The advantages of creating a positive radiation safety culture in the higher education and research sectors.

The safety culture of any organisation plays a critical role in setting the tone for both effective delivery of service and high standards of performance. By embedding safety at a cultural level, organisations are able to influence the attitudes and behaviours of stakeholders. To achieve this requires the ongoing commitment of heads of organisations and also individuals to prioritise safety no less than other competing goals (e.g. in universities, recruitment and retention are key) to ensure the protection of both people and the environment. The concept of culture is the same whatever the sector, e.g. medical, nuclear, industry, education, and research, but the higher education and research sectors within the UK are a unique challenge in developing a strong safety culture. This report provides an overview of the challenges presented by the sector, the current status of radiation protection culture, case studies to demonstrate good and bad practice in the sector and the practical methods to influence change.

Estimated skin dose look-up tables and their effect on dose awareness in the fluoroscopy-guided imaging suite.

OBJECTIVE: The displayed air kerma during a fluoroscopy-guided procedure often does not represent the entrance skin dose. The purpose of this work is to develop a system-specific air kerma-to-entrance skin dose look-up table (LUT) for immediate reference and to evaluate its clinical utility. MATERIALS AND METHODS: Physicists are often involved in retrospective dosimetry and risk estimates. Conservative dosimetry conversion factors, represented by the total conversion factor, prospectively estimate the maximum potential skin dose from the displayed air kerma. Air kerma-to-skin dose LUTs with corresponding tissue reactions and approximate time-of-onset can be posted for reference. By developing skin dose LUTs, physicians can actively evaluate during the procedure the potential for deterministic skin reactions. System user surveys evaluated the impact of LUTs on dose awareness. RESULTS: The range of the total conversion factor to the displayed air kerma for the nine systems evaluated was 0.8-1.6 for frontal x-ray tubes. Skin dose LUTs were posted in all imaging suites, and two surveys reported user feedback. Radiology technologists indicated that LUTs improved user dose awareness. Twelve of 14 physician respondents indicated an understanding that entrance skin dose is not equal to the displayed air kerma. CONCLUSION: Our efforts focused on educating fluoroscopy users about differences between displayed air kerma and the entrance skin dose while increasing dose awareness using an accessible and easy-to-understand tool. Skin dose LUTs provide physicians and staff an immediate reference for the maximum estimated entrance skin dose and the associated deterministic skin effects, allowing appropriate patient management.

Induction of staff and team training.

Good training is vital for the safe and effective integration of a new team member. This training will be made easier if a deliberate, structured approach is taken, which takes due account of the need to safeguard their health, safety and welfare, from the moment they start.

[Promising directions of optimization of providing radiological safety in large-scale treatment-and-preventive institutions].

The article contains results of fulfilled studies that allowed finding main features of radiology safety, working out academic and research recommendations to perfect radiology safety in treatment-and-preventive institutions (TPI) and creating a method of calculation of authorized staffing needed by radiological safety services. It was established that the following actions are least fulfilled: radiation control, organization of radiation safety education, authorization for work with ionizing radiation both for military men and civil staff, maintenance of documentation. We suggest that promising direction of optimization of providing radiological safety in large-scale TPI is the following: allotment of special structure that will provide comprehensive fulfillment of regulatory documents demands, it may be, e. g. radiological safety service.

An approach to simulate and visualize intraoperative scattered radiation exposure to improve radiation protection training.

Intraoperative radiography based on mobile image intensifier systems (C-arms) is widely used during the treatment of trauma and emergency patients. These devices produce scattered radiation, potential hazardous for surgeon and operation room personal (ORP). The propagation and intensity of scattered radiation is not intuitive, is not perceivable by human senses and depends on many variables. At courses on radiation protection the knowledge of the behavior of scattered radiation and the modus operandi to minimize the radiation exposure should be taught to ORP and surgeons. Currently this can only be done theoretically using fixed pictures and precalculated videos. This paper presents an approach to interactively simulate and visualize scattered radiation with a computer based training system for mobile image intensifier systems. The simulation depicts radiation propagation and intensity for arbitrary C-arm adjustments and different irradiated materials. This teaching component focuses on improving the current radiation protection training with interactive visual and practical aspects.

Behaviour and knowledge skill levels of orthopedic surgeons about radiation safety and fluoroscopy use: A survey analysis.

OBJECTIVE: The aim of this study was to evaluate the behaviour and knowledge skill levels of Turkish orthopedic surgeons about fluoroscopy usage and radiation safety. METHODS: The questionnaire, consisting of nineteen questions, was sent to orthopaedic surgeons and requested by a total of 323 surgeons online. The questions were about personal information, training and behaviours related to radiation and fluoroscopy usage, and the use of protective equipment. RESULTS: A total of 277 individuals completed the questionnaire. The answers of 180 surgeons whose working duration was more than 1 year and also who participated in at least one fluoroscopy requiring operation per week, were analysed. 22 (12%) participants answered that they were trained on fluoroscopy usage. Sixty people (33.3%) reported that they did not use any protective equipment regularly. The most commonly used protection methods were lead aprons 123 (68.3%). Thyroid protectors were used by 92 participants (52.1%). There was no significant difference between the groups when comparing the use of protective equipment according to the academic title. Only 19 (10.6%) of the surgeons noted that they used dosimeter regularly, and 15 (83.3%) of them reported that they controlled their dosimeters. CONCLUSION: In this study, Orthopedic surgeons were found not to be adequately trained about use and risks of fluoroscopy and also not to be equipped about methods for preventing radiation damage.

