194 M . El Fahssi et al .: Radioprotection 2024 , 59 ( 3 ), 189 – 196
Training institutes should reinforce their curricula with theoretical and practical courses relating to patient radiation protection , particularly in terms of reducing radiation doses and image quality ( Semghouli et al ., 2022 ). Although the delivery of radiation doses is the responsibility of radiographers , they should improve their knowledge of radiation dose levels . Therefore , education is the best way to improve awareness of the potential risks of ionizing radiation ( Aldhafeeri , 2020 ; MirDerikvand et al ., 2023 ).
In addition , a positive correlation between knowledge and attitudes of radiographers was statistically validated , and radiation safety training was identified as a significant factor affecting these attitudes ( Alomairy , 2024 ).
Institutional factors can also explain the gap raised by this study between radiographers ’ declarations and their actual practices , in particular the absence of establishment of quality assurance programs in medical imaging departments , the absence of audit aimed at identifying practices hindering the proper protection of patients against ionizing radiation , and the absence of the medical physicist responsible for the optimization process in the majority of hospitals in the Souss Massa region . Optimization of radiation doses while maintaining good image quality for reliable diagnosis can be achieved by improving the knowledge of radiographers and radiologists regarding radiation protection , justification , and optimization of protocols through rigorous audits of hospital radiation at the national level ( Semghouli et al ., 2024b ).
67.5 % of our radiographers confirmed that they do not use a guide to radiological procedures , including written procedures for the most common radiological examinations and recommendations for reducing radiation doses . However , a guide of radiological procedures and others for regular quality control of radiological equipment are needed to optimize diagnostic procedures and prevent adverse events ( Amaoui et al ., 2023 ). In this framework , guides to radiological procedures , such as those produced by the French Society of Radiology ( SFR ), help to apply the principle of optimisation by providing written procedures for the most common radiological examinations in conventional radiology , CT scan , interventional radiology and paediatric radiology , as well as indication of diagnostic reference levels for the most common examinations and recommendations for reducing radiation doses ( ASN , 2011 ). Furthermore , Council Directive 2013 / 59 / Euratom of December 5 , 2013 , laying down basic safety standards for health protection against the dangers arising from exposure to ionising radiation , states that written protocols for every type of standard medical radiological procedure must be established for each equipment for relevant categories of patients ( ESR , 2015 ).
The results show that 40 % of the population studied often add additional radiological examinations to the examination requested when they consider them useful to the diagnosis , 40 % sometimes do so , and 12.5 % always do so . Only 7.5 % of the participants stated that they did not add any examinations to the examination requested . In addition , 97.5 % of our participants said that they automatically , without medical advice , repeat the X-ray examination if the image is a failure ( image not interpretable ), and 55 % repeat it if they consider that the image taken does not meet all the success criteria indicated by the radiological procedure . This result shows that repeat radiological examinations are common practice among our participants , unlike the radiographers who took part in a similar study in Ghana , who confirmed that they did not repeat radiological examinations always / most of the time ( Fiagbedzi , 2022 ). In fact , repeated radiological examinations due to poor image quality result in unnecessary patient exposure to ionizing radiation , possible loss of diagnostic information , and increased economic costs of health care ( Muhogora et al ., 2008 ).
85 % of our participants confirmed that they had checked for the possibility of pregnancy each time a woman of childbearing age was involved in a conventional X-ray , compared with 97.5 who checked for the possibility of pregnancy in a CT scan . This result is satisfactory when compared with the study performed by Fiagbedzi et al ., which showed that 37.5 % of radiographers found that it was not encouraging to ask patients about their pregnancy status before radiological examinations and that over thirty percent were not asked frequently ( Fiagbedzi et al ., 2022 ). Before any exposure to ionising radiation , it is important to determine whether a female is or could be pregnant because for some patients , the exposure may be inappropriate , placing the embryo / foetus at increased risk ( ICRP , 2007 ). Raising awareness among radiographers and the public and introducing visual aids in the departments explaining the risks of radiation exposure to pregnant women in the local language could improve this result .
On estimating patient doses , 90 % of radiographers said that they do not report information on dose estimate ( mAs , kV , FFD , field size , number of examinations ) for each conventional X-ray examination , and 72.5 % of them do not report information about the dose estimate for CT-scan examinations such as DLP and CTDI . This result is similar to that of a previous study conducted at the Souss Massa Regional Hospital , where only 10 % of radiographers reported information regarding dose estimation during imaging ( Semghouli et al ., 2015 ). However , the exposure parameters and the resultant patient doses should be standardised , displayed and recorded ( ICRP , 2017 ). Directive 2013 / 59 / Euratom also confirms that information on patient exposure must be included in the report on the medical radiological procedure ( ESR , 2015 ).
Regarding the adaptation of acquisition parameters to the patient ’ s age and morphology , 90 % of radiographers say they always adjust acquisition parameters in conventional radiology , compared with 42.5 % in CT-scans . Normally , image acquisition parameters change with the anatomy of the patient , such as size , age group , and gender ( Manmadhachary et al ., 2017 ). In fact , the non-standardization of acquisition parameters in hospitals in the Souss Massa region leads to variability in practices and a dispersion of the dose delivered to patients ( El Fahssi et al ., 2023 ). In CT , radiographers tend to use standard protocols for each examination without adjusting the acquisition parameters according to the patient ’ s age and build , which justifies the percentage of 42.5 % quoted above . In fact , a recent study in the same region analysing data from six different CT scans showed the use of standard preestablished protocols and the lack of adjustment of these protocols to the morphology of the patients and the conditions of the examination ( El Fahssi et al ., 2024 ).
Concerning the radiation protection of children in conventional radiology , only 37.5 % of our participants stated