Radiation Protection Practices Research Articles

일부지역 치과위생사의 디지털 방사선 안전관리 실태와 지식, 태도, 실천

Objectives: The aimed to understand the current state, knowledge, attitude of digital radiation safety management in dental medical institutions, and to find ways to secure radiation safety management in dental medical institutions. Methods: This study conducted a convenience-sampled online survey (Google questionnaire) targeting 290 dental hygienists working in clinical settings from June 3 to June 24, 2023. Results: There is a positive correlation between Knowledge related to radiography (Knowledge), attitudes during radiography (Attitudes), and practices regarding radiation protection (Practices). When Knowledge is high, Attitudes (r=.181) and Practices (r=.284) are also high, and there is a positive correlation between Attitudes and Practices (r=.542). Conclusions: It is believed that institutional arrangements are needed to strengthen radiation safety management rules and laws and improve Knowledge, Attitudes, and Practices.

A study on awareness, knowledge, and practice of radiation exposure protection protocols by dentists in a Nigerian teaching hospital

Objectives: The role of dental radiography cannot be over-emphasized but the harmful effect of its radiation cannot be overlooked, thereby making the knowledge and practice of exposure protection very important. While studies on awareness, knowledge, and practice exposure protection are available in other countries, it appears that there is a dearth of such studies in our environment. The aim of this survey was to assess the awareness, knowledge, and practice of radiation hazards and exposure protection techniques of dentists in a Nigerian teaching hospital. Materials and Methods: This cross-sectional study design was conducted between December 2022 and February 2023 at the dental complex of a Nigerian teaching hospital among dental practitioners. The data were collected with a 23-item, structured, close-ended, and self-administered questionnaire. The data collected were age, gender, department of respondents, medical status, years of experience, and additional degree. Other collected data were awareness, knowledge, and practice of radiation protection. Both descriptive and inferential statistics were performed. The data were entered and analyzed using the Statistical Package for the Social Sciences, version 26 (IBM, Armonk, NY, United States of America). A critical probability level (P < 0.05) was used as the cutoff level for statistical significance. Results: A total of 100 questionnaires were distributed, and 82 were retrieved, giving a response rate of 82%. The mean age of the respondents was 45.3 ± 5.1 years. There were more males (58.5%) with a male-to-female ratio of 1.4:1. The prevalence of poor awareness and inadequate knowledge of radiation exposure protection was 48.2% and 22.4%, respectively. The prevalence of poor practice toward radiation exposure was 66.7%. Only years of experience and additional degree influenced the prevalence of inadequate knowledge of radiation exposure (P < 0.05). Conclusion: The prevalence of poor awareness, inadequate knowledge, and poor practice of radiation exposure protection, with values of 48.2%, 22.4%, and 66.7%, respectively, were quite high. The prevalence of inadequate knowledge of radiation exposure protection was influenced by years of practice and additional degrees.

Radiation Safety Awareness Among Nursing Students in Universiti Sultan Zainal Abidin (UniSZA): A Survey Study

Excessive exposure to unnecessary radiation may cause long-term effects to human being. Thus, nursing students should be knowledgeable about radiation protection and safety before starting their clinical placement at the hospital to minimize the risk of radiation. This research aims to identify the awareness level among nursing students in UniSZA toward radiation safety. An online questionnaire was distributed to all nursing students in UniSZA. The questionnaire survey consisted of a section for socio-demographic information and two sections for 5-point Likert scale questions, which were radiation knowledge and radiation protection practice. A total of 108 nursing students consented and participated in the study. Descriptive statistics were used for elaborating respondent’s demographic characteristics. Independent t-test was used to use to evaluate the influence of clinical training duration towards radiation safety awareness. All analyses were performed using SPSS 21.0. The results showed that nursing students have a high level of radiation knowledge with a mean score 3.67±0.68 and a high level of radiation protection practice with mean score 3.98±0.73. Furthermore, the findings indicated that the mean score of knowledge and practice among respondents with a clinical training duration of more than 8 weeks were 47.29±8.09 and 33.23±5.56, respectively. It was a higher mean score of the knowledge and practice towards radiation safety in respondents with a longer clinical training duration as compared with respondents with shorter clinical training duration with p<0.005. The awareness of radiation safety among nursing students is crucial for assuring the health and safety of both patients and healthcare professionals. Through education and training, nursing students gain the knowledge and skills necessary to effectively handle and minimise the risks associated with radiation exposure in healthcare settings.

