綜論：醫師與病人對電腦斷層輻射及風險認知之文獻回顧

Review: Physicians’ and Patients’ Awareness of Radiation Exposure from Computed Tomography

電腦斷層早已於臨床上廣泛應用，其輻射劑量所產生的致癌風險也業已證實。近年電腦斷層檢查量呈現急速的增長，學界、醫界對放射診斷檢查輻射劑量暴露所致之風險亦更加關注。醫師開立放射線檢查與否，醫師以及病人對電腦斷層輻射暴露及風險之知識與態度是主要影響因素。此篇文章回顧2004~2013年的研究結果，針對此議題進行討論。許多研究發現多數臨床醫師對於放射線檢查輻射劑量及風險有錯誤的認知，尤以電腦斷層為最，這種現象可能歸因於非放射科醫師於求學或實習階段並無修習足夠輻射風險相關課程。病人及家屬多希望醫療人員在進行放射線檢查前，能告知有關輻射相關的風險。基於上述論點，在全國衛生政策層面可建立雲端醫學影像紀錄共享平台、健保IC卡建置個人醫療輻射暴露史，避免開立過多非必要的檢查。在醫學教育層面，建議應於醫師養成教育或在職教育置入足夠輻射風險與管理相關課程。在醫院管理層面，建議建立臨床醫師與放射科專科醫師的諮詢機制，並與病人進行充分的風險溝通，建立醫療團隊與病人間的夥伴關係，使醫療品質能夠持續提升，也避免不必要的浪費。

Computed tomography is useful and routinely done for clinical purposes, but the detrimental effect has been identified. The number of examination is increasing rapidly in recent years. Lately, there has been a growing awareness of risk of medical radiation from diagnostic imaging. Additionally, the physicians’ and patients’ knowledge and attitudes about the radiation risks are one of major factors for the increasing volume. We reviewed the articles published from 2004 to 2013 and summarized this issue. Many studies found the clinical physicians have incorrect cognition of the risk from computer tomography radiation. However, the situation could be due to that they have not learned relative sufficient radiation risk courses at the stage of medical schooling. The patients or patients’ family hope that more risk communication of CT could be implemented in clinical process. We address some suggestions. For national health policy, the medical image record sharing platform could be built and medical imaging history should be record in personal health insurance card. In medical education aspect, radiation risk course should be implemented in medical schooling stage and professional stage. In hospital management aspect, communication mechanism between clinical physicians, radiologists and patients should be set up, and thereby further increase the confidence during medical processes.