Assessing the Impact of Regulations on Radiation Safety Culture and Practices in Radiology Departments ()
1. Introduction
The health, safety, and wellness of healthcare practitioners and patients rely on the successful implementation of the workplace safety policy and professional code of conduct. Technological advancements in the healthcare sector have enabled the use of various systems [1] [2]. The increased global interest in accreditation is significant because it is considered an important tool for improving the quality and safety of healthcare services [3]. However, a perceived gap exists in the knowledge concerned with the evaluation of accreditation impact on healthcare organizations [4]. Therefore, the radiology department of healthcare facilities is expected to be governed by a radiation safety culture and practice to enhance the care of both medical experts and patients [5]. This study aims to identify and assess the impact of regulations and processes on improving the radiation safety culture and practices in radiology departments. This assessment will also help evaluate the knowledge and behavior of medical staff regarding radiation safety policies and procedures enforced in their departments. This study methodology includes a questionnaire for employees working in the radiology departments of the aforementioned hospitals. The goal is to obtain workers’ opinions on current radiation safety practices, the efficacy of these standards, and the application of regulations.
2. Methods
2.1. Survey Participants
We conducted this study in the radiology departments of three JCI-accredited hospitals in the Riyadh Region. Concerning the scope of the services offered in the three hospitals, the radiology departments offer all radiology procedures, and all healthcare providers in the radiology departments hold a valid license from the Saudi Commission for Health Specialties, which includes all radiologists (consultants, registrars, and residents), technologists, specialists, and technicians working in all aspects of diagnostic radiology. Morgan’s law was used to determine the sample size with a confidence level of 90% and a margin of error of 5%. The sample size of PSMMC was 160, the sample size of KSMC was 136, and the sample size of SHH was 46. As a result, the study sample consisted of 342 employees. On a voluntary basis, the participants were selected through the convenience sampling strategy of all healthcare providers in the radiology departments. All participants were informed that the results would only be used for this scientific study.
2.2. Measurement Tool
After reviewing the literature on the subject of the study, a questionnaire was designed and prepared to identify and assess the impact of national radiation regulations and the accompanying process on the improvement of radiation safety culture and practices in radiology departments [6] [7]. The questionnaire included 15 multiple-choice questions that offered between three and five possible answers. Some of the questions allowed the participants to select more than one answer. The questionnaire sought three types of information: 1) the demographic information of the respondents; 2) the opinion of the professionals about the impact of regulations on safety and the creation of a safety culture; 3) an assessment of radiation safety levels. The demographic information of the respondents included gender (male or female), education level (diploma, bachelor’s, master’s, doctorate, or other), job experience (less than a year, 2 - 5 years, 6 - 10 years, or over 10 years), and professional specialty (radiologist, technician/technologist, specialist, or other).
2.3. Statistical Analysis
For the analysis, the statistical package for the social sciences (SPSS) version 16 tool was used. Spreadsheets were used to analyze the responses, and a grading system was used to evaluate the answers. Each possible answer was given a score, ranging from 0 to 1. The maximum score that could be obtained per question was one, meaning that the attainable scores for groups of questions were 6 and 5 for (a) and (b), respectively. A high total score in each group indicated that the participants (a) agreed that the regulations had a positive impact toward enhancing radiation safety in radiology departments and creating a radiation safety culture; (b) indicated high levels of radiation safety.
3. Results
Characteristics of the respondents who filled out the questionnaire are given in Table 1. The frequencies and percentages of the sample were calculated according to the following variables: gender, education level, work specialty, and job experience. From the sample size, a total of 342 participants filled out their questionnaires.
Referring to Table 2, based on the questionnaire data, 80.49% of the participants agreed with the assertion that the staff working in radiological facilities should have the necessary qualifications and experience. The results show that 81.42% of the participants agree that assigning the responsibility for radiation safety in regulations to the head of the organization aids implementation. At the same time, 65.33% of the participants agree that assigning the responsibility for radiation safety in regulations to the head of the organization raises safety awareness at the managerial level. Also, 54.60% of the participants agree that the radiation practice regulations have motivated them and their department to estimate patient doses and compare them with reference/guidance levels. Otherwise, they would not have received much attention.
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Table 1. Characteristics of participants.
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Table 2. Questions addressed to professionals participated to probe their opinion about (a) impact of regulations and (b) assessment of safety levels. Value in parentheses represent the percentage of each answers a fraction of the total answers for each question.
The results show that 55.99% of the participants agree that the requirement for optimizing patient radiation practice helps in obtaining resources from management. Moreover, 68.85% of the participants agree that the requirement for keeping records on patient doses and exposure parameters is beneficial for improving patient protection. At the same time, 14.10% of the participants agree that this requirement is reasonable but not yet implemented in their facility. Further, 6.89% of the participants agree that the condition will increase their record-keeping workload with no explicit benefit. Also, the results show that 60.33% of the participants agree that QC checks are performed regularly, while 15.41% of them think that they are performed sometimes. The results indicate that 49.51% of the participants concur that their institution regularly exposes patients to radiation, compared to diagnostic reference levels or other institutions. However, 23.28% of the respondents did not give an opinion on this matter.
The results show that 70.30% of the participants agree that there is straightforward access to information on the number of radiological procedures in records. Furthermore, 45.21% of the participants check their doses on a regular basis, with 13.20% doing so occasionally. Meanwhile, 20.13% of the participants use the dosimeter. However, 21.13%, they do not know where to check the report of the badge.
