Radiation Protection Practices Research Articles

EVALUATION OF RADIATION PROTECTION PRINCIPLES OBSERVANCE IN DENTAL RADIOGRAPHY CENTERS (WEST OF IRAN): CROSS-SECTIONAL STUDY

The aim of this study is to assess the evaluation of radiation protection principles observance in dental radiography centers and hazards. This cross-sectional study was designed to assess level of radiation protection principles in dentistry centers. The present cross-sectional study was conducted by enrolling 103 dentistry centers in Kermanshah province (west of Iran). Our finding illustrates 75.7% of the centers were equipped with an intraoral radiography. Although observance principles of radiation protection for patient at dentistry center were at appropriate level (97.3%), the observance of the protective principles was not adequate for the skilled workers in any center. The most commonly used protective measure was the observance of a distance from patient (97.3%) and the minimum protective measures such as the use of high-speed film (1.4%). According to results in this study, the knowledge and practice of radiation protection are not satisfactory.

Current Sudan protective practice in diagnostic nuclear medicine and patient dose

Reflecting upon the influence of current diagnostic imaging radiation protection practices in Sudan, a sampling evaluation is made of administered activity across all five of the nuclear medicine departments in the country. Data were collected in respect of 423 patients, administered nuclide activities showing accord with international levels. For administered activity, four of the five departments use International Atomic Energy Agency (IAEA) Basic Safety Standard protocols, the other adopting UK Administration of Radioactive Substances Advisory Committee (ARSAC) practice. For national nuclear medicine diagnostic purposes overwhelming use is made of 99mTc. Thyroid and parathyroid scans account for 43% of the 423 investigations, while whole body bone and renal scans provide for the imaging needs of the respective 34% and 23% remaining patients. Of the acquired images, in excess of 80% of these were planar. The mean and standard deviation effective dose values were 2.26 ± 0.61, 4.70 ± 0.77 and 1.03 ± 0.29 mSv, for thyroid, bone and dynamic renal scans respectively, comparable with that of previous studies. While department designs are observed to comply with radiation protection regulations, the personal monitoring service is much less satisfactory, data frequently being found to be absent in all five departments. Moreover, only 60% of the medical physicists have been in receipt of regular radiation protection training, while other medical staff within the departments have not benefited from the relevant training at all, including physicians, nurses and nuclear medicine technologists. None have received regular specific medical checks. Accordingly, the Sudanese Nuclear & Radiological Regulatory Authority are now playing a major role in development of nuclear medicine practice and associated safety requirements, seeking accord with the principle of ALARA. Physician/medical physicist cooperation is needed in addressing optimization of radiation dose and image quality, also radiation protection awareness and training, as well as in medical surveillance.

ESTIMATION OF OCCUPATIONAL RADIATION EXPOSURE FOR MEDICAL WORKERS IN RADIOLOGY AND CARDIOLOGY IN THE UNITED ARAB EMIRATES: NINE HOSPITALS EXPERIENCE.

Occupational radiation exposure for medical workers in radiology and cardiology was analyzed in nine hospitals in the UAE between 2002 and 2016. The purpose of the study was to determine the time trend and the differences in occupational radiation exposure among worker groups and hospitals in the country. Readings of 5700 thermoluminescence dosimeters (TLDs) were obtained from 1011 medical workers and grouped into 5 worker groups (radiographers, diagnostic radiologists, nurses, cardiologists and physicians). The mean annual effective dose was from 0.38 to 0.62mSv per worker. Even though an increase in the collective effective dose has been noticed during the study period, no significant time trend was observed in the mean effective dose. Furthermore, cardiologists received higher mean and maximum effective doses than the other worker groups. The annual effective doses were below the limits set by national legislation and international standards, and for the average worker, the likelihood of high exposure is small. However, improvements in radiation protection practices could be implemented to reduce occupational radiation dose to cardiologists, who were the most exposed worker group in this study.

