Occupational Health and Safety Measures in Radiology Diagnostic Unit

This study aims to assess the awareness of medical professionals related to radiation exposure and Occupational Health Safety Measures in radiology diagnostic unit in the hospital. A descriptive questionnaire survey method was employed in this study. Participants provided detailed information about the demographic details and awareness of the safety use of radiation exposure and equipments.

Healthcare
1

Introduction:
Working in the healthy and safe environment is the fundamental right for workers. As
compared to other workers, healthcare workers are being considered as working in the safe
environment because these are considered as professionals who can take care of their own
health. Occupational health and safety is a provision of safe environment for work. It is the
responsibility of the employer to provide safe environment to employee and to improve
awareness among workers related to hazardous material, equipment and procedures.
Improving awareness of ill effects of radiation procedures among medical workers is helpful
in avoiding illness and injury due to radiation exposures (McLinton et al., 2018). According
to Occupational Health and Safety Act 2004, it is obligation of every employee to report
hazard in the workplace (Toyoda, Kubo, & Mori, 2016). Awareness of hazards is important
for reporting hazards at the workplace. Maximum permissible doses for the radiation
exposure are equivalent to the safe non-radiologic exposures. It is not implication that doses
less than permissible doses are always safe and doses more than the permissible are always
toxic. Hence, most of the radiation exposure techniques does not cross the limit exceeding 30
% of maximum permissible doses to minimize exposure to unnecessary dose. Health workers
need to wear lead aprons or use lead screens for the protection from X-ray rooms. Nurse,
medical student and doctor should not look after the same patient for the longer duration;
those who are getting exposure to radiation on the regular basis (Almost et al., 2018).
In the earlier period, many users of ionizing radiation didn’t realize adverse effects of
ionizing radiation despite its unquestionable application for diagnosis. However, it is evident
form the literature that ionizing radiation are responsible for dermatoses, hematological
disorders, cataract and cancer disease (Nichol et al., 2019; Barbone et al., 2018). Medical
radiation workers associated with interventional fluoroscopy are at higher risk of radiation
exposures as compared to conventional radiation procedures (Linet et al., 2017; Rajaraman et
al., 2016). Interventional cardiology workers are more prone to adverse effects due to
radiation as compared to other interventional medical workers (Andreassi et al., 2016; Klein
et al., 2015). In the recent years, there is increase in the use diagnostic radiation; hence, there
is augmentation in the number of radiation workers. Radiation procedures were being used in
number of medical specialities. It is necessary to give special attention to radiation
procedures with high risk. Comprehensive approach needs to be undertaken to improve
awareness about radiation effects among medical workers. Occurrence of adverse effects due
to ionizing radiation resulted in the promotion of research (Bijwaard et al., 2017). Hence,
2

interview-based study was planned to assess awareness of medical professionals related to
radiation exposure.
Objectives:
To study varied Occupational Health Safety Measures in radiology diagnostic unit in the
hospital.
To assess the awareness about Occupational Health Safety among the medical and diagnostic
professionals in radiology unit.
Materials and methods:
A descriptive questionnaire survey method was employed in this study. Questionnaires were
prepared through following literature survey and experts in the filed were incorporated in
preparation of survey. Following aspects were considered during the preparation of
questionaries’: labour law, policies and regulations related to occupational health and safety
and regulations of employee safety (Kelley-Quon, 2018). Questionnaire was categorised into
part I and part II. Part I comprising of questions related to demographic characteristics like
age, gender, department and designation of the employee. Part II comprising of questions
related to knowledge, attitude and behaviour of medical employees towards radiation
exposure. Survey was conducted between July to December among 150 employees of the
radiology imaging and nuclear medicine centre of Government Hospital. Survey
questionnaires consisted of structured and closed-ended questions and comprises of questions
related to medical professionals and knowledge and skills necessary for carrying out radiation
procedures and basic principles for radiation protection. Questionnaires were designed to
assess the awareness of the Occupational Health Safety of medical professionals working
with the radiation exposure (Bentley and Levine, 2016; Yurt, Berrin & Türkan, 2014;
Szarmach et al., 2015). Purposive sampling technique was employed for the recruitment of
the participants. The objective of survey questions was to identify the knowledge of the
medical employees about the specific topics of radiation protection and maximum achievable
limits of doses of ionizing radiation. Questions related to other aspects like total number of
years of experience in the ionizing radiation procedures, frequency of working with radiation
procedures, position holding while handling radiation exposure and department were also
included.
Data was collected by the senior researcher who received extensive training in the qualitative
research methods. Interviews were lasted for approximately 45 – 60 minutes. Filed notes
were recorded during the interview process and entire interview process was audio recorded.
3