There are statistically significant differences between the grading system results in the answers provided by the various groups of respondents according to work specialty, job experience, education level, and gender. These results are explained below.
Work Specialty
To validate this hypothesis, we used the one-way ANOVA test. Table 3 displays the results, revealing statistically significant differences in the grading system results among different groups of respondents based on their work specialty.
We used the results of the LSD test, as shown in Table 4, to determine whether the differences were in favor of any work specialty. We conclude that there are statistically significant differences in the impact of regulations in the answers provided by various groups of respondents according to work specialty, favoring technicians.
Job Experience
To validate this hypothesis, we used the one-way ANOVA test. Table 5 displays the results, revealing no statistically significant differences in the grading system results among the various groups of respondents based on job experience.
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Table 3. Results of the impact of regulations and assessment of safety level.
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Table 4. Work specialty results of the impact of regulations and assessment of safety level.
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Table 5. Job experience results of the impact of regulations and assessment of safety level.
4. Discussion
This study evaluated the knowledge and behavior of medical staff regarding radiation safety regulations and procedures, as well as the impact of national radiation protection regulations on minimizing radiation exposure in all medical practices. We designed this study to gather comprehensive information about the impact of regulations and safety levels from radiologists working in three JCI-accredited hospitals in the Riyadh Region, each with different funding support mechanisms.
All individuals working in radiological facilities should comply with certain requirements to enhance safety [8]. Therefore, 80.49% of the respondents stated that the requirements help develop manpower equipped with safety skills. The responsibility for radiation protection rests with the health managers of the facilities, who, according to 81.42% of the respondents, assist in implementing radiation safety in hospitals.
Optimization is a key concept in radiation protection. In practice, this mainly involves compromising image quality and doses given to patients [8]. However, 54.60% of respondents stated that radiation practice regulation motivates them to estimate patient doses and compare them with reference levels. Furthermore, 17.78% of the respondents stated that it did not alter their practice, with 12.06% saying that they would do it regardless of regulations.
Potential reduction in patient doses is crucial to minimizing the risk of exposure [8]. Similar findings were observed regarding the requirement for keeping records of patient doses. In this study, 68.85% of the respondents stated that the requirement was very useful for protecting patients. The SDFA requires data management systems for keeping records of personnel and patients to ensure safe practice in radiological services in healthcare facilities. However, healthcare providers should provide radiation monitoring badges to improve safety for all staff members who might encounter 10% of the public dose limit while working [9].
Participants’ responses to the questions in this area demonstrated the suitability of these questions. Many participants (60.33%) said that the QC checks were performed regularly. However, 15.41% of them stated that the checks were performed sometimes, and 13.11% said that the checks should be performed when there are problems.
Justification, optimization, and limitation are the core concepts of radiation protection and safety [7] [9]. As for justification, radiological practices should be performed by radiologists, and cases should be discussed with clinicians. It is clear that the regulatory requirements should include written protocols and that radiological procedures should be enforced more strictly. Furthermore, according to 63.28% of the respondents, radiologists were responsible for justifying radiological procedures and making appropriate test decisions [8]. The revised International Basic Safety Standards require that the responsibility to justify the procedures be shared between clinicians and radiologists [10]-[12]. Therefore, consultation between referring clinicians and radiologists could reduce the number of unnecessary examinations. However, 29.28% of the respondents said they always followed the clinicians’ requests.
Regulating actions to enhance the tracking and recording of previous radiological procedures and doses received by patients is also necessary [13]. Further, 70.30% of the respondents stated that obtaining information on the number of radiological procedures from the records was straightforward, while 14.19% of them claimed that it was impossible to access information on previous procedures.
5. Conclusion
This study questionnaire was sent to the radiology departments of three JCI-accredited hospitals in the Riyadh Region. The results illustrated the impact of regulations on enhancing patient safety. The importance of creating a safety culture was appreciated by the respondents, notably among specialists compared with technicians. The results are encouraging because they indicate a relatively high correlation between the use of regulatory tools and a high academic level. Responses suggest that safety levels in the participating facilities are satisfactory. Radiation safety levels concern national and international regulatory bodies who are responsible for strengthening regulatory frameworks, especially regarding the evaluation and consideration of patient doses and the use of written protocols for radiological procedures. Also, this questionnaire recognized the need to strengthen regulations for technicians with a diploma degree. The results of this study suggest that an exposure tracking system and a regulatory action that supports it may be useful in the ongoing task of improving patients’ radiation safety.
6. Limitations and Recommendations
This study has some limitations. One limitation is that it was only carried out in departments that had services under their umbrella for their target people. Second, the time for data collection was short for introducing a self-intervention to increase the response rate. Thirdly, I encountered challenges in reaching out to most participants due to their varying work shifts. Further studies with larger populations and multiple centers will provide more insight into this issue. Future studies should focus on technicians with a diploma degree and investigate the extent of their knowledge of legislation and regulations governing radiation safety practices in radiology departments.
Acknowledgements
We would like to express my sincere appreciation and deepest gratitude for all radiology professional healthcare workers who completed questionnaire forms and for all departments that gave me access to their target participants.
Ethical Considerations
The study proposal was approved by PSMMC, and ethical approval was obtained from PSMMC’s ethical committee.