Should we consent for CT?
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Radiology
Should we consent for CT?
Chat about radiology with radiologists and those who want to get into the speciality
With the recent Lancet article on increased cancer risk in children exposed to CT examinations ( link here ) and a few doc2doc discussions on the risk of iatrogenic radiation (e.g. 1 , 2 )
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Forums » Open clinical » Radiology » Should we consent for CT?
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Should we consent for CT?
posted at 7/6/2012 2:12 PM BST
on bmj.com
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Posts: 317
First: 27/10/2011 Last: 8/5/2013 |
With the recent Lancet article on increased cancer risk in children exposed to CT examinations (link here) and a few doc2doc discussions on the risk of iatrogenic radiation (e.g. 1, 2), should we now be consenting for CT exposures?
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Re: Should we consent for CT?
posted at 7/6/2012 4:32 PM BST
on bmj.com
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Posts: 3037
First: 27/3/2012 Last: 18/5/2013 |
Yes, we should consent for CT in writing, considering increasing risks of leukemia & brain tumors, due to the radiation, especially in children, the consent may be obtained from the parents or the guardian. |
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Re: Should we consent for CT?
posted at 7/6/2012 10:20 PM BST
on bmj.com
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Posts: 1177
First: 19/4/2010 Last: 16/5/2013 |
Hmm. I think patients should be fully informed of the risks of every procedure and investigation we subject them to. At what point that consent should be written rather than verbal, I'm not certain. We get written consent for chest drains, but not central lines. We get consent for bronchoscopies, but not CT scans. I *do* get patients to sign a form to say that they understand that being referred for surgery for their lung cancer means that there is a risk that what we chop out isn't lung cancer, for example...
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Re: Should we consent for CT?
posted at 8/6/2012 5:52 AM BST
on bmj.com
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Posts: 873
First: 17/6/2011 Last: 17/5/2013 |
For whose benefit are we asking for consent - ours or the patient's? There is no procedure in medicine that is risk free. i think an information leaflet that can be picked up is enough. |
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Re: Should we consent for CT?
posted at 8/6/2012 8:53 AM BST
on bmj.com
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Posts: 317
First: 27/10/2011 Last: 8/5/2013 |
Sadian, you raise an interesting point... I think that the primary purpose of consent should be for the benefit of the patient, but I am sure that medics' perception of it as a shield for their own position devalues it for the patient. |
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Re: Should we consent for CT?
posted at 8/6/2012 8:36 PM BST
on bmj.com
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Posts: 2035
First: 12/3/2010 Last: 19/5/2013 |
In Response to Re: Should we consent for CT?: We get written consent for chest drains, but not central lines. We get consent for bronchoscopies, but not CT scans. Posted by DundeeChest It may surprise some but the advice still is that there should be no written consent to anaesthesia. Instead, we are advised to note the discussion about the technique we will use and the risks that incurs that we have with our patient. Moreover, the general advice is that it is the informing of the patient about risk versus benefit that is most important in obtaining consent. Dated signatures merely show that the doctor and the patient signed them on that date, not even that they were in the same room or that the patient understood anything. In general, British law (and Kirked will correct me if necessary) the risks to be discussed should be selected on a sliding scale that multiplies how often they happen by the damage they can do. Common but trivial complication (eg transient sore throat - almost everyone) should be mentioned, and permanent paralysis after epidural (1: 250,000, possibly) . "One excess case of brain tumour per 10 000 head CT scans" has to be included under the last heading. However, while death under anaesthesia happens, that is almost never mentioned except to the most ill patient. John |
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Re: Should we consent for CT?
posted at 9/6/2012 9:46 AM BST
on bmj.com
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Posts: 958
First: 15/7/2011 Last: 15/5/2013 |
In Response to Re: Should we consent for CT?: In Response to Re: Should we consent for CT? : It may surprise some but the advice still is that there should be no written consent to anaesthesia. Instead, we are advised to note the discussion about the technique we will use and the risks that incurs that we have with our patient. Moreover, the general advice is that it is the informing of the patient about risk versus benefit that is most important in obtaining consent. Dated signatures merely show that the doctor and the patient signed them on that date, not even that they were in the same room or that the patient understood anything. In general, British law (and Kirked will correct me if necessary) the risks to be discussed should be selected on a sliding scale that multiplies how often they happen by the damage they can do. Common but trivial complication (eg transient sore throat - almost everyone) should be mentioned, and permanent paralysis after epidural (1: 250,000, possibly) . "One excess case of brain tumour per 10 000 head CT scans" has to be included under the last heading. However, while death under anaesthesia happens, that is almost never mentioned except to the most ill patient. John Posted by John D Yes I agree with you John. There is no legal requirement for written consent. If a complication is rare but catastrophic then it should be told to the patient. There are several cases that highlight this. |
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Re: Should we consent for CT?
posted at 11/6/2012 10:09 PM BST
on bmj.com
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Posts: 317
First: 27/10/2011 Last: 8/5/2013 |
Cancer is pretty catastrophic, kirked, and yet we still dish out the milliSieverts without informing our patients. Is there are reasonable legal argument to say that in the face of investigating a potentially life-threatening illness, then the justifying radiologist is making an informed decision on behalf of the patient (as with IRMER)? |
Forums » Open clinical » Radiology » Should we consent for CT?
