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AJR Am J Roentgenol. 2013 Jun;200(6):1275-83. doi: 10.2214/AJR.12.10011.

Journal club: How radiation exposure histories influence physician imaging decisions: a multicenter radiologist survey study.

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Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114, USA.



The purpose of this article is to evaluate the influence of patient radiation exposure histories on radiologists' imaging decisions.


We conducted a physician survey study in three academic medical centers. Radiologists were asked to make an imaging recommendation for a hypothetical patient with a history of multiple CT scans. We queried radiologists' decision making, evaluating whether they incorporated cancer risks from previous imaging, reported acceptance (or rejection) of the linear no-threshold model, and understood linear no-threshold model implications in this setting. Consistency between radiologists' decisions and their linear no-threshold model beliefs was evaluated; those acting in accordance with the linear no-threshold model were expected to disregard previously incurred cancer risks. A Fisher exact test was used to verify the generalizability of results across institutions and training levels (residents, fellows, and attending physicians).


Fifty-six percent (322/578) of radiologists completed the survey. Most (92% [295/322]) incorporated risks from the patient's exposure history during decision making. Most (61% [196/322]) also reported acceptance of the linear no-threshold model. Fewer (25% [79/322]) rejected the linear no-threshold model; 15% (47/322) could not judge. Among radiologists reporting linear no-threshold model acceptance or rejection, the minority (36% [98/275]) made decisions that were consistent with their linear no-threshold model beliefs. This finding was not statistically different across institutions (p = 0.070) or training levels (p = 0.183). Few radiologists (4% [13/322]) had an accurate understanding of linear no-threshold model implications.


Most radiologists, when faced with patient exposure histories, make decisions that contradict their self-reported acceptance of the linear no-threshold model and the linear no-threshold model itself. These findings underscore a need for educational initiatives.

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