Italian cardiologist urges more emphasis on patient consent

Radiologists often fail to request patients' informed consent for imaging examinations, and even when they do, many patients are not fully informed about radiation exposure and long-term risk, according to a cardiologist.

Assessing radiological risk is complicated, but doctors must share certain important details with patients, Dr. Eugenio Picano wrote in the British Medical Journal (Oct. 4, 2004;329:849-851). Failure to do so violates basic principles of modern medical practice and disregards patients' rights.

"The language of radiation protection is not readily understood by non-specialists, and it is easy to get lost in a lexicon that expresses radiation doses in megabecquerels and risks as nominal probability coefficients for stochastic effects. The hapless prescribing (and practising) physician who wants to know about radiation risk enters a Tower of Babel, where essential information is 'hidden beneath the veil of verses so obscure,'" wrote Picano, a staff member of the Institute of Clinical Physiology at the National Research Council in Pisa, Italy.

Risk can be communicated to patients by expressing the dose as multiples of a chest x-ray, and the risk of cancer can be explained by the number of extra cases in the exposed population. The U.K. College of Radiologists has suggested this method, and the European Commission had endorsed it. Explanation of dose should be mandatory for the higher risk investigations, Picano said.

"Better knowledge of risks will help us to avoid small individual risks translating into substantial population risks," he said. "Radiological protection should come to mean not just another form to fill in, but a way of thinking, so that long-term risk is familiar to doctors."