What Patients Want to Know About CT Radiation Exposure Harm and What Doctors Actually Tell Them: A Gap in Patient-Doctor Communication

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Alrasheed, Abdulrahman M. Alammar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3956987/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: CT scan utilizes ionizing radiation poses a danger to the patient's health. Thus, telling the patient about ionizing radiation would be critical in promoting shared decision-making and improving patient-doctor communication. However, few studies have examined this topic broadly. Objectives : study was conducted to identify the frequency of physicians informing patients about the radiation risk before ordering a CT scan, as well as to assess the knowledge, perceptions, and preferences of patients undergoing CT scans in regard to radiation risk. Methods: A cross-sectional study was performed between September 2020 and January 2021. The sample was 387 patients who underwent a CT scan at a tertiary hospital in Saudi Arabia. We randomly selected every other name using the patient list for a physician to contact them by telephone. Verbal informed consent was obtained. Results: When examining knowledge, 58% of patients knew that CT involves harmful radiation. This knowledge was significantly associated with higher education level and previous experience with CT scans. Regarding doctors’ practice of providing information to patients about the scan, 344 (88.9%) patients indicated that their doctor had explained to them why they needed the scan. Only 28 (7.2%) patients stated that their doctor had mentioned the amount of radiation, and 74 (19.1%) patients indicated that doctors mentioned the risks associated with the radiation of the scan. Almost all patients (96.9%) preferred to be told about why they needed a CT scan. About 94.3% of patients expected to be told about the risks associated with CT scans, and 78.6% preferred to know about the radiation dose. Conclusions: The vast majority of patients who underwent CT scans did not receive enough information about the harm of the scans. However, most of them preferred to know about this harm. Therefore, filling this gap in doctor-patient communication is highly needed. Figures Figure 1 Introduction Computed tomography (CT) is an important radiological imaging technology and involves a series of radiographic projections that are combined to obtain computer-generated cross-sectional images. Since its invention in 1970, CT has worked wonders in the field of medicine by improving diagnoses, treatment therapies, and surgical procedures. 1 CT machines are widely available and offer accurate diagnosis to physicians in minutes. In addition, CT scans have reduced the number of emergency surgeries, ICU admissions, and length of hospital stay. 1,2 Millions of CT scans are performed worldwide every year. 3 In just the USA and UK, more than 70 million and 5 million CT scans are performed every year, respectively. 4 Although CT scans have revolutionized the diagnostic department of medicine, they raise important public concerns about exposure to ionizing radiation, which could lead to harmful biological effects such as malignancy. It has been reported that a CT coronary angiogram exposes the breasts and lungs to radiation levels equivalent to 15 mammography studies and 711 X-rays of the chest, respectively. 5 . CT scans deliver 50-1000 times more radiation to the human body than a conventional X-ray, contributing to about 50% of all medical radiation. 6 . The utilization of CT scans is increasing day by day, exposing more and more people to the risk of ionizing radiation. Growing concern about long-term outcomes of ionizing radiation, such as malignancy, warrants the application of fundamental protection rules in health care systems, such as justification, optimization, and dose limitation of radiological imaging techniques. 7 Justification of CT scans is of prime importance on the part of referring physician and radiologist as they must weigh the benefits of the imaging against the possible risks of radiation. In this context, CT scans can be replaced by non-radiating modalities, such as ultrasonography and magnetic resonance imaging (MRI) where possible. Similarly, optimization of CT scan guidelines and protocols could reduce unnecessary radiation exposure. In this regard, referring physicians and radiologists must have proper understanding of CT and accurate estimation of the amount of radiation being delivered to patients. A survey evaluated the attitudes of radiologists towards radiation dose and exposure in Saudi Arabia and reported that radiologists have good comprehension of the carcinogenicity risk for patients undergoing CT scans. 7 The fundamental principles of radiation protection are even more important when dealing with pediatric populations, as children are more sensitive to radiation than adults. 8 CT poses a significant long-term risk of cancer due to radiation exposure. To respect the dignity and autonomy of the patients, obtaining informed consent for radiological examinations is their ethical and legal right. 9 Therefore, prior to advising and embarking on CT imaging, physicians and radiologists should obtain informed consent after clearly explaining the hazards of the radiation exposure. This practice could help with shared decision making between physicians and patients. In this context, one of the fundamental principles of modern medicine is to make informed decisions about the patients’ treatment. 10 The purpose of obtaining informed consent is to ensure that the patients fully understand the procedure while avoiding underestimation and overestimation of the hazards of large and small risks of the radiation that patients might absorb during the procedure. CT scan with intravenous contrast infusion may result in extra hazards, such as contrast-related hypersensitivity and contrast-induced nephropathy, in addition to the radiation-related risks. 11 . In this regard, patients must be informed about these contrast-induced complications via informed consent forms. Moreover, some patients may have a history of previous CT imaging, and CT imaging poses further radiation-related hazards that should be communicated to the patients. The statements offered in the informed consent forms may vary. Recent consent forms follow one of three philosophies: “do not say a word,” “understatement,” and “full disclosure” [10]. “Do not say a word” refers to not mentioning the hazard of radiation, and the legal right of informed consent is eclipsed by the patients’ perception that the experts are efficient and know best. “Understatement” is based on imprecise statements to avoid “useless” concern about risk that is unavoidable. The third philosophy of “full disclosure” uses straightforward statements in providing informed consent, especially when it comes to the research projects. Only preliminary studies are available from Saudi Arabia about the knowledge, perceptions, and preferences of patients undergoing CT imaging. 12 In addition, studies that examined this topic broadly to determine the gap in patient-doctor communication are lacking in Saudi Arabia. Therefore, this study was conducted to assess these issues. This study could be a useful addition to the literature from Saudi Arabia about these patient characteristics and clinician practice. Methods Study design and setting. This cross-sectional study involved patients undergoing CT scans. The study was conducted in the outpatient department at a tertiary hospital in Riyadh. The study was approved by the Institutional Review Board of the College of Medicine of King Saud University (No. E-19-3904). The study was conducted using phone call interviews. Verbal consent was obtained from participants before they answered the questionnaire, and their identity was kept confidential. Participants and survey instrument. Participants included patients who underwent a CT scan within three months at a tertiary hospital in Riyadh at the outpatient radiology department. Data were collected between September 2020 and January 2021 by simple random sampling. A list of patients who underwent CT was obtained, and we selected every other patient. Using phone interviews, the researchers asked all the questions in the questionnaire. We created the questionnaire after an extensive literature review .13, 14 The questionnaire was then reviewed by two expert radiologists and family physicians who have the expertise in this area. Afterwards, the suggested adjustments were made, and a final draft was set after a pilot study. The pilot study took place with 20 patients to ensure that the questions were clear, understandable, and in a logical order. Those who participated in the pilot study were not enrolled in the final analysis. The internal consistency (reliability) was measured using Cronbach's alpha coefficient, which was >0.7. The questionnaire was divided into four