Assessment of Knowledge and Practice on Radiation Protection in Radiological Imaging Among Healthcare Professionals at HPUniSZA

Ionizing radiation aids in diagnosing and treating diseases. However, without proper knowledge and practice of radiation protection, it can be harmful, especially among healthcare professionals. This study aims to examine the knowledge and practice of radiation protection among healthcare workers at the HPUniSZA. A cross-sectional study was conducted in the HPUniSZA from March 2022 to June 2023 for healthcare professionals in HPUniSZA. The questionnaire was distributed online and through face-to-face interviews. Descriptive statistics were used to analyze sociodemographic, knowledge, and practice of radiation protection while Pearson’s correlation was used to determine the relationship between knowledge and practice of radiation protection among the respondents. A total of 60 healthcare professionals in HPUniSZA participated in this study. The mean knowledge level was found to be 6.20 (SD, 2.905) indicating a range of medium-good level of knowledge of radiation protection while for practice was found to be 8.20 (SD, 2.394) indicating a good practice of radiation protection among healthcare professionals. A significant positive and fair correlation (r = 0.48, p < 0.001) was demonstrated between knowledge and practice levels on radiation protection in radiological imaging. The knowledge level and the practice of radiation protection among healthcare professionals are in the range of medium-good level and good levels respectively. There is a correlation between knowledge and practice of radiation protection among healthcare professionals in HPUniSZA. Assessing the knowledge and practice of radiation protection among healthcare professionals is of utmost importance to ensure patient safety, minimize radiation risks, and facilitate effective and efficient healthcare delivery both now and in the future.

Approaches to Establishing National Diagnostic Reference Levels for Computed Tomography: A Systematic Review

Background: The international commission on radiation protection (ICRP) publican 135 recommends that Diagnostic Reference Levels (DRLs) should be tied to defined technical and patient parameters for the imaging task. Whereas for computed tomography (CT) examinations, DRLs are defined in terms of two established technical parameters namely, Volume-based Computed Tomography Dose Index (CTDIvol) and Dose Length Product (DLP), a debate has ensued as to whether patient size, age and weight or clinical indication should be used as patient parameters. The objective of diagnostic reference levels (DRLs) is to assist in the optimisation of radiation dose to the patients while maintaining diagnostic image quality. It is generally accepted that each country requires having national DRLs to guide the practice of radiography regarding dose optimization as a prerequisite to good radiation protection practice. Objective: This review aimed to establish commonly used approaches to establishing national diagnostic reference levels for computed tomography. Methods: A systematic literature search in databases containing leading journals in radiography, radiology and medical physics was performed aided by the use of carefully selected search terms that relate to CT and DRLs. The literature search was achieved by the use of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flow chart. A total of 109 studies were screened out of which 54 were excluded and 55 sought for retrieval. After further assessment for quality, 20 studies were included in this study for review. Key Findings: 95% of the studies in this review used CTDIvol and DLP as technical parameters indicating dose. 70% of the studies reviewed used patient size, age and weight while 30% used clinical indication as patient parameters. 30% of the reviewed articles did indicate that the surveys to establish NDRLs employed a retrospective approach, while 35% employed a prospective approach and 35% did ..

