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Communicating Radiation Risks in Paediatric Imaging Risks in Paediatric Imaging

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Communicating Radiation Risks in Paediatric Imaging Risks in Paediatric Imaging COMMUNICATING RADIATION COMMUNICATING RADIATION RISKS IN PAEDIATRIC IMAGING RISKS IN PAEDIATRIC IMAGING The use of ionizing radiation in paediatric imaging saves lives and Information to support healthcare discussions in many cases prevents the need for more invasive procedures. about benefit and risk While every day applications of X-rays for medical imaging help millions of patients worldwide, inappropriate use may result in IMAGING RISKS IN PAEDIATRIC RADIATION COMMUNICATING unnecessary and preventable radiation risks, particularly in children. A balanced approach is needed that recognizes the multiple health benefits, while addressing and minimizing health risks. Patients and families should have access to risk-benefit discussions about paediatric imaging when, where, and in the way they need to best understand the information and to be able to use it for making informed choices. Accurate and effective radiation risk communication is also necessary between health care providers who request or perform radiological medical procedures in children. By enabling informed decision-making, effective radiation risk communication contributes to ensure the greatest possible benefit of paediatric imaging, at the lowest possible risk. This document is intended to serve as a tool for health care providers to communicate known or potential radiation risks associated with paediatric imaging procedures, to support risk-benefit dialogue during the process of paediatric health care delivery. ISBN 978 92 4 151034 9 Department of Public Health, Environmental and Social Determinants of Health (PHE) Family, Women and Children’s Health Cluster (FWC) World Health Organization (WHO) Avenue Appia 20 – CH-1211 Geneva 27 Switzerland www.who.int/phe Communicating radiation Preliminaryrisks in paediatric imaging doseInformation estimation to support healthcare discussions about benefit and risk from the nuclear accident after the 2011 Great East Japan Earthquake and Tsunami WHO Library Cataloguing-in-Publication Data Communicating radiation risks in paediatric imaging: information to support health care dis- cussions about benefit and risk. 1.Radiation Exposure. 2.Radiation Injuries – prevention and control. 3.Informed Consent. 4.Diagnostic Imaging. 5.Pediatrics. 6.Patient Education as Topic. 7.Risk Factors. I.World Health Organization. ISBN 978 92 4 151034 9 (NLM classification: WN 240) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (http://www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (http://www.who.int/about/licensing/copyright_form/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organiza- tion concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to oth- ers of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distrib- uted without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Switzerland Cover photo: Garrett Allison and his mom Gemini Janas speak with Dr. Rajan Gupta at Duke University Hospital (Durham, US) about the risk of radiation during diagnostic testing, such as a CT scan. © Shawn Rocco/Duke Medicine (with permission) Photo page 2: Billington Jesse Semwogerere and his mom Victoria Nandagire have a conver- sation with Dr. Deborah Babirye at Ecurei-Mengo Hospital (Kampala, Uganda) about the risk of radiation during diagnostic testing, such as a CT scan. Source: Miss Elizabeth Nabunya Kawooya (with permission). Contents FOREWORD ..........................................................................................3 PREFACE .............................................................................................4 ACKNOWLEDGEMENTS ...............................................................................6 CONTRIBUTORS. .7 EXECUTIVE SUMMARY ................................................................................9 CHAPTER 1: SCIENTIFIC BACKGROUND ............................................................. 11 1.1 Introduction to radiation and overview of trends in medical imaging .............................. 12 1.1.1 Types of radiation and ionizing radiation dose units ...................................... 12 1.1.2 Sources of radiation exposure .......................................................... 14 1.1.3 Radiation exposures from medical imaging today ........................................ 16 1.2 Radiation doses and risks in paediatric procedures ............................................. 20 1.2.1 Radiation doses for paediatric procedures ............................................... 20 1.2.2 Radiation risks of medical imaging: health effects of radiation exposure ................... 22 1.2.3 Susceptibility to ionizing radiation in children: unique considerations ..................... 26 CHAPTER 2: RADIATION PROTECTION CONCEPTS AND PRINCIPLES .................................. 29 2.1 Appropriate use of radiation in paediatric imaging .............................................. 30 2.1.1 Fundamentals of radiation protection in health care ...................................... 30 2.1.2 Justification and appropriateness of procedures ......................................... 33 2.1.3 Optimization: child-size and indication-adjusted exam performance ....................... 37 2.2 Promoting a radiation safety culture to improve practice ........................................ 44 2.2.1 What is radiation safety culture in health-care settings? .................................. 44 2.2.2 Radiation safety and clinical governance ................................................ 46 2.2.3 Establishing a radiation safety culture .................................................. 47 CHAPTER 3: RISK–BENEFIT DIALOGUE .............................................................. 49 3.1 Practical tips for risk–benefit discussion ....................................................... 50 3.1.1 Communication goals and challenges ................................................... 50 3.1.2 Communicating radiation benefits and risks ............................................. 52 3.1.3 Communication with the paediatric patient .............................................. 53 3.1.4 How to establish a dialogue in a clinical setting ......................................... 54 3.1.5 Practical examples of communicating with paediatric patients ............................ 56 3.1.6 Questions and answers for patient-centred communication ............................... 58 3.1.7 Key messaging examples .............................................................. 65 3.2 Ethical considerations ....................................................................... 66 3.3 Creating a dialogue in the medical community ................................................. 67 3.3.1 Participants .......................................................................... 67 3.3.2 Dialogue between referrers and radiological medical practitioners ......................... 68 3.3.3 Dialogue between medical imaging staff and medical facility administration ............... 69 3.3.4 Dialogue between other health professionals involved in paediatric health care ............. 70 3.3.5 The public health role in risk–benefit dialogue. 71 REFERENCES ...................................................................................... 72 ANNEXES .......................................................................................... 79 ANNEX A. ABBREVIATIONS ...................................................................... 80 ANNEX B. GLOSSARY. 81 ANNEX C. ADDITIONAL RESOURCES ............................................................. 86 COMMUNICATING RADIATION RISKS IN PAEDIATRIC IMAGING – InformaTION TO SUPPORT HEALTHCARE DISCUSSIONS ABOUT BENEFIT AND RISK / 1 2 / COMMUNICATING RADIATION RISKS IN PAEDIATRIC IMAGING – InformaTION TO SUPPORT HEALTHCARE DISCUSSIONS ABOUT BENEFIT AND RISK Foreword Advancing imaging technology has opened new horizons In response to this need, the World Health Organization for clinical diagnostics and has greatly improved pa- (WHO) convened a global collaboration to implement a tient care. As a result, the use of medical imaging has project on radiation risk communication to support risk– increased rapidly worldwide during the past
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