Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114, USA.
AJR Am J Roentgenol. 2013 Jun;200(6):1275-83. doi: 10.2214/AJR.12.10011.
The purpose of this article is to evaluate the influence of patient radiation exposure histories on radiologists' imaging decisions.
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).
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.
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.
本文旨在评估患者辐射暴露史对放射科医生影像学决策的影响。
我们在三家学术医疗中心进行了一项医师调查研究。放射科医生被要求为一名有多次 CT 扫描史的假设患者提出影像学建议。我们查询了放射科医生的决策，评估他们是否将先前影像学检查的癌症风险纳入考量，报告对线性无阈模型的接受（或拒绝）情况，并了解在此背景下线性无阈模型的含义。评估放射科医生的决策与其线性无阈模型信念之间的一致性；预计那些符合线性无阈模型的人会忽略先前发生的癌症风险。使用 Fisher 精确检验来验证结果在机构和培训水平（住院医师、研究员和主治医生）上的普遍性。
56%（322/578）的放射科医生完成了调查。大多数（92%[295/322]）在决策过程中考虑了患者暴露史带来的风险。大多数（61%[196/322]）也报告接受了线性无阈模型。较少（25%[79/322]）拒绝线性无阈模型；15%（47/322）无法判断。在报告接受或拒绝线性无阈模型的放射科医生中，少数（36%[98/275]）的决策与他们的线性无阈模型信念一致。这一发现并未因机构（p=0.070）或培训水平（p=0.183）的不同而有所不同。少数放射科医生（4%[13/322]）对线性无阈模型的含义有准确的理解。
当面对患者的暴露史时，大多数放射科医生的决策与他们自我报告的对线性无阈模型的接受以及线性无阈模型本身相矛盾。这些发现强调了教育计划的必要性。
