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Knowledge of Radiation among Radiology Professionals and Students
Poster · June 2017
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First National Conference of Medical Imaging Technology and Radiological Science, National Academy of Medical Sciences (NAMS),
Bir Hospital, Kathmandu, Nepal, June 24, 2017
Knowledge of Radiation among Radiology
Professionals and Students
Surendra
1National Academy
1
Maharjan
of Medical Sciences (NAMS), Bir Hospital
Introduction
The usage of radiation has become an inevitable part of human life.[1] They receive 19.7% (0.6mSv)
of radiation from medical usage.[2] Radiation technology not only facilitates medical management,
but also causes severe adverse effects.[3] Therefore, the knowledge and practice of radiology
professionals regarding harmful biological effects of ionizing radiation and radiation safety is an
utmost essential topic to be addressed.[1-3] Awareness of radiation protection and measures of
precautions is the biggest hurdle in order to manage radiation hazards properly and promptly. To
accomplish this arduous task and to set standard guidelines, various international organizations have
been established. The importance of knowledge and safe operation of radiation has been drawing
special attention, from the era of Roentgen’s discovery of x-rays.[4] Medical exposure is closely
associated with manifold increase in lifetime cancer risk.[5] To avoid unnecessary exposure and
facilitate better patient care, radiology professionals should be well aware of these issues. Many
radiology professionals still ignore as x-rays do not cause immediate severe adverse effects.[4] Till
today, x-ray imaging technology have glanced numerous advancement. Still, they neglect and are
reluctant to practice radiation using safety precautions. This highlights the lack of inadequate
knowledge of radiation protection principles and they are still insensitive about their daily working
ethics. To the best of our knowledge, this is the first study in Nepal that identifies the perception of
radiation protection and its safe usage. To date, only a handful of studies have been conducted to
assess knowledge and awareness of radiation protection elsewhere as well. When the title of this
manuscript was typed in the Pub Med Central (PMC) database, only 129 articles were shown and an
ample of relevant literatures was accessed in this article. This also signifies the importance of this
study in international context as well. The main goal behind this survey-based study was to obtain a
better understanding of the current status of knowledge and awareness of radiation protection, the
need for safe practices among radiology professionals and to compare the data with international
literatures.
Methods
A questionnaire survey was performed to provide a snapshot of knowledge and awareness of
radiation dose and risks associated with medical imaging among radiology professionals (radiologist,
medical physicist, medical imaging faculty, technologist, and radiographers), residents and students
of medical imaging technology. The survey included questions regarding demographic
characteristics (age, gender), academic qualification and work experience. Twenty questions
regarding general knowledge in relation to radiation, radiation protection, safety, health risks and
doses imparted in radiological examinations. The multiple choice questions (MCQ) were asked to
every radiology staff and students in Universal College of Medical Sciences (UCMS), Bhairahawa,
Nepal. UCMS is a pioneer institute in medicine and dentistry, affiliated with Tribhuvan University
(TU), recognized by Nepal Medical Council (NMC). There were 20 MCQ where three questions
were related to participant personal information regarding knowledge and experience in radiation
protection. In two questions, participants could choose multiple answers and one question demands
opinion. Thus, there were remaining 14 questions that could underpin the level of self-awareness and
perception of the participant.
Participants
All the staff and students of the Department of Radiology participated in the survey. The data were
collected from 1st to 10th October, 2015. The department comprises Radiologist, Medical Physicist,
Medical Imaging faculty, Radiologic Technologist, Radiographers, MD Radio-diagnosis residents
and undergraduate students of medical imaging technology. Each one of them expressed interest in
completing the survey. Participants were handed out the hardcopy survey by the author himself and
are requested to complete within twenty minutes. They handed the completed survey and they were
not allowed to discuss and ask anything regarding the content of the form. Each correct answer was
given 1 score and for negative answers, there was no negative markings. Questions which ask the
information of the respondent and in which multiple answers can be chosen were also freed of
scoring system.
Data Analysis
Data from the survey were entered from paper into SPSS Statistical Software (v.20.1, Chicago,
USA). A descriptive analysis was performed. Categorical response options were coded (e.g. yes 1;
no 2; don’t know 3) and were outlined as frequencies and percentages. The mean, standard
deviations (SD) as well as range were used for the description of quantitative variables whereas
qualitative variables were transposed into quantitative variables further analysis and data
interpretation were performed. Chi-square test was performed to compare the proportion of staff and
students who were able to provide correct answers to questions regarding radiation dose. A p-value
<0.05 was afforded significance.
Ethics
An approval was obtained from concerned authority of Universal College of Medical Sciences
(UCMS). A consensus informed form was used and the anonymity of the participants was
completely ensured.
Results
Of all 35 participants, 13/35 (37.1%) were students and 22/35 (62.9%) were staff in Department of
Radiology and Imaging. Out of total 35, there were 28 male and 7 female respondents, with mean
age 26.09±7.18 years. We noticed varying academic qualification (Table 1). There were 23
individuals whose experience was less than 1 year and 12 have experience more than 1 increasing up
to 10 years. Among 14 questions, the maximum and minimum scores obtained were 13 and 4
respectively. Novice radiographers obtained less marks than other fellow participants. Radiologist
doctors, radiologic technologist and medical physicist had excellent impression whereas students of
Bachelor of Science in Medical Imaging Technology (B.Sc.MIT) and Doctor of Medicine in Radiodiagnosis (MDRD) residents have quite good conception, however Radiographers had very poor
notion about radiation protection.
