Knowledge and practice of radiation safety among radiographers in the radiology department in Pune, India

Abstract

Background

Knowledge of radiation safety and practices among radiographers working in the radiology department of a tertiary care hospital is crucial for ensuring patient and staff safety. This research aims to evaluate radiographers' understanding and adherence to radiation safety protocols, thereby identifying areas for improvement and promoting a culture of safety within the department. This prospective cross-sectional survey of 90 participants assesses radiation safety knowledge among radiographers in Pune's radiology departments. A convenience sampling technique was used as the professionals were working at tertiary care hospitals in Pune. Data collection via a Google Form questionnaire ensures confidentiality and informed consent. SPSS software was used to analyze the data. Pearson correlation analysis was used to compare the relationships between research variables.

Results

Out of the total of 90 participants, 65 were male and 25 were female, showing an overall 55.71% level of knowledge. There is statistical significance of knowledge score by year of experience and qualification. According to years of experience, the level of knowledge of zero to four years is high whereas taking academic qualification, the level of knowledge of diploma graduates was inadequate.

Conclusions

Our study reveals that the collective knowledge level of all participants is average. Participants with 0–4 years of experience demonstrated higher knowledge levels, indicating that both novices and veterans in the radiography profession could benefit from enhanced understanding. Development of tailored continuous education modules emphasizing radiation safety protocols for diploma graduates and experienced professionals with knowledge gaps is needed.

Background

The term "radiation safety" describes the procedures and policies to shield people from the damaging effects of ionizing radiation. For radiographers working in radiology departments, radiation safety is a critical component [1]. According to current data, 3.6 billion imaging examinations are performed annually globally, increasing the effective radiation dosage by 70% [2]. It is imperative for healthcare professionals working with ionizing radiation to possess knowledge updates on the risks associated with radiation exposure. Radiographers are critical in capturing high-quality diagnostic images, assisting in interventional procedures, and delivering radiation therapy. Still, their constant exposure to ionizing radiation requires a thorough understanding of radiation safety principles and practices [3]. The ALARA principle is a fundamental concept in radiation safety; radiographers are responsible for taking practical measures to safeguard patients and other healthcare workers from unnecessary radiation exposure. It is crucial to prioritize patient protection by avoiding the excessive exposure of sensitive areas such as the gonads, thyroid, bone marrow, breasts, lungs, stomach, colon, and eyes to the primary radiation beam [3]. The use of shielding, when applicable, along with essential tools such as collimation, cones, and filters, helps to minimize tissue irradiation and reduce scatter radiation [4]. Furthermore, using immobilization devices such as sponges, sandbags, and compression bands is essential to ensure patient comfort and minimize the need for image repetition. Selecting appropriate exposure parameters, including short exposure times, geometric factors, source-to-image distance (SID), focal spot size, and tube filtration, is vital to prevent movement dullness and image blurring while providing high-quality diagnostic information. These measures support the implementation of the ALARA (as low as reasonably achievable) principle in radiation safety [3, 4]. Radiation safety is of paramount importance to both radiographers as well as patients [5].

However, understanding radiographers' safety practices and knowledge is critical for appropriate management in the radiography unit. The knowledge and practice of radiation safety among radiographers can vary, making it essential to evaluate the current knowledge and adherence to radiation safety practices within the radiology department [6]. A key component of radiation safety is proper training and education for staff, adherence to strict protocols and guidelines for using radiation equipment, monitoring radiation doses, and implementing safety measures to limit unnecessary exposure [7]. The primary responsibility of radiology experts, including doctors and technologists, is to decide whether to execute operations. However, referring physicians should also know the risks associated with radiological procedures because they are the ones who refer patients for radiological tests [8]. However, a few such studies have been done in India, regarding their awareness, knowledge, and practices in radiation safety. Given the high volume of patients requiring x-rays, CT, and mammography in India, there are prevailing concerns about unnecessary exposure of patients and radiographers due to radiographer’s lack of understanding of radiation safety [9, 10]. This lack of understanding potentially leads to poor radiation safety practice at standalone radiology centers/departments at hospitals [11]. The primary objective of this study is to evaluate the knowledge and practices related to radiation safety among radiographers working in the radiology department. The secondary objective aims to investigate potential differences in radiation safety knowledge and practices among radiographers based on their years of experience. Therefore, this study reveals radiographers' knowledge, awareness, and practices in radiation protocols.

