Consents for CTs?

[Stitch]

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I've noticed that our radiologists are now documenting the radiaction exposure for each CT scan. They mention it at the end of each dictation; for example my last CT abdomen/pelvis had this tacked on at the end 'The radiation exposure CTDI during this examination was:
6.17 mGy.'

One of the military residents who rotates with us mentioned that they are now getting parental consent for patients under 18 prior to a CT scan.

Is anyone else doing this? Is it the inevitable future? Will it protect us when the slimebag lawyers catch on and start running commercials that start with "Have YOU been diagnosed with glioblastoma or leukemia? Have YOU had a CT scan in the past 10 years?"

 

[dpmd]

I always discuss the theoretical increase in risk with the parents, but I don't think I really document at all. Same goes for scans in pregnant patients, except I do document things then because if they say no and they end up with an undiagnosed injury I want everyone to be sure it was the patient and not me that decided to skip films. We don't have them sign any special consent (although they usually get contrast, and that they do have to consent for).

I don't know the right answer. I certainly don't want to start getting consents for every medical treatment I provide to include foleys and IV's. But I think when there is increased risk a conversation should take place.

 

[southerndoc]

I discuss it and document when we elect not to CT the patient.

I discuss but don't document when we CT the patient. The patient is consented for every CT scan, and the CT tech discusses with them radiation exposure.

 

[Stitch]

I discuss it and document when we elect not to CT the patient.

I discuss but don't document when we CT the patient. The patient is consented for every CT scan, and the CT tech discusses with them radiation exposure.

Interesting. Ever had anyone refuse based on what the tech told them? I like the idea of someone from the rads department doing it.

I always discuss the theoretical increase in risk with the parents, but I don't think I really document at all. Same goes for scans in pregnant patients, except I do document things then because if they say no and they end up with an undiagnosed injury I want everyone to be sure it was the patient and not me that decided to skip films. We don't have them sign any special consent (although they usually get contrast, and that they do have to consent for).

I document both refusal or acceptance, especially if they insist on a scan. I also document that I used the word 'cancer' in my discussion

I don't know the right answer. I certainly don't want to start getting consents for every medical treatment I provide to include foleys and IV's. But I think when there is increased risk a conversation should take place.

I can see where hospital admins/JCAHO could go crazy with consent forms. Our admin tried to make us get consent for pelvic exams about two years ago. We as a department just blatently refused to get them. It was ridiculous. 🙄

 

[kungfufishing]

I have started documenting that I discussed the radiation/cancer risk with patients.

 

[southerndoc]

Interesting. Ever had anyone refuse based on what the tech told them? I like the idea of someone from the rads department doing it.

I've only had one to refuse (a pregnant patient with a rule out PE who I discussed the risks with beforehand). She returned the next day with worsening pain, finally got the CTA, and ended up with bilateral PE's.

 

[emd123]

Good luck to any lawyer who tries to sue you 20 yrs from now and blame you for his clients cancer out of the many CTs and xrays the person will have had over those 20yrs. They will definitely sue the pants off of you if you miss a PE, subdural etc. Of all the things we need to worry about getting dragged into court over, I think this is one of the least. What they are laying the groundwork for, however, is class action lawsuits against the corporations who make CT scanners much like they sued breast implant makers over real or imagined complications.

 

[Stitch]

Good luck to any lawyer who tries to sue you 20 yrs from now and blame you for his clients cancer out of the many CTs and xrays the person will have had over those 20yrs. They will definitely sue the pants off of you if you miss a PE, subdural etc. Of all the things we need to worry about getting dragged into court over, I think this is one of the least. What they are laying the groundwork for, however, is class action lawsuits against the corporations who make CT scanners much like they sued breast implant makers over real or imagined complications.

I guarantee you will see more discussion of 'who to scan' and the risks of radiation exposure to young children in the near future. It seems that adults presenting to the ED get a lot more scans in general, which I assume is a mix of liability concerns and a result of the different disease processes that adults get compared to children: I deal very little with PEs, anyone on coumadin, or anyone pregnant. Child abuse is always on my differential and not something anyone wants to miss, but how much can you trust your exam?

Most of my patients come in with 'fell from the table' or 'dropped on head' so the question comes up with should you scan this otherwise healthy kid who is otherwise normal. Some parents come in demanding a scan for a short fall. Should we do it? Quite often I'm called by an adult doc and asked to advise whether I think a scan is needed in a younger kid after a fall. It's a difficult question to answer and I think we (adult and peds) overscan kids in general.

The PECARN study which recently came out is an excellent review of over 40,000 children who had head CTs, and makes a very good case for NOT scanning the majority of these children (negative predictive value of 99.95%).

With estimated rates of fatal malignancy being anywhere from 1/2500 to 1/5000 (according to our radiologists here) you could very well find yourself questioned when little baby jonny, who's had no further radiation exporsure except for that CT you gave him after a minor fall, gets cancer as a teenager. Concerns about pediatric radiation exposure has been well documented here and here amongst other places.

Do I let this fear drive my practice? No. But I document risk benefit discussion each time I scan. It can't hurt.

Sorry for the soapbox.