Breakdown of answers given by respondents to the questions of all subject areas
| Subject area tested | Question | Possible answers | All physicians | Consultants | Residents | Developed countries | Developing countries |
|---|---|---|---|---|---|---|---|
| A. Importance of acquiring information about previous diagnostic exposures of patients | A.1. How often do you ask patients about previous examinations involving radiation? | Never (N) | 62 (8.5) | 35 (9.5) | 25 (7.4) | 24 (6.3) | 38 (11.0) |
| Occasionally (N) | 350 (48.1) | 173 (46.8) | 173 (51.2) | 185 (48.6) | 165 (47.7) | ||
| Very often (P) | 204 (28.1) | 110 (29.7) | 85 (25.1) | 115 (30.2) | 89 (25.7) | ||
| Always (P) | 111 (15.3) | 52 (14.1) | 55 (16.3) | 57 (15.0) | 54 (15.6) | ||
| No answer | 1 | 0 | 1 | 0 | 1 | ||
| A.2. What is the purpose of asking about previous examinations using radiation? | Clinical Need (N) | 235 (32.4) | 123 (33.2) | 100 (29.7) | 109 (28.6) | 126 (36.5) | |
| Radiation risk (P) | 60 (8.3) | 28 (7.6) | 24 (7.1) | 25 (6.6) | 35 (10.1) | ||
| Both (NEU) | 431 (59.4) | 219 (59.2) | 213 (63.2) | 247 (64.8) | 184 (53.3) | ||
| No answer | 2 | 0 | 2 | 0 | 2 | ||
| A.3. If a patient has undergone 10 or more CT scans in last 2 years, will it affect your decision in prescribing next CT scan if the clinical indications are not so demanding? | Yes (P) | 611 (84.3) | 310 (84.0) | 290 (85.8) | 349 (91.6) | 262 (76.2) | |
| No (N) | 55 (7.6) | 23 (6.2) | 25 (7.4) | 12 (3.1) | 43 (12.5) | ||
| I do not know (NEU) | 59 (8.1) | 36 (9.8) | 23 (6.8) | 20 (5.2) | 39 (11.3) | ||
| No answer | 3 | 1 | 1 | 0 | 3 | ||
| A.4. If you know that a patient has undergone only one CT scan in the last 2 years, will it make it easier for you to prescribe next CT scan? | Yes (N) | 432 (59.3) | 218 (58.9) | 197 (58.1) | 211 (55.4) | 221 (63.7) | |
| No (P) | 95 (13.0) | 51 (13.8) | 42 (12.4) | 61 (16.0) | 34 (9.8) | ||
| Not really (P) | 164 (22.5) | 76 (20.5) | 88 (26.0) | 101 (26.5) | 63 (18.2) | ||
| I do not know (NEU) | 37 (5.1) | 25 (6.8) | 12 (3.5) | 8 (2.1) | 29 (8.4) | ||
| No answer | 0 | 0 | 0 | 0 | 0 | ||
| A.5. How frequently do you come across situations where clinical indications are enough to prescribe CT scan irrespective of history of CT scans? | Very frequently (N) | 292 (40.1) | 153 (41.4) | 136 (40.1) | 149 (39.1) | 143 (41.2) | |
| Occasionally (NEU) | 298 (40.9) | 139 (37.6) | 154 (45.4) | 158 (41.5) | 140 (40.3) | ||
| Rarely (P) | 138 (19.0) | 78 (21.1) | 49 (14.5) | 74 (19.4) | 64 (18.4) | ||
| No answer | 0 | 0 | 0 | 0 | 0 | ||
| A.6. How often in your clinical practice do you think knowing history of previous CT scans will help in making a better decision? | Always (P) | 160 (22.0) | 87 (23.5) | 67 (19.8) | 63 (16.5) | 97 (28.0) | |
