Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-18T01:18:46.288Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  01 April 2015

David Barbic ,
Skye Barbic  and
Jerrald Dankoff
David Barbic*
Affiliation:
Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON
Skye Barbic
Affiliation:
Social Aetiology of Mental Illness Program, Centre for Addiction and Mental Health, Toronto, ON
Jerrald Dankoff
Affiliation:
Emergency Department, Jewish General Hospital, Montreal, QC.
*
Correspondence to: Dr. David Barbic, Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5; david.barbic@gmail.com.

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Résumé

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.

Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 2 , March 2015 , pp. 131 - 139
Copyright
Copyright © Canadian Association of Emergency Physicians 2015 

References

1. Broder, J, Warshauer, DM. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 2006;13:25–30, doi:10.1007/s10140-006-0493-9.CrossRefGoogle ScholarPubMed
2. Lee, J, Kirschner, J, Pawa, S, et al. Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007. Ann Emerg Med, 2010 56:591–6.e1, doi:10.1016/j.annemergmed.2010.05.027.CrossRefGoogle ScholarPubMed
3. Broder, J, Fordham, LA, Warshauer, DM.. Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006. Emerg Radiol 2007;14:227–232, doi:10.1007/s10140-007-0618-9.CrossRefGoogle ScholarPubMed
4. Larson, DB, Johnson, LW, Schnell, BM, et al.. National trends in CT use in the emergency department: 1995–2007. Radiology 2011;258:164–173, doi:10.1148/radiol.10100640.CrossRefGoogle ScholarPubMed
5. Larson, DB, Johnson, LW, Schnell, BM, et al.. Rising use of CT in child visits to the emergency department in the United States, 1995-2008. Radiology 2011;259:793–801, doi:10.1148/radiol.11101939.CrossRefGoogle Scholar
6. Randen, A, Laméris, W. EsHW, et al. Profiles of US and CT imaging features with a high probability of appendicitis. Eur Radiol 2010;20:1657–1666, doi:10.1007/s00330-009-1706-x.CrossRefGoogle Scholar
7. Eray, O, Cubuk, M, Oktay, YC, et al. The efficacy of urinalysis, plain films, and spiral CT in ED patients with suspected renal colic. Am J Emerg Med 2003;21:152–154, doi:10.1053/ajem.2003.50027.CrossRefGoogle ScholarPubMed
8. Hof, KHI, Krestin, GP, Steijerberg, EW, et al. Interobserver variability in CT scan interpretation for suspected acute appendicitis. Emerg Med J 2009;26:92–94, doi:10.1136/emj.2008.058990.CrossRefGoogle Scholar
9. Remy-Jardin, M, Remy, J. Spiral CT angiography of the pulmonary circulation. Radiology 1999;212:615–636, doi:10.1148/radiology.212.3.r99se02615.CrossRefGoogle ScholarPubMed
10. Berrington de Gonzalez, A, Mahesh, M, Kim, KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009;169:2071 doi:10.1001/archinternmed.2009.440.CrossRefGoogle ScholarPubMed
11. Smith-Bindman, R, Lipson, J, Marcus, R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009;169:2078–2086, doi:10.1001/archinternmed.2009.427.CrossRefGoogle ScholarPubMed
12. Brenner, DJ, Hall, EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007;357:2277–2284, doi:10.1056/NEJMra072149.CrossRefGoogle ScholarPubMed
13. Eisenberg, MJ, Afilalo, J, Lawler, PR, et al. Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction. CMAJ 2011;183:430–436, doi:10.1503/cmaj.100463.CrossRefGoogle ScholarPubMed
14. Lee, CI, Haims, AH, Monico, EP, et al. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 2004;231:393–398, doi:10.1148/radiol.2312030767.CrossRefGoogle ScholarPubMed
15. Shiralkar, S, Rennie, A, Snow, M, et al. Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 2003;327:371–372, doi:10.1136/bmj.327.7411.371.CrossRefGoogle ScholarPubMed
16. Keijzers, GB, Britton, CJ. Doctors’ knowledge of patient radiation exposure from diagnostic imaging requested in the emergency department. Med J Aust 2010;193:450–453.CrossRefGoogle ScholarPubMed
17. Frankel, RM, Devers, KJ. Study design in qualitative research—2: sampling and data collection strategies. Educ Health Change Learn Pract 2000;13:263–271, doi:10.1080/13576280050074543.Google Scholar
18. Glaser, BG.. The discovery of grounded theory: strategies for qualitative research. Chicago Aldine Publishing; 1967.Google Scholar
19. Lincoln, Y. Naturalistic inquiry. Beverley Hills (CA) Sage; 1985.CrossRefGoogle Scholar
20. Dillman, DA. Mail and Internet surveys: the tailored design method, 2nd ed. New York John Wiley & Sons; 2000.Google Scholar
21. Griffey, RT, Sodickson, A. Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol 2009;192:887–892, doi:10.2214/AJR.08.1351.CrossRefGoogle ScholarPubMed
22. Brenner, D, Elliston, C, Hall, E, et al. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289–296, doi:10.2214/ajr.176.2.1760289.CrossRefGoogle ScholarPubMed
23. de Jong, PA. Estimation of cancer mortality associated with repetitive computed tomography scanning. Am J Respir Crit Care Med 2005;173:199–203, doi:10.1164/rccm.200505-810OC.CrossRefGoogle ScholarPubMed
24. Busey, JM, Soine, LA, Yager, JR. Patient knowledge and understanding of radiation from diagnostic imaging. Arch Intern Med 2012 doi:10.1001/2013.Google Scholar
25. Canadian Institute for Health Information. Emergency departments and children in Ontario. Available at: https://secure.cihi.ca/estore/productFamily.htm?locale5en&pf5PFC1008&lang5en&media50 (accessed January 3, 2013)..Google Scholar
26. Lang, ES, Wyer, PC, Eskin, B. Executive summary: knowledge translation in emergency medicine: establishing a research agenda and guide map for evidence uptake. Acad Emerg Med 2007;14:915-8 doi:10.1111/j.1553-2712.2007.tb02364.x.CrossRefGoogle Scholar
27. Lang, ES, Wyer, P, Tabas, JA, et al. Educational and research advances stemming from the academic emergency medicine consensus conference in knowledge translation. Acad Emerg Med 2010;17:865–869, doi:10.1111/j.1553-2712.2010.00825.x.CrossRefGoogle ScholarPubMed
28. Kawamoto, K. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005;330:765 doi:10.1136/bmj.38398.500764.8F.CrossRefGoogle ScholarPubMed
29. Vollmar, HC, Schürer-Maly, C-C, Frahne, J, et al. An elearning platform for guideline implementation—evidenceand case-based knowledge translation via the Internet. Methods Inf Med 2006;45:389–396.Google ScholarPubMed
30. Shershneva, MB, Harper, PL, Elsinger, LM, et al. Facilitating multiorganizational smoking cessation knowledge translation through on-line toolkit for educators and clinicians. J Contin Educ Health Prof 2010;30:149–150, doi:10.1002/chp.20072.CrossRefGoogle ScholarPubMed
31. Nagykaldi, Z, Mold, JW. The role of health information technology in the translation of research into practice: an Oklahoma Physicians Resource/Research Network (OKPRN) study. J Am Board Fam Med 2007;20:188–195, doi:10.3122/jabfm.2007.02.060084.CrossRefGoogle ScholarPubMed
32. Wright, KB. Researching Internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and Web survey services. J Comput Mediat Commun 2006;10:00–00, doi:10.1111/j.1083-6101.2005.tb00259.x.CrossRefGoogle Scholar