Developing the radiation protection safety culture in the UK

Assessment of safety culture in radiotherapy facilities using safety performance indicators

This paper describes the development of the Safety Performance Indicators (SPIs), the methodology for assessment of the safety culture of radiotherapy institutions using SPIs and common strengths and common areas for improvement. SPIs were categorized into eight sections which all together contain 23 attributes and each attribute has scoring criteria from 0 to 2 (in steps of 0.5). The maximum absolute cumulative score of SPIs was 46. A relative cumulative SPIs score of >80% indicates an institution strong commitment towards safety while score <50% indicates need for additional guidance to enhance safety culture. The assessment using SPIs was conducted for 17 radiotherapy institutions. The methodology of assessment includes interactive discussion, direct observations and document analysis. The relative cumulative SPIs score of seven institutions was found to be >80% while it was found in the range of 67.0% to 80% for the remaining ten institutions. Institutions were communicated about the cumulative SPIs score, areas of strengths, and areas for improvement. SPIs were found to be a good tool for safety culture assessment and can be utilized by the radiotherapy institutes for self-assessment to identify the areas of improvement. Based on SPIs score, regulatory body can grade the institutions from a radiation safety compliance point of view.

Radiation Protection among South African Diagnostic Radiographers-A Mixed Method Study

ABSTRACT

Worldwide, radiographers' radiation protection practices vary. In South Africa, evidence of diagnostic radiographers' suboptimal radiation protection practices has been reported, but the reasons for these practices and suggestions to improve practices were lacking. Therefore, this study explored radiation protection among South African diagnostic radiographers. This study used an explanatory, sequential, mixed-method approach. Data were collected in three phases. Phase I, the quantitative phase, used an online questionnaire and respondents from Phase I interested in participating in Phase II, the qualitative phase, were interviewed, yielding 13 in-depth semi-structured telephone interviews. In Phase III, eight radiography managers co-constructed change strategies to optimize radiation protection in South Africa in two focus group interviews. Radiation protection was suboptimal despite diagnostic radiographers having a good attitude, subjective norm and perceived behavioral control toward radiation protection and optimal radiation protection knowledge. Varying attitudes to radiation protection, lack of resources, and support from radiography management and healthcare teams contributed to suboptimal radiation protection practices. Radiography managers suggested increasing radiation protection awareness, ameliorating the diminished stature of the radiographer in the healthcare team, and increasing the availability of optimal quality resources. South African diagnostic radiographers' radiation protection knowledge was optimal, but the implementation of radiation protection varied and was influenced by multiple factors. A radiation protection culture supported by management is advocated to optimize radiation protection. However, ultimately radiation protection practices are incumbent on the individual radiographers' choice to practice radiation protection.

Concepts to Bolster Biorisk Management

The rapid increase in the power of the life sciences has not been accompanied by a proportionate increase in the sophistication of biorisk management. Through conversations with thought leaders in biosafety and biosecurity, we have identified 19 concepts that are critical for biorisk management to continue to ensure the responsible and safe conduct of the life sciences in the future. Our work is not meant to be a comprehensive list, but rather a collection of topics that we hope will spark dialogue in the policy, research, and biorisk management communities.

Malaysian Nurses' Knowledge of Radiation Protection: A Cross-Sectional Study

Radiology is a vital diagnostic tool for multiple disorders that plays an essential role in the healthcare sector. Nurses are majorly involved in a healthcare setting by accompanying patients during the examination. Thus, nurses tend to be exposed during inward X-ray examination, requiring them to keep up with radiation use safety. However, nurses' competence in radiation is still a concept that has not been well studied in Malaysia. The study aimed to define the level of usage understanding and radiation protection among Malaysian nurses. In this research, a cross-sectional survey was conducted among 395 nurses working in hospitals, clinics, and other healthcare sectors in Malaysia. The survey is based on the developed Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale, distributed via the online Google Forms. SPSS version 25.0 (IBM Corporation) was used to analyze the data in this study. Malaysian nurses reported the highest knowledge level in radiation protection with a mean of 6.03 ± 2.59. The second highest is safe ionizing radiation guidelines with 5.83 ± 2.77, but low knowledge levels in radiation physics and radiation usage principle (4.69 ± 2.49). Therefore, healthcare facilities should strengthen the training standards for all nurses working with or exposed to radiation.