sections. The first section describes socio-demographics, the second assesses the encounter between the patient and the physician before ordering the CT scan, and the third section focuses on the participants. The final part measured knowledge regarding radiation, patient perceptions, and the amount of information that participants wanted regarding radiation. Sample size. We estimated that for a precision of 5% with 95% confidence intervals, at least 323 people would be required to estimate the proportion of individuals who know that imaging tests incur a health risk. Based on a literature review, around 70 % of the population could be aware of it. Next, 20% was added, so our sample size was 388 patients. Statistical tests. Data were entered and analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Armonk, NY: IBM Corp.). Categorical data are presented as numbers and percentages. The chi-squared test was used to assess the association between awareness about the CT risk and patients’ baseline characteristics. The level of significance was set at α =0.05. Results The study included 387 patients who underwent CT scan, and 203 (52.5%) patients were males. A majority of the patients (190 patients; 49.1%) belonged to the age group of 40 to 60 years old. More than half of the patients (200 patients; 51.7%) were university graduates. Internal medicine and urology were the most common referral specialties for the CT scan at 21.2% and 20.2%, respectively. Around one-quarter of the patients (25.1%) had never had a CT scan before, and 118 (30.5%) had at least four CT scans before (Table 1). Regarding the doctors’ practices toward information provided to patients about the scan, 344 (88.9%) patients indicated that their doctor had explained to them why they needed the scan. Only 28 (7.2%) patients stated that the doctor mentioned the amount of radiation, and 74 (19.1%) patients’ doctors mentioned the risks associated with the radiation of the scan. When IV contrast was used, 106 (27.4%) patients received information about the potential risks associated with the scan (Table 2). Regarding patients’ perceptions and preferences, 284 (73.4%) did not receive information about the scan, and 56 (14.5%) believed that provision of information had no effect on them (Table 3). Almost all patients (96.9%) preferred to be told about why they needed a CT scan. About 94.3% of patients expected to be told about the risks associated with the CT scan, and 78.6% preferred to know about the radiation dose(Table 3). In terms of patients’ baseline characteristics, the patients with higher education level and previous experience with a CT scan had significantly higher knowledge about CT scans and their hazards. As the education level increased, the knowledge of CT increased (p-value = 0.015). Similarly, the number of previous scans was associated with higher knowledge of the potential risks of CT (p-value = 0.032; Table 4). Furthermore, 58% of patients knew that CT involves harmful radiation, and only 27% knew that mammograms involve harmful radiation. However, only 20% of patients knew that MRIs do not involve harmful radiation (Figure 1). Table 1 - Patients’ baseline characteristics N % Age (years) 18-24 33 8.5 25-39 148 38.2 40-60 190 49.1 60 or more 16 4.1 Gender Male 203 52.5 Female 184 47.5 Education level Less than high school 77 19.9 High school 110 28.4 University/College 200 51.7 Which specialty is following up with you? Oncology 44 11.4 General Surgery 59 15.2 Internal Medicine 82 21.2 Orthopedics 44 11.4 Family Medicine 22 5.7 Urology 78 20.2 ENT 21 5.4 Others 37 9.6 How many times have you undergone a CT scan previously? Never 97 25.1 Once 72 18.6 Twice 64 16.5 Three times 36 9.3 More than three times 118 30.5 Table 2 - Doctor’s practice toward information provided to patients about the scan Practice Yes No N % N % Has your doctor explained to you why you need this scan? 344 88.9 43 11.1 Has your doctor mentioned to you the amount of radiation associated with this scan? 28 7.2 359 92.8 Has your doctor mentioned to you the risks associated with the radiation expected from this examination? 74 19.1 313 80.9 Table 3 - Patients’ perceptions, beliefs, and preferences Variable Category N % The effect of the information you receive I do not trust it 2 0.5 It has no special effect on me 56 14.5 It reassures me 45 11.6 Not explained 284 73.4 Do you think you should be told about why you need a CT scan? Yes 375 96.9 No 12 3.1 Do you expect to be told about the associated risks? Yes 365 94.3 No 22 5.7 Do you think you should be told about the radiation dose? Yes 304 78.6 No 83 21.4 Table 4 - Association between patients’ baseline characteristics and CT scan radiation risk awareness. Variable Category Awareness of computed tomography radiation risk P-value Yes No‎ N % N % Age (years) 18-24 18 54.5 15 45.5 0.293 25-39 94 63.5 54 36.5 40-60 106 55.8 84 44.2 60 or more 7 43.8 9 56.3 Gender Male 115 56.7 88 43.3 0.533 Female 110 59.8 74 40.2 Education level Less than high school 37 48.1 40 51.9 0.015* High school 58 52.7 52 47.3 University/College 130 65.0 70 35.0 Which specialty is following up with you? Oncology 28 63.6 16 36.4 0.685 General Surgery 33 55.9 26 44.1 Internal Medicine 46 56.1 36 43.9 Orthopedics 25 56.8 19 43.2 Family Medicine 10 45.5 12 54.5 Urology 51 65.4 27 34.6 ENT 13 61.9 8 38.1 Others 19 51.4 18 48.6 How many times have you undergone CT scan previously? Never 45 46.4 52 53.6 0.032* Once 43 59.7 29 40.3 Twice 35 54.7 29 45.3 Three times 22 61.1 14 38.9 More than three times 80 67.8 38 32.2 P-values were calculated using the chi-squared test. * indicated significant associations. Discussion This study was conducted to assess the knowledge, perceptions, and preferences of Saudi patients in Riyadh undergoing CT scans in regard to the risk of radiation they may receive during the procedure. The results show a significant association of education level and previous experience with CT scan knowledge. Most of the patients were referred from the departments of internal medicine and urology. Also, most of the patients perceived that they should be told and preferred to be told about why they needed a CT scan, the radiation dose, and the risk. Furthermore, most of the patients received an explanation about why they needed to undergo a CT scan. However, the vast majority of patients were not told about the amount of radiation and its risks. CT is a distinct source of radiation exposure. Ionizing radiation is a known carcinogen, and the amount of radiation delivered by CT imaging varies across patients, institutions, and regions. 15 . The risk of cancer depends on several factors, such as the part of the body exposed, age of the patient, gender, and dose of radiation delivered to the patient’s tissues. 16 A single CT scan of the abdomen may expose the patient to 10 millisieverts (mSv) of radiation. 17 Radiation-induced risk at doses of 10-100 mSv is controversial and falls in the range of medical imaging, especially CT imaging. 15 However, patients who undergo multiple CT scans or multiphasic CT are at increased risk of cancer. 17 Interestingly, the medical imaging delivers a dose of radiation of 10 mSv or less, and no direct evidence is available in terms of increased risk of cancer. 17 However, it does not reflect that there is no radiation-related risk with CT imaging. Overall, studies have reported limited or lacking knowledge about ionizing radiation among patients undergoing radiological procedures. 18 This is in line with our result, where only 58% of participants correctly believed that CT scans are harmful, while 80% wrongly believed that MRI is harmful. According to the World Health Organization (WHO), the major barriers in effective communication include insufficient knowledge of physicians, radiographers, and nuclear medicine technologists about radiation exposure, as well as underestimation of the radiation dose and its risks. 19 Al-Mallah et al. conducted a cross-sectional study with 416 Bahraini patients attending the radiology department to evaluate the patients’ awareness and knowledge about the associated risks of ionizing radiation. They compared the radiation-related knowledge between prescribed and self-presenting patients and reported no significant effect of age, gender, or education level on the awareness and knowledge about the risk of ionizing radiation. However, they reported more knowledge about ionizing radiation among prescribed patients than among self-reporting patients in terms of minimization and prevention of radiation exposure, lifelong health concern, and belief of better diagnosis with radiological procedures. This difference may be attributed to the information offered in the informed consent procedure provided by the clinician prior to the radiological procedure. Another possible reason is direct conversation between the patient and the clinician about the need for a CT scan and its radiation hazards during a visit. 