Radiation Protection Knowledge, Attitude, and Practice (KAP) in Interventional Radiology

Worker's exposure to radiation in fluoroscopy, assessing and instruments: A systematic literature review

This review aims to identify and analyze the instruments employed for assessing the overall performance of workers exposed to fluoroscopy during surgical procedures and/or interventional procedures, using the PRISMA methodology. The studies were located through searches conducted on PubMed, Web of Science, Lilacs, ScienceDirect, B-ON, EBSCOhost, and EBSCO Discovery Service on March 27, 2023. Additional studies were identified using backward and forward citation techniques. The PEO strategic model was followed. The search spanned studies published between 2012 and 2022. The quality of the studies underwent assessment using the Joanna Briggs Institute checklist for analytical cross-sectional studies. Out of the 23 studies identified, encompassing 3604 individuals, 12 (52%) addressed the reliability and/or validity of the instruments, while 3 (13%) focused on the development and psychometric testing of the instruments. Only 5 instruments (23%), validated and reliable, exclusively evaluated occupational radiological protection. The predominant dimension covered was knowledge (82%, n = 19). The population was assessed in 18 studies, pre- and post-intervention in 2 studies, and 21 studies provided recommendations or tools for improvement. Individuals in the studies utilized passive dosimeters (ranging from 5% to 98%), thyroid shields (15% to 98%), and aprons or lead skirts/coats (28% to 99%). The evidence quality was moderate (6/8). This study underscores the imperative to enhance compliance with protective and monitoring equipment. Furthermore, additional information is warranted concerning the validity and reliability of the instruments used, as well as the development of instruments that are both valid and reliable.

Occupational radiation exposure dose and associated factors among radiology personnel in Eastern Amhara, Ethiopia

BACKGROUND

Ionizing radiation is being used more frequently in medicine, which has been linked to recognized biological effects such as cancer and mortality. Radiology services are becoming more widely available in Ethiopian health facilities but there is no compiled record of worker's radiation dose. So, assessing the magnitude and identifying the associated factors of occupational radiation exposure dose among radiology personnel help to design strategies for radiation protection.

OBJECTIVE

The study was designed to assess the occupational radiation exposure dose and associated factors among radiology personnel in eastern Amhara, northeast Ethiopia, 2021.

METHODS

Cross-sectional study was conducted from March 25 to April 30, 2021, in 57 health institutions among 198 radiology personnel. The study comprised all eligible radiology personnel. The data were collected using an electronic-based (Google form) self-administered questionnaire, and document review. The data were entered into an excel spread sheet and then, exported to Stata 14 software. Linear regression model was used to analyse the data after checking its assumptions. Variables with a p-value < 0.25 were entered into a multiple linear regression analysis, and those with a p-value < 0.05 were judged significant. VIF was used to check for multi-collinearity. Coefficient of determination was used to check the model fitness.

RESULTS

The mean (± SD) annual shallow and deep dose equivalents of radiology personnel were 1.20 (± 0.75) and 1.02 (± 0.70) mSv, respectively. Body mass index (β = 0.104, 95% CI: 0.07, 0.14), practice of timing (β = -0.43, 95% CI: -0.73, -0.13), working experience (β = -0.04, 95% CI: -0.048, -0.032), and practice of distancing (β = -0.26, 95% CI: -0.49, -0.17) were found to be statistically significant factors of annual deep dose equivalent. In addition, body mass index (β = 0.113, 95% CI: 0.08, 0.15), practice of timing (β = -0.62 95% CI: -0.93, -0.31) and, working experience (β = -0.044, 95% CI: -0.053, -0.036 had statistically significant associations with annual shallow dose equivalent.

CONCLUSION

The annual dose equivalents were two times higher than the global average of annual per caput effective dose due to medical exposure. Body mass index, practice of timing, working experience, and practice of distancing were factors of occupational radiation exposure dose. Strategies focusing on increasing the skill, experience, and lifestyle of radiology personnel would be supreme important means to reduce occupational radiation exposure dose.

