Ionizing Radiation Hazards and Protection Practices among Radiographers at Cairo University Hospitals

Transcription

1 Med. J. Cairo Univ., Vol. 85, No. 4, June: , Ionizing Radiation Hazards and Protection Practices among Radiographers at Cairo University Hospitals RANIA H. MOHAMMED, M.Sc. 1 ; NAGAH M. ABDOU, D.N.Sc. 2 ; SAHAR A. FARAHAT, D.N.Sc. 3 and EMAN M. SEIF, D.N.Sc. 4 The Departments of Community Health Nursing, Faculty of Nursing, Cairo University 1,2,4 and Occupational & Environmental Medicine 3, Cairo University Abstract Aim of the Study: To assess the ionizing radiation hazards and protection practices among radiographers at Cairo University Hospitals. Subject and Methods: A descriptive research design was utilized. Setting: The study was conducted in three hospitals affiliated to Cairo University; El Monera, El Manial Specialized and El Manial University Hospitals. The radiology departments in El Monera and El Manial Specialized hospitals will be included, in addition to, radiology room in Emergency Department and cardiac cathateralization in Intensive Care Unit in El Manial University Hospital. Sample: A convenience sample of all available radiographers who are working with X-Ray devices in the selected settings. The total sample reached 90 radiographers. Tools: Three tools were used; 1 st tool Ionizing Radiation Hazards Structured Questionnaire which included reported data related to work and hazards related to working with ionizing radiation. 2nd tool Radiographers Practices Checklist. 3rd tool Environmental Safety Checklist. Data collection took three months (November, 2015 till January, 2016). Results: Reveals that 31.1% of radiographers were aged 31 to 35 years old with mean And 60% had menstrual problems, 40% exposed to abortion between females sample. 31.7%, 8%, 6% and 10% complains from easy fatigue, leukopenia, thrombocytopenia, anemia respectively and 4.8% of them had cataract, use personal dosimeter by 5.6% radiographers, 6.7% of them wear intact aprons and all selected settings didn t use radiation warning posters. All of the settings had the X-ray devices installed in the dedicated rooms and 25% of settings had not intact glass window and leaded walls. The result revealed statistically significant differences between not using personal dosimeter, not wearing apron, being in X- ray rooms during imaging and occurrence of leukopenia, Correspondence to: Dr. Rania H. Mohammed, The Department of Community Health Nursing, Faculty of Nursing, Cairo University anemia and thrombocytopenia. With p.value (0.0001*, *, *, *, *, *, 0.005**, 0.002**, 0.015**, 0.02*) respectively. Presence of statistically significant relation between easy fatigue of radiographers and broken window in X-ray room with p.value (0.001*). A statistically significant relations between age and occurrence of leukopenia, anemia, Thrombocytopenia and easy fatigue. Statistically significant relation was also found between anemia, easy fatigue and work experience. As well, statistically significant relations was found between daily working hours and easy fatigue. There were statistically significant relations between number of daily cases and menstrual problems, abortion and easy fatigue. With p.value (0.0001*, 0.002*, 0.001*, 0.02*, 0.002*, *, *, 0.001*) respectively. Conclusion: The study concluded that, radiographers had various health hazards related to work with ionizing radiation and didn't follow all protection practices against ionizing radiation hazards. Recommendation: Educational programs about ionizing radiation hazards and protection practices should be obligatory to all radiographers. Key Words: Ionizing radiation hazards radiographers Protection safety of ionizing radiation. Introduction RADIOGRAPHER are one member of the medical team that deals with ionizing radiation (Xray). Work load among radiographer seem to put them at ionizing radiation hazards for gastrointestinal system, reproductive system, in addition to different types of cancer, dermatological signs and symptoms, cataracts and genetic effects. Hence, radiation protection practices are necessary for all radiographers to protect them from ionizing radiation hazards by environmental protection through radiation processing rooms of walls, windows, doors, control rooms. It also includes ensuring the safety of the X-ray devices used, using personal protective equipment. Furthermore, health status 1535