Bonn call for action and the unfinished task of radiation protection of children and adolescents in low and middle-income countries: A focus on Sub-Saharan Africa

OBJECTIVES

The Bonn call for action, with the theme: "Setting the scene for the next decade," was declared over nine years ago to strengthen radiation protection in medicine. This study reviews key actions and activities related to radiation protection of children and adolescents consistent with the Bonn call for action in sub-Saharan Africa to highlight progress and identify existing gaps.

KEY FINDINGS

A lot has happened since the declaration of the Bonn call-for-action such as a follow-up conference in 2017 on achieving change in the practice of radiation protection. However, there exists a huge gap that needs to be filled in the radiation protection of children and adolescents in low and middle-income countries particularly sub-Saharan Africa, where limited resources in health compete with radiation protection demands. Some of the gaps that remain are the apparent lack of implementation of the use of referral guidelines and establishment of national and regional diagnostic reference levels for paediatric imaging among others.

CONCLUSION

Several strides have been achieved on a global scale for the Bonn call for action, ranging from the justification of medical exposures to the current drive for radiation safety culture in medical imaging. However, several unmet needs for radiation protection for children and adolescents remain such as implementation of referral guidelines for justification and paediatric diagnostic reference levels.

IMPLICATIONS FOR PRACTICE

Step up actions and close collaboration is required to strengthen the practice of paediatric radiation protection in low and middle-income countries because children account for a greater proportion of the population and are vulnerable to the negative effects of radiation like possible cancer induction.

An assessment of medical students' proficiency regarding the hazards of radiological examinations on the health of workers and patients: a cross-sectional study from Palestine

BACKGROUND

The use of radiological examination is increasing worldwide. Since radiation exposure can result in many health hazards, medical professionals, as well as medical students, should possess adequate knowledge regarding radiation and its related hazards to protect themselves and the patients. Many studies have assessed medical students' knowledge on this topic, but never in Palestine. In this study, we aimed to examine Palestinian medical students' awareness and knowledge regarding radiological examination modalities and their risks on themselves and their patients.

METHODS

This was an observational, cross-sectional, population-based study, conducted to assess the awareness of radiation exposure and its risks among Palestinian medical students. An online questionnaire was implemented on medical students at An-Najah National University. A total knowledge score that ranged from 0 to 22 was calculated for each participant, with higher scores indicating better knowledge regarding radiation doses and the related hazards.

RESULTS

Two hundred eighty and seven students participated in our study, with a response rate of 71%. The average knowledge score of the participants was 10.97 ± 4.31 out of a maximum of 22 points. Male participants and participants in advanced study years achieved better knowledge scores (p-values were 0.034 and < 0.001, respectively). Perceived radiology knowledge was significantly associated with the actual knowledge score among the participants (p-value< 0.001). Receiving radiology lectures in fourth and fifth years significantly affected the participants' knowledge score (p-values were < 0.001).

CONCLUSIONS

We found a severe lack of knowledge regarding radiation doses and related risks among medical students. Therefore, we recommend that medical schools update and supplement their curriculum regarding knowledge on radiation.

Team perception of the radiation safety climate in the hybrid angiography suite: A cross-sectional study

BACKGROUND

Good radiation safety practice in the angiosuite is essential to protect patients and healthcare workers. Most strategies aim to advance radiation safety through technological upgrades and educational initiatives. However, safety literature suggests that additional ways to improve radiation safety in the angiosuite do exist. The safety climate reflects the way team members perceive various key characteristics of their work environment and is closely related to relevant safety outcomes. A specific 'radiation safety climate' has not been described nor studied in the hybrid angiosuite. This study explores the radiation safety climate in the hybrid angiosuite and its relation to team members' radiation safety behavior, knowledge and motivation.

MATERIALS AND METHODS

Vascular surgeons, fellows/trainees and operating room nurses active in the angiosuite at five hospitals were invited to complete an online self-report questionnaire assessing the radiation safety climate (28 items); radiation safety behavior; radiation safety knowledge and radiation safety motivation. Relations between climate scores and behavior were investigated using Pearson correlations. Mediation was analyzed using the Baron and Kenny analysis. P-Values < 0.05 were considered statistically significant.

