Evaluation of the level of fear of radiation
among radiology staff in hospitals affiliated to Hamadan University of Medical
Sciences, Iran, in 2014
Ghazikhanlu-Sani
K, PhD1, Alizadeh M, MSc2*, Mohammadi F, BSc3,
Mohamadpour S, BSc3, Hadidi Sh, BSc3, Mohammadi Y,
PhD4
1-
Assistant Prof., Dept. of Radiology, Faculty of Para Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran. 2- MSc in Medical physics, Dept.
of Radiology, Faculty of Para Medicine, Hamadan University of Medical Sciences,
Hamadan, Iran. 3- BSc in Radiology, Dept. of Radiology, Hamedan University of
Medical Sciences, Hamadan, Iran. 4-Assistant Prof, Dept of Biostatistics &
Epidemiology, School of Public Health, Hamadan University of Medical Sciences,
Hamadan, Iran.
Abstract
Received: August
2016, Accepted:
December 2016
Background: The biological effects of radiation on radiology personnel are divided into two groups of deterministic effects and stochastic effects. Due to the effects of radiation on health, radiology staff may be afraid of radiation. Younger personnel with little work experience, compared with older personnel, have higher level of fear. The fear among radiology personnel, like employees of various departments, can impact their job satisfaction and performance. Materials and Methods: This descriptive, cross-sectional research was performed on radiology staff of hospitals affiliated with Hamadan University of Medical Sciences, Iran, in the year 2014. In total, 70 questionnaires were distributed among the radiology personnel of these hospitals, of which 49 questionnaires were completed. This questionnaire consisting of 14 questions scored on a 5-point Likert scale ranging from 1-5 (from very high to very low). All P-values of more than 0.05 (P > 0.05) were considered significant. Results: No significant relationship was observed between fear of radiation and education, age, gender, marital status, and work experience. Conclusions: The total mean for very low level of fear of radiation among the radiology staff of hospitals affiliated to Hamadan University of Medical Sciences was 15.73%. Furthermore, no significant relationship was observed between fear and other variables such as education, age, gender, marital status, and work experience (P > 0.05). |
Keywords: Radiology, Radiation, Fear
Introduction
Approximately 30 million workers
are professionally exposed to radiation, and of these workers, interventional
fluoroscopists (cardiologists and radiologists) are amongst the most exposed.
In fact, their annual exposure is equivalent to 5 mSv per year which would lead
to a projected lifetime attributable excess cancer risk of 1 in 100 (1). Due to their
penetrating ability, hard X-rays are widely used for imaging the inside of
objects, e.g., in medical radiography (2). The radiation doses involved in
radiology procedures other than interventional procedures are seldom*
sufficiently large to have deterministic effects (3).
By definition, a deterministic effect has a practical threshold in dose, the
severity of the effect increases with dose, and it results from damage to many cells. Stochastic effects are those that occur by
chance and consist primarily of cancer and genetic effects. Stochastic effects are
often revealed years after exposure. The probability of the occurrence of cancer
or a genetic effect increases with increase in individual dose (4). However, at
no time, even for high doses, is it certain that cancer or genetic damage will be
the outcome. Similarly, for stochastic effects, there is no threshold dose
below which it is relatively certain that an adverse effect cannot occur. In
addition, because stochastic effects can occur in individuals that have not
been exposed to radiation above background levels, it can never be determined
for certain that an occurrence of cancer or genetic damage was due to a specific
exposure (2, 4).
Due to the
effects of radiation on health, radiology workers may be afraid of radiation. This
fear of radiation can be illogical or positive; illogical fear is fear of radiation
that interferes with routine performance. The radiation worker overtaken by this
kind of fear may be aware that it is illogical fear, but at the same time be
unable to overcome it. On the other hand, positive fear of radiation is due to
lack of knowledge and disregard for safety measures (5, 6). In addition, the personnel
working in other hospital departments have perhaps experienced fear or stress related
to their occupation (7, 8).