2 1536 Ionizing Radiation Hazards & Protection Practices among Radiographers for all radiographers should be checked to ensure the controlling of ionizing radiation hazards [1]. Radiation describes the way energy moves from one place to another. The various types of radiation are grouped according to how much energy they contain. Non-ionizing radiation has less energy than ionizing radiation; it does not possess enough energy to produce ions. Examples of non-ionizing radiation are radio waves, microwaves, and sunlight. High energy radiation such as ultraviolet (UV) light from the sun and X-rays, is known as ionizing radiation [2]. Ionizing radiation has many benefits for diagnosing diseases and the most common imaging modalities used in diagnostics are radiography (Xrays). It has sufficient energy to cause chemical changes in cells and damage them, some cells may die or become abnormal. Its hazards are classified into two main types stochastic effects and nonstochastic effects. Stochastic effects are associated with long-time of exposure with low level of ionizing radiation dose that cause different types of cancer such as leukemia and hereditary effects. Non-stochastic effects appear in cases of exposure to high levels of ionizing radiation dose that cause radiation sickness as nausea, vomiting, general weakness, hair loss or diminished organ function and reproductive effects such as sterility [3]. According to International Commotion of Protection Practices, the objective of radiation protection practices is to enable medical team to derive the benefits of ionizing radiation with minimal risk to radiographers. Radiation protection practices is classified into two types: Personal protection practices and environmental safety [4]. However, protection principles of time, distance and shielding actions minimize exposure to radiation. Time for radiation, limiting or minimizing the exposure time reduces the dose from the radiation source. As for distances control, distance from the source of ionizing radiation devices has to be increased. Shielding barriers of lead, concrete form of ionizing radiation protect all radiographers from ionizing radiation hazards [5]. Other radiation protection practices are necessary for all radiographers who work in the departments of radiology. That require appropriate lab investigation monitoring such as Complete Blood Count and Tumor Markers, they must also be monitored by dosimeters like film badge and receive education and training appropriate to their jobs [6]. Significance of the study: In spite of the hazards caused by ionizing radiation and the importance of the protection practice, researches in this respect are lacking in Egypt. Therefore, the result of the current study that determine the ionizing radiation hazards and protection practices among the radiographers at Cairo University Hospitals will identify the gaps in protection practices which will help developing training programs to decrease ionizing radiation hazards. It will also help developing guidelines to protect the radiographers that would be integrated in the curriculum of occupational health nursing and radiology. Subjects and Methods Research question: 1- What are the ionizing radiation hazards among radiographers? 2- What are the protection practices among radiographers? Study design: A descriptive design was utilized to fulfill the aim of the study. As stated by Polit and Beck, descriptive design aims at identifying the current problems with current practice, observe, describe and document aspects of a situation [7]. Setting: The proposed study was conducted in three hospitals affiliated to Cairo University; El Monera, El Manial Specialized and El Manial University Hospitals. The radiology departments in El Monera and El Manial Specialized Hospitals were included. While in El Manial University Hospital, two settings were included, radiology rooms in the Emergency Department and Cardiac Catheterization rooms in Intensive Care Unit. All hospitals include two X-ray rooms and one X-ray device in each room. These hospitals were included in this study because of big number of radiographers available in these settings according to the investigator assessment. Sample: A convenience sample of all radiographers working in X-ray rooms was recruited for the reached sample was 90 radiographers (65 in El Manial University Hospital, 15 in El Monera and 10 at El Manial Specialized Hospital). Tools for data collection: Three tools were developed by the investigator based on extensive review of related literature to collect data pertinent to the study. I: Ionizing Radiation Hazards Structured Questionnaire.