Are radiographers an influencing factor in the radiation protection practices of speech-language therapists performing videofluoroscopic swallowing studies?

IntroductionA videofluoroscopic swallowing study (VFSS) is a fluoroscopic examination conducted by radiographers and speech-language therapists (SLTs) to assess dysphagia. Given the potential of SLTs to feed patients during the procedure, they may be exposed to radiation. The research aimed to assess radiation protection practices utilised by SLTs to determine if radiographers have a role in providing ongoing practical education. MethodsAn online questionnaire was distributed to SLTs from six countries (Australia, Canada, Ireland, New Zealand, United Kingdom and United States of America). Responses were analysed quantitatively using frequencies and chi-square analysis (p = 0.05) and supported by written comments. ResultsA total of 224 responses were analysed. Thyroid shields (94%) were used more frequently than full aprons (72%). Differences (p < 0.0001) were seen between Australian and USA participants regarding the use and position of radiation monitors; 43% of Australian participants stating they always used a monitor, compared to 75% of USA participants. Nearly all Australian SLTs wore monitors under shielding (92%) and at waist level (69%), while USA participants reported wearing them outside shielding (97%) and at thyroid level (94%). Participants’ radiation practice was influenced primarily by other SLTs (64%), followed by radiographers (57%). However, written comments revealed the significance of the radiographer in providing training as “radiographers are excellent at ensuring we [use] right equipment, stand in the right places and use exposure monitoring”. ConclusionSLTs did not always adopt the ICRP principle of shielding and there were inconsistencies with regards to the use and placement of radiation monitors. Radiographers are well positioned to provide advice with regards to safe practice. Implications for practiceOpportunities to enhance radiation protection practices are evident, as is the advising role of radiographers.

Radioprotección en cateterismo cardiaco pediátrico

Cardiology interventionists perform a large amount of increasingly complex procedures with a good success rate, but with a higher dose of radiation, not only for the patient, but also for the occupational exposed workers. There are simple methods to minimise the dose received. These include minimising the time of the radiographic equipment and the number of images acquired, as well as using the technologies available for reducing the dose for patients. The geometry of the equipment should be adjusted, to collimate, avoid reflected radiation zones, as well as using all the shielding available. Quality controls should also be made on the imaging equipment, as well as using personal dose meters to know the dose received.The efficient use of methods not only requires education and training for all personnel occupationally exposed, but also the availability and use of radiation protection elements in the laboratory and for the equipment. There must be a regular review of the equipment and investigation of doses received by the staff, accompanied by the necessary changes in the way the procedures are performed, in order to ensure improved radiation protection practices in the cardiovascular intervention laboratory.

Radiation protection knowledge and practices in interventional cardiologists practicing in Africa: a cross sectional survey

We conducted a survey of doctors working in the cardiac catheterisation laboratories in Africa on their knowledge, attitude and practice with respect to radiation protection. Of seventy-two respondents contacted, 61 (84.7%) completed the questionnaire. Twenty-eight, (45.9%) were younger than 45 years. Thirty-seven, (60.6%) had less than 10 years of experience in the laboratory. Only 28 (45.9%) had undertaken radiation protection training. Fifty-eight, (95.1%) consistently used lead aprons. Forty-seven, (77%) reported consistently using thyroid shields. Ten (16.4%) consistently used radiation protection eyeglasses, whilst 36 (59%) never used them. Thermoluminescent Dosimeter badges were consistently used in 23 (37.7%). Forty-two, (68.9%) reported having ceiling mounted lead/acrylic shields. Level of radiation exposure in the most recent one year was ≤2 mSv in 14, between 2 and 20 mSv in 8 and between 20 and 30 mSv in 2, whilst 33 did not know their dose readings. The use of basic radiation protection tools as well as the knowledge and measurement of radiation exposure among interventional cardiologists working in Africa is low. The unavailability of some of the protective tools and a knowledge gap in terms of radiation protection and monitoring of self-exposure were some of the reasons for suboptimal self-protection against ionising radiation among our respondents. We suggest that initiatives be taken by all stakeholders to train this group of medical professionals in basic radiation protection to avoid unnecessary exposure to themselves, co-workers and patients.

