... PEER REVIEW Fctors Relted to Rdition Sfety Prctices in Cliforni JANET THOMPSON REAGAN, PhD ANITA MARIE SLECHTA, MS, R.T.(R)(M), FASRT Bckground A ntionl study of rdiologic technologists rdition sfety prctices in 2003 documented poor complince. In ddition, the 2003 study found tht yers of work experience nd length of employment t work site were significntly relted to dherence with sfety prctices. The current study is refinement nd extension of the 2003 study. Purpose To determine the degree of complince with personnel rdition sfety prctices nd ptient rdition sfety prctices s correlted with initil professionl eduction, highest level of eduction, yers of employment in the rdiologic sciences nd type of work site. Method A 33-item questionnire ws miled to rndom smple of 1500 Cliforni rdiologic technologists certified by the Americn Registry of Rdiologic Technologists. The return rte ws 32. Results Men scores were 77.1 for complince with ptient sfety prctices nd 70.5 for complince with personnel sfety prctices. Performnce on individul items rnged from 95.6 to 27.4 complince. Two independent vribles, yers of employment in the rdiologic sciences nd work site, were significntly relted to dherence with sfety prctices (P <.05). Conclusion The results of this study corroborted those of the ntionl study nd indicted the need for eductionl nd orgniztionl interventions to increse complince with sfety prctices for ptients nd personnel. A ntionl study of fctors relted to rdiologic technologists knowledge of nd complince with rdition sfety prctices documented poor complince. 1 The study found tht 2 independent vribles yers in prctice s rdiologic technologist nd length of employment t the work site were significntly relted to sfety prctices. Complince with sfety prctices ws higher in lrge hospitls nd, s yers of prctice incresed, initil complince incresed nd then lter declined. Contrry to the reserchers expecttions, the type of initil eduction ws not significntly relted to complince with sfety prctices. Although the study did not intend to investigte differences between personnel sfety prctices nd ptient sfety prctices, n exmintion of performnce on individul items reveled consistently better complince with ptient sfety prctices thn with personnel sfety prctices. Literture Review Becuse complince with sfety prctices ws consistently lower for personnel sfety thn ptient sfety, n extensive review of the literture on helth risks to the rdiologic technologist due to long-term occuptionl exposure to low-dose ionizing rdition ws conducted. Of the rticles identified, most were reports of reserch conducted using the dt generted by the U.S. Rdiologic Technologists Study initited in 1982. Severl rticles 2-4 provide n overview of the purpose nd methods of this study. Erly studies found cumultive exposure to ionizing rdition incresed with length of employment, 2 but the risk of brest cncer ws not relted to length of employment s rdiologic technologist. 3 Although the results of lter studies were mixed nd often difficult to interpret, they identified helth risks to rdiologic technologists nd some chllenged current ssumptions regrding sfe levels of exposure. 5 Results of study published in 2002 showed n incresed risk for brest cncer for technologists employed prior to 1950. 4 A 2003 rticle reported n incresed risk for solid tumors, brest cncer nd thyroid cncers for femle technologists, nd n incresed risk for melnom nd thyroid cncer in mle technologists. For both sexes, the risks of certin other cncers (eg, lung cncer) were less thn would be expected, 6 complicting the interprettion of the 538 July/August 2010, Vol. 81/No. 6 RADIOLOGIC TECHNOLOGY
