A SURVEY OF RADIATION PROTECTION AWARENESS AMONG NON RADIATION WORKERS

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A SURVEY OF RADIATION PROTECTION AWARENESS AMONG NON-RADIATION WORKERS. (A CASE STUDY OF 68 NIGERIAN ARMY REFERENCE HOSPITAL YABA LAGOS STATE).

 

ABSTRACT

Nowadays the use of radiation for diagnostic and therapeutic purposes is increasingly concern because of its harmful effects. The awareness of medical professionals about radiation-associated risks, radiation doses in diagnostic imaging, and radiation safety is one of the main factors for decreasing the patient’s dose in medical practice.

          This cross-sectional study is titled “A survey of radiation protection awareness among non-radiation workers. (A case study of 68 Nigerian Army reference hospitals Yaba Lagos State)”. The population of the study comprised medical doctors who were not radiation professionals in selected army hospitals in Yaba, Lagos State. This study was performed between September to December 2019. The self-administered questionnaire was used and this study recruited purposively half of the sample from interventional doctors who used radiation in their procedures and another half from noninterventional doctors.

    Responded by 128 doctors, including 19 specialists, 93 postgraduate students, and 16 assistant surgeons. Male 69.5% and female 30.5% participated and their mean duration of service was 4.7 years. The overall mean knowledge score percentage of all participants was 50%. Only half of the doctors (51.6%) believed there is a lifetime risk of cancer in a child from abdominal CT and 64.1% accepted that radiation increases the risk of cancer in patients. Most of the doctors (>60%) did not know the radiation doses the patients received during some radiological investigations and one-fourth of the doctors underestimated it. MRI and Ultrasound were wrongly associated with ionizing radiation by 22.7% and 1.6% respectively. Very few percent (3.9%) of doctors answered that they had got radiation safety training. Worryingly, none of the interventional doctors used dosimeters to limit their radiation exposure. 

The present study demonstrated that awareness of radiation safety was a deficit among medical doctors. Therefore more training and education programs should be implemented for radiation safety practice.

 

CHAPTER (1)

INTRODUCTION

1.1.      Background Information

The parallel discoveries of X-rays and radioactivity in the late 19th century and early 20th century raised many hopes for the application of this discovery not only in medicine but also in other areas. In the early period of use of these rays, no one suspected that the rays could be harmful because of the slow onset of symptoms. Thomas Edison, William J. Moron, and Nikola Tesla were the first to report possible adverse effects when they discovered eye irritations after experimentation with X-rays and fluorescent substances. The persons who were early exposed to radiation resulted in the loss of limbs and even lives (Reed, 2011).

In the present day, diagnostic radiology becomes upgraded and the usage of more advanced technology is increasing. Several medical procedures including angiography, fluoroscopy, computed tomography (CT), and radiographic imaging utilize radiation.

Moreover, technological methods that cause minimal damage to soft tissue and reduce morbidity have become widespread. This minimally invasive procedure needs indirect visualization of the anatomy. Fluoroscopic imaging (C-arm) can help doctors to obtain such indirect images but its disadvantage is the increased risk of radiation exposure to patients, interventionists, and staff.

Radiation exposure from medical procedures is a threat to health affecting millions worldwide. Nigeria has, for a very long time, engaged in the peaceful application of nuclear technology. The use of ionizing radiation, because of its unique properties, has considerably increased over the years in the oil and gas industry. Due to the adverse health effect when people are over-exposed to ionizing radiation, radiation is feared by many, worldwide, and Nigerians are no exception. This concern is even much higher with inhabitants living in proximity to nuclear establishments and other facilities using ionizing radiation sources. What most people do not realize is that radiation is present everywhere, in everything in the environment and even in the bodies (Oyeyinka et al, 2012). There is cosmic radiation made up of protons, alpha particles, and heavy nuclei bombarding the earth from space which, upon interaction with the atmosphere results in a large assortment of secondary particles, including pie (π) and mu (µ) mesons, electromagnetic photons, neutrons, protons and electrons contributing high radiation dose burden to man even at sea level (Maduemezia et al, 2008). Other natural radiation includes the terrestrial gamma rays from land, sea, and walls of houses we live.

Humans are also internally exposed to radiation emitted by radionuclides absorbed into the body through the consumed food (Oyeyinka et al, 2012). Examples of such radionuclides are potassium40, heavy elements, and carbon-14. Therefore, living isolated from radiation is almost impossible in the modern world as humans and animals are subjected to both natural and artificial radiation in the environment, due to the increase in living standards (Zakari et al, 2009). There is no need for fear of radiation but there is the need to understand its properties, make use of it and reduce the exposure to dose levels that society judged as acceptable, with minimum associated risk. As long as the contribution from the artificial radionuclides does not push the annual dose equivalent level beyond 1mSv for the public and 20mSv averaged over five years for classified workers, then there is no need to fear radiation (NNRA, 2003).

1.2       Statement of the Problem

For nearly a century, radiation-based technologies have been positively contributing to industries, medicine, agriculture, and research. The use of radiation sources in the industry has significantly increased in the past 20 years due to advances in technologies that take advantage of the unique properties of ionizing radiation (Abujarad 2008).

Radioactive materials, sealed sources, and radiation generators are used extensively by the oil and gas industry, in areas such as oil and gas exploration, production, industrial inspection, refineries, laboratory analysis, and security inspection. All equipment, tools, and machinery have hazards associated with their use, and radiation-based technologies are no different. The presence of these radioactive materials and radiation generators results in the need to control occupational exposure to ionizing radiation (IAEA, 2010).

The study of Mettler et al provides worldwide estimates for 2000-2007 indicating that 3.6 billion medical procedures with ionizing radiation (3.1 billion diagnostic radiologic, 0.5 billion dental, and 37 million nuclear medicine examinations) are performed annually. The worldwide average annual per capital effective dose from medical procedures has approximately doubled in the past 10-15 years (Mettler et al., 2009).