Methods

A questionnaire survey was conducted to gather knowledge of radiation safety among radiographers. The survey included demographic characteristics (age, gender, academic qualification, and work experience) and multiple choice questions (MCQ) about radiation safety. The questionnaire consisted of nineteen questions. Five questions were related to demographic information regarding age, gender, academic qualification, and work experience. The remaining 14 multiple choice questions (MCQ) measured the level of knowledge and practice of radiation safety. Experts in the field conducted content validity and reliability of questions. The study design for this research is a prospective cross-sectional survey conducted in the radiology departments of hospitals and diagnostic centers in Pune. A convenience sampling technique was implemented, as the radiographers were working at tertiary care hospitals in Pune. The inclusion criteria for the study are the radiographers currently working in these facilities and have completed their education and training in radiography. Radiographers who are not directly involved in patient care in the radiology department will be excluded from the study. The sample size for the survey is 90, which is a true representation of the total radiographers working in the Pune region. The data collection was done online using a Google Form questionnaire. Informed consent was obtained from all participants. Confidentiality was maintained throughout the study. Data analysis was through SPSS software version 23. Pearson correlation analysis was used.

Results

In the depicted data, male participants constitute a majority at 72% (65 individuals), while females represent a minority at 28% (25 individuals) out of a total sample size of 90 participants as shown in Fig. 1. Out of 90, we included 30 participants of Diploma in Radiology, 30 participants of B.Sc. in Radiology, and 30 participants of M.Sc. in Radiology.

Fig.1

Gender details of the participants

Our investigation reveals in Fig. 2 that among the 90 participants, a small proportion of 21% (19 individuals) demonstrated low levels of knowledge. In comparison, an average level of understanding was observed in 33% (30 Participants). Additionally, 46% (41 individuals) exhibited a high level of expertise. These participants had diverse educational backgrounds, including bachelor's degrees, diplomas, and postgraduate degrees.

Fig.2

Total scoring grades of the participants

The collective knowledge level of all 90 participants stands at 55.71%. Despite individuals with varying educational backgrounds, the majority exhibit at least an average level of knowledge, with a significant proportion displaying high level knowledge.

Correlation analysis revealed a highly significant difference between qualification and scores, years of experience and scores (r = − 0.220 & P = 0.000). When categorized into three groups based on their qualification, participants who had a Diploma in Radiology demonstrated 23% knowledge, participants who had a B.Sc. in Radiology demonstrated 32% knowledge, participants who did an M.Sc. in Radiology demonstrated a higher level of knowledge 45% (Fig. 3).

Fig.3

Based on qualification participation total scores

Table 1 shows that based on experience levels, participants with zero to four years of experience demonstrate a higher level of knowledge 45%, participants ranging between five to nine years of experience demonstrate 33% knowledge whereas participants ranging between ten to fourteen years of experience demonstrate low level of knowledge 22%.