One of the most important effective factors on decreasing radiology personnel’s
fear of radiation can be awareness of its damages (5). Since 1928, the International
System of Radiological Protection (ICRP) has developed, maintained, and
elaborated the ICRP used worldwide as the common basis for radiological
protection standards, legislation, guidelines, programs, and practice. The ICRP
offers its recommendations to regulatory and advisory agencies, and provides
advice intended to be of help to the management and professional staff with
responsibilities for radiological protection (2, 3).
The results of the most recent studies have shown that following the radiological
protection standards has caused a decrease in mortality due to cancer among
radiology personnel (2).
The fear among radiology personnel as well as the personnel of different
departments can affect their function and job satisfaction; radiology
assistants, due to fear or stress, may not be able to perform portable
radiology or may not have motivation to work for additional hours (9, 10). Radiology
personnel generally work with radiology instruments in different hospital
departments, and the fear of radiation may affect their function. Other hazards
of working with radiation have been studied in recent years (1, 9). Young
personnel with little work experience, in comparison with older personnel, may
have higher level of radiation fear. The present study was undertaken with the
aim to evaluate the level of radiation fear among radiology personnel in order
to offer ways for overcoming fear and stress.
Material and Methods
The present cross-sectional research
was conducted among radiology personnel in hospitals affiliated with Hamadan
University of Medical Sciences, Iran, in the year 2014. The statistical
population consisted of all radiology personnel of 5 hospitals in Hamadan.
A
questionnaire was designed by the researchers in order to collect data. The
validity of the questionnaire was verified by 4 professors of the Department of
Radiology of Hamadan University of Medical Sciences. The reliability
coefficient of the questionnaire was evaluated using Cronbach's alpha (α =
0.938).
The number of 70 questionnaires was distributed
in 3 different shifts at the hospitals. The questionnaires were collected after
2 weeks. In total, 49 questionnaires were completed and returned by personnel.
The questionnaire consisted of 14 multiple choice items scored on a 5-point
Likert scale ranging from 1-5 (very low to very high). The questions were
related to personnel’s feelings during working with a fixed radiography system and
portable radiography system, tendency toward working an extra shift,
and radiation protection. Their fear of radiation was investigated indirectly
in these questions. The obtained data were analyzed in SPSS software (version
16, SPSS Inc., Chicago, IL, USA).
Chi-square and Fisher’s exact tests were used to determine
fear. Moreover, variables such as gender, age, education, marital status, and work
experience were also considered. The fear of radiation was expressed as a
percentage. Furthermore, scores of 14 to 42 indicated low level
of fear, 42 to 70 indicated high level of fear, and 42 was considered as the
average.
Results
The demographic characteristics of
personnel are presented in table 1. As can be seen, 49 personnel were studied,
52% and 48% of whom were, respectively, over 30 years of age and below 30 years
of age. In terms of marital status, 66% of the personnel were married and 34%
of them were single. Furthermore, 68% of personnel were men and 32% of them were
women. In terms of education level, 71% of personnel had a bachelor’s degree,
27% had an associate degree, and 2% had a Master of Science degree. Moreover,
57% of total personnel had less than 10 years of work experience and 43% had
more than 10 years of work experience.
Table 1: The demographic characteristics of personnel
|
Age (year) |
Marital status |
Gender |
Educational degree |
Work experience |
|
||||||
|
31-53 |
21-30 |
Married |
Single |
Female |
Male |
Associate degree |
Bachelor’s degree |
Master of Science degree |
Under 10 years |
Over 10 years |
|
|
25 |
24 |
32 |
17 |
33 |
16 |
13 |
35 |
1 |
28 |
21 |
Number |
|
52 |
48 |
66 |
34 |
68 |
32 |
27 |
71 |
2 |
57 |
43 |
Percentage |
The relation among variables and personnel’s level of fear are presented in
table 2. For the assessment of the relation between variables, the chi-square
statistical test was used. According to this test, level of
fear had no significant
association with variables such as gender, age, education, marital
status, and work experience. All P-values of more than 0.05 (P-value>0.05) were
considered significant.
