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Radiographers attitudes towards radiation protection and safety. This is in the form an Annotated bibliography review. Essay Example

Radiographer’s Attitudes towards Radiation Protection and Safety

Annotated Bibliography Review


This report is an annotated bibliography on radiographers’ attitudes towards radiation protection and safety. Radiography is a field that entails viewing non-uniform matter or material using x-rays, where the ray is used to create an image with distinct density and composition of the matter to form a 2D image. Radiography is primary used for medical and industrial purposes.

Despite the benefits it produces to the medical and industrial fields, radiography presents challenges which include its harmful radiation effects on people and the environment which includes land, water and air pollution, biological radiation effects on humans where living tissues and cells of the body are destroyed causing DNA destruction and mutation. DNA destruction can results in senescence, apoptosis and cancers and at worse cause congenial birth defects and deaths of humans. The harmful effects of radiation occur when the ionizing radiation hits the living cells and damages the molecules of the cellular matter.

Although there are many factors that are cited to contribute to harmful radiation in medical and industrial uses, the attitudes of radiographers towards radiation protection and safety is deemed among the major ones, which explains the importance of this report.

The annotated bibliography has been complied using varied sources which includes sources addressing radiation protection and safety, harmful effects of radiation, impact of attitudes of radiographers in limiting harmful radiation, policy and regulatory issues in radiation, and factors that influence radiation protection and safety.

The methods used to compile the bibliography ranges from use of library catalogue, article indexes to identify journals, book chapters and theses on the subject matter, searching through the reference lists outlined in peer reviewed articles that have useful information on the subject matter and through electronic database searches using key terms and phrases such as ‘radiation safety,’ and ‘radiographers attitudes towards radiation safety and protection’ among others. Other articles were identified by consulting specialized radiographers.

The selection criteria used to select the five most important references are that the literature must have been published within the last ten to fifteen years, the reference must be from a credible publication source which includes peer reviewed journal articles, books and research articles and the literature must contain relevant information in relation to protection and safety in radiography and more importantly touching on radiographers attitudes towards radiation protection and safety.

During the exercise, there are important lessons that were learnt which entails that not all literature and readings dealing with the topic offer accurate and reliable information, effective choice of a good reference requires deliberate effort which is illustrated by reading thoroughly, the contents of each source to ensure credibility of the contents and conclusively, it is important to include literatures and readings with varied viewpoints to ensure balance and objectivity in carrying out the research. In addition, when carrying out a critical review, it is important to compare and contrast viewpoints and not focus on one perspective, it is essential to exclude one’s point of view and it is equally vital to establish the significance of the reviewed article to the research area. More importantly, one should avoid being descriptive but focus on being more analytical.

The list of bibliographic items

  1. Andersson, B. T., Fridlund, B., Elgán, C. & Axelsson, A. B. 2008. Radiographers’ areas of professional competence related to good nursing care. Scandinavian Journal of Caring Sciences, 22: 401–409. doi: 10.1111

  2. B.I.N.D.T. 1995. Insight: non-destructive testing and condition monitoring, Volume 37. British Institute of Non-Destructive Testing: London, UK.

  3. Berlin L.2001. Malpractice issues in radiology: radiation-induced skin injuries and fluoroscopy.American Journal of Roentgenology, 177: 21 -25

  4. Berrington, G. A. & Darby S. 2004. Risk of cancer from diagnostic x-ray: estimates for the UK and 14 other countries. Lancet,
    363: 345-51.

  5. Bushong, S.C. 2001. Radiologic Science for Technologist: Physics, Biology, and Protection, 7th ed. Mosby, Inc: St. Louis, Missouri.

  6. Cooper, M.D. 2000. Towards a model of safety culture. Safety Science, 36, 111-136

  7. Cunningham R., Ilari O., Ishiguro A et al .2004. Radiation protection today and tomorrow: an assessment of the present status and future perspective of radiation protection. Organization for Economic Co-operation and Development (OECD). Paris OECD Nuclear Energy Agency Publication.

