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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 1-6

Dermatologists’ knowledge towards computed tomography radiation dose in the Kingdom of Saudi Arabia


Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia

Date of Web Publication13-Aug-2020

Correspondence Address:
MD Hend M Al Atif
Department of Internal Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/WKMP-0204.291961

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  Abstract 


Objective: To assess the knowledge of Saudi dermatologists regarding protection against hazards of ionizing radiation during computed tomography (CT) procedure. Methods: It was a cross-sectional research design, comprising of dermatologists. A study questionnaire was designed and developed by the researcher, which included personal characteristics of the participants and statements on their knowledge regarding risks of exposing patients to ionizing radiation during radiological investigations. Results: This study included 120 dermatologists. The majority of participants (93.3%) did not attend any course on protection against ionizing radiation. Only 19.2% were familiar with the ALARA principle, while 51.7% were aware of a link between radiation exposure and increased risk of developing cancer. Recommended dose limits (1.7%) concern about radiation doses delivered to patients (31.79%) from requested CT, and alternative imaging investigations (80%) other than CT known to the participants, was found unsatisfactory. Most participants (86.7%) had poor knowledge regarding exposure to ionizing radiation. Attending courses on radiation protection was significantly associated with better knowledge (p<0.001). Conclusion: Knowledge of most Saudi dermatologists regarding hazards of ionization radiation is poor. This can be attributed to their lack of exposure to any courses on radiation protection. Awareness of Dermatologists can be done by conducting more workshops and associated seminars, in order to enhance their knowledge regarding this issue.

Keywords: Dermatologists, Knowledge, Ionizing radiation, Saudi Arabia


How to cite this article:
Al Atif HM. Dermatologists’ knowledge towards computed tomography radiation dose in the Kingdom of Saudi Arabia. King Khalid Univ J Health Scii 2020;5:1-6

How to cite this URL:
Al Atif HM. Dermatologists’ knowledge towards computed tomography radiation dose in the Kingdom of Saudi Arabia. King Khalid Univ J Health Scii [serial online] 2020 [cited 2020 Oct 23];5:1-6. Available from: https://www.kkujhs.org/text.asp?2020/5/1/1/291961




  Introduction Top


With great advancement in medical science and rapidly developing technologies in healthcare services, techniques for diagnostic imaging and interventional radiology are progressively applied to perform accurate diagnosis in various fields of medicine. Nevertheless, despite the fact that these modern technologies offer better management of diseases, their inappropriate use leads to unnecessary radiation exposure of patients.[1]

Ionizing radiation is associated with genetic damage, which is causally linked to carcinogenesis.[2] Exposure to ionizing radiation may lead to both morphological and functional changes.[3] β-radiation can penetrate the skin for several centimeters, whereas high energy y-radiation can penetrate through skin tissue and traverse through the human body, if unshielded.[4]

The extent of resulting injuries due to exposure to ionizing radiation depends on the total dose, proportion of body, volume of tissues exposed, as well as the duration of exposure to radiation.[5] The most vulnerable organ systems include the bone marrow, reproductive system, gastrointestinal system, skin, muscles, and the brain.[6]

When exposed to X-ray beam energy, part of it is absorbed by the body, which causes a release of energy in tissues, leading to subsequent cellular damage.[7] One type of biological effect of exposure to ionizing radiation that can occur is the “deterministic” effect. It appears once a threshold is exceeded, and its clinical severity correlates with exposure intensity. Mainly, it represents a risk for patients’ skin and hair. The most common manifestations of deterministic effects are cutaneous. Thus, they are frequently referred to as “radiation dermatitis.”[8] Transient erythema can occur in patients who are exposed to a radiation dose of >2 Gy, and severe tissue loss may occur with greater exposures.[9]

The expected benefits of radiation exposure should outweigh the potential health risks.[9] Protection from radiation hazards should be maximized, with the aim of keeping the likelihood of harm and the number of exposed subjects as low as reasonably achievable (ALARA). Moreover, the radiation dose limits should not be exceeded.

Several skin changes have been reported to be caused by ionizing radiation, and radiation dermatitis remains a significant health concern. It occurs in almost 95% of cancer patients undergoing radiotherapy. Its severity may range from mild erythema to moist desquamation and ulceration.[10]

In general, the awareness among non-radiologist physicians regarding the radiation risks and their knowledge of alternative examination techniques is a major requirement to reduce radiation-associated complications.[11] However, medical professionals’ knowledge about radiation exposure during various radiological procedures remains suboptimal.[12],[13],[14]

The aim of this study was to assess the knowledge of Saudi dermatologists regarding protection against hazards of ionizing radiation during computed tomography (CT) procedure.


