Radiation-safety ‘knowledge gaps’ not hard to find in the emergency room

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Actionable awareness of radiation concerns is spotty in the emergency department, with midlevel providers who order imaging (mainly nurse practitioners and physician assistants) making factual errors and emergency-medicine residents shying away from counseling patients about imaging-related radiation risks. And attending docs struggle with the counseling piece too.  

At least, that the case at one five-hospital, university-affiliated health system, according to a study running in the September edition of the Journal of the American College of Radiology.

Corresponding author Tarek N. Hanna, MD, of Emory University and colleagues sent an electronic questionnaire to 210 ED providers (41 attending physicians, 32 residents, 31 midlevel providers) within their health system.

More than half responded (n = 106), and, upon analyzing the results, the researchers found that more than two in five providers (44.6 percent) could not correctly identify which of six common imaging modalities uses ionizing radiation.

Midlevel providers were more likely than the other provider categories to incorrectly identify as modalities that did not use ionizing radiation radiography (25 percent) and fluoroscopy (29 percent).

Midlevel providers were also more likely to incorrectly rank a selection of imaging tests by radiation exposure and to incorrectly answer a question on the effects of ionizing radiation on patients.

Meanwhile, fewer attending physicians (14.6 percent) than residents (37.5 percent) were not very comfortable or were uncomfortable explaining the risks of radiation to patients.

And almost half of attending physicians (47.5 percent) and nearly three-quarters of residents (71.9 percent) were not very comfortable, were uncomfortable, or were extremely uncomfortable explaining the amount of radiation in certain imaging tests to patients.

In their discussion, lead author Noah Ditkofsky, MD, of the University of Toronto and colleagues at Emory note that their findings are consistent with previous analyses of knowledge gaps around imaging radiation exposure.

But theirs is likely the first study to compare knowledge rates among the three ED provider categories.  

Knowledge gaps among ED providers regarding radiation safety, exposure and dose “may affect ED patient care,” note the authors, who acknowledge among their study’s limitations its small, single-institution sample, which may undercut its generalizability.

Moves can be made to close these gaps, they add, by taking such measures as increasing radiation education “at all stages of medical training, from preclinical lectures to attending-level continuing medical education.”

“The implementation of credentialing programs and on-the-job training is an additional option,” the authors write. “Residents, interns and faculty members should look to physicians in the field of radiology as a source of radiation safety knowledge.

“With radiologist leadership, educational modules in both residency and MLP training programs may help alleviate these knowledge gaps.”