RESULTS

No major differences were identified in total radiation safety climate scores between centers or team member functions. Scale reliability for radiation safety climate was good to excellent (α > 0.663). Total radiation safety climate scores were positively related to the radiation safety behavior score (r = 0.403; p = 0.015). This relation was partially mediated by radiation safety knowledge (β = 0.1730; 95% CI: [0.0475; 0.3512]), while radiation safety motivation did not act as a mediator: (β = 0.010; 95% CI: [-0.0561; 0.0998]).

CONCLUSION

A well-developed radiation safety climate in the hybrid angiosuite fosters positive radiation safety behaviors, which may partially be explained through improved radiation safety knowledge transfer. Further research on (radiation) safety climate and its impact on radiation safety-related outcome measures for patients is recommended.

Nurses' knowledge of radiation protection: A cross-sectional study

INTRODUCTION

Nursing roles are changing, as several countries have amended legislation so that nurses can make referrals for medical imaging examination that utilize ionising radiation. Nevertheless, nurses' radiation knowledge remains a poorly studied concept. The aim of the study was to characterize Finnish nurses' knowledge of radiation use and radiation safety. In this study, nurses were working in operating theaters, first aid clinics and cardiology laboratories.

METHODS

A cross-sectional design was applied in which data were simultaneously collected from nurses working in eight hospitals. All nurses working in operating theaters, first aid clinics and cardiology laboratories (N = 1500) at the hospitals in Finland were invited to participate in the study. The response rate was 17% (n = 252). The employed Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale included three areas of knowledge: radiation physics, biology and principles of radiation use; radiation protection; and guidelines of safe ionizing radiation use. Descriptive statistics and logistic regression analyses were used to identify factors that influence these three areas.

RESULTS

Nurses reported high knowledge levels in radiation protection but low knowledge levels in radiation physics, biology and principles of radiation use. Moreover, nurses who had not received radiation education reported lower knowledges across all three areas than the nurses who had completed education.

CONCLUSION

This study identified one major factor that significantly affects nurses' radiation knowledge, namely, having completed medical radiation education, as this factor positively influenced all three of the included areas of radiation knowledge factors. Therefore, healthcare organizations should concentrate on providing education to all nurses working with, or exposed to, radiation.

IRPA GUIDANCE-THE ROLE OF STAKEHOLDERS, RADIATION PROTECTION CULTURE AND ETHICS IN EMERGENCY PREPAREDNESS

The International Radiation Protection Association, IRPA, promotes the excellence in radiation protection by providing benchmarks of good practice, as well as enhancing professional competence and networking. In relation to emergency situations, including post-accident and recovery phases, a key issue is the ability of the system of protection to take a broader view of societal values, along with the need to develop processes which support and respect the dignity and well-being of the affected populations. Regarding the various situations of radiation exposure, IRPA's activities include aspects which can contribute to medical preparedness in radiation emergencies, focusing particularly on stakeholder engagement, radiation protection culture, the ethical dimensions of radiation protection and public understanding of risks. As it is a combination of science, experience, ethical and social values, radiation protection culture promotes radiation risk awareness in the different exposure situations, including the implementation of countermeasures in radiation and nuclear emergencies and post-accident situations, with attention also on medical countermeasures.

Interventionalists' perceptions on a culture of radiation protection

BACKGROUND

Occupational exposure to ionising radiation poses potential health risks to radiation workers unless adequate protection is in place. The catheterisation laboratory is a highly contextualised workplace with a distinctive organisational and workplace culture.

OBJECTIVE

This study was conducted to understand the culture of radiation protection (CRP).

METHODS

This study was a qualitative study and data were collected through 30 in-depth and 6 group interviews with 54 purposively selected South African interventionalists (interventional radiologists and cardiologists). The participants included a diversity of interventionalists who varied in sex, geographic location and years of experience with fluoroscopy. The transcribed data were analysed thematically using a deductive and inductive approach.

RESULTS

'Culture of radiation protection' emerged as a complex theme that intersected with other themes: 'knowledge and awareness of radiation', 'radiation safety practice', 'personal protective equipment (PPE) utilisation' and 'education and training'.