  Subjects and Methods Top


This study followed a cross-sectional study, in which Saudi residents, specialists, and consultants of dermatology working in the Kingdom of Saudi Arabia were included.

The study questionnaire was designed and developed on the basis of thorough review of relevant literature. The study questionnaire included personal characteristics of the participating dermatologists, in addition to statements on their knowledge regarding risks of exposing patients to ionizing radiation during radiological investigations. The face and content validity of the study questionnaire was assessed by a Professor of Dermatology at King Khalid College of Medicine, Saudi Arabia.

The questionnaire was uploaded on Google Drive for access and was shared via WhatsApp with the dermatologists working in the Kingdom of Saudi Arabia, who were invited to participate in the study. The duration of data collection was 3 months (i.e., February–April, 2019).

Statistical Methods

Data were collected, revised, coded and fed into a computer and then analyzed using the Statistical Package for Social Sciences (IBM SPSS, version 25). Frequency and percent were used to describe each category for different variables. Chi square test was applied and p-values less than 0.05 were considered as statistically significant.

The ethical approval (ECM#2019-48) - (HA-06-B- 001) was granted to this study by the King Khalid University, College of Medicine Research Ethical Committee dated on 15.05.2019.


  Results Top


Characteristics of study sample are described in [Table 1]. Most participants (93.3%) did not attend any course on protection against ionizing radiation.
Table 1: Characteristics of study sample (n=120)

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Participants’ responses regarding knowledge, attitude, and practice statements related to hazard of CT scan radiation exposure are described in [Table 2]. Only 19.2% were familiar with the ALARA principle, while 51.7% were aware of studies suggesting a link between radiation exposure and increased risk of developing cancer. Only 1.7% of participants correctly knew the recommended dose limits for occupational exposure, 5.8% knew the correct dose limits by ICRP for exposure, 4.2% knew the correct answer about radiation dose to the skin necessary for the production of radiation injuries.
Table 2: Participants’ responses regarding knowledge, attitude, and practice statements related to hazard of CT scan radiation exposure

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[Figure 1] shows that 86.7% of participants had poor knowledge regarding exposure to ionizing radiation, 5.8% had fair knowledge, while 7.5% had good knowledge.
Figure 1: Dermatologists’ knowledge grades regarding exposure to ionizing radiation

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[Table 3] shows that better knowledge among participant dermatologists was significantly associated with their attendance of courses on radiation protection (p<0.001). However, participants’ knowledge grades did not differ significantly according to their location, gender, or their duration of experience in dermatology.
Table 3: Participants’ knowledge grades according to their personal characteristics

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  Discussion Top


Approximately one third of the participants did not know which body organs are most vulnerable to radiation, less than one fifth of the participants were familiar with the ALARA principle, and only a few participants correctly knew the recommended dose limits for occupational exposure, dose limits by ICRP for exposure, and radiation dose to the skin necessary for the production of radiation injuries.

These findings are in accordance with those reported by Grove, who stated that most non-radiological physicians are not optimally aware about radiation dose delivered by different imaging modalities.[15]

Similarly, in Saudi Arabia, Saeed et al. (2018) reported that the knowledge of physicians regarding ionizing radiation was generally poor.[16] Most physicians could not identify the most vulnerable tissues, while 17.6% could characterize the effective dose equivalent for X-ray chest examination, and only 12.6% could correctly state that 20 mSv is the effective radiation dose received by adult patients from CT examination of the abdomen and pelvis, that is repeated with or without contrast materials.

In Jeddah, Saudi Arabia, Barnawi et al. (2018) found that only one fifth of the physicians that specialized in different areas of medicine correctly responded to questions related to radiation doses of different imaging modalities, and the potential associated risks.[17]

The lack of sufficient knowledge about the risks of ionizing radiation among Saudi dermatologists can be explained by their low attendance at training courses. The present study showed that the majority of Saudi dermatologists never attended any courses related to the prevention of hazards of ionizing radiation. It was also found that the few participants who attended courses related to guarding against ionizing radiation hazards had significantly better knowledge grades than those who did not attend such courses.

In Iran, Zakeri et al. (2016) reported limited knowledge of radiation exposure hazards among general practitioners and specialists.[18] They emphasized the need to improve physicians’ knowledge by means of targeted training and reeducation.