REAGAN, SLECHTA findings. Incresed risks for nonmelnom skin cncer 7 nd ctrcts lso hve been found. 5 Although results re not lwys consistent, reserch in generl supports the need to estblish nd observe sfety prctices to minimize the exposure of rdiologic technologists. No recent rticles on methods of improving complince with personnel sfety prctices were found. Most literture focuses on complince with ptient sfety prctices, which re of primry concern for rdiologic technologists. Complince with ptient sfety for dignostic rdiogrphy, computed tomogrphy (CT) nd mmmogrphy, the primry focus of this study, is rrely ddressed in the literture. Notble exceptions re the 2007 review of the literture on ptient dose from CT nd the 2006 review of rdition protection prctices. 8,9 The focus of these reviews ws the incresed use of CT nd the ctul procedurl ptient dose, documenttion of the ptient dose nd peditric procedurl dose djustments. No literture other thn the ntionl study 1 focused on either ptient or personnel rdition protection prctices in broder sense. Study Objectives, Vribles nd Limittions The current study hd 2 primry objectives: To scertin whether key findings of the ntionl study would be replicted with revised instrument nd with the Cliforni-bsed popultion of Americn Registry of Rdiologic Technologists (ARRT) registrnts. To determine whether there ws significnt difference between complince with personnel sfety prctices nd complince with ptient sfety prctices. In the ntionl study, the 2 dependent vribles were knowledge of sfety prctices nd complince with sfety prctices. Knowledge of sfety prctices ws higher (82) thn complince (72), nd there ws significnt, positive correltion between them. Although knowledge is not unimportnt, for this study the focus ws on complince nd whether the level of complince ws different for personnel sfety vs ptient sfety. Thus, the 2 dependent vribles were complince with ptient sfety prctices nd complince with personnel sfety prctices. The independent vribles in the ntionl study were initil eduction, yers in prctice, prticiption in continuing eduction (CE) nd type of work site. Almost ll (98.9) of the respondents in the ntionl study hd completed CE in the pst yer. Thus the reltionship between CE nd the dependent vribles could not be exmined. For this study, prticiption in CE ws dropped from the independent vribles nd highest level of eduction ws dded. The 4 independent vribles were initil eduction, highest level of eduction, yers in prctice nd type of work site. Bsed on the previous study, the following predictions were mde: complince with ptient sfety prctices would be significntly higher thn complince with personnel sfety prctices; complince with personnel nd ptient sfety prctices would be correlted with type of work site nd yers in prctice; complince with personnel nd ptient sfety prctices would not be correlted with type of initil eduction; nd complince with personnel nd ptient sfety prctices would be correlted with highest level of eduction. The ssumptions underlying the study were s follows: Respondents would give ccurte responses regrding sfety prctices. Any bis in responses would result in n overestimte of complince. The questionnire provides vlid ssessment of complince with ptient sfety prctices nd personnel sfety prctices. The predicted results re resonble bsed on the results reported in the Tilson, 10 Lemley 11 nd Slecht nd Regn 1 studies. The limittions of the study re the following: Although the 32 return rte is not uncommon for miled survey, it limits the bility to generlize the results to the popultion smpled, even though the chrcteristics of the respondents were similr to those of the popultion of ARRT registrnts in terms of sex distribution, yers of prctice s n ARRT registrnt nd site of employment. The questionnire ws revised, refined version of n instrument used in previous study. Experts in the field reviewed the instrument for relevncy to the field of prctice nd content vlidity. However, test-retest relibility hs not been estblished. Respondents were sked to indicte their primry re of prctice nd instructed to complete items pertining to their own ctivities. Results indicted tht mny respondents engged in ctivities outside their primry re of prctice. For exmple, 62 respondents indicted their primry re of prctice s CT, yet the number responding to the items ssessing complince with CT sfety prctices rnged from 152 for item 17 to RADIOLOGIC TECHNOLOGY July/August 2010, Vol. 81/No. 6 539
