Knowing the Enemy: Health Care Provider Knowledge of Computed Tomography Radiation Dose and Associated Risks

BackgroundThere is ionizing radiation and associated risk from many medical imaging examinations, especially computed tomography (CT). Unfortunately, health care providers often have limited knowledge regarding radiation dose levels and potential risk.Research objectivesTo assess knowledge of dose levels and risk among referring physicians, imaging technologists, and radiologists in Saskatoon, Saskatchewan, and to identify potential differences between and within those groups.Materials and methodsA survey was designed and administered to health care professionals.ResultsA total of 308 of 328 surveys were completed (91% response rate). Overall 73% of physicians, 97% of radiologists, and 76% of technologists correctly believed that there is a risk for cancer from an abdomen–pelvic CT scan. Although only 18% of physicians, 28% of radiologists, and 22% of technologists selected the most appropriate estimate of abdominal–pelvic CT dose in terms of chest x-ray equivalents, this is similar to other reported studies. Physicians and technologists who use CT were more likely to select the correct dose than those who do not. Most respondents (91% of physicians, 100% of radiologists, and 100% of technologists) felt that pregnant patients should always be informed about radiation dose as a risk. Although frequency of discussing risk decreased with increasing patient age, technologists were more likely to discuss risk at any age. A total of 93% of respondents expressed interest in receiving dose feedback from medical imaging procedures.ConclusionsRadiologists and technologists generally showed better knowledge than referring physicians. Among physicians and technologists, knowledge was better in those who use CT than those who do not.     

Supporting Radiation Therapy Patients with Limited Health Literacy

Health literacy is one of the most important determinants of patient outcome. Literacy levels are influenced by factors such as formal education status, socioeconomic circumstances, age, language, cultural background, and employment status. Few health professionals are aware of health literacy issues, and even fewer can accurately address them. The purpose of this review article was to bring attention to the issue of health literacy, to provide information on how to identify patients at risk of limited health literacy, and to develop communication strategies designed to support cancer patients and their families. This article also aimed to develop and identify specific tools for radiation therapists and the radiation medical science community based on literature, evidence, and educational material from nursing and other allied professions. Health care organizations and professionals need to be aware of their duty to ensure that patients fully comprehend both the complex and simple information presented. Improving comprehension related to health choices leads to better decision making by the patient, improves patient outcomes, reduces hospitalization rates, and cuts health care costs.     

Changes in Shielding Practice for Radiographers—Implications for Radiologic and Imaging Nursing

The American Association of Physicists in Medicine (AAPM) published a position statement regarding the limitation of fetal and gonadal shielding in radiographic imaging procedures. For the imaging community, this statement was alarming, as shielding patients was one of the longest-held principles of imaging technologists. In an effort to alleviate the concerns of technologists and other professionals working in medical imaging, the AAPM created a committee of professionals in the field to disseminate education about the change called the Communicating Advances in Radiation Education Committee. This committee published a frequently asked questions document addressing the concerns of technologists and educators in the field of medical imaging and providing guidance on educating patients and other health professionals. This article seeks to provide an overview of the change in shielding practice, the science that fueled the change, and the implications for healthcare professionals and patients in the medical imaging department. Although technologists, nurses, and any other participating personnel proximal to radiation production must protect themselves, in most instances, patients do not need to be shielded and in fact, may be harmed by the use of shields. Future research should focus on the attitudes of technologists and patients toward shielding and whether or not all medical professionals and the public are informed about shielding recommendations.     

糖尿病患者授权能力与健康素养的相关性研究

目的:调查糖尿病患者的授权能力与健康素养水平,了解患者授权和健康素养现状,并探讨两者之间的关系,以了解其对健康状况的影响,为糖尿病的防治提供参考。方法:通过便利抽样方法选取某省5所三级甲等综合医院住院的糖尿病患者作为研究对象,采用一般资料调查表、糖尿病授权简化量表、慢性病健康素养量表,调查糖尿病患者的一般资料、授权能力和健康素养现状。结果:341例糖尿病患者的授权能力总分为(3.49±0.74)分,健康素养总分为(94.28±9.15)分;不同受教育程度、职业类型、户籍所在地、月收入、医疗付费方式、医疗经济负担、糖尿病类型、病程、是否接受健康教育、并发症发生情况、合并其他慢性疾病、糖尿病家族史的糖尿病患者授权能力有所不同(P<0.05,P<0.01);婚姻状况、受教育程度、职业类型、户籍所在地、月收入、医疗付费方式、医疗经济负担、糖尿病类型、病程、是否接受健康教育、并发症发生情况、合并其他慢性疾病的糖尿病患者健康素养水平不同(P<0.05,P<0.01)。糖尿病患者授权能力与健康素养呈正相关(r=0.353,P<0.01)。结论:糖尿病患者的授权能力与健康素养水平呈正相关关系,但授权能力与健康素养水平仍处于低水平,需要加大糖尿病健康教育的宣传力度,促进糖尿病患者的授权能力与健康素养水平的提高。     

