|Year : 2021 | Volume
| Issue : 2 | Page : 93-99
A cross-sectional study based on the assessment of the radiation dose for medical radiation workers
Ali Aldhebaib1, Oinam Gokulchandra Singh1, Fayaz Ul Haq1, Saleh Talal Alqurbani1, Abdullah Ibrahim Barakheel Albarkheel2, Ahmed Alshamrani1, Azzam Omar Alnuwaiser1, Mohammed Abdullah Alsumykhi1, Ibrahem Ahmad Alhenaki1, Jayachandran Vetrayan3
1 Radiological Sciences Program, College of Applied Medical Sciences; King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Centre; King Abdul-Aziz Medical City-Ministry of National Guard Health Affiars, Riyadh, Saudi Arabia
2 King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Centre; King Abdul-Aziz Medical City-Ministry of National Guard Health Affiars; Department of Preventive Science, College of Dentistry, Riyadh, Saudi Arabia
3 King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Centre; King Abdul-Aziz Medical City-Ministry of National Guard Health Affiars; Occupational Therapy Program, College of Applied Medical Sciences, Riyadh, Saudi Arabia
|Date of Submission||02-Jun-2021|
|Date of Acceptance||31-Aug-2021|
|Date of Web Publication||12-Jan-2022|
Radiological Sciences Department, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh
Source of Support: None, Conflict of Interest: None
Background: A monitoring for radiological technologists and radiation workers must be implemented to ensure the radiation safety.
Aims: The aim of our study was to measure the occupational radiation dose for medical workers from the Department of Diagnostic Radiology, Cardiac Catheterization Laboratory, Nuclear Medicine, Dental Services, Endoscopy, and Surgery at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.
Materials & Methods: This study was conducted at KAMC, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia. Across-sectional study and a suitably and structured questionnaire was adapted from the previous similar studies and monitored radiation doses designed in line with the study's objectives were collected among the different medical workers. A total of 223 medical radiation workers were involved in this study, and descriptive statistics were used to analyze the data.
Results: It is noted that the diagnostic radiology department recorded the highest value of effective dose followed by cardiac catheterization laboratory and nuclear medicine and so on. The measured amount of effective dose for diagnostic radiology, cardiac catheterization laboratory, nuclear medicine, dental services, endoscopy, and surgery at KAMC was found to be 14.35, 5.23, 4.56, 3.88, 3.52, and 1.87 mSv, respectively.
Conclusions: This study provide an evidence that the occupational radiation dose for all the monitored departments at KAMC are well below the international recommended dose limit (20 mSv).
Keywords: Effective dose, ionizing radiation, medical radiation workers, thermoluminescent dosimeter
|How to cite this article:|
Aldhebaib A, Singh OG, Haq FU, Alqurbani ST, Barakheel Albarkheel AI, Alshamrani A, Alnuwaiser AO, Alsumykhi MA, Alhenaki IA, Vetrayan J. A cross-sectional study based on the assessment of the radiation dose for medical radiation workers. King Khalid Univ J Health Sci 2021;6:93-9
|How to cite this URL:|
Aldhebaib A, Singh OG, Haq FU, Alqurbani ST, Barakheel Albarkheel AI, Alshamrani A, Alnuwaiser AO, Alsumykhi MA, Alhenaki IA, Vetrayan J. A cross-sectional study based on the assessment of the radiation dose for medical radiation workers. King Khalid Univ J Health Sci [serial online] 2021 [cited 2022 Aug 8];6:93-9. Available from: https://www.kkujhs.org/text.asp?2021/6/2/93/335630
| Introduction|| |
Radiology is a branch of medicine where technology has revolutionized and transformed the delivery of health care on which most of the medical field depends. The continuous advancement improvement in technology has impacted the accuracy and efficiency of the patient's treatment plan, thereby improving the delivery of health care. There are many imaging modalities in medical imaging such as X-ray, fluoroscopy, computed tomography (CT), nuclear medicine, magnetic resonance imaging (MRI), ultrasound (USG), angiography and other department associated with the use ionizing radiation as the main source. All these modalities may be applied for the diagnosis and treatment purposes. Radiation is very harmful to human beings, and it causes different type of biological effects. Various forms of DNA damages can be induced because of the radiation exposures such as chromosomal aberrations and micronuclei. Radiation is used in various applications such as experimental studies, medicine, education, industry, and agriculture. People are exposed to radiation frequently from many sources rather than medical or occupational sources. Other sources called natural radiation sources to exist naturally, like solar sources and some foods containing some radioactive substances. Occupational radiation is a consequence of the radiation dose received by people because of the environmental workplace,, and the International Labor Organization uses the term occupational radiation