RADIATION SAFETY PRACTICES Tble 1 Study Design Personnel Rdition Protection 11 Questions Ptient Rdition Protection 15 questions Totl Number of Questions Portble/ Mobile Rdiogrphy Questions No. 6, 7, 8 170 for item 15, indicting tht mny ARRT registrnts engge in CT ctivities even though CT is not their primry re of prctice. Therefore, one cnnot drw conclusions bout the complince with sfety prctices by individuls whose primry re of prctice is CT by reviewing performnce on the CT items. Methods A survey of 1500 ARRT-certified rdiologic technologists in Cliforni ws conducted. Questionnires were miled September 19, 2005, with requested return dte of October 21, 2005. All responses were nonymous. Smple Design The smple frme ws the dtbse of the ARRT, which supplied simple rndom smple nd summry dt on the chrcteristics of the Cliforni registrnts. Registrnts who hd dvnced certifiction in mgnetic resonnce (MR) imging, rdition therpy Fluoroscopy CT Generl Rdiogrphy Questions No. 9, 10, 11, 12, 13 Question No. 14 Tble 2 Summry Sttistics for Dependent Vribles Dependent Vrible Personnel Sfety Ptient Sfety Questions No. 15, 16, 17 Questions No. 20, 21, 22 Questions No. 18, 19, 23, 24, 25, 26, 27, 28, 29, 30, 31 3 6 3 14 n Men Stndrd Devition Stndrd Error of Men 95 Confidence Intervl of Men Lower Boundry Upper Boundry 317 70.5 17.6.99 68.6 72.4 420 77.1 13.1.64 76.5 77.7 nd ultrsound were excluded from the smpling frme. A smple of 1500 ws drwn from the study popultion of 7301 becuse response rtes to miled surveys re usully low. With n estimted 20 response rte (bsed on the return rte of the previous study), smple of 1500 would yield 300 responses, sufficient for 95 confidence level with 6 mrgin of error nd, therefore, sufficient for the plnned sttisticl nlyses. 12 Questionnire Design The questionnire ws modified version of the questionnire used in the ntionl study. 1 Response ctegories to items soliciting demogrphic informtion were modified to mtch those used by the ARRT. This llowed for better comprison of respondent demogrphic chrcteristics with those of the ARRT registrnts thn ws possible in the ntionl study. In ddition, becuse this study exmined complince with personnel sfety prctices nd ptient sfety prctices seprtely nd did not exmine knowledge of sfety prctices, ll items ssessing knowledge of sfety prctices were excluded from the questionnire nd the number of items ssessing complince with sfety prctices ws incresed to ensure content vlidity. The resulting 33-item instrument solicited bsic demogrphic informtion, informtion on the 4 dependent vribles (ie, type of initil professionl eduction, highest level of eduction, yers in professionl prctice nd type of work site) nd informtion on the 2 dependent vribles (ie, complince with personnel sfety prctices nd complince with ptient sfety prctices) (see Tbles 1, 2 nd 3). Of 540 July/August 2010, Vol. 81/No. 6 RADIOLOGIC TECHNOLOGY