Directed Reading: Designing a Professional Development Program for Medical Radiation Technologists

By participating in some form of professional development, medical radiation technologists can increase their skill, knowledge, and competence, leading to improved quality, safety, and standards of practice. Participation will also demonstrate acceptance of the responsibility for medical radiation technologists' own professional development. Over the past 10 years, the profession of medical radiation technology has progressed dramatically, with many changes in technology. The need for medical radiation technologists to keep up-to-date on these advancements is evident. Many medical radiation technologists participate in some form of professional development, and the decision to do so is either mandated at the provincial level or it remains a personal one. Because education is a provincial matter, the continuity of professional development or continuing education for medical radiation technologists across the country does not exist. The purpose of this directed reading is to review the options available to medical radiation technologists for professional development, to provide an overview of professional development programs from various health care professional groups, to outline how to effectively introduce a professional development program to medical radiation technologists, and to recommend the most appropriate program to implement for medical radiation technologists.     

Pediatric Positron Emission Tomography–Computed Tomography Protocol Considerations

Pediatric body oncology positron emission tomography-computed tomography studies require special considerations for optimal diagnostic performance while limiting radiation exposure to young patients. Differences from routine adult procedures include the patient preparation phase, radiopharmaceutical dose, computed tomography acquisition parameters, and approach to computed tomography contrast materials and imaging sequence. Attention to these differences define the best practice for positron emission tomography-computed tomography examinations of children with cancer contributing to optimal care of these patients.     

Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.     

A practical guide for paediatric diagnostic reference levels (PiDRLs)

This guide was designed to provide a foundation for developing paediatric diagnostic reference levels (PiDRLs) for conventional radiography. In principle, the calculation of diagnostic reference levels (DRLs) is recommended for diagnostic x-ray imaging examinations for radiosensitive patients, such as paediatric patients. PiDRLs are fundamentally important when considering dose optimisation in diagnostic radiology, computed tomography and interventional radiology for paediatric patients. DRLs can assist to point to non-optimised practices and the improvement of paediatric dose optimisation. The purpose of this continuing medical education article is to give medical radiation professionals an overview of PiDRLs for conventional radiography, an understanding of the benefits, the data collection process and some of the calculation methods. The readers can use these steps to establish and implement PiDRLs for different examinations.     

Public health nursing: Challenges and innovations for health literacy in rural area

Health literacy is a critical component of public health nursing, particularly in rural areas where access to health services is severely limited. As it relates to quality of care, cost of care, safety of care, and appropriate decision-making in general public health, health literacy can also be seen as an important public policy issue. Several challenges that can be found in rural communities in terms of access to health literacy, such as limited access to healthcare services, limited resources, low literacy rate, cultural and language barriers, financial constraints, and digital divide. Based on these challenges, several innovations can be pursued such as community-based health education, health literacy training among healthcare professionals, digital health technology, partnerships with community-based organizations, health literacy radio programs, and community health ambassadors. This reflection highlights the challenges and innovations that nurses can do to overcome the problem of low-health literacy in rural communities. In the future, the development of community empowerment and technology will be needed to refine the progress made so that a gradual increase in health literacy in rural communities can be seen.     

