AR: Radiation education unlikely to change CT ordering patterns
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With the risks of radiation exposure in the spotlight and the continued rise in CT scans, healthcare providers, the government and payors are attempting to curb inappropriate CT utilization.
Despite a lack of background education in radiation issues, nonradiologist clinicians are on the CT front lines, ordering studies and responding to patient questions, explained Jeanne M. Horowitz, MD, from the department of radiology at Feinberg School of Medicine, Northwestern University in Chicago, and colleagues.
Horowitz and colleagues devised a study to determine if attending a one-hour lecture would alter CT ordering patterns of orthopedic and radiology residents and also to gauge the interest of referring clinicians in such education programs.
Thirty-six physicians attended the lecture, which included background data about radiation risk, techniques to limit dose (automated tube current modulation, limiting the number of phases, weight-based protocols and iterative reconstruction) and tips for patient education.
Twenty-one participants returned the survey, and 90 percent reported that CT ordering remained constant after the lecture. Residents cited the clinical necessity of the exam and the utility of CT as common reasons for CT studies. CT ordering decreased for the remaining two residents.
Of the 10 urology residents attending the lecture, 30 percent reported ordering different types of CT studies, specifically noncontrast low-dose renal stone CT, a two-phase CT urography protocol and triphasic renal CT studies. The researchers noted that the array of CT protocols in some specialties can be confusing, and optimized protocols can better utilize resources and decrease radiation risk.
Thirty-three percent of physicians reported an increase in MRI and ultrasound orders after the lecture.
Eight respondents used information from the lecture to discuss CT benefits and risks with patients, wrote Horowitz and colleagues.
“The relatively small percentage of clinicians who indicated they had reduced their CT ordering volumes perceived after the lecture should further encourage radiologists to educate their fellow physicians on CT radiation safety and risk,” according to the authors. They noted that some radiologists may be reluctant to provide such education, fearing that it might reduce referrals.
Horowitz and colleagues pointed to several benefits of radiation education, including: the most appropriate utilization of CT scans, reassurance to clinicians regarding the benefits of CT and reassurance to patients.
The authors pointed to other outcomes of the lectures, as additional physician groups requested similar lectures after the initial series. “This shows that referring physician groups are interested and willing to listen about this topic, and there is the potential for a larger education effort for referring physicians throughout our and perhaps all institutions.”
Horowitz and colleagues suggested that radiology groups designate a single radiologist to give lectures and they noted such services can strengthen relationships between radiologists and referring physicians. They also advised radiologists to share the Image Wisely campaign and American College of Radiology's (ACR) Appropriateness Criteria with referring physicians and recommended that radiologists include a short demonstration of the ACR Appropriateness Criteria search engine during radiation education lectures.
Finally, they emphasized that education should begin in medical school and suggested that future research include pre- and post-lecture questionnaires, quantitative ordering data and assessments of behavior and attitudes.
To visit Image Wisely, click here.
To view the ACR Appropriateness Criteria, click here.