1
Radiology exposure and control in UAE
Manar Fawzi Bani Mfarrej
1and Maryam Mohamed Alnuaimi
1 Qualitative Research in Environmental Health and SafetyRadiology Exposure and Control in UAE ABSTRACT
Radiation is part of the earth’s natural process. Natural radiation occurs on a daily basis in different ways and through different mediums. Artificial radiation also occurs in different ways.
This study acknowledges that radiation has adverse effects on populations if the necessary steps are not taken to control its exposure. The main focus of this study was to establish the factors contributing to radiation exposure and control measures in hospitals in the UAE. The area of focus was in Abu Dhabi, UAE. The methods used in the study were a descriptive survey design and questionnaires as the data collection method. The data was collected from a sample size of 10 hospitals in Abu Dhabi. The study found out that some hospitals in Abu Dhabi, the UAE, have adequate control measures to handle radiation, while some had inadequate control measures.
Also, the study found out that facility design and the presence/absence of control measures in hospitals played a crucial role in establishing the level of exposure to radiation and control.
Certainly, radiation exposure in hospitals in the UAE has been a subject of much discussion and deliberation because of the effects associated with it, thus it is instrumental for effective control measures to be set in place to prevent and regulate such effects. The strengths of the study were the capacity to collect data from specialists in radiology and the principal heads of radiology departments from hospitals in Abu Dhabi. Particularly, this was fundamental in the collection of credible data for the study. However, the limitation of the study is that the views and opinions of other stakeholders were overlooked in the study. For instance, the views of patients and how radiation has affected them were overlooked in the study because the study focused on heads of radiology departments from the sample population only.
Key words: Radiology, Artificial Radiation, Descriptive Survey Design, Questionnaires, Exposure, Stakeholders.
INTRODUCTION
Radiation refers to the energy or particles from a source and travels through space or any other medium. Ionizing radiation refers to the energy released by atoms as electromagnetic waves or particles 4. Radioactivity processes are part of the earth, there are naturally occurring radioactive materials in the earth’s crust, homes, schools, offices and hospitals 4,5.
Radiology exposure and control is increasingly becoming an area of great significance, Radiation- based technologies are highly expansive in the UAE, thus making it important for the necessary authorities to come up with ways of controlling exposure to radioactive materials. The UAE has constantly committed itself towards the establishment of radiation protection measures to address cases of radiation exposure that are causing adverse effects on affected populations 7. The UAE has adopted training of workers from different fields as an
important aspect in the regulation of radiation activities. It accomplishes this by setting standards that are in line with the International Atomic Energy Agency (IAEA) standards 7,9. The UAE’s Radiation Safety Department is mandated to ensure that high standards of radiation protection are adhered to in medicine, industrial work and nuclear plants. A study by Simon et al. 17, highlights the importance of regulation by national bodies for the purpose of enhancing radiation protection. Through the joint efforts of different agencies and institutions, the UAE strives to control radiation levels by giving licenses and regulatory approvals to different institutions carrying out radiology-based technologies and activities 7.
In this respect, this study seeks to ascertain the level of radiation exposure and control in the UAE. By focusing on the medicine field, the study evaluates radiation exposure and control measures in radiology departments in hospitals in Abu Dhabi. Hospitals in the UAE utilize radiology-based technologies and
2 procedures to treat and diagnose diseases, thus it is important to investigate on the aspects of radiation exposure and control measures in such institutions.
The need for radiologists in the UAE has also been increasing lately; hence, making radiology departments integral components of our hospitals.
For instance, in 2016, the UAE Ministry of Health signed an agreement with GE Health care for the development and improvement of radiology departments in hospitals in the UAE 15. Some of the hospitals in the UAE offering radiology services include NMC Specialty Hospital in Abu Dhabi. A full or range screening, diagnostic and treatment services utilizing radiology technology are offered at NMC Specialty hospital 12, which shows that radiology-based technologies and procedures are primary components of the country’s health care system.
The purpose of the study is to identify factors contributing to radiation exposure in hospitals and the control measures that can be used to prevent cases of radiation. Indeed, radiation exposure in hospitals in the UAE has been a subject of much discussion and deliberation because of the effects associated with it, thus it is instrumental for effective control measures to be set in place to prevent and regulate such effects.
Radioactivity refers to the disintegration of atoms; the process of radioactivity involves the disintegration or decay of the nuclei, thus releasing energy through radiation 5. The radioactive atoms released in a radioactivity process are known as nuclei. Today, an increasing number of people are exposed to radiation because of the significance attached to ionizing radiation, there are several uses of ionizing radiation including: agriculture, medical purposes, research, and industrial uses. Examples of people who work in environments utilizing ionizing radiation include:
Radiologists
Nuclear medicine health care professionals
Cardiology technologists
Radiation therapy technologists
Nurses taking care of radionuclide therapy patients
The increased use of ionizing radiation increases the possibility of health hazards, if it is not used properly or contained appropriately. Sources of radiation can either be natural or man-made. Natural sources of radiation include:
Terrestrial radiation. For example, Radon is a natural gas that comes from rocks and
soil particles and is the chief source of natural radiation 9. Research shows that on a daily basis, people breathe in and consume radionuclides from air, water and food 16.
