Patient knowledge regarding radiation exposure from spinal imaging

Abstract Background Context Spine surgeons employ a high volume of imaging in the diagnosis and evaluation of spinal pathology. However, little is known regarding patients' knowledge of the radiation exposure associated with these imaging techniques. Purpose To characterize spine patients' knowledge regarding radiation exposure from various imaging modalities. Study Design/Setting A cross-sectional survey study. Patient Sample 100 patients at their first clinic visit with a single spine surgeon at an urban institution. Outcome Measures The primary outcome was patient estimate of radiation dose for various common spinal imaging modalities as compared to true dose. Methods An electronic survey was administered to all new patients prior to their first appointment with a single spinal surgeon. The survey asked patients to estimate how many chest x-rays (CXRs) worth of radiation were equivalent to various common spinal imaging modalities. Patient estimates were compared to true effective radiation doses determined from the literature. The survey also asked patients whether they would consider avoiding types of imaging modalities out of concern for excessive radiation exposure. Results Patients accurately approximated the radiation associated with two views of the cervical spine, with a median estimate of 3.5 CXRs, compared to an actual value of 4.7 CXRs. However, patients underestimated the dose for CT scans of the cervical spine (2.0 CXRs versus 145.3 CXRs), two views of the lumbar spine (3.0 CXRs versus 123.3 CXRs), and CT scans of the lumbar spine (2.0 CXRs versus 638.3 CXRs). The majority of patients believed there is at least some radiation exposure associated with MRIs. The percent of patients who would consider forgoing imaging recommend by their surgeon out of concern for radiation exposure was 14% for x-rays, 13% for CT scans, and 9% for MRIs. Conclusion These results demonstrate a lack of patient understanding regarding radiation exposure associated with common spinal imaging techniques. These data suggest that patients might benefit from increased counseling and/or educational materials regarding radiation exposure prior to undergoing diagnostic imaging of the cervical or lumbar spine.