An Investigation of the Level of Public Awareness of the Adverse Effects of Ionizing Radiation on Health in Trinidad and Tobago
Phillip Simon 00019115
School of Nursing, Health and Environmental Sciences
Department of Health Science Technologies
Table of Contents
Chapter 1 2
1.1 History 2
1.2 General 3
1.3 Background 4
1.4 Rationale 5
1.5 Problem definition 5
1.6 Research Problem 6
1.7Research statement 6
1.8 Aim 6
1.9 Objectives 6
1.10 Scope 7
2.1 Literature review 8
3.1 Methodology 12
3.11 Research Design 12
3.12 Setting 12
3.13 Sampling 12
3.14 Instrumentation 13
4.1 Data collection 15
4.2 Results 16
4.3 Discussion 24
4.4 Benefits 28
4.5 Limitations 28
Appendix I 29
References 29
Chapter 1
1.1 History
The discovery of x-ray by the German physicist Wilhelm Röntgen in 1895 has been considered by some to be one of the most important discoveries and can be credited for saving countless lives. Its contribution to medicine is immeasurable and without it some of the most ‘simple’ medical procedures would seem almost impossible. The world marvelled and rejoiced at this revolutionary discovery and soon began using it for many purposes. The use of this mysterious ray ranged from making sure that a customer’s shoes fit properly before purchase at a store to a novelty trick in the homes of the rich. X-rays took the world by storm but no one knew exactly how much damage this storm was capable of doing.
The great inventor Nikola Tesla was the first to realize the dangers of x-rays a year after its discovery when his fingers were burnt after exposing them to ionizing radiation for an extended period of time. Eventually the destructive power of this miraculous ray was quite evident as many radiologist lost eyes, fingers and even their lives to it. Of course x-rays was not the only type of radiation claiming victims. Madame Marie Curie, the great Polish chemist and physicist who was most famous for her work on radioactivity died of aplastic anemia due to the fact that she spent many years studying ionizing radiation unprotected in a shed and carrying around radioactive material in test tubes in her pocket. She was not the only scientist to die from being exposed to ionizing radiation without the use of protection or shielding. Two U.S scientists died of acute radiation exposure in two separate incidences in the years 1945 and 1946 due to exposure to ionizing radiation from the same subcritical mass of plutonium later nicknamed the ‘Demon core’.
The real bombshell that rocked the world of radiation was the atomic bombings of Hiroshima and Nagasaki in Japan. The ‘Little boy’ and ‘Fat man’ shook Japan along with all the ideas scientists previously had about the effects of radiation on cells and the human body. Another tragic event that added to the body of knowledge about the dangers of radiation was the disaster at the nuclear power plant at Chernobyl. The radiation from this accident spread to other countries and the effects were catastrophic. After this event there was no denying the adverse effects of ionizing radiation and it defined many of the precautions that exist today when it comes to handling or working around radiation.
1.2 General
Even though the past was tragic and many casualties were claimed the knowledge that was gained became invaluable in determining the safest way of dealing with ionizing radiation. Because of these events physicists were able to discover that when it comes to radiation there are two types of effects; deterministic and stochastic. Deterministic effect is the acute effect that radiation has on tissue or organs. This effect depends on the level of radiation the tissue is exposed to i.e. after a threshold dose is reached, the severity of the effect increases with an increase in the level of radiation the tissue is exposed to. Stochastic effect is caused by mutation of cells due to exposure to low doses of radiation. There is no threshold dose that has to be reached for an effect to occur meaning any amount of radiation can cause a stochastic effect. The result of the exposure does not present itself immediately but can show up as cancer or other diseases years later. Unlike deterministic effect the level of severity of the damage is not determined by the level of radiation the person is exposed to, however, the more radiation a person is exposed to the higher the chance that an effect may occur. In other words with deterministic effect; higher dose = more severe effect, and with stochastic effect; more exposure = increased chance of effect.
Physicists also realized that when it came to radiation protection the three most important factors to take into account is; time (length of exposure to ionizing radiation), distance (away from the source of the radiation), and shielding (e.g. lead). These factors are what are considered when doing an examination on a patient. The patient is exposed for the shortest time possible with little to no repeats and should be given shielding or gonad protection for most exams. This is to observe the ALARA principle (as low as reasonably achievable). This principle was made to ensure that radiographers use the lowest radiation dose that they can possible deliver without compromising the diagnostic quality of the image. It is the job of the radiographer to uphold this principle at all cost and even though most of them do, there are still some who neglect this principle. If a patient is made aware of the risk involved in taking these exams they would be able to protest and stand up for themselves during an exam where a radiographer is not taking the right precautionary measures. But what happens if the patient does not know?
1.3 Background
Despite the risks that exposing a patient to ionizing radiation my have, the benefits of examinations that utilizes ionizing radiation, in most cases, greatly out way them. Although this may be true one must never forget that there is risk involved and therefore precautionary methods must be implemented. Many times doctors send patients for x-rays that are unnecessary or excessive while other times it is the radiographer that is guilty of not using proper precautionary measures such as gonad shielding or neglecting to ask female patients of child-bearing age whether they might be pregnant. Whether it is the radiographer or the doctor who is at fault, it is the patient who suffers. Patients usually view medical staff, especially doctors, as all-knowing beings and, most times, will comply with the requests and instructions that are given. So if a doctor requests five radiographs for an injury that may only require two, most patients would subject themselves to those exams without a question. If a radiographer takes an x-ray without using gonad protection most patients just go along with it, some of them not knowing that any protection is even required.
