai pilote en vue de sa distribution aux membres de l’Association canadienne des médecins d’urgence.

Résultats: Dix-huit médecins d’urgence et trois résidents en médecine d’urgence ont participé aux groupes de discussion. Se sont dégagés des échanges quatre grands thèmes: 1) les connaissances des médecins concernant les risques associés à la TDM; 2) les stratégies de prise en charge des risques; 3) les communications; et 4) l’application des connaissances. Le taux de réponse à l’enquête a atteint 49.8% (638 membres sur 1281). L’âge moyen des répondants était de 40.9±9.9 ans, et 70.7% d’entre eux étaient des hommes. Par ailleurs, 82.5% des répondants se sont déclaré smédecins traitants en pratique active; 56.4% des participants exerçaient dans des services d’urgence d’hôpitaux universitaires en milieu urbain, et la durée moyenne de la pratique s’élevait à 10.7±9.6 ans. La radiographie et la TDM ont été relevées correctement par 92.2% et 95.1% des répondants, en âge de procréer. Une minorité (37.2%) de participants a indiqué faire part des risques de la TDM à la majorité des patients. Enfin, 74.8% des répondants ont indiqué qu’ils préféraient les moyens électroniques comme outil d’application des connaissances dans le domaine.

Conclusions: L’enquête a mis en évidence des lacunes bien définies en matière de connaissances sur les doses de rayonnement émis par la TDM et les risques associés, parmi les médecins d’urgence et les résidents en médecine d’urgence au Canada.

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Copyright

Corresponding author

Correspondence to: Dr. David Barbic, Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5; david.barbic@gmail.com.

References

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