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There was not a single personnel who stated that he had not attended any formal education (lecture
or training course) related to the radiation protection and safety issues. 6 personnel stated that they
have inadequate knowledge about risk of radiation and radiation safety. As all the participants
including students need to undertake practical duty and residency, they all have clinical posting or
job experience. In the present context, medical radiation represents the biggest portion among
artificial sources of radiation and diagnostic radiological examinations are the mostly used.
However, only 10/35 (28.6%) provided correct answer of SI unit for measurement of absorbed dose
equivalent. To my best surprise, six staff was unaware that Computed Tomography (CT) scan uses xradiation. Again, 4 (11.4%) reported that Ultrasound uses x-rays. This showed that they are not
sensible to other medical imaging modality other than general x-ray equipment. Similarly, ten
employees had misconception concerning Magnetic Resonance Imaging (MRI) scan that it involves
x-ray just like in x-ray machine and CT scan. 12/35 (34.3%) do not have idea that the protective
clothes used in x-ray examination are made up of lead. 21 participants thought it was essential to
inform the patients that they will be irradiated with x-rays during surgery in Operation Theater
whereas others did not think it was important to notify them. This may have either occurred due to
lack of awareness about radiation safety of radiology health professionals, especially radiographers,
carelessness or due to knowledge-practice gap. This could raise questions regarding patient care and
safety. 1 staff had also no knowledge regarding usage of x-rays in Mammography. It is very
necessary to know the minimum safe distance from x-ray tube while performing portable x-rays and
implement in practical settings as well. In this study, 14 individuals (40.0%) were ignorant regarding
the secure distance. This signifies that they were neglecting or are blind to the three cardinal
principles of radiation protection, i.e. time, distance, shielding. Again, radiology professionals
should know the highest permitted level of occupational radiation dose. However, there were only
23/35 (65.7%) correct answers. This is the most devastating situation that they are not sensitive
regarding their own radiation dose. Out of 35, only 16 correct answers were reported for the standard
unit of measurement of radioactivity. For the question regarding probability of risk of cancer after
undergoing a chest x-ray examination, only 24 stated right answer. Most of them were not conscious
regarding safety of pregnant cases. 8 (22.9%) mentioned pregnant nurses can work in fluoroscopy in
first trimester whereas 8 (22.9%) did not know about this subject. Gamma rays have been in use in
medical science from the time of x-ray discovery. It carries the history long back just like x-rays.
But, 7 (20.0%) were oblivious regarding medical usage of gamma rays. At 5% level of significance
(p=0.5), Chi-Square test (χ) denoted that there was statistical significance of the level of
understanding of participants both on the basis of work experience and academic qualification.
Figure 1: Box Whisker
plot showing frequency of
correct answers within
different academic
qualification.
There were two outliers in MDRD Residents group, whereas there were no variations among
BScMIT and Medical Physicist groups. Portable radiography requires highest level of precautions.
Besides patient, visitors and radiographers themselves are exposed to radiation during ward x-rays.
During that situation, 4 candidates preferred staying in the nursing station and monitoring patients
through central monitoring system, 10 going out of the unit, 5 going to the break room, 19 standing
behind a lead apron, and 13 standing behind a wall or a pillar near to the radiographer. Many chose
multiple answers, still observing patients during that particular circumstance would definitely cause
unnecessary exposure. There are numerous radiation protective apparels and devices. 30 favored to
use lead aprons, 15 thyroid shields, 16 protective eye glasses, 12 lead gloves and 12 dosimeters
respectively. Furthermore, most of them desired to use two or more than two equipment.
Conclusion
Overall awareness and knowledge of radiation protection and radiological procedures of
radiologists, radiologic technologist and medical physicist were very good. Nonetheless, the
knowledge of radiographers was very poor. Therefore, we recommend that radiation protection and
safety training should be a part of mandatory training for radiology professionals, especially
radiographers. We suspect that these local findings represent a neglected issue among radiation
practitioners. The knowledge about radiation protection and safety is satisfying with definitely
possibilities for further improvement. Regular CMEs should be organized and implemented through
collaboration between national and international organizations with the involvement of all
government representatives and hospital administration departments. In the education system, the
government has a very important role and responsibility to start giving information from school level
itself.
References
1. Balsak H, Güneş G, Ulutaşdemir N. Knowledge, Attitude and Behavior of Radiology Professionals about the
Harmful Effects of Radiation which is used for Diagnosis. Electronic International Journal of Education, Arts,
and Science (EIJEAS). 2016 Feb 24;2(3).
2. WHO. Scientific background. In: Communicating radiation risks in paediatric imaging Information to support
healthcare discussions about benefit and risk. 2016. http://www.who.int/ionizing_radiation/pub_meet/radiationrisks-paediatric-imaging/en.
3. Günalp M, Gülünay B, Polat O, Demirkan A, Gürler S, Akkaş M, Aksu NM. Ionising radiation awareness
among resident doctors, interns, and radiographers in a university hospital emergency department. La radiologia
medica. 2014 Jun 1;119(6):440-7.
4. Kang KW. History and Organizations for Radiological Protection. J Korean Med Sci. 2016 Feb;31(Suppl
1):S4-S5. https://doi.org/10.3346/jkms.2016.31.S1.S4.
5. Singh N, Mohacsy A, Connell DA, Schneider ME. A snapshot of patients' awareness of radiation dose and risks
associated with medical imaging examinations at an Australian radiology clinic. Radiography. 2016 Nov 17.