Table 2: Relation among
variables and personnel’s
level of fear
|
Variable |
|
Low |
High |
Total |
P-value |
|
Educational degree |
Associate degree |
11 |
2 |
13 |
0.364 |
|
Bachelor’s degree |
28 |
7 |
35 |
||
|
Master of Science degree |
1 |
0 |
1 |
||
|
Total |
40 |
9 |
49 |
|
|
|
Age (year) |
21-30 |
18 |
6 |
24 |
0.24 |
|
31-53 |
22 |
3 |
45 |
||
|
Total |
40 |
9 |
9 |
|
|
|
Gender |
Male |
12 |
4 |
16 |
0.697 |
|
Female |
28 |
5 |
33 |
||
|
Total |
40 |
9 |
49 |
|
|
|
Marital status |
Married |
14 |
3 |
17 |
0.924 |
|
Single |
26 |
6 |
32 |
||
|
Total |
40 |
9 |
49 |
|
|
|
Work experience |
Under 10 years |
21 |
7 |
28 |
0.166 |
|
Over 10 years |
19 |
2 |
21 |
||
|
Total |
40 |
9 |
49 |
|
Statistical indicators related to the
score of fear for each variable are presented in table 3. The analyzed data
showed that the level of fear of radiation was low among 81.6% of personnel and
the level of fear of radiation was high among 18.4% of personnel.
Table 3: Statistical indicators related to the score of fear for each
variable
|
Variables |
|
Mean |
Standard deviation |
P |
|
Educational degree |
Associate degree |
38.15 |
4.61 |
0.89 |
|
Bachelor’s degree |
38.60 |
5.87 |
||
|
Master of Science degree |
37 |
0 |
||
|
Age (year) |
21-30 |
38.45 |
5.50 |
0.63 |
|
31-53 |
38.12 |
5.75 |
||
|
Gender |
Male |
38.75 |
7.01 |
0.77 |
|
Female |
38.30 |
4.64 |
||
|
Marital status |
Married |
38.58 |
5.45 |
0.89 |
|
Single |
38.37 |
5.55 |
||
|
Work experience |
Under 10 years |
38.82 |
5.86 |
0.46 |
|
Over 10 years |
37.95 |
4.97 |
Discussion
Johson conducted
a study on public fear of radiation in 2011 (11). Although radiation is deadly
in very specific circumstances, there is public fear of radiation because of the existing
myths about radiation; thus, this fear can be decreased by enhancement of the level of
knowledge (11). As an example, the Chernobyl incident in recent years has
caused a public fear of radiation (12).
Gheledof et al.,
in their study about fear of working in proximity to radiation, concluded that
the difficult working conditions have caused fear of radiation (13).
Pastel et al. investigated the fear of radiation among the U.S. military medical personnel (14). The questionnaires
were completed by
the personnel before and after 3 days of education on radiation. The results
showed a positive correlation between increasing knowledge on radiation and more positive
attitudes (14). Another study on fear of radiation during work
with portable radiography was performed by Grazer et al. (15). Their results indicated
that standing at an appropriate distance, using an apron, and taking care of
the patient can decrease radiation dose (15). Balter studied fluoroscopic personal
radiation protection equipment, and showed that unwarranted radiation fears
should not drive the radiation protection system to the point of decreasing
overall safety (16). The study by Shakerian et al. on radiation fear in Royal
Melbourne Hospital, Australia, showed that concerns regarding fetal radiation
have resulted in a low rate of compliance with recommended trauma guidelines in
their institution (17). The fear of radiation in treatment with iodine-131 may
be successfully managed by rational, authoritative, and empathic explanation on
the definition of the risk, and gain patients’ willing acceptance within the
context of domiciliary patient care (18).
Conclusion
The radiology personnel work with X-ray equipment continuously, and fear may
have negative effects on their function. A large number of personnel dislike performing
portable radiography; this may be due to their fear of radiation. Younger
personnel with little work experience, in comparison with older personnel, showed
higher level of fear. The results show that increase in staff’s awareness regarding
radiation can reduce fear of radiation. In addition, courses on radiation
protection can be useful for personnel. Based on the findings of this research,
it can be concluded that the mean very low and low level of fear of radiation among radiology personnel in
hospitals in Hamadan was 15.73% and 16.58%, respectively. Moreover,
fear had no significant relationship with other variables such as
gender, age, education, marital status, and work experience. Therefore, the findings in
this research show that further research is necessary on this topic (P > 0.05).