20 Usually, patients underestimate the radiation risk that they undergo and cannot compare radiation exposure between radiological modalities. 21 Therefore, they must be told about the radiation dose that they are to receive and its risks. This would allow them to share in making decisions with the clinician, and patient autonomy is one of the fundamental principles of medical ethics. In the present study, the majority of patients reported that they were not told about the radiation risk (19.1%) and its dose (7.2%). Nevertheless, most of the participants preferred to know this information (94.3% and 78.6%, respectively). To our knowledge, this study is the first study to report what doctors tell their patients about the radiation risk and to what extent patients prefer to know about it in Saudi Arabia. Therefore, we cannot compare these results with other local data. However, the results of a recent survey in Spain are comparable to our findings as they showed that less than 20% of participants indicated that they were told about the risk of radiation from imaging. 13 In addition, another study showed that 95.9% of patients expected to be told about the risk of the radiation, and 94.6% expected to be told about the dose. 14 Moreover, a study conducted in an emergency department indicates that nearly all of participants were not told about the radiation dose and the risk. 22 This could be explained by the nature of the patients’ illnesses and the pain associated with them in the emergency department in comparison to outpatient settings. Obviously, the responsibility at the end is the clinicians’, who must inform patients and mention the hazards of CT scan radiation. This issue might have arisen due to two of the philosophies mentioned above—i.e., “do not say a word” and “understatement,” where patients’ rights to know are eclipsed by a paternalistic vision and unavoidable risk. 10 Above all, it is a legal and ethical right of the patients to know about the procedure and its risks. In this regard, the present study has reported that those who had previous experience with CT scans had improved knowledge about CT imaging. Medical professionals are the main source of radiation-related information. Therefore, physicians and radiologists must have up-to-date knowledge about CT scan radiation and its hazards. Unfortunately, medical professionals lack knowledge about radiation doses and their risks, and they underestimate the radiation dose being delivered to the patients. 19 In this context, courses could be arranged to refresh the knowledge of medical professionals about radiation hazards and protection. 23 The present study has practical value as it offers a comprehensive approach to the perceptions and preferences of patients about CT scans and their radiation hazards. It also points out that most of the patients are not told about the radiation dose and its long-term hazards, thus warranting more precise and comprehensive sessions between patients and clinicians before embarking on radiological procedures. This would help to promote shared decisions and patient-centered care. However, the study has limitations as well. The single-centered study design restricts the generalizability of the results. Therefore, further studies are warranted at larger scales with multiple centers. Also, the duration between the physician interaction and the time until the patient answered the questionnaire could have caused some recall bias. Conclusion Despite the majority of patients preferring to know about the harm of CT scan radiation, most of them did not receive enough information from their clinicians about it. The education level of patients and previous experience with CT scans were significantly associated with better patient knowledge about CT imaging and its radiation hazards. Offering patient-centered care and sharing decisions between the patient and the clinician after discussing the benefits and risks of CT scans will help to meet the patients’ expectations and preferences, as well as to fill the gap in doctor-patient communication. Declarations Author Contribution In line with the authorship policy outlined by Springer, we detail the contributions of each author to the manuscript as follows:Abdullah A. Alrasheed (AAA) from the Department of Family and Community Medicine, College of Medicine, King Saud University, and King Saud University Medical City, Riyadh, Saudi Arabia, conceptualized the study design, led the data analysis efforts, and was instrumental in writing the Introduction and Discussion sections. AAA also played a pivotal role in integrating the study's findings with broader implications for patient-doctor communication strategies.Abdulrahman M. Alammar (AMA), affiliated with King Saud University, King Saud University Medical City, in the Family and Community Medicine department, Riyadh, Saudi Arabia, was crucial in the data collection process, interpretation of the findings, and significantly contributed to drafting the Methods section. AMA also provided substantial input into the literature review, emphasizing the current knowledge and gaps in patient education regarding CT radiation exposure.Both authors prepared and reviewed all figures, ensuring that they accurately represented the study's findings. Additionally, AAA and AMA collaboratively worked on revising the manuscript critically for important intellectual content, thereby enriching the discussion with their unique perspectives on improving patient-doctor communication within the context of CT radiation exposure. Each author has provided their expert critique, contributed to the final manuscript draft, and approved the final version for publication.It is agreed upon by both Abdullah A. Alrasheed and Abdulrahman M. Alammar that they will be accountable for all aspects of the work. This includes, but is not limited to, ensuring questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 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SAGE Open Med [Internet]. 2020 Jan [cited 2021 Jul 13];8:205031212090173. Available from: /pmc/articles/PMC6977219/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3956987","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":273012702,"identity":"2f787539-783d-4c71-af91-94f9578425ac","order_by":0,"name":"Abdullah A. Alrasheed","email":"data:image/png;base64,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","orcid":"","institution":"King Saud University","correspondingAuthor":true,"prefix":"","firstName":"Abdullah","middleName":"A.","lastName":"Alrasheed","suffix":""},{"id":273012703,"identity":"5884e98b-5e0e-4ab9-948f-3313138124e6","order_by":1,"name":"Abdulrahman M. Alammar","email":"","orcid":"","institution":"King Saud University, King Saud University Medical City","correspondingAuthor":false,"prefix":"","firstName":"Abdulrahman","middleName":"M.","lastName":"Alammar","suffix":""}],"badges":[],"createdAt":"2024-02-14 21:18:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3956987/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3956987/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51330571,"identity":"09eb366e-1005-4f7c-8524-e6de286f1821","added_by":"auto","created_at":"2024-02-19 17:49:05","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56945,"visible":true,"origin":"","legend":"\u003cp\u003ePatients’ knowledge about harmful radiations. The figure on the left “red” bars represents the percentage correct answer of harmful radiation (Yes). The figure on the right “green” bars represents the percentage correct answer of non-harmful radiation (No).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3956987/v1/85f9a2c7eb33e4bf6f5e9b39.jpg"},{"id":51369468,"identity":"8803c4f3-909a-4c36-8923-81b2e51c91bf","added_by":"auto","created_at":"2024-02-20 11:29:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":337431,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3956987/v1/06545928-42cc-4d4f-93f2-de3a12041ad8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"What Patients Want to Know About CT Radiation Exposure Harm and What Doctors Actually Tell Them: A Gap in Patient-Doctor Communication","fulltext":[{"header":"Introduction","content":"\u003cp\u003eComputed tomography (CT) is an important radiological imaging technology and involves a series of radiographic projections that are combined to obtain computer-generated cross-sectional images. Since its invention in 1970, CT has worked wonders in the field of medicine by improving diagnoses, treatment therapies, and surgical procedures.\u003csup\u003e1\u003c/sup\u003e CT machines are widely available and offer accurate diagnosis to physicians in minutes. In addition, CT scans have reduced the number of emergency surgeries, ICU admissions, and length of hospital stay.\u003csup\u003e1,2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eMillions of CT scans are performed worldwide every year.\u003csup\u003e3\u003c/sup\u003e In just the USA and UK, more than 70 million and 5 million CT scans are performed every year, respectively.