  8. Deroo, K., Rau, S., Smith, B., Stevenson, J., Hollenbeck, J., & Pawloski, B. 2011. Effect of patient handling education on radiation therapy students. Radiologic Technology, 82:396-407

  9. Dowd, S.B. 1994. Practical Radiation Protection and Applied Radiobiology. W.B. Saunders Co.: Philadelphia, Pennsylvania.

  10. Engel-Hills, P.C. 2007. Professional expertise for radiation therapists in Africa. Journal of Radiotherapy in Practice. Journal of Radiotherapy in Practice, 6: 125-131

  11. European Commission (EC). 1998. Radiation protection 102: implementation of the “Medical Exposure Directive” (97/43/ Euratom). Proceedings of the international workshop. Madrid.

  12. European Society for Therapeutic Radiology and Oncology (ESTRO). 1995. Quality assurance in radiotherapy. Radiotherapy Oncology, 35: 61–73.

  13. Fazel, R., Krumholz, H.M., Wang, Y., Ross, J.S., Chen, J., Ting, H.H., Shah, N.D., Nasir, K., Einstein, A.J., & Nallamothu, B.K. 2009. Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures. The New England Journal of Medicine, 361:849-857

  14. Friberg, E.G., Widmark, A.,Solberg, M., & Wohni, T. 2011.Level of compliance with the radiation protection regulation –A survey among Norwegian hospitals and x-ray institutes. Radiation Protection Dogimetry, DOI: 10.1093

  15. Grossman, H., Altman, D.H., Baker, D.H., Gwinn, J.L., Kirkpatrick Jr., Shopfner, C.E., Swischuck, L., Tefft, M., White, H., Wilkinson, R.H. 1973. Radiation Protection in diagnostic radiography of children. Pediatrics, 51(1): 141 -144

  16. Gruppetta, E. 2009. Ethical issues for radiographers: general observations and a pilot qualitative study. Radiation Proectiont Dosimetry, 135 (2): 88-89. doi: 10.1093

  17. IAEA. 1996. International Basic Safety Standard for the Protection against Ionizing Radiation and for the Safety of Radiation Sources. IAEA Safety Series, No. 115, Vienna.

  18. IAEA. 1998. Lessons learned from accidents in industrial radiography. International Atomic Energy Agency, Safety Report Series, No. 7, Vienna, Austria.

  19. IAEA. 2004. The radiological accident in Cochabamba. International Atomic Energy Agency, Vienna, Austria.

  20. IAEA. 2011. Radiation Safety in Industrial Radiography. Specific Safety Guide No. SSG-11. International Atomic Energy Agency, Vienna, Austria.

  21. International Atomic Energy Agency (IAEA) 1999. Radiation protection and safety in industrial radiography. Safety Reports Series, No.13, IAEA, Vienna.

  22. International Commission on Radiological Protection (ICRP). 1982. Protection Against Ionizing Radiation from External Sources Used in Medicine. Publication 33. Pergamon Press, New York, US.

  23. Johnston, J., Killion, J.B., Veale, B., & Comello, R. 2011. U.S. technologists’ radiation exposure perceptions and practices. Radiologic Technology, 82:311-320

  24. King S., Pitcher E.M & Smail M.A (2002). Optimizing medical radiation exposures for urological procedures, with special emphasis on pediatric imaging. The British Journal of Urology, 89(6): 510-516.

  25. L.D., L.S.B., & U SBLS. 2010. Occupational outlook handbook. Government Printing Office: Washington D. C.

  26. Lau, L.S., Perez, M.R., Applegate, K.E., Rehani, M.M., Ringertz, H.G., & Goerge, R. 2011.Global imaging: improvement actions. Journal of the American College of Radiology doi: 10.1016, pp 330-334.Radiographers attitudes towards radiation protection and safety. This is in the form an Annotated bibliography review., 8(5),

  27. Leech, M., Craig, A., Poole, C., Broderick, M., Ni Chuinneagain, S., Coffey, M., & Byrne, J. 2009. Clinical Oral Examinations: Assessment of Competency in Radiation Therapy. Journal of Radiotherapy in Practice, 8(3):115 – 118