Data analysis:
Audio recorded interviews were transcribed verbatim and transcripts were incorporated into
NVIVO 10 (qualitative software data programme). It helped in storing, organising and
analysis the collected data. Grounded theory approach was employed for the analysis of the
data. Coding was done by the experienced researcher independent of the study. Collected
data was subjected to analysis using the Microsoft Excel 2007 spreadsheet and the Statistica
8.5 software package (Szarmach et al., 2015).
Questionnaire:
What is your name and age ?
What is your profession? – Physician, Nurse, X-ray diagnostic technician.
Which department you work at ? – Radiology, oncology, emergency, anaesthesiology,
surgery
What is duration of your total service ? - less than 2 year, 2-5 years, 6-10 years, 11-20 years
and more than 21 years.
What is your frequency for radiation exposure ? None, few times in a day, few times week,
few times a month.
Do you think X- radiation causes dermatoses, hematological disorders, cataract and cancer
disease ? – No opinion, yes, no.
Which radiation protection measures your are aware of ? – none, lead aprons, safe distance
from radiation, time of exposure
Are you aware of maximal tolerated dose of radiation exposure ? - none, yes, no.
Are you aware of radiation safety manual ? – none, yes, no.
Are you aware of radiation warning signs posted at the entrance ? none, yes, no.
Are you aware of state policies and regulations for protection against radiation safety ? none,
yes, no.
Have you participated in the radiation safety programme ? – none, yes, no.
4

Are you aware of the radiation safety committee in the hospital ? - none, yes, no.
Are you ware of standard operating procedures (SOPs) for handling radiation equipments ? –
none, yes, no.
Results:
Table 1: Demographic data about the medical professionals.
Age
21 - 30 67
31 - 40 40
41 - 50 21
˂ 50 22
Department
Radiology 52
Oncology 45
Emergency 21
Anaesthesiology 22
Surgery 10
Profession
Physician 60
Nurse 20
X-ray diagnostic
technician 70
Service
duration
Less than 2 year 50
2-5 years 47
6-10 years 23
11-20 years 20
More than 21 years 10
Frequency of
exposure
None 10
Few times in a day 12
Few times week 75
Few times a month 53
5

Radiation
protection
measure
None 6
Lead aprons 139
Safe distance from
radiation 135
Time of exposure 142
Table 2: Awareness of medical professionals about radiation exposure.
Yes No
Are you aware of maximal tolerated dose of radiation exposure 102 48
Are you aware of radiation safety
manual 126 24
Are you aware of radiation warning signs posted at the entrance 131 19
Are you aware of state policies and regulations for protection against radiation
safety 101 49
Have you participated in the radiation safety programme 105 45
Are you aware of the radiation safety committee in the
hospital 131 19
Are you aware of standard operating procedures (SOPs) for handling radiation equipments 135 15
All the 150 participants completed interview process. Demographic characteristics of the
participants are presented in the table number 1. Age of the participants ranged from 21 - 58
years. Maximum number of participants ranged from 21 – 30 years were 67 participants.
Number of participants between age group 31 – 40, 41 – 50 and ˂50 years were 40, 21 and 22
respectively. Mean age was 39.26 years with standard deviation was 10.88. Maximum
number of participants (52) were from the radiology department. Medical professionals from
oncology, emergency, anaesthesiology and surgery departments were 45, 21, 22 and 10 in
numbers respectively. It is necessary for the physicians and X-ray diagnostic technicians to
work for the longer duration and more frequency with radiation exposure. Hence, out of 150
participants; 60 and 70 were physicians and X-ray diagnostic technicians respectively. It was
observed that 20 nurse professionals were participated in the study. Experience or service
duration of the participants was categorised in five durations. Participants with experience
less than 2 years and between 2 – 5 years were 50 and 47 respectively. Approximately 65 %
of the participants were with experience less than 5 years. Out of remaining 35 %
participants, 23, 20 and 10 were between 6 – 10 years, 11 – 20 years and more than 21 years
6