\u003csup\u003e4\u003c/sup\u003e Although CT scans have revolutionized the diagnostic department of medicine, they raise important public concerns about exposure to ionizing radiation, which could lead to harmful biological effects such as malignancy. It has been reported that a CT coronary angiogram exposes the breasts and lungs to radiation levels equivalent to 15 mammography studies and 711 X-rays of the chest, respectively.\u003csup\u003e5\u003c/sup\u003e. CT scans deliver 50-1000 times more radiation to the human body than a conventional X-ray, contributing to about 50% of all medical radiation.\u003csup\u003e6\u003c/sup\u003e. The utilization of CT scans is increasing day by day, exposing more and more people to the risk of ionizing radiation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGrowing concern about long-term outcomes of ionizing radiation, such as malignancy, warrants the application of fundamental protection rules in health care systems, such as justification, optimization, and dose limitation of radiological imaging techniques.\u003csup\u003e7\u003c/sup\u003e Justification of CT scans is of prime importance on the part of referring physician and radiologist as they must weigh the benefits of the imaging against the possible risks of radiation. In this context, CT scans can be replaced by non-radiating modalities, such as ultrasonography and magnetic resonance imaging (MRI) where possible. Similarly, optimization of CT scan guidelines and protocols could reduce unnecessary radiation exposure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this regard, referring physicians and radiologists must have proper understanding of CT and accurate estimation of the amount of radiation being delivered to patients. A survey evaluated the attitudes of radiologists towards radiation dose and exposure in Saudi Arabia and reported that radiologists have good comprehension of the carcinogenicity risk for patients undergoing CT scans.\u003csup\u003e7\u003c/sup\u003e The fundamental principles of radiation protection are even more important when dealing with pediatric populations, as children are more sensitive to radiation than adults.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eCT poses a significant long-term risk of cancer due to radiation exposure. To respect the dignity and autonomy of the patients, obtaining informed consent for radiological examinations is their ethical and legal right.\u003csup\u003e9\u003c/sup\u003e Therefore, prior to advising and embarking on CT imaging, physicians and radiologists should obtain informed consent after clearly explaining the hazards of the radiation exposure. This practice could help with shared decision making between physicians and patients. In this context, one of the fundamental principles of modern medicine is to make informed decisions about the patients\u0026rsquo; treatment.\u003csup\u003e10\u003c/sup\u003e The purpose of obtaining informed consent is to ensure that the patients fully understand the procedure while avoiding underestimation and overestimation of the hazards of large and small risks of the radiation that patients might absorb during the procedure.\u003c/p\u003e\n\u003cp\u003eCT scan with intravenous contrast infusion may result in extra hazards, such as contrast-related hypersensitivity and contrast-induced nephropathy, in addition to the radiation-related risks.\u003csup\u003e11\u003c/sup\u003e. In this regard, patients must be informed about these contrast-induced complications via informed consent forms. Moreover, some patients may have a history of previous CT imaging, and CT imaging poses further radiation-related hazards that should be communicated to the patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe statements offered in the informed consent forms may vary. Recent consent forms follow one of three philosophies: \u0026ldquo;do not say a word,\u0026rdquo; \u0026ldquo;understatement,\u0026rdquo; and \u0026ldquo;full disclosure\u0026rdquo; [10]. \u0026ldquo;Do not say a word\u0026rdquo; refers to not mentioning the hazard of radiation, and the legal right of informed consent is eclipsed by the patients\u0026rsquo; perception that the experts are efficient and know best. \u0026ldquo;Understatement\u0026rdquo; is based on imprecise statements to avoid \u0026ldquo;useless\u0026rdquo; concern about risk that is unavoidable. The third philosophy of \u0026ldquo;full disclosure\u0026rdquo; uses straightforward statements in providing informed consent, especially when it comes to the research projects.\u003c/p\u003e\n\u003cp\u003eOnly preliminary studies are available from Saudi Arabia about the knowledge, perceptions, and preferences of patients undergoing CT imaging.\u003csup\u003e12\u003c/sup\u003e In addition, studies that examined this topic broadly to determine the gap in patient-doctor communication are lacking in Saudi Arabia. Therefore, this study was conducted to assess these issues. This study could be a useful addition to the literature from Saudi Arabia about these patient characteristics and clinician practice.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy design and setting.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThis cross-sectional study involved patients undergoing CT scans. The study was conducted in the outpatient department at a tertiary hospital in Riyadh. The study was approved by the Institutional Review Board of the College of Medicine of King Saud University (No. E-19-3904). The\u0026nbsp;study was conducted using phone call interviews. Verbal consent was obtained from participants before they answered the questionnaire, and their identity was kept confidential.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants and survey instrument.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eParticipants included patients who underwent a CT scan within three months at a tertiary hospital in Riyadh at the outpatient radiology department. Data were collected between September 2020 and January 2021 by simple random sampling. A list of patients who underwent CT was obtained, and we selected every other patient. Using phone interviews, the researchers asked all the questions in the questionnaire.\u003c/p\u003e\n\u003cp\u003eWe created the questionnaire after an extensive literature review\u003csup\u003e.13,\u003c/sup\u003e\u003csup\u003e14\u003c/sup\u003e The questionnaire was then reviewed by two expert radiologists and family physicians who have the expertise in this area. Afterwards, the suggested adjustments were made, and a final draft was set after a pilot study. The pilot study took place with 20 patients to ensure that the questions were clear, understandable, and in a logical order. Those who participated in the pilot study were not enrolled in the final analysis. The internal consistency (reliability) was measured using Cronbach\u0026apos;s alpha coefficient, which was \u0026gt;0.7.\u003c/p\u003e\n\u003cp\u003eThe questionnaire was divided into four sections. The first section describes socio-demographics, the second assesses the encounter between the patient and the physician before ordering the CT scan, and the third section focuses on the participants. The final part measured knowledge regarding radiation, patient perceptions, and the amount of information that participants wanted regarding radiation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample size.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eWe estimated that for a precision of 5% with 95% confidence intervals, at least 323 people would be required to estimate the proportion of individuals who know that imaging tests incur a health risk. Based on a literature review, around 70 % of the population could be aware of it. Next, 20% was added, so our sample size was 388 patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical tests.\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eData were entered and analyzed using IBM SPSS Statistics for Windows, Version 24.0 (Armonk, NY: IBM Corp.). Categorical data are presented as numbers and percentages. The chi-squared test was used to assess the association between awareness about the CT risk and patients\u0026rsquo; baseline characteristics. The level of significance was set at \u0026alpha; =0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 387 patients who underwent CT scan, and 203 (52.5%) patients were males. A majority of the patients (190 patients; 49.1%) belonged to the age group of 40 to 60 years old. More than half of the patients (200 patients; 51.7%) were university graduates. Internal medicine and urology were the most common referral specialties for the CT scan at 21.2% and 20.2%, respectively. Around one-quarter of the patients (25.1%) had never had a CT scan before, and 118 (30.5%) had at least four CT scans before (Table 1).