  28. Malone, J.F. 2008. New ethical issues for radiation protection in diagnostic radiology. Radiation Protection Dosimetry, 129(1-3): 6-12. doi: 10.1093

  29. Martin, L.M., Marples, B., Coffey, M., Lawler, M., Lynch, T.H., Hollywood, D., & Marignol, L. 2010. DNA mismatch repair and the DNA damage response to ionizing radiation: making sense of apparently conflicting data., Cancer treatment reviews, 36(7): 518-27

  30. Moores, B.M. 2006.
    Radiation safety management in health care – The application of Quality Function Deployment. Radiography, 12(4): 291-304

  31. National Radiological Protection Board (NRPB). 2004. Patient dose reduction in diagnostic radiology: report by the Royal College of Radiologist and the National Radiological Protection Board. Documents of NRPB, 1(3)

  32. Oberhofer, M., C.E.C.J.R.C., & I.E. 1991. Advances in radiation protection. Springer: New York, US.

  33. Ortiz, P., Oresegun, M., & Wheatley, J. 2000. Lessons from major radiation accidents. International Atomic Energy Agency, Vienna, Austria.

  34. Picano E. 2004. Sustainability of medical imaging- Doctors and patients should be more aware of the long term risks of radiological investigations. British Medical Journal 328(7439): 578-580.

  35. Raffensberger, C. & Tickner, J. (eds). 1999. Protecting public health and the environment: Implementing the precautionary principle. Island Press, Washington, DC, US.

  36. Rayner, S. 1986. Management of radiation hazards in hospitals: Plural rationalities in a single institution. Social Studies of Science, 16(4): 573-591

  37. Rehani, M.M. 2007. Training of interventional cardiologists in radiation protection—the IAEA’s initiatives. International Journal of Cardiology, 114(2): 256-260

  38. Reiman, R.E. 2011. Radiation Protection of Technologists and Ancillary Personnel. Clinical PET-CT in Radiology, 83-90, DOI: 10.1007

  39. Rogers, L. F. 2001. Serious business: Radiation safety and Radiation protection. American Journal of Roentgenology, 177(1)

  40. Schandorf, C. & Tetteh G.K 1998. Analyses of dose and dose distribution for patients undergoing selected X-ray diagnostic procedures in Ghana. Radiation Protection Dosimetry, 76(4): 249-256.

  41. Shapiro, J. 2002. Radiation protection: a guide for scientists, regulators, and physicians. La Editorial, UPR.

  42. Shapiro, J. 2002. Radiation protection: a guide for scientists, regulators, and physicians. La Editorial, UPR: San Juan, Puerto Rico, United States.

  43. Sonsbeek, R.V. 2006. Developing a safety culture in industrial radiography. ECNDT, — Th.3.5.3

  44. Sprawls, P. 1987. Physical Principles of Medical Imaging. Aspen Publishers, Inc: Rockville, Maryland.

  45. Vassileva, J. 2009. Towards higher level of patient safety and control of medical exposure in Bulgaria. IFMBE Proceedings, 25(3): 576-577, DOI: 10.1007

  46. Waaler, D., & Hofmann, B. 2010. Image rejects/retakes—radiographic challenges. Radiation Protection Dosimetry, 39(1-3): 375-379. doi: 10.1093

  47. Washington State Department of Health (WSDH) 2003. How to explain radiation risk: professional personnel. Environmental Health Programs Office of Radiation protection.

  48. White, S.C. 1992 Assessment of radiation risk from dental radiography. Dentomaxillofacial Radiology, 21: 118-26.

  49. Wooton, .R. & R.P.M.M.S. 1993. Radiation protection of patients. Cambridge University Press: Cambridge, England.

  50. Yu, S., & Watson, A.D.1999. A review on the subject of medical X-ray examinations and metal based contrast agents.
    Chemical Reviews, 99: 2353–2378

Critical Summaries of five most important references

    • Picano E. 2004. Sustainability of medical imaging- Doctors and patients should be more aware of the long term risks of radiological investigations. British Medical Journal 328: 578-580.

