RESEARCH ARTICLE


Ionizing Radiation: Are Radiology Professionals at Risk?



Sharmin Sultana1, *, Faisal Muhammad1, 2, 3, ABM Alauddin Chowdhury1, Salim Khan4
1 Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Daffodil Smart City, Birulia, Savar, Dhaka 1216, Bangladesh
2 Department of Public and Community Health, Faculty of Medicine and Health Sciences, Frontier University Garowe, Puntland, Somalia
3 Otu Institute of Research and Training, Kano, Nigeria
4 Department for Therapies and Public Health, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK


Article Metrics

CrossRef Citations:
0
Total Statistics:

Full-Text HTML Views: 239
Abstract HTML Views: 144
PDF Downloads: 151
ePub Downloads: 116
Total Views/Downloads: 650
Unique Statistics:

Full-Text HTML Views: 160
Abstract HTML Views: 97
PDF Downloads: 107
ePub Downloads: 78
Total Views/Downloads: 442



Creative Commons License
© 2023 Sultana et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Daffodil Smart City, Birulia, Savar, Dhaka 1216, Bangladesh; Tel: +8801914004601; E-mail: sharmin.rit@gmail.com




Dear Editor,

A number of scientific discoveries towards the end of the 19th century brought a greater understanding of radiation and, in particular, its harmful effects [1]. Nevertheless, radiation has become a useful tool in modern medicine and science. Ionizing radiation, in particular, is an effective diagnostic technique used in medical imaging [2]. Examples of ionizing radiation include high-energy ultraviolet radiation, X-rays, neutrons, gamma rays, alpha particles, and beta particles [3]. Ionizing radiation comes from a variety of natural sources which include cosmic radiation from space and environmental radiation from rocks and soil. The term “background radiation” is used to describe these radiation sources. Nuclear energy sources, and medical equipment, for example, X-ray machines, CT scanners, and mammography, as well as industrial equipment used for scientific study and measurement, are all examples of artificial sources of ionizing radiation [3]. Ionizing radiation has numerous uses in industry, agriculture, research, and medicine. However, when radiation doses exceed a particular threshold, severe health problems may develop, including skin burns or acute radiation syndrome. Even at low doses, prolonged ionizing radiation can result in cancer [4]. Short-term exposure to radiation doses of 10 Sv and higher can affect the normal functioning of organs and tissues within the body and continued exposure can lead to death [5].

Radiology professionals made up a sizable portion of the working population exposed to radiation from man-made sources and were among the first occupational groups to be subjected to ionizing radiation [6, 7]. To ensure that exposure to ionized radiation is prevented, radiology professionals make use of protective equipment which includes physical protection via gloves, eye protection, masks, face shields, gowns, lead aprons, thyroid shields, and personal radiation dosimeters [8].

Caseload and exposure to ionizing radiation appear to vary depending upon country. In South Korea, male professionals were more frequently involved in interventional radiology, portable X-rays, and CT scans, whereas female professionals performed most mammography procedures. The average yearly effective dose for male and female professionals in South Korea for example, was 2.3 mSv and 1.3 mSv, respectively [9]. Despite receiving lower radiation doses than males, female professionals had a greater risk of radiation-related cancers. Women's increased risk of breast and thyroid cancer was the main cause of their higher lifetime attributable risk (LAR). In most other cancer locations, men had greater LARs than women [10].

Several studies have shown that being exposed to medical radiation increases the risk of thyroid carcinoma, bone marrow suppression, cataract, infertility, and congenital disabilities [11-13]. Different radiation-related disorders have different threshold doses. For instance, cancer and teratogenic consequences [13] are linked to doses of 100–200 mGy, but cataracts are linked to doses of 500 mGy [14]. Therefore, decreasing radiation exposure among radiology professionals depends greatly on awareness and knowledge of radiation hazards and protective procedures [15].

In Greece, the level of health professionals' general knowledge of the safety of radiation protection was unsatisfactory [16]. There were higher misconceptions about radiation and radiation protection among women and workers with lower levels of education [16]. Recent literature has raised concerns that referring doctors' awareness of radiation doses received during diagnostic radiological procedures was insufficient [17, 18]; that knowledge about radiation dose and risk among radiology professionals is still inadequate [19, 20]; and many radiology practitioners still maintain that X-rays do not immediately generate serious adverse effects [21]. In addition, such practitioners are not sufficiently aware of radiation protection [22] or are not using appropriate protection correctly. In Bangladesh, 10% of radiological technologists have some knowledge of the As Low As Reasonably Achievable principle and ionizing radiation; 28% of the technologists did not regularly wear lead aprons at work [23]; and radiation protection equipment is deficient or completely absent in many hospitals [7].

Ultrasound is another diagnostic procedure that is not based on ionizing radiation. This procedure could prevent exposure to ionizing radiation. The most commonly used medical imaging technique for examining the fetus during pregnancy is ultrasound. Furthermore, the diagnosis of lung cancer in clinical practice benefits from using lung ultrasonography [24].

