EXPLORATION OF KNOWLEDGE OF CLINICIANS ON IONISING RADIATION AT

NTCHISI DISTRICT HOSPITAL

1. Introduction

Ionizing radiation refers to radiation that has enough energy to remove tightly bound electrons
out of their orbits around atoms, thus creating ions or charged atoms (Radhi 2015). Ionizing
radiation is a type of energy released by atoms that travels in the form of electromagnetic waves
(gamma or x-rays) or particles (neutrons, beta or alpha). Natural sources of ionizing radiation
include cosmic rays, terrestrial radiation, internally deposited radionuclides, and radon.World
Health Organization (WHO 2016)

Artificial or man-made radiation sources include nuclear energy, medical devices such as x-rays,
computed tomography scans, and mammography, as well as baggage x-ray screening devices
(WHO 2016). Ionizing radiation can be produced by speeding charged particles through an
electric potential or by spontaneous radioactive decay, as is the case with x-rays (Radhi 2015).
High-energy electromagnetic and particle radiation can cause ionization as they pass through
matter (Friedland et al., 2020). This process involves the removal of electrons from atoms or
molecules, resulting in the formation of positively charged ions and negatively charged electrons.

Radiation hazards refer to irreversible cell changes caused by direct or indirect nuclear effects
from any sort of radiation (Radhi 2015). Ionizing radiation, which has a high-frequency
electromagnetic wave with the potential to damage DNA, poses a threat to human health (Pater,
2021). The biological effects of ionizing radiation can be divided into two types: stochastic
effects, which occur randomly and are usually associated with long-term exposure, and
deterministic effects, which have a threshold below which no effect is observed and are usually
associated with acute exposure United Nations Scientific Committee on the Effects of Atomic
Radiation (UNSCEAR, 2017). Deterministic damage occurs when a set exposure threshold is
exceeded, and the severity of damage increases as the dose increases. Deterministic damage
includes abnormalities such as cataracts and skin erythema (Dance et al. 2014). Stochastic
damage occurs when the dose is exceeded without a threshold dose. Stochastic damage is
associated with pathologies such as infertility and cancer (Yurt et al. 2014).
While the diagnostic and therapeutic use of ionizing radiation is helpful for millions of
individuals all over the world (Alotaibi and Muhyi 2018), healthcare professionals should be
aware of the radiation hazards and protection strategies to obtain the required benefits while
avoiding risks (United Nations cited in Alotaibi and Mudhy 2018). Radiation protection is an
effective measure employed by radiation workers to safeguard patients, personnel, and the
general public from unnecessary exposures to large doses of ionizing radiation, which can cause
cancer and genetic mutations, and even small doses can cause unpredictable risks (WHO 2017).

1.2 Problem statement

The use of ionizing radiation in medical diagnosis and treatment has significantly improved
patient care (National Research Council, 2006). However, ionizing radiation poses risks to both
patients and healthcare workers if not properly managed. Limited knowledge of ionizing
radiation among clinicians can lead to inappropriate use of radiation and inadequate radiation
protection measures, potentially resulting in unnecessary radiation exposure and adverse health
effects (Shojaei et al., 2019). Therefore, this study aims to explore the knowledge of clinicians
on ionizing radiation at Ntchisi District Hospital to identify gaps in knowledge and training
needs for radiation safety and protection (Shokri et al., 2021).

1.3 Justification

Radiation exposure in medical imaging is a critical issue that needs attention, especially in low-
and middle-income countries where resources are limited (Shojaei et al., 2019). In Malawi, for
instance, there is a high demand for diagnostic imaging, and the use of ionizing radiation in
medical imaging is on the rise (Kampondeni et al., 2019). However, the level of knowledge of
clinicians on ionizing radiation is not well known. This lack of knowledge among clinicians can
lead to inappropriate use of radiation and inadequate radiation protection measures, which can
cause unnecessary radiation exposure and adverse health effects (Shojaei et al., 2019). Therefore,
this study is justified as it aims to explore the knowledge of clinicians on ionizing radiation at
Ntchisi District Hospital to identify gaps in knowledge and training needs for radiation safety
and protection. This study will provide essential information for improving the quality of care
and ensuring patient safety in medical imaging. Furthermore, the findings of this study may
inform the development of policies and guidelines to ensure that the use of ionizing radiation in
medical imaging is safe and appropriate in Malawi.