    Despite the crucial information radiography generates, the safety especially for the patients and the radiographers is of the utmost importance. According to Picano (2004, 578), radiation safety and protection should not be compromised and both the medical personnel and the patients should be informed of the potential threats and negative effects of using radiography, which helps them in making informed decisions and choices. The author indicates that creating awareness on the risks of radiography helps in minimizing cases or scenarios which exposes the patients and the radiographers to health risks such as unnecessarily radiographies among others.

    The main reason why this reference is of particular importance to the report is the holistic approach it adopts as it focuses on what both the patient and the radiographers can do to minimize the harmful effects of radiation by upholding simple radiation protection and safety measures. The reference uses a wide array of credible sources such as United Nation’s reports, published works from the International Commission on Radiological Protection and guidelines from the European Commission among others. These sources not only establish accuracy of the report but also enhance the reliability of information presented by the reference (Picano 2004, 580).

    The article does highlight the main health risks generated by medical radiation. According to Pican, (2004, 579), there is increased need for development of effective interrelationships and communication systems between the radiographer and the patient in order to help design quality, accessible, appropriate health solutions that contain as minimal a risk in exposing the patient to harmful effects of radiation unnecessarily. This can be achieved by educating patients on the benefits and limitations of radiographic scans, training radiographers to know the amount of radiation amount and exposure that is harmful to themselves and the patients, ensuring patients have referral letters from physicians in order to procure scans and seeking alternative follow up options other than doing routine scans to assess health improvement especially for patients suffering from benign illness. The radiographers have the obligation to adjust dose to weight, minimize the number of scans one patient undergoes per duration of time while medical personnel needs to justify the need for radiographic scans and examinations for patients prior to recommending it.

    The author concludes by stating the need to incorporate new technologies and laws within radiological clinical practice, where patients and radiographers have ample information on radiography and its benefits and harmful long term effects (Picano 2004, 579).

    Despite the valuable information contained in the reference, the article is descriptive in nature and lacks the empirical evidence to support content.

      • Sonsbeek, R.V. 2006. Developing a safety culture in industrial radiography. ECNDT, — Th.3.5.3

      Facilitating safe and secure medical and industrial radiography that has less impact on people and the environment is easier said than done. The reference draws attention to developing an environment encompassed by safety regulations within industrial radiography.

      According to Sonsbeek (2006, 1), use of low radiation doses and safeguarding against accidental dosage that results in deterministic effects are key to ensuring radiation protection and safety for the community, environment and the radiographers themselves. The author is very categorical in stating that radiation safety is reliant on having effective policies and procedures and establishment of a safety culture that fosters positive outlook and perceptions on radiation safety and limiting complacency on the part of the company and the radiographers.

      The reference is significant because it does not only recommend establishment of safety policies and procedures , but it highlights the need for development of a safety culture which ultimately influence the attitudes of radiographers in adhering to the set policies and procedures hence industrial radiography safety.

      Sonsbeek (2006, 2) states that the top management is fully accountable for developing a safety culture within their organization which permits attitudes of learning and questioning radiation protection and safety and limiting complacency by radiographers. In addition, a safety culture ensures issues that seek to compromise radiation protection and safety are efficiently identified and effectively dealt with, it allows all stakeholders including individual radiographers and the management are fully aware of their responsibility in protection and safety and they are equipped with adequate skills and information. The author indicates that positive attitudes of radiographers towards radiation safety and protection can only be generated by establishing a safety culture where all responsibilities essential to radiation safety are performed appropriately and accurately, with keenness, using ample knowledge and sound judgment.

      The reference is fundamental for its focus on how to develop a culture of safety in order to influence the attitudes, ideals, beliefs, style and conduct of radiographers in regards to sustaining radiation protection and safety. The reference highlights the process of developing a safety which includes policy level commitment, management commitment and individual commitment to radiation safety. Importantly, the reference uses a case study of RTD Netherlands to help expound on development of a safety culture. The reference uses varied credible sources of literature as a basis of its findings.