CONCLUSION

Establishing and sustaining a CRP provides an opportunity to mitigate the potentially detrimental health effects of occupational radiation exposure. Education and training are pivotal to establishing a CRP. The time to establish a culture of radiation in the catheterisation laboratory is now.

Integration of risks from multiple hazards into a holistic ALARA/ALARP demonstration

The principle of As Low As Reasonable Achievable (ALARA) stems from the field of radiological protection. In the UK, this principle has been incorporated into the Health and Safety at Work Act 1974 and rather than applying solely to radiological hazards, applies to all hazards in totality. Given that the current methods for assessing hazards are somewhat isolated, in that one hazard is assessed independently of another, it can be challenging to ensure a truly holistic view of the risks, and demonstrate they have been reduced to ALARA or As Low As Is Reasonably Practicable (ALARP) as required in the UK regulatory regime. The following paper presents a proposed framework for the integrated assessment of risks from multiple hazards. In addition, it presents an overview of some of the key challenges that may be encountered when producing a holistic ALARA demonstration.

Report of IRPA task group on the impact of the eye lens dose limits

In 2012 IRPA established a task group (TG) to identify key issues in the implementation of the revised eye lens dose limit. The TG reported its conclusions in 2013. In January 2015, IRPA asked the TG to review progress with the implementation of the recommendations from the early report and to collate current practitioner experience. This report presents the results of a survey on the view of the IRPA professionals on the new limit to the lens of the eye and on the wider issue of tissue reactions. Recommendations derived from the survey are presented. This report was approved by IRPA Executive Council on 31 January 2017.

Perceptions of radiation safety training among interventionalists in South Africa

Exposure to ionising radiation may have deterministic and stochastic health effects, which include skin changes, chromosomal aberrations, cataracts and carcinomas. Formalised training in radiation safety and protection improves knowledge on the subject and facilitates greater compliance in safety practices. This qualitative study included 54 interventionalists (adult and paediatric cardiologists, and interventional radiologists). The participants were purposively selected and interviewed to explore their perceptions about radiation safety. A thematic analysis of the transcripts was done using a deductive and inductive approach. Findings showed participating cardiologists had less knowledge about radiation safety than participating radiologists. Cardiologists reported little or no formal training on radiation safety and did not display a culture of radiation safety. There was no consensus on how the training gap should be addressed. There is a perceived need to change and enhance the radiation safety culture among interventionists, and the participants proffered some ideas. These included the need for re-curricularisation of cardiologists’ training to create awareness of radiation safety practices.

Radiation Safety Culture in the UK Medical Sector: A Top to Bottom Strategy

UK professional bodies have established a number of sectorial working parties to provide guidance on the improvement of radiation safety (RS) culture in the workplace. The medical sector provides unique challenges in this regard, and the remit of the medical group was to review the current state of RS culture and to develop a framework for improvement. The review of current RS culture was based on measurable indicators, including data from regulatory inspections, personal monitoring data and incident data. An online survey to capture the RS-related views and experience of hospital staff at all levels was carried out, and the responses provided a wealth of information on RS awareness and implementation across the country. The framework for improving RS culture includes both 'top-down' initiatives to engage management and regulators, and 'bottom-up' initiatives relating to engagement and training of different staff groups. A 'Ten-point Assessment' on what constitutes a good approach to medical RS culture has been proposed, which provides a tool for management to assess RS culture in the workplace and has potential use in regulatory inspections in the UK.

The advantages of creating a positive radiation safety culture in the higher education and research sectors

The safety culture of any organisation plays a critical role in setting the tone for both effective delivery of service and high standards of performance. By embedding safety at a cultural level, organisations are able to influence the attitudes and behaviours of stakeholders. To achieve this requires the ongoing commitment of heads of organisations and also individuals to prioritise safety no less than other competing goals (e.g. in universities, recruitment and retention are key) to ensure the protection of both people and the environment. The concept of culture is the same whatever the sector, e.g. medical, nuclear, industry, education, and research, but the higher education and research sectors within the UK are a unique challenge in developing a strong safety culture. This report provides an overview of the challenges presented by the sector, the current status of radiation protection culture, case studies to demonstrate good and bad practice in the sector and the practical methods to influence change.