respectively. Approximately, 85 % participants get exposed to radiation. Maximum number
of participants (75) get exposed to radiation few times a week. While 53 participants get
exposed to radiation few times in a month. Few participants like 12 and 10 get exposed to
radiation few times in a day and not exposed to radiation respectively. Participants were
assessed for the awareness of the radiation protection measures. Almost all the participants
except 6 participants were not aware of the radiation protection measures. It was evident that
139, 135 and 142 participants were aware of radiation safety measures like lead aprons, safe
distance from the radiation and time of exposure respectively.
Participants were enquired about the maximal tolerated dose of radiation exposure. It was
observed that 102 and 48 participants were aware of and not aware of maximum tolerated
dose respectively. It was evident that 126 and 24 participants were ware of and not aware of
radiation safety manual respectively. Participants were queried for the awareness of radiation
warning signs posted at the entrance and it was apparent that 131 and 19 participants were
aware of and not aware of radiation warning signs posted at the entrance respectively. 101
and 49 were aware of and not aware of respectively for state policies and regulations for
protection against radiation safety. Participation in the radiation safety programme indicates
awareness of safety aspects of radiation exposure. Survey demonstrated that 105 and 45
participants were aware of and not aware of radiation safety programme respectively.
Radiation safety committee in the hospital helps in improving awareness of the medial staff
about the radiation exposure. Participants were well aware of the radiation safety committee
in the hospital. 131 and 19 participants were aware and not aware of the it respectively. Safe
handling of the radiation equipments is necessary to prevent damage due to radiation
equipment. Medical professionals need to refer SOPs for safe handling of equipments. Hence,
these professionals should be aware of SOPs. Participants stated that 135 and 15 participants
were aware and not aware of the SOPs respectively.
Discussion:
Safety of medical professionals working with ionizing radiation is of prime importance.
Hence, medical staff working with ionizing radiation should be aware of safety measures of
radiation exposure. Augmented use of ionizing radiation in the clinical practice prompted to
improve the awareness of medical professionals about ionizing radiation (De Sio et al., 2016;
Zanzonico, 2019). In this study, medical professionals with frequent contact with the ionizing
radiation were incorporated. Moreover, medical professionals with diverse traits in terms of
7

length of experience, department and profession were incorporated in this study. It helped in
comparing the awareness among these diverse groups. Excellent knowledge of the medical
professionals in the radiology department is not astounding; since, it is their speciality
department. Moreover, medical professionals of the emergency department are also having
good knowledge because their frequent use of radiation procedures. Frequent use of radiation
procedures is helpful in better understanding of procedures and augmenting awareness
(Younger, Douglas & Warren-Forward, 2018). Surprising results were obtained from the
oncology department. Most of the medical professionals of the oncology department should
use ionizing radiation for both diagnostic and therapeutic purpose. However, awareness
among the medical professionals of the oncology department is low.
Another interesting result obtained in this study that nurses are with low level of awareness
about ionizing radiation. Previous study carried out by Alotaibi et al., (2006) reported that
nurses are not fully aware of the protection measures and risks of radiation. Nurse should
have high level of awareness because they encounter frequent handling of ionizing radiation.
However, nurses mentioned that they are concerned about the radiation and they wish to
acquire more knowledge about the diagnostic radiation. Results obtained in this study
provided thought-provoking information about knowledge of medical professionals about
ionizing radiation. Participants provided detailed information about the demographic details
and awareness of the safety use of radiation exposure and equipments. It helped in the
detailed exploration of the practices followed by medical professionals in radiation
equipments. Awareness about the health effects of radiation exposure would be helpful in
improving attention of participants to augument awareness of safe use of radiation
equipments (Infantino et al., 2017).
This study collected comprehensive information related to the awareness of radiation
exposure; hence, this study would be helpful in addition of evidence about occupational
exposure of radiation in the medical professionals. This study is also helpful in exploring the
work-related factors and radiation status in the medical professionals. This study assessed
awareness of occupational health safety measures in different aspects like general safety
measures, personal safety measures, equipment safety measures, organisational safety
measures and process safety measures.
Results indicated that medical professionals exhibited varied experience about awareness of
the radiation exposure. Participants exhibited adequate awareness about radiation safety
8

