Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
OBJECTIVE
Increased computer tomography (CT) scan use has contributed to a rise in medically-associated radiation exposure. The extent to which clinicians consider radiation exposure when ordering imaging tests is unknown. We examined (1) outpatient clinician attitudes towards considering radiation exposure when ordering CT scans; and (2) clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry.


METHODS
We conducted nine focus groups with primary care clinicians and subspecialty physicians (nephrology, pulmonary and neurology) (n=50) who deliver outpatient care across 12 hospital-based clinics and community health centres in an urban safety-net health system, which use a common electronic order entry system. We analysed focus group transcripts using an inductive framework to identify emergent themes and illustrative quotations.


RESULTS
Clinicians felt they had limited knowledge of the clinical implications of radiation exposure. Many believed clinically relevant information such as the increased risk of malignancy from CT scans would be useful to inform decision-making and patient-clinician discussions. Clinicians noted that patient vulnerability and long wait times for tests with less radiation exposure (such as MRI or ultrasound) often acted as barriers to minimise patient radiation exposure from CT scans. Clinicians suggested providing patients' cumulative radiation exposure or formal decision aids to improve the usefulness of the radiation exposure information.


CONCLUSIONS
Displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging. However, limited access to tests with lower radiation exposure in safety-net settings may trump efforts to minimise patient radiation exposure.
Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA.
Jenna F
JF
Kruger
Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA.
Alice Hm
AH
Chen
Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA.
Alex
A
Rybkin
Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA.
Kiren
K
Leeds
UCLA Division of General Internal Medicine & HSR, Department of Medicine, Palo Alto Medical Foundation Research Institute; Gordon & Betty Moore Foundation, Palo Alto, California, USA.
Dominick L
DL
Frosch
Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA.
L Elizabeth
LE
Goldman
D003657:Decision Making; D003952:Diagnostic Imaging; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011829:Radiation Dosage; D012495:San Francisco
Attitudes; Health services research; Qualitative research; Shared decision making