ABSTRACT
The use of X-rays in medical diagnostic radiology has increased globally. The medical use of X-ray for diagnosis of illness is subject to the principles of justification and optimization for the protection of exposed individuals. Medical X-ray accounts for the largest exposure of humans to man-made ionizing radiation. Exposure of individuals can lead to long-term stochastic effects. Over exposure of humans in interventional procedures can also lead to deterministic effects such as skin burns in the short term. Even though, measures are put in place to protect the operators of the X-ray equipment, including radiologists, there are no systems to protect patients undergoing radiological examinations. To circumvent this problem therefore, this study was conducted to determine whether safety precautionary measures necessary for shielding patients contact to unsafe dose of radioactivity were being adhered to or not. The factors that affect patient protection include equipment performance, operator knowledge and skills in exposing the patient correctly to obtain the best diagnostic image with a minimum dose to the patient and monitoring and evaluation of patient dose to ensure consistency with Institutional Diagnostic reference level.
To achieve the study objectives therefore, the level of protection patients received during simple radiographic examinations in the Korle-Bu Teaching hospital and the Ridge hospital, was evaluated.
A cross-sectional study design was used in this research. A total of 175 participants were selected conveniently from the Korle-Bu Teaching and the Ridge hospitals. A selfadministered structured questionnaire was administered to obtain scientific and personal data. The entrance surface dose of radiation was measured using Multi-Purpose Detector. From the study, the performance indicator of protection measured was 1.6 (80%), Safety operations by management 1.06 (53%), Safety operations by radiographers 1.79 (89.5%), patients’ safety and knowledge 0.89 (44.5%), investigations and quality assurance 1.6 (80%), local rules and supervision 1.29 (64.5) and clinical dosimetry 1(50%).
There were no radiation survey meters in both facilities. Radiographers did not weigh patients to estimate their doses. Majority of Physicians were unaware of the accepted exposure dose of various segments of the human body. Due to poor record keeping, enquiries of previous radiographic examinations from patients were not conducted. Finally, patients at Ridge Hospital were exposed to relatively higher doses of radiation even though both facilities were within the diagnostic reference range for Akwa Ibom.
CHAPTER ONE
INTRODUCTION
1.1 Background
In November 1895, Von Rontgen of Wurzburg, Germany, discovered the X-ray while working with a Crookes’ tube (Berkeley, 1989). In 1896, Henri Becquerel also discovered radioactivity while working on X-ray (Radiation Protection Dosimetry, 2015). Radiology is the scientific use of X-rays and other high energy radiations for diagnosis and treatment (Sharma et al., 2016). Radioactive material or device is any substance that emits electromagnetic waves. The emission of electromagnetic particles is called radiation and the disintegration or breaking down of the atoms into ions is called ionization. Electromagnetic waves that are capable of disintegrating atoms into ions are known as ionizing radiations.
The knowledge of the harmful effects of ionizing radiation has since been documented. However, accidents that result in people getting injured still persist irrespective of the considerable development in radiation safety (Bengtsson, 1978).
Every material in nature has energy called the latent energy, which is an inherent property of the material. All materials have a fundamental elementary unit known as the atom. Each atom has subdivisions know as protons, neutrons and electrons. When the atoms of a particular substance have an unequal number of protons and neutrons, the substance is rendered unstable in electromagnetic energy and will therefore emit the excess energy in order to become stable. A radioactive material is therefore any substance that is unstable due to an unequal number of protons and neutrons and will release energy in a process called radioactive decay in order to be stable.
Radiation protection is a term applied to concepts, requirements, technologies and activities that are aimed at protecting people (Cunningham et al., 2004). Diagnostic and interventional radiology, are vital parts of present day medical practice (Inkoom et al., 2012). Improvements in X-ray imaging technology, coupled with developments in digital technology have had a significant impact on the practice of radiology. This comprises improvements in image quality, reductions in dose and a broader range of available applications resulting in better patient diagnosis and treatment (Heath et al., 2011). Nonetheless, the basic principles of X-ray image formation and the risks related with X-ray exposures have not changed significantly. X-rays have the potential for destroying healthy cells and tissues; therefore, all medical procedures involving X-ray equipment must be carefully controlled. In all facilities and for all types of equipment, procedures must be in place to ensure that exposures to patients, staff and the public are kept as low as reasonable achievable (ALARA).
Diagnostic X-rays account for a greater proportion of exposure of humans to ionizing radiations (Inkoom et al., 2012). On assessment of the global population dose of medical exposures to ionizing radiation from 1997 to 2007, the 2008 United Nations Scientific Committee on the effect of Atomic Radiation (UNSCEAR) reports that medical exposure continues to be the largest source of man-made exposure to ionizing radiation and it keeps growing substantially (Inkoom et al., 2012). Though individual doses associated with conventional radiography are mostly small, examinations concerning computed tomography and radioscopy can be significantly higher. However, a well-designed, installed and maintained X-ray equipment and the thorough use of appropriate procedures by trained operators reduce undue patients’ exposure without decreasing the value of medical information that is derived (Schandorf & Tetteh, 1998). Mostly, X-ray machine operators are aware of the problems associated with over exposures. However, the fundamental requirements are often not adhered to.
