Westra Sjirk J
Division of Pediatric Radiology, Massachusetts General Hospital, 34 Fruit St., White 246A, Boston, MA, 02114, USA,
Pediatr Radiol. 2014 Oct;44 Suppl 3:525-33. doi: 10.1007/s00247-014-3087-9. Epub 2014 Oct 11.
In order to personalize the communication of the CT risk, we need to describe the risk in the context of the clinical benefit of CT, which will generally be much higher, provided a CT scan has a well-established clinical indication. However as pediatric radiologists we should be careful not to overstate the benefit of CT, being aware that medico-legal pressures and the realities of health care economics have led to overutilization of the technology. And even though we should not use previously accumulated radiation dose to a child as an argument against conducting a clinically indicated scan (the "sunk-cost" bias), we should consider patients' radiation history in the diagnostic decision process. As a contribution to future public health, it makes more sense to look for non-radiating alternatives to CT in the much larger group of basically healthy children who are receiving occasional scans for widely prevalent conditions such as appendicitis and trauma than to attempt lowering CT use in the smaller group of patients with chronic conditions with a limited life expectancy. When communicating the CT risk with individual patients and their parents, we should acknowledge and address their concerns within the framework of informed decision-making. When appropriate, we may express the individual radiation risk, based on estimates of summated absorbed organ dose, as an order of magnitude rather than as an absolute number, and compare this with the much larger natural cancer incidence over a child's lifetime, and with other risks in medicine and daily life. We should anticipate that many patients cannot make informed decisions on their own in this complex matter, and we should offer our guidance while maintaining respect for patient autonomy. Proper documentation of the informed decision process is important for future reference. In concert with our referring physicians, pediatric radiologists are well-equipped to tackle the complexities associated with the communication of CT risk, a task that often falls upon us, and by becoming more involved in the diagnostic decision process we can add value to the health care system.
为了使CT风险的沟通更具个性化，我们需要在CT临床获益的背景下描述风险。如果CT扫描有明确的临床指征，那么其临床获益通常会高得多。然而，作为儿科放射科医生，我们应注意不要夸大CT的益处，因为要意识到医疗法律压力和医疗保健经济学的现实已导致该技术的过度使用。尽管我们不应将儿童先前累积的辐射剂量作为反对进行临床指征扫描的理由（“沉没成本”偏差），但在诊断决策过程中，我们应考虑患者的辐射史。为了对未来的公共卫生做出贡献，对于大量基本健康、因阑尾炎和创伤等普遍疾病偶尔接受扫描的儿童，寻找CT的非辐射替代方法比试图减少预期寿命有限的慢性病患者群体的CT使用更有意义。在与个体患者及其家长沟通CT风险时，我们应在知情决策的框架内承认并解决他们的担忧。在适当的时候，我们可以根据累积吸收器官剂量的估计，将个体辐射风险表示为一个数量级，而不是绝对数字，并将其与儿童一生中高得多的自然癌症发病率以及医学和日常生活中的其他风险进行比较。我们应预料到，许多患者无法自行就这一复杂问题做出知情决策，我们应提供指导，同时尊重患者的自主权。对知情决策过程进行适当记录以供将来参考很重要。与我们的转诊医生协同合作，儿科放射科医生完全有能力应对与CT风险沟通相关的复杂性，这一任务常常落在我们身上，通过更多地参与诊断决策过程，我们可以为医疗保健系统增添价值。
