The Level of Knowledge About Radiation Safety and the Frequency of the Use of Protective Equipment Among Healthcare workers Exposed to Radiation in Different Units

Introduction

Methods

Results

Table 1: Demographic and occupational data

The healthcare workers were also asked about whether they knew the legal working hours per month; it was found that 84.9% knew about their rights, 10.6% did not know, and 4.5% were not sure. Of the participants, 90.1% had a dosimeter. There was no significant difference between the occupational categories in terms of having a dosimeter. However, 40.6% of the nurses/physician"s assistants and only 11.5% of the personnel working with fluoroscopy had a dosimeter. Of those who had a dosimeter, 71.3% wear it daily but 6.3% never wear it. Only 20.3% of the personnel trusted the dosimeter readings (Table 2).

Table 2: Use of and trust in dosimeters

Of the participants, 86.2% stated that they had received training about the health hazards of radiation. In line with this, when asked about the health hazards of radiation, 61.2% were aware of the acute symptoms, such as nausea and vomiting; 90.5% were aware of skin disorders; 80.1% were aware of cataract; 64.1% were aware of bone marrow suppression; 77.4% were aware of infertility; 72.7% were aware of congenital malformations; 93.2% were aware of secondary cancers; and 67.7% were aware of radiation-related death. Likewise, when asked about the sensitivity of organs to radiation damage, 91.4% indicated that reproductive organs are susceptible, 42.7% indicated that nerve tissue is resistant, 85.3% indicated that the eye lens is sensitive, 59.8% indicated that muscular tissue is resistant, and 31.2% indicated that the spleen is sensitive.

The participants were also asked about what types of personal protective equipment were available in their departments. The most and least commonly available gears were lead aprons (88.3%) and lead gloves (22.1%), respectively. Thyroid protectors were available in 79.7% of the departments; however, 7.7% of the personnel working with fluoroscopy were not aware of its presence.

The frequency of the use of these protective gears was as follows: lead shield, 50.6%; lead aprons, 39.7%; thyroid protector, 36.6%; protective goggles, 5.2%; and lead gloves, 2.9%.

In a comparison of the personnel working in the cardiology unit with those working in nuclear medicine and fluoroscopy units, where there is direct exposure to radiation, all of the former used thyroid protectors and lead aprons, whereas 34.1% and 22.7% of the latter did not use these equipment, respectively. The difference was statistically significant (p<0.01). The use of safety goggles, lead shields, and lead gloves was more frequent among the medicine and fluoroscopy unit, but the difference was not statistically significant (Table 4).

Table 3: Availability of protective equipment by departments

Table 4: Usage of personal protective equipment by departments

Among the personnel working in the cardiology unit or with fluoroscopy, there was no significant relationship between the use of lead aprons or protective goggles and gender, marital status, age, occupation, years of exposure to radiation, or training on health effects of radiation. Thyroid protector use was found operatto be significantly higher among males than females (p<0.05). However, there was no relationship between thyroid protector use and other variables.

Of the participants, 80.1% stated that they knew, 16.5% that they partly knew, and 3.4% that they did not know when to use personal protective equipment. Similarly, 80.6% stated that they knew, 15.8% that they partly knew, and 3.4% that they did not know how to use protective equipment. Additionally, 20.8% believed, 73.4% partially believed, and 5.9% did not believe in the protective function of such equipment.

Most of the participants learned how to protect themselves from radiation at their school of higher education (91.6%), followed by in-service training and self-teaching (41.5%), colleagues (33%), and workshops organized by Turkish Atomic Energy Authority (TAEK), professional associations, or companies (14.9%).

The participants were also asked about why they do not use protective equipment; 80.4% cited restriction of mobility, 61.6% physical discomfort, 26.4% disbelief in the adequacy of equipment"s protective function, 23.7% poor material quality among other reasons, whereas 10.8% did not believe in the necessity of such equipment for the work done, and 10.4% were not given protective equipment.

Discussion

Depending on the dose and duration, exposure to radiation can cause cellular and chromosomal damage and associated cancers in the skin, thyroid, bone marrow, eye, and gonads. Healthcare workers working with ionizing radiations are regularly and continuously exposed to such radiation. As such, the chronic effects of radiation can be a risk for healthcare workers.[]

Some tissues and cells are more susceptible to radiation due to their structure and intrinsic properties. Therefore, additional protective equipment is used for susceptible organs or body parts, such as the thyroid, eyes, and gonads. Knowledge of the radiosensitive organs is important for healthcare workers to protect themselves. We found that the participants" knowledge of radiosensitive/radioresistant organs did not significantly change based on the department they work in. However, it is noteworthy that those working with fluoroscopy had less knowledge about the subject.

