Radiation Exposure Monitoring in Medical

Literature Review

Most of the studies needed to monitor radiation exposure in the fields of medicine or dentistry for doctors, nurses, and radiographers. To identify knowledge gaps and to inform on the research method proposed for this study, the approach or strategy has been to access studies such as the proposed study to inform on the current trends both from student as well as professional point of view who are involved in diagnostic radiation medical imaging examinations. This indicates that starting nationally and then internationally to access studies is necessary. The monitoring devices and various types of monitoring devices used to measure occupational dose and the strategies to prevent unnecessary dose will be delved in the literature review.

The literature review was performed using numerical data in a wide variety of database such as Elsevier, PubMed, LISTA(EBSCO), Web of Science SCI, Web of Science SSCI, Google Scholar, BioOne, ScienceDirect and Government publications. Boolean Operators with combinations are used in our search with time-frame from 2000 onwards to have the validity.

Keywords used are Radiation protection, Occupational radiation dose, Student radiographer, monitors TLD OSLD, Placement in diagnostic radiography, and Awareness of radiation safety.

The researches on students have limited amount of time very often in submitting to the IRB. Alternately, there are unrealistic expectations in them related to when there will be returning of the IRB approval. It is difficult reviewing the complicated studies and may have the requirement of full board review and have greater likelihood of needing further full board’s review or the revisions being delayed.

Overall, the transcript analysis identified that the experience of student learning may be placed into a couple of broad categories: firstly, the ones that have been shared with supervisors and the ones that have been a feature of the developing practice of their own. At the student-supervisor level, the key concepts of confidence, radiographic technique, and experimental learning have been identified.

The members of Safety and Health Committee of SIR (Society of Interventional Radiology) and the Standards of Practice committee of CIRSE (Cardiovascular and Interventional Society of Europe) are the representative of the experts in interventional procedures of broad spectrum from both academic and private sectors of medicine. In general, the majority of the professional time of these committee members is dedicated in performing the interventional procedures. They, as such, represent broad and a valid subject matter expert constituency under consideration.

The intervention procedures guided fluoroscopically have been subject to performance in large numbers in United States and Europe. The procedural numbers performed across the world annually have augmented over past two decades (Miller, 2008). The interventional radiology’s benefits to patients are beyond dispute and extensive, although several of these procedures have the potentiality of producing high enough patient radiation doses for causing the radiation effects that too are high enough for causing concern to interventional radiologists with occupational doses (Miller, 2008). On patient radiation, a joint SIR–CIRSE guideline addresses this patient issue (Stecker et al, 2009). The intention of this guideline is serving as a companion to that document and the provision of guidance in helping minimizing the occupational radiation dose.

The recipient of the radiation dose by the interventional radiologists may be varying by the greater degree than an order of magnitude for the similar patient dose and identical type of procedure. In the recent times, the concern has been particularly intense with regards to the occupational dose to the lens of the interventional radiologists’ eye (Vano, Gonzalez, Fernández, & Haskal, 2008). From the exposed human populations, the new data is suggestive that the occurrence of the lens opacities (cataracts) at far lower doses compared to the ones believed previously in causing cataract (Worgul et al, 2007).

There is availability of statistical analysis of the data available in suggesting a threshold dose’s absence, although if there is no existence of one, there is possibility that this is less than 0.1 Gy (Nakashima, Neriishi, & Minamoto, 2006). In addition, apparently the radiation’s latency period for the formation of radiation cataract has inverse relationship with the radiation dose.

The occupational radiation dose can be measured through individual monitor, which is directly linked with awareness of radiation safety (Botwe et al., 2015, p. 2). There are a few factors that contributes to the amount of radiation exposure such as distance from the radiation source, time of x-ray exposure, the knowledge level of the radiation user, and the application of shielding or monitor and so on(Chang et al., 2014, p. 163). One of studies evaluated the occupational exposure dose values being below the relevant dose limits and decreased from 1.94 from 0.94 mSv to 0.8 mSv in diagnostic radiology after employment of radiation protection standards. Thus, the assessment of radiation exposure dose is an important aspect to evaluate radiation risks and establish radiation protection for health professionals (Motevall & Borhanazad, 2015, pp. 431-438).

Regarding radiation awareness among dentistry field including radiography students, one study undertaken by Furmaniak KZ, Kołodziejska MA.and Szopiński KT (2016) in Poland found that there is slightly weakness of radiation awareness in dentistry area including qualified radiographers. The other study evaluated the radiation awareness among radiology residents, radiography students and medical students. Student radiographers’ level of knowledge on radiation protection was assumed to be the same level as that of radiology residents’, which is significantly higher than medical students’(Faggioni, Paolicchi, Bastiani, Guido, & Caramella, 2017, p. 141).

In diagnostic imaging field of the students who completed the regular curriculum are expected to be fully aware of understanding of what ionizing radiation and the role of the monitor to implement ionising radiation safety before commencing a placement. However, only a few studies have revealed the accumulated radiation exposure dose of students in diagnostic radiography during the placement. One of studies in United Arab Emirates report that the mean annual effective dose is 0.095 mSv and the range of effective doses is 0.01–0.97 mSv respectively using TLD (Abuzaid & Elshami, 2017, pp. 244-247). Other study has considered the relationship between radiation exposure and safety from Saudi Arabia has been conducted to assess radiation protection practices among undergraduate internship students from radiologic technology department. This prospective comparative study is structured with two parts to collect data with self-including administered questionnaire regarding radiation protection and radiation safety as well as the measurement of annual occupational radiation dose. The measurement of average deep doses was evaluated 4-6 mSv, and shallow doses was 0.5 - 2mSv respectively which was less than the dose limits 20 mSv per year(Al-Sayyari & Kalagi, 2018, pp. 71-77).