exposure to describe this situation. Even though evidence proves the biological effects caused by exposure to high to moderate radiation doses, there is still a significant debate regarding the biological effects caused by exposure to low radiation doses. Radiographers are almost at a higher risk of developing biological effects caused by occupational radiation exposure, and one of the major effects induced through long exposure to low radiation doses such as X-ray are hematological changes, cancer and chromosomal damge.,, Many epidemiological studies on occupational workers and atomic bomb survivors showed that radiation exposure to low doses of ionizing radiation could lead to cancer, specifically, myeloma and leukemia. Whereas the primary radiation beam is the main source for the patient radiation dose, the scattered radiation from the patient's body is the primary source of the radiation dose for radiographers. Since radiography and radiation help diagnose patients through radiographic images, the regulation required to be used safely is a major issue. Assessment of the awareness of the occupational health workers and holding courses regarding radiation protection could be beneficial in the reduction of the radiation exposure dose to patients and staff. Radiation could be very hazardous when the protective and preventive practices are not considered, and the protection devices are not used. Occupational radiation protection is mandatory whenever radiation is used in practicing medicine. Radiation protection is a responsibility shared between specialized workers such as radiologists, radiological technologists, and medical physicists. There are many ways to make the patients and the radiographer safe from scattered radiation. The medical physicist considers a set of protocols to decide the necessity of using lead to shield the walls, doors, windows, floors, and ceilings to protect radiological and none radiological personal from unnecessary exposure to ionizing radiation. The shielding of walls and windows between the control room and the examination room results in no account of scattered radiation reaching the radiographer; rather than shielding the walls and windows, the radiographer could follow some easy ways like reducing the exposure time of the area to radiation. The distance plays an important role as well, and the exposure dose could be reduced by making a distance of 1 m between the personal and the scattered radiation source. Radiation protection could also be achieved through many other ways and by using various devices such as leaded aprons, thyroid shields, leaded glasses, and leaded gloves. The assessment of the exposure radiation dose to the occupational workers is critical to be considered. A monitoring program for radiological technologists and radiation workers should be implemented. There are many reasons for occupational radiation exposure to be monitored, and the most obvious reason is to confirm and show the difference with their regulatory dose limits. The most widely used techniques of personal monitoring are the film badge and thermoluminescent dosimeter (TLD) used to assess the whole-body radiation exposure. Dental film in the radiation workers' pockets is the technique which was used among radiation workers, and the exposure dose was amassed by how much fogging are in the film or the gross density on the film, and then the method is abandoned after the invention of film badges which give much more precise measurements of exposure. Nowadays, TLDs are the way to measure the exposure radiation dose, and it is made up of calcium fluoride with manganese or lithium fluoride, which is more widely used those materials emit light (thermoluminescence) when heated after the radiation exposure. The aim of our study was to measure the occupational radiation dose history, identify the highest exposure department and check the radiation guideline followed in King Abdul-Aziz Medical City (KAMC), Riyadh, Saudi Arabia
| Materials and Methods|| |
The aim of this study was to measure the occupational radiation dose for medical workers from the Department of Diagnostic Radiology, Cardiac Catheterization Laboratory, Nuclear Medicine, Dental Services, Endoscopy, and Surgery at KAMC, Riyadh, Saudi Arabia. A cross-sectional study and a suitably and structured questionnaire was adapted from the previous similar studies and monitored radiation doses designed in line with the study's objectives were collected among the different medical workers. The survey consisted of seven questions consisting of demographic characteristics, job type, use of the protective lead shield, the experience of high radiation exposure, and the level at which TLD badges are worn. All participants were adults above 18 years of age with more than 5 years of experience in any medical radiation imaging modalities and willing to provide written informed consent. Participants who are unwilling to give consent and work in nonionizing imaging modalities such as MRI and USG modalities and any medical radiation workers with <5 years of experience are excluded from this study.