Natural cosmic rays. Natural cosmic rays particularly at high altitude are exposed to humans. Further environmental research also highlights that 80% of the annual amount of background radiation that people receive is attributed to cosmic radiation sources 16.
Human body. The human body contains natural radionuclides. Potassium 40 is one of the natural radionuclides in the human body
16.
Man-made sources of radiation include:
The utilization of nuclear medical technology. In the medical field, radiation technology is used for diagnosis and treatment. X-ray machines are radiation- based technologies that are sources of radiation. Studies reveal that 98% of all man- made sources of radiation come from the medical field 9. On a global scale, more than 3600 million radiology-related activities are performed in hospitals annually 16.
Consumer products like televisions, microwaves, luminous dial watches and lantern mantles 9,16.
Gamma radiation. Gamma radiation is related to x-rays and light. Gamma rays are able to penetrate through iron. Health care personnel interacting with highly radioactive materials emitting gamma rays have increased chances of exposure to radiation
9.
Beta radiation. Beta radiations are less penetrating than gamma radiations. Contrary to gamma rays, thin layers of metal or plastic are able to stop beta rays 9.
Exposure to ionizing radiation is usually acquired through different pathways and can either be internal or external exposure. Internal exposure happens in instances whereby a radionuclide is ingested into a person’s bloodstream, while internal exposure can happen through injection or open wounds. Scientists point out that internal exposure to radiation can be dealt with through excretion or treatment 3. External exposure to radioactive material happens when such material is deposited on the skin or clothing of a person 3. Examples of people who are at risk of succumbing to the harmful effects of radiation include:
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Patients in hospitals
Nuclear plant workers
Hospital staff involved in radioactive procedures
Radiologists and even at home through appliances like microwaves.
When the dosage of radiation exceeds the expected levels, this could lead to various effects. The effects of radiation are classified into short-term and long- term effects. Short-term effects of radiation are usually observed within 3 months of exposure, and are associated with high radiation dosages 4 .According to Ehrlich and Coakes 6, short-term effects are further classified in relation to the body system affected. This includes:
The central nervous system
Gastrointestinal
Hematologic
Some of the short-term effects of radiation according to Ehrlich and Coakes 6 include:
Radiation burns on the skin causing a reddening called erythema
Seizures and coma that can lead to death in a short time (Central nervous effect)
Research shows that when pregnant mothers are exposed to ionizing radiation between week 8 and 25, this might cause brain damage to fetuses 17.
Damaging of the digestive tract (Gastrointestinal effect)
Weak immune system (Hematologic and Gastrointestinal effects)
Anemia (Hematologic effect)
Long-term effects of radiation take between 5 to 30 years to manifest. The greatest percentage of long-term manifestations occurs between 10 and 15 years. The difference between short-term and long- term effects of radiation is that long-term effects occur years after radiation exposure. The long-term effects of radiation include:
Cataractogenesis. Radiographers and radiologists who repeatedly expose their eyes to radioactive material are likely to develop cataracts on the lens of their eyes 6.
Carcinogenesis. Long-term radiation exposure is said to cause various cancers like skin, thyroid, breast and blood cancers 6.
Life span shortening. Radiologists who perform radiation processes have a shorter
life span compared to physicians who do not use utilize radiation-based procedures 6. MATERIALS AND METHODS
This part presented the methodology used in carrying out the study. It focused on various aspects including:
research design, target population, setting of the study, sampling procedure, sample size, identification of variables and data collection instruments and procedures.
Research Design: The research used a descriptive survey design using the quantitative approach. The design was pertinent because a descriptive study involves the collection of data to test a hypothesis and/or to respond to questions about the subject of a research and provide a report on the status of things
8. The design was also found to be ideal for this study because the researcher intended to establish the factors contributing to radiation exposure and control measures in hospitals in Abu Dhabi. The rationale for choosing the descriptive survey design was that it makes it possible to collect data using questionnaires from a sample population to determine the status of the target population in respect to the study’s variables. The independent variables in the study were level of staff knowledge on radioactivity, presence of control measures and facility design. The dependent variable in the study was the outcomes of radiation exposure and control including retention of hospital staff, health effects and quality of services in radiology-related procedures in hospitals.
Location of Study: The location of the study was at the city of Abu Dhabi in the UAE. The city was chosen for the study because most of the hospitals in the area were actively using radiology-based technology to diagnose and treat patients, the location was seen as ideal to establish the effects and control measures of radiation in hospitals in the UAE. To our best knowledge, there had not been a similar study conducted in the city of Abu Dhabi.