Over exposure to X-ray beams, poor infrastructure and unnecessary X-ray referrals are among factors reported to cause high exposure dose to patients above international recommendations (Schandorf & Tetteh, 1998a; Schandorf & Tetteh 1998b).
According to the 1998 report of UNSCEAR the need for radiation protection exists because exposure to ionizing radiation can result in damaging effects that manifest not only in the exposed individuals but also in their descendants. These effects are called somatic and genetic effects, respectively. Somatic effects are characterized by noticeable changes occurring in the organs of the exposed individual. The changes may appear within a few hours, or after many years, depending on the amount and duration of exposure to the individual (Harrison et al., 1983). Genetic effects however, are characterized by chromosomal damage in germ cells leading to mutation that give rise to genetic defects (abnormalities) such as leukemia (Akrobortu et al., 2013). Busch (1997) reported that, while the amount of dose of diagnostic radiation required to induce genetic defects may be small and may seem to cause no immediate noticeable damage, they are an equal cause for concern because of the ultimate consequences on the exposed individual.
1.2 Problem statement
The regulations for use of ionizing radiations (IRs) in medicine and industry have been in existence for years now, however, some health professionals, X-ray operators and technicians are still unaware of these regulations. As such, the aforementioned individuals are often not compliant to such regulations (Kyei & Antwi 2015). The knowledge, awareness and adherence to these regulations are key to reducing the level of exposure to IRs and the associated deleterious consequences (Dewi et al., 2010).
Secondly, most studies in radiology have focused on the protection of the worker through the use of dosimeter (Breitenstein & Seward, 2001). The perception is that, workers spend more time in areas of ionizing radiation and as such, it is they who need protection. For this reason, during simple radiographic examination, X-ray operators are stationed in a separate protected room, leaving the patient alone in an area that is charged with IR.
Finally, since institutional health and safety practices stipulate that healthcare facilities should be places for acquiring quality healthcare rather than contracting diseases (Brennan et al., 1991), it is imperative to set up safety measures to protect patients undergoing radiographic procedures or examinations.
1.3 Justification
X-rays are very useful in diagnosis and treatment of diseases. However, they are ionizing radiations and can therefore lead to various deleterious health outcomes such as cancers especially when there is over exposure during radiological examinations. In view if this, the findings of this study would enhance accreditation and regular monitoring of X-ray facilities to ensure that only qualified personnel and good equipment are used in radiological examinations necessary to ensure protection of patients against unsafe doses of X-ray.
Also, findings from this research would add to the knowledge of the roles that owners of Xray machines ought to possess in order to ensure protection of clients against harmful dose effects ionizing radiations. This will also serve as a protocol to be followed during employment of qualified personnel and the procurement of certified equipment in radiological examinations.
Furthermore, this study would provide critical knowledge on the need for X-ray facilities to be manned/operated by only technically qualified personnel who regularly undertake refresher courses in order to ensure that patients are exposed to only safe doses of X-ray during radiological examinations.
Lastly, this study would provide the critical evidence needed to support the importance of standardized and regularly maintained X-ray equipment and functional radiation monitoring and control system in administering safe doses of X-ray necessary to protect patients against excessive radiation exposure.
1.4 Research questions
1. Do X-ray facilities at the Korle-Bu Teaching and Ridge hospitals meet International safety standards set for patients?
2. Do Radiographers at the Korle-Bu Teaching and Ridge Hospitals have adequate training and certification?
3. Are patients at the Korle-Bu Teaching and Ridge Hospitals exposed to safe ionizing radiation doses that are consistent with international safety standards?
4. Are physicians at the Korle-Bu Teaching and Ridge Hospitals aware of the harmful effects of X-rays?
1.5 General Objective
To investigate the level of protection for patients against unsafe levels of radiation doses during radiological examination in X-ray facilities in Uyo
1.6 Specific Objectives
1. To assess safety standards at the X-ray facilities in Korle-Bu Teaching and Ridge Hospitals.
2. To assess the level of training and certification of radiographers at the X-ray facilities
3. To determine the actual doses of ionizing radiation that patients are exposed to during radiological examination at the Korle-Bu Teaching Hospital and Ridge Hospital.
4. To assess the knowledge of physicians on the hazardous effect of X-rays on patients during radiological examination
1.7 Conceptual framework
Figure 1 describes the conceptual framework for this research
Legal owners of X-ray facilities set up rules and regulations that ensure reduction in exposure of patients against radiation. These legal owners also ensure that qualified X-ray machine operators are employed. Periodically, they also advocate for in-service training to increase the knowledge of X-ray technicians, which also help in the reduction in exposure of patients to IR. Legal owners put in place systems to keep records of the patients’ histories at the X-ray facilities. This ensures that technicians keep records of previous encounters, thus reducing unnecessary and repeated examinations. Such practices reduce the long-term effect of patient’s exposure to ionizing radiation. Patients, who are also knowledgeable in radiation related issues are also better equipped to protect themselves from unnecessary exposure to IR by observing and adhering strictly to instructions given. Safety features at the radiological department are also necessary to prevent overexposure of patients to ionizing radiations. Physicians also justify X-rays in patients before they are taken. Lastly, when legal owners ensure quality assurance, there is reduction in exposure of clients to IR in the radiological departments.
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