REAGAN, SLECHTA the 33 items, 7 solicited informtion bout respondent chrcteristics, including sex, ge, yers in prctice, primry re of prctice, work site, initil rdiologic technology eduction nd highest level of eduction (see Tbles 4 nd 5). Complince with ptient sfety prctices ws ssessed through 15 items nd complince with personnel sfety prctices ws ssessed through 11 items (see Tble 3 Study Anlysis Independent Vribles Initil rdiologic science eduction Spermn =.025 Kendl =.021 Highest level of eduction Spermn =.038 Kendl =.030 Yers s rdiologic technologist Tbles 6-14). Survey questions focused on portble/ mobile imging (3 questions), fluoroscopy (6 items), CT (3 items) nd generl rdiogrphy (14 items) (see Tble 1). Dt Anlysis Scoring guides were developed for clculting the scores for complince with personnel nd ptient sfety prctices. The highest possible score ws 22 for personnel sfety nd 37 for ptient sfety. Not ll respondents completed ll items becuse of different res Dependent Vribles Personnel Sfety Prctice Ptient Sfety Prctice Spermn =.053 Kendl =.042 Spermn =.006 Kendl =.002 Spermn =.130 Spermn =.05 Kendl =.088 Kendl =.077 Primry work site Spermn =.114 b Spermn =.100 Kendl =.084 Kendl =.073 Significnt t P <.05. b Spermn.114 is wek correltion but P <.05 mens we hve confidence in this finding nd it is not likely due to chnce. nd scopes of prctice. When the highest possible score for respondent ws less thn 11 for personnel sfety or less thn 19 for ptient sfety, no complince score ws clculted. Even though the N for this study ws 431, the n for ptient sfety ws 420 nd the n for personnel sfety ws 317. The number of responses to individul items rnged from low of 131 for item 13 to high of 412 for item 16. Dt were nlyzed using SPSS (SPSS Inc, Chicgo, Illinois) to provide descriptive sttistics nd tests for ssocitions mong the dependent nd independent vribles. Tble 4 Initil Rdiologic Technology Eduction nd Complince With Rdition Sfety Prctice Cliforni Study (N = 431) Ntionl (N = 451) Initil R.T. Eduction Personnel Sfety Ptient Sfety Combined Personnel nd Ptient Sfety Men SD Men SD Men SD Hospitl-bsed progrm/certificte 69.1 19.6 76.4 11.7 74.3 23.2 progrm Associte degree 71.8 16.8 77.7 13.4 71.6 22.9 Bchelor s degree in rdiologic 66.3 17.7 78.8 12.6 69.9 29.1 technology/science Militry progrm 64.5 17.4 74.9 15.6 70.2 17.1 Other 81.8 54.5 NA 64.0 29.0 Stndrd devition RADIOLOGIC TECHNOLOGY July/August 2010, Vol. 81/No. 6 541
RADIATION SAFETY PRACTICES Tble 5 Highest Level of Eduction nd Complince with Rdition Sfety Prctice Cliforni Study Highest Eduction Results Of the 1500 questionnires, 480 were returned for response rte of 32, which ws higher thn the nticipted return rte of 20. Only 431 questionnires (28.7) were usble for nlysis; 49 were excluded becuse of insufficient responses. Chrcteristics of Respondents Forty-nine percent of the respondents were women nd 41 were men. Most respondents hd long Personnel Sfety (n = 317) Ptient Sfety (n = 385) Men SD Men SD Hospitl-bsed progrm/certificte progrm 71.0 19.3 77.2 10.6 Associte degree 70.8 17.0 77.5 13.5 Bchelor s degree 68.8 18.8 76.1 14.9 Mster s degree 75.1 2.8 71.9 5.1 Other 74.8 21.6 72.6 8.9 Stndrd devition Tble 6 Personnel Rdition Sfety Prctice Questions 6. When performing portble exms, how often do you wer led pron if you cnnot stnd 6 feet from the ptient? n = 319 Alwys 60.2 Sometimes 29.8 Never 10.0 7. When setting up C-rm procedure nd when room size nd ptient bed llows, how often do you plce the x-ry tube bove the imge intensifier tube for the procedure? n = 248 Alwys 27.4 Sometimes 45.2 Never 27.4 Best prctice work history; 46.1 hd been in prctice for 16 or more yers. The primry re of prctice for most respondents ws dignostic/ generl (67), followed by CT (14.4) nd mmmogrphy (11.1). Most respondents worked in hospitls (64), followed by clinics (20.9). Of those working in hospitls (n = 276), 16.3 were in smll hospitls (1 to 99 beds), 48.6 were in medium hospitls (100 to 299 beds) nd 35.1 were in lrge hospitls (300 or more beds). Sex distribution, verge yers of prctice s n ARRT registrnt nd plce of employment were similr for the respondents nd the Cliforni ARRT registrnt popultion. Most of the respondents received their initil rdiologic technology eduction through ssocite degree progrms (61.7) or hospitl-bsed certificte progrms (28.8). Few hd completed bchelor s progrms (3), militry progrms (6.3) or other types of progrms (0.2). For most respondents, the highest Tble 7 Personnel Rdition Sfety Prctice Questions 8. How often do you hold ptients during portble rdiogrphy? Cliforni Study Ntionl Study Comprble n = 284 n = 318 At lest once week 17.6 Dily 4.7 Once week 22.3 27.0 At lest once month 28.2 Once month Once yer 24.5 24.5 26.7 Once yer or less 54.2 Never 21.7 48.5 Best prctice 542 July/August 2010, Vol. 81/No. 6 RADIOLOGIC TECHNOLOGY
