190 M . El Fahssi et al .: Radioprotection 2024 , 59 ( 3 ), 189 – 196
The application of the optimisation principle calls for collaboration between radiologists , medical physicists and radiographers , each of whom contributes to specific aspects of the imaging process ( ICRP , 2017 ). In this context , radiographers are a key player in assuring the commitment toward the three principles of radiation protection , as recommended by the International Commission of Radiation Protection ( Paulo , 2020 ).
Given the responsibilities they hold in the process of producing medical imaging , radiographers are called upon to master the operation of the equipment and software , as well as their implications for the radiation protection of their patients . Ongoing training is required whenever new equipment or software is installed and when significant changes are made ( IAEA , 2018 ).
In Morocco , radiographers undergo a specific education and training program in diagnostic radiology , radiotherapy , and nuclear medicine , spread over 3 years of study ( 6 semesters ). This training culminates in the award of a bachelor ’ s degree in health techniques , specialising in radiology . These healthcare professionals are directly involved in optimising the doses delivered to patients in conventional radiology and CT . They require appropriate basic training and periodic ongoing training , particularly in patient radiation protection . In this context , this study assessed radiographers ’ attitudes toward the principles of patient radiation protection in the Souss Massa region of Morocco .
2 Materials and methods
2.1 Study population
This cross-sectional study was conducted between March and August 2023 , involving all radiographers from six public hospitals in the Souss Massa region of Morocco . Of the 85 radiographers working in the region ’ s public sector , 80 accepted to participate in the study ( 94 % participation ), including five radiographers who took part in the questionnaire validation stage .
2.2 Questionnaire
An online questionnaire comprising 3 sections and 22 questions was drawn up with reference to the literature ( ESR , 2015 ; ASN , 2016 ).
The first section focused on the demographic characteristics of the participants , such as gender , age , professional experience , education level and worksite . The second part consisted of 20 questions relating to the principles of justification and optimisation : knowledge of justification procedures , use of the radiological procedures guide , performing X-ray examinations with and without an examination voucher , importance of clinical indications , dealing with X-ray examinations that have to be repeated , use of protocol guides for each CT examination , adaptation of exposure parameters ( kV , mAs ), transcription of dosimetric data , treatment of women of childbearing age and optimisation in pediatric radiology . The third section was devoted to the question of whether or not our participants had received basic and ongoing training in radiation protection .
2.3 Questionnaire reliability and validity
The Cronbach ’ s alpha value for our measurement scale is 0.734 , which indicates acceptable reliability of the scale for measuring the internal consistency of its components .
Construct validity was assessed using Pearson ’ s correlation test to evaluate the relationship between the questionnaire items . The results indicate that the majority of items are significantly and positively correlated with each other . However , some items showed only a weak correlation , which may require future revision to strengthen the validity of the questionnaire .
Before being sent to the participants , the questionnaire was distributed to a group of 5 radiographers to test the clarity of the questions . Some questions were reworded considering the comments made during this stage .
2.4 Statistical analysis
Fisher ’ s exact statistical test was used to establish the relationship between the categorical variables , namely gender , professional experience , place of work , and radiographers ’ practices . The relationship is significant if the p-value is less than 5 %.
2.5 Ethical approval
This study received ethical approval from the ethics committee for biomedical research , Mohammed V University of Rabat , under protocol number 28 / 22 .
Participants were informed of the objectives of the research , the data collection process , and the confidentiality of their answers . To obtain informed consent , a tick box entitled ’ I agree to take part in this survey ’ was provided on the first page of the online questionnaire .
3 Results
3.1 Socio-professional characteristics of the study population
A total of 80 questionnaires were received and analysed out of 85 sent to participants , with a response rate of 94 %. Table 1 presents the sociodemographic data of the participants . The population of our study is made up of 65 % women and 35 % men . Of the participants , 97.5 % are under 35 years old . 95 % of the participants have less than 10 years of professional experience . In terms of level of education , most participants ( 92.5 %) had a bachelor ’ s degree , with the remainder ( 7.5 %) having a master ’ s degree . The participants of this study worked at six public hospitals in the Souss Massa region : H1 ( 32.5 %), H2 ( 11.25 %), H3 ( 12.5 %), H4 ( 18.75 %), H5 ( 15 %), and H6 ( 10 %).
3.2 Application of the principles of justification and optimisation in conventional radiology and CT
Table 2 summarizes the radiographers ’ answers to this study regarding their radiation protection attitudes .
65 % of our participants stated that they are aware of the procedures for the justification of radiographic examinations .