Initial knowledge at radiation protection courses from 2005-2013 (3): tendencies and conclusions.

PURPOSE: The necessity of refresher courses is controversial and is frequently questioned. The present study examines whether the courses have a lasting effect and whether improvements are indicated. MATERIALS AND METHODS: With the help of a questionnaire (9 questions) to be answered before the course, a self-assessment was performed and questions about the knowledge and structure of radiation protection were asked. 1361 participants were surveyed (55 % physicians, 31 % doctor's assistants, 13 % technicians, 1 % medical physicists) in the period of 2005 - 2013 (3) and 39 courses were evaluated. The assessment entailed the comparison of 3 subgroups: 2005 - 2007, 2008 - 2010, 2011 - 2013. RESULTS: The self-assessment is about 3.0 (1 - very good, 5 - very poor) with fluctuations regarding time course and occupation. For all questions, there was an increase in correct answers from the period 2005 - 2007 to the period 2008 - 2010 (+ 15 %), while the rate fell again for the period 2011 - 2013 (3) (- 8 %). The questions were answered significantly better for organization-related topics than knowledge-based topics. Overall 53 % of the answers were correct. CONCLUSION: This study shows an increase in knowledge since starting refresher courses. However, recently the effect has decreased again. In order to maintain the knowledge, the yearly instruction must be held on time, which according to participants' statements actually occurs in only 60 % of cases.

Radiological protection in medicine: work of ICRP Committee 3.

Committee 3 of the International Commission on Radiological Protection (ICRP) is concerned with protection in medicine, and develops recommendations and guidance on the protection of patients, staff, and the public against radiation exposure in medicine. This paper presents an overview of the work of Committee 3 over recent years, and the work in progress agreed at the last annual meeting in Bethesda, MD in October 2011. The reports published by ICRP dealing with radiological protection in medicine in the last 10 years cover topics on: education and training in radiological protection; preventing accidental exposures in radiation therapy; dose to patients from radiopharmaceuticals; radiation safety aspects of brachytherapy; release of patients after therapy with unsealed radionuclides; managing patient dose in digital radiology and computed tomography; avoidance of radiation injuries from medical interventional procedures; pregnancy and medical radiation; and diagnostic reference levels in medical imaging. Three new reports will be published in the coming months dealing with aspects of radiological protection in fluoroscopically guided procedures outside imaging departments; cardiology; and paediatric radiology. The work in progress agreed by Committee 3 is also described.

Continuing dental education in radiation protection: monitoring the outcomes.

OBJECTIVES: To evaluate an evolving radiation protection dental postgraduate course run in Wales between 2003 and 2007. METHODS: We compared three standardized course series. Course content was enhanced in 2006 to target areas of weakness. In 2007, a single best answer multiple choice questionnaire instrument superseded a true/false format. Practitioners' performance was studied pre- and immediately post-training. 900 participants completed identical pre- and post-course validated multiple choice questionnaires. 809 (90%) paired morning-afternoon records, including those of 52 dental care professionals (DCPs), were analysed. RESULTS: Mean (standard error) pre- and post-course percentage scores for the three courses were 33.8 (0.9), 35.4 (1.4), 34.6 (1.0) and 63.6 (0.9), 59.0 (1.4), 69.5 (0.9). Pre-training, only 2.4%, 3.1% and 4.9% of participants achieved the pass mark compared to 57.7%, 48.4% and 65.9% post-training, indicating a rather greater pass rate and gain in the most recent series than earlier ones. In recent series, older more experienced candidates scored slightly higher; however, their gain from pre- to post-training was slightly less. CONCLUSIONS: Baseline levels of radiation protection knowledge remained very low but attending an approved course improved this considerably. Targeting areas of weaknesses produced higher scores. Current radiation protection courses may not be optimal for DCPs.

A survey of awareness of radiation dose among health professionals in Northern Ireland.

Increasing concern has recently been expressed in the literature that the referring doctor's knowledge of radiation doses incurred during radiological procedures is inadequate. Such information may be particularly relevant when the expansion of imaging technology is considered. To assess this, a survey was conducted of the awareness of radiation dose and risk among health professionals in Northern Ireland. A questionnaire was circulated to 300 consultants and 200 junior doctors selected randomly from a range of specialties. Participants were asked about the radiation dose from a chest radiograph, the annual dose from background radiation, and to estimate the radiation dose and cancer risk from several common radiological procedures. In total, 153 questionnaires were returned. A mean score of 7.1 out of 18 was achieved (39%). 26% of doctors achieved a score of 50% or more, and 20% of respondents knew the effective dose of a chest radiograph. 52 doctors had received formal training about ionizing radiation, and these participants scored more highly than those with no previous training in this area (p = 0.003). Our survey confirmed that clinician awareness of radiation doses imparted during common radiological procedures, and the consequent risk to the individual patient, is poor. It identified that training does increase awareness about radiation dose. There is a need to educate clinicians about (i) ionizing radiation relevant to medical imaging, given their legal responsibility as referrers under the Ionizing Radiation (Medical Exposure) regulations in the UK, and (ii) their clinical role to provide accurate information to their patients.