G . Rincón et al .: Radioprotection 2024 , 59 ( 3 ), 173 – 183 181
Lucy : ‘ I used to have very good eyesight , but now I can ’ t see very well up close ’.
Raul : ‘ During 12 h , we performed about 40 procedures of all ...’.
Alex : ‘ You end up knowing the tricks of the equipment and it is up to oneself to fix it ’.
Ana : ‘ The mammograms had to be performed using chemicals and an extractor , but an old machine ...’.
Procedures related to optimisation can be violated , and activities related to dose manipulation , in which the principle of radioprotection ( ALARA ) may not be observed .
4 Discussion
Understanding of occupational risk depends on the participants views and perception , which are influenced by factors such as institutional context , available resources , and workplace processes ( Scheer et al ., 2014 ). The participants understood the workplace environment , physical consequences , and triggering of behavioural changes .
Numerous studies have shown a deficit in knowledge about radiation protection among healthcare professionals ( Bayatiani et al ., 2023 ; Housni et al ., 2023 ) which leads to a misuse of protective tools . In our study , it was found that the participants knew the basic principles of radiation protection . However , during the investigation and in individual participant perceptions , low use of PPE , especially glasses , vests , and screens ( Poveda and Plazas , 2020 ) was observed , as well as the material weight they are made of , resulted in increased risk perception , known as ‘ biomechanical risk ’, which is the result of long working days when using leaded protection elements ( Puerta and Morales , 2020 ) and is associated with cumulative trauma injuries .
Although the risks of cancer induction and non-cancer disease from radiation exposure have been documented ( Bazyka et al ., 2018 ), the use of radiation was associated and recognised with short- and long-term health impairments among participants . Education , training , and communication processes can increase knowledge and perceptions of radiation care ( Schieber et al ., 2020 ).
Regarding qualifications and workplace environments , non-compliance with working conditions caused discomfort among workers . Some participants began their work empirically ; however , they later attained a 3-year university education , which when compared with training in other countries , provides knowledge of the radiological protection ( both theoretical and practical ) necessary to autonomously deal with the technical aspects of performing medical imaging procedures using ionizing radiation ( Faggioni et al ., 2017 ). This empirical learning may produce a low-risk perception related to maturity or adolescence , considering that a person ’ s views are formed according to their environmental context , learning style , and epistemic curiosity . Hence , each participant is responsible for their own preparation and training in a given context ( Navarrete , 2013 ). The accumulated experience of the participants should be addressed in order to reduce the radiation dose variability and raise awareness of the effect of doses on the patient , worker , and patient ’ s health as reported by ( Zanca et al ., 2020 ), leading to standardised protocols in the future as described in the Bonn Call for Action .
The most common occupational incidents among the participants were associated with the physical conditions of the organisation ( Gil , 2012 ), indicating proportionality between the occurrence of incidents and their culmination as accidents ( Mejía et al ., 2019 ). Although exposure to low doses of radiation and cognitive dysfunction seem inconsistent according to the literature , the stress associated with the real or perceived exposure derived from the multiplicity of tasks found in this research has a negative impact , producing psychological stress and overlapping with pro-inflammatory effects ( Collett et al ., 2020 ). This suggests that occupational safety is co-constructed by workers when their feelings are considered and a notification and reporting process is maintained ( Rossignol , 2015 ).
Studies on prevention against occupational risk include terms associated with standards in radiology without knowing their applied basis such as distance , time , and shielding . Owing to the limited and poorly applied knowledge of radiological protection , knowledge gaps exist in dose use , training , and effective education ( IAEA and WHO , 2012 ; Faggioni et al ., 2017 ), leading to diagnostic or treatment errors , although the participants bear the greatest responsibility in dose administration ( Soffia et al ., 2017 ; Schieber et al ., 2020 ;).
Participants understood that radiological studies can harm patients , the environment , and themselves and also considered that the risk-benefit ratio is not isolated from the fear of making a mistake , since 30 % of the procedures are not justified ( EC , 2000 ). Among participants , little acknowledgement of radiation protection principles such as justification and optimisation were found ( Malone and Zölzer , 2016 ); some stated that the number of procedures depended on their perception , excluding academic concepts ( Zölzer , 2020 ), indicating that this is not just a matter of science , but clearly has consequences and ethical issues .
Some studies mentioned the use of older technologies and equipment that clearly correlate to the perception of increased exposure risk related to equipment ageing ( Zanca et al ., 2020 ). However , some risk factors such as patient obesity are strong predictors for defining radiation doses , which are understood as deviations in healthcare processes , leading to higher exposure for both workers and patients ( EC , 2012 ).
Dose optimisation , a multi-step process including everything from a quality assurance plan to the dose effect on patients and image quality ( Tsapaki , 2020 ), involves keeping patient exposure at the minimum necessary level to achieve the required diagnostic or interventional objective ( IAEA , 2009 ). The participants were aware of the theory and were experienced ; however , in practice , this principle was weakly applied among these participants . The repetitiveness of processes and use of numerous repeated tests was described by the participants in their daily procedures , without considering that radiation use was associated with cancer risk , while ignoring the patient ’ s self-care and cancer risk ( IARC , 2000 ) andtheirownselfcare , as well as care for others and the environment ( Garcés and Giraldo , 2013 ; Prasarn , 2014 ). Therefore , safety standards must be optimised because there is no such thing as ‘ very little ’ radiation ( OEIA , 2016 ). The procedures described were barely practiced according to the ALARA concept .