A report on a survey among Portuguese Association of Interventional Cardiology associates regarding ionizing radiation protection practices in national interventional cath-labs

Introduction and objectivesConcerns surrounding the consequences of ionizing radiation (IR) have increased in interventional cardiology (IC). Despite this, the ever-growing complexity of diseases as well as procedures can lead to greater exposure to radiation. The aim of this survey, led by Portuguese Association of Interventional Cardiology (APIC), was to evaluate the level of awareness and current practices on IR protection among its members. MethodsAn online survey was emailed to all APIC members, between August and November 2021. The questionnaire consisted of 50 questions focusing on knowledge and measures of IR protection in the catheterization laboratory. Results were analyzed using descriptive statistics. ResultsFrom a response rate of 46.9%, the study obtained a total sample of 159 responses (156 selected for analysis). Most survey respondents (66.0%) were unaware of the radiation exposure category, and only 60.4% reported systematically using a dosimeter. A large majority (90.4%) employed techniques to minimize exposure to radiation. All participants used personal protective equipment, despite eyewear protection only being used frequently by 49.2% of main operators. Ceiling suspended shields and table protectors were often used. Only two-thirds were familiar with the legally established limit on radiation doses for workers or the dose that should trigger patient follow-up. Most of the survey respondents had a non-certified training in IR procedures and only 32.0% had attended their yearly occupational health consultation. ConclusionsSafety methods and protective equipment are largely adopted among interventional cardiologists, who have shown some IR awareness. Despite this, there is room for improvement, especially concerning the use of eyewear protection, monitoring, and certification.

Management of pregnant or potentially pregnant patients undergoing diagnostic and interventional radiology procedures: Investigation of clinical routine practice

It is well known that foetuses are highly sensitive to ionising radiation and special attention to justification and optimisation of radiological procedures involving a pregnant patient is required. A task to review, validate and compare different approaches to managing the pregnant patient and to estimating the associated foetal doses arising from a diagnostic or interventional radiology (DIR) procedure was designed in the framework of EURADOS working group 12.As a first step, a survey of radiation protection practice including dosimetry considerations among EURADOS members was performed using online questionnaire. Then, to evaluate the possible differences in the estimated foetal doses, a comparison of assessed dose values was made for three cases of pregnant patients that underwent different CT procedures.More than 120 professionals from 108 institutions and 17 countries that are involved in managing pregnant patients undergoing DIR procedures answered the questionnaire. Most of the respondents use national or hospital guidelines on the management of pregnant patients undergoing DIR procedures. However, the guidelines differ considerably among respondents. Comparison of foetal dose assessments performed by dosimetry experts showed the variety of methods used as well as large variability of estimated foetal doses in all three cases.Although European and International commission on radiation protection guidelines already exist, they are more than 20 years old and, in some aspects, they are obsolete. This paper shows that there is a need to revise and update these guidelines.

EURADOS project on the impact of the proposed ICRU operational dose quantities.

Following the publication of the joint The International Commissions on Radiation Units and Measurements (ICRU) and on Radiological Protection (ICRP) report on new operational quantities for radiation protection, the European Dosimetry Group (EURADOS) have carried out an initial evaluation. The EURADOS report analyses the impact that the new quantities will have on: radiation protection practice; calibration and reference fields; European and national regulation; international standards and, especially, dosemeter and instrument design. The task group included experienced scientists drawn from across the various EURADOS working groups.

Radiation exposure in fluoroscopy guided spinal interventions: A prospective observational study of standard practice in a physiatry academic center