| Mostly (P) | 362 (49.7) | 175 (47.3) | 177 (52.2) | 198 (52.0) | 164 (47.3) | ||
| Occasionally (N) | 159 (21.8) | 83 (22.4) | 74 (21.8) | 88 (23.1) | 71 (20.5) | ||
| Rarely (N) | 47 (6.5) | 25 (6.8) | 21 (6.2) | 32 (8.4) | 15 (4.3) | ||
| No answer | 0 | ||||||
| A.7. If a patient has undergone radiological examinations such that estimated dose is about 100 mSv, will this make it difficult for you to prescribe another CT scan? | Yes (P) | 484 (67.2) | 263 (71.5) | 215 (64.0) | 238 (62.5) | 246 (72.6) | |
| No (N) | 236 (32.8) | 105 (28.5) | 121 (36.0) | 143 (37.5) | 93 (27.4) | ||
| No answer | 8 | 2 | 3 | 0 | 8 | ||
| A.8. Do you think having a system by which you have quick information about patients’ exposure history will be helpful? | Yes (P) | 440 (60.5) | 237 (64.1) | 188 (55.6) | 196 (51.4) | 244 (70.5) | |
| Maybe (NEU) | 231 (31.8) | 106 (28.6) | 122 (36.1) | 148 (38.8) | 83 (24.0) | ||
| Not really (N) | 56 (7.7) | 27 (7.3) | 28 (8.3) | 37 (9.7) | 19 (5.5) | ||
| No answer | 1 | 0 | 1 | 0 | 1 | ||
| A.9. Do you think that a CT scan should be prescribed totally based on clinical indication, irrespective of the age of the patient? | Yes (N) | 249 (34.3) | 124 (33.6) | 116 (34.3) | 106 (27.8) | 143 (41.4) | |
| No, I consider age to be an important factor when making a decision (P) | 477 (65.7) | 245 (66.4) | 222 (65.7) | 275 (72.2) | 202 (58.6) | ||
| No answer | 2 | 1 | 1 | 0 | 2 | ||
| B. Knowledge about radiation exposure from diagnostic examinations and familiarity with radiation exposure units and age-related radiosensitivity | B.1. Give a rough estimate of the equivalent number of chest X-rays (PA) for abdomen CT | 10 X-rays (N) | 105 (14.5) | 57 (15.6) | 41 (12.1) | 24 (6.3) | 81 (23.7) |
| 100 X-rays (N) | 319 (44.1) | 167 (45.6) | 147 (43.4) | 165 (43.3) | 154 (45.0) | ||
| 500 X-rays (P) | 251 (34.7) | 119 (32.5) | 128 (37.8) | 169 (44.4) | 82 (24.0) | ||
| 1000 X-rays (N) | 48 (6.6) | 23 (6.3) | 23 (6.8) | 23 (6.0) | 25 (7.3) | ||
| No answer | 5 | 4 | 0 | 5 | |||
| B.2. Give a rough estimate of the equivalent number of chest X-rays (PA) for (abdomen+pelvic) X-ray | 5 X-rays (N) | 89 (12.3) | 59 (16.1) | 27(8.0) | 20(5.2) | 69 (20.2) | |
| 10 X-rays (N) | 102 (14.1) | 62 (16.9) | 36(10.7) | 25(6.6) | 77 (22.6) | ||
| 50 X-rays (P) | 98 (13.6) | 56 (15.3) | 35 (10.4) | 37 (9.7) | 61(17.9) | ||
| 100 X-rays (P) | 91 (12.6) | 52 (14.2) | 35 (10.4) | 48 (12.6) | 43 (12.6) | ||
| 500 X-rays (N) | 203 (28.1) | 82 (22.4) | 121 (35.8) | 155 (40.7) | 48 (14.1) | ||
| 1000 X-rays (N) | 139 (19.3) | 55 (15.0) | 84 (24.9) | 96(25.2) | 43 (12.6) | ||
