Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 7, July, p. 923–929

doi: 10.17219/acem/94146

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Patient awareness, perception and attitude to contrast-enhanced CT examination: Implications for communication and compliance with patients’ preferences

Alena Lambertova1,A,B,C,E,F, Pavel Harsa1,A,E,F, Lukas Lambert2,A,B,C,D,F, Petr Kuchynka3,C,D,F, Jan Briza4,D,E,F, Andrea Burgetova2,D,E,F

1 Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

2 Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

3 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic

4 1st Department of Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic


Background. Despite the high volume of contrast-enhanced computed tomography (CECT) examinations, there is limited awareness about its risks among patients and little is known about the influence of patient information sheets.
Objectives. The objective of this study was to assess patients’ awareness and perception of risks related to CECT examination and how they are influenced by an information sheet.
Material and Methods. A total of 263 adult patients scheduled for a CECT examination completed a questionnaire. The first page evaluated patients’ characteristics, their fear and awareness about examination-related risks, and source of information. Page 2 contained the Zung self-rating anxiety scale. After reading the information sheet, patients completed page 3 that surveyed how their awareness and fear had changed.
Results. Nearly half of the patients underestimated the risk of secondary malignancy (n = 121, 46%), or the risk of renal impairment (n = 110, 42%). The vast majority (n = 227, 86%) stated that they were not instructed to maintain fluid intake up to 1 h before the procedure. After reading the information sheet, patients generally corrected their knowledge, but 195 (74%) reported experiencing greater fear (p < 0.0001). Fear was more pronounced in younger female patients who had not undergone CT previously. Patients feared the result more than examination-related risks. Most patients (n = 204, 78%) would feel uncomfortable before receiving the examination result.
Conclusion. Most patients do not assess risks related to CECT examination correctly. Although the information sheet improves patients’ understanding of CECT-related risks, it lacks empathically delivered reassurance and increases their fear. Fast communication of examination results would make patients feel more comfortable.

Key words

multidetector computed tomography, radiation exposure, patient education, test anxiety scale, patient preference

References (19)

  1. Adam EJ. Changes in the computed tomography patient population. Eur Radiol Suppl. 2006;16(4):D38–D42.
  2. Lambert L, Foltan O, Briza J, et al. Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need. Wien Klin Wochenschr. 2017;129(5–6):159–163.
  3. Caoili EM, Cohan RH, Ellis JH, Dillman J, Schipper MJ, Francis IR. Medical decision making regarding computed tomographic radiation dose and associated risk: The patient’s perspective. Arch Intern Med. 2009;169(11):1069–1081.
  4. Raman SP, Johnson PT, Deshmukh S, Mahesh M, Grant KL, Fishman EK. CT dose reduction applications: Available tools on the latest generation of CT scanners. J Am Coll Radiol. 2013;10(1):37–41.
  5. Lambert L, Ourednicek P, Briza J, et al. Sub-milliSievert ultralow-dose CT colonography with iterative model reconstruction technique. Peer J. 2016;4:e1883. doi:10.7717/peerj.1883
  6. Baumann BM, Chen EH, Mills AM, et al. Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure. Ann Emerg Med. 2011;58(1):1–7.e2.
  7. Ramanathan S, Ryan J. Radiation awareness among radiology residents, technologists, fellows and staff: Where do we stand? Insights Imaging. 2015;6(1):133–139.
  8. Szarmach A, Piskunowicz M, Świętoń D, et al. Radiation safety awareness among medical staff. Pol J Radiol. 2015;80:57–61.
  9. Boutis K, Cogollo W, Fischer J, Freedman SB, Ben David G, Thomas KE. Parental knowledge of potential cancer risks from exposure to computed tomography. Pediatrics. 2013;132(2):305–311.
  10. Zung WW. A rating instrument for anxiety disorders. Psychoso­matics. 1971;12(6):371–379.
  11. Power SP, Moloney F, Twomey M, James K, O’Connor OJ, Maher MM. Computed tomography and patient risk: Facts, perceptions and uncertainties. World J Radiol. 2016;8(12):902–915.
  12. Singh N, Mohacsy A, Connell DA, Schneider ME. A snapshot of patients’ awareness of radiation dose and risks associated with medical imaging examinations at an Australian radiology clinic. Radiogr Lond Engl 1995. 2017;23(2):94–102.
  13. Hricak H, Brenner DJ, Adelstein SJ, et al. Managing radiation use in medical imaging: A multifaceted challenge. Radiology. 2011;258(3):889–905.
  14. Dickinson MC, Kam PCA. Intravascular iodinated contrast media and the anaesthetist. Anaesthesia. 2008;63(6):626–634.
  15. Lin MP, Probst MA, Puskarich MA, et al. Improving perceptions of empathy in patients undergoing low-yield computerized tomographic imaging in the emergency department. Patient Educ Couns. 2017;101(4):717-722.
  16. Doss M. Linear no-threshold model may not be appropriate for estimating cancer risk from CT. Radiology. 2014;270(1):307–308.
  17. Ukkola L, Oikarinen H, Henner A, Honkanen H, Haapea M, Tervonen O. Information about radiation dose and risks in connection with radiological examinations: What patients would like to know. Eur Radiol. 2016;26(2):436–443.
  18. Krille L, Hammer GP, Merzenich H, Zeeb H. Systematic review on physician’s knowledge about radiation doses and radiation risks of computed tomography. Eur J Radiol. 2010;76(1):36–41.
  19. Pahade J, Couto C, Davis R, Patel P, Siewert B, Rosen M. Reviewing imaging examination results immediately after study completion with a radiologist: Patient preferences and assessment of feasibility in an academic department. AJR Am J Roentgenol. 2012;199(4):844–851.