According to Al-Sayyari & Kalagi (2018) and Abuzaid & Elshami (2017), insufficient understanding of application of monitor and unconcern of occupational limits dose can cause safety issue during the placement. Therefore, the information of radiation dose measured from individual monitor can play an important role to achieve ALARA principle (Furmaniak, Kołodziejska, & Szopiński, 2016, pp. 1-5; Motevall & Borhanazad, 2015, p. 77).

Majority of previous works in this field were not of Australian origin, and tended to focus mainly on general medicine or dentistry instead of radiography student, and reported to date with a passive radiation detection device such as TLD but OSLD is currently used in most clinical places in Australia. This demonstrates a knowledge gap and creates not only an opportunity and necessity for an investigation using OSLD on the radiation exposure also at what level the monitor is placed during the placement on radiography students in Australia.

Radiology, much like other healthcare professions, is established with full professional recognition. Usually, quantitative research is placed with emphasis focusing on the scientific confirmatory method’s deductive component. However, there is change in the situation following the medical research’s post-positivist philosophy and its emergence. This is suggestive of the needs for both qualitative and quantitative research for grasping the reality with better understanding.

The qualitative research’s nature is exploratory and inductive unlike quantitative research. This provides insight into some little known topics and therefore complements quantitative research.

Although, the qualitative research’s role has the recognition to be important, for the radiology community members and other disciplines of healthcare, few opportunities began emerging in learning and its application (Wright & Schmelzer, 1997). The qualitative tradition of reserach has been identified which may be applicable to radiology with the provision of review in terms of weaknesses and strength, areas of inquiry, different applications in accordance with the nature of the study.

The radiography studies conducted previosuly with the use of qualitaive approches are reviewed critically in illustrtaing these issues and their applications along with the discussions on the basis of proposed framework of radiology reserach that was identified by Adams and Smith into broad research areas of radiography that aims for furthering the radiographers’ research capacity and the profession, with the help of qualitaive research in particular.

References

• Miller, D. L. (2008). Overview of contemporary interventional fluoroscopy procedures. Health Phys., 95:638–644.
• Stecker, M. S., Balter, S., Towbin, R. B., et al. (2009). Guidelines for patient radiation dose management. J Vasc Interv Radiol., 20:S263–S273.
• Vano, E., Gonzalez, L., Fernández, J. M., & Haskal, Z. J. (2008). Eye lens exposure to radiation in interventional suites: caution is warranted. Radiology, 248:945–953.
• Worgul, B. V., Kundiyev, Y. I., Sergiyenko, N. M., et al. (2007). Cataracts among Chernobyl clean-up workers: implications regarding permissible eye exposures. Radiat Res., 167:233–243.
• Nakashima, E., Neriishi, K., & Minamoto, A. (2006). A reanalysis of atomic-bomb cataract data, 2000–2002: a threshold analysis. Health Phys., 90:154–160.
• Wright, K. B. & Schmelzer, M. (1997). Qualitative research: exploring new frontiers. Gastroenterology Nursing, 20(3):74-8.
• Abuzaid, M., & Elshami, W. (2017). Measurments of radiation exposure of radiography students during their clinical training using thermoluminescent dosimetry. In Radiation Protection Dosimetry (Vol. 179, pp. 244-247).
• Al-Sayyari, A. A., & Kalagi, S. (2018). Assessment of Radiation Protection practices among University Students, Buraydah, Saudi Arabia. Journal of Dental and Medical Sciences, 17(3), 71-77.
• Botwe, B. O., Antwi, W. K., Adesi, K. K., Anim-Sampong, S., Dennis, A. M. E., Sarkodie, B. D., & Opoku, S. Y. (2015). Personal radiation monitoring of occupationally exposed radiographers in the biggest tertiary referral hospital in Ghana. Safety in Health, 1(17), 1-7. doi:10.1186/s40886-015-0009-y
• Chang, Y. J., Kim, A. N., Oh, I. S., Woo, N. S., Kim, H. K., & Kim, J. H. (2014). The radiation exposure of radiographer related to the location in C-arm fluoroscopy-guided pain interventions. The Korean journal of pain, 27(2), 162.
• Faggioni, L., Paolicchi, F., Bastiani, L., Guido, D., & Caramella, D. (2017). Awareness of radiation protection and dose levels of imaging procedures among medical students, radiography students, and radiology residents at an academic hospital: Results of a comprehensive survey. European Journal of Radiology, 86, 135-142.
• Furmaniak KZ, Kołodziejska MA, & KT, S. (2016). Radiation awareness among dentists, radiographers and students.
• Furmaniak, K. Z., Kołodziejska, M. A., & Szopiński, K. T. (2016). Radiation awareness among dentists, radiographers and students. Dentomaxillofacial Radiology, 45(8), 20160097.
• Motevall, S. M., & Borhanazad, A. M. (2015). Assessment of occupational exposure in medical practice in Tehran, Iran. Romanian Reports in Physics, 67(2), 431-438.

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