Abstract
The extensive use of radiation in medical imaging raises safety concerns due to its potential risks if it is not properly regulated. Throughout this study, the term ‘radiation’ refers specifically to ionising radiation. To mitigate these risks, the International Commission on Radiological Protection established three guiding radiation protection principles: justification, optimisation, and dose limits. These principles aim to minimise unnecessary radiation exposure to patients, personnel, and the public. Despite global guidelines advocating adherence to these radiation protection principles, implementation remains unsatisfactory, particularly among diagnostic radiographers. Factors such as unclear clinical histories, inconsistent use of lead protection apparel and monitoring devices, and the absence of quality assurance programmes are reasons for non-compliance. This non-compliance with radiation protection principles is a concern because it poses potential hazards to all stakeholders, reflecting the necessity to determine their application. This study aimed to determine diagnostic radiographers’ application of the radiation protection principles of justification, optimisation and dose limits in Mpumalanga province, where research on this topic is currently limited.
This study used a quantitative approach with a cross-sectional design. A questionnaire was adapted from previous studies and distributed online through QuestionPro® as the data collection tool. The target population consisted of 230 diagnostic radiographers from 37 public and private hospitals of Mpumalanga province, and the calculated sample size was 146. Stratified random sampling was initially used, but due to the low response rate, a non-probability quota sampling method was subsequently included, yielding a response rate of 86.6%. Data were analysed using descriptive and inferential statistics. Validity was ensured through content validity, construct validity and piloting of the questionnaire. Reliability was tested using Cronbach’s alpha. The ethical principles of autonomy, beneficence, non-maleficence and justice were strictly upheld throughout the study, and gatekeeper permissions were obtained.
The results revealed several barriers to the application of justification, including insufficient clinical histories (66.4%), limited professional autonomy influenced by hierarchical (66.4%) and financial constraints (56.4%), poor communication with clinicians (48.8%) and radiologists in cases of incomplete referrals (31.3%), requested exam-clinical history mismatch (32.8%), and referral appropriateness (39.5%). Referral guidelines were reported to be effective in reducing patient dose (57.9%) and unnecessary imaging (50%). In terms of optimisation, most X-ray rooms were equipped with functional structural elements such as warning lights (80%), lead-coated doors (91.4%), and appropriately placed windows (98.1%). Patients were also
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identified using multiple identifiers (93.2%), such as their name, surname or date of birth, to verify whether the correct examination was performed on the correct patient. However, access to radiation protection apparel varied, with public hospitals having no access to lead goggles (78.8%) and gloves (62.1%). Regarding dose limits, 97.1% of respondents indicated that they received monitoring devices and 53.5% reported wearing monitoring devices consistently. Moreover, the improper placement of monitoring devices, particularly in instances where only a lead apron or a lead apron and a thyroid shield were worn, was frequently noted among experienced diagnostic radiographers. Alarmingly, only 33.3% of respondents indicated that they regularly received radiation dose readings.
The study revealed suboptimal application of radiation protection principles among diagnostic radiographers in Mpumalanga province and provided insights into the current state of radiation safety practices, indicating the need for strict adherence. Further research should explore alternative methodologies and engage all relevant stakeholders.