REAGAN, SLECHTA Tble 8 Personnel Rdition Sfety Prctice Questions 9. Where do you stnd during typicl upper GI fluoroscopic procedure? Cliforni Study (n = 284) Ntionl Study (n = 264) By the ptient s hed 5.6 10.6 Behind the doctor 75.1 70.4 In the control room 15.4 11.7 At the foot of the tble 3.9 2.6 Other NA 4.5 10. Where do you stnd during typicl lower GI fluoroscopic procedure? Cliforni Study Ntionl Study By the ptient s hed 0.4 3.4 Behind the doctor 68.7 61.7 In the control room 11.6 7.6 At the foot of the tble 19.4 22.4 Other NA 5.3 12. During fluoroscopic procedure, how often do you wer thyroid shield? Cliforni Study Ntionl Study (n = 301) (n = 270) Alwys 49.8 34.1 Sometimes 33.6 37.4 Never 16.6 28.5 Best prctice level of eduction ws n ssocite degree (59.6) or certificte progrm (19.5). A bchelor s degree ws held by 18.3, followed by 2.4 with mster s or higher degree. Complince With Personnel nd Ptient Sfety Prctices Complince with sfety prctices ws evluted by clculting 2 scores, one for personnel sfety prctices nd one for ptient sfety prctices. The men score for personnel sfety prctice (N = 317) ws 70.5 with SD of 17.6; the men score for ptient sfety prctice (N = 385) ws 77.1 with SD of 13.1. With 95 confidence, the men for personnel sfety flls between 68.6 nd 72.4. The men for ptient sfety flls between 76.5 Tble 9 Personnel Rdition Sfety Prctice Questions 11. Where do you wer your personnel monitoring device? Cliforni Study (n = 315) At wist level outside pron 0.3 At collr level outside pron 88.3 At collr level inside pron 9.5 Other 1.9 13. How often do you hold ptients during fluoroscopic procedures? Cliforni Study (n = 273) At lest once week 6.6 At lest once month 26.0 In the control room 11.6 Once yer or less 67.4 Best prctice nd 77.7 (see Tble 2). The 2 mens re significntly different, t = 5.60, P <.005, two-tiled test. Although the distributions for the complince scores were skewed to the right, the skewness vlue ws within the cceptble rnge of ±2. Becuse the distributions of the complince scores were not norml, the reltionship between them ws evluted using Kendll rnk correltion nd Spermn correltion. For both tests, the reltionship between the scores ws wek, positive nd significnt: =.172, P <.01 level, nd =.251, P <.01, indicting tht respondents who complied with ptient sfety prctices were only slightly more likely to comply with personnel sfety prctices. Reltionships Among Independent nd Dependent Vribles Reltionships mong independent nd dependent vribles were tested using Spermn rnk correltion ( ) nd Kendl rnk correltion for ctegoricl vribles (see Tble 3). A wek, positive reltionship ws found for primry work site nd personnel sfety prctices ( =.114, P <.05), nd wek, negtive reltionship ws found for yers in prctice nd personnel sfety prctices ( =.100, P <.05). No significnt reltionships were found between initil eduction nd complince or highest level of eduction nd complince (see Tbles 3, 4 nd 5). RADIOLOGIC TECHNOLOGY July/August 2010, Vol. 81/No. 6 543
