Counsel a parent about radiation risk and consent for a paediatric CT — OSCE

OSCE communication and decision-making station: apply the principles of radiation protection to a child referred for a CT, justify or substitute the request, counsel the anxious parent about the radiation risk in plain language, and apply the ALARA principle and the imaging-stewardship pathway.

communication and decision-making station3 min readVerification in progress

Prompt

A 6-year-old boy, under oncology follow-up after treatment for a Wilms tumour, is due for a routine surveillance CT of the chest and abdomen. His parent is anxious and is asking whether the scan is really necessary, having read online that repeated CT scans cause cancer. You are the paediatric registrar asked to apply the radiation-aware approach: decide on the imaging in discussion with the parent, counsel them about the radiation risk, and demonstrate the principles of radiation protection and imaging stewardship.

Candidate brief

You have this station to apply the radiation-aware approach to a child referred for a surveillance CT, decide on the imaging in discussion with the anxious parent, and counsel them about the radiation risk and the reasoning behind your decision. Treat this as a communication and decision-making encounter: confirm the clinical context and the justification, communicate the radiation risk in accurate plain language, name the alternatives and the optimisation, and demonstrate the principles of radiation protection and imaging stewardship. [8] [10]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References4Show ledger

[1]Pearce MS, Salotti JA, Little MP, et al Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study Lancet, 2012.PMID 22681860
[3]Brenner DJ, Hall EJ Computed tomography--an increasing source of radiation exposure N Engl J Med, 2007.PMID 18046031
[8]Frush DP, Frush KS The ALARA concept in pediatric imaging: building bridges between radiology and emergency medicine Pediatr Radiol, 2008.PMID 18810422
[10]Kanal KM, Butler PF, Chatfield MB, et al U.S. Diagnostic Reference Levels and Achievable Doses for 10 Pediatric CT Examinations Radiology, 2022.PMID 34928733