Caution is required, however, to ensure that information on this potentially controversial topic is related to patients in the most appropriate way. “The question isn’t whether you should inform patients about dose,” Judd says, “but rather, how can you let them know that the dose they’re receiving is justified. It’s a challenge to communicate that well because it’s a complicated question.”
Organizations should begin by making full use of their dose-monitoring and -reporting software to create meaningful checks and balances, Judd says. “That’s a valuable message to be able to communicate to the patient: that qualified professionals have agreed that this is the right procedure and the right dose,” he points out.
Judd recommends that organizations be as transparent as possible regarding the referral and justification process. “Communicate to patients that their cumulative dose and prior imaging history are being used during the decision-making process,” he says. “They should know that you are checking to see whether requests are duplicative or in error. It’s comforting to patients who might not remember all of their own medical histories to know that you are looking back in time to ensure appropriateness.”
After patients have been informed of the facility’s procedures for ensuring exam appropriateness and safety, Judd suggests pointing them to vetted informational resources for further education. “Patients need unambiguous, direct, and layman-friendly information on imaging procedures and radiation dose,” he says. “The message is that you’re protecting patients as much as you can, you’re being as transparent as you can, and you have specific information sources you can point them to so they can educate themselves.”
What not to do
Radiation is poorly understood by the general public, and well-publicized incidents of excessive dose associated with some CT exams haven’t helped the situation. “The problem with the entire subject, as far as communicating with patients is concerned, is creating a measurement that will be meaningful to them,” Judd says. “Just telling patients what the actual dose was, in milligrays, doesn’t create the context they need.”
A recent update to JCAHO standards states that as of July 1 of this year, all hospitals that have CT scanners that record dose must print patient dose on reports. Judd cautions, however, against introducing the concept of excessive radiation. “What is too much? In certain contexts, there’s no such thing,” he notes. “The fact of the matter is that there are very few cases where last year’s radiation has any bearing on today’s radiation. The basic concept should always be to ensure that the risk of damage from the radiation is outweighed by expected clinical benefits of the procedure.”
As a result, he says, “I would very much warn providers away from issuing raw figures to patients. Instead a message that the procedure was carried out without any issues and within acceptable parameters. Issuing raw data may send a very dangerous message, and it may result in a patient’s refusal of a necessary procedure because he or she believe that it will involve too much radiation to be safe.”
Rather, organizations should put the focus squarely on publicizing their established processes for ensuring the use of minimal (and clinically appropriate) radiation. “Your physicians, helped by the right imaging technology and dose-monitoring software, are considering and justifying each request for radiation on its own merits, and that’s the message you want to share,” Judd says.
“Organizations shouldn’t publish their results in a table—how could you compare a pediatric and an oncology center with one another? Instead, they should explain the processes that they go through to determine whether exams are safe and appropriate. When your organization is making the investment in putting patient care before profits, that’s a very powerful message to share with the public,” he concludes.