The risks of medical imaging: a survey of doctors' knowledge and consenting practice

Master Thesis


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University of Cape Town

Background: Diagnostic imaging forms an integral part of patient evaluation and its use has increased dramatically. Not only is medical imaging a source of increased radiation dose, but also poses other risks such as those related to the procedure performed, the contrast and drugs administered, acoustic and heat deposition and para-magnetic risks. While many studies have assessed doctors' knowledge of radiation risk, data regarding doctors' knowledge of the remaining risks of medical imaging and doctors' attitudes toward consenting practice for imaging is lacking. Aim: To survey and compare the levels of knowledge between referring clinicians and radiologists regarding the risks to patients undergoing medical imaging and to explore doctors' attitudes toward consenting practice. Method: A cross sectional, observational, descriptive study design was employed. The study was conducted using a non-validated, piloted, self-administered three-page questionnaire. The questionnaire was distributed to doctors in various stages of their medical careers at a tertiary level hospital. The questionnaire was constructed in sections including demographics, risks of medical imaging and consent practice. The maximum score potentially attainable was 79, with a point given for each correct answer. No points were given for incorrect, unsure or blank responses. Results: A total of 431 questionnaires were distributed but only 85 doctors (19 radiologists and 66 clinicians) returned a completed survey, yielding a response rate of 19,7%. Older respondents with more years of experience had greater levels of knowledge regarding the risks of medical imaging. There were no significant differences according to gender or university. Although the levels of knowledge of risk was poor overall, radiologists had greater levels of knowledge (mean knowledge score expressed as a percentage =79% compared to that of clinicians= 71%). The largest proportion of doctors' (49%) were of the opinion that clinicians should be responsible for obtaining consent for medical imaging. Only 18% of doctors (radiologists and clinicians) and 5% of clinicians admitted to feeling adequately prepared to obtain consent for medical imaging. Conclusion: We successfully surveyed and compared the levels of knowledge of medical imaging risks amongst doctors and determined their attitudes toward responsibility for consent. The levels of knowledge of the risks of medical imaging is inadequate among radiologists and poor amongst non-radiologists. While statutory body guidelines recommend that the performing health care provider obtain consent, there remains varying opinion as to who should obtain consent. The largest proportion of doctors' were of the opinion that clinicians should obtain consent for medical imaging - this despite clinicians' feelings of inadequacy when consenting patients to the risks of imaging. It is therefore important to take into consideration the levels of knowledge and comfort when making decisions as to who is best suited to obtain consent for medical imaging. With the increased dependence on medical imaging as part of the diagnostic work up, awareness of the risks of medical imaging is of tantamount importance. It is essential to review educational curricula and local policies in order to improve the levels of knowledge of risks of medical imaging amongst healthcare providers, thereby ensuring improved patient safety.