1.4 Significance of the Study

The use of ionizing radiation in medical diagnosis and treatment has significantly improved
patient care (National Academies of Sciences, Engineering, and Medicine, 2018). However,
ionizing radiation poses risks to both patients and healthcare workers if not properly managed.
Limited knowledge of ionizing radiation among clinicians can lead to inappropriate use of
radiation and inadequate radiation protection measures, potentially resulting in unnecessary
radiation exposure and adverse health effects (Soffia et al., 2020). Therefore, this study aims to
explore the knowledge of clinicians on ionizing radiation at Ntchisi District Hospital to identify
gaps in knowledge and training needs for radiation safety and protection (Al-Zahrani et al.,
2021).

2.0 OBJECTIVES

Objectives are crucial goals that researchers aim to achieve through their studies. They are
specific, measurable, and achievable, and provide direction, clarity, and focus to the research
process. By establishing clear objectives, researchers can ensure that their study is relevant,
contributes to the existing body of knowledge, and is conducted efficiently with the proper
allocation of resources. Objectives also serve as a benchmark for measuring the success of the
study, making them an essential component of any research project (Smith, 2018, p. 12).
Additionally, Jones (2015) highlights the importance of objectives in ensuring that the study's
research questions are answered effectively and accurately. The following are the study
objectives:

2.1. BROAD OBJECTIVE

To explore clinician’s knowledge about ionizing radiation and radiation protection at Ntchisi
district hospital
2.3. SPECIFIC OBJECTIVES
1. To assess the current level of knowledge among clinicians at Ntchisi district hospital
regarding the risks and benefits associated with the use of ionizing radiation in medical
diagnosis.
2. To identify any gaps in knowledge and understanding of radiation protection measures
among clinicians at Ntchisi district hospital.
3. To determine the training needs of clinicians at Ntchisi district hospital in order to
enhance their knowledge and adherence to radiation safety and protection measures.

3.0 LITERATURE REVIEW

A literature review involves a comprehensive and critical analysis of existing literature on a

particular topic, which includes reviewing and summarizing previous research, theories, and
other relevant works to identify gaps, inconsistencies, and controversies in the existing literature
(Cooper, 1984; Fink, 2010). The purpose of a literature review is to provide a foundation for the
research question and to establish the context for the research by demonstrating how the
proposed study fits into the larger body of knowledge in the field (Machi & McEvoy, 2016). The
following is the literature review of the study

3.1 To assess the current level of knowledge among clinicians at Ntchisi district hospital
regarding the risks and benefits associated with the use of ionizing radiation in medical
diagnosis.

Ionizing radiation has been widely used in medical diagnosis and treatment, and while it has
greatly improved patient care, it also poses risks to both patients and healthcare workers if not
properly managed (Shojaei et al., 2019). Therefore, it is crucial that healthcare workers have
adequate knowledge about the risks and benefits associated with the use of ionizing radiation in
medical diagnosis.

A study conducted by Eze and colleagues (2021) aimed to assess the level of knowledge about
radiation protection among healthcare workers in Nigeria. The study revealed that although
healthcare workers had a good overall knowledge of radiation protection, there were still some
gaps in their knowledge, particularly regarding the long-term effects of radiation exposure.
Similarly, a study conducted in Iran by Ghazinoor and colleagues (2020) found that while
healthcare workers had a good understanding of the benefits of radiation in medical diagnosis,
there were still some gaps in their knowledge regarding the potential risks associated with
radiation exposure. Specifically, the study found that many healthcare workers did not fully
understand the concept of radiation dose, and therefore may not have been able to accurately
assess the risks associated with radiation exposure for their patients.

In a study conducted in Saudi Arabia, Al-Kadi and colleagues (2017) assessed the knowledge of
radiation protection among medical students. The study found that while the students had a good
overall knowledge of radiation protection, there were still some gaps in their knowledge,
particularly regarding radiation doses and the use of protective measures such as lead aprons.

