Occupational Radiation Monitoring in Tertiary Health Institutions of Northwestern Nigeria

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International Journal of Advances in Health Sciences (IJHS) ISSN 2349-7033 Vol 3, Issue 2, 2016, pp138-144 http://www.ijhsonline.

1 International Journal of Advances in Health Sciences (IJHS) ISSN Vol 3, Issue 2, 2016, pp Research Article Occupational Radiation Monitoring in Tertiary Health Institutions of Northwestern Nigeria Maikudi Dauda, Geofery Luntsi, Nwobi Chigozie Ivor and Prince Ogenyi Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Borno State. Corresponding author: Luntsi Geofery. address: GSM number: [Received-15/06/2016, Accepted-22/06/2016, Published- 27/06/2016] ABSTRACT Title: Occupational radiation monitoring in tertiary health institutions of northwestern Nigeria Objective: To determine knowledge of occupational radiation monitoring and level of personnel radiation monitoring in some tertiary institutions in Northwestern Nigeria. Methods: A prospective cross-sectional survey design was adopted for this study. It was carried out for a period of 4 months, from December March Questionnaires were distributed to radiologist, radiographers, darkroom technicians, and nurses who work in the radiology department of the selected hospitals in this study. Data analysis was done using statistical package for social sciences version 16.0 where descriptive statistics was used for analysis. Result: A total of 68 questionnaires were distributed and 62 were returned, giving a response rate of 91.2%. There were 55 (88.7%) males and 7 (11.30%) females with age ranged from years with a mean age of 24.5 years. There were 18 (19.00%) radiologist, 32 (51.60%) radiographers, 12 (19.40%) darkroom technicians and 0 (0.00%) nurses in the study. Conclusion: This study found an appreciable level of knowledge on occupational radiation monitoring among radio-diagnostic staff in northwestern Nigeria and there was an appreciable level of radiation monitoring in northwestern Nigeria, although much still need to be done on the practice of radiation protection. Key Words: Radiation Protection, Personnel monitoring, Dosimeter, Occupation. INTRODUCTION The science of using radiation in the field of medicine began after the discovery of x-rays in 1895 by Professor W. C. Roentgen, a German Physicist (Adejumo, 2012). The use of radiation for diagnostic and therapeutic purposes in the medical field has made the radiology department a pivotal part of the overall provision of healthcare (European Commission, 2001). Radiation is broadly divided into ionizing and non-ionizing radiation. Ionizing radiation is a form of radiation with sufficient energy to remove electrons from their atomic orbit or molecular orbital shells in the matter of tissues they penetrate (Arslanoglu et. al., 2007). Radiation which is used extensively to diagnose and treat human disease, poses occupational health risk for the concerned health workers (Ghazi, 2009). When radiation workers carried out radiological examinations using radiation (xrays), millions of photons pass through their

2 bodies, due to scatter radiation and radiation receive during interventional procedures. This can damage any molecule by ionization but damage to the DNA in the chromosomes is of particular importance. Despite the enormous and indispensable role of ionizing radiation in the medical field, radiation has deleterious biological effects. Examples of these effects are dermatitis, alopecia, chronic ulceration, genetic effects among others (Scanff et. al, 2008). The realization of these harmful effects has given rise to radiation monitoring to ensure proper protection of radiation workers, patient and members of the general public from the harmful effect of ionizing radiation. Occupational radiation monitoring is a method of ensuring that radiation workers are monitored to avoid exceeding the regulating limits (Okaro, 2010). Henceforth, this research concentrates on the occupational radiation monitoring in tertiary health institutions in northwestern Nigeria. MATERIALS AND METHODS A prospective cross-sectional survey design was used for this study. It was carried out