\u003c/p\u003e\n\u003cp\u003eRegarding the doctors\u0026rsquo; practices toward information provided to patients about the scan, 344 (88.9%) patients indicated that their doctor had explained to them why they needed the scan. Only 28 (7.2%) patients stated that the doctor mentioned the amount of radiation, and 74 (19.1%) patients\u0026rsquo; doctors mentioned the risks associated with the radiation of the scan. When IV contrast was used, 106 (27.4%) patients received information about the potential risks associated with the scan (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding patients\u0026rsquo; perceptions and preferences, 284 (73.4%) did not receive information about the scan, and 56 (14.5%) believed that provision of information had no effect on them (Table 3). Almost all patients (96.9%) preferred to be told about why they needed a CT scan. About 94.3% of patients expected to be told about the risks associated with the CT scan, and 78.6% preferred to know about the radiation dose(Table 3).\u003c/p\u003e\n\u003cp\u003eIn terms of patients\u0026rsquo; baseline characteristics, the patients with higher education level and previous experience with a CT scan had significantly higher knowledge about CT scans and their hazards. As the education level increased, the knowledge of CT increased (p-value = 0.015). Similarly, the number of previous scans was associated with higher knowledge of the potential risks of CT (p-value = 0.032; Table 4). Furthermore, 58% of patients knew that CT involves harmful radiation, and only 27% knew that mammograms involve harmful radiation. However, only 20% of patients knew that MRIs do not involve harmful radiation (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;-\u0026nbsp;\u003c/strong\u003ePatients\u0026rsquo; baseline characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"463\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.24137931034483%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.543103448275865%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.69827586206897%\" valign=\"top\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003e25-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e38.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003e40-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e49.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003e60 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.543103448275865%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.69827586206897%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.543103448275865%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.69827586206897%\" valign=\"top\"\u003e\n \u003cp\u003eLess than high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eUniversity/College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.543103448275865%\" rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich specialty is following up with you?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.69827586206897%\" valign=\"top\"\u003e\n \u003cp\u003eOncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eGeneral Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eInternal Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eOrthopedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eFamily Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eUrology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.543103448275865%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow many times have you undergone a CT scan previously?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.69827586206897%\" valign=\"top\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.379310344827587%\" valign=\"top\"\u003e\n \u003cp\u003e25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eOnce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eTwice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eThree times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.43769968051118%\" valign=\"top\"\u003e\n \u003cp\u003eMore than three times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.28115015974441%\" valign=\"top\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;-\u0026nbsp;\u003c/strong\u003eDoctor\u0026rsquo;s practice toward information provided to patients about the scan\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"551\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.457350272232304%\" rowspan=\"2\"\u003e\n \u003cp\u003ePractice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.771324863883848%\" colspan=\"2\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.771324863883848%\" colspan=\"2\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.183098591549296%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.816901408450704%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.183098591549296%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.816901408450704%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.457350272232304%\" valign=\"top\"\u003e\n \u003cp\u003eHas your doctor explained to you why you need this scan?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.433756805807622%\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.337568058076226%\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.433756805807622%\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.337568058076226%\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.457350272232304%\" valign=\"top\"\u003e\n \u003cp\u003eHas your doctor mentioned to you the amount of radiation associated with this scan?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.433756805807622%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.337568058076226%\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.433756805807622%\"\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.337568058076226%\"\u003e\n \u003cp\u003e92.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.457350272232304%\" valign=\"top\"\u003e\n \u003cp\u003eHas your doctor mentioned to you the risks associated with the radiation expected from this examination?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.433756805807622%\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.337568058076226%\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.433756805807622%\"\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.337568058076226%\"\u003e\n \u003cp\u003e80.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;-\u0026nbsp;\u003c/strong\u003ePatients\u0026rsquo; perceptions, beliefs, and preferences\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"529\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.582230623818525%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.166351606805293%\" valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.775047258979207%\" valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.476370510396976%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.582230623818525%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eThe effect of the information you receive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.166351606805293%\" valign=\"top\"\u003e\n \u003cp\u003eI do not trust it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.775047258979207%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.476370510396976%\" valign=\"top\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.779411764705884%\" valign=\"top\"\u003e\n \u003cp\u003eIt has no special effect on me\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.955882352941178%\" valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.264705882352942%\" valign=\"top\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.779411764705884%\" valign=\"top\"\u003e\n \u003cp\u003eIt reassures me\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.955882352941178%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.264705882352942%\" valign=\"top\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.779411764705884%\" valign=\"top\"\u003e\n \u003cp\u003eNot explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.955882352941178%\" valign=\"top\"\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.264705882352942%\" valign=\"top\"\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.582230623818525%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDo you think you should be told about why you need a CT scan?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.166351606805293%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.775047258979207%\" valign=\"top\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.476370510396976%\" valign=\"top\"\u003e\n \u003cp\u003e96.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.779411764705884%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.955882352941178%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.264705882352942%\" valign=\"top\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.582230623818525%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDo you expect to be told about the associated risks?