32.2.18 Knowledge and Practice of Radiation Protection among Dental Surgeons Practicing in Lahore

Original Article

 

Knowledge of Radiation Protection Among Dental Surgeons

Knowledge and Practice of Radiation Protection among Dental Surgeons Practicing in Lahore

Shahlisa Hameedi1, Sana Chaudhry2, Faryal Ali Syed3, Nadia Muneer4, Omair Anjum5 and Muhammad Behzad Salahuddin1

ABSTRACT

Objective: The aim of this study is to evaluate the knowledge of radiation protection among dental surgeons practicing in Lahore, Assess the strategies adopted in department for radiation protection and recommend remedial measures to improve the existing conditions.

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at the Dental practitioners practicing in Lahore from  September 2019 to March 2020.

Materials and Methods: A pre-designed questionnaire, containing the demographic information, questions to judge the knowledge of radiation protection and different strategies adopted in their setups for radiation protection, was distributed among 217 practicing dental surgeons of Lahore. These questionnaires were then retrieved and the data was collected and analyzed.

Results: 55.3% of the respondents were male with mean age of 41.54 ± 4.2 years. Majority only had basic knowledge regarding the harmful effects of x-rays while being unaware of the radiosensitive organs of the body, ALARA principle or position distance rule. 11.1% were aware of annual recommended dose limit for occupationally exposed workers.46.1% used protective apparels with lead apron being most frequent. A significant number did not using any radiation monitoring device or use appropriate filtration and collimation.

Conclusion: Bulk of the dental surgeons exhibited unsatisfactory knowledge and adopted inadequate measures for radiation protection. The need of the hour is to organize periodic lectures and workshops to dispense latest teachings regarding the dangers of radiation and methods for the safety of workers as well as the patients.

Key Words: Dental Surgeons, Knowledge, Lahore, Practice, Radiation protection, x-rays

Citation of article: Hameedi S, Chaudhry S, Syed FA, Muneer N, Anjum O, Salahuddin MB. Knowledge and Practice of Radiation Protection among Dental Surgeons Practicing in Lahore. Med Forum 2021;32(2):71-75.

 

 

INTRODUCTION

The accidental discovery of x-rays by German physicist Wilhelm Roentgen gave birth to radiology. However,
x-rays are ionizing electromagnetic radiations and exposure can lead to an array of health hazards1.

 

 

1. Department of Community & Preventive Dentistry Department, Avicenna Dental College, Lahore.

2. Department of. Oral Biology, Avicenna Dental College, Lahore.

3. Department of Orthodontics, De’montmorency College of Dentistry, Lahore.

4. Department of Dental Materials, Avicenna Dental College, Lahore.

5. Department of Dental Materials, Lahore Medical & Dental College, Lahore.

 

 

Correspondence: Shahlisa Hameedi, Assistant Professor, Community & Preventive Dentistry Department, Avicenna Dental College, Lahore.

Contact No: 0321-5248688

Email: dr.shahlisa@gmail.com

 

 

Received:  August, 2020

Accepted:  October, 2020

Printed:      February, 2021

 

 

Increased radiation exposure causes cell death, whereas limited exposure leads to damage or change in the DNA of irradiated cells2. These effects are categorized as either stochastic effects, which are not dose-related, such as cancer, or deterministic effects, such as necrosis or burns, which are only observed after relatively high-dose exposure3.Children are even more susceptible to the effects of ionizing radiation, with the probability of developing carcinoma being the most in childhood and becoming less with progression of age4.

Radiology holds fundamental importance in dentistry for diagnosis, planning and monitoring of treatment as well as follow up5. It plays innumerable roles from the basic diagnosis of caries, minute fractures to assisting in complicated processes like implant planning6. Dental surgeons employ radiographs more frequently than other medical specialties with the radiographic modalities varying from intraoral periapical radiograph to advanced techniques like cone beam computed tomography7. Increased use of cone beam computed tomography in orthodontics patients has been associated with the increased incidences of breast cancers in female patients, especially during age range of 10 to 30 years8. Various studies exhibit increased incidence of thyroid and breast carcinomas in female dentists and more frequent development of melanomas in male dentists9.

The main principle of radiation protection is to curtail radiation exposure to the least while permitting use of the radiation for specific advantageous purposes10.In 1973, ALARA principle (as Low as Reasonably Achievable) was developed for optimization of radiographic doses with the aim of judicious use of radiation11. Partial/segmented dental panoramic views, that limit the x-ray beam only to the area of interest, can be used successfully to reduce radiation exposure12.

This study was carried out to evaluate the knowledge and the steps taken for radiation protection among dental surgeons practicing in Lahore. By having a general insight to this data, we can further suggest remedial measures to improve upon the existing situation.  This would also allow us to pinpoint specific areas which need to be focused in this regard.