Awareness of Medical Radiologic Technologists of Ionizing Radiation and Radiation Protection

Japanese people experienced the Hiroshima and Nagasaki atomic bombings, the Japan Nuclear Fuel Conversion Co. criticality accident, it was found that many human resources are needed to respond to residents' concerns about disaster exposure in the event of a radiation disaster. Medical radiologic technologists learn about radiation from the time of their training, and are engaged in routine radiographic work, examination explanations, medical exposure counseling, and radiation protection of staff. By learning about nuclear disasters and counseling, we believe they can address residents' concerns. In order to identify items needed for training, we examined the perceptions of medical radiologic technologists in the case of different specialties, modalities and radiation doses. In 2016, 5 years after the Fukushima Daiichi nuclear power plant accident, we conducted a survey of 57 medical radiologic technologists at two medical facilities with different specialties and work contents to investigate their attitudes toward radiation. 42 participants answered questions regarding sex, age group, presence of children, health effects of radiation exposure, radiation control, generation of X rays by diagnostic X ray equipment, and radiation related units. In a comparison of 38 items other than demographic data, 14 showed no significant differences and 24 showed significant differences. This study found that perceptions of radiation were different among radiology technologists at facilities with different specialties. The survey suggested the possibility of identifying needed training items and providing effective training.

Meslek yüksekokulu öğrencileri ve akademisyenlerin radyasyon bilgi düzeylerinin değerlendirilmesi

Amaç: Bu çalışma bir üniversitenin meslek yüksekokulunda sağlık programlarında öğrenim gören öğrenciler ile bu üniversiteye bağlı meslek yüksekokullarında çalışan akademisyenlerin radyasyon bilgi düzeylerini değerlendirme amacıyla yapıldı. Yöntem: Tanımlayıcı tipte planlanan araştırma Şubat 2022- Mart 2022 tarihleri arasında, 163 öğrenci ve 100 akademisyen ile tamamlandı. Veri toplama formu olarak “Öğrenci Tanıtıcı Bilgi Formu”, “Akademisyen Tanıtıcı Bilgi Formu” ve “Radyasyon Tutum Ölçeği” kullanıldı. Veriler elektronik ortamda (Google Formlar) online olarak toplandı. Veri analizi SPSS 25.0 paket programında yapıldı. İstatistiksel anlamlılık için p

Radiation Protection Capability of Operating Room Personnel: Development and Psychometric Properties of a Questionnaire

Background:

Radiation protection is an important principle in some wards of the hospital such as radiology, catheterization laboratory and operating room. Due to the increasing use of radiation in the operating room, there is a need to design an accurate and appropriate tool to evaluate the radiation protection capability of operating room personnel.

Objective:

This study aims to test the psychometric properties of a questionnaire on radiation protection capability.

Material and Methods:

This cross-sectional study was conducted in two stages. The first stage was designing items based on the review of available literature, and the second stage was measuring the validity and reliability of the questionnaire using face validity and content validity Content Validity Index (CVI) and Content Validity Ratio (CVR). Then the questionnaire was filled out by 200 operating room nurses to evaluate the construct validity by Principal Component Analysis method. Reliability of the questionnaire was evaluated by test–retest and Cronbach’s alpha analysis method.

Results:

Due to the results, test–retest correlation coefficient was 0.912, and Cronbach’s alpha coefficient was 0.824, indicating a desirable internal consistency.

Conclusion:

This study introduces a valid and reliable questionnaire for evaluating the radiation protection capability of operating room nurses.

ASSESSMENT OF THE AWARENESS LEVEL OF RADIATION PROTECTION AMONG RADIOGRAPHERS WORKING IN THE MEDICAL IMAGING WARDS OF THE HOSPITALS IN ZANJAN, IRAN

X-ray usage in medical diagnosis could have hurtful effects for both patient and medical imaging wards' personnel as a result of failure to follow radiation protection (RP) principles (shielding, distance and time) by radiographers. This cross-sectional descriptive-analytical study was carried out by valid and reliable online questionnaire, which was completed by 103 radiographers. Data were analyzed by using descriptive statistics (mean, standard deviation and frequency) and analytical statistics (Pearson's correlation coefficient test, Student's independent t-test and analysis of variance test) in the Statistical Package for Social Sciences version 20 (sig: P < 0.05). The study's response rate was 67.32%. The mean scores of participants' total, RP and device knowledge were 42.76, 42.86 and 42.72 out of 100, respectively. Work experience and age of participants were significantly related to device and total knowledge (P < 0.01). Results revealed an undesirable level of participants' awareness, indicating the necessity of holding training courses, especially for less experienced radiographers.

Radiation protection among health care workers: knowledge, attitude, practice, and clinical recommendations: a systematic review

OBJECTIVES

This study was performed to determine the knowledge, attitude, and practice (KAP) of health care workers (HCWs) towards radiation protection.