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.166351606805293%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.775047258979207%\" valign=\"top\"\u003e\n \u003cp\u003e365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.476370510396976%\" valign=\"top\"\u003e\n \u003cp\u003e94.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.779411764705884%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.955882352941178%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.264705882352942%\" valign=\"top\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.582230623818525%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDo you think you should be told about the radiation dose?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.166351606805293%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.775047258979207%\" valign=\"top\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.476370510396976%\" valign=\"top\"\u003e\n \u003cp\u003e78.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.779411764705884%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.955882352941178%\" valign=\"top\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.264705882352942%\" valign=\"top\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e-\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAssociation between patients\u0026rsquo; baseline characteristics and CT scan radiation risk awareness.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"704\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.49431818181818%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.301136363636363%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.704545454545453%\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness of computed tomography radiation risk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.191489361702125%\" colspan=\"2\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.808510638297875%\" colspan=\"2\"\u003e\n \u003cp\u003eNo\u0026lrm;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.74468085106383%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.4468085106383%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.93617021276596%\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.872340425531913%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.49431818181818%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.301136363636363%\" valign=\"top\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.5397727272727275%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.664772727272727%\"\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.392045454545454%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.107954545454546%\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"4\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003e25-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003e40-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e55.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003e60 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e56.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.49431818181818%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.301136363636363%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.5397727272727275%\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.664772727272727%\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.392045454545454%\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.107954545454546%\"\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.49431818181818%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.301136363636363%\" valign=\"top\"\u003e\n \u003cp\u003eLess than high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.5397727272727275%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.664772727272727%\"\u003e\n \u003cp\u003e48.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.392045454545454%\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.107954545454546%\"\u003e\n \u003cp\u003e51.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.015*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eUniversity/College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e65.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e35.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.49431818181818%\" rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich specialty is following up with you?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.301136363636363%\" valign=\"top\"\u003e\n \u003cp\u003eOncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.5397727272727275%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.664772727272727%\"\u003e\n \u003cp\u003e63.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.392045454545454%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.107954545454546%\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"8\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eGeneral Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e55.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eInternal Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e56.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e43.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eOrthopedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e56.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eFamily Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eUrology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e65.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e61.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e48.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.49431818181818%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow many times have you undergone CT scan previously?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.301136363636363%\" valign=\"top\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.5397727272727275%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.664772727272727%\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.392045454545454%\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.107954545454546%\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" rowspan=\"5\"\u003e\n \u003cp\u003e0.032*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eOnce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e59.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eTwice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e54.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e45.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eThree times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e61.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.507246376811594%\" valign=\"top\"\u003e\n \u003cp\u003eMore than three times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.304347826086957%\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.681159420289855%\"\u003e\n \u003cp\u003e67.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.46376811594203%\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eP-values were calculated using the chi-squared test. * indicated significant associations.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was conducted to assess\u0026nbsp;the\u0026nbsp;knowledge, perceptions, and preferences\u0026nbsp;of\u0026nbsp;Saudi\u0026nbsp;patients\u0026nbsp;in Riyadh\u0026nbsp;undergoing\u0026nbsp;CT scans\u0026nbsp;in\u0026nbsp;regard to\u0026nbsp;the risk of\u0026nbsp;radiation they may receive during the procedure. The results show a significant association of education level and previous experience with CT scan knowledge. Most of the patients were referred from the departments of internal medicine and urology. Also, most\u0026nbsp;of the patients perceived that they should be told and preferred to be told about why they needed a CT scan, the radiation dose, and the risk. Furthermore, most of the patients received an explanation about why they needed to undergo a CT scan. However, the vast majority\u0026nbsp;of patients were not told about the amount of radiation and its risks.\u003c/p\u003e\n\u003cp\u003eCT is a distinct source of radiation exposure. Ionizing radiation is a known carcinogen, and the amount of radiation delivered by CT imaging varies across patients, institutions, and regions.\u003csup\u003e15\u003c/sup\u003e. The risk of cancer depends on several factors, such as the part of the body exposed, age of the patient, gender, and dose of radiation delivered to the patient\u0026rsquo;s tissues.\u003csup\u003e16\u003c/sup\u003e A single CT scan of the abdomen may expose the patient to 10 millisieverts (mSv) of radiation.\u003csup\u003e17\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRadiation-induced risk at doses of 10-100 mSv is controversial and falls in the range of medical imaging, especially CT imaging.\u003csup\u003e15\u003c/sup\u003e However, patients who undergo multiple CT scans \u0026nbsp;or multiphasic CT are at increased risk of cancer.