| No answer | 6 | 4 | 1 | 0 | 6 | ||
| B.3. Which imaging modality imparts the highest radiation dose to the patient? | MRI (N) | 16 (2.2) | 7 (1.9) | 9 (2.7) | 7 (1.8) | 9 (2.6) | |
| CT abdomen(P) | 675 (92.8) | 352 (95.1) | 316 (93.5) | 372 (97.6) | 303 (87.6) | ||
| Ultrasound (N) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| Skull X-ray (N) | 36 (5.0) | 11 (3.0) | 13 (3.8) | 2 (0.5) | 34 (9.8) | ||
| No answer | 1 | 0 | 1 | 0 | 1 | ||
| B.4. What is your assessment of radiation dose in mSv for one chest CT scan? | Dose<5 mSv (N) | 82 (15.3) | 62 (22.5) | 20 (7.7) | 22 (6.6) | 60 (29.7) | |
| 5≤dose≤20 mSv(P) | 304 (56.6) | 149 (54.0) | 156 (60.0) | 224 (66.9) | 80 (39.6) | ||
| 20<dose≤30 mSv (N) | 9 (1.7) | 5 (1.8) | 4 (1.5) | 5 (1.5) | 4 (2.0) | ||
| Dose>30 mSv (N) | 142 (26.4) | 60 (21.7) | 80 (30.8) | 84 (25.1) | 58 (28.7) | ||
| No answer | 191 | 94 | 79 | 46 | 145 | ||
| B.5. Do you find the units used to express radiation exposure confusing? | Yes (N) | 260 (35.9) | 135 (36.7) | 112 (33.1) | 119 (31.2) | 141 (41.0) | |
| No(P) | 188 (25.9) | 100 (27.2) | 80 (23.7) | 99 (26.0) | 89 (25.9) | ||
| Somewhat (NEU) | 277 (38.2) | 133 (36.1) | 146 (43.2) | 163 (42.8) | 114 (33.1) | ||
| No answer | 3 | 2 | 1 | 0 | 3 | ||
| B.6. How do you solve the confusion of radiation units in your practice? | I seek education (P) | 9 (2.1) | 6 (2.3) | 3 (1.9) | 1 (0.5) | 8 (3.4) | |
| I seek consultation (P) | 98 (22.8) | 58 (22.3) | 38 (24.4) | 41 (20.7) | 57 (24.6) | ||
| I find no solution/I do not know (N) | 132 (30.7) | 71 (27.3) | 58 (37.2) | 81 (40.9) | 51 (22.0) | ||
| I do some research (P) | 65 (15.1) | 35 (13.5) | 31 (19.9) | 23 (11.6) | 51 (22.0) | ||
| Other (P) | 126 (29.3) | 90 (34.6) | 26 (16.7) | 52 (26.3) | 65 (28.0) | ||
| No answer | 298 | 110 | 183 | 183 | 115 | ||
| B.7. Which age group is the most sensitive to radiation? | Child(P) | 671 (92.4) | 341 (92.4) | 311 (92.0) | 351 (92.1) | 320 (92.8) | |
| Adolescent (N) | 37 (5.1) | 16 (4.3) | 21 (6.2) | 21 (5.5) | 16 (4.6) | ||
| Adult (N) | 2 (0.3) | 1 (0.3) | 1 (0.3) | 0 (0.0) | 2 (0.6) | ||
| Old (N) | 16 (2.2) | 11 (3) | 5 (1.5) | 9 (2.4) | 7(2.0) | ||
| No answer | 2 | 1 | 1 | 0 | 2 | ||
| B.8. Which age group is the least sensitive to radiation? | Child (N) | 10 (1.4) | 6 (1.6) | 3 (0.9) | 4 (1.1) | 6 (1.7) | |
| Adolescent (N) | 12 (1.7) | 6 (1.6) | 6 (1.8) | 5 (1.3) | 7 (2.0) | ||
| Adult (N) | 294 (40.6) | 121 (32.9) | 170 (50.3) | 155 (40.8) | 139 (40.3) | ||
| Old (P) | 409 (56.4) | 235 (63.9) | 159 (47.0) | 216 (56.8) | 193 (55.9) | ||
| No answer | 3 | 2 | 1 | 1 | 2 | ||