  Conclusions Top


The present study revealed that Saudi dermatologists’ knowledge regarding ionizing radiation risks is poor. This can be attributed to their lack of exposure to any courses on radiation protection. Therefore, continuing medical education on management of ionization radiation hazards should be organized to all dermatologists. Up-to-date education regarding radiation amounts and potential dangers from imaging is obligatory for dermatologists’ to safeguard optimal utilization of this paramount diagnostic appliance and the preservation of premier medical practices.

Conflict of Interest: None



 
  References Top

1.
Chun-sing W, Bingsheng H, Ho-kwan S, Wai-lam W, Ka-ling Y, Tiffany CY. A questionnaire study assessing local physicians, radiologists and interns’ knowledge and practice pertaining to radiation exposure related to radiological imaging. Eur J Radiol. 2012; 81(3):e264-8.  Back to cited text no. 1
    
2.
Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med. 2007: 357(22):2277-84.  Back to cited text no. 2
    
3.
Mendelsohn FA, Divino CM, Reis ED, Kerstein MD. Wound care after radiation therapy. Adv Skin Wound Care. 2002; 15(5):216-24.  Back to cited text no. 3
    
4.
Wolbarst AB, Wiley Jr AL, Nemhauser JB, Christensen DM, Hendee WR. Medical response to a major radiologic emergency: a primer for medical and public health practitioners. Radiology. 2010; 254(3):660-77.  Back to cited text no. 4
    
5.
Ang KK, Cox JD. Radiation oncology: rationale, technique, results. 9th edn. 2010; Philadelphia, PA: Mosby Elsevier.  Back to cited text no. 5
    
6.
Hall E, Giaccia A. Radiobiology for the Radiologist. 6th edn. 2006; Philadelphia, PA: Lippincott Williams & Wilkins  Back to cited text no. 6
    
7.
Brown KR, Rzucidlo E. Acute and chronic radiation injury. J Vasc Surg. 2011;53:15S-21S.  Back to cited text no. 7
    
8.
Hymes SR, Strom EA, Fife C. Radiation dermatitis: clinical presentation, pathophysiology, and treatment 2006. J Am Acad Dermatol. 2006; 54(1):28-46.  Back to cited text no. 8
    
9.
Hertault A et al. Editor’s Choice - minimizing radiation exposure during endovascular procedures: basic knowledge, literature review, and reporting standards. Eur J Vasc Endovasc Surg. 2015; 50(1):21-36.  Back to cited text no. 9
    
10.
Ryan JL. Ionizing Radiation: the good, the bad, and the ugly. J Invest Dermatol. 2012; 132(3):985-93.  Back to cited text no. 10
    
11.
Krille L, Hammer GP, Merzenich H, Zeeb H. Systematic review on physician’s knowledge about radiation doses and radiation risks of computed tomography. Eur J Radiol. 2010; 76(1):36-41.  Back to cited text no. 11
    
12.
Jacob K, Vivian G, Steel JR. X-ray dose training: are we exposed to enough? Clin Radiol. 2004; 59(10):928-34.  Back to cited text no. 12
    
13.
Lee CI, Haims AH, Monico EP, Brink JA, Forman HP. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004; 231(2):393-8.  Back to cited text no. 13
    
14.
Arslanoglu A, Bilgin S, Kubali Z, Ceyhan MN, Ilhan MN, Maral I. Doctors’ and intern doctors’knowledge about patients’ionizing radiation exposure doses during common radiological examinations. Diagn Interv Radiol. 2007; 13(2):53-5.  Back to cited text no. 14
    
15.
Grove ML. Doctors’ knowledge of exposure to ionising radiation: Just tell them the dose. BMJ. 2003;15; 327:1166.  Back to cited text no. 15
    
16.
Saeed MK, Al-shaari H, Almarzooq MMS, Alsareii SA, Aljerdah SA, Al-ayed MS. Radiation awareness among physicians about the hazards of radiological examinations on the health of workers and their patients in Saudi Arabia. J Rad Res Appl Sci. 2018; 11(4):299-304.  Back to cited text no. 16
    
17.
Barnawi RA, Alrefai WM, Qari F, Aljefri AA, Hagi SK, Khafaji M. Doctors’ knowledge of the doses and risks of radiological investigations performed in the emergency department. Saudi Med J. 2018; 39(11):1130-38.  Back to cited text no. 17
    
18.
Zakeri F, Shakeri M, Rajabpour MR, Farshidpour MR, Mianji F. Physicians’ knowledge about radiation dose and possible risks of common medical tests: A survey in Iran. Rad Prot Dosim. 2016; 172(1-3):311- 6.  Back to cited text no. 18
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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