In this study, TLD badges were used. The medical physicist interpreted the TLD dose measurements. It consists of different components within the TLD badge, such as cards with holders containing Harshaw detector crystal known as LiF: Ti, Mg (Lithium fluoride with Magnesium and Titanium dopants), and an essential ingredient. It provides the overall dose of skin and deep tissue. All the occupational medical workers were recommended to wear the TLD badge in proper places during their work. Our sample size was 223 medical radiation workers in which most of the medical workers wear the TLD badge at the chest level considering 207 medical workers out of 223. In the nuclear medicine department case, 16 occupational workers were obtained for the fingertips of the index and middle fingers to measure the Hp (0.07) personal dose equivalent values for the skin and to the hand and feet at a depth of 0.07 mm. All the medical workers were recommended to have one TLD badge except the workers in the nuclear medicine department, for they required more than one TLD badge. A Strontium-90 (90Sr) internal irradiator with a dose of 0.5 mCi was applied for calibration and quality control purposes. All the TLD reading for the medical workers was done in a designated area of the dosimetry laboratory at King Abdullah Specialist Hospital and Children's Hospital. TLD reader model from theromoscientific harshaw TLD 66,000 was used to measure the body dose, including the Hp (10) and Hp (0.07), from 2015 to 2020. Following the report from International Commission on Radiation on Radiological Units and Measurements (ICRP) guidelines for monitoring and analyzing, the whole body dose was reported in term of personal dose equivalent Hp (10).
The collected data were entered in Microsoft Excel and transferred to JMP statistical computer program for statistical analysis. Descriptive statistics in terms of mean, percentage, and frequencies were used to analyze the respondent answer and TLD dose. The confidentiality of all patients was protected, and personal data stored on the computer were accessible only to the researcher. Subject data were coded, and participant's name was not used
| Results and Discussion|| |
Distribution of occupational medical workers
According to our study, distributed questionnaires among the 223 medical radiation workers were returned and properly filled. As stated in [Table 1] and [Table 2], it is reported that 163 participants were male and 60 were female. It is also clarified that 164 occupational medical workers were monitored from the diagnostic radiology department, followed by 25 from dental service, 22 cardiac catheterization laboratories, 20 endoscopies, 16 nuclear medicine, and 8 from the surgery department, respectively. The percentage distribution is a follows: Diagnostic radiology department (59.19%), dental services (11.21%), cardiac catheterization laboratory (9.86%), endoscopy department (8.96%), nuclear medicine (7.17%), and surgery department (3.58%). [Figure 1] shows the contribution of each type of medical radiation worker to the total monitored workers in all categories of medical, occupational radiation workers, and their designation during 2015–2020. According to the participant's answer about the experience of high-level radiation exposure, 98.65% of the respondent answered “yes,” and 1.35% answered “no.” Moreover, participants were asked about the use of radiation protective devices during the procedure; entire respondents answered “yes;” when asked about at which level do you wear TLD badge, 92.82% were answered at the level of collar and 7.17% at the level of extremities. Similarly, it is also found that 100% of the entire employees were full-time.
|Table 1: Distribution of questionnaires among the occupational medical worker|
Click here to view
|Table 2: Distribution of radiation workers monitored in all occupational categories|
Click here to view
|Figure 1: Contribution of each type of medical radiation worker to the total monitored workers|
Click here to view
Distribution of radiation doses at the department of diagnostic radiology department (general X-ray, fluoroscopy, computed tomography scan, and vascular and nonvascular angiography section)
It is illustrated in [Table 3] for a different type of occupational radiation workers concerning the measured doses for diagnostic radiology department (general X-ray, fluoroscopy, CT scan, and vascular and nonvascular angiography section) including their job position such as X-ray technologist, CT technologist, angiography technologist, radiology nurse, radiologist, and medical physicist. For the radiologist, this represents the most significant number of radiation workers, and [Table 2] indicates that the mean effective dose over a period for 5 years from 2015 to 2020 ranged from 1.38 to 2.97 mSv, with an average effective dose of 2.39 mSv. Similarly, the individual annual mean effective dose ranged from 0.27 to 0.59 mSv, with an average effective dose of 0.47 mSv. In comparison to the ICRP, all these obtained values are below the international recommendation dose limit, 20 mSv for occupational medical radiation workers. It is to mention that all radiation workers were wearing radiation protective devices while performing procedures, as shown in [Table 1]. As shown in [Table 3], the highest number of radiation dose was recorded from a radiologist with an individual annual effective dose ranged from 0.74 to 28.82 mSv recorded by the chest TLD worn followed by X-ray technologist, angiography technologist, CT technologist, radiology nurse, and medical physicist, respectively. To conclude, diagnostic radiology occupied the highest number of effective radiation doses among medical radiation workers.