3 Rania H. Mohammed, et al II: Observational Checklist of Radiographers Protection Practices. III: Observational Checklist for Environmental Safety. Ethical consideration: A written approval was received from the Research Ethics Committee at the Faculty of Nursing, Cairo University. In addition, an official permission to conduct the proposed study was obtained from Faculty of Nursing and submitted to directors of Cairo University hospitals included in the study. Written formal consents were obtained from the radiographers after explaining the aim of the study, its benefits, duration of the study and the data collection tools. The investigator informed the radiographers that all data gathered during the study will be considered confidential. The investigator also informed them about their rights to withdraw from the study at any time without giving any reason and without any pressure from the directors of the departments. They were also ensured that the data collected will be used by the investigator for the purpose of this study only. Pilot study: A pilot study was conducted on 10% (9 radiographers) of the sample, to ensure clarity and to determine the time required to complete data collection tools. According to the results of the pilot study no modification was needed, so pilot sample was included in the actual study. Procedure: After obtaining official permission, the investigator interviewed each radiographer individually to explain the nature and purpose of the current study then completion of the questionnaire was completed by radiographers. Observational checklists of radiographers protection practices was completed by the investigator observation of radiographers during work. Then environmental safety was observed by the investigator using environmental safety checlist. The time spent to complete the questionnaire by each radiographer ranged between 10 to 15 minutes. Data collection took three months (November, 2015 till January, 2016), three days per week, around 4-5 radiographers in each day. Statistical analysis: The collected data was scored, tabulated and analyzed using the recent statistical package for the social sciences (SPSS) program version 20. Descriptive (frequency and percentage) was utilized to analyze data pertinent to the study. Level of significance was set at p<0.05. Results Table (1) shows that, the study subjects consisted of 90 radiographers, 31.1% and 23.3% of the radiographers aged from years and years respectively with a mean of 32.9 years. Most radiographers (94.4%) were males and 81.1% were married. None of the radiographers had any health problem before employment as reported by them. Table (2) shows that, 42.2% of radiographers have been working for 10 to less than 20 years, while 35.6 had 1 <10 years of work experience with a mean 15 years. Regarding to daily work hours, 70% were working for 12 hours per day and 65.6% of radiographers did X-ray imaging for more than 20 cases per day. Table (3) reveals that, all females (5.6%) in this study were exposed to obstetric problems as 60% had menstrual problems and 40% had abortion. Regarding to other health complaints, 41.6%, 33.3%, 31.7% and 25% complained of easy fatigue, leukopenia, thrombocytopenia, anemia respectively and only 4.8% of them had cataract. Table (4) shows that, personal dosimeter was used by only 5.6% of radiographers, only 6.7% wore intact aprons. Around one third (34.4%) were observed inside X-ray rooms during imaging. All radiographers didn t follow distance and time protection control. As well, they didn t close the X-ray room door during imaging. Table (5) shows that, all selected settings didn t have radiation warning posters and audible warning signals, while 75% used visible warning. All of settings had X-ray devices in the dedicated rooms and controller area outside the X-ray rooms. However, 25% of settings had not intact glass window and leaded walls. Table (6) clarifies the relation between health complaint among radiographers and observed personal practices. The result revealed statistically significant differences between not using personal dosimeter, not wearing apron and occurrence of leukopenia, anemia and thrombocytopenia. In addition, there were high statistically significant relation between being in X-ray rooms during imaging and occurrence of leukopenia, anemia and thrombocytopenia. Table (7) shows the relation between observed environmental Safety practices and radiographers health complaint. The table revealed the presence

4 1538 Ionizing Radiation Hazards & Protection Practices among Radiographers of statistically significant relation between easy fatigue of radiographers and broken window in X- ray room. No statistically significant relation were found between complaint from leukopenia, anemia and observed environmental safety practices. As well, there were not statistical relation between easy fatigue and the broken wall and presence the external controller outside the X-ray rooms. Table (8) shows statistically significant relations between age and occurrence of leukopenia, anemia, Thrombocytopenia and easy fatigue. Statistically significant relation was also found between anemia, easy fatigue and work experience. As well, statistically significant relations was found between daily working hours and easy fatigue. There were statistically significant relations between number of daily cases and menstrual problems, abortion and easy fatigue. Table (1): Numbers and percentage distribution of the radiographers characteristics (N=90). Variables No % Age/year: > Sex: Male