| C. Opinions on whether patients should be provided with information about dose from their medical exposure to radiation | C.1. How often do you come across patients who discuss the radiation dose issue with you before getting the investigation done? | Very often (NEU) | 31(4.3) | 11 (3.0) | 9 (2.7) | 9(2.4) | 24 (6.9) |
| Occasionally (NEU) | 175 (24.1) | 97 (26.3) | 74 (21.8) | 79 (20.7) | 96 (27.7) | ||
| Very rarely (NEU) | 343 (47.2) | 175 (47.4) | 165 (48.7) | 193 (50.7) | 149 (43.1) | ||
| Never (NEU) | 178 (24.5) | 86 (23.3) | 91 (26.8) | 100 (26.2) | 77 (22.3) | ||
| No answer | 1 | 1 | 0 | 0 | 1 | ||
| C.2. Do you feel uncomfortable when a patient asks you about radiation risk from the CT scan that you are prescribing? | Yes (N) | 58 (8.0) | 31 (8.4) | 22 (6.5) | 13 (3.4) | 45 (13.0) | |
| No(P) | 515 (70.9) | 271 (73.4) | 242 (71.6) | 306 (80.3) | 209 (60.6) | ||
| Mildly (NEU) | 153 (21.1) | 67 (18.2) | 74 (21.9) | 62 (16.3) | 91 (26.4) | ||
| No answer | 2 | 1 | 1 | 0 | 2 | ||
| C.3. Should patients be provided information about radiation dose in the report of a CT examination? | Yes (P) | 515 (71.0) | 261 (70.9) | 245 (72.5) | 277 (72.7) | 238 (69.2) | |
| No (N) | 144 (19.9) | 81 (22.0) | 53 (15.7) | 68 (17.8) | 76 (22.1) | ||
| I do not bother (NEU) | 66(9.1) | 26 (7.1) | 40 (11.8) | 36 (9.4) | 30 (8.7) | ||
| No answer | 3 | 2 | 1 | 0 | 3 | ||
| C.4. If it was made mandatory that physicians should give written justification whenever a CT examination is prescribed, will you be comfortable with that? | No problem with me (P) | 348 (47.9) | 170 (46.1) | 176 (52.1) | 211 (55.4) | 137 (39.7) | |
| I do not think it should be required (N) | 179 (24.7) | 85 (23.0) | 94(27.8) | 105 (27.6) | 74 (21.4) | ||
| It will be very helpful in achieving better radiation protection (P) | 199 (27.4) | 114 (30.9) | 68 (20.1) | 65 (17.1) | 134 (38.8) | ||
| No answer | 2 | 1 | 1 | 0 | 2 | ||
| D. Self-assessment of appropriateness of referral | D.1. How often have you ordered a CT scan that you subsequently realised was of no clinical use in patient management? | Very often (P) | 11 (1.5) | 4 (1.1) | 4 (1.2) | 2 (0.5) | 9 (2.6) |
| Often (P) | 93 (12.8) | 32 (8.7) | 55 (16.3) | 45 (11.8) | 48 (14.0) | ||
| Rarely (N) | 620 (85.6) | 332 (90.2) | 279 (82.5) | 334 (87.7) | 286 (83.4) | ||
| No answer | 4 | 2 | 1 | 0 | 4 |
Answers given by all physicians are shown. Percentages as fractions of total responses to each answer are provided in parentheses. The number of physicians who did not provide an answer to each question is also shown. The notations (P), (N), (NEU) beside the possible answers represent the coding of responses for the evaluation of the themes represented by each group of questions.