Rationale and Objectives
To investigate residents’ knowledge of adverse effects of ionizing radiation, frequency of their education on radiation safety, and their use of radioprotective equipment.
Materials and Methods
Residents from 15/16 residency programs at Emory University were asked to complete a resident radiation safety survey through SurveyMonkey ® . The associations between the residents’ knowledge and use of radioprotective equipment with residents’ specialty and year of training were investigated.
Results
Response rate was 32.5% (173/532 residents). Thirty-nine percent residents reported radiation safety is discussed in their residency curriculum at least every 6 months. Ninety-five percent believed in a link between radiation exposure and development of cancer. Overall and Radiology residents’ knowledge about specific estimated dose effects (correct responses) was limited: radiation dose associated with fetus brain malformation in pregnancy (10% vs. 26%), risk of developing cataract in interventional personnel (27% vs. 47%), lifetime risk of cancer mortality from a single abdominal computed tomography (CT) in children (22% vs. 29%), greater radiosensitivity of children compared to adults (35% vs. 50%), and relative radiation dose from an abdominal CT compared to a chest x-ray (51% vs. 48%). Radiology residents had modestly higher knowledge. There was no significant difference in residents’ knowledge across their postgraduate training years. Use of lead thyroid shields was reported by 86% (97% radiology vs. 80% nonradiology; P = .03) and radiation-monitoring badges in 39% (68% radiology vs. 15% nonradiology; P < .001) of the residents.
Conclusions
Although radiology residents scored higher, knowledge of radiation safety for patients and healthcare workers is limited among residents regardless of medical specialty. These findings emphasize the need for educational initiatives.
The National Council for Radiation Protection and Measurement (NCRP) performs periodic surveys of radiation exposure from all sources to the American population. Their most recent survey reported that there is a rapid increase in average exposure to the American population from medical imaging, particularly computed tomography (CT) and cardiac nuclear medicine testing, from 15% in the early 1980s to 48% in 2006 . Effective dose is a risk estimate for a patient population from radiation exposure and is expressed in Sieverts (Sv) . The risk that a radiation dose will induce a cancer in a specific organ changes with age, gender, and individual patients’ variations of intrinsic radiation sensitivity. The population baseline lifetime cancer risk is 25%. For every 100 mSv of radiation dose to an average population, lifetime cancer mortality risk increases from 25% to 25.5% . The relationship between radiation dose and cancer risk is highly controversial; however, the scientific community generally assumes that there is no safe threshold at low dose (the linear no-threshold model) . There is growing public concern that low-dose (<100 mSv) ionizing radiation from diagnostic imaging may be associated with increased cancer risk depending on radiation dose and duration of exposure. Extrapolating from data of the Life Span Study of Japanese atomic bomb survivors, Brenner and Hall estimated that up to 2% of future cancers may be attributable to CT scanning.
The potential for cancer induction associated with medical radiation is even more important in children and pregnant women. The younger a patient, the more radiosensitive they are for certain tumors . They also have a greater postradiation exposure life expectancy compared to adults in which to manifest radiation-induced tumors .