Low-dose cardiac imaging: reducing exposure but not accuracy

Cardiac imaging techniques that use ionizing radiation have become an integral part of current cardiology practice. However, concern has arisen that ionizing radiation exposure, even at the low levels used for medical imaging, is associated with the risk of cancer. From a single diagnostic cardiac imaging procedure, such risks are low. On a population basis, however, malignancies become more likely on account of stochastic effects being more probable as the number of procedures performed increases. In light of this, and owing to professional and industrial commitment to the as low as reasonably achievable (ALARA) principle, over the last decade major strides have been made to reduce radiation dose in cardiac imaging. Dose-reduction strategies have been most pronounced in cardiac computed tomography. This was important since computed tomography has rapidly become a widely used diagnostic alternative to invasive coronary angiography, and initial protocols were associated with relatively high radiation exposures. Advances have also been made in nuclear cardiology and in invasive coronary angiography, and these reductions in patient exposure have all been achieved with maintenance of image quality and accuracy. Improvements in imaging camera technology, image acquisition protocols and image processing have lead to reductions in patient radiation exposure without compromising imaging diagnostic accuracy.     

Health literacy and functional health status in Korean older adults

Aims and objectives. The aim of the study was to investigate the relationships of health literacy to chronic medical conditions and the functional health status among community‐dwelling Korean older adults. Background. In the literature, limited health literacy has been reported to have adverse effect on health outcomes. However, the link between health literacy to health status among Korean older adults needs to be clarified. Design. A cross‐sectional survey. Methods. A cross‐sectional survey of 103 community‐dwelling Korean older adults was conducted from June 2007–September 2007. Health literacy was measured using the Korean Functional Health Literacy test and functional health status was measured using the subscales of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Results. Individuals with a low health literacy had significantly higher rates of arthritis and hypertension. After adjusting for age, education and income, older individuals with low health literacy had higher limitations in activity and lower subjective health. In a model adjusting for age and income only, older individuals with low health literacy were more likely to report lower levels of physical function and subjective health and higher levels of limitations in activity and pain. Conclusions. Among community‐dwelling Korean older adults, limited health literacy is associated independently with higher rates of chronic medical conditions and lower subjective health status. Relevance to clinical practice. Nurses are key to providing health education to older adults. The understanding of the relationship of health literacy to health status is essential to develop communication and health education efforts for older adults in nursing practice.     

Developing and testing the health literacy universal precautions toolkit

The health literacy demands of the healthcare system often exceed the health literacy skills of Americans. This article reviews the development of the Health Literacy Universal Precautions (HLUP) Toolkit, commissioned by the Agency for Healthcare Research and Quality and designed to help primary care practices structure the delivery of care as if every patient may have limited health literacy. The development of the toolkit spanned 2 years and consisted of 3 major tasks: (1) developing individual tools (modules explaining how to use or implement a strategy to minimize the effects of low health literacy), using existing health literacy resources when possible, (2) testing individual tools in clinical practice and assembling them into a prototype toolkit, and (3) testing the prototype toolkit in clinical practice. Testing revealed that practices will use tools that are concise and actionable and are not perceived as being resource intensive. Conducting practice self-assessments and generating enthusiasm among staff were key elements for successful implementation. Implementing practice changes required more time than anticipated and some knowledge of quality improvement techniques. In sum, the HLUP Toolkit holds promise as a means of improving primary care for people with limited health literacy, but further testing is needed.     

Techniques and parameters for estimating radiation exposure and dose in cardiac computed tomography

With increasing clinical use of cardiac CT imaging it is important that all health care providers referring for or administering such examinations are familiar with the concepts and values of radiation dosimetry in CT as well as with the basic principles of radiation protection. There are important technical differences pertinent to radiation dose between the CT scanner types that are currently being used for imaging of the heart and coronary arteries. As a result of these differences, the radiation dose typically is higher when a cardiac examination is performed with multidetector-row CT (MDCT) than when it is performed with electron beam CT. Several techniques have been described to reduce radiation dose of MDCT imaging by varying the X-ray tube current during a CT examination. The volume computed tomographic dose index (CTDI_vol), the dose length product (DLP), and the effective dose (E) are the most useful parameters to describe and compare radiation doses received from cardiac CT examinations. When comparing radiation doses between scanning protocols and scanner types, the degree of image noise must be considered. Diagnostic, rather than aesthetic, quality of images should be the most important factor guiding the development of scanning protocols for cardiac CT imaging. Cardiac CT examinations should be ordered only by qualified health care providers, and the ordering clinicians should be aware of their responsibility of weighing risks of the radiation exposure against the expected benefits.     