Whilst the impact of radiation is becoming more prevalent, many radiology professionals are still not fully cognizant of the associated health hazards. There needs to be a more concerted effort to promote the importance of appropriate health and safety amongst radiology professionals and a more rigorous approach to the use of protective equipment to prevent exposure to ionizing radiation and its long-term impact on health.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

We are extremely grateful to Dr. Mushtaque Ahmed Jalali, Associate Professor & Head, Department of Radiology & Imaging, National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka-1212, Bangladesh..

REFERENCES

[1] Bushberg JT, Seibert JA, Jr EML, Boone JM. The essential physics of medical imaging. 2003. [http://dx.doi.org/10.1007/S00259-003- 1310-2]
[2] Apostolova DB, Paskalev ZD. Ionizing radiation used in medical diagnostics as a source of radiation exposure of the patient with occupational diseases. Available from:https://inis.iaea.org/collection/ NCLCollectionStore/_Public/32/039/32039821.pdf
[3] About radiation. 2016. Available from:https://www.canada.ca/en/ health-canada/services/health-risks-safety/radiation/understanding/about.html
[4] Ionizing radiation, health effects and protective measures. 2016. Available from:https://www.who.int/news-room/fact-sheets/detail/ ionizing-radiation-health-effects-and-protective-measures
[5] Health effects of ionising radiation Available from:https://www.arpansa.gov.au/understanding- radiation/what-is-radiation/ionising-radiation/health-effects
[6] Yoshinaga S, Mabuchi K, Sigurdson AJ, Doody MM, Ron E. Cancer risks among radiologists and radiologic technologists: Review of epidemiologic studies. Radiology 2004; 233(2): 313-21.
[7] Salama K, AlObireed A, AlBagawi M, AlSufayan Y, AlSerheed M. Assessment of occupational radiation exposure among medical staff in health-care facilities in the Eastern Province, Kingdom of Saudi Arabia. Indian J Occup Environ Med 2016; 20(1): 21-5.
[8] Bickle I. Personal protective equipment. 2020. Available from:https://radiopaedia.org/articles/personal-protective-equipment
[9] Lee J, Cha ES, Jeong M, Lee WJ. A national survey of occupational radiation exposure among diagnostic radiologic technologists in South Korea. Radiat Prot Dosimetry 2015; 167(4): 525-31.
[10] Lee WJ, Choi Y, Ko S, et al. Projected lifetime cancer risks from occupational radiation exposure among diagnostic medical radiation workers in South Korea. BMC Cancer 2018; 18(1): 1206.
[11] Dagal A. Radiation safety for anesthesiologists. Curr Opin Anaesthesiol 2011; 24(4): 445-50.
[12] Iglesias ML, Schmidt A, Ghuzlan AA, et al. Radiation exposure and thyroid cancer: a review. Arch Endocrinol Metab 2017; 61(2): 180-7.
[13] Sont WN, Zielinski JM, Ashmore JP, et al. First analysis of cancer incidence and occupational radiation exposure based on the National Dose Registry of Canada. Am J Epidemiol 2001; 153(4): 309-18.
[14] Chodick G, Bekiroglu N, Hauptmann M, et al. Risk of cataract after exposure to low doses of ionizing radiation: a 20-year prospective cohort study among US radiologic technologists. Am J Epidemiol 2008; 168(6): 620-31.
[15] Khamtuikrua C, Suksompong S. Awareness about radiation hazards and knowledge about radiation protection among healthcare personnel: A quaternary care academic center–based study. SAGE Open Med 2020; 8: 2050312120901733.
[16] Goula A, Chatzis A, Stamouli MA, Kelesi M, Kaba E, Brilakis E. Assessment of health professionals’ attitudes on radiation protection measures. Int J Environ Res Public Health 2021; 18(24): 13380.
[17] Jacob K, Vivian G, Steel JR. X-ray dose training: Are we exposed to enough? Clin Radiol 2004; 59(10): 928-34.
[18] Gower-Thomas K, Lewis MH, Shiralkar S, Snow M, Galland RB, Rennie A. Doctors’ knowledge of radiation exposures is deficient. BMJ 2002; 324(7342): 919.
[19] Ramanathan S, Ryan J. Radiation awareness among radiology residents, technologists, fellows and staff: where do we stand? Insights Imaging 2015; 6(1): 133-9.
[20] Maharjan S, Parajuli K, Sah S, Poudel U. Knowledge of radiation protection among radiology professionals and students: A medical college-based study. Eur J Radiol Open 2020; 7: 100287.
[21] Kang KW. History and organizations for radiological protection. J Korean Med Sci 2016; 31(Supp 1): S4-5.
[22] Paolicchi F, Miniati F, Bastiani L, et al. Assessment of radiation protection awareness and knowledge about radiological examination doses among Italian radiographers. Insights Imaging 2016; 7(2): 233-42.
[23] Hossen M, Rana S, Parvin T, Muraduzzaman SM, Jalali MA. Evaluation of knowledge, awareness, and attitude of MRI technologists towards MRI safety in Dhaka city of Bangladesh. Int J Pure Med Res 2019; 5(5): 16-9.
[24] Esposito F, Palumbo F, Romano C, et al. Ultrasound tips in the lung cancer diagnosis: A pilot study. WCRJ 2023; 10: e2483.