ContextFluoroscopy is the recommended image guidance modality for most spinal pain interventions. However, it exposes interventional pain physicians to chronic ionizing radiation, with known risks to the eye, skin, and hand. The use of protective glasses and gloves is variable among pain physicians. ObjectivesTo document the total radiation exposure (mSv) by pain physicians to their eyes, hands and chest in an academic setting including various spinal interventions. MethodsFour pain physicians wore a finger, head/collar (equivalent to eye exposure) and chest dosimeter over and under their lead apron during a three-month period where they performed their usual fluoroscopy-guided interventions, including close supervision of trainees. We calculated an average exposure per intervention and extrapolated the recorded exposure to a maximum, worst-case scenario of a caseload of 13 procedures per day, 5 days a week and 52 weeks per year. ResultsFour pain physicians of variable experience performed 15 different types of procedures on 607 patients throughout the study period. The yearly maximum exposure scenarios for each pain physician were all below the Canadian Nuclear Safety Commission thresholds for nuclear energy workers: for the hands (31.56 mSv, 25.67 mSv, 20.59 mSv, 21.51 mSv; threshold = 500 mSv), eyes (16.01 mSv, 18.64 mSv, 24.08 mSv, 18.68 mSv; threshold = 50 mSv) and chest over the lead apron (28.27 mSv, 46.91 mSv, 30.00 mSv, 40,03 mSv; whole body threshold = 50 mSv), with some doses even below general population thresholds. The exposure under the lead apron was 0 mSv for each pain physician. ConclusionThe standard practice of an interventional pain physician using fluoroscopy in this academic setting is below radiation exposure regulations, even in a theoretical, worst-case, maximum exposure scenario. Standard radiation protection practices such as the use of lead aprons and thyroid shields should still be used. However, this data is reassuring for pain physicians with a practice in fluoroscopy-guided interventions who wish to not use protective glasses or gloves.

Better safe than so ray: national survey of radiation protection amongst interventional radiology trainees in the United Kingdom.

To establish the provision and use of radiation personal protective equipment (PPE) and dosimetry amongst UK interventional radiology (IR) trainees and highlight areas of improvement in order to enhance the radiation safety. A survey questionnaire was designed by members of the British Society of Interventional Radiology (BSIR) trainee committee via survey monkey and distributed to UK IR trainees via the BSIR membership mailing list, local representatives and Twitter. The survey was open from 04/01/2021 to 20/02/2021. Only IR trainees in years ST4 and above were included. Of the 73 respondents, 62 qualified for analysis. Respondents (81% male) spent a median of 5.5 sessions (half day list) per week in the angiography suite and 58% (n=36) had difficulty finding appropriately sized lead aprons at least once a week. Overall 53% (n=33) had concerns about their radiation PPE. Furthermore 56% of trainees (n=35) experienced back pain among other symptoms attributed to wearing the lead aprons available to them. 77% (n=48) regularly wore lead glasses. For trainees requiring prescription glasses (n=22) overfit goggles were provided however 17 (77%) of these trainees felt the goggles compromised their ability to perform the procedure. Eye and finger dosimeters were used by 50% and 52% of respondents respectively. Compliance with body dosimetry was 99%. Provision of radiation PPE and dose monitoring for IR trainees is suboptimal, particularly access to adequate eye protection or suitably fitting leads. Based on the findings of this survey, recommendations have been made to promote the safety and radiation awareness of IR trainees. Radiation protection practices for IR trainees nationally are poor. Provision of suitable eye protection and well fitting lead body protection is low.

Impact of supporting substrate on the measured neutron yields from natLi (p, n) system: A case study with natC and natTa stopping targets

Abstract The high energy neutron generation facilities worldwide uses the Li(p,n) system for production of the quasi mono-energetic neutrons from epithermal to few hundreds of MeV. Among the facilities either self-standing thick Li target or Li foil supported on a target assembly is used. In case of a supported Li target, either low or high mass supporting substrates like Al, C, Au, Ta etc. can be used. However, the neutron emission from the supporting substrate can interfere with the Li(p,n) reaction neutrons. In the present study neutron yields from a thin natural Li target supported on the thick natural Ta (high Z) and C (low Z) targets were measured at incident proton energies between 8-20 MeV. The proton irradiation of targets were performed at the Pelletron accelerator Facility, Mumbai and the emitted neutrons were measures at both forward (0°) and lateral (90°) directions with respect to the incident beam. The neutron yield was estimated using the CR-39 detectors and dual scintillator based active neutron spectrometer. A neutron dose equivalent (NDE) meter was also used to measure the neutron ambient dose equivalent at the measurement point. Experimentally measured neutron yields and ambient neutron dose equivalent estimates indicated higher Li(p,n) neutron yield with carbon as the supporting substrate. This is due to fewer self-emissions from natC compared to natTa target. Carbon supporting substrate also ensures improved spectral features of the Li(p,n) emission neutrons and lesser neutron fluence around the source location. This ensures efficient implementation of radiation protection practices with carbon target due to lower neutron fluence around the source compared to tantalum target. Carbon is a favorable supporting substrate compared to high Z- metal targets like Ta for emission neutron studies on Li target at proton energies between 8-20 MeV.