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Methods
Study Population
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Survey
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Data Analyses
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Results
Study Population
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Table 1
Demographic Characteristics of Respondents
All Respondents, n (%) Response Rate, n (%) Gender Male 104/173 (60) — Female 69/173 (40) — Specialty 173/532 (33) Emergency medicine 22/162 (14) 22/59 (37) Family medicine 1/162 (1) 1/21 (5) General surgery 16/162 (10) 16/58 (28) Internal medicine 41/162 (25) 41/173 (24) Neurosurgery 2/162 (1) 2/18 (11) Nuclear medicine 3/162 (2) 3/4 (75) Obstetric/Gynecology 10/162 (6) 10/36 (28) Orthopedic surgery 6/162 (4) 6/25 (24) Plastic surgery 0/162 (0) 0/9 (0) Diagnostic radiology 36/162 (22) 36/61 (59) Radiation oncology 9/162 (6) 9/19 (47) Thoracic surgery 4/162 (3) 4/10 (40) Transitional year 9/162 (6) 9/22 (41) Urology 3/162 (2) 3/15 (20) Postgraduate year 1 50/174 (29) — 2 38/174 (22) — 3 46/174 (26) — 4 26/174 (15) — 5 or more 14/174 (8) —
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Radiation Safety as Part of the Residency Curriculum
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Table 2
Discussion Frequency and Comfort Level with Radiation Safety in Residency Programs
All Specialties, n (%) Specialties, n (%)P Value ¶ Medicine ∗ Surgery † Obstetric/Gynecology Radiology ‡ Discussion over radiation safety at least once in 6 months in residency. 64/164 (39) 13/68 (19) 5/30 (17) 3/10 (30) 38/45 (84)<.001 Discussion over radiation safety in pregnant women at least once in 6 months in residency § 66/145 (46) 13/51 (25) 7/28 (25) 6/10 (60) 37/45 (82)<.001 Discussion over radiation safety in children at least once in 6 months in residency ‖ 56/120 (47) 11/35 (31) 8/28 (28) 1/4 (25) 34/44 (77)<.001 Feeling comfortable making decisions for imaging in pregnancy § 87/143 (61) 17/50 (34) 18/28 (64) 8/10 (80) 38/44 (86)<.001 Feeling comfortable making decisions for imaging in children ‖ 79/106 (75) 17/28 (61) 19/26 (73) 2/3 (67) 37/41 (90).04
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Table 3
Residents’ Perceptions and Knowledge about Radiation Safety across Postgraduate Year and by Gender
Postgraduate Year, n (%) Gender, n (%) 1 2 3 4 5P Value ‡ Male Female_P_ Value § Feeling comfortable making decisions for imaging in pregnancy ∗ 14/38 (37) 21/32 (65) 23/35 (66) 19/24 (79) 10/14 (71) .008 51/85 (60) 35/57 (61) .87 Feeling comfortable making decisions for imaging in children † 11/21 (52) 22/27 (81) 22/27 (81) 15/20 (75) 9/11 (82) .13 48/68 (70) 30/37 (81) .24 Knowledge There is a link between ionizing radiation and future development of cancer 40/42 (95) 35/36 (97) 39/41 (95) 23/25 (92) 13/13 (100) .81 95/97 (98) 54/59 (92).06 Ionizing radiation > 200 mGy is associated with fetal brain malformation. 2/42 (5) 2/36 (6) 6/41 (15) 4/25 (16) 2/13 (15) .36 9/97 (9) 6/59 (10) .85 There is a risk of developing cancer in patients or interventional personnel who are frequently exposed to ionizing radiation, but is uncommon 30/42 (71) 24/36 (67) 32/41 (78) 16/25 (64) 9/13 (69) .75 69/97 (71) 41/59 (69) .83 Patients undergoing fluoroscopy are at risk of developing skin burns depending on the dose of radiation they are exposed to 23/42 (55) 20/36 (56) 24/41 (59) 17/25 (68) 10/13 (77) .55 71/97 (73) 22/59 (37)<.001 Interventional personnel are five times more at risk of developing cataract 8/42 (19) 10/34 (29) 9/41 (22) 10/25 (40) 6/13 (46) .17 40/97 (41) 3/57 (5)<.001 Radiation dose from abdominal computed tomography (CT) scan is equivalent to 100 chest x-rays 17/40 (43) 18/33 (54) 27/40 (68) 10/25 (40) 6/13 (46) .14 52/96 (54) 26/55 (47) .41 Children are five times more radiosensitive compared to adults 12/41 (29) 10/33 (30) 17/40 (43) 9/25 (36) 5/13 (39) .74 36/96 (38) 17/56 (30) .37 Estimated risk of lifetime fatal cancer from a single abdominal CT is 1:1500 in children 4/41 (10) 11/33 (33) 12/41 (29) 2/25 (8) 6/13 (46) .007 22/96 (23) 13/57 (23) .99 Risk of lifetime fetal cancer is 20% in the American population. 7/41 (17) 6/33 (46) 13/39 (33) 6/25 (24) 5/13 (39) .29 26/96 (27) 11/55 (20) .33
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Residents’ Knowledge about Radiation Safety