|Table 3: Distribution of the effective dose (mSv) to radiation workers in the radiology department monitored for a cumulative period of 5 years from 2015 to 2020|
Click here to view
Distribution of occupational doses at the department of nuclear medicine department
[Table 4] shows the distribution of effective doses by radiation workers in the nuclear medicine department. The results for the hand equivalent dose were monitored and illustrated below. The annual mean effective dose ranged from 0.43 to 0.47 mSv at the chest level, whereas the hand equivalent dose ranged from 8.12 to 36.61 mSv. Based on the international recommendation dose limit to the skin of the hands (500 mSv/year), our study concluded that the measured doses are well below the dose limit., It was noted that nuclear medicine received a higher value of individual monitoring for the assessment of the dose to the skin and the hands and feet at a depth of 0.07 mm of skin than any other medical radiation department. It is because nuclear medicine job responsibilities carry out the examinations according to the given protocol.
|Table 4: Distribution of the effective dose (mSv) by radiation workers in the nuclear medicine department|
Click here to view
Occupational doses at the department of cardiac catheterization laboratory
Cardiology is the most dynamic field in terms of medical exposure due to the application of diagnostic X-rays. As shown in [Table 5], the cardiac catheterization laboratory was found to measure an effective annual dose of 0.46–0.26 mSv with an average effective dose 0.52 mSv/year. The annual effective dose to a cardiac laboratory technologist ranged from 0.14 to 6.07 mSv). For consultant, the annual effective dose ranged from 1.41 to 7.40 mSv). This does remain well below the international recommended dose limit. It is also reported that the cardiac catheterization laboratory department occupied a higher average effective dose than the diagnostic radiology department.
|Table 5: Distribution of the effective dose (mSv) by radiation workers in the cardiac catheterization laboratory|
Click here to view
Occupational doses at the department of surgery, dental, and endoscopy
[Table 6] shows the distribution of annual dose for differences among the occupational workers in another department. The annual effective for the orthopedic surgery department ranged between 0.07 and 0.30 mSv. Similarly, in the dental services, the annual effective was recorded between ranged from 0.48 to 0.29 mSv. The annual effective dose to a dentist ranged from 0.55 to 6.66 mS. For dental technicians, the annual effective ranged between 0.46 and 2.97 mSv. Moreover, it also concluded that a gastroenterologist was reported to measure an annual effective dose from 0.63 to 2.09 mSv with an average effective dose of 0.36 mSv/year. For ERCP technicians, the annual effective ranged between 1.44 and 2.57 mSv. All the monitored doses were well below the international recommendation dose limit.
|Table 6: Distribution of the effective dose (mSv) by radiation workers in other departments (surgery, dental services, and endoscopy)|
Click here to view
[Figure 2] shows the distribution of the annual average effective dose of every department of KAMC, Riyadh, Saudi Arabia, during the period from 2015 to 2020
|Figure 2: Average annual effective dose (mSv) for medical radiation workers in (a) the diagnostic radiology department (b) the nuclear medicine department (c) cardiac catheterization laboratory (d) the other department including the dental services, surgery department, and endoscopy department. MP: Medical Physicist, XT: X-ray technician, CTT: CT scans Technologist, AT: Angiography Technologist, R: Radiologist, NMT: Nuclear Medicine Technologist, NMP: Nuclear Medicine Physician, RN: Radiology Nurse, CLC: Catheterization Laboratory Consultant, CLT Catheterization Laboratory Technician, OT: Orthopedic Technician, OS: Orthopedic surgeon, D: Dentist, DT: Dental Technician, GT: Gastroenterologist, and ET: Endoscopic Technician|
Click here to view
[Table 7] shows the available worldwide annual effective dose in three medical fields for occupational exposure during a block of 4 years.,, Approximately more than 60% of all monitored medical radiation workers at King Abdul-Aziz Medical City (KAMC) had annual effective doses below the average level of global occupational exposure of 0.5 mSv as reported among the 7440,000 monitored individual occupational medical radiation worker during 2000–2002.
|Table 7: Comparison of the average annual effective dose in the medical exposure fields of diagnostic radiology, nuclear medicine, and other departments at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia, with that of other countries of the world and with world United Nations Scientific Committee on the Effects of Atomic Radiation data|
Click here to view
[Figure 3] shows clearly that the diagnostic radiology department recorded the highest value of effective dose followed by cardiac catheterization laboratory and nuclear and so on. For the diagnostic radiology department, the maximum number of effective doses came from the radiologist of the angiography section. Subsequently, the dose obtained is still below the recommended dose limit 20 mSv/year, which is 100 mSv cumulative for 5 years. As shown in [Table 7], the available global annual effective dose during a block of 4 years is given with United Nations Scientific Committee on the Effects of Atomic Radiation data and our values.