Reduction of Radiation Doses in Cardiac Imaging, Part II: New Advances and Techniques in Nuclear Perfusion Imaging and Cardiac CT

Noninvasive cardiac imaging has become a critical pathway for diagnosis and risk assessment in patients with known or suspected ischemic heart disease. Low-level ionizing radiation is used in most of these procedures like radionuclide myocardial imaging and cardiac CT scanning. There is lack of any direct data which indicates the occurrence of any radiation-related adverse events with these diagnostic tests. However, recent concern has been raised due to the cumulative dose of radiation that patients receive during these procedures. Efforts are underway to help reduce the radiation exposure while preserving image quality for accurate interpretation and avoidance of repeat testing. This review will focus on the various advancements and methods to reduce the radiation dose in patients undergoing nuclear myocardial perfusion imaging and cardiac CT scanning.     

Health literacy,behavioral and psychosocial characteristics in coronary artery patients:A hospital-based study in Turkey

Objective:To investigate health literacy,behavioral and psychosocial characteristics in coronary artery patients.Methods:Between March 2019 and 2020 years,275 coronary artery patients aged≥50 years were included in the study.Turkish Health Literacy Scale-32 and Beck Depression Inventory were used to collect the data.Results:General health literacy index score was 31.7 and the prevalence of limited health literacy was 59.3%.Adequate health literacy was 2.8 fold higher in the 50-64 age group,3.1 fold higher among men,3.4 fold higher among married and 5.3 fold higher among those who believed in the necessity of individual protective practices(P<0.05).Significant differences were also found in different working status,living places,perceived economic situation,perceived general health status,comorbidities,family history of coronary artery disease,angiography history,material skills on reading and understanding,level of depressive syptom,commitment to individual protective practices health check-ups,utilizing health services,cigarette and alcohol use,and exercise and nutrition between limited and adequate health literacy(P<0.05).Logistic regression analysis showed that adequate health literacy was significantly higher among younger patients(OR:2.81;95%CI:1.46-5.62),male gender(OR:3.10;95%CI:1.46-6.58),married(OR:3.42;95%CI:1.39-8.44)and those with belief in individual protective practices(OR:5.3;95%CI:1.93-14.96).Conclusions:Health literacy is poor among coronary artery patients and behavioral and psychosocial variables differ with health literacy levels.To keep cardiovascular health among these patients,health literacy-based interventions should be adopted in coronary artery clinics,especially for risky population.     

A New and Inclusive Intake Form for Diagnostic Imaging Departments

IntroductionThe gender landscape is changing. For professionals in health care, particularly diagnostic imaging (DI), we need better communication tools to obtain personal information from this gender diverse community. We need more specific information from patients because we are performing examinations in which radiation is involved. It is our professional duty to protect a patient's reproductive organs whenever possible, but we must know where those organs are located. In addition, we must determine if a patient could be pregnant or not. Compliance to the professional duty must also extend to transgender and nonbinary patients. Transgender patients do not express or identify the same as their sex assigned at birth; therefore, we may shield inappropriately and expose their reproductive organs unintentionally. Nonbinary patients do not identify as either male or female, and therefore, their expression does not indicate reproductive organ location.MethodThere are currently no specific forms in DI that ask the questions we need to know to protect the public from unnecessary radiation exposure to reproductive organs. In developing the new form, we began looking at current practices in DI departments to better understand where the communication gap was and what important information would be required in the new form.ResultThe authors have created a new intake form that accommodates all patients—regardless of age or gender. The result is the SIGE (Sex, Identity, Gender, Expression) form.DisscussionThe SIGE form is inclusive and asks the necessary questions medical radiation technologists need to know in a respectful and professional manner so that we can shield gonadal tissue from ionizing radiation. In addition, the intention of the form is to help the gender diverse community to feel safe and respected in our department.     

健康素养对肝硬化代偿期患者生存质量的影响:链式中介模型

目的 探讨肝硬化患者生存质量与健康素养、疾病不确定感和应对方式的关系。方法 采用一般资料调查问卷、慢性肝病问卷、慢性病患者健康素养量表、疾病不确定感成人量表、医学应对方式量表,于2020年1-5月对280例肝硬化代偿期患者进行调查。结果 肝硬化代偿期患者生存质量得分为(84.21±18.01)分,健康素养得分(85.52±18.46)分,疾病不确定感得分(85.06±10.84)分;肝硬化患者健康素养、面对与生存质量呈正相关(r=0.77,P<0.01; r=0.77,P<0.01),疾病不确定感、回避、屈服与生存质量呈负相关(r=-0.88,P<0.01; r=-0.83,P<0.01; r=-0.84,P<0.01)。疾病不确定感和应对方式对生存质量有直接效应,疾病不确定感和应对方式是健康素养影响生存质量的中介变量。结论 肝硬化代偿期患者生存质量和疾病不确定感处于中等水平,健康素养水平较低,护理人员要重视健康素养水平和疾病不确定感及相关因素的影响,引导患者采取积极的应对方式,进而提高生存质量。     