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Table 4
Resident Knowledge and Perceptions about Radiation Safety across Specialties
All Specialties, n (%) Specialties, n (%)P Value § Medicine ∗ Surgery † Obstetric/Gynecology Radiology ‡ There is a link between ionizing radiation and future development of cancer 151/159 (95) 60/66 (91) 28/29 (96) 10/10 (100) 41/42 (98) .36 Ionizing radiation > 200 mGy is associated with fetal brain malformation 16/160 (10) 3/66 (5) 0/29 (0) 2/10 (20) 11/42 (26).04 There is a risk of developing cancer in patients or interventional personnel who are frequently exposed to ionizing radiation, but is uncommon 112/160 (70) 43/66 (65) 19/29 (65) 8/10 (80) 33/42 (79) .06 Patients undergoing fluoroscopy are at risk of developing skin burns depending on the dose of radiation they are exposed to 96/160 (60) 30/66 (45) 18/29 (62) 2/10 (20) 36/42 (86)<.001 Interventional personnel are five times more at risk of developing cataract 43/158 (27) 7/66 (11) 12/29 (41) 1/9 (11) 20/42 (47)<.001 Radiation dose from abdominal computed tomography (CT) scan is equivalent to 100 chest x-rays 79/154 (51) 36/62 (58) 16/29 (55) 4/10 (40) 19/40 (48) .09 Children are five times more radiosensitive compared to adults 54/155 (35) 18/63 (28) 9/29 (31) 3/10 (30) 20/40 (50) .09 Risk of lifetime fetal cancer from abdominal CT (performed based on adult protocol) is 1:1500 35/156 (22) 10/63 (16) 10/29 (34) 1/10 (10) 12/41 (29) .51 Risk of lifetime fatal cancer is 20% in the American population 38/154 (25) 14/63 (22) 5/29 (17) 0/9 (0) 16/40 (40).03
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Radiology Specialty Residents
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Table 5
Relative Knowledge of Radiation Safety and Use of Radioprotective Equipment among Diagnostic Radiology Residents Compared to Other Specialties (Percent Correct Responses)
Diagnostic Radiology, n (%) Nuclear Medicine and Radiation Oncology, n (%) All Other Specialties, n (%)P Value † Ionizing radiation > 200 mGy is associated with fetal brain malformation. 11/31 (35) 0/11 (0) 5/105 (5).001 Patients undergoing fluoroscopy are at risk of developing skin burns depending on the dose of radiation they are exposed to. 30/31 (97) 6/11 (54) 50/105 (48)<.001 Interventional personnel are five times more at risk of developing cataract. 18/31 (58) 2/11 (18) 20/104 (19)<.001 Radiation dose from abdominal computed tomography (CT) scan is equivalent to 100 chest x-rays. 14/29 (48) 5/11 (45) 56/101 (55) .26 Children are five times more radiosensitive compared to adults. 14/29 (48) 6/11 (54) 30/102 (30) .09 Risk of lifetime fatal cancer from abdominal CT (performed based on adult protocol) is 1:1500. 8/30 (27) 4/11 (36) 21/102 (20) .96 Reported frequency of wearing radiation-monitoring badges everyday or most of the time ∗ 18/28 (64) 3/3 (100) 6/40 (15)<.001 Reported frequency of wearing lead thyroid shield ∗ 28/28 (100) 2/3 (67) 32/40 (80).03 Image Gently/Image Wisely use 13/33 (39) 1/12 (8) 3/105 (3)<.001
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Use of Radiation-monitoring Badges and Lead Thyroid Shields
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Table 6
Importance of Wearing Radiation Safety Badges and Lead Apron across Specialties
All Specialties Radiology ∗ Nonradiology † P Value Importance of wearing radiation-monitoring badges, mean ± standard deviation (SD) 4.3 ± 0.9 4.2 ± 0.2 4.5 ± 0.1 .12 ‡ Reported frequency of wearing radiation-monitoring badges everyday or most of the time, n (%) 30/78 (39) 21/31 (68) 6/40 (15)<.001 § Importance of wearing lead thyroid shield, mean ± SD 4.8 ± 0.5 4.8 ± 0.07 4.8 ± 0.1 .52 ‡ Reported frequency of wearing lead thyroid shield, N (%) 67/78 (86) 30/31 (97) 32/40 (80).03 § Reported preference of two-piece lead aprons, n (%) 52/79 (66) 25/31 (80) 23/40 (57).04 § Reported availability of two-piece lead aprons, n (%) 40/79 (51) 19/31 (61) 17/40 (42) .12 §
Only residents who are exposed to ionizing radiation were queried.
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Discussion
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Limitations
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Conclusions
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