\u003csup\u003e17\u003c/sup\u003e Interestingly, the medical imaging delivers a dose of radiation of 10 mSv or less, and no direct evidence is available in terms of increased risk of cancer.\u003csup\u003e17\u003c/sup\u003e However, it does not reflect that there is no radiation-related risk with CT imaging.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, studies have reported limited or lacking knowledge about ionizing radiation among patients undergoing radiological procedures.\u003csup\u003e18\u003c/sup\u003e This is in line with our result, where only 58% of participants correctly believed that CT scans are harmful, while 80% wrongly believed that MRI is harmful. According to the World Health Organization (WHO), the major barriers in effective communication include insufficient knowledge of physicians, radiographers, and nuclear medicine technologists about radiation exposure, as well as underestimation of the radiation dose and its risks.\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAl-Mallah et al. conducted a cross-sectional study with 416 Bahraini patients attending the radiology department to evaluate the patients\u0026rsquo; awareness and knowledge about the associated risks of ionizing radiation. They compared the radiation-related knowledge between prescribed and self-presenting patients\u0026nbsp;and reported no significant effect of age, gender, or education level on the awareness and knowledge about the risk of ionizing radiation. However, they reported more knowledge about ionizing radiation among prescribed patients than among self-reporting patients in terms of minimization and prevention of radiation exposure, lifelong health concern, and belief of better diagnosis with radiological procedures. This difference may be attributed to the information offered in the informed consent procedure provided by the clinician prior to the radiological procedure. Another possible reason is direct conversation between the patient and the clinician about the need for a CT scan and its radiation hazards during a visit.\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eUsually, patients underestimate the radiation risk that they undergo and cannot compare radiation exposure between radiological modalities.\u003csup\u003e21\u003c/sup\u003e Therefore, they must be told about the radiation dose that they are to receive and its risks. This would allow them to share in making decisions with the clinician, and patient autonomy is one of the fundamental principles of medical ethics. In the present study, the majority of patients reported that they were not told about the radiation risk (19.1%) and its dose (7.2%). Nevertheless, most of the participants preferred to know this information (94.3% and 78.6%, respectively).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo our knowledge, this study is the first study to report what doctors tell their patients about the radiation risk and to what extent patients prefer to know about it in Saudi Arabia. Therefore, we cannot compare these results with other local data. However, the results of a recent survey in Spain are comparable to our findings as they showed that less than 20% of participants indicated that they were told about the risk of radiation from imaging.\u003csup\u003e13\u003c/sup\u003e In addition, another study showed that 95.9% of patients expected to be told about the risk of the radiation, and 94.6% expected to be told about the dose.\u003csup\u003e14\u003c/sup\u003e Moreover, a study conducted in an emergency department indicates that nearly all of participants were not told about the radiation dose and the risk.\u003csup\u003e22\u003c/sup\u003e This could be explained by the nature of the patients\u0026rsquo; illnesses and the pain associated with them in the emergency department in comparison to outpatient settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObviously, the responsibility at the end is the clinicians\u0026rsquo;, who must inform patients and mention the hazards of CT scan radiation. This issue might have arisen due to two of the philosophies mentioned above\u0026mdash;i.e., \u0026ldquo;do not say a word\u0026rdquo; and \u0026ldquo;understatement,\u0026rdquo; where patients\u0026rsquo; rights to know are eclipsed by a paternalistic vision and unavoidable risk.\u003csup\u003e10\u003c/sup\u003e\u0026nbsp; Above all, it is a legal and ethical right of the patients to know about the procedure and its risks. In this regard, the present study has reported that those who had previous experience with CT scans had improved knowledge about CT imaging.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedical professionals are the main source of radiation-related information. Therefore, physicians and radiologists must have up-to-date knowledge about CT scan radiation and its hazards. Unfortunately, medical professionals lack knowledge about radiation doses and their risks, and they underestimate the radiation dose being delivered to the patients.\u003csup\u003e19\u003c/sup\u003e In this context, courses could be arranged to refresh the knowledge of medical professionals about radiation hazards and protection.\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe present study has practical value as it offers a comprehensive approach to the perceptions and preferences of patients about CT scans and their radiation hazards. It also points out that most of the patients are not told about the radiation dose and its long-term hazards, thus warranting more precise and comprehensive sessions between patients and clinicians before embarking on radiological procedures. This would help to promote shared decisions and patient-centered care. However, the study has limitations as well. The single-centered study design restricts the generalizability of the results. Therefore, further studies are warranted at larger scales with multiple centers. Also, the duration between the physician interaction and the time until the patient answered the questionnaire could have caused some recall bias.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite the majority of patients preferring to know about the harm of CT scan radiation, most of them did not receive enough information from their clinicians about it. The education level of patients and previous experience with CT scans were significantly associated with better patient knowledge about CT imaging and its radiation hazards. Offering patient-centered care and sharing decisions between the patient and the clinician after discussing the benefits and risks of CT scans will help to meet the patients\u0026rsquo; expectations and preferences, as well as to fill the gap in doctor-patient communication.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eIn line with the authorship policy outlined by Springer, we detail the contributions of each author to the manuscript as follows:Abdullah A. Alrasheed (AAA) from the Department of Family and Community Medicine, College of Medicine, King Saud University, and King Saud University Medical City, Riyadh, Saudi Arabia, conceptualized the study design, led the data analysis efforts, and was instrumental in writing the Introduction and Discussion sections. AAA also played a pivotal role in integrating the study's findings with broader implications for patient-doctor communication strategies.Abdulrahman M. Alammar (AMA), affiliated with King Saud University, King Saud University Medical City, in the Family and Community Medicine department, Riyadh, Saudi Arabia, was crucial in the data collection process, interpretation of the findings, and significantly contributed to drafting the Methods section. AMA also provided substantial input into the literature review, emphasizing the current knowledge and gaps in patient education regarding CT radiation exposure.Both authors prepared and reviewed all figures, ensuring that they accurately represented the study's findings. Additionally, AAA and AMA collaboratively worked on revising the manuscript critically for important intellectual content, thereby enriching the discussion with their unique perspectives on improving patient-doctor communication within the context of CT radiation exposure. Each author has provided their expert critique, contributed to the final manuscript draft, and approved the final version for publication.It is agreed upon by both Abdullah A. Alrasheed and Abdulrahman M. Alammar that they will be accountable for all aspects of the work. This includes, but is not limited to, ensuring questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePower SP, Moloney F, Twomey M, James K, O\u0026rsquo;Connor OJ, Maher MM. Computed tomography and patient risk: Facts, perceptions and uncertainties. World J Radiol [Internet]. 2016 [cited 2021 Jul 13];8(12):902. Available from: /pmc/articles/PMC5183924/\u003c/li\u003e\n\u003cli\u003eWJ van den H, GM van der W, F B, FJ I, SJ R, R H. Early CT scanning in the emergency department in patients with penetrating injuries: does it affect outcome? Eur J Trauma Emerg Surg [Internet]. 