NATIONAL DOSE REGISTRY AND TRENDS OF OCCUPATIONAL EXPOSURE TO IONISING RADIATION IN CHINA (2009-2018).

The registry and analysis of occupational exposure is significant for radiation protection against ionising radiation. This paper presents the current status of the 'Chinese Registry of Radiation Workers (CRRW)' and trends as well as the distribution of occupational exposure to ionising radiation in China from 2009 to 2018. A database with total 6.6 million monitoring records from 820000 workers in 85000 radiation units for medical uses, industrial uses and miscellaneous uses is established by the CRRW. The Mann-Kendall test shows statistically significant decreasing trends of average annual effective dose for the total, medical uses and industrial uses (p<0.01), by 0.035, 0.042 and 0.020mSv/y, respectively. The average annual effective dose for the monitored workers is 0.403mSv for the 10-y period. More than 96.1% of the monitored workers receive annual doses less than the limit for public exposure (1mSv) in 2018. The annual average effective dose in medical uses is significantly higher than industrial uses and miscellaneous uses (p<0.05/3=0.017). In 2018, the annual collective dose of 107.41man·Sv is received by 378428 monitored workers, with medical uses as the dominant contributor. These observations could be a result of improvements in radiation protection practices in China. However, it is still necessary to take rigorous and continuous surveillance and radiation protection measures, to keep individual dose as low as reasonably achievable, especially for those found to receive relatively higher doses in medical uses.

A study to assess the knowledge and practice of medical professionals on radiation protection in interventional radiology.

Objective:Ionizing radiation has been extensively used in medical procedures throughout the world. Such interventional radiological procedures could result in occupational exposure that needs urgent control. Therefore, MPs (medical professionals) should receive education and appropriate training on occupational radiation protection. In this context, the present study is aimed to investigate the MPs' knowledge and practice regarding radiation protection principles during interventional radiological procedures.Material and Methods:A descriptive questionnaire-based study was carried out among 215 MPs involved in interventional fluoroscopy procedures. The practice of 31 MPs was studied using a checklist based on ALARA principles and ICRP guidelines.Results:A total of 43.3% and 45.1% answered correctly for knowledge and practice. However, the difference between radiation protection knowledge and practice between the physicians and nurses was statistically significant. The knowledge and practice survey of MPs demonstrated that nurses rarely adhered to radiation-protection measures.Conclusion:The present study reflects the lack of knowledge and practice concerning radiation protection concepts among the nurses. This deficiency needs to be resolved by periodic practical radiation protection courses in the curriculum of medicine.

Potential health effects of low dose radiation and what it means to the practice of radiation protection

Potential health effects of low dose radiation and what it means to the practice of radiation protection

Induced activity from Cu and SS-304 targets on proton bombardment

Presently accelerator facilities emphasizes on generating charged particles with enhanced energy and flux. The radiation protection practices at these facilities are considered in civil engineering designs and strictly implemented through different administrative, access control measures (Sarkar in Radiat Meas 45:1476–1483, 2010). However, concern arises from induced activities, during maintenance and decommissioning stages, when sections of accelerator and shielding materials become highly radioactive. Major contribution of induced activity arises from stainless steel (SS-304) beam enclosures and Cu-dumps. Present work focuses on the generation of induced radioactivity profiles with delay counting of SS-304 and Cu along with instantaneous gamma and neutron dose rate measurements at various proton energies for source term estimation.

