Issue
Radioprotection
Volume 57, Number 1, January-March 2022
Page(s) 49 - 54
DOI https://doi.org/10.1051/radiopro/2021034
Published online 17 January 2022

© SFRP, 2022

1 Introduction

Medical imaging is an essential modality for medical staff in diagnosing and treating several diseases. The most common imaging tools used in medical imaging include positron emission tomography, computed tomography, conventional radiography, mammography, and fluoroscopy. These imaging modalities use ionizing radiation, which can pose a risk to both patients and staff. It has been shown that ionizing radiation interferes with human cells can destroy cell function, and may cause degenerative diseases, developmental abnormalities, genetically determined diseases, and cancer (Hall and Giaccia, 2006). Thus, radiation protection is indeed needed. Radiation protection is a term used by health professionals to describe the steps they take to protect themselves, their patients, other clinical staff, and public members from the harmful effects of ionizing radiation (Guide, 2018; Turner, 2008).

Nurses play a critical role in providing care to their patients undergoing diagnostic or therapeutic imaging tests in the nuclear medicine department (NMD), demonstrating and explaining the treatment procedures, preparing the patients for the procedures, ensuring patient safety, and organizing the use of radioactive and non-radioactive medications (Vijayakumar et al., 2006; Ubolnuch, 2015). Healthcare workers, particularly nurses, are at a significant risk of exposure to the harmful effects of ionizing radiation. However, nurses working in NMDs should understand the practical control measures for minimizing external radiation exposure using different radiation protection procedures, such as knowing the principles of radiation protection procedures using shielding, distance, and time. Nurses working in NMDs should also monitor devices, such as thermo-luminescent dosimeters (TLDs) and the Geiger-Müller (GM) counter. According to the 10-day rule, non-urgent examinations involving pelvic radiation in women of childbearing age should be limited to the first 10 days of the menstrual cycle. As low as reasonably achievable (ALARA) aims to maximize benefits while avoiding risks by using the minimum radiation dosage. The use of shielding, maintaining a greater distance from the radiation source, and reducing the time of radiation exposure minimize exposure to external radiation (Kim, 2018; Martin et al., 2018).

The standard education of nurses is mainly focused on patient care, with little attention paid to patient care in NMDs and radiation protection. In previous studies, nurses working in radiology departments were found to have a general lack of radiation protection education (Alotaibi and Saeed, 2006; Badawy et al., 2016). Similar findings were reported in studies from different countries about nurses working in NMDs (Alotaibi et al., 2015; Yunus et al., 2014). In Saudi Arabia, there were no studies in which radiation protection awareness and safety practices among nurses working in NMDs, in particular, were evaluated. Therefore, this study was aimed to evaluate the level of radiation protection awareness and safety practices among nurses working in NMDs in Saudi Arabia.

2 Materials and methods

In this study, a cross-sectional survey was used to evaluate the level of radiation protection awareness and safety practices among nurses working in NMDs in governmental, private, and specialized hospitals in Saudi Arabia. There was no national database for nurses who worked in NMDs at the time of the study. In addition, nurses who rotate between all radiology departments affected the ability to tally the exact number of NMDs nurses. Therefore, the study initially identified non-rotating NMD nurses by contacting NMDs across the country. A total of 42 nurses were identified as working continuously in 12 NMDs across the country.

The original proposal was developed as a face-to-face interview. However, due to the COVID-19 pandemic, the protocol changed to a web-based survey. Therefore, the questionnaire and participation consent form were e-mailed to the identified nurses working in the NMDs with a link. The initial e-mail was followed by three monthly reminders to increase the response rate. A response rate greater than 60% may be considered sufficient for the majority of research purposes (Polit and Beck, 2004). In this study, 29 questionnaires with a 69% response rate were completed. The responses of the participants were anonymous and processed following the published principles of the recommended research practice. Data were collected between March and June 2021 using a self-administered and structured questionnaire. The questionnaire, in which its content was previously validated and tested by many radiologists and radiologic technologists (Quinn et al., 1997; Eksioglu and Üner, 2012; Alotaibi et al., 2015; Szarmach et al., 2015). The questionnaire consisted of (a) items regarding demographic data, (b) 12 items regarding radiation protection awareness, (c) 6 items regarding safety practices, and (d) one open-ended item about the recommendation to increase the level of awareness and safety practices.

