Evaluation of non-radiologist physicians' knowledge on aspects related to ionizing radiation in imaging

REFERRING PHYSICIANS' KNOWLEDGE OF THE RADIATION DOSES FOR COMMONLY RADIOLOGICAL INVESTIGATIONS IN NASIRIYA TURKISH HOSPITAL

OBJECTIVE

The aim: To assess the referring physicians' knowledge of the radiation doses for commonly radiological investigations in Nasiriya Turkish Hospital (NTH).

PATIENTS AND METHODS

Materials and methods: A cross-sectional study of referring physicians in NTH was carried out. A two-part questionnaire was distributed to all Referring Physicians' apart from radiologists. Radiological examinations were listed and Referring Physicians' were asked to estimate equivalent doses using the dose of postero-anterior chest X-Ray as a reference. Questions on knowledge of radiation (including radiation exposure and doses, protection, maximizing effectiveness, impacts of ionizing radiation) and utilization of referral guidelines were included.

RESULTS

Results: A total of 50 were distributed to the participants, 32 were returned and deemed acceptable for inclusion in this study. The participants' demographic data shows that most are male 21 (65.6%), while 11 (34.4%) are female. Up to 23 (71.9%) of participants had knowledge of ionizing radiation, but only 7 (21.9%) physicians were aware of its unit measurement. Most participants were unable to accurately estimate the radiation dose absorbed by patients during the various radiological examinations; 68.8% had no knowledge of radiations' stochastic and non-stochastic impacts; 14 (43.7%) were aware of the referral guidelines and used them. The majority of the participants 24 (75%) are aware that USS is safe for pregnant women. only 1(3%) physician knew that there is no ionizing radiation involved in MRI.

CONCLUSION

Conclusion: Most participants did not able to accurately estimate the radiation dose absorbed by patients during the various radiological examinations.

Radiation safety awareness and practices amongst orthopaedic surgeons in Scotland

As orthopaedic surgeons we use x-rays every day; not only when diagnosing pathology but often to assist in operative management of said pathology or ensure satisfactory outcomes for our patients in clinic. An awareness of the correct use of ionising radiation in the form of fluoroscopic imaging is therefore of great importance to reduce intraoperative exposure and has led to the development of the As Little As Reasonably Achievable (ALARA) principle. The primary aim of this study is to determine the knowledge and practises of radiation safety amongst orthopaedic surgeons in Scotland. Secondary aim is to assess the prevalence of back pain and relation to lead gowns. A google forms survey containing 20 questions about both an individual's radiation practises, and knowledge and departmental practises were distributed to all 4 deaneries in Scotland. In total 72 responses were received from 20 hospitals across all 4 Scottish deaneries. This included 28 Consultants, 23 Senior trainees and 21 Junior trainees. We found that the level of radiation training and knowledge varied considerably across seniority and the nation. Of those surveyed 100% reported always wear lead aprons/gowns however only 46.2% (n = 34) frequently or always wear thyroid protection when using X-rays. Only 55% (n = 40) of those surveyed had completed a radiation safety course with this being far less likely amongst junior trainees (29%, n = 6) than amongst Consultants (82%, n = 23) and senior trainees (48%, n = 11) (p < 0.0001). To our knowledge this is the most extensive survey into the radiation practises of Orthopaedic Surgeons in the literature and shows the need for increased education and awareness of radiation safety practises, particularly amongst junior trainees.

Physician Knowledge of Radiation Exposure and Risk in Medical Imaging

PURPOSE

Medical imaging is an increasingly important source of radiation exposure for the general population, and there are risks associated with such exposure; however, recent studies have demonstrated poor understanding of medical radiation among various groups of health care providers. This study had two aims: (1) analyze physicians' knowledge of radiation exposure and risk in diagnostic imaging across multiple specialties and levels of training, and (2) assess the effectiveness of a brief educational presentation on improving physicians' knowledge.

METHODS

From 2014 to 2016, 232 health care providers from multiple departments participated in an educational presentation and pre- and postpresentation tests evaluating knowledge of radiation exposure and risk at a large academic institution.

RESULTS

Knowledge of radiation exposure and risk was relatively low on the prepresentation test, including particularly poor understanding of different imaging modalities, with 26% of participants unable to correctly identify which modalities expose patients to ionizing radiation. Test scores significantly increased after the educational presentation. Radiologists had higher prepresentation test scores than other specialties, and therefore less opportunity for improvement, but also demonstrated improvement in radiation safety knowledge after education. Aside from radiology, there was no significant difference in initial knowledge of radiation exposure and risk among the other specialties.

CONCLUSIONS

Providers' knowledge of radiation exposure and risk was low at baseline but significantly increased after a brief educational presentation. Efforts to educate ordering providers about radiation exposure and risk are needed to ensure that providers are appropriately weighing the risks and benefits of medical imaging and to ensure high-quality, patient-centered care.

Study of scattered radiation during fluoroscopy in hip surgery

Objective

To measure the scattered radiation dose at different positions simulating hip surgery.

Materials and Methods

We simulated fluoroscopy-assisted hip surgery in order to study the distribution of scattered radiation in the operating room. To simulate the patient, we used a anthropomorphic whole-body phantom, and we used an X-ray-specific detector to quantify the radiation. Radiographs were obtained with a mobile C-arm X-ray system in continuous scan mode, with the tube at 0º (configuration 1) or 90º (configuration 2). The operating parameters employed (voltage, current, and exposure time) were determined by a statistical analysis based on the observation of orthopedic surgical procedures involving the hip.

Results

For all measurements, higher exposures were observed in configuration 2. In the measurements obtained as a function of height, the maximum dose rates observed were 1.167 (± 0.023) µSv/s and 2.278 (± 0.023) µSv/s in configurations 1 and 2, respectively, corresponding to the chest level of health care professionals within the operating room. Proximal to the patient, the maximum values were recorded in the position occupied by the surgeon.

Conclusion

We can conclude that, in the scenario under study, health care professionals workers are exposed to low levels of radiation, and that those levels can be reduced through the use of personal protective equipment.

Patterns and trends of computed tomography usage in outpatients of the Brazilian public healthcare system, 2001-2011

While the patterns and trends of computed tomography (CT) are well documented in developed countries, relatively little is known about CT usage in developing countries, including Brazil. We evaluated CT usage among outpatients from the public healthcare system in Brazil (SUS), which is the unique healthcare provider to about 75% of the Brazilian population. We collected the annual number of CT procedures and type of CT examinations performed in SUS for the period 2001-2011. Age at examination was evaluated for 2008-2011. CT usage in Brazil has more than tripled during the study period, but the most striking annual increase (17.5%) was observed over the years 2008-2011. Head was the most frequently examined region for all age groups, but a decreasing trend of proportional contribution of head CT, with a simultaneous increase of abdomen/pelvis and chest CT over time was observed. CT examination for pediatric and young adult patients was about 13% of all CTs (9% if we considered age-standardized CT rates). CT usage has grown rapidly in Brazil and may still be increasing. Increased CT usage may certainly be associated with improved patient care. However, given the high frequency of pediatric and young adult CT procedures and the suggested associated cancer risk, efforts need to be undertaken to reduce unwarranted CT scans in Brazil.