2018 Aug 1 [cited 2021 Jul 13];44(4):607\u0026ndash;14. Available from: https://pubmed.ncbi.nlm.nih.gov/28868591/\u003c/li\u003e\n\u003cli\u003eBercovich E, Javitt MC. Medical Imaging: From Roentgen to the Digital Revolution, and Beyond. Rambam Maimonides Med J [Internet]. 2018 Oct 4 [cited 2021 Jul 13];9(4):e0034. Available from: /pmc/articles/PMC6186003/\u003c/li\u003e\n\u003cli\u003eM B de B, JA S, MS P, J M, L R, I B, et al. Trends and patterns in the use of computed tomography in children and young adults in Catalonia - results from the EPI-CT study. Pediatr Radiol [Internet]. 2016 Jan 1 [cited 2021 Jul 13];46(1):119\u0026ndash;29. Available from: https://pubmed.ncbi.nlm.nih.gov/26276264/\u003c/li\u003e\n\u003cli\u003eR S-B, J L, R M, KP K, M M, R G, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med [Internet]. 2009 Dec 14 [cited 2021 Jul 13];169(22):2078\u0026ndash;86. Available from: https://pubmed.ncbi.nlm.nih.gov/20008690/\u003c/li\u003e\n\u003cli\u003eFA M, PW W, JA L, CA K. CT scanning: patterns of use and dose. J Radiol Prot [Internet]. 2000 [cited 2021 Jul 13];20(4):353\u0026ndash;9. Available from: https://pubmed.ncbi.nlm.nih.gov/11140709/\u003c/li\u003e\n\u003cli\u003eAlmohiy HM, Hussein K, Alqahtani M, Elshiekh E, Loaz O, Alasmari A, et al. Radiologists\u0026rsquo; Knowledge and Attitudes towards CT Radiation Dose and Exposure in Saudi Arabia\u0026mdash;A Survey Study. Med Sci 2020, Vol 8, Page 27 [Internet]. 2020 Jul 20 [cited 2021 Jul 13];8(3):27. Available from: https://www.mdpi.com/2076-3271/8/3/27/htm\u003c/li\u003e\n\u003cli\u003eAL-Rammah TY. CT radiation dose awareness among paediatricians. Ital J Pediatr 2016 421 [Internet]. 2016 Aug 31 [cited 2021 Jul 13];42(1):1\u0026ndash;6. Available from: https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0290-3\u003c/li\u003e\n\u003cli\u003eV D, JC BP. Duty to Inform and Informed Consent in Diagnostic Radiology: How Ethics and Law can Better Guide Practice. HEC Forum [Internet]. 2016 Mar 1 [cited 2021 Jul 13];28(1):75\u0026ndash;94. Available from: https://pubmed.ncbi.nlm.nih.gov/25749428/\u003c/li\u003e\n\u003cli\u003eE P. Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. BMJ [Internet]. 2004 Oct 9 [cited 2021 Jul 13];329(7470):849\u0026ndash;51. Available from: https://pubmed.ncbi.nlm.nih.gov/15472270/\u003c/li\u003e\n\u003cli\u003eAD B, MH T, B J. Informed consent in diagnostic radiology practice: Where do we stand? Indian J Radiol Imaging [Internet]. 2017 Oct 1 [cited 2021 Jul 13];27(4):517\u0026ndash;20. Available from: https://pubmed.ncbi.nlm.nih.gov/29379250/\u003c/li\u003e\n\u003cli\u003eAldhebaib A, Singh OG, Almutlaq Z, Alaqeel A, Alkhalifah RSM, Alnasser TNI, et al. A Study Based on Perception towards the Radiation Exposure to Adult Patients at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. J Adv Med Med Res [Internet]. 2018 Jun 6 [cited 2021 Jul 13];26(9):1\u0026ndash;11. Available from: https://www.journaljammr.com/index.php/JAMMR/article/view/11549\u003c/li\u003e\n\u003cli\u003eLumbreras B, Vilar J, Gonz\u0026aacute;lez-\u0026Aacute;lvarez I, Guilabert M, Pastor-Valero M, Parker LA, et al. Avoiding fears and promoting shared decision-making: How should physicians inform patients about radiation exposure from imaging tests? PLoS One. 2017;12(7):1\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eSin HK, Wong CS, Huang B, Yiu KL, Wong WL, Chu YCT. Assessing local patients\u0026rsquo; knowledge and awareness of radiation dose and risks associated with medical imaging: A questionnaire study. J Med Imaging Radiat Oncol. 2013;57(1):38\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eSmith-Bindman R, Wang Y, Chu P, Chung R, Einstein AJ, Balcombe J, et al. International variation in radiation dose for computed tomography examinations: prospective cohort study. BMJ [Internet]. 2019 Jan 2 [cited 2021 Jul 13];364. Available from: https://www.bmj.com/content/364/bmj.k4931\u003c/li\u003e\n\u003cli\u003eReactor Concepts Manual Biological Effects of Radiation. \u003c/li\u003e\n\u003cli\u003eLin EC. Radiation Risk From Medical Imaging. Mayo Clin Proc [Internet]. 2010 [cited 2021 Jul 13];85(12):1142. Available from: /pmc/articles/PMC2996147/\u003c/li\u003e\n\u003cli\u003eA R, O H, N D, I M, K M, J T, et al. Ionising radiation exposure from medical imaging - A review of Patient\u0026rsquo;s (un) awareness. Radiogr (London, Engl 1995) [Internet]. 2020 May 1 [cited 2021 Jul 13];26(2):e25\u0026ndash;30. Available from: https://pubmed.ncbi.nlm.nih.gov/32052780/\u003c/li\u003e\n\u003cli\u003eWJ L, SH W, SH S, DH K, JH W, SP C, et al. Physician and nurse knowledge about patient radiation exposure in the emergency department. Niger J Clin Pract [Internet]. 2016 Jul 1 [cited 2021 Jul 13];19(4):502\u0026ndash;7. Available from: https://pubmed.ncbi.nlm.nih.gov/27251968/\u003c/li\u003e\n\u003cli\u003eA A-M, AG V, M A-S, M A-M. Awareness and Knowledge of Ionizing Radiation Risks Between Prescribed and Self-Presenting Patients for Common Diagnostic Radiological Procedures in Bahrain. Oman Med J [Internet]. 2017 Sep 1 [cited 2021 Jul 13];32(5):371\u0026ndash;7. Available from: https://pubmed.ncbi.nlm.nih.gov/29026468/\u003c/li\u003e\n\u003cli\u003eSJ S, J B. Patient Knowledge and Perception of Radiation Risk in Diagnostic Imaging: A Cross-Sectional Study. J patient Exp [Internet]. 2020 Feb [cited 2021 Jul 13];7(1):110\u0026ndash;5. Available from: https://pubmed.ncbi.nlm.nih.gov/32128379/\u003c/li\u003e\n\u003cli\u003eCI L, AH H, EP M, JA B, HP F. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology [Internet]. 2004 May [cited 2021 Jul 13];231(2):393\u0026ndash;8. Available from: https://pubmed.ncbi.nlm.nih.gov/15031431/\u003c/li\u003e\n\u003cli\u003eKhamtuikrua C, Suksompong S. Awareness about radiation hazards and knowledge about radiation protection among healthcare personnel: A quaternary care academic center\u0026ndash;based study. SAGE Open Med [Internet]. 2020 Jan [cited 2021 Jul 13];8:205031212090173. Available from: /pmc/articles/PMC6977219/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3956987/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3956987/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCT scan utilizes ionizing radiation poses a danger to the patient's health. Thus, telling the patient about ionizing radiation would be critical in promoting shared decision-making and improving patient-doctor communication. However, few studies have examined this topic broadly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: study was conducted to identify the frequency of physicians informing patients about the radiation risk before ordering a CT scan, as well as to assess the knowledge, perceptions, and preferences of patients undergoing CT scans in regard to radiation risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was performed between September 2020 and January 2021. The sample was 387 patients who underwent a CT scan at a tertiary hospital in Saudi Arabia. We randomly selected every other name using the patient list for a physician to contact them by telephone. Verbal informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eWhen examining knowledge, 58% of patients knew that CT involves harmful radiation. This knowledge was significantly associated with higher education level and previous experience with CT scans. Regarding doctors’ practice of providing information to patients about the scan, 344 (88.9%) patients indicated that their doctor had explained to them why they needed the scan. Only 28 (7.2%) patients stated that their doctor had mentioned the amount of radiation, and 74 (19.1%) patients indicated that doctors mentioned the risks associated with the radiation of the scan. Almost all patients (96.9%) preferred to be told about why they needed a CT scan. About 94.3% of patients expected to be told about the risks associated with CT scans, and 78.6% preferred to know about the radiation dose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The vast majority of patients who underwent CT scans did not receive enough information about the harm of the scans. However, most of them preferred to know about this harm. Therefore, filling this gap in doctor-patient communication is highly needed.\u003c/p\u003e","manuscriptTitle":"What Patients Want to Know About CT Radiation Exposure Harm and What Doctors Actually Tell Them: A Gap in Patient-Doctor Communication","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-19 17:49:01","doi":"10.21203/rs.3.rs-3956987/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed9354b6-b71b-46fe-93c3-a717a4edab1e","owner":[],"postedDate":"February 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-20T11:29:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-19 17:49:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3956987","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3956987","identity":"rs-3956987","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}