manual, radiation warning signs posted at the entrance, radiation safety committee in the
hospital and SOPs. Participants exhibited inadequate awareness about maximum tolerated
dose of radiation exposure, state policies and regulations for protection against radiation
safety and radiation safety programme. Previous studies also demonstrated similar trend of
results in relation to inadequate knowledge for maximum tolerated dose for radiation dose.
Zhou, Wong, Nguyen, & Mendelson, (2010) and Aslanoglu et al. (2007) reported insufficient
knowledge for maximum tolerated dose for radiation dose. It was also evident that variability
in lack of awareness among individuals. Educational level was one of the most significant
factors responsible for the individual variability in the lack of awareness (Hobbs et al., 2018).
Medical professionals with higher educational level were with higher level of awareness in
comparison to the lower educational level. It was also evident that young medical
professionals (20 – 30 yrs age) and with more experience (˂ 50 age) were with more
awareness in comparison to the other medical professionals. One of the noteworthy
observations from this study was no variability in awareness among genders. Training and
education were also important factors responsible for the lack of awareness among the
medical professionals (Hobbs et al., 2018).
Medical professionals exhibited lack of awareness who didn’t receive proper training and
education related to use of radiation equipments. Hence, hospital needs to establish dedicated
training and education unit to improve awareness of radiation exposure. Persistent training
and periodic refresher courses are helpful in improving awareness of medical professionals. It
was evident that radiation department was well established in the hospital. However, safety
directives were not available and regular workplace radiation monitoring was not performed.
It might also lead to lack of awareness among medical professionals. Interviews indicated
that warning signs related to radiation exposure and SOPs to use radiation exposure were
according to the international radiation protection regulation. Most of the participants were
not aware of the ill effects of the radiation exposure. It might be one of the significant reasons
for the lack of awareness of aspects related radiation exposure. Knowledge about the health
effects of the radiation exposure would have been helpful in improving enthusiasm of the
medical professionals to acquire more knowledge about radiation exposure. Hence, hospital
should arrange regular health check-up for the medical professionals working with radiation.
It could be helpful in health effects of radiation on medical professionals (Almost et al.,
2018).
9

Lack of knowledge about the radiation exposure indicates medical professionals are not able
to protect themselves and patients from the harmful effects of radiation exposure. Standard
courses for education and training of the radiation exposure need to be developed and
implemented. These courses need to be made mandatory in the curriculum of the medical
professionals (Hobbs et al., 2018). In this study also, it is evident that education and training
are beneficial in improving awareness about the awareness about the radiation exposure. In
the current study, physicians and radiology professionals demonstrated more knowledge
about radiation because courses on radiation are included in their curricula. Improved
education planning with incorporation of radiology courses would be helpful in improving
awareness of all healthcare professionals about radiation exposure (McLinton et al., 2018)
Conclusion:
Study was conducted to understand the Occupational Health Safety of radiation exposure. In
this study, it was observed that medical professionals were not fully aware of the
Occupational Health Safety measures of radiation exposure. It was evident that a greater
number of medical professionals were aware of different aspects of radiation exposure like
radiation safety manual, radiation warning signs posted at the entrance, availability of
radiation safety committee in the hospital and SOPs for handling radiation equipments.
However, a smaller number of participants were aware of the different aspects of radiation
exposure like maximal tolerated dose of radiation exposure, state policies and regulations for
protection against radiation safety and radiation safety programme. Young medical
professionals and medical professionals with more experience were more aware of
Occupational Heath Safety aspects of radiation exposure. Medical professionals form the
radiology and oncology department were more aware of the Occupational Health Safety
aspects of radiation exposure. More number of nurses should be aware of the Occupational
Health Safety aspects of the radiation exposure; however, it was observed that most of the
nurses were not aware of it. Even though, few of the medical professionals were aware of the
radiation exposure; these, professionals need to update this information through continuing
education and trainings.
10