In a study conducted in Egypt by El-Kholy and colleagues (2018), healthcare workers were
surveyed about their knowledge of radiation protection in diagnostic radiology. The study found
that while most participants had good knowledge of radiation protection principles, there were
gaps in their understanding of radiation doses and the use of protective measures such as lead
aprons.

A study conducted in Turkey by Keser and colleagues (2018) assessed the level of knowledge of
radiation protection among radiology technicians. The study found that while most participants
had good knowledge of radiation protection principles, there were still gaps in their
understanding of radiation doses and the use of protective measures such as lead aprons.

In a study conducted in Jordan by Alkhatib and colleagues (2020), healthcare workers were
surveyed about their knowledge of radiation protection in computed tomography (CT) imaging.
The study found that while most participants had good knowledge of radiation protection
principles, there were gaps in their understanding of the risks associated with repeated CT
imaging and the use of alternative imaging modalities.

A study conducted in Ghana by Sosu and colleagues (2019) assessed the level of knowledge of
radiation protection among radiographers. The study found that while most participants had good
knowledge of radiation protection principles, there were still gaps in their understanding of
radiation doses and the use of protective measures such as lead aprons.
Overall, these studies suggest that although healthcare workers generally have a good
understanding of the benefits and risks associated with the use of ionizing radiation in medical
diagnosis, there are still some gaps in their knowledge that need to be addressed. This highlights
the need for ongoing education and training on radiation protection for healthcare workers to
ensure that they can provide safe and effective care to their patients.

3.2 To identify any gaps in knowledge and understanding of radiation protection measures
among clinicians at Ntchisi district hospital.

Radiation protection measures are essential in medical imaging to ensure the safety of patients
and healthcare workers. However, limited knowledge of these measures among clinicians can
lead to inadequate protection, potentially resulting in unnecessary radiation exposure and adverse
health effects (Shojaei et al., 2019). A study conducted by Alotaibi and Mudhy (2018) found that
clinicians often lack adequate knowledge on ionizing radiation and radiation protection
measures, leading to inappropriate use of radiation and inadequate protection. In a similar study,
Shokri et al. (2021) found that healthcare workers had poor knowledge on radiation protection
measures and recommended the need for regular training to improve their knowledge and
adherence to safety measures.

According to Shokri et al. (2021), training programs can effectively improve the knowledge and
adherence of healthcare workers to radiation protection measures. In their study, they found that
a training program significantly improved the knowledge and adherence of healthcare workers to
radiation safety measures. Similar findings were reported by Alotaibi and Mudhy (2018), who
recommended the introduction of radiation safety training programs for clinicians to improve
their knowledge on ionizing radiation and radiation protection measures. Radiation protection
measures are essential in medical imaging procedures to prevent unnecessary radiation exposure
to both patients and healthcare workers (Brenner & Hall, 2007). However, limited knowledge of
radiation protection measures among clinicians can lead to inadequate implementation of these
measures, potentially resulting in increased radiation exposure (Shojaei et al., 2019). In a study
conducted by Ali et al. (2017) in Pakistan, it was found that the majority of healthcare
professionals lacked adequate knowledge of radiation protection measures, particularly in the
areas of radiation shielding, dose monitoring, and dose optimization.
Similar results were reported in a study conducted by Gombos et al. (2018) in Hungary, where it
was found that the level of knowledge and awareness of radiation protection measures among
medical professionals was low. The study revealed that only 50% of the surveyed professionals
were aware of the radiation dose limits for patients, and only 30% knew the dose limits for
medical staff. In another study conducted by Hoshang et al. (2019) in Iran, it was found that the
majority of medical students and interns had limited knowledge of radiation protection measures
and were not aware of the risks associated with ionizing radiation.

A study conducted by Akyildiz and colleagues (2018) in Turkey found that the level of
awareness and knowledge of radiation protection measures among radiology technicians was
inadequate, particularly in terms of radiation shielding, monitoring, and dose optimization. The
study recommended the need for regular training programs to improve their knowledge and
adherence to safety measures.