The data analysis was performed using a statistical package for the social sciences (version 20, IBM Inc., Chicago, IL). Demographic data were analyzed with descriptive statistics. A scoring system was established to assess the overall radiation protection awareness and safety practices of nurses working in NMDs. The score for each correct answer was 1, whereas it was 0 for each negative response, yielding a maximum of 12 points for radiation protection awareness and 6 points for safety practice. A score less than 70% of the total score was considered a poor awareness level and inadequate safety practices. A descriptive analysis was performed. Also, Chi-square was used to determine differences among nurses of the NMDs with various demographic variables. The results were investigated and shown with confidence intervals of 95%. An α-value of 0.05 was used to determine statistical significance.

3 Results

A total of 29 nurses working in NMDs in governmental, specialized, and private hospitals in Saudi Arabia responded to the current cross-sectional questionnaire. In Table 1, a summary of the demographic characteristics of the nurses is shown. In brief, more than 62.1% of the nurses who responded to this cross-sectional survey were females. The age of the majority of the participants was in the range of 26–36 years. Nurses with bachelor’s degrees represented 82% of the total participants, of which 20.7% were fresh graduates and newly joined NMDs (less than one year). More than half of the nurses (62.1%) had 2–5 years of working experience. A small percentage (13.7%) of the nurses did not have any training courses on radiation safety.

In Table 2, the level of awareness and safety practices among NMD nurses is demonstrated. As shown in Table 3, the total satisfactory awareness score among the nurses working in NMDs was 93.1%, with a significant difference between the nurses in NMDs, and the mean awareness score was 9.58 ± 1.0 (out of 12). However, only 27.5% of nurses had adequate safety practices, with a significant difference between them in NMDs (P = 0.01), and the mean safety practices score was 2.48 ± 0.1 (out of 6).

In Table 4, it was shown that the satisfactory awareness of radiation protection among the nurses of NMDs was highly significantly associated with gender (P = 0.04) and nurses who received training courses (P = 0.01). However, age and years of experience were not significantly associated with awareness. For safety practices, the study revealed that there was no significant correlation with age, gender, training, and years of experience.

The open-ended question about suggestions to improve radiation protection awareness and safety practices among NMD nurses was completed by 15 nurses. They all suggested that regular lectures, training, and courses related to radiation protection should be regularly provided to improve their knowledge of radiation protection practices and awareness.

Table 1

Summary of demographic characteristics of Saudi nurses working in NMDs.

Table 2

Radiation protection awareness and safety practices among nurses working in NMDs (n = 29).

Table 3

Mean scores of the level of radiation protection awareness and safety practices among nurses in NMDs.

Table 4

Associations between radiation protection awareness and safety practices among nurses working in NMDs and demographic variables (n = 29).

4 Discussion

Radiation protection is critical for a safe work environment. Nurses play a critical role in patient care in radiology departments, especially in NMDs. During the work routines of nurses in the NMD, external exposure occurs when they work close to the patients. The radiation exposure received by nurses is most likely due to the amount of time they spend near patients during and after administering radiopharmaceuticals (Oatway et al., 2016; Sont and Ashmore, 1999). A previous study reported that the mean annual effective dose for Saudi nurses in different departments ranged from 0.67 mSv to 1.01 mSv, where nurses in nuclear medicine received the highest mean annual effective dose (1.01 mSv) (Shubayr et al., 2021). Similarly, NMD technologists are exposed to radiation, as it was reported in several studies that they are the most highly exposed workers among all other radiology departments (Oatway et al., 2016; Alnaaimi et al., 2017). In Saudi Arabia, the mean annual effective dose for NMD technologists was found to be 1.22 mSv (Alashban and Shubayr, 2021), compared to other technologists in the diagnostic radiology departments (0.88 mSv) (Shubayr et al., 2021). The fact that medical staff in NMDs including nurses are exposed to higher radiation doses emphasizes the importance of knowledge on radiation protection. Poor levels of knowledge and awareness and a lack of standard education on radiation protection among nurses were reported in several studies (Alzubaidi et al., 2017; Hirvonen et al., 2019; Shafiee et al., 2020; Behzadmehr et al., 2020). Similar poor levels were reported among other medical staff in Saudi Arabia (Alshumrani, 2021; Shubayr and Alashban, 2021). The need for a safe work environment for nurses involved in radiological procedures and potentially exposed to radiation is warranted. Assessment of the level of radiation protection awareness and safety practices among NMD nurses is a contribution to occupational safety and health in their workplace.