RADIATION SAFETY PRACTICES Tble 10 Personnel Rdition Sfety Prctice Questions Cliforni Study Only n At lest once week () At lest once month () Once yer or less () 20. How often do you hold dult ptients during routine rdiogrphy? 360 10.3 22.5 67.2 21. How often do you hold peditric ptients during routine rdiogrphy? 356 15.4 32.3 52.2 22. How often do you hold ptients during trum rdiogrphy? 386 8.4 30.4 61.2 Best prctice Although both the Cliforni nd the ntionl studies found significnt reltionship between the type of work site nd complince with sfety prctices, the site with best prctice ws different in the 2 studies (see Tble 4). For the ntionl study, complince ws highest in lrge hospitls; for the Cliforni study, complince ws highest for outptient fcilities, imging centers nd privte offices. Although the bsolute difference ws not gret in either study, it ws significnt difference (P <.05) nd not likely due to chnce. For the Cliforni study, complince with sfety prctices declined with yers in prctice nd the decline in the men complince score ws greter for personnel sfety (6.6 points) thn for ptient sfety (3.6 points). This difference ws wek nd significnt for personnel sfety, =.130 nd P <.05, wek nd not significnt for ptient sfety (see Tble 3). For the ntionl study, there ws curviliner reltionship: Initil complince ws low (68), then incresed to 76 complince by 16 to 25 yers nd then declined to 73 fter 26 yers. Scores on individul items rnged from high of 95.6 best prctice on question 25 (see Tble 13), to low of 27.4 best prctice for question 7 (see Tble 6). ARRT registrnts in the Cliforni study scored consistently higher thn those in the ntionl study from 3.1 to 21.9 higher on the 8 items common to both studies (see Tbles 7, 8 nd 11). Using 85 best prctice (in eductionl terminology grde of B ) s the desired level of performnce, ARRT registrnts met the stndrd for best prctice on only 6 of the 26 items. Clerly, complince levels should be higher to protect the technologist nd ptient. Conclusion nd Recommendtions The results of this study corroborte some of the findings of the ntionl study nd support the predictions tht complince would be higher for ptient sfety prctices thn for personnel sfety prctices, nd tht yers in prctice nd type of work site would be relted to sfety complince. This study, in combintion with the ntionl study, hs incresed our understnding of knowledge of nd complince with rdiologic sfety prctices nd hs rised severl questions tht merit dditionl reserch. Mjor findings from the ntionl nd the current study re s follows: Ntionl Prticiption in CE ws high, 98.9, yet complince with sfety prctices ws low, 72.2. Knowledge of sfety prctices ws higher thn complince with sfety prctices, 82.2 nd 72.2, respectively. Ntionl nd Cliforni Study Complince ws higher for ptient sfety prctices thn for personnel sfety prctices, 77.1 nd 70.5, respectively. Although complince my hve incresed since the current study ws completed, there ws no notble improvement in complince scores in the 3 yers between the ntionl study nd the current study. Type of initil eduction nd highest level of eduction were not relted to level of complince. The reltionships between type of work site nd yers in prctice to complince re complex nd inconsistent. Additionl reserch is needed to ddress the following questions: Considering tht CE is required nd there is lmost universl prticiption, why is complince with sfety prctices low? Ares for investigtion include topics covered in CE, methods most often employed (eg, Directed Redings, conferences, etc) nd the incentives or disincentives for trnsferring lerning to prctice. Why is complince with sfety prctices greter for ptients thn for personnel? With poor 544 July/August 2010, Vol. 81/No. 6 RADIOLOGIC TECHNOLOGY