for a period of 4 months, from December March Questionnaires were distributed to radiologist, radiographers, darkroom technicians, and nurses who were trained to work in the radiology department of the selected hospital of this study. Informed consent was sought from all radio diagnostic staff of the hospital visited and acceptance to participate in the study was considered as consent, participant were allow to either withdraw or continue with the study. Data analysis was done using statistical package for social sciences version 16.0 where descriptive statistics was used for analysis. RESULT A total of 68 questionnaires were distributed and 62 were returned, giving a response rate of 91.2%. There were 55 (88.7%) males and 7 (11.30%) females with age ranged from years with a mean age of 24.5 years. There were 18 (19.00%) radiologist, 32 (51.60%) radiographers, 12 (19.40%) darkroom technicians and 0 (0.00%) nurses in the study. Majority of the respondents 21 (33.87%) were from ABUTH, 19 (30.65%) were from AKTH, 16 (25.80%) were from UDUTH and 6 (9.68%) were from NECCS. Participants had working experience of <5yrs 31 (50.80%), between 5 and 10 years 18 (29.50%), years, 10 (16.40%) and 21 years (3.30%) as shown in table 1 below. Table 1: Socio-Demographic parameters Variables Female frequency (%) Male Total Frequency (%) Frequency (%) Gender 7 (11.30) 55 (88.70) 62 (100.00) Age (Years) (57.10) 29 (52.70) 33 (53.20) (28.60) 18 (32.70) 20 (32.20) (14.30) 8 (14.50) 9 (14.50) 50-above 0 (0.00) 0 (0.00) 0 (0.00) Designation of respondent Radiologist 3 (42.90) 15 (27.30) 18 (29.00) Radiographer 3 (42.90) 29 (52.70) 32 (51.60) Dark room technician 1 (14.20) 11 (20.00) 12 (19.40) Nurse 0 (0.00) 0 (0.00) 0 (0.00) Place of practice ABUTH 3 (4.84) 18 (29.03) 21 (33.87) AKTH 2 (3.23) 17 (27.42) 19 (30.65) UDUTH 1 (1.61) 15 (24.19) 16 (25.80) NECC 2 (3.23) 4 (6.45) 6 (9.68) Work experience (Years) Under 5 years 4 (57.10) 27 (50.00) 31 (50.80) 5-10 years 1 (14.30) 17 (31.50) 18 (29.50) years 2 (28.60) 8 (14.80) 10 (16.40) Geofery Luntsi, et al. 139

3 21 years and above 0 (0.00) 2 (3.70) 2 (3.30) Table 2: Knowledge of occupational radiation monitoring Variable Female frequency (%) Male Frequency (%) Overall Frequency (%) The dose received by an individual in a restricted area can be termed as occupational radiation Strongly agree 5 (20) 20 (80) 25 (40.30) Agree 2 (6.70) 28 (93.00) 30 (48.40) Not agree 0 (0.00) 7 (100.00) 7 (11.30) Occupational radiation can be monitored using personnel monitoring devices Strongly agree 6 (11.10) 48 (88.90) 54 (90.00) Agree 1 (16.70) 5 (83.30) 6 (10.00) Not agree 0 (0.00) 0 (0.00) 0 (0.00) The occupational radiation monitoring devices include Film badge only 0 (0.00) 6 (100.00) 6 (9.70) Pocket ionizing chamber 0 (0.00) 0 (0.00) 0 (0.00) TLD only 0 (0.00) 2 (100.00) 2 (3.20) All of the above 7 (13.00) 47 (87.00) 54 (87.10) Personnel monitoring devices are not supposed to be taken for reading Strongly agree 0 (0.00) 2 (100.00) 2 (3.20) Agree 1 (50.00) 1 (50.00) 2 (3.20) Not agree 6 (10.30) 52 (89.70) 58 (93.60) How often are personnel radiation monitoring devices supposed to be taken for reading? Monthly 4 (23.50) 13 (76.50) 17 (28.30) Quarterly 3 (10.30) 26 (89.70) 29 (48.30) Six months and above 0 (0.00) 14 (100.00) 14 (23.30) Key: TLD = Thermoluminiscent dosimeter only Table 3: Practice of personnel radiation monitoring Variable Female frequency (%) Male Frequency (%) Overall Frequency (%) Do you have the services of any of the personnel radiation monitoring in your department? No 4 (44.40) 5 (55.60) 9 (14.80) Yes 3 (5.80) 49 ( (85.20) If yes from the above, what type of radiation monitoring device do you use in your department? TLD 3 (8.60) 32 (91.40) 35 (63.60) Film badge 1 (5.60) 17 (94.40) 18 (32.70) Pocket ionizing chamber 0 (0.00) 2 (100.00) 2 (3.70) How often do you wear your personnel radiation monitoring device? Always when at work 5 (12.20) 36 (87.80) 41 (74.50) Twice in a week 1 (16.70) 5 (83.30) 6 (10.90) Once in a week 1 (12.50) 7 (87.50) 8 (14.50) Is there any gender preference in the issuance of the personnel radiation monitoring device? No 7 (11.60) 41 (85.40) 48 (81.40) Yes 0 (0.00) 11(0.00) 11 (18.60) If yes from above, which gender is most considered? 8 (61.50) 5 (38.50) Which of the under listed radiation protection device is not obtainable in your department? Lead prone 0 (0.00) 1 (100.00) 1 (2.00) Gonad shield 3 (11.10) 24 (88.90) 27 (54.00) Lead screen 0 (0.00) 4 (100.00) 4 (8.00) Lead gloves 3 (16.70) 15 (83.30) 18 (36.00) How many lead aprons are available? (0.00) 6 (100.00) 6 (10.20) (27.30) 8 (72.70) 11(18.60) (9.50) 38 (90.50) 42(71.20) How often is quality assurance test done in the department? Routinely 1 (8.30) 11 (91.70) 12 (20.30) Geofery Luntsi, et al. 140