Health literacy and beliefs among a community cohort with and without chronic low back pain

Health literacy, the ability to seek, understand and utilise health information, is important for good health. Suboptimal health literacy has been associated with poorer health outcomes in many chronic conditions although this has not been studied in chronic low back pain (CLBP). We examined the health literacy of individuals with CLBP using a mixed methods approach. One-hundred and seventeen adults, comprising 61 with no history of CLBP and 56 with CLBP (28 with low and high disability, respectively, as determined by a median split in Oswestry scores) participated. Data regarding severity of pain, LBP-related disability, fear avoidance, beliefs about LBP and pain catastrophizing were collected using questionnaires. Health literacy was measured using the Short-form Test of Functional Health Literacy in Adults (S-TOFHLA). A sub-sample of 36 participants with CLBP also participated in in-depth interviews to qualitatively explore their beliefs about LBP and experiences in seeking, understanding and using information related to LBP. LBP-related beliefs and behaviours, rather than pain intensity and health literacy skills, were found to be important correlates of disability related to LBP. Individuals with CLBP-high disability had poorer back pain beliefs and increased fear avoidance behaviours relating to physical activity. Health literacy (S-TOFHLA) was not related to LBP beliefs and attitudes. Qualitatively, individuals with CLBP-high disability adopted a more passive coping style and had a pathoanatomic view of their disorder compared to individuals with CLBP-low disability. While all participants with CLBP had adequate health literacy scores (S-TOFHLA), qualitative data highlighted difficulties in seeking, understanding and utilising LBP information.     

Making education count: the nurse's role in asthma education using a medical home model of care

Asthma care for patients who have limited health literacy is very costly. The resources to help patients who have lower health literacy levels are very few are not well identified. Significant gains in asthma control, self-efficacy in managing asthma, and improvement in overall costs of care for this patient population can be achieved when health literacy challenges are addressed. This research suggests that one-on-one education with an asthma educator that specifically addresses health literacy levels and care designed around the National Asthma Guidelines can produce significant reductions in the cost for asthma care through decreased emergency department visits and hospitalizations, and improved self-management of asthma exacerbations.     

Eliminating the stigma: A systematic review of the health effects of low-dose radiation within the diagnostic imaging department and its implications for the future of medical radiation

BackgroundLow-dose radiation exposure to Canadians is exponentially increasing due to the influx of diagnostic imaging and medical procedures that utilize radiation. Despite the use of medical radiation since 1896, the standardized acceptable dose for the Canadian public is still debated. The current annual dose limit for the public is set at 1 millisievert (mSv). This set dose limit intrinsically restricts the use of medical radiation for diagnosis due to concerns of public health.MethodsThis systematic review is in the form of a retrospective meta-analysis of previous experimental studies and observational reviews of low-dose radiation health effects. A database search using PubMed and Medscape identified 1,296 articles using the terms “low-dose radiation”, “radiation hormesis”, “radiation safety”, “dose exposure”, and “medical radiation”. Full text articles were excluded for the following reasons: radiation dose level not <100mSv, results of radiation effects not included, or no inclusion of biologic effects on living tissue. After screening, 15 studies were selected for inclusion.ResultsThe concerns of radiation exposure are based on epidemiological and experimental studies that have indicated that high-dose ionizing radiation has toxic effects and increases cancer risk. In contrast, low-dose radiation has experimentally demonstrated various beneficial effects through a combination of molecular and cohort studies, randomized control trials, and observational analysis. The limitation of radiation in medical imaging is founded on the assumption that low-dose radiation health risks are a linear extrapolation of high-dose radiation.Discussion/conclusionsThrough a systematic review of research, it is proposed that the current dose-response extrapolation for radiation-related health risks cannot be linearly based on the effects at high doses. By altering this knowledge, we could effectively improve patient diagnosis and public health by redefining the restrictions of current radiation limits within diagnostic imaging.