CT, fluoroscopy, and nuclear medicine procedures involve repeated or extended radiation exposure, these types of examinations are associated with a higher radiation dose than projection radiography such as chest x-ray and mammography. The adult effective dose from a CT examination of the abdomen is roughly equivalent to the adult effective dose from roughly 400 chest X-rays (U.S. FDA, 2010). Moreover, a large number of thin adjacent CT slices results in 30-50% more radiation dose to the patient than using fewer thicker slices to scan the same anatomy (Nickoloff and Alderson, 2001).

Among radiation uses procedures, CT scanning is increasing because it is the most remarkable advance in medical imaging since the discovery of X-rays. CT examinations are requested for all aspects of medical problems and also replaced the historic conventional radiographs (Schauer and Linton, 2009). Worldwide, the frequency of CT scanning increased from one to three procedures per 1000 population during 1977-1980 to about 35 procedures per 1000 population during 1997-2007 (Mettler et al., 2009).

In the United States, occupational exposures to radiation mainly include medical workers 39% and involve aviation personnel 38%, commercial nuclear power workers 8%, and others with 7% (Schauer and Linton, 2009).

In the UK, it is estimated that 100 to 250 deaths per year are due to cancers directly related to such medical exposures (Quinn et al., 1997). The lifetime risk of inducing fatal cancer in an adult from a standard abdominal CT scan is 1 in 2000 (Tshuma and Salahudeen, 2012).

Various studies have documented deficiencies in knowledge among medical doctors concerning radiation doses and the associated health risks (Krille et al., 2010). An understanding of radiation safety principles and their application in practice is critical for all healthcare workers. The level of awareness concerning radiation protection influences staff behavior. If they do have not enough information related to radiation safety, their practice will not be safe.

It is important to follow proper operating and protection procedures to maximize the benefits and minimize the risk associated with ionizing radiation-based practices. To achieve maximum radiation safety objectives in dealing with artificial radiation sources, national and international radiation protection regulations should be strictly adhered to.

3.1      General Objective

To assess radiation protection awareness among non-radiation workers. (A case study of 68 Nigerian Army reference hospitals Yaba Lagos State).

 

3.2       Specific Objectives

  • To assess awareness concerning radiation and the ill effects of radiation exposure
  • To determine awareness of radiation protection
  • To describe the use of fluoroscopy
  • To assess awareness of radiation exposure from fluoroscopy and methods for preventing radiation hazards

1.4       Justification of the Study

The radiation monitoring program started in Nigeria after the French weapons tests in the Sahara desert in the early sixties (Agu, 1965). Since then, the use of ionizing radiation in medicine, industry, and research has increased considerably. To maximize benefits and minimize hazards associated with the use of ionizing radiation sources, national radiation protection laws and regulations shall be implemented. The objective of radiation protection is to define how one can protect individuals, property, and the environment from the harmful effects of ionizing radiation ICRP 60 (1990). The Federal Radiation Protection Service (FRPS) was established in 1965 in the Department of Physics, University of Ibadan, Ibadan, Nigeria, and assigned the responsibility of ensuring radiation safety throughout the country. FRPS has managed over the years to carry out duties such as environmental and personnel monitoring, facility inspection, research, and training services (Farai and Obed, 2001).

Due to a lack of infrastructure, and enabling laws and regulations, the FIRS was unable to effectively execute some vital roles such as personnel monitoring, authorization, and enforcement. Most private establishments operate without dosimetry coverage or supervision by a Regulatory Body (Farai and Obed, 2001). Moreover, many Oil and Gas companies have been in operation in Nigeria before the establishment of the Nuclear Regulatory Body in the country. Therefore, many Radiation Sources have been imported into the country and many practices involving the use of ionizing radiation sources have been in operation without proper regulation by a Competent Authority.  In 1995, the Nuclear Safety and Radiation Protection (NSRP) law came into being, with the passage of Act 19 of the Federal Republic of Nigeria (NSRP) (NNRA, 1995). The enactment of this law brought about the establishment of a nuclear regulatory authority known as the Nigerian Nuclear Regulatory Authority (NNRA) in 2001.

Today, patient safety is a global issue affecting all countries. Many patients suffer from preventable harm during receiving health care in hospitals. Professional factors such as healthcare professionals’ awareness have an impact on patient safety.

From the quality aspect of health care, patient safety and occupational safety are essential components of the Quality Management System (QMS). Now all the public and private health care facilities are competing to give good quality health care services. Therefore more advanced imaging equipment that uses ionizing radiation is introduced to get more rapid diagnosis of diseases in health care facilities. Moreover, healthcare professionals become more dependent on diagnostic imaging instead of making clinical decisions. And also increasing demand from patients because they believe that they can get rapid diagnoses and cures for their diseases by using more and more advanced technologies.

So knowledge of referring doctors and awareness of medical professionals in interventional laboratories are very important to optimize exposures, keeping radiation exposure as low as reasonably achievable.

Awareness of healthcare professionals on radiation exposure can effectively protect either themselves or their patients. It is beneficial for both patients and healthcare providers.

This study aimed to assess the awareness of radiation safety among non-radiation workers. It was expected to be baseline information or just a seed for further studies.

 

 1.5       Significance of the Study

The study will assist the operating organizations and professionals in the implementation and maintenance of its Radiation Safety Programme and measures.

1.6 Scope of the Study

The study aims at assessing radiation protection awareness among non-radiation workers. The study covers 68 Nigerian Army reference hospitals in Yaba Lagos State, GET MORE RADIOLOGY PROJECT TOPICS AND MATERIALS

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