Target Population: The target population for this study comprised of 30 hospitals in Abu Dhabi, targeting the heads of radiology departments in these hospitals. The heads of the hospitals’ radiology departments were chosen for the research because of their expertise in the field of radiology. The target population was appropriate for this study because they would give sufficient and reliable information regarding the exposure effects and control measures of radiation in their hospitals.
4 Sampling Procedures and Sample Size: Gatrell, Bierly and Jensen 8 refer to a sample size as a representation of a target population. The research targets a target population of 30 hospitals in Abu Dhabi with 30 heads of radiology departments in the hospitals. Out of the 30 hospitals, its decided to settle for 10 hospitals as the sample size for the research, then used purposive sampling to get the appropriate sample size for the study because the primary data for the research could only be obtained from a specific group of participants. For the purposes of the study, only radiology departmental heads of reputable hospitals offering radiology-based health care services could be used as respondents for this research study.
Research Instruments: For the purposes of this study, questionnaires were used as the data collection instruments. Questionnaires are imperative when respondents are required to give honest responses regarding the subject matter of a research without revealing their identity. Thus, it was used in collecting data from the radiology departmental heads on what they perceived were effects of radiation exposure and control measures in hospitals.
The questionnaires were divided into two sections:
the first section contained demographic information of respondents while the second section dealt with the level of staff knowledge on radioactivity, the presence of control measures in radiology departments and the facility designs of radiology departments from the hospitals represented in the study.
Data Collection Procedure: We paid a visit to the overall health offices in Abu Dhabi to seek for an official consent to introduce himself to the sampled 10 hospitals. After being granted with the permission to do so, the researcher proceeded to the sampled hospitals and presented the request to collect primary data from the heads of radiology departments in the hospitals to the respective hospital administrations.
After being granted permission by the hospitals’
administrations, the researcher was introduced to the heads of radiology departments and then explained the purpose of the research. The respondents were assured of confidentiality and also explained the content of the questionnaire as well as how to respond to the questions. After explaining the details of the questionnaire and what was expected of them, the sampled heads of radiology were asked to give their responses to the questionnaire. After completing the data collection process, the questionnaires were collected.
Data Analysis: The researcher collected and organized the data collected from the respondents.
The study produced quantitative and qualitative information, which were analyzed using descriptive statistics. The qualitative analysis comprised of the opinions generated from the respondents.
Percentages were utilized in the presentation of the data from the respondents. The analysis of the research considered the varying demographic characteristics of the respondents. An analysis of the collected data sought to ascertain the impact of the level of training on the scale of effects and control measures of radiation in hospitals in Abu Dhabi, UAE. Then assessed the usefulness of the information in responding to the research questions.
RESULTS AND DISCUSSION
The purpose of this study was to establish the effects and control measures of radiation in hospitals in Abu Dhabi, UAE. This part presents the findings of the data collected from the participants. The research was directed by the following research questions:
What level of knowledge do hospital staff working in radiology departments have concerning radioactivity and the operations of radiology-based technology?
How are control measures utilized in hospitals to protect hospital staff and patients from beyond-threshold radiation exposure?
Are radiology facility designs structured in a way that supports the effective and safe utilization of radiology-based technology in hospitals?
The Level of Staff Knowledge on Radioactivity:
From the response generated from the respondents, it was found out that not all hospitals had their staff having sufficient knowledge on radioactivity and the operations of radiology-based technology. From the responses, 80% of the participants reported that their hospital staffs had adequate knowledge and expert on radioactivity and operations of radio-based technology. The 20% that reported insufficient expertise on radiation technology, asserted that experience was a major contributing factor to the inadequacy of adequate knowledge. Of great importance still, 20% of the respondents reported that the hospital administration was not keen on regular trainings of staff about radiation technology and safety while working on radioactive processes, Dr Ali Aljarad from Dar Alshifaa hospital stated that in his hospital there was no regular training of staff and they must depend of themselves to upgrade their
5 level of knowledge. From the collected data, 80% of the heads of radiology departments reported that their departments were keen on refreshing the skills and expertise of their hospital staff to equip them with the necessary knowledge on dealing with the dangers of radiation exposure for both patients and staff, Burjeel hospital in specific was very keen on staff training as they have monthly meetings and refresh courses for the staff, there was also weekly meetings regarding the development and updates on the newest technology in the field, Dr. Mohannad Al atrash from Gulf diagnostic center hospital also stated that they have monthly training inside the hospital and quarterly training outside the hospital.
The findings from the research study revealed that low level of staff knowledge on radioactivity and effective operations on radiology-based technology caused poor outcomes. Additionally, 20% of the respondents reported that without adequate knowledge on the subject, it was difficult to retain some members of