Knowledge, Attitude, and Practices Regarding Occupational Radiation Safety Among Employees in Various Radiology Departments Across Different Hospitals In Sulaimani City

Introduction

The discovery of X-rays by Wilhelm Conrad Roentgen in 1895 revolutionized the field of medical imaging, making ionizing radiation an indispensable tool for diagnosis and treatment in modern medicine (Panchbhai, 2015). However, despite the invaluable benefits of ionizing radiation, its exposure poses significant risks to both patients and healthcare professionals. Radiation exposure has been linked to various health issues, including dermatosis, hematological problems, cataracts, and an increased risk of cancer, particularly for those consistently exposed in radiology departments (Mansouria, Alihemmatia, & Mesbahia, 2020; Chaturvedi & Jain, 2019).

Occupational radiation safety practices are critical to protect healthcare professionals from these adverse effects. The guiding principle of radiation safety is encapsulated in the ALARA (As Low As Reasonably Achievable) concept, which emphasizes minimizing exposure through the control of time, distance, and shielding (Jha, Nayak, & Subramanian, 2016). Ensuring adherence to these principles is essential in high-risk environments like radiology and nuclear medicine departments.

Global research has shown varying levels of knowledge, attitude, and practice (KAP) regarding radiation safety among healthcare professionals. For instance, a study conducted by Maharjan et al. (2020) highlighted the need for continuous education and training for radiology professionals to enhance radiation safety. Similarly, Seifi et al. (2019) found that insufficient training and awareness of ionizing radiation hazards resulted in inadequate protective measures in nuclear medicine centers.

In Iraq, few studies have investigated the awareness and safety practices related to occupational radiation exposure among healthcare professionals. Given the high risk associated with continuous exposure to ionizing radiation in medical settings, it is critical to assess and improve KAP levels among radiology staff. This study aims to evaluate the knowledge, attitude, and practice of occupational radiation safety among physicians working in radiology departments in Iraq, thereby identifying gaps in their awareness and protective measures.

Methodology

Study Design

This study employed a cross-sectional design to assess the knowledge, attitude, and practice (KAP) of occupational radiation safety among physicians working in radiology departments across Iraq. The cross-sectional approach is appropriate for this type of research, as it allows for the examination of a sample population at a specific point in time, thereby providing a snapshot of KAP levels.

Study Population and Setting

The study was conducted between 2022 and 2023, targeting physicians exposed to X-ray radiation in various hospitals and medical centers across Iraq. A total of 250 physicians, including radiologists and other healthcare workers involved in radiology services, participated in the study. The inclusion criteria for the study were:

• Physicians aged 18 years and older.
• Those with at least one year of experience in radiology departments.
• Physicians who are exposed to ionizing radiation (e.g., X-rays) during their professional duties.

Exclusion criteria included physicians with a history of mental or physical illness that could hinder their ability to participate, as well as those who were unwilling to provide informed consent.

Data Collection Tool

Data were collected using a structured, researcher-made questionnaire. The questionnaire was designed based on existing literature on radiation safety and occupational health (Jha et al., 2016; Maharjan et al., 2020). It consisted of three main sections:

1. Demographic Information: This section included items on age, gender, marital status, level of education, job title, occupational experience, and type of hospital (government, private, or educational).
2. Knowledge of Radiation Safety: This section assessed participants' knowledge of ionizing radiation risks, protective measures, and international safety guidelines such as ALARA (As Low As Reasonably Achievable).
3. Attitude Towards Radiation Safety: This section evaluated participants' attitudes towards the use of radiation safety protocols and the importance of continuous education and training in radiation protection.
4. Practice of Radiation Safety: This section focused on the actual safety practices adopted by participants, such as the use of protective equipment, adherence to time and distance guidelines, and shielding techniques during radiological procedures.

The questionnaire was reviewed by two radiation safety experts for content validity, and a pilot test was conducted with 20 radiologists to ensure clarity and relevance. Cronbach's alpha was calculated for reliability, with a value of 0.84, indicating high internal consistency.

Data Collection Procedure

Prior to data collection, the study's objectives were explained to all participants, and written informed consent was obtained. Participation in the study was voluntary, and all responses were kept anonymous to maintain confidentiality. The questionnaires were distributed and collected in person by trained research assistants at each hospital and medical center. Participants were given sufficient time to complete the questionnaire, and ambiguities were clarified by the research assistants when necessary.

Statistical Analysis

Data were analyzed using SPSS version 23 software. Descriptive statistics, including means, standard deviations, frequencies, and percentages, were used to summarize demographic characteristics and KAP levels. Inferential statistics were used to explore relationships between KAP scores and demographic variables.