MATERIALS AND METHODS

The study was conducted among dental surgeons privately practicing Lahore, from 15 September 2019 to 14 March 2020. 217 dental surgeons, both male and female, practicing in either private clinics or in academic institutions in Lahore, were included in the study. Dental surgeons without x-ray facility in their setups were excluded from the study. Sample size was calculated using openepi sample size calculator, taking usage of radiography in dental practice as 69%13, confidence interval as 95%. 217 came out to be the sample size. Non-probability, purposive sampling was done. Approval of the institute’s ethical committee for research was obtained before starting the research.

A structured questionnaire, consisting of multiple choice questions, was developed after research on the subject and discussion with experts. The first section consisted of basic information. The second section comprised of questions which dealt with the knowledge regarding radiation protection. The third section constituted of the various protocols adopted in the department for the purpose of radiation protection. The respondents were asked to select one option as the answer to the question.

The data collected was analyzed using SPSS version 21. Mean and standard deviation was calculated.

RESULTS

120 (55.3 %) of the respondents were male while 97(44.7 %) were females. The age range was from 25 years to 65 years while mean age was 41.54 ± 4.2 years.131 (60.4 %) had done B.D.S (graduation) while 86 (39.6 %) were holding a post-graduate qualification. 42.4 % had been practicing for 5 to 10 years, followed by those practicing for less than 5 years (35.5 %).63.1 % dental surgeons were practicing in private setups while 36.9 % were performing institutional duties. The demographic data is shown in table1.

Table No.1: Demographic data of the respondents

S.No

Demographic Data

Results

1.

Gender 

Male

55.3%

Female

44.7%

2.

Age

25 - 34 years

19.4%

35 - 44 years

31.8%

45 - 54 years

28.6%

55 – 64 years

16.6%

65 years and above

3.7%

3.

Qualification

Graduate (BDS)

60.4%

Post-graduate qualification (MCPS/FCPS/Masters etc)

39.6%

4.

Clinical Experience 

Less than 5 years

35.5%

Between 5 – 10 years

42.4%

More than 10 years

22.2%

5.

Practicingat

 

Academic institution

36.9%

Private clinic

63.1%

Table No.2: Response regarding section-II of the questionnaire

S.No

Knowledge About Radiation Protection

Results

1.

Are you aware of the harmful effects of x-rays on human health?

 

Yes

93.1%

 

No

6.9%

2.

Do you know the most radiosensitive organs of human body?

 

Yes

52.1%

 

No

47.9%

3.

Are you familiar with the ALARA principle?

 

Yes

24.9%

 

No

75.1%

4,

Do you have an understanding of the Position Distance Rule?

 

 

Yes

29.5%

 

No

70.5%

5.

Do you know the effect of filtration and collimation on radiation exposure?

 

Yes

31.8%

 

No

68.2%

6.

Do you understand link between kVp and exposure time with radiation dose?

 

Yes

26.3%

 

No

73.7%

7.

Are you aware of the annual permitted dose limit for occupationally exposed workers as recommended by the ICRP?

 

Yes

11.1%

 

No

88.9%

8.

Have you ever attended any workshop / seminar regarding radiation protection?

 

Yes

6.5%

 

No

93.5%

Table No.3: Response Regarding Section-III of the Questionnaire

S.No.

Practice of Radiation Protection

Results

1.

Are the following radiation protection apparel used in your department?

 

A)  Lead apron

 

                             Yes

46.1%

 

                              No

53.9%

 

B)   Thyroid collar

 

                  Yes

24.9%

 

                               No

75.1%

 

C)   Gonadal shield

 

                   Yes

35.0%

 

                    No

65.0%

 

D)  Breast shield

 

                   Yes

25.3%

 

                    No

74.7%

 

E)   Safety Glasses

 

                    Yes

30.4%

 

                     No

69.6%

2.

What mechanism is used for holding the film?

 

Staff

63.1%

 

Patients attendant

27.6%

 

Film holder

9.3%

3.

Do you stand behind a lead barrier when the x-ray is performed?

 

Yes

44.7%

 

No

55.3%

4,

Are X-ray warning / caution signs displayed in the department?

 

Yes

75.6%

 

No

24.4%

5.

What radiation monitoring devices are used in your department?

 

Film badges

66.3%

 

TLDs

0%

 

OSLDs

0%

 

Electronic personal dosimeters

0%

 

None

33.7%

6.

Is the Position Distance Rule strictly followed?

 

Yes

28.6%

 

No

71.4%

7.

Can other people enter the room when x-ray is being performed?

 

Yes

61.3%

 

No

38.7%

8.

Do you use appropriate collimation and filtration in your department?

 

Yes

64.9%

 

No

35.1%

 

93.1% had basic knowledge regarding the harmful effects of x-rays on human health however, only 52.1% were aware of the radiosensitive organs of the body. Only 24.9% understood the ALARA principle while 29.5% were familiar with the position distance rule. Only 11.1% were aware of the annual recommended dose limit for occupationally exposed workers. Bulk (93.5%) of the respondents had never attended a seminar, lecture or a workshop on radiation protection.  Data regarding the answers to section II is shown in table 2.