The use of personal dosimeters by healthcare workers exposed to radiation is required by law.[] Despite the law, 9.9% of the participants did not have a dosimeter. The lower rate of dosimeter ownership among the nurses/physician"s assistants and staff working with fluoroscopy was because the staff working in the operattoing room was largely composed of nurses. Having a low confidence in the dosimeter readings may be one of the most important factors affecting its use. The dosimeter"s sensitivity to the levels of radiation in the working environment is important in this low confidence. Film dosimeters cannot detect low-dose radiation.[] Recently, thermoluminescence dosimeters have been introduced to overcome this problem.

In previous studies, it has been shown that each part of the body is exposed to radiation at different levels depending on the type of radiation, and the necessity of using the right protective equipment was emphasized.[] Several measures have been reported to protect against the harmful effects of ionizing radiation. Equipment such as lead goggles, thyroid protectors, lead aprons, etc., is very important in preventing radiation exposure, particularly in fluoroscopic examinations where workers are exposed to direct radiation. [] In our study, although most of the departments/ units studied were found to have lead aprons, thyroid protectors, and lead shields, they were mostly found to lack lead goggles, lead gloves, and gonadal shields.

The most commonly used protective equipment was lead shields, and the least commonly used was lead gloves. The more common use of the lead shield was because most of the participants were radiology workers, among whom the technicians constituted a very high proportion.

Several studies have shown that wearing lead aprons is an important method of protection from radiation. [] A lead sheet of 0.5-mm thickness was reported to reduce radiation exposure by 97%?99%.[] In our study, the use of lead aprons was found to be significantly higher in personnel working in the cardiology department and those working with fluoroscopy.

Dawson and Punwani indicated that the thyroid is the most critical organ in terms of radiation damage and that radiation is one of the well-known causes of thyroid cancers.[] In one study, the incidence of thyroid cancer among healthcare workers was found to be higher than that among the general population.[] Faulkner et al. reported that the use of lead goggles and thyroid shields significantly reduces eye and thyroid problems due to radiation exposure.[] In our study, the rate of thyroid protector use was 100% in the cardiology department. However, it was 53.8% among the personnel working with fluoroscopy, which was found to be due to the absence of thyroid protector equipment in some of the operating rooms using fluoroscopy. Despite the fact that thyroid protectors are mostly available in radiology units, the low rate of their use might be because the frequency of fluoroscopic procedures in radiology units is less.

In a study comparing groups of physicians in various branches who were and were not exposed to occupational ionizing radiation, Auvinen et al. found that physicians who were exposed to ionizing radiation lost more of their eye lens"s transparency.[] Similarly, Hammer et al.[] reported that cataracts were more common among physicians who performed fluoroscopic examinations and were exposed to ionizing radiation for a long time and that there was no threshold dose for cataract formation. The use of lead goggles was very low in all departments/units in our study, which was considered to be due to the absence of lead goggles or the lack of using habits.

The hands of healthcare workers who conduct interventional work are directly exposed to X-rays. Singer reported that during operations performed under fluoroscopy guidance, primary radiation exposure is to the hands of the surgeons, with scattered radiation received by the trunk. The healthcare workers were urged to use radiation protection equipment to prevent such exposure.[] Stoeckelhuber et al. reported that the use of lead gloves alone during procedures performed under fluoroscopy guidance provides a 77% reduction in exposure. Wearing lead gloves was recommended if it does not prolong the procedure.[] Another study reported that the use of disposable sterile lead gloves hinders mobility, interventional manipulations, and finger sensitivity due to their thickness.[] In our study, only 2.9% of all the participants reported using lead gloves, while those working with fluoroscopy and in invasive cardiology units did not use them at all. The availability of lead gloves in these two groups was 10.3%. The low use of this equipment in these two groups may be due to inaccessibility in the departments/units as well as difficulties in using them, such as decreased mobility and reduced finger sensitivity.

Although most of the participants knew when and how to use protective equipment, only 20.8% of them believed in the protective function of the equipment. This may be due to the lack of knowledge about the effectiveness of protective equipment.

Most of the participants learned how to protect themselves from radiation at school, which was followed by in-service training (41.5%), self-education (41.5%), colleagues (33%), and training sessions organized by TAEK, professional associations, and companies (14.9%). It was notable that regular institutional on-site training about radiation safety was not sufficient.

The limitation of our study is the possibility that the participants were not unbiased in their responses; hence, it was difficult to evaluate the radiation protection practices objectively, despite the precautions taken.

Conclusion

Peer-review: Externally peer-reviewed.

Conflict of Interest: The authors declare that there is no conflict of interest.

Authorship contributions: Concept - N.K.; Design - S.K.; Supervision - N.K., S.K.; Materials - S.K., N.K.; Data collection &/or processing - S.K., N.K.; Analysis and/or interpretation - S.K.; Literature search - S.K., N.K.; Writing - S.K.; Critical review - N.K., S.K.

References