Patients' Perceptions of Radiation Exposure Associated With Mammography.

OBJECTIVE: Radiation associated with breast imaging is a sensitive issue, particularly for women who undergo mammography as a screening measure to detect breast cancer. Misinformation and misunderstanding regarding the risks associated with ionizing radiation have created heightened public concern and fear, which may result in avoidance of diagnostic procedures. The objectives of this study were to ascertain patients' knowledge and opinion of ionizing radiation as a whole and specifically in mammography, as well as to determine common misunderstandings and points of view that may affect women's decisions about whether to have a mammogram. MATERIALS AND METHODS: Over a 9-month period, a total of 1725 patients presenting for a mammogram completed a 25-point questionnaire focused on the following: general knowledge of radiation dose in common imaging modalities, the amount of radiation associated with a mammogram relative to five radiation benchmarks, and patients' opinions of the involvement of radiation in their health care. RESULTS: Although 65% of the women receiving a mammogram responded that they had been informed of the risks and benefits of the examination, 60% overestimated the radiation in a mammogram. CONCLUSION: Efforts should be made to accurately inform women of the risks and benefits of mammography, specifically highlighting the low dose of mammographic ionizing radiation and providing objective facts to ensure that they are making an informed decision regarding screening.

Strategies for Decreasing Screening Mammography Recall Rates While Maintaining Performance Metrics.

RATIONALE AND OBJECTIVE: This study aimed to determine the impact of interventions designed to reduce screening mammography recall rates on screening performance metrics. MATERIALS AND METHODS: We assessed baseline performance for full-field digital mammography (FFDM) and digital breast tomosynthesis mammography (DBT) for a 3-year period before intervention. The first intervention sought to increase awareness of recalls from screening mammography. Breast imagers discussed their perceptions regarding screening recalls and were required to review their own recalled cases, including outcomes of diagnostic evaluation and biopsy. The second intervention implemented consensus double reading of all recalls, requiring two radiologists to agree if recall was necessary. Recall rates, cancer detection rates, and positive predictive value 1 (PPV1) were compared before and after each intervention. RESULTS: The baseline recall rate, cancer detection rate, and PPV1 were 11.1%, 3.8/1000, and 3.4%, respectively, for FFDM, and 7.6%, 4.8/1000, and 6.0%, respectively, for DBT. Recall rates decreased significantly to 9.2% for FFDM and to 6.6% for DBT after the first intervention promoting awareness, as well as to 9.9% for FFDM after the second intervention implementing group consensus. PPV1 increased significantly to 5.7% for FFDM and to 9.0% for DBT after the second intervention. Cancer detection rate did not significantly change with the implementation of these interventions. An average of 2.3 minutes was spent consulting for each recall. CONCLUSION: Reduction in recall rates is desirable, provided performance metrics remain favorable. Our interventions improved performance and could be implemented in other breast imaging settings.

Perceptions of Improved Biomass and Liquefied Petroleum Gas Stoves in Puno, Peru: Implications for Promoting Sustained and Exclusive Adoption of Clean Cooking Technologies.

Many households in low- and middle-income countries cook with inefficient biomass-burning stoves, which cause high levels of household air pollution and threaten long-term health. Although clean stoves and fuels are available, uptake and consistent use has been low. Using observations and in-depth interviews, we assessed the attitudes, preferences, and beliefs about traditional versus liquefied petroleum gas (LPG) stoves in rural Puno, Peru. A total of 31 in-depth interviews were conducted with primary cooks and their families, health workers, community leaders, and improved stove contractors. Six in-home observations of meal preparation were also conducted. Six major barriers to consistent use of clean stoves were identified: (1) perceived differences in food taste and nutrition by stove type; (2) cooking niches filled by different stoves; (3) social norms related to cooking practices; (4) safety concerns; (5) comparative costs of using different stoves; and (6) lack of awareness and concern about long-term health risks. These findings suggest that to successfully reduce household air pollution, clean cooking programs and policies must consider the many factors influencing adoption beyond health, such as cost, taste, fears, and cultural traditions. These factors could be incorporated into community-based and national efforts to scale-up sustained and exclusive adoption of clean cooking.

Successful patient recruitment in CT imaging clinical trials: what factors influence patient participation?

RATIONALE AND OBJECTIVES: Analyze factors that influence participation in research studies that use coronary computed tomography (CT) imaging. MATERIALS AND METHODS: A 12-point survey using a questionnaire was conducted on 80 subjects, of whom 40 agreed to participate in a cardiovascular CT imaging research study (enrolling subjects) and 40 declined participation (non-enrolling subjects). Potential factors that motivated the acceptance or refusal of enrollment were evaluated using a 5-point Likert scale. The following aspects were addressed: (1) additional health information, (2) free imaging, (3) altruistic benefit to society, (4) monetary compensation, (5) radiation exposure, (6) role as an experimental subject, (7) possible loss of confidentiality, (8) contrast or investigational drug use, (9) premedication use, (10) blood draw or intravenous placement, (11) time commitment, and (12) personal medical opinion. Response distributions were obtained for each question and compared between enrolling and non-enrolling groups. RESULTS: Enrolling subjects gave significantly higher ratings than non-enrolling subjects for the following factors: additional health information (P < .001), free imaging (P < .001), and the altruistic benefit to society (P < .001). For non-enrolling subjects, concern for possible drug use or contrast injection (P < .001), concern for possible premedication (P < .001), and personal availability or time commitment (P < .001) were all given significantly higher ratings. Concern for radiation exposure (P = .002) and personal medical opinion (P < .001) received significantly high ratings among both groups but did not differ between groups. CONCLUSIONS: Several influential concerns and benefits were identified from potential research subjects. Knowledge of what influences patient participation in studies involving CT imaging may allow researchers to effectively address concerns and highlight the potential benefits related to participation.