Female Marital status: Single Married Widower Health problems before employment: Table (2): Distribution of radiographers according to related work data (N=90). Work related data No % Work Experiences: 1- less than 10 years less than 20 years less than 30 years More than 30 years 9 10 Daily work hours: 5h h Number of cases per day: More than Table (3): Distribution of radiographers according to reported health complaints (N=90). * Health complains No % Radiographers complaint: Yes No Menstrual problems (n=5) Abortion (n=5) Easy fatigue(n=82) Anemia (n=12) Leukopenia (n=12) Thrombocytopenia (n=12) 3 25 Cataract (n=82) *Response are not mutually exclusive. Table (4): Distribution of radiographers according to observed radiographers practices (N=90). Variables No % Use personal dosimeter: Yes No Wear intact lead aprons: Yes No Presence on X-ray rooms during patient imaging: Yes No Follow distance protection control: Yes 0 0 Follow time limit exposure principle: Yes 0 0 Leave X-ray room doors open: Yes 0 0 Table (5): Distribution of settings according to observed environmental safety practices (N=4). Variables No % Visible warning posters at entrance: No Visible warning signals before and during imaging: Yes 3 75 No 1 25 Audible warning signals before and during imaging: No Regular maintenance of radiation sources and X-ray rooms: No X-Ray devices in dedicated rooms: Yes External controller outside the ionizing radiation room: Yes Intact glass window in the control area: Yes 3 75 No 1 25 Intact leaded walls: Yes No Intact X-ray room sealed doors: Yes

5 Rania H. Mohammed, et al Table (6): Relation between observed radiographers practices and health complaint. Observed personal practices Health complaint Not using dosimeter Wearing apron Being in X-ray room during imaging Chi square p-value Chi square p-value Chi square p-value Leukopenia Iron deficiency (Anemia) Thrombocytopenia Cataract Table (7): Relation between observed environmental safety practices and radiographers health complaint. Observed environmental safety practices Health complaint External controller Broken window in X-ray room Wall not intact Chi square p-value Chi square p-value Chi square p-value Leukopenia Iron deficiency (anemia) Easy fatigue Table (8): Relation between some work related data and health compliant. Health complaint Age Work experience Daily working hours No. of daily cases Chi square p-value Chi square p-value Chi square p-value Chi square p-value Leukopenia Iron deficiency (Anemic) Thrombocytopenia Menstrual problems Abortion Easy fatigue Discussion Radiographers are constantly exposed to specific ionizing radiation related health hazards that categorized as stochastic and non-stochastic health effects as cancers skin effects, reproductive system diseases, cataract and hematological problems. Awareness regarding these health hazards and implementation of protection practices can provide safe workplace for all radiographers [8]. I: Health complaints of Ionizing Radiation Exposure: The majority of the radiographers were males and this results in was agreement with study done by Mohamed, (2013) to assess radiological hazards and safety measures as perceived by health care team at National Cancer Institute affiliated to Cairo University Hospitals. Revealed that, the majority of radiographers were males. However, the majority of males reported not affected by ionizing radiation in the form of infertility and sperm deformities [9]. Results of this study also revealed that, around two thirds of female radiographers had menstrual problems while more than one third of them were aborted. This evidenced by the presence of highly statistical significance relation between menstrual problems and abortion with number of daily cases done. This results was assistant with the results of Mohammed, (2009) in his study to assess the effects of ionizing radiation on DNA damage among the personnel working in radio-diagnosis departments. He found that, menstrual irregularity, aborted fetus among female radiographers reported 8% and 5.6% respectively [10]. Regarding to lab investigations done to radiographers, around two thirds had CBC analysis and most of them informed about results. The results of CBC showed that leukopenia, anemia and thrombocytopenia reported small percentages of radiographers. A highly statistical significance relation was found between personal practices used by radiographers as not using dosimeter, not wearing aprons, staying for long time in X-ray rooms and results of CBC analysis. In another hand found statistically significance relations between leukopenia, thrombocytopenia and age. Statistically significant relation was also found between anemia with age and work experience. This result agreed