4 Occasionally 5 (11.90) 37 (88.10) 42 (71.20) None 1 (20.00) 4 (80.00) 5 (8.50) Key: TLD- Thermoluminiscent dosimeter Table 4: Respondents suggestion of ways to improve on personnel radiation monitoring. Suggestions Female Frequency (%) Male Frequency (%) Total (%) Provision of adequate personnel monitoring devices to all staff 2 (40.00) 6 (60.00) 8 (25.00) Use of fast film/screen combinations to encourage selections of low KVA during exposure 0 (0.00) 2 (100.00) 2 (6.30) Locating staff offices away from machine rooms 0 (0.00) 1 (100.00) 1 (3.10) Hire a radiation safety officer meant for the department 1 (50.00) 1 (50.00) 2 (6.30) Limiting the dose by avoiding repeat 0 (0.00) 2 (100.00) 2 (6.30) Providing adequate protective devices 0 (0.00) 10 (100.00) 10 (31.30) Enforce relevant rules 0 (0.00) 2 (100.00) 2 (6.30) Rotation from areas of ionizing radiation to non-ionizing radiation areas from time to time (work schedules) 0 (0.00) 1 (100.00) 1 (3.10) Constant monitoring of protective equipment and quality assurance 2 (50.00) 2 (50.00) 4 (12.50) DISCUSSION Personnel radiation monitoring is an important safety precaution in the practice of radiography. It does not in itself provide protection against ionizing radiations. Its main purpose is to measure radiation dose received by radiology personnel, and also to verify that facilities for radiation monitoring are adequate and show that radiation protection techniques are acceptable (Okaro et al., 2010). Findings from the study revealed that there were 55 (88.7%) male and 7 (11.30%) females. This signifies that there were more male radiation workers in tertiary health institutions of Northwestern Nigeria than females. The age range of the respondents was between years and above with a man age of 24.5 years. Majority of the respondents were radiographers with 32 (51.6%) followed by radiologist with 18 (29.00%), and the least was technicians with 12 (19.40%) while there was more radiographers in the study areas as radiographers were the ionizing radiation dispensers in all the centers visited. This is in consonant with the recommendations of Adejumo et al., (2010) who stated that radiographers needs to be aware of their role in ensuring total compliance to standard radiation safety measures in their institutions. Findings from the study revealed that significant number 55 (88.70%) of the respondents had good knowledge of personnel radiation monitoring. This is similar to the findings of Eze et al., (2013) and Adejumo et al., (2010) who found out that, radio-diagnostic staff showed high rate of awareness and compliance to personnel radiation monitoring. Although there were few 7 (11.30%) of them that had poor knowledge of personnel radiation monitoring. This was similar to the findings of Okaro, Ohagwu and Njoku (2010) who found out that, some radio-diagnostic staff had abysmally poor knowledge on personnel radiation monitoring. This is because radiology department is composed personnel with different level of knowledge and academic qualifications ranging from technicians, radiographers and radiologist, though as regarding the knowledge of the delicate ionizing radiation, no one should be left uninformed adequately about it. A significant number of the respondents 46(76.6%) had their personnel radiation monitoring devices read either monthly or quarterly. This is similar to the findings of Okaro, Ohagwu and Njoku, et al., (2010), who found out that radiation monitoring devices are read fairly regularly at about every quarter of the year but it takes more than three years for fresh supplies of radiation monitoring devices to be made in the hospitals where radiation monitoring is carried out. Although few of them Geofery Luntsi, et al. 141