The role of radiation protection professionals in the landscape of low dose radiation

Radiation protection professionals benefit from using and applying a robust system of radiological protection that has evolved and matured through decades of research and experience. Nevertheless, uncertainties in potential health effects from low doses and low dose rates of radiation continue to remain. This uncertainty, coupled with complex jargon and nuances, has created an environment where the system of radiological protection can be misrepresented, even by radiation safety professionals, and by extension, misunderstood by the public. While it is universally agreed that the linear-no-threshold model cannot adequately explain or predict health effects of low dose radiation for all cancers, all individuals, or all exposure situations, the recommendation of authoritative scientific bodies to use this model for managing risks of radiation exposure is unequivocal. The role of individual radiation protection professionals in communicating radiation health and risk information is critical and consistent with the primary objective of professional organisations that represent them, mainly to promote best science and practice of radiation protection. If radiation protection professionals provide advice contrary to the recommendations and advice of regulatory and authoritative scientific bodies, it can erode public confidence in the system of radiological protection and harm the credibility of our profession.

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 0.83mSv. 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.

Trends and Distribution Analysis of Occupational Exposure From Medical Practices in China (2010-2016).

Occupational exposure to ionizing radiation from medical practices in China has been collected for a 7 y period between 2010 and 2016 from roughly 220 individual monitoring service providers through the Chinese Registry of Radiation Workers. Statistical dose distributions and characteristic tendencies are presented based on the evaluation in terms of six occupational categories. A reduction can be seen in average annual effective dose for interventional radiology, nuclear medicine, diagnostic radiology, radiotherapy, dental radiology, and others by 52%, 47%, 46%, 34%, 69%, and 31%, respectively, for the 7 y period. More than 94.5% of radiation workers received annual doses less than the public dose limit (1 mSv) in 2016. Workers engaged in nuclear medicine and interventional radiology activities were found to receive relatively more dose than the other fields of practice. Diagnostic radiology makes the dominant contribution of 68% to the collective effective dose of 73,641.3 person mSv received by 211,613 radiation workers in medical practices in 2016. The observation of workers in medical practices receiving well below the recommended occupational dose limit (20 mSv) could be a result of an improvement in radiation protection practices in the medical field in China. However, it is still necessary to control and manage the workplace and radiation workers to avoid unnecessary exposures, in particular for the workers engaged in nuclear medicine and interventional radiology activities.

Knowledge, attitude and practice of nuclear medicine staff towards radiation protection

Introduction: Ionizing radiation in medical imaging is one of the dominant sources of exposure, and correct knowledge of radiation protection, affects staff safety behaviors during procedures. This study aimed to assess the radiation protection Knowledge, Attitude and Practice (KAP) amongst nuclear medicine centers' staff in Iran. Methods: To evaluate the level of radiation protection KAP, a validated questionnaire was distributed between 243 participants considering demographic characteristics in different geographical regions in Iran from 2014 to 2015. Results: There were statistically significant differences in the level of nuclear medicine staff KAP radiation protection with gender (p&lt;0.05), practice age KAP level and radiation protection (p&lt;0.05) among nuclear medicine staff with different working regions and healthcare market. There is no significant connection between educational age and KAP level of radiation protection of nuclear medicine department staff (p&gt;0.05). Conclusion: Our findings have shown that radiation protection KAP level of nuclear medicine staff was inadequate in some regions. This might be due to the lack of continuous training and absence of adequate safety knowledge about ionizing radiation. It seems that awareness about radiation protection rules and regulations, along with continuous training and preparations has a direct effect on radiation practice leading to enhanced KAP of staff in nuclear medicine centers.

Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists.