6 1540 Ionizing Radiation Hazards & Protection Practices among Radiographers with study done by El-Zayat, (2010) to assess the health risks for medical radiation workers at Cairo University, which indicated that, one quarter were suffering from mild hypochromic anemia, 16% had mild normocytic normochromic anemia, minority for mild microcytic hypochromic anemia and 5% for Leucopenia [11]. On the other hand, easy fatigue has been detected in around one third of radiographers. The current study also indicated, statistical significant relation between easy fatigue with broken window in X-ray room, age, work experience, daily work hours and number of cases. In relation to health complains of ionizing radiation exposure among radiographers, minority of radiographers were suffering from cataract. This result agrees with study done by Preston and Miller, (2014) to assess the ionizing radiation hazards among radiographers at United States of America. It revealed that, less than quarter of sample complained from cataract [12]. Also the current study found statistically significance relation between cataract occurrence and staying long time in X-ray rooms. II: Radiation protection practices: In relation to observed personal practices, this study revealed that, around one third of radiographers were staying in X-ray rooms during patient imaging. While minority of radiographers wear aprons and used personal dosimeter. Also all radiographers didn t follow protection time and distance control and made all patient imaging with opens room doors. The same result were in agreement this result with, a study done by Jun and Bin, (2012) in China showed that, majority of radiographers did not follow the protection practices principles such as time, distance control and un appropriate use of PPE [13]. Regarding to observed environmental safety practices, this study revealed that, all of selected settings didn t use radiation warning posters and audible warning signals. Furthermore, a study done by Swanson& Jim, (2012) showed that, all of radiological departments had warning posters and visible & audible signs. Unfortunately, the investigator observed that, all the studied settings just used only X-ray labels on rooms not standardized warning posters [14]. Regarding to X-ray rooms, the current study indicated that, all X-ray devices were kept in their dedicated rooms. Also all of selected settings had the controller area outside the X-ray rooms. However, all of selected settings didn t follow regular maintenance of X-Ray devices as the investigator observed some of X-ray devices malfunctioning. While one quarter of selected settings had broken glass windows and not having intact leaded wall. On the contrary these result were congruent with study done by Osman, (2008) who found that, radiation machines and rooms content were not regularly checked up [15]. Conclusion: The study concluded that, radiographers had various health hazards related to work with ionizing radiation and didn't follow all protection practices against ionizing radiation hazards. There were statistically significant relations between reported health complaints with observed radiographers practices, environmental safety practice and some related work data. Recommendation: - Educational programs about ionizing radiation hazards and protection practices should be obligatory to all radiographers. - Provide complete PPE with high quality for all radiographers to increase controls of ionizing radiation hazards. - Enforce compliance of radiographers and employers with safety regulations of ionizing radiation. - Ensure performance of periodic lab investigations and diagnostic procedures for all radiographers to provide early detections of symptoms related to ionizing radiation hazards. - Further wide scale studies are need to be conducted on other settings in Egypt to have a baseline data about the personal and environmental safety practices undertaken to avoid or decrease the ionizing radiation hazards among radiographers. References 1- O'SULLIVAN B.: The Radiographer (Medical Imaging Technologist). Australian: Inside Radiology Available at insideradiology. com. au/pages/view. Php, SEHLEN A., VORDERMARK S. and SCHAFER M.: Basics of radiation. Minister of Public Works and Government Services Canada (PWGSC) 2012 PWGSC catalogue number CC172-93/2012E-PDF ISBN , BARADEI A. and COWAN S.: Ionizing radiation, at German University of science. Radiological Department. 58 (5): , International commission of radiation protections. (ICRP) (2). A study of radiation hazards and protection practices among radiographers. Available at ( ionizing radiation.com), Environmental Protection Agency (EPA): Environmental Protection Agency 2014 Radiation Protection Adviser Consultation and Advisory Visits, Radiation Library, Vol. 86, 2014.

7 Rania H. Mohammed, et al TRONDHEIM J.: A study of Radiation Protection Principles, Norwegian University of Science and Technology. Methods and Applications, , POLIT D.F. and BECK C.T.: Essential of Nursing Research, uses of descriptive design in research. Eigh th Edition, 080: PE-17675, BONZINI M., COGGON D. and PALMER K.T.: Risk of ionizing health effectc in relation to working hours and physical activities: A systematic review. Occupational and Environmental Medicine, MOHAMED, A.: Assessment of radiological hazards and its safety measures as perceived by health care team in National Cancer Institution, 17 (03)-44, MOHAMMED R.: Resident of industrial medicine, Faculty of Medicine, Cairo University, Assess the effects of ionizing radiation on DNA damage among the personnel working in radio-diagnosis departments, EL-ZAYAT D.: At Biophysics Department, Faculty of Science, Cairo University to asses the health risks for medical radiation workers in the field of nuclear medicine and radiotherapy, PRESTON D. and MILLER J.: Assess the ionizing radiation hazards among radiographers. At department of health; National Library of Medicine. Radiation research, 158 (2): , JUN C. and BIN T.: At Henan Institute of Occupational Medicine, Zhengzhou, China,Assess the knowledge and awareness of ionizing radiation protection, 00465: , SWANSON M. and JIM A.: Radiographers oncology and photon energy for ionization: Newton ask a scientist, Retrived 4 November, 78 (4), OSMAN E.: Workers perceptions of safety culture at a hospitals. Tidsskr Nor Laegeforen, 127 (20): , 2008.