METHODS

In this systematic review study, three international databases (Web of Science, PubMed, Scopus) were searched for related published articles in the English language from 1 January 2000 to 1 February 2020. The quality of the included studies was evaluated using the Hoy et al. tool.

RESULTS

Out of the 1,848 studies examined, 41 studies that were performed on 11,050 HCWs were included in the final stage. The results indicated that in most studies, more than half (50%) of the participants had average knowledge. Furthermore, 60% of the participants had a positive attitude, but in most studies, they had average practice regarding radiation protection. The most important recommendation for improving KAP among the participants was incorporating radiation protection standards in the student curriculum.

CONCLUSION

Considering the results of the study, further attention should be paid to proper education regarding radiation protection standards and improvement of HCW performance.

Factors Affecting Radiation Protection Behaviors among Emergency Room Nurses

This study aimed to examine factors affecting radiation protection behaviors among emergency room nurses by assessing knowledge about radiation protection and attitude towards radiation protection, employing a cross-sectional design. Subjects were a convenience sample of 129 nurses working in the emergency rooms of three advanced general hospitals. Data were collected using self-report questionnaires and analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression. There were significant relations between knowledge about radiation protection and attitude towards radiation protection (r = 0.34, p < 0.001), knowledge about radiation protection and radiation protection behaviors (r = 0.37, p < 0.001), and attitude towards radiation protection and radiation protection behaviors (r = 0.33, p < 0.001). The factors affecting radiation protection behaviors were radiation protection knowledge (β = 0.12, p = 0.045), attitude towards radiation protection (β = 0.17, p = 0.009), the experience of radiation protection education (β = 0.27, p < 0.001), and wearing of protective equipment (β = 0.29, p < 0.001). The governments, hospital administrators, and radiation protection agencies should strengthen their radiation defense environment to protect emergency room nurses from radiation. Research and development of radiation defense equipment and the medical examination of emergency room nurses should be carried out, radiation defense behavior protocols should be developed, radiation defense education opportunities should be provided, and the use of defense equipment should be encouraged.

The importance of public health in radiology and radiation protection

The ionizing radiation belongs to the basic physical factors that can be measured. We forget often about its risks and the possible damage to our health. The imaging methods which use the ionizing radiation increase the diagnostics quality and they have become a certainty for many medical workers. Therefore, they are being used without rational thinking many times. With this is related to increasing the cumulative dose of patients. Next problem can be radiation safety knowledge of medical workers. The enormous increase in the use of sources ionizing radiation in medicine and rapid development, there may be a disproportionate acquisition of radiation safety knowledge of healthcare workers. At the same time, constant attention must be paid to the biological effects of radiation and realize epidemiology studies. In all the areas mentioned the public health has space. However, it is sad that presently, the radiation safety is not considered important enough in Public Health.  Based on many sources, it is safe to say that this is a major problem, because the public health itself can play an important role in radiation safety. It is important to point out, that safety and effectivity of using the source of ionizing radiation is one of the main components of Good Medical Practice.

Investigation of radiation protection and safety measures in Rwandan public hospitals: Readiness for the implementation of the new regulations

BACKGROUND

An essential concept that all radiographers are required to implement is the use of techniques and the provision of protective devices to minimize radiation to patients and staff. Methods to achieve this could include good communication, immobilization, beam limitation, justification for radiation exposure, shielding, appropriate distances and optimum radiographic exposures factors.

PURPOSE

The aim of this study was to assess the availability and utilization of radiation protection and safety measures by medical imaging technologists (MITs) in Rwandan hospitals.

METHODS

A quantitative, non-experimental descriptive design was used and data collected by means of a self-designed questionnaire. One hundred and sixteen MITs (n = 116) representing 96.67% of the total population participated in the study.

RESULTS

The study found radiation safety measures were not adequately implemented in government hospitals. Only 58.62% of MITs had radiation-measuring devices, with 29% receiving dose readings inconsistently. Lead rubber aprons were available at 99.13% of the hospitals; however, 59% of the participants had never checked the integrity of the aprons. Lead rubber aprons and lead equivalent barriers were most prevalent in the facilities.

CONCLUSION

The study found there was a lack of adequate radiation safety equipment. Exposure charts and immobilization devices were not adequately implemented in the hospitals. The level of education and experience of the MITs did not appear to influence the radiation safety practice significantly. There is a need for concerted efforts between the Rwanda Utilities Regulatory Authority (RURA), Ministry of Health, University of Rwanda and hospital management to improve the radiation safety culture, especially in view of the law governing radiation protection that was recently promulgated.