Acknowledgements
The authors would
like to thank Hamadan University of Medical Sciences for funding this work, and
the personnel of the radiology department of hospitals in Hamadan for their
kind assistance in completing the questionnaires.
Conflict of interest: None
declared
References
1.
Marazziti D, Baroni S, Lombardi A, Falaschi V, Silvestri
S, Piccinni A, federico Mucci, Liliana dell’osso, et
al. Psychiatric effects of ionizing radiation. Clin Neuropsychiatry 2014;
11(2):61-7.
2.
Hall EJ, Giaccia
AJ. Radiobiology for the Radiologist. Philadelphia,
United States: Lippincott Williams & Wilkins; 2006.
3.
Armstrong IS,
Saint KJ, Tonge CM, Arumugam P. Evaluation of general-purpose collimators
against high-resolution collimators with resolution recovery with a view to
reducing radiation dose in myocardial perfusion SPECT: A preliminary phantom
study. J Nucl Cardiol 2016; 23(149):1-9.
4.
Statkiewicz-Sherer
MA, Visconti PJ, Ritenour ER, Haynes K. Radiation protection in medical
radiography. 7th ed. Missouri, United States: Mosby;
2013. 392.
5.
Quimby EH. The
fear of radiation. Am Assoc Ind Nurses J 1967; 15(3):19.
6.
Katayama H.
Relationship between emotional
labor and job-related stress among hospital nurses. Nihon Eiseigaku Zasshi
2010; 65(4):524-9.
7.
Suresh P,
Matthews A, Coyne I. Stress and stressors in the clinical environment: a
comparative study of fourth-year student nurses and newly qualified general
nurses in Ireland. J Clin Nurs 2013; 22(5-6):770-9.
8.
Xie Z, Wang A,
Chen B. Nurse burnout and its association with occupational stress in a
cross-sectional study in Shanghai. J Adv Nurs 2011; 67(7):1537-46.
9.
Vanhoudt N,
Vandenhove H, Real A, Bradshaw C,
Stark K,
et al. A review of multiple stressor studies that include ionizing radiation.
Environ Pollut 2012; 168:177–92.
10.
Davidhizar R,
Dowd S, Giger J. Managing a multicultural radiology staff. Radiol Manage 1997;
19(1):50-5.
11.
Johnson R.
Psychological and mental health aspects of ionizing radiation exposure.
Amsterdam, London: Elsevier; 2015.
12.
Donna Coates T.
Public relations and the radiation processing industry. Radiat Phys Chem 1990;
35(1-3): 354-6.
13.
Gheldof EL, Vinck
J, Vlaeyen JW, Hidding A, Crombez G. The differential role of pain, work
characteristics and pain related fear in explaining back pain and sick level in
occupational settings. Pain 2005; 113(1-2):71-81.
14.
Pastel RH,
Mulvaney J. Fear of radiation in U.S. military medical personnel. Mil Med 2001;
66(2):80-2.
15.
Grazer RE,
Meislin HW, Westerman BR, Criss EA. Exposure to ionizing radiation in the
emergency department from commonly performed portable radiographs. Ann Emerg
Med 1987; 16(4):417-20.
16.
Balter S.
Promoting fluoroscopic personal radiation protection equipment: unfamiliarity,
facts and fears. Radiat Prot Dosimetry 2016; 172(1-3):181-6.
17.
Shakerian R,
Thomson BN, Judson R, Skandarajah AR. Radiation fear: Impact on compliance with
trauma imaging guidelines in the pregnant patient. J Trauma Acute Care Surg
2015; 78(1):88-93.
18.
Calais PJ, Page
AC, Turner JH. Management of fear of radiation exposure in carers of
outpatients treated with iodine-131. Ann Nucl Med 2012; 26(6):508-14.
* Corresponding author: Majid Alizadeh, Dept. of Radiology, Faculty of Para
Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
E-mail: Alizadeh_majid@ymail.com