      By establishing a safety culture, the attitudes, conduct and perceptions of radiographers towards radiation safety will improve as they will see the variable as a way of life and they will take ownership, be committed and accountable to ensuring the safety goals and objectives set are effectively and efficiently achieved.

      Be it as it may, the conclusion given is limited and sketchy in nature and more insights would have been gained if the reference had collected primary data and coupled it with the secondary data it used for its research

        • Ortiz, P., Oresegun, M., & Wheatley, J. 2000. Lessons from major radiation accidents. International Atomic Energy Agency, Vienna, Austria

        This reference is of particular importance to this study owing to its ability to incorporate varied accidents that have occurred in industrial and medical radiography which generates essential information on the role radiographers or human actions and omissions play in causing these accidents. In so doing, radiographers and the public among other stakeholders can understand the best way to safeguard these accidents and facilitate radiation safety and protection. The retrospective analysis used by this reference offers tangible elements that are essential to fostering radiation protection and safety.

        According to Ortiz, Oresegun & Wheatley (2000, 1), majority of radiation accidents in industrial radiography occur as a result of inadequate layers of safety which are meant to prevent a single error on part of the radiographer or a technical failure from escalating into accidents or alternatively, when the established safety layers are poorly managed or ignored by involved stakeholders.

        As highlighted by the article, varied accidents have occurred in industrial radiography which are caused by different factors such as failure of radiographers to comply with radiation safety policies and procedures, lack of radiographer competence owing to inadequate training on radiation protection and safety, lack of effective regulatory and safety control systems, poor maintenance of radiographic equipments and systems, break down of radiographic machines and equipments and poor perceptions of radiographers towards radiation safety and protection as highlighted by Ortiz, Oresegun & Wheatley (2000, 2).

        More often than not, majority of accidents occur because of the carelessness and negligence on the part of the radiographer since they either fail to utilize survey meters to verify whether the source is protected or at worse, they pay little or no attention to alarm signals. It happens that following numerous procedures, radiographers become over confident on their ability and their fear for radiation risks diminishes as they get accustomed to same procedures and perceive the system safe from accidents. This attitude towards radiation risks and dangers makes them less keen, less aware of potential radiation accidents and risks and are therefore unprepared when the radiation accidents eventually occur as supported by Ortiz, Oresegun & Wheatley (2000, 2).

        The reference is essential because it not only highlight the causes of radiation accidents in industrial radiography but also highlights ways of preventing them ranging from managerial measures, regulatory safety control, use of defence in depth for irradiators, licencing and regular inspection. The reference has analyzed radiation accidents in various areas, the number of causlties involved and the main contributing factors for the accidents in order to generate solutions for radiation accidents in industrial radiography. The results findings and the conclusions are comprehensive and describes the necessarily actions required to prevent future radiation accidents based on lessons learnt from radiation accidents that have occurred in the past in varied geographic locations. The reliance on information from the IAEA (International Atomic Energy Agency) enhances the credibility, reliability and relevance of the information content of the reference. However, the reference fails to illicit new hypotheses and new research questions which are essential for a good research.

          • Johnston, J., Killion, J.B., Veale, B., & Comello, R. 2011. U.S. technologists’ radiation exposure perceptions and practices. Radiologic Technology, 82:311-320

          The reference seeks to analyze existing perceptions and attitudes of radiographers towards radiation protection and safety practices in order to evaluate the main reasons for the high application of radiation doses in the United States. This comes at the back drop of rising concerns of potential risks of ionizing radiation in medical radiography. The reference is important because it lays emphasis and establishes the reasons why radiographers have continuously exposed themselves and their patients to high doses of ionizing radiation despite the fact that they know of the impending dangers, risks and harmful health effects of radiation Johnston et al. (2011, 311).

          The study uses a survey as the most appropriate research method to collect the large information content required for the study. The population sample consists of two thousand respondents who are qualified and practicing radiological technologists in the United States.

          The research sampling method is stratified random sampling. The research method used offers adequate information required to validate the authenticity, reliability and relevance of the data since many respondents representing the population are involved. In addition, survey methods are adequate in collecting data particularly on a large sample size such as this compared to other research methods.