OCCUPATIONAL DOSE AND RADIATION PROTECTION PRACTICE IN UAE: A RETROSPECTIVE CROSS-SECTIONAL COHORT STUDY (2002-2016)

A two-phased retrospective cross-sectional study analysed the occupational dose and radiation protection practice among medical workers in two hospitals in the UAE. Phase 1 evaluated radiation protection practice using a questionnaire, whereas phase 2 assessed the occupational dose. Readings of 952 thermoluminescence dosimeters were analyzed. The result showed 52% of medical workers have a good level of radiation protection practice. Readings of 952 thermoluminescence dosimeters were analyzedAverage annual effective dose per worker ranged from 0.39 to 0.83 mSv. Cardiologists and nurses displayed a higher average of occupational radiation dose compared to other workers. There were no significant correlations between radiation protection practice and hospital, occupation or department. Finally, the occupational dose was within the international and national limits, but the reduction of radiation dose to cardiologist and nurses is essential. Moreover, training is essential to promote radiation safe practice among medical workers.

Perceptions on radioprotective garment usage and underlying reasons for non-adherence among medical radiation workers from public hospitals in a middle-income Asian setting: A qualitative exploration

Background

Radioprotective garments protect medical radiation workers from exposure to radiation at workplace. However, previous studies have found poor adherence to the use of radioprotective garments.

Objectives

We explored the perceptions and practices related to the use of radioprotective garments among medical radiation workers in public hospitals, and sought to understand the reasons for non-adherence.

Design and setting

A qualitative approach was applied by conducting face-to-face in-depth interviews with 18 medical radiation workers from three university hospitals using a semi-structured interview guide.

Results

Five themes emerged with respect to perceptions on the use of radioprotective garments: (i) the dilemmas in practising radiation protection, (ii) indication of workers' credibility, (iii) physical appearance of radioprotective garments, (iv) practicality of radioprotective garment use, and (v) impact on workflow. Actual lack of radioprotective garment use was attributed to inadequate number of thyroid shield and other garments, radioprotective garments' unsightly appearance including being dirty and defective, impracticality of using radioprotective garments for some nuclear medicine procedures, disruption of workflow because of workers’ limited movements, attitudes of workers, and organisational influences.

Conclusion

Medical radiation workers demonstrated a definitive practice of using radioprotective aprons, but often neglected to use thyroid shields and other garments. Availability and hygiene are reported as the core issues, while unclear guidelines on practical use of radioprotective garments appear to lead to confusion among medical radiation workers. To the best of our knowledge, this is the first qualitative study of its kind from a middle-income Asian setting.

Reducing radiation dose in paediatric interventional cardiac catheterisation

OBJECTIVE

Radiation exposure during paediatric cardiac catheterisation procedures should be minimised to "as low as reasonably achievable". The aim of this study was to evaluate the effectiveness of a modified radiation safety protocol in reducing patient dose during paediatric interventional cardiac catheterisation.

METHODS

Radiation dose data were retrospectively extracted from January 2014 to December 2015 (Standard group) and prospectively collected from January 2016 to December 2017 (Low-dose group) after implementation of a modified radiation safety protocol. Both groups included five most common procedures: atrial septal defect closure, patent ductus arteriosus closure, perimembranous ventricular septal defect closure, pulmonary valvuloplasty, and supraventricular tachycardia ablation.

RESULTS

Median air Kerma was 48.4, 50.5, 29.75, 149, 218, and 12.9 mGy for atrial septal defect closure, pulmonary valvuloplasty, patent ductus arteriosus closure <20 kg, ventricular septal defect closure <20 kg, ventricular septal defect closure ≧20 kg, and supraventricular tachycardia ablation in Standard group, respectively, which significantly decreased to 18.75, 20.7, 11.5, 41.9, 117, and 3.3 mGy in Low-dose group (p < 0.05). This represents a reduction in dose to each patient between 46 and 74%. Among five procedural types in Low-dose group, dose of ventricular septal defect closure was the highest with median air Kerma of 62.5 mGy, dose area product of 364.7 μGy.m2, and dose area product per body weight of 21.5 μGy.m2/kg, respectively, along with the longest fluoroscopy time of 9.9 minutes.

CONCLUSION

We provided a feasible radiation safety protocol with specific settings on a case-by-case basis. Increasing awareness and adequate training of a practical radiation dose reduction program are essential to improve radiation protection for children.