Fluoroscopy use during ERCP exposes patients and providers to deleterious effects of radiation. Formal training in fluoroscopy/radiation protection is not widely emphasized during therapeutic endoscopy training, and radiation use during GI endoscopy has not previously been characterized in the USA. In this study, we evaluated radiation training, fluoroscopy use patterns, and radiation protection practices among US therapeutic endoscopists. An anonymous electronic survey was distributed to US therapeutic endoscopists, and responses were analyzed using descriptive statistics. State-specific requirements for fluoroscopy utilization were determined from state radiologic health branches. A total of 159 endoscopists (response rate 67.8%) predominantly those working in university hospitals (69.2%) with > 5years of experience performing ERCP (74.9%) completed the questionnaire. Although the majority of endoscopists (61.6%) reported that they personally controlled fluoroscopy during ERCP, most (56.6%) had not received training on operating their fluoroscopy system. Only a minority (18-31%) of all respondents reported consistently utilizing modifiable fluoroscopy system parameters that minimize patient radiation exposure (pulsed fluoroscopy, frame rate modification or collimation). Endoscopists appear to undertake adequate personal radiation protective measures although use of a dosimeter was not consistent in half of respondents. The majority of states (56.8%) do not have any stated requirement for certification of non-radiologist physicians who intend to operate fluoroscopy. Most US gastroenterologists performing ERCP have not received formal training in operating their fluoroscopy system or in minimizing radiation exposure to themselves and to their patients. Such formal training should be included in all therapeutic endoscopy training programs, and fluoroscopy system-specific training should be offered at all hospitals.

Knowledge, Attitude and Practice of Radiation Protection Protocols amongst Students of a Dental College

Objective: To assess the knowledge, attitude and practice of radiation protection among dental students in a dental college in eastern India. Background: Radiation hazard is one of the major challenges of modern dental practices. Reliance on radiation imaging has increased tremendously during recent years. The effect of radiation on human being is very negative. Knowledge and awareness regarding radiation protection during dental training is crucial for ensuring better radiation protection practice after training. Materials and Methods: A cross sectional survey was conducted among 107 dental students comprising of undergraduate students, dental interns and post-graduate students in teaching dental institute in capital city in eastern Indian state. Results: 56% of the participants were aware about the harmful effects of radiation exposure. Only 27% students overall were aware about symbol of radiation hazard. 77% of UG students and 52% of interns were aware about ideal distance to stand during radiography. Overall 88% students which included all PG students, 94% of interns and 77% of UG students were aware about personal protective equipments. Almost all dental students (97%) were using lead apron in designated area for protection from radiation exposure. Overall 82% of students were using the personal protection badge. Conclusion: Based on results of this finding, the overall knowledge, Awareness and Practice regarding radiation protection among dental student was not uniformly good.

Practice of radiation protection in nuclear emergency medicine

Practice of radiation protection in nuclear emergency medicine

Evaluation of the Observance of Radiation Protection Principles in Dentistry Centers in Kermanshah province (West Iran)

Introduction: Radiography plays an important role in the diagnosis of oral and dental disease and one of the most common diagnostic procedures in dentistry. Recent reports have raised concern about the increased use of ionizing radiation in dental imaging and the possibility of cancers. The effective dose of some dental radiographic examinations is high enough, so appropriate protective measures should be taken to reduce the dose of the patient. This study was designed to investigate the principles of radiation protection in dentistry centers. Materials and Methods: This cross-sectional study was design to assess level of radiation protection principles in dentistry centers. The radiology departments of 74 dentistry centers volunteers participated in this study. The data collection tool was a checklist that based on principles of radiation protection, which was used after verifying its content validity. Data were analyzed by SPSS 18 and the results were presented using descriptive statistics including mean and variance for quantitative and frequency variables and percentage for qualitative variables. Results: Based on the findings of this study, 75.7% of the centers were equipped with an intra-oral radiography. Despite observance principles of radiation protection for patient at dentistry center were in appropriate level (97. 3%), the observance of the protective principles was not adequate for the skilled workers in any center. Also, automatic processor for film processing wasn’t used at any of the centers and there was no systematic quality control program for radiographic devices. The most commonly used protective measure was the observance of a minimum distance of 2 meters from the patient (97.3%) during radiation. and the minimum protective measures, the use of high-speed film (1/4%), respectively. Conclusion: According to results in this study, the knowledge and practice of radiation protection are not satisfactory. Therefore, organizing retraining programs, equipped x-ray rooms with protection devices, Periodic monitoring of fully observance of safety regulations in these centers are recommended