          Despite having properly laid down safety procedures and regulatory safety systems and strict professional code of ethics and standards, radiographers have contributed immensely to diminishing radiation protection and safety since they either are not conversant with the regulations on radiation safety and protection, or they use shortcuts to carryout radiographic processes and practices. In addition, radiographers do not inform their clients or the patients on the long term side effects of regular scans and instead focus on short term benefits of radiography.

          Their attitudes towards radiation protection and safety is such that they are so accustomed to radiographic procedures and their administration on patients and over time, they get complacent and less alert on potential risks of ionizing radiation and radiation doses.

          Radiation safety and protection systems and measures which form a significant portion of medical and industrial radiographic practices are often ignored owing to the time and energy required of the radiographers to adhere to. Among safety measures are namely managing the alarm signals, security checks on levels of radiation, consultations among staff and verifying facts from instruction and guiding manuals, clearance of the controlled area and safe lock up and storage of exposure vessels.

          The reference is important to the report for the important insights it provides to understanding how the attitudes of radiographers impact on sustainability and application of radiation protection safety programs and measures. The results are easily transferable to radiation safety in other parts of the world.

          However, the reference fails to focus in depth on what role the management and patients play in enhancing radiation risks and minimizing effectiveness of radiation safety and protection.

            • International Atomic Energy Agency (IAEA) 1999. Radiation protection and safety in industrial radiography. Safety Reports Series, No.13, Vienna.

            The reference is important because majority of the references included in the annotated bibliography have cited it as an essential source of information on radiation protection and safety. The reference is among the varied publications on safety reports developed by the International Atomic Energy Agency (IAEA) is an international firm which emphasizes enhancement of effective use of nuclear energy and safeguards and prohibits its use to harm people and the environment.

            The reference not only highlights current radiation safety best practices for secure control and operation of radiographic devices but also, offers important insights on the roles and ways of fostering radiation safety for operating firms, regulatory agencies, radiographers, equipment manufacturers and the public among others. The reference is comprehensive in nature by highlighting in depth the aims of radiation safety and protection and it outlines what roles various stakeholders such as the regulatory agencies, radiographers, manufacturers, the public and the operating firm have to play in sustaining radiation safety and protection. In addition, the reference indicates various types of exposure equipments, the design and use of shielded enclosures, site radiography procedures, how to store, move and transport radiographic sources and exposure equipments and it also highlights emergency response planning.

            By focusing on best practices for safe control and use of radiographic devices, the reference helps enlighten both the radiographers and regulatory agencies who may or may not have ample experience, skills and knowledge on how to use them especially when the radiation safety programs are lacking.

            According to IAEA (1999, 16), radiographers have the core duty to guarantee the safe conduct of their practices, acquire necessarily skills and knowledge in carrying out safe radiographic procedures and participate in regular training in radiation protection measures. The author maintains that it is essential for radiographers to have a professional attitude to their roles and responsibilities and adhere to safety policies and procedures. The reference points out the importance of not only being competent workers but ensuring radiographers and any other person is not exposed to radiation needlessly and ensuring the radiation dose received is ALARA. The reference offers both preventive and curative measures for handling radiation accidents. Although the reference does not primarily base its content on the attitude of radiographers, it offers great insights on what is required of them as professionals, which consequently influence their ideals, attitudes, beliefs and behaviour towards radiation safety and protection.

            Additional Summary

            The above summarized references are considered the most important to the area of analyzing the radiographers’ attitudes towards radiation protection and safety because they are all comprehensive in nature, they take holistic approaches in evaluating the contributing factors to failure of radiation safety measures and they all highlight both the problems and the solutions. In addition, they are easy to apply in real life situations and are essential sources in influencing a positive attitude of radiographers towards radiation protection and safety. Apart from citing how radiographers contribute to radiation accidents and risks, the references also highlight effective strategies and best practices that radiographers can adopt to enhance and maintain radiation protection and safety for themselves and others at all time.