Less than half of the respondents were wearing protective apparels in their departments while performing x-rays. In 63.1% of the departments, dental staff was holding the radiographic film while x-ray was performed. 33.7% were not using any radiation monitoring device. Radiation warning signs and cautions were not displayed in 24.4% of the departments. Answers to section III is in table 3.

DISCUSSION

Dental surgeons utilize x-rays more commonly as compared to any other medical branch13. Radiation exposure in dentistry has been linked with to increased incidence of tumors of the salivary and thyroid glands, meningiomas and increased frequency of low birth weight children in exposed pregnant females14. Radiation protection holds critical importance for health care professionals with the purpose of diminishing needless radiation exposure and reducing its hazards15. The three cardinal principles of radiation protection are justification (benefit of exposure should outweigh risks), optimization (exposure kept as low as possible) and dose limitation (total dose should be less than permissible dose for occupationally exposed workers)16.

In our study, 55.3% participants were male, having age between 35 – 44 years.60.4% were graduates, 42.4% had clinical experience between 5 -10 years and 63.1% were working in private setups. Most of our respondents had only basic knowledge and lacked detailed awareness or critical insight on radiation protection. Similar results have been seen in other studies performed on this subject all over the world. A study concerning the knowledge of dental surgeons, x-ray technicians, dental undergraduate students and radiography students regarding radiation protection was conductedin Poland, Europe17. The study inferred that radiation awareness amongst all the four groups of respondents was unsatisfactory with the differences between them being not statistically significant.

In our study, only 29.5% of the dental surgeons were aware of the position distance rule while 70.5% were unfamiliar with it. Similarly, only 9.3% dentists, in our study, employed film holder to hold radiographic film while performing x-rays while in 63.1% cases, staff of the dental department was utilized to hold the film. A study carried out to evaluate the perception of radiation protection in dental surgeons in India, also yielded similar results 18. Bulk of the dental surgeons included in the study (54%) did not know the position distance rule while only 46% were familiar with it. Majority (59%) of the dentists did not utilize film-holding deviceswith only 41% employing film-holding devices.

Our study showed that the various steps taken for radiation protection in the departments were insufficient and needed improvement. Less than half of the respondents used protective apparels with lead apron being most frequent (46.1%). A study conducted to ascertain the radiographic safety practices of dentists, concluded that these practices were insufficient. Majority (60.4%) employed only lead protection for performing dental x-rays, even of pregnant females whereas a large proportion of respondents (39%) themselves placed the radiographic films insidethe mouth of the patient19.

Hence, the results of our study agree with the different national and international studies performed for this purpose and reinforce them. The main limitation of our study is that it is a questionnaire based research and the answers may not accurately depict the exact knowledge and practice of the respondent in actual.  Secondly, as the answers were fixed, there was lesser margin for the participants to provide answers that may correctly manifest their feelings on the subject. However, it appears from the results of our study that the situation in our setup locally is even more dismal and requires substantial improvements. Thiscalls for appropriate training of healthcare workers in the field of radiation protection to make sure that they possess sufficient knowledge and can implement consequential changes in their department. This information is crucial not only for all healthcare workers but is extremely critical for the patients visiting the hospitals as well as general public20.

CONCLUSION

Bulk of the dental surgeons exhibited unsatisfactory knowledge regarding radiation protection while majority of the departments showed inadequate measures adopted for this purpose. The need of the hour is to organize periodic lectures and workshops to dispense latest teachings regarding the dangers of radiation and methods for the safety of workers as well as the patients.

Recommendations: On the basis of the research done for this study, following recommendations are made to improve the knowledge and practice of radiation protection.

1.     Adoption of standard x-ray views to produce x-rays with acceptable quality and prevent repeat x-rays.

2.     Daily maintenance of x-ray machine with periodic calibration to prevent leak radiation.

3.     Usage of protective apparel to prevent exposure to radiosensitive organs.

4.     Use of rare earth metal intensifying screen to reduce radiation exposure.

5.     Use of appropriate collimation and filtration to limit the patient’s exposure to low energy x-rays.

6.     Employment of film holding devices when the
x-ray is being performed.

7.     Detailed chapter regarding radiation protection should be included in the curriculum, both at undergraduate and post-graduate levels.

8.     Dental surgeons lacking proficiency in radiation protection should undergo dedicated lectures / seminars / workshops to enhance their knowledge of the field.

9.     PNRA should hold periodic inspections in all institutions. Failure to meet safety standards should result in temporary cancellation of license till the situation is improved.

10.            Creating awareness amongst the patients and the general public regarding the hazards of ionizing radiation and the basic radiation protection.

 

Author’s Contribution:

Concept & Design of Study:

Shahlisa Hameedi

Drafting:

Sana Chaudhry,
Omair Anjum

Data Analysis:

Faryal Ali Syed

Revisiting Critically:

Nadia Muneer, Muhammad Behzad Salahuddin

Final Approval of version:

Shahlisa Hameedi

Conflict of Interest: The study has no conflict of interest to declare by any author.

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