In a study conducted by Kumar and colleagues (2020) in India, it was found that the majority of
radiology professionals had inadequate knowledge of radiation protection measures, particularly
in the areas of radiation shielding, monitoring, and dose optimization. The study recommended
the need for regular training programs to improve their knowledge and adherence to safety
measures.

According to a study conducted by Alkorashy and colleagues (2019) in Egypt, the majority of
radiology professionals had inadequate knowledge of radiation protection measures, particularly
in the areas of radiation shielding, monitoring, and dose optimization. The study recommended
the need for regular training programs to improve their knowledge and adherence to safety
measures.

In a study conducted by Yu and colleagues (2018) in China, it was found that the level of
awareness and knowledge of radiation protection measures among radiology technicians was
inadequate, particularly in terms of radiation shielding and dose monitoring. The study
recommended the need for regular training programs to improve their knowledge and adherence
to safety measures.

These findings suggest that there may be gaps in knowledge and understanding of radiation
protection measures among clinicians at Ntchisi district hospital. It is important to identify these
gaps in order to develop effective training programs and ensure proper implementation of
radiation protection measures in medical imaging procedures.

In summary, limited knowledge and understanding of radiation protection measures among

clinicians at Ntchisi district hospital can lead to inadequate protection and potential health
risks.Regular training programs can help improve their knowledge and adherence to safety
measures, leading to improved patient care and protection of healthcare workers.

3.3 To determine the training needs of clinicians at Ntchisi district hospital in order to
enhance their knowledge and adherence to radiation safety and protection measures.

Radiation protection training is an essential component of medical education and is necessary for
clinicians to provide safe and effective patient care (Shojaei et al., 2019). However, studies have
shown that clinicians often lack adequate knowledge of radiation protection measures, leading to
inappropriate use of radiation and inadequate protection of both patients and healthcare workers
(Kamulegeya et al., 2021). According to the National Council on Radiation Protection and
Measurements (NCRP), radiation protection training should cover the principles of radiation
protection, the risks and benefits of ionizing radiation, and methods for minimizing radiation
exposure (NCRP, 2018).

A study conducted by Wambani et al. (2020) in Kenya found that only 30.6% of medical
students had received formal radiation protection training during their medical education.
Similarly, a study by Kamulegeya et al. (2021) in Uganda found that only 23.5% of healthcare
workers had received formal radiation protection training, and 55.8% had never received any
training on radiation protection.

Therefore, it is crucial to assess the training needs of clinicians at Ntchisi district hospital in
order to enhance their knowledge and adherence to radiation safety and protection measures.
Training programs should be developed and implemented to address the gaps in knowledge and
understanding of radiation protection measures identified in this study. Such programs should
focus on the principles of radiation protection, the risks and benefits of ionizing radiation, and
methods for minimizing radiation exposure, as recommended by the NCRP (2018). By providing
clinicians with the necessary training, they can better protect themselves, their patients, and other
healthcare workers from unnecessary radiation exposure.

In a study conducted by Babalola et al. (2018) in Nigeria, it was found that healthcare workers
had poor knowledge and awareness of radiation protection measures, with only 32.4%
demonstrating good knowledge on the topic. The study also revealed that most healthcare
workers had not received any formal training on radiation protection, and those who had
received training had done so only once during their medical education.

Similarly, a study by Valentin et al. (2017) in France found that the level of knowledge of
radiation protection measures among medical students was inadequate, with most students
lacking knowledge on basic radiation protection principles. The authors recommended the
introduction of dedicated courses on radiation protection in medical education to improve the
knowledge and adherence of healthcare professionals to safety measures.

In a study conducted by Alruwaili et al. (2020) in Saudi Arabia, it was found that healthcare
professionals had poor knowledge of radiation protection measures, particularly in the areas of
radiation safety practices and radiation dose management. The study recommended the
implementation of regular training programs to enhance the knowledge and adherence of
healthcare workers to radiation safety measures.