1.4 Rationale
I think if patient’s were aware of the risks involved in diagnostic examinations using ionizing radiation and the precautions that should be taken they would be better equipped to protect themselves and stand up for their rights. It is a patient’s right to only undergo an exam or medical procedure after giving informed consent but how can they do so if they are not truly informed? It is my belief that most patients lack the basic knowledge of radiation to be able to protect themselves during the various diagnostic exams that use them. It is my hope that by highlighting the fact that the average patient knows little to nothing about the risk involved when undergoing an exam that requires the use of ionizing radiation it will show the need for more effort on the part of the radiology staff to make patients aware. It is also my hope that this paper will highlight the factors that contribute to a patient’s lack of knowledge as far as the risks are concerned so that we as medical professionals can know exactly how to correct it.
1.5 Problem definition
The use of ionizing radiation as a diagnostic tool has immeasurable benefits. Not only has it eliminated the need for much more invasive diagnostic procedures such as exploratory surgery but with advances in technology it is becoming extremely precise and can even show things that exploratory surgery cannot. However, nothing in life is perfect or without risk and ionizing radiation is no exception to this fact. Ionizing radiation at any dose can increase the risk of cancer. Even though this risk is proportional to the level of radiation dose and the level of the dose of radiation used in diagnostic examinations are not very high the risk is still there. Various x-rays, ct scans and nuclear medical procedures are done on patients for a wide variety of disease and ailments that range from the minor to the severe but how many of these patients know the risk involved? Usually patients who come in to a hospital seeking medical help will comply with a doctor’s orders. So if a doctor orders excessive and unnecessary radiological examinations a patient may not complain, since they may have little to no knowledge of the risk involved. It is important for people to be aware of the risks these exams carry but how many of them are?
1.6 Research Problem
What percent of patients that are required to have exams that utilize ionizing radiation know the risk that comes with it?
1.7Research statement
The average patient is not fully aware of the risk involved in exams that use ionizing radiation.
1.8 Aim
To determine the percentage of patients that are aware of the risk involved when it comes to exams using ionizing radiation.
1.9 Objectives
1. To record the number of patients that come into certain x-ray departments for examinations that utilize ionizing radiation and know about the risks involved.
2. To record the number of patients that come into certain x-ray departments for examinations that utilizes ionizing radiation and do not know the risks involved.
3. To compare the figures to prove that the average patient does not know about the risks involved with the examinations.
4. To determine the factors that contribute to a patient’s knowledge of the risks involved with taking the examinations.
1.10 Scope
This study seeks to ascertain the level of awareness of the public of Trinidad and Tobago when it comes to the adverse effects of ionizing radiation on health, thereby highlighting the need for medical staff to inform patients of these effects before radiological examinations.
Chapter 2
2.1 Literature review
The ability to diagnosis diseases has improved exponentially since x-rays was discovered on November 8th 1895 by German physicist Wilhelm Röntgen. Countless lives have been saved during that 115 year time period because of that discovery. Radiographic technology has come a long way since its origins in Mr. Röntgen’s lab. Radiographic technology is not just limited to imaging bone anymore but can image blood vessels and organs with the use of contrast media and a CT scanner can take images that cuts the patient’s body into slices. Even the smallest of tumors and cancerous bodies can not hide from the path of this amazing beam. Exams using x-rays have diagnosed many diseases thereby assisting in the preservation of many lives but this ‘saviour of lives’ has a dark and dangerous side and, if the proper precautions are not taken, can be the cause of the very diseases that it helps to diagnose.
Many incidences throughout history and many scientific studies have shown the very real risk associated with radiation. Many radiologist who pioneered such procedures as fluoroscopy, lost their eyes, fingers and lives to x-rays and radiography. A lot has changed since then and radiographic procedures and precautions have improved, making radiography safer for both the patient and the radiographer but the risks still remain. The low doses of radiation that a person’s body is exposed to during one of those procedures can be associated with and increase in the lifetime chance of cancer. This is especially true for children whose organs are more susceptible to damage caused by radiation and also have more years to live than adults and therefore more years in which cancer can present itself. In a recent study done by the Journal of the American Medical on the estimated risk of cancer associated with radiation exposure from coronary angiography using a 64-Slice ct scanner, it was found that the risk of lifetime cancer with a standard cardiac scan was 1 in 143 for 20 year old women. This chance is increase to 1 in 114 when the aorta is scanned along with the heart (Einstein, MD PhD et al, 2007). The benefits of having one of these exams done greatly out weighs the risks, but this does not negate the fact that the risks still exists. It is these slight chances that lifetime cancer can occur that a radiographer needs to take precaution against.
The chance of lifetime cancer occurring in patients as a result of these exams can be greatly reduced by simple precautions such as gonad shielding and having the beam enter the patient posteriorly instead of anterioly in certain procedures thereby avoiding the direct beam interacting with organs such as the thyroid, breast and eyes that are more susceptible to damage by radiation. Unfortunately many radiographers neglect to take these precautions. Radiographers are not the only ones to blame as doctors often send patients for radiological exams that may be excessive or not required for examining the patient’s pathology. Many times an alternative exam that does not require exposing the patient to radiation may be done but doctors still send patients to be exposed. It is my belief that if patients were aware of the risks involved, they would be able to protect themselves from this injustice and stand up for their rights. Unfortunately there is evidence to prove that the average patient knows little about the risks involve with having these exams done and the precautions that are needed to protect them. According to a recent article featured in the ‘AAP NewsWire’ patients have little knowledge of the cancer risk associated with exams that use x-rays such as CT (2010).