• Knowledge Scores: Knowledge scores were categorized as poor, moderate, or good based on predefined cutoff values.
• Attitude and Practice Scores: Similarly, attitude and practice scores were also categorized as poor, moderate, or good.
• Chi-Square Tests: Chi-square tests were performed to assess the association between categorical demographic variables (e.g., age group, gender, and education) and KAP scores.
• ANOVA: Analysis of Variance (ANOVA) was used to compare mean KAP scores across different demographic groups.
• Significance Level: A p-value of less than 0.05 was considered statistically significant for all analyses.

Ethical Considerations

Ethical approval for this study was obtained from the ethics committee of [Name of University]. Participation was voluntary, and all participants were informed of their right to withdraw from the study at any time. Informed consent was obtained from each participant before data collection. All data were anonymized, and personal identifiers were removed to ensure confidentiality. The study adhered to the ethical principles outlined in the Declaration of Helsinki.

Limitations

Some limitations of the study include the reliance on self-reported data, which may introduce bias due to social desirability or recall errors. Additionally, the study was limited to a specific geographic region, and thus the findings may not be generalizable to other populations.

Results

Demographic Characteristics of Participants

A total of 250 physicians working in radiology departments participated in the study. The majority of participants were male (60.8%), with females accounting for 39.2% of the sample. The age distribution showed that 22% of participants were aged between 20-30 years, 47.2% were aged between 31-40 years, and 30.8% were aged between 41-50 years. Most participants were married (73.6%), and 67.2% resided in urban areas. Regarding occupational status, 74.8% of participants were radiographers, while 12.8% were radiology doctors, and 12.4% were other radiology staff. Most of the participants had a diploma degree (81.6%), and the majority worked in government hospitals (80.4%).

Knowledge of Radiation Safety

The knowledge of radiation safety among participants was categorized into three levels: poor, moderate, and good. Most participants had moderate knowledge of radiation safety (58.4%), with 35.2% demonstrating poor knowledge and only 6.4% exhibiting good knowledge. The mean knowledge score was 27.04 ± 4.29 (on a scale of 5-53).

• Participants with 1-10 years of occupational experience showed a lower mean knowledge score (26.41 ± 4.85) compared to those with more than 10 years of experience (28.05 ± 6.13) (p=0.02).
• Significant associations were found between knowledge levels and alcohol consumption history (p=0.01), average working hours (p=0.004), and the number of patients diagnosed per day (p=0.03). However, no significant associations were observed between knowledge and variables such as gender, marital status, education level, or type of hospital.

Attitude Towards Radiation Safety

The attitude of participants towards radiation safety was also assessed and categorized into poor, moderate, and good levels. The majority of participants (64.4%) had a moderate attitude towards radiation safety, while 35.6% demonstrated a poor attitude. None of the participants exhibited a good attitude based on the scoring system used. The mean attitude score was 31.14 ± 3.23 (on a scale of 5-78).

• A statistically significant relationship was found between age group and attitude (p=0.001), with participants in the 41-50 age group having a more positive attitude (mean score: 32.03 ± 4.32) compared to younger age groups.
• Additionally, there was a significant association between occupational status and attitude (p=0.03), with radiology doctors showing a more favorable attitude towards radiation safety than radiographers and other radiology staff. No significant associations were found between attitude and variables such as gender, marital status, or education level.

Practice of Radiation Safety

In terms of radiation safety practices, most participants exhibited moderate levels of practice (88.8%), with only 6.4% displaying poor practices and 4.8% showing good practices. The mean practice score was 38.16 ± 6.71 (on a scale of 14-82).

• Participants working in private hospitals had significantly better practice scores (mean: 42.12 ± 8.67) compared to those in government hospitals (mean: 37.31 ± 6.03) (p<0.0001).
• Additionally, there was a significant association between age group and practice (p=0.03), with participants aged 20-30 years demonstrating better safety practices (mean score: 40.07 ± 7.08) compared to older age groups.
• Occupational experience also played a role in radiation safety practices, with participants having more than 10 years of experience showing significantly better practice scores (p=0.001).
• No significant associations were observed between practice scores and other variables such as gender, marital status, or education level.

Overall KAP Assessment

The overall assessment of knowledge, attitude, and practice (KAP) revealed that the majority of participants exhibited moderate levels across all three domains: knowledge (58.4%), attitude (64.4%), and practice (88.8%). The results suggest that while participants are aware of radiation safety principles, there is room for improvement, particularly in terms of converting knowledge and attitudes into safer practices. Continuous education and training are recommended to enhance KAP levels among radiology professionals in Iraq.

Table 1. Radiation protection knowledge, attitude, and practice among the radiology staff