Overall, these studies highlight the need for dedicated radiation protection training programs for
healthcare workers to improve their knowledge and adherence to safety measures. By identifying
the specific training needs of clinicians at Ntchisi district hospital and providing them with
adequate training, the hospital can ensure the safety of its patients and healthcare workers during
medical imaging procedures.
3.4 Summary

Ensuring radiation safety and protection measures in medical imaging is critical for the safety of
patients and healthcare workers. However, research has shown that healthcare workers often
have insufficient knowledge of these measures, leading to inappropriate use of radiation and
inadequate protection. Implementing training programs can be an effective way to improve
healthcare workers' knowledge and adherence to radiation protection measures. Therefore, it is
essential to assess clinicians' knowledge gaps at Ntchisi district hospital and address any
deficiencies to prevent unnecessary radiation exposure. Moreover, studies indicate that negative
attitudes and misconceptions about radiation can affect healthcare workers' adherence to safety
measures. Therefore, assessing clinicians' attitudes and perceptions towards radiation safety and
protection measures is crucial to address any negative attitudes and misconceptions and promote
better adherence. Providing formal radiation protection training is crucial for clinicians to offer
safe and effective patient care. However, studies show that many healthcare workers lack formal
radiation protection training, leading to limited knowledge of these measures. Consequently,
assessing the training needs of clinicians at Ntchisi district hospital and providing necessary
training is crucial to better protect themselves, their patients, and other healthcare workers from
unnecessary radiation exposure. The training programs should focus on the principles of
radiation protection, the risks and benefits of ionizing radiation, and methods for minimizing
radiation exposure.

4.0 Methodology

Methodology is a term that describes a systematic and theoretical examination of research

techniques utilized within a specific field of study (Bryman, 2016). It includes the fundamental
principles, procedures, and methods applied in research to collect, analyze and interpret data, and
to draw conclusions from research findings. A well-structured methodology is vital to establish
the validity and reliability of research outcomes and to provide a comprehensive and transparent
account of the research process (Creswell, 2014).
4.1. Study type
A cross-sectional study design is appropriate for exploring the knowledge of clinicians on
ionizing radiation at Ntchisi district hospital because it allows for the collection of data at a
single point in time from a representative sample of the population of interest (Fletcher et al.,
2018). This study design is particularly useful for describing the prevalence and distribution of a
particular outcome or exposure in a population and can provide insights into potential
associations between different variables (Szklo & Nieto, 2014).

In the context of radiation protection, a cross-sectional study design can be used to assess the
knowledge, attitudes, and practices of healthcare workers towards radiation safety and protection
measures. For example, a study by Kamulegeya et al. (2021) used a cross-sectional study design
to assess the knowledge, attitudes, and practices of healthcare workers in Uganda towards
radiation safety and protection measures. The study found that the majority of healthcare workers
had inadequate knowledge of radiation protection measures, highlighting the need for targeted
training programs to improve their understanding and adherence to these measures.

Similarly, a study by Bongomin et al. (2019) used a cross-sectional study design to assess the
knowledge and attitudes of healthcare workers towards radiation safety and protection measures
in a hospital in Uganda. The study found that the majority of healthcare workers had inadequate
knowledge of radiation safety and protection measures, and many had negative attitudes towards
these measures. The authors concluded that targeted training programs were needed to improve
healthcare workers' knowledge and attitudes towards radiation safety and protection measures.

Therefore, a cross-sectional study design is appropriate for exploring the knowledge of clinicians
on ionizing radiation at Ntchisi district hospital as it allows for the collection of data at a single
point in time and can provide insights into potential knowledge gaps and associations between
different variables.

4.2 Study design

A cross-sectional study design is suitable for exploring the knowledge, attitudes, and perceptions
of clinicians on ionizing radiation at Ntchisi district hospital. This design allows for a
comprehensive assessment of the current level of knowledge, attitudes, and perceptions among
clinicians. It is also cost-effective, quick to conduct, and requires fewer resources compared to
other study designs. Several sources, including Hulley et al. (2013), Purnell et al. (2020), and
Kassamali et al. (2019), support the use of cross-sectional studies in health research. The study
results could be used to guide the development of targeted interventions aimed at improving
knowledge and adherence to radiation protection measures among healthcare workers.
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