REAGAN, SLECHTA Tble 11 Ptient Rdition Sfety Prctice Questions 14. During fluoroscopy with n under-the-tble x-ry tube, where do you plce the imge intensifier? Cliforni Study (n = 212) As fr wy from the ptient s possible Ntionl Study (n = 130) 6.8 15.3 As close to the 91.9 80.9 ptient s possible The distnce or position does not mtter 0.0 3.8 15. Do you use gondl shielding on womn of child-bering ge during CT of the chest? Cliforni Study (n = 170) Ntionl Study ( n = 136) Alwys 45.9 40.4 Sometimes 27.6 36.8 Never 26.5 22.8 16. Where do you plce gondl shielding during CT exm of the chest? Cliforni Study (n = 168) Ntionl Study (n = 142) On top of the ptient 11.3 9.2 Around the entire 67.3 70.4 pelvis Under the ptient 0.6 2.1 No gondl shielding is necessry 20.8 18.3 18. Hve you compred rdition from the sun to rdition from dignostic x-rys when tlking to ptients who re nervous bout the dose for their dignostic procedure? Cliforni Study (n = 426) Ntionl Study (n = 413) Alwys 20.0 9.9 Sometimes 62.0 50.1 Never 18.1 40.0 Best prctice Tble 12 Ptient Rdition Sfety Prctice Questions 17. How often do you lter the mnufcturer s recommended technique (ma & kvp) for chest or bdomen CT when you re imging peditric ptient? Cliforni Study Only (n = 152) Alwys 47.4 Sometimes 37.5 Never 13.2 19. For which of the following ptients would you use gondl shielding for foot x-ry? Cliforni Study Only (n= 431) 2-dy-old bby 95.4 15-yer-old girl 94.9 85-yer-old mn 18.3 50-yer-old mn 52.2 33-yer-old mn 86.3 24-yer-old womn 95.1 7-yer-old girl 96.3 24. How hve you ttempted to decrese your ptient s dose in the lst yer? (Select ll tht pply.) Cliforni Study Only (n = 431) Decrese mas 65.9 Use led shielding 85.2 Increse kvp 62.9 Unble to mnipulte dose 3.7 Best prctice sfety prctice, both will be t risk for unnecessry exposure to rdition. Yet, the risk for excessive exposure my be greter for stff, considering they my hve 20- to 30-yer creers. Wht cn be done to increse complince with sfety prctice? A multipronged pproch involving professionl ssocitions nd helth cre orgniztions is required. RADIOLOGIC TECHNOLOGY July/August 2010, Vol. 81/No. 6 545
RADIATION SAFETY PRACTICES Tble 13 Ptient Rdition Sfety Prctice Questions Cliforni Study Only n Alwys Sometimes Never 25. How often do you sk femles tht re in their reproductive yers if they re pregnnt before dignostic exms? 427 95.6 4.2 0.2 26. How often do you use gondl shielding on 3-yer-old boy who needs chest x-ry? 395 92.4 6.3 1.3 How often do you use gondl shielding on who needs x-ry? n Alwys Sometimes Never 27. 16-yer-old boy/l-spine 395 92.4 6.3 1.3 28. 37-yer-old mn/knee 408 62.3 26 11.8 29. 21-yer-old womn/finger 407 84.3 11.1 4.7 30. 10-yer-old boy/pelvis 400 39.8 28.5 31.8 31.19-yer-old mn/esophgrm 322 61.8 18.6 19.6 Best prctice Wht impct will chnging technology hve on risk of nd levels of unnecessry exposure for ptients nd personnel? Future reserch on rdition protection prctices will not only hve to focus on personnel nd ptient sfety, but will need to ddress new technologies such s digitl rdiogrphy nd CT tht hve the potentil to increse ptient dose. 13,14,15 Becuse the mjority of technologists using these newer technologies were educted initilly in nlog technology, they my not understnd how best to decrese ptient dose using digitl rdiogrphy nd CT systems. Becuse rdition protection prctice ws consistently poor in both the ntionl nd Cliforni studies, we Tble 14 Summry of Poor Personnel Rdition Sfety Prctice Cliforni Study Only Question No. Best Prctice 6. (pron usge) 60.2 7. (C-rm/II position) 27.4 8. (hold ptient for portble) 54.2 10. (where R.T. stnds for BE) 80.3 12. (wer thyroid shield) 49.8 13. (hold ptient for fluoro) 67.4 20. (hold ptient for rdiogrphy) 67.2 21. (hold peditric ptient) 52.2 22. (hold trum ptient) 61.2 Defined s less thn 85. Summry of Poor Ptient Rdition Sfety Prctice Cliforni Study Only Question No. Best Prctice 15. Gond shield on CT femle 45.9 16. Loction of gond shield CT femle 67.3 17. Vry technique on peditric CT 47.4 18. Compre sunlight to x-ry 18.1 24. Decrese dose with technique (mas, kvp) 65.9, 62.9 28. Shield 37-yer-old mle knee 62.3 30. Shield 10-yer-old mle pelvis 39.8 31. Shield 19-yer-old mle 61.8 esophgrm Defined s less thn 85. need to evlute current CE prctices s remedition for these poor prctices. These re most timely questions, since the ARRT is considering different systems of recertifiction for individuls certified fter 2011. Will the recertifiction system ddress the poor rdition protection prctices identified in these reserch projects? Rdition protection prctice for both ptients nd personnel is fundmentl to every spect of the rdiologic technologist s role. Further reserch my identify how to improve protection prctices. 546 July/August 2010, Vol. 81/No. 6 RADIOLOGIC TECHNOLOGY
