Barriers and pathways to informed consent for ionising radiation imaging examinations: A qualitative study.

INTRODUCTION: Informed consent for ionising radiation medical imaging examinations represents a recent change to medical imaging practice. This practice has not had a definitive and authoritative integration into clinical practice, and lack of direction has caused many health care professionals to be unsure of an appropriate consent methodology. Consent practices have been undertaken inconsistently and sometimes poorly. This research sought to investigate what barriers exist to meaningful informed consent, and what pathways are suggested to overcome these barriers. These views are then discussed in the context of practical health care consent practices. METHODS: A semi-structured interview explored the views of radiographers and radiologists on the practice of disclosing the ionising radiation risk of a clinical medical imaging examination. Qualitative data was analysed using a nominal method of quantitative transformation. Responses were reviewed, and a set of definitive themes constructed. Participants considered the influences, logistics and barriers to the informed consent process. Participants were then asked what pathways might be developed that would improve the process. RESULTS: Twenty-one (21) radiographer participants and nine (9) radiologists were interviewed. The barriers to consent identified issues of time constraints, lack of a unified message, and patient presentations. Pathways suggested included limiting the scope of the consent practice, sharing the consent responsibility, and formulation of definitive consent guidelines. CONCLUSION: A unified, definitive series of guidelines for informed consent for ionising radiation examinations would alleviate many of the identified barriers. Having the consent process consistently begin with the referring doctor would facilitate more meaningful consent.

A review of visual ethnography: Radiography viewed through a different lens.

INTRODUCTION: The objective of this article is to provide a short review of the research methodology 'visual ethnography'. METHOD: The review article will provide a summary of the foundations of visual ethnography, outline the key debates and refer to some of the main authors working in this field. RESULTS: Visual Ethnography is both a methodology and a method of research. It should be selected for research in radiography when research questions seek to focus upon aspects or elements of a culture. A research plan that is designed using a visual ethnographic approach should be flexible and take into account the requirements of the researcher and research participants. Visual methods of research include the use of various images, for example, photographs, collage, film or drawings. Visual methods are commonly employed together with interviews, conversations and observation. The approach enables researchers to generate new and unique insights into cultures. CONCLUSION: This review of visual ethnography provides background information that informs an introduction to the methodology. It demonstrates a methodology with the potential to explore culture and expand knowledge of radiography practice. IMPLICATIONS FOR PRACTICE: The authors suggest that for future studies visual ethnography is a methodology that can expand the paradigm of radiography research.

Informed consent in human research: what to say and how to say it.

To ensure that the possibility of harm to human research subjects is minimized, clinical trials and other research protocols are subject to oversight by Institutional Review Boards (IRBs). IRBs require that subjects be fully informed about the real or potential risks of participation in a research study. The use of radiological examinations in research protocols subjects the participants to exposure to ionizing radiation, which in theory carries a risk of stochastic effects such as radiation-induced cancer, and in practice may lead to deterministic effects such as skin injury. Because IRB members and clinical study coordinators may have little knowledge of radiation effects or how best to communicate the risk to the research subjects, they will consult with institutional Radiation Safety Committees and radiation protection professionals regarding how to integrate radiation risk information into the informed consent process. Elements of radiation informed consent include: (1) comparison of the radiation dose to some benchmark that enables the study subjects to make a value judgment regarding the acceptability of the risk; (2) a quantitative expression of the absolute risk of stochastic effects; (3) an expression of uncertainty in the risk; and (4) understandability. Standardized risk statement templates may be created for specific radiological examinations. These standardized risk statements may be deployed as paper forms or electronically in the form of internet-based applications. The technical nature of creating useful radiation risk statements represents an opportunity for radiation protection professionals to participate productively in the clinical research process.

Ethical issues for radiographers: general observations and a pilot qualitative study.

This paper is based on general observation arising from many years experience in managing and delivering radiography services in the health service. In addition, it presents the results of a pilot qualitative study based on unstructured interviews. The interviews were undertaken with a view to identifying the reasons for radiography that may not be well justified. The study was undertaken in the public and private sectors and many of the reasons are shared by both. The reasons for poor justification include: inadequate radiation protection education for referrers; avoidance of medical litigation; defensive medicine attitude by referrers and, in the private sector, pursuit of profit. The study provides a starting point for further more quantitative investigations that are clearly required in the area.

Patient self-referral for radiologic screening tests: clinical and ethical concerns.

Retail marketing of radiologic screening tests is increasingly common in the United States. Without a physician referral, patients can now directly purchase screening computed tomography (CT) or ultrasound scans. In this article, we consider the clinical and ethical ramifications of widespread screening of low-risk populations with 4 commonly marketed tests: whole-body CT, CT-based heart scans, heel ultrasound for osteoporosis, and carotid duplex sonography for carotid stenosis. All the tests are too inaccurate for screening in low-risk populations, and none has been proven to lead to early, beneficial intervention. Screening could be harmful if false-positive tests lead to extensive or invasive diagnostic evaluation. Finally, widespread testing could increase health care costs with little public health benefit. Patients should probably avoid radiologic screening tests until the tests have been appropriately evaluated in controlled studies and recommended by unbiased national panels, such as the United States Preventive Services Task Force. Primary care physicians and their professional societies should emphasize the uncertain benefits and potential hazards of indiscriminate imaging among healthy, asymptomatic consumers.