The overall score of the radiation protection awareness of nurses was satisfactory (93.1%) in this study. The overall score indicates that nurses who work continuously in NMDs have a reasonably decent awareness. Additionally, receiving radiation safety training courses could contribute to this level of satisfaction. However, some of the items answered by the nurses of NMDs related to awareness had a low awareness level, such as questions about the 10-day rule, familiarity with the half-value layer, how to decontaminate radioactive spills, and returned pregnant nurses to NMD during pregnancy. The low satisfaction may be because its name is not precisely known as the 10-day rule, despite its application, which is consistent with other studies (Alotaibi et al., 2015; Ng and Sa, 2020). Also, decontaminating radioactive spills is not usually performed by nurses in NMDs, as it is part of the RSO duties. It was found in this study that about 69% of these nurses were familiar with the procedure. This result may be because almost all nurses had already attended radiation protection training courses and had adequate experience working in NMDs.

Regarding the overall score of safety practices, inadequate practices concerning the use of radiation protection tools, such as thyroid shields, eye goggles, and lead gloves, were shown in the results. This study was in accordance with previous studies (Yunus et al., 2014; El-Feky et al., 2017), in which it was found that a small percentage of healthcare workers, including nurses, were using some of the radiation protection tools in NMDs, such as eye goggles and thyroid shields. This finding may be explained by the fact that those nurses may not be fully involved during the NM examinations. Another explanation could be that these tools are not available, such as eye goggles and thyroid shields used by NM technologists and radiologists. However, most nurses in this study reported using lead aprons (79.3%), consistent with the previous studies (Luntsi et al., 2016; Ahmed et al., 2015). Time, distance, and shielding are three practical approaches to controlling external radiation exposure. Interestingly, most nurses (96%) showed a high awareness of safety precautions regarding these practical methods, which indicates following good radiation practices. This result is more frequent than what was reported in previous studies (Alotaibi et al., 2015).

The results of the open-ended question regarding improving the level of radiation protection awareness and safety practices suggested regular and frequent courses, seminars, and workshops in radiation protection. With this result and the significant findings of the overall scores for radiation protection awareness and safety practices, we emphasize the need for training and continuing education in radiation protection for nurses involved in radiological procedures in NMDs.

This study was limited by the small sample of the nurses who work continuously in NMDs in Saudi Arabia, where the number of respondents is relatively low (n = 29), with a response rate of 69%, which may represent a weakness of the study. However, this was counterbalanced by an adequate representation of NMDs in all regions of Saudi Arabia.

5 Conclusion

Nurses in NMDs are exposed to higher radiation doses compared to other nurses in radiology departments, which indicates the need for assessment of their level of knowledge on radiation protection. Therefore, this study investigated radiation protection awareness and safety practice levels among nurses working in NMDs in Saudi Arabia. In this study, a satisfactory level of awareness of radiation protection among NMD nurses was revealed in this study, with an overall score (9.58/12). Inadequate safety practices by most nurses were also shown in this study, with an overall score (2.48/6). We recommend that training and continuing education in radiation protection for nurses involved in radiological procedures in NMDs should be developed to ensure better radiation protection awareness and safety practices levels.

Conflicts of interest

The authors declare no conflict of interest.

Funding

This research did not receive any specific funding.

Ethical approval

Ethical approval was not required.

Informed consent

Written informed consent was obtained from all participants.

Authors contributions

Ali S. Alyami, Naif A. Majrashi, and Nasser A. Shubayr: Conceptualization, Methodology, Ali S. Alyami, Naif A. Majrashi, and Nasser A. Shubayr: Writing original draft. Nada A. Alomairy, Nouf H. Abuhadi: Visualization, Investigation. Nasser A. Shubayr: Supervision. Nasser A. Shubayr and Ali S. Alyami: Writing-Reviewing and Editing.

Acknowledgments

The authors would like to thank the Deanship of Scientific Research at Jazan University for their support.

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Cite this article as: Alyami A, Majrashi N, Shubayr N, Alomairy N, Abuhadi N. 2022. Assessment of radiation protection awareness and safety practices among nurses in nuclear medicine departments in Saudi Arabia. Radioprotection 57(1): 49–54

All Tables

Table 1

Summary of demographic characteristics of Saudi nurses working in NMDs.

Table 2

Radiation protection awareness and safety practices among nurses working in NMDs (n = 29).

Table 3

Mean scores of the level of radiation protection awareness and safety practices among nurses in NMDs.

Table 4

Associations between radiation protection awareness and safety practices among nurses working in NMDs and demographic variables (n = 29).

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