References:
Almost, J.M., VanDenKerkhof, E.G., Strahlendorf, P., Caicco Tett, L., Noonan, J., Hayes, T.,
…… Silva E Silva V. (2018). A study of leading indicators for occupational health
and safety management systems in healthcare. BMC Health Services Research,
18(1):296. doi: 10.1186/s12913-018-3103-0.
Alotaibi, M., & Saeed, R. (2006). Radiology nurses’ awareness of radiation. Journal of
Radiology Nursing, 25, 7-12.
Andreassi, M.G., Piccaluga, E., Guagliumi, G., Del Greco, M., Gaita, F., & Picano, E. (2016)
Occupational health risks in cardiac catheterization laboratory workers. Circulation:
Cardiovascular Interventions, 9:e003273. DOI:
10.1161/CIRCINTERVENTIONS.115.003273
Arslanoğlu, A., Bilgin, S., Kubalı, Z., Ceyhan, M.N., İlhan, M.N., & Maral, I. (2007).
Doctors’ and intern doctors’ knowledge about patients’ ionizing radiation exposure
doses during common radiological examinations. Diagnostic and Interventional
Radiology, 13, 53-55.
Barbone, F., Barbiero, F., Belvedere, O., Rosolen, V., Giangreco, M., Zanin, T.,……. Fasola
G. (2018). Impact of low-dose computed tomography screening on lung cancer
mortality among asbestos-exposed workers. International Journal of Epidemiology,
47(6), 1981-1991.
Bentley, M.A., & Levine, R. (2016). A National Assessment of the Health and Safety of
Emergency Medical Services Professionals. Prehospital and Disaster Medicine,
31(S1), S96-S104.
Bijwaard, H., de Vries, G., Scheurleer, J., Roding, T., Erenstein, H., Ravensbergen, W.,
….van Welie F. (2017). Compliance to Diagnostic Reference Levels for radiation
exposure in common radiological procedures in Dutch hospitals: A nation-wide
survey carried out by medical imaging students. Radiography, 23(3), 197-201.
De Sio, S., Mandolesi, D., Colasanti, V., Goglia, C., Cuzzola, S., Di Traglia, M.,..Greco, E.
(2016). Ionizing radiation and stress: the analysis of the medical ray technician.
Clinical Therapeutics, 167(5), e137-e141.
Hobbs, J.B., Goldstein, N., Lind, K.E., Elder, D., Dodd, G.D., & Borgstede, J.P. (2018).
Physician Knowledge of Radiation Exposure and Risk in Medical Imaging. Journal
of the American College of Radiology, 15(1 Pt A), 34-43.
Infantino, A., Cicoria, G., Lucconi, G., Pancaldi, D., Vichi, S., Zagni, F., ….Marengo, M.
(2017). Radiation Protection Studies for Medical Particle Accelerators using Fluka
Monte Carlo Code. Radiation Protection Dosimetry, 173(1-3), 185-191.
Kelley-Quon, L.I. (2018). Surveys: Merging qualitative and quantitative research methods.
Seminars in Pediatric Surgery, 27(6), 361-366.
Klein, L.W., Tra, Y., Garratt, K.N., Powell, W., Lopez-Cruz, G., Chambers, C., … Goldstein,
J.A. (2015). Occupational health hazards of interventional cardiologists in the current
11

decade: Results of the 2014 SCAI membership survey. Catheterization and
Cardiovascular Interventions, 86, 913–24.
Linet, M.S., Kitahara, C.M., Ntowe, E., Kleinerman, R.A., Gilbert, E.S., Naito, N., …Miller
D.L. (2017). Berrington de Gonzalez A. Mortality in US physicians likely to perform
fluoroscopy-guided interventional procedures compared with psychiatrists, 1979 to
2008. Radiology, 284, 482–94.
Nichol, K., Copes, R., Kersey, K., Eriksson, J., & Holness, D.L. (2019). Screening for hand
dermatitis in healthcare workers: Comparing workplace screening with dermatologist
photo screening. Contact Dermatitis, 24. doi: 10.1111/cod.13231.
McLinton, S.S., Loh, M.Y., Dollard, M.F., Tuckey, M.M.R., Idris, M.A.,…Morton, S.
(2018). Benchmarking working conditions for health and safety in the frontline
healthcare industry: Perspectives from Australia and Malaysia. Journal of Advanced
Nursing, doi: 10.1111/jan.13580.
Rajaraman, P., Doody, M.M., Yu, C.L., Preston, D.L., Miller, J.S., Sigurdson, A.J.,…. Linet
MS. (2016). Cancer risks in US radiologic technologists working with
fluoroscopically guided interventional procedures, 1994-2008. American Journal of
Roentgenology, 206, 1101–9.
Szarmach, A., Piskunowicz, M., Świętoń, D., Muc, A., Mockałło, G., Dzierżanowski, J.,…
Szurowska, E. (2015). Radiation safety awareness among medical staff. Polish
Journal of Radiology, 80, 57-61.
Toyoda, H., Kubo, T., & Mori, K. (2016). Occupational Safety and Health System for
Workers Engaged in Emergency Response Operations in the USA. Sangyo Eiseigaku
Zasshi, 58(6), 260-270.
Younger, C.W.E., Douglas, C., & Warren-Forward, H. (2018). Ionising radiation risk
disclosure: When should radiographers assume a duty to inform? Radiography, 24(2),
146-150.
Yurt, A., Berrin, Ç., & Türkan, G. (2014). Evaluation of Awareness on Radiation Protection
and Knowledge About Radiological Examinations in Healthcare Professionals Who
Use Ionized Radiation at Work. Molecular Imaging and Radionuclide Therapy, 23(2),
48-53.
Zanzonico, P.B. (2019). Benefits and Risks in Medical Imaging. Health Physics, 116(2), 135-
137.
Zhou, G.Z., Wong, D.D., Nguyen, L.K., & Mendelson, R.M. (2010). Student and intern
awareness of ionizing radiation exposure from common diagnostic imaging
procedures. Journal of Medical Imaging and Radiation Oncology, 54, 17-23.
12