title: Journal club: How radiation exposure histories influence physician imaging decisions: a multicenter radiologist survey study.
abstract: OBJECTIVE
  The purpose of this article is to evaluate the influence of patient radiation exposure histories on radiologists' imaging decisions.
  
  
  METHODS
  We conducted a physician survey study in three academic medical centers. Radiologists were asked to make an imaging recommendation for a hypothetical patient with a history of multiple CT scans. We queried radiologists' decision making, evaluating whether they incorporated cancer risks from previous imaging, reported acceptance (or rejection) of the linear no-threshold model, and understood linear no-threshold model implications in this setting. Consistency between radiologists' decisions and their linear no-threshold model beliefs was evaluated; those acting in accordance with the linear no-threshold model were expected to disregard previously incurred cancer risks. A Fisher exact test was used to verify the generalizability of results across institutions and training levels (residents, fellows, and attending physicians).
  
  
  RESULTS
  Fifty-six percent (322/578) of radiologists completed the survey. Most (92% [295/322]) incorporated risks from the patient's exposure history during decision making. Most (61% [196/322]) also reported acceptance of the linear no-threshold model. Fewer (25% [79/322]) rejected the linear no-threshold model; 15% (47/322) could not judge. Among radiologists reporting linear no-threshold model acceptance or rejection, the minority (36% [98/275]) made decisions that were consistent with their linear no-threshold model beliefs. This finding was not statistically different across institutions (p = 0.070) or training levels (p = 0.183). Few radiologists (4% [13/322]) had an accurate understanding of linear no-threshold model implications.
  
  
  CONCLUSIONS
  Most radiologists, when faced with patient exposure histories, make decisions that contradict their self-reported acceptance of the linear no-threshold model and the linear no-threshold model itself. These findings underscore a need for educational initiatives.
authors.affiliation: Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114, USA. pari@mgh-ita.org
authors.forename: Pari V
authors.initials: PV
authors.lastname: Pandharipande
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Eisenberg
authors.forename: Laura L
authors.initials: LL
authors.lastname: Avery
authors.forename: Martin L
authors.initials: ML
authors.lastname: Gunn
authors.forename: Stella K
authors.initials: SK
authors.lastname: Kang
authors.forename: Alec J
authors.initials: AJ
authors.lastname: Megibow
authors.forename: Ekin A
authors.initials: EA
authors.lastname: Turan
authors.forename: H Benjamin
authors.initials: HB
authors.lastname: Harvey
authors.forename: Chung Yin
authors.initials: CY
authors.lastname: Kong
authors.forename: Emily C
authors.initials: EC
authors.lastname: Dowling
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: Karen
authors.initials: K
authors.lastname: Donelan
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
mesh_terms: D000046:Academic Medical Centers; D003657:Decision Making; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011829:Radiation Dosage; D011835:Radiation Protection; D012306:Risk; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014481:United States