342. “MEDIRAD – Implications of Medical Low Dose Radiation Exposure”: A European-funded project aims to enhance the protection of patients and health professionals from exposure to low dose medical radiation

Purpose The use of ionising radiation in medicine has been steadily increasing, and this trend is set to continue, with obvious health benefits for the population thanks to improved diagnostic and therapy technologies.However, this increase in radiation exposure levels also raises a number of safety concerns:the potential health effects among patients and medical workers need to be evaluated, dose evaluation tools for clinical practice need to be developed, and practices need to be optimised in order to reduce exposure doses and ensure adequate radiation protection.A new EC-funded project will bring together medical and radiation scientists, physicists and clinicians to enhance the radiation protection of patients and medical professionals.The four-year MEDIRAD project (2017–2021) is led by the European Institute for Biomedical Imaging Research (EIBIR) and comprises a consortium of 33 partners from 14 European countries. Methods The MEDIRAD Project consists of six interdependent and complimentary work packages (WP), listed in Table. Work Packages Description WP1: Project management and dissemination Scientific and clinical coordination, ethics management, knowledge management and exploitation, internal and external communication WP2: Dose evaluation and optimisation in medical imaging Optimisation of chest CT, interventional procedures and multimodality imaging, and development of imaging and radiation dose biobank WP3: Impact of low dose radiation exposure Standardisation, biokinetic modelling and treatment planning, dosimetry, biomarkers of absorbed doses, protocol for epidemiological study WP4: Possible health impact of paediatric scanning Epidemiological study on cardiovascular changes after radiotherapy, measuring markers of exposure and risk modelling WP5: Breast radiotherapy and secondary cardiovascular risk Epidemiological study of paediatric CTs and cancer, including (epi) genetic biomarkers of sensitivity, dosimetry and statistical analyses WP6: Bringing together medical & nuclear scientific communities Formulation of science-based policy recommendations, consultation of stakeholders, organisation of dissemination seminars Results MEDIRAD has three major operational objectives:to improve organ dose estimation and registration; to evaluate and understand the mechanisms of the effects of medical exposures, focusing on two outcomes of public health relevance:cardiovascular effects of radiotherapy in breast cancer treatment, and cancer risks following CT scanning in children and adolescents; and to develop science-based consensus policy recommendations for the effective protection of patients, workers and the general public.The ISS, due to its long and consolidated experience in the field of Quality Assurance in Radiological Sciences, has been invited to contribute to the latter issue. Conclusions MEDIRAD’s overall goal is to address these needs by enhancing the scientific bases and practice of radiation protection in medicine. MEDIRAD has received funding from the Euratom research and training programme 2014–2018 (grant agreement N°755523). More information can be found at http://www.medirad-project.eu/ .

Occupational doses to cardiologists performing fluoroscopically-guided procedures

Interventional cardiologists (ICs) receive the largest radiation dose of any medical specialist working with X-ray techniques. The aim of present study has been to obtain dose estimates received by ICs during fluoroscopically-guided imaging and interventional procedures. TLDs in the form of badges, rings, and chips have been used, measuring Hp(10) and Hp(0.07) as appropriate. During the course of 41 coronary angiography (CAG) cases, 50 percutaneous coronary intervention (PCI) cases and 9 (CAG + PCI) procedures, cardiologist doses to the skin of the hands, upper neck area and to the eyes were assessed. Two-TLD badges were placed at the level of the Pb-composite collar exterior to the shielding, with a further two placed under and two more over the Pb-composite apron. Four chip-form TLDs were positioned above the eyebrows (two for the right- and two for the left eye), and two ring dosimeters were worn on the left and right hands. Cardiologist doses correlated with total fluoroscopy time over the five month period of the survey, the annual effective doses received by the body, eyes, hands and upper trunk area being estimated to be 8.0-, 10.7-, 24.3- and 10.2 mSv respectively, all well below the ICRP recommended equivalent dose limits, indicating well-controlled radiation protection practices.