|Figure 3: Mean effectiveness of all the medical radiation departments during 2015–2020|
Click here to view
| Conclusion|| |
The measured amount of effective dose for diagnostic radiology, cardiac catheterization laboratory, nuclear medicine, dental services, endoscopy, and surgery at KAMC was 14.35, 5.23, 4.56, 3.88, 3.52, and 1.87 mSv. The occupational radiation dose for all the monitored departments is well below the recommended dose limit (20 mSv). Subsequently, similar studies on the global assessment for the personal dose monitoring in the department of dental, endoscopy, and surgery were found to be very limited.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aldhebaib A, Singh OG, Almutlaq Z, Alaqeel A, Alkhalifah RS, Alnasser TN, et al
. A study based on the perception towards the radiation exposure to adult patients at King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. J Ad Med Med Res 2018; 26:1-11.
Alashban Y. An assessment of occupational effective dose in several medical departments in Saudi Arabia. J King Saud Univ Sci 2021; 33:101402.
Hendee WR. Estimation of radiation risks. BEIR V and its significance for medicine. JAMA 1992; 268:620-4.
Nassef M, Kinsara A. Occupational radiation dose for medical workers at a university hospital. J Taibah Univ Sci 2017;11:1259-66.
Salama KF, 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;20:21-5
Jabeen A, Munir M, Khalil A, Masood M, Akhter P. Occupational exposure from external radiation used in medical practices in Pakistan by film badge dosimetry. Radiat Prot Dosimetry 2010;140:396-401.
Al-Abdulsalam A, Brindhaban A. Occupational radiation exposure among the staff of departments of nuclear medicine and diagnostic radiology in Kuwait. Med Princ Pract 2014;23:129-33.
Valuckas KP, Atkočius V, Samerdokienė V. Occupational exposure of medical radiation workers in Lithuania, 1991-2003. Acta Med Lit 43 2007;14(3):155-159
Musa NA. Effects of Long Term Low X-ray Radiation Dose on Blood Compounds of Radiology Staff of Health Centers in Libya: The National Ribat University; 2017.
Zakeri F, Hirobe T, Akbari Noghabi K. Biological effects of low-dose ionizing radiation exposure on interventional cardiologists. Occup Med (Lond) 2010; 60:464-9.
Paolicchi F, Faggioni L, Bastiani L, Molinaro S, Caramella D, Bartolozzi C. Real practice radiation dose and dosimetric impact of radiological staff training in body CT examinations. Insights Imaging 2013; 4:239-44.
Shabani F, Hasanzadeh H, Emadi A, Mirmohammadkhani M, Bitarafan-Rajabi A, Abedelahi A, et al
. Radiation protection knowledge, attitude, and practice (KAP) in interventional radiology. Oman Med J 2018;33:141-7.
ALMasri HY, Kakinohana Y, Yogi T. Occupational radiation monitoring at a large medical center in Japan. Radiol Phys Technol 2014; 7:271-6.
Miller DL, Vañó E, Bartal G, Balter S, Dixon R, Padovani R, et al
. Occupational radiation protection in interventional radiology: A joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol 2010; 33:230-9.
Meghzifene A, Vano E, Le Heron J, Cheung KY. Roles and responsibilities of medical physicists in radiation protection. Eur J Radiol 2010; 76:24-7.
Steven B, Dowd ER. Practical Radiation Protection and Applied Radiobiology. 2nd
ed. Philadelphia, USA: Saunders; 1999.
Le Heron J, Padovani R, Smith I, Czarwinski R. Radiation protection of medical staff. Eur J Radiol 2010; 76:20-3.
Abdulsalam A, Brindhaban A. Occupational radiation exposure among the staff of departments of nuclear medicine and diagnostic radiology in Kuwait. Med Princ Pract 2014; 23:129-33.
ICRP (The International Commission Radiological Protection). The 2007 Recommendation of the international Commission on Radiological Protection (ICRP Publication 103; Annals of the ICRP 37 (2-4).
Samerdokiene V, Atkocius V, Kurtinaitis J, Valuckas KP. Occupational exposure of medical radiation workers in Lithuania, 1950-2003. Radiat Prot Dosimetry 2008; 130:239-43.
Charles M. Effects of Ionizing Radiation: United Nations Scientific Committee on the Effects of Atomic Radiation: UNSCEAR 2006 Report, Volume 1 – Report to the General Assembly, with Scientific Annexes A and B. Oxford University Press; 2010.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]