5 14 (23.30%) showed that personnel radiation monitoring devices were read only after every six months and above in a year. This is in line with the findings of Adejumo et al., (2012) who found out those radiographers in government hospitals showed dissatisfaction in the safety devices provided due to its inability to meet the standard required. This is because to limit the probability effect of radiation (stochastic) on radiation personnel, exposure doses have to be constantly monitored using suitable devices and at regular interval of a month as recommended by ICRP. Majority 52 (85.20%) of the respondents practice personnel radiation monitoring while 9 (14.80%) do not practice personnel radiation monitoring. This was similar to the findings of Eze et al., (2013) who found out that radiodiagnostic staff had excellent knowledge of personnel radiation monitoring but did not match the practice. This could be due to inadequate provision personnel radiation monitoring devices by the management and also negligence from the radio-diagnostic staff as many were found to use their personnel monitoring devices once or twice a week. The findings of this study revealed that TLD was the most 35 (63.60%) used personnel radiation monitoring device among the institutions visited, followed by film badge 18 (32.70%) and pocket ionizing chamber 2 (3.70%). Okaro, Ohagwu, and Njoku (2010) had similar findings in hospitals where personnel radiation monitoring devices were available. This is because TLD badges are portable and light weight and it has the ability of storing radiation dose over a period of time, it has high sensitivity and it can be reused several times after reading. Findings of this study show that majority 41 (74.50%) of the participants complied with radiation safety standard by wearing their personnel radiation monitoring devices always when at work. This is in agreement with the findings of Okaro et al., (2010) who found that every worker is expected to wear his/her personnel radiation dosimeter always while working. This is because dosimetric readings of every staff must be recorded and kept for history purpose. Although about number 14 (25.40%) of them show poor attitude towards wearing their personnel dosimeters when at work. This contradicts the findings of Adejumo et al., (2012) who found out that everyone involved in radiation usage needs to know what radiation is and how to handle it because the number of diagnostic radiology procedures performed continues to grow yearly. With this growth, there should be concern for practice of radiation safety. This might be that regulations were not put in place to checkmate compliances of radiation personnel towards wearing their dosimeter when at work, or just a mere carefree attitude from them. Majority 48 (81.40%) of the participants indicated that there were not gender preference in the issuance of personnel radiation monitoring devices among the institutions visited. This is in line with Washington Hospital Radiologic Technology program brochure, 2011, which stated in item number 2 of the student radiation protection criteria that a radiation monitoring device is issued to each student. The radiation safety officer, faculty and students review the monthly report of exposure. And under its pregnancy policy, required that all female students upon entering the hospital program must read and sign pregnancy notification procedure (form 1), indicating they have been instructed in the area of radiation protection for the pregnant radiographer. This is because pregnant radiation worker has the right to either declare or not her pregnancy status and pregnant radiation workers unit of duty are reviewed upon declaration of pregnancy from the area of ionizing radiation to that of nonionizing radiation like MRI, USS. Findings of this research also revealed that radiation protection device like caution lights, lead apron, lead doors, gonad shields, lead screen, lead gloves and lead goggles were provided in the hospitals visited, though lead apron and lead screen were predominantly available in most of the institutions visited while gonad shields, lead goggles and lead gloves were inadequately provided. This is in consonant with the research conducted by Adejumo, (2012), Omiyi, Irurhe et al., (2012) Geofery Luntsi, et al. 142

