Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study).

OBJECTIVES: To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN: A quantitative and qualitative evaluation through a survey and focal groups. SETTING: San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS: The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS: Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS: Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study.

OBJECTIVE: To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient's features associated with malignancy in a non-high-risk clinical population. METHODS: Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. RESULTS: 25,529 patients were included: 23,102 (90.5%) underwent chest radiograph and 2,497 (9.5%) a CT. The prevalence of SPN was 2.1% (95% CI 1.9 - 2.3) in radiographs and 17.0% (95% CI 15.5 - 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. CONCLUSIONS: The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. KEY POINTS: There is a lower SPN prevalence in the clinical population than in screening studies. SPN prevalence is associated with some patient characteristics: sex, age, imaging test. Nodule characteristics related to malignancy were associated with some patient characteristics.

Intracranial and mediastinal inflammatory myofibroblastic tumour.

Inflammatory myofibroblastic tumour (IMT) is a rare neoplastic condition, commonly known as inflammatory pseudotumour, which is the most frequent primary tumour of the lung in childhood. IMT can have an extrapulmonary location, but is infrequent in the brain and mediastinum, and it is extremely unusual that both lesions appear simultaneously as in our patient. The definitive diagnosis is established by biopsy, but there are some MRI findings that can be useful to identify the lesion.

[A survey of the basic knowledge of chronic respiratory patients]. / Encuesta sobre los conocimientos básicos de los enfermos respiratorios crónicos.

Sixty patients diagnosed as having chronic respiratory diseases were surveyed in order to establish how many knew the name of their disease, the medications they were taking, the name of the medical specialty dedicated to treating their condition and the nature of spirometry. Only 23 patients (38%) knew the name of their disease; among them were all those suffering asthma or silicosis, but only 24% of those with other diseases. Thirty-three (55%) were unable to name their medications. Only 22% knew what a pneumologist does or could define spirometry, although at least 45% of these patients had undergone the procedure. The majority, on the other hand, knew what a cardiologist (70%) does and what an electrocardiogram (80%) is. A large number of patients with chronic respiratory diseases know very little about basic aspects of their conditions. Use of correct terminology appears to be necessary if patient knowledge is to increase.