REAGAN, SLECHTA References 1. Slecht AM, Regn JT. An exmintion of fctors relted to rdition protection prctices. Rdiol Technol. 2008;79(4):297-305. 2. Boice JD Jr, Mndel JS, Doody MM, Yoder CY, McGown R. A helth survey of rdiologic technologists. Cncer. 1992;69(2):586-598. 3. Boice JD Jr, Mndel JS, Doody MM. Brest cncer mong rdiologic technologists. JAMA. 1995:274(5):394-401. 4. Mohn AK, Huptmn M, Freedmn DM, et l. Cncer nd other cuses of mortlity mong rdiologic technologists in the United Sttes. Int J Cncer. 2003;103(2): 259-267. 5. Chodick G, Bekirogiu N, Huptmnn M, et l. Risk of ctrct fter exposure to low doses of ionizing rdition: 20-yer prospective cohort study mong US rdiologic technologists. Am J Epidemiol. 2008;168(6):620-631. 6. Sigurdson AJ, Doody MM, Ro RS, et l. Cncer incidence in the US rdiologic technologists. Cncer. 2003;97(12):3080-3089. 7. Yoshing S, Huptmnn M, Sigurdson AJ, et l. Nonmelnom skin cncer in reltion to ionizing rdition exposure mong US rdiologic technologists. Int J Cncer. 2005;115(5):828-834. 8. Colng JE, Killion JB, Vno E. Ptient dose from CT: literture review. Rdiol Technol. 2007;79(1):17-26. 9. Engel-Hills P. Rdition protection in medicl imging. Rdiogrphy. 2006;12(2):153-160. 10. Tilson E. Eductionl nd experientil effects on rdiogrphers rdition sfety behvior. Rdiol Technol. 1982;53(4):321-325. 11. Lemley AA, Hedl JJ Jr, Griffin EE. A study of rdition sfety eduction prctices in cute cre Texs hospitls. Rdiol Technol. 1987;58(4):323-331. 12. Shi L. Smpling in helth services reserch. In: Helth Services Reserch Methods. Albny, NY: Delmr Publishers. 1997;226-242. 13. Bushong S. Digitl rdiogrphy. In: Bushong S. Rdiologic Science for Technologists. 8th ed. St. Louis, MO: Elsevier. 2004;403. 14. Compgnone G, Csdio Bleni M, Pgen L. Comprison of rdition doses to ptients undergoing stndrd rdiogrphic exmintions with conventionl screen-film rdiogrphy, computed rdiogrphy nd direct digitl rdiogrphy. Br J Rdiol. 2006(79):899-904. 15. Neofotistou V, Ispki V, Kottou S, et l. Does digitl imging decrese ptient dose? A pilot study nd review of the literture. Rdit Prot Dosimetry. 2005;117(1-3):204-210. of the grdute helth dministrtion progrm. She hs served s chirmn of the bord of directors of the Assocition of University Progrms in Helth Administrtion, s well s chirmn of the Committee on Eduction of the Americn College of Helthcre Executives. Her reserch interests nd publictions re primrily in the res of humn resource mngement nd qulity improvement. Anit Slecht, MS, R.T.(R)(M), FASRT, is full professor of helth science t Cliforni Stte University, Northridge, nd progrm director of the bchelor s degree progrm in rdiologic technology. She served s chirmn of the ASRT s Tsk Force on Bcclurete Curriculum, ws delegte for ASRT s Eduction Chpter nd hs been chirmn of the ASRT Commission on Eduction. Her interests include licensure nd eduction, with the purpose of protecting the public from unnecessry rdition. The uthors wish to cknowledge the Deprtment of Helth Sciences t Cliforni Stte University, Northridge, for providing support for this reserch. Reprint requests my be sent to the Americn Society of Rdiologic Technologists, Communictions Deprtment, 15000 Centrl Ave SE, Albuquerque, NM 87123-3909, or e-mil communictions@srt.org. 2010 by the Americn Society of Rdiologic Technologists. Jnet T Regn, PhD, is full professor of helth dministrtion t Cliforni Stte University, Northridge, nd director RADIOLOGIC TECHNOLOGY July/August 2010, Vol. 81/No. 6 547