Table 1 Age-wise participation total scores

Many respondents displayed varying levels of understanding and knowledge regarding radiation safety practices during radiation procedures. While 77.66% (69 P) accurately identified the appropriate personal protective equipment (PPE), only 39% (35 P) correctly identified the maximum permissible dose for occupational exposure. Non-stochastic effects were understood by 34.44% (31 P) of respondents, properly used personal radiation monitoring devices by 73.33% (66 P), and only 28% (25 P) demonstrated comprehension of the "distance principle" in ALARA. However, a high percentage 95.55% (86 P) correctly identified the most effective shielding material for patient protection. Regarding staff protection, 45.55% (41 P) correctly identified the best location to minimize exposure to scattered radiation. Notably, 64% (58 P) accurately identified major factors in consent forms for contrast procedures and 68% (61 P) correctly identified the full form of AERB, whereas 23% (21 P) correctly identified when CT calibration is performed, a high percentage 89% (80 P) correctly identified how to place lead apron and proper patient identification 49% (44 P) of respondents. About 32.22% (29 P) acknowledged the role of continuous quality improvement (CQI) in radiation safety. 52.22% (47) acknowledged the benefits of advancements in radiation safety guidelines (Table 2).

Table 2 Questionnaire correct answer and correct responses percentage

Overall, our study underscores the importance of ongoing education and training initiatives to enhance radiographers awareness and understanding of radiation safety. By identifying areas of strength and opportunities for improvement, our findings can inform the development of tailored educational interventions to optimize radiation safety practices within the radiography profession.

Discussion

In this cross-sectional survey-based study, we evaluated the awareness levels among radiographers regarding radiation safety through measures of knowledge assessment. A total of 90 radiographers participated in the study, comprising 65 males (72%) and 25 females (28%), as illustrated in Fig. 1. Our findings indicate that a small proportion, comprising 21% (19 individuals) of the total participants, needed to improve their levels of knowledge. Conversely, 33% (30 participants) demonstrated average knowledge, while 46% (41 individuals) exhibited good knowledge. It is worth noting a comparative study by Rania Mohammed Ahmed et al. reported that 41.30% of respondents exhibited good knowledge, with 58.7% displaying poor knowledge [12]. Furthermore, our study observed that participants with zero to four years of experience exhibited good knowledge levels compared to other experience groups. This contrasts with a study by Abdul Saeed Shah et al., where individuals with 16 to 20 years of experience showed higher knowledge levels compared to other experience groups [13]. Our study found that diploma graduates have a low knowledge level of 23% regarding radiation protection, indicating a significant lack of awareness. There is a substantial need to improve their understanding of radiation protection issues through targeted education and training. Similarly, a study done by Maharjan et al. shows the knowledge level regarding radiation protection among diploma graduates was 7.76, equating to 55.42% [14].

Our research contributes to the understanding of knowledge levels among radiographers regarding radiation safety. The distribution of participants based on gender and educational qualifications provides insights into the demographic characteristics of the sample population. Identifying low, average, and good knowledge levels highlights the spectrum of awareness among radiographers, emphasizing the need for targeted interventions to address knowledge gaps. Moreover, the comparison with previous studies underscores the dynamic nature of knowledge levels within the field, influenced by factors such as study population, methodologies, and contextual differences. Observing that participants with zero to four years of experience exhibit good knowledge levels suggests a potential association between experience duration and knowledge acquisition. However, further research is warranted to explore this relationship in depth. The study has certain limitations; the data collected from Google Forms must be more balanced. Data analysis using statistical tests is complex, leading to issues in reliability and generalizability. The study does not have an equal number of male and female participants. The sample size for the study is small; a more extensive study needs to be conducted to identify trends and better statistical analysis.

Limitations

Small sample size restricted to a single location (Pune City); therefore, the generalizability of the findings may be compromised. Further studies should focus on a larger sample size, sampled from many regions in India. Due to convenience sampling, the results could be biased, and therefore, further studies should consider the use of random sampling techniques among the radiographer population.

Conclusions

Our study reveals that the collective knowledge level of all 90 participants averages 55.7, with significant gaps based on experience and education. Participants with 0 to 4 years of experience demonstrated higher knowledge levels, indicating that both novices and veterans in the radiography profession could benefit from enhanced understanding. Development of tailored continuous education modules emphasizing radiation safety protocols for diploma graduates and experienced professionals with knowledge gaps is needed. Use of simulation-based learning, interactive tools to enhance understanding, and application of radiation safety principles is essential.