6 who stated that concerning the assessment of safety devices most of the diagnostic centers studied were able to provide the caution light, lead aprons, lead doors, gonad shields, lead line, lead screens. This is because radiation protection to radiation workers depends greatly on the proper use of radiation protection devices in radiology department and the management has a duty to adequately provide such devices before establishing as radiology department. There were quality assurance (QA) test done on the equipment in the majority of the hospitals visited with 42 (71.20%) carrying out QA test occasionally and 12(20.30%) did it routinely. This is not in agreement with the findings of Eze et al., (2010) who found that quality assurance is one of the best means of maintaining patient exposure to minimum. It was generally poor in all the hospitals surveyed. About 5 (8.50%) of the participant indicated that quality assurance was not practiced in their institution. This is in line with the findings of Eze et al., (2010) who stated that QA was generally poor in all hospitals surveyed. This is because QA program aids to maintain optimal diagnostic image quality with minimum hazard and distress to personnel s and patients. CONCLUSION This study found an appreciable level of knowledge on occupational radiation monitoring among radio-diagnostic staff in northwestern Nigeria and there was an appreciable level of radiation monitoring among radiodiagnostic staff in in northwestern Nigeria, although much still need to be done on the practice of radiation protection as the attitude of some radiation workers towards the wearing of the personnel monitoring devices (dosimeter) was found to be inadequately poor and management of radiology departments need to do more on provision of adequate personnel monitoring devices and regularly monitor for the practice and use among radio-diagnostic staff in northwestern Nigeria. REFERENCES 1. Ahidjo A. Mustapha Z. Ahmed A. Garba I. Ahmed U. (2012). Referring Doctors Knowledge about patients Dose undergoing common Radiologic examination. Journal of medicines and Med. Sci. Vol. 2 (4) pp. Available at http//www. Interest journals. Org/Jmms 2. Adejumo, B. Irurhe K. Olowoyeye A. Ibitoye Z. Eze U. Omiyi D. (2012). Evaluation of compliance of Radiation Safety Standard Amongst Radiographers in Radio diagnostic centers in South west, Nigeria. World Journal of Medical Sciences 7(3): Bushong S. (2008). Radiological sciences for Technologists: physics, Biology and Protection 9 th ed. Mosby P: Eze U., Abonyi L., Njoku J., Irurhe N., and Olowu O. (2013). Assessment of Radiation protection practice among Radiographers in Lagos. Nigeria medical Journal. 5. European Commission (EC). (2001). Radiation Protection 123: Low dose ionizing radiation and risk of cancer. Office for official publication of the EE; Luxembourg. Htt:// europa. Ev. Int/comm./environment rad prof/publications. 6. Ghazi; Khanlou S.K, Jafari M., Mohammed M; Mojri M; Rahimi A; (2009). Iranian physician knowledge about Radiation Dose, Received by patient in Diagnostic Radiology. Iran J. Radiat. 6(4), Grover, S.B; J. Kumar, A. Gupta and L. Khanna. (2002). Protection against radiation hazards: regulatory bodies safety norms, dose limits and protection devices. Indian Radiology imaging 12: Ibitoye Z; M. Aweda and N. Irurhe. (2011). Annual Effective dose status among the radiation staff of Lagos University Teaching Hospital Lagos. African J. Basic and Appl. Sc. 3: International Atomic Energy Agency (IAEA). (2006). Safety Standard for Protecting people and environment Fundamental safety principles. No Sf 1 IAEA, Vianna. 10. International Atomic Energy Agency/International labour organization RS-G-1.1. (1999). Occupational Radiation protection series, IAEA. Vianna. 11. International Atomic Energy Agency RS-G 1.5 Safety Guide. (2002). Radiological Geofery Luntsi, et al. 143

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