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Radiation safety and knowledge: an international survey of 708 interventional pain physicians
  1. David Anthony Provenzano1,
  2. Samuel Ambrose Florentino1,2,
  3. Jason S Kilgore3,
  4. Jose De Andres4,
  5. B Todd Sitzman5,
  6. Scott Brancolini6,
  7. Tim J Lamer7,
  8. Asokumar Buvanendran8,
  9. John A Carrino9,
  10. Timothy R Deer10 and
  11. Samer Narouze11
  1. 1Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA
  2. 2University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
  3. 3Washington and Jefferson College, Washington, Pennsylvania, USA
  4. 4Anesthesiology Critical Care and Pain Management, Valencia University Medical School and General University Hospital, Valencia, Spain
  5. 5Advanced Pain Therapy, Hattiesburg, Mississippi, USA
  6. 6Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  7. 7Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  8. 8Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
  9. 9Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
  10. 10Spine and Nerve Center of the Virginias, West Virginia University - Health Sciences Campus, Morgantown, West Virginia, USA
  11. 11Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
  1. Correspondence to Dr David Anthony Provenzano, Pain Diagnostics and Interventional Care, Sewickley, PA 15143, USA; davidprovenzano{at}hotmail.com

Abstract

Introduction Interventional pain procedures have increased in complexity, often requiring longer radiation exposure times and subsequently higher doses. The practicing physician requires an in-depth knowledge and evidence-based knowledge of radiation safety to limit the health risks to themselves, patients and healthcare staff. The objective of this study was to examine current radiation safety practices and knowledge among interventional pain physicians and compare them to evidence-based recommendations.

Materials and methods A 49-question survey was developed based on an extensive review of national and international guidelines on radiation safety. The survey was web-based and distributed through the following professional organizations: Association of Pain Program Directors, American Academy of Pain Medicine, American Society of Regional Anesthesia and Pain Medicine, European Society of Regional Anesthesia and Pain Therapy, International Neuromodulation Society, and North American Neuromodulation Society. Responses to radiation safety practices and knowledge questions were evaluated and compared with evidence-based recommendations. An exploratory data analysis examined associations with radiation safety training/education, geographical location, practice type, self-perceived understanding, and fellowship experience.

Results Of 708 responding physicians, 93% reported concern over the health effects of radiation, while only 63% had ever received radiation safety training/education. Overall, ≥80% physician compliance with evidence-based radiation safety practice recommendations was demonstrated for only 2/15 survey questions. Physician knowledge of radiation safety principles was low, with 0/10 survey questions having correct response rates ≥80%.

Conclusion We have identified deficiencies in the implementation of evidence-based practices and knowledge gaps in radiation safety. Further education and training are warranted for both fellowship training and postgraduate medical practice. The substantial gaps identified should be addressed to better protect physicians, staff and patients from unnecessary exposure to ionizing radiation during interventional pain procedures.

  • pain management
  • chronic pain
  • education

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Footnotes

  • Twitter @DProvenzanoMD, @sam_florentino, @AsokumarMD, @doctdeer, @NarouzeMD

  • Presented at American Society of Regional Anesthesia and Pain Medicine 18 th Annual Meeting. New Orleans, LA. November 2019. Abstract ID #262. North American Neuromodulation Society 23rd Annual Meeting. Las Vegas, NV. January 2020.

  • Contributors DAP: This author conceived and presented the idea. He was involved in the survey development, survey revision, interpretation of data, drafting of the manuscript and review of all aspects of this manuscript. SAF: This author was involved in survey development, survey revision, survey validation, performing statistical analysis, interpreting data and the drafting of the manuscript and review of all aspects of this manuscript. JSK: This author was involved in survey development, survey revision, performed the statistical analysis, interpreting data and the drafting of the manuscript and review of all aspects of this manuscript. JDA: This author contributed to survey revision and the implementation of the experiment. BTS: This author contributed to survey revision and the implementation of the experiment. SB: This author contributed to survey revision and the implementation of the experiment. TJL: This author contributed to survey revision and the implementation of the experiment. AB: This author contributed to survey revision and the implementation of the experiment. JAC: This author contributed to survey revision and the implementation of the experiment. TRD: This author contributed to survey revision and the implementation of the experiment. SN: This author contributed to survey revision and the implementation of the experiment. All authors have read, critically revised and approved the entirety of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Conflict statements were provided. However, the conflicts are not related to the manuscript.

  • Patient consent for publication Not required.

  • Ethics approval The survey study (protocol #201810141876) was reviewed and approved by Robert Morris University Institutional Review Board on November 1 2018.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The deidentified data can be requested from Pain Diagnostics and Interventional Care.

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