Establishment of ex vivo calibration curve for X-ray induced “dicentric + ring” and micronuclei in human peripheral lymphocytes for biodosimetry during radiological emergencies, and validation with dose blinded samples

In the modern developing society, application of radiation has increased extensively. With significant improvement in the radiation protection practices, exposure to human could be minimized substantially, but cannot be avoided completely. Assessment of exposure is essential for regulatory decision and medical management as applicable. Until now, cytogenetic changes have served as surrogate marker of radiation exposure and have been extensively employed for biological dose estimation of various planned and unplanned exposures. Dicentric Chromosomal Aberration (DCA) is radiation specific and is considered as gold standard, micronucleus is not very specific to radiation and is considered as an alternative method for biodosimetry. In this study dose response curves were generated for X-ray induced “dicentric + ring” and micronuclei, in lymphocytes of three healthy volunteers [2 females (age 22, 23 years) and 1 male (24 year)]. The blood samples were irradiated with X-ray using LINAC (energy 6 MV, dose rate 6 Gy/min), in the dose range of 0–5Gy. Irradiated blood samples were cultured and processed to harvest metaphases, as per standard procedures recommended by International Atomic Energy Agency. Pooled data obtained from all the three volunteers, were in agreement with Poisson distribution for “dicentric + ring”, however over dispersion was observed for micronuclei. Data (“dicentric + ring” and micronuclei) were fitted by linear quadratic model of the expression YC + αD + βD2 using Dose Estimate software, version 5.2. The data fit has resulted in linear coefficient α = 0.0006 (±0.0068) “dicentric + ring” cell−1 Gy−1 and quadratic coefficient β = 0.0619 (±0.0043) “dicentric + ring” cell−1 Gy−2 for “dicentric + ring” and linear coefficient α = 0.0459 ± (0.0038) micronuclei cell−1 Gy−1 and quadratic coefficient β = 0.0185 ± (0.0010) micronuclei cell−1 Gy−2 for micronuclei, respectively. Background frequencies for “dicentric + ring” and micronuclei were 0.0006 ± 0.0004 and 0.0077 ± 0.0012 cell−1, respectively. Established curves were validated, by reconstructing the doses of 8 dose blinded samples (4 by DCA and 4 by CBMN) using coefficients generated here. Estimated doses were within the variation of 0.9–16% for “dicentric + ring” and 21.7–31.2% for micronuclei respectively. These established curves have potential to be employed for biodosimetry of occupational, clinical and accidental exposures, for initial triage and medical management.

Investigation of the Radiographer's adherence and compliance with radiation protection and infection control practices during COVID-19 mobile radiography

Radiological staff, especially radiographers, work as front liners against the COVID-19 outbreak. This study aims to assess compliance with radiation protection and infection control practices during COVID-19 mobile radiography procedures. This cross-sectional study included 234 radiographers (females, 56%, n = 131; males, 44%, n = 103) who were asked to complete an online questionnaire consisting of demographic data, radiation protection and infection control practices during COVID-19 portable cases, and knowledge and awareness. After informed consent was completed, SPSS statistical software was used for the data analysis. The most common age group of participants ranged from 18 to 25 years old (30.3%, n = 71). Bachelor's degree holders were 74.4% (n = 174). Most radiographers (39.7%, n = 93) had a working experience of 1–5 years, followed by 27.8% (n = 65) with more than 16 years of experience. Most respondents (62.4%, n = 146) handled approximately 1–5 cases daily, the majority of them (56%, n = 131) stated affirmatively they had obtained special training to handle COVID-19, and when inquired if they had received any special allowances for handling COVID-19 suspected/confirmed cases most of them stated negative (73.9%, n = 173). Most participants stated that they always wear a TLD during portable cases (67.1%, n = 157) and a lead apron (51.7%, n = 121). Around 73% (n = 171) knew the latest information on COVID-19 and attended the COVID-19 awareness course. A significant association was found between the work experience of the radiographers and their responses to following the best practices (p = 0.018, α = 0.05). Radiographers who had COVID-19 training (μ = 48.78) tend to adhere more to best practices than those who have not (p = 0.04, α = 0.05). Further, respondents who handled more than 16/more COVID-19 suspected/confirmed cases followed the best practices more (μ = 50.38) than those who handled less (p = 0.04, α = 0.05). This study revealed detailed information on radiation protection and infection control practices during COVID-19 mobile radiography. It has been observed that the participants/radiographers have good knowledge and awareness of radiation protection and infection-control practices. The present results may be used to plan future requirements regarding resources and training to ensure patient safety.

Radiation detriment estimation: on the possibility of effective dose usage to assess the number of years of the healthy life lost

The Russian Law “On Radiation Safety of the Population” defines the effective dose as “the amount of exposure to ionizing radiation used as a measure of the risk of long-term consequences of human’s body exposure…” In turn, the Russian “Radiation Safety Standards” (RSS 99/2009) establish a procedure for assessing the health risk, associated with exposure to low doses, for two types of harmful effects (oncological diseases and hereditary effects) and two age and sex groups (“whole population” and “adults”) by multiplying corresponding linear risk coefficients per effective dose. At the same time, these documents do not impose restrictions on the risk assessment procedure, without excluding the use of any other risk indicators or risk assessment for other sex and age groups of the population. The value of radiation detriment to health, calculated by the method described in RSS 99/2009 to characterize the risk, as a unit of measurement, uses the fatal oncological disease caused by exposure to ionizing radiation, weighted by the number of years of life lost, or weighted by the severity of non-fatal cancer. Currently, mortality-based health measures are considered insufficiently informative characteristics of the impact of external factors on population health. Such indicators are poorly suited for a comparative analysis of risks, especially taking into account the different distribution of negative consequences over time. The paper presents an applied approach to expand the application of the radiation risk assessment methodology, without making significant changes to the established practice of radiation protection. The possibility of using the DALY value (disability-adjusted life years) as an measure of radiation risk is being considered; the expediency of changing approaches to calculating the effective dose (by using different values of weighting factors for tissues and organs during effective dose calculation for different age and sex groups of the population) and the possible scope of the proposed approaches to risk assessment in practice are discussed; an approach is proposed for calculating the DALY value using the effective dose and the corresponding risk factors (DALY×Sv-1).

A Questionnaire Survey on Radiation Protection among Medical Staff Working in Cardiac Catheterization Laboratory

Background and aims: It is essential for cardiologists, technologists, and nurses working in the cardiac catheterization laboratory to understand radiation protection. However, protective equipment usage is still low, wearing dosimeters is also low and there is little awareness of radiation protection in practice.

Finger doses due to 68Ga-labelled pharmaceuticals in PET departments—results of a multi-centre pilot study

Introduction: Although the use of 68Ga has increased substantially in nuclear medicine over the last decade, there is limited information available on occupational exposure due to 68Ga. The purpose of this study is to determine the occupational extremity exposure during the preparation, dispensing and administration of 68Ga-labelled radiopharmaceuticals. Method: Workers in eight centres wore a ring dosimeter for all tasks involving 68Ga-labelled radiopharmaceuticals for a minimum of one month. Additionally, the fingertip dose was monitored in two centres and the hand with the highest ring dose during 68Ga procedures was also identified in one centre. Results: The median normalised ring dose for 68Ga procedures was found to be 0.25 mSv GBq−1 (range 0.01–3.34). The normalised 68Ga ring doses recorded in this study are similar to that found in the literature for 18F. This study is consistent with previous findings that the highest extremity dose is found on the non-dominant hand. A limited sub study in two of the centres showed a median fingertip to base of the finger dose ratio of 4.3. Based on this median ratio, the extrapolated annual 68Ga fingertip dose for 94% of the workers monitored in this study would be below Category B dose limit (150 mSv) and no worker would exceed Category A dose limit (500 mSv). Conclusion: When appropriate shielding and radiation protection practices are employed, the extremity dose due to 68Ga is comparable to that of 18F and is expected to be well below the regulatory limits for the majority of workers.

An audit of patient radiation doses in interventional radiology at a South African hospital.

Interventional radiology (IR) is becoming more relevant in patient care and is associated with increased patient radiation exposure and radiation-induced adverse effects. Diagnostic reference levels (DRLs) are crucial for radiation control. There is a paucity of published DRLs for IR in South Africa and sub-Saharan Africa. This study aimed to determine local DRLs for fluoroscopically-guided IR procedures and compare the achieved DRLs with published local and international DRLs. Retrospective, descriptive, single-centre study. Kerma air product (KAP), reference point air kerma (Ka,r) and fluoroscopy time (FT) were collected for patients (12 years and older) who underwent IR procedures at a university hospital from 01 January 2019 to 31 December 2019. The 75th percentile of the distribution of each dose parameter (KAP, Ka,r and FT) per procedure was calculated and taken as the local diagnostic reference levels (LDRL). The established LDRLs were compared to published DRLs. A total of 564 cases were evaluated. The 13 most frequent procedures (with 15 or more cases) represented 86.1% (487/564). Percutaneous transhepatic biliary drainage was the most common procedure (n = 146, 25.9%). Diagnostic cerebral angiogram DRLs exceeded the published DRL data ranges for all parameters (DRL 209.3), and interventional cerebral angiogram exceeded published ranges (DRL 275). Uterine artery embolisation (UAE) exceeded these ranges for KAP and Ka,r. (KAP-954.9 Gy/cm2, Ka,r-2640.8 mGy). The LDRLs for diagnostic cerebral angiogram, interventional cerebral angiogram and UAE exceeded published international DRL ranges. These procedures require radiation optimisation as recommended by the International Commission on Radiological Protection (ICRP). In addition to informing radiation protection practices at the level of the institution, the established LDRLs contribute towards Regional and National DRLs.

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

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.

Radiation protection in the operating room: Need for training, qualification and accompaniment for the professionals

The objective of this work was to evaluate the knowledge of the professionals working in the operating room about the risks associated to exposure to X-rays, and the radiation protection practices. To meet this objective, we conducted a multicenter study in three Moroccan hospitals. Data collection was carried out with a self-administered questionnaire to the professionals. The results showed that more than a third of the participants ignore the ionizing nature of X-rays; and that the effects of exposure to ionizing radiation are related to cumulative dose. Three percent of the participants were aware about the effective dose limit of ionizing radiation for workers for a year and the annual dose limits to the extremities or to the skin. 45.50% of participants had no knowledge about the most irradiating technique when using the amplifier; 58.21% felt that continuous fluoroscopy mode was the most irradiating. All of the participants declared the absence of a radiation protection referent, and did not use any written procedures guide for the most common radiological examinations in interventional imaging. Multidisciplinary cooperation, at least, between radiology staff and operating room staff appears imperative, and seems to strengthen the system of vigilance and protection against the harmful effects of ionizing radiation.

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