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Vilar-Palop et al., 2018; Martins et al., 2020), often linked to prescribing physicians’ lack of knowledge about radiation protection. Several studies consistently highlight a lack of awareness regarding radiation doses and related hazards, leading to a common overestimation of the dangers associated with these procedures( Kada, 2010; Rehani, 2017; Bwanga, 2019; Bonnici, 2021).
The Moroccan context reflects the worldwide trend. Research in Morocco shows that many physicians remain uninformed about the hazards of radiation exposure, particularly the radiation dosages associated with CT scanning. For example, numerous practitioners underestimate the potential harm of low-dose X-rays( Semghouli et al., 2017; Tahiri et al., 2022; Amaoui et al., 2023).
Furthermore, it has proved that general practitioners, serving as the primary prescribers of medical imaging exams, prescribe less suitable examinations than specialists. For example, Spanish research found that general practitioners request 40.4 % of inappropriate referrals compared to 18.9 % for hospital specialists( Vilar-Palop et al., 2018). These findings highlight the importance of appropriate education for practitioners to accurately assess the necessity for diagnostic testing, understand the risks involved, and make adequate decisions.
In this context, this study aims to evaluate Moroccan general practitioners’ knowledge, attitudes, and practices regarding the justification of radiological exams and to identify the factors that influence these practices. The findings might have significant implications for Moroccan medical education and clinical practice, potentially contributing to better radiation protection measures and more appropriate use of medical imaging.
2 Materials and methods
Between January and March 2024, 367 Moroccan general practitioners working in various health institutions nationwide participated in this descriptive study. The study examined their knowledge of the justification for radiological tests, their attitudes toward this justification, and their practices, particularly concerning computed tomography( CT).
A structured electronic questionnaire, developed based on data from the scientific literature, was created using the Google Forms platform and then distributed to general practitioners via multiple social media networks. The questionnaire consisted of 44 items, including multiple-choice and Likert scales. It examined participants’ personal and professional characteristics, as well as their knowledge and attitudes toward justifying radiological examinations and their practices.
The first part discusses the participants’ general characteristics, such as gender, age, professional experience, radiation protection training, level of satisfaction with the training, the need for more training, and scanner prescription routines.
The second section included 12 multiple-choice questions designed to assess general practitioners’ knowledge of the justification for radiological examinations. The topics covered comprised identifying irradiating examinations, determining the least invasive alternative to CT scanning, knowing the presence of radiation-induced cancer risk from the dose of ionizing radiation associated with computed tomography( CT) scans, recognizing the most sensitive tissue to ionizing radiation, identifying the most vulnerable age group, knowing the dose limit for pregnant women, the mean dose administered in a typical abdominopelvic CT scan, awareness of the comparative effective dose between a chest CT scan and a chest X-ray, understanding the meaning of the justification principle in radiation protection, identifying the essential criteria for justifying a radiological examination, knowing the need to document the justification for an examination and finally understanding the conditions warranting a reevaluation of the rationale for a radiological examination.
The third section comprises 12 statements designed to evaluate general practitioners’ attitudes toward the justification for radiological examinations. These statements evaluate various aspects, including physicians’ responsibility in justifying radiological procedures, their focus on systematically assessing the benefit-risk balance for each examination, their adherence to best practice guidelines, and their commitment to continuously evaluating the justification for examinations. Additionally, the section explores their views on incorporating continuing education to justify radiological exams, the importance of collaborating with radiologists, their approach of advising patients about the hazards resulting from CT scans before prescribing them, and their awareness of the need to reduce unnecessary medical examinations. The section also evaluates their perspectives on how enhanced patient communication might decrease the number of unnecessary scan requests, their confidence in justifying radiological procedures, the importance of conducting pregnancy tests before radiological exams in women of childbearing age, and their perspectives on over-prescribing scans.
The replies to these assertions get scored on a Likert scale with five points, ranging from“ strongly disagree "( 1 point) to“ strongly agree "( 5 points). Possible scores vary from 12 to 60 points, with higher scores suggesting a more positive attitude about the justification for radiological tests and a greater predisposition to adopt appropriate practices.
The final part consisted of 12 questions about general practitioners’ practices in justifying radiological exams. Participants were required to specify how frequently they used the following practices: assessment of clinical indications and consideration of non-ionizing alternatives, taking into account the age of the patient when prescribing a radiological examination, systematic verification of recent imaging history of the patient, consultation of good practice guidelines, assessment of the benefits and possible hazards associated with the use of X-rays, discussion of the need for the examination with a radiologist, clarification of the specific clinical question on the prescription, providing comprehensive information to the patient about the potential risks of radiation and the benefitto-risk ratio before ordering a scan, requesting beta-HCG measurements in women of childbearing age before prescribing an abdominopelvic scan, refraining from requiring a repeat radiological examination even if the quality of the images or the initial interpretation is imperfect, systematic refusal of radiological examinations requested by patients, and responding to patients’ concerns about the hazards of X-rays. Respondents rated the frequency of these practices on a Likert scale with five points, from " Never "( 1 point) to“ Always”( 5 points).