A third of patients receiving CT scans did not realize the procedure exposed them to radiation, a small study at a large medical center found. More patients reported worries about whether their parking ticket would be validated or if they would be able to eat later than about radiation risks.

Study authors were first inspired to conduct the research when the risks of radiation were making headlines a few years ago.

"We wondered what patients were thinking when they went in for all these big fancy tests," Laurie A. Soine, study co-author, told DOTmed News. "A lot of our radiology colleagues were so worried that patients were getting the wrong impression of the procedures."
The results "dramatically" surprised them, Soine said. Rather than describing fears surrounding radiation, most patients surveyed were concerned with whether the test would hurt, how long it would last and if it would yield the answers they were looking for, such as whether their cancer had returned.

In the survey, only 3 percent of patients reported thinking about radiation before undergoing the scan, and 34 percent of patients did not know that the scan exposed them to radiation. Over half of patients, 66 percent, believed that the scan was medically necessary and that it would lead them to feel better or live longer. Only five percent of patients believed that scan radiation would increase their lifetime risk of cancer.

The team surveyed a total of 235 patients undergoing CT or SPECT scans. The mean age of the study participants, 63 percent of whom were men, was 55. Fifty-eight percent had a college education, and 17 percent had at some point held positions in the medical field.

"Studies such as this show that patients think differently about these procedures than those of us who do the procedures," said Soine. "When I'm making a decision, I'm applying what I know of the risks in the overall population because that's what I'm schooled in. But for patients, they're basing choices on people in their lives, diseases people in their social circles have and what they've read."

For example, if a healthy, young patient wanted a stress test because several people she knew had heart attacks, the risk of receiving a false positive may be higher than the risk of actually having cardiac trouble, Soine said.

For CT, while risks associated with the scans are quite low, there is the potential for side effects as with most imaging procedures. The American Association of Physicists released a statement in the fall of 2012 stating that the risk of medical imaging of effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable and may not exist. An average CT scan involves a dose of 10 mSv.

Soine said providers should use her study to think about how they present the value of a particular scan to a patient.

"In American society, we have a tendency to assume more is better," said Soine. "But that's not always the case in health care. If you spend the time to explain the risks and benefits to patients, you are serving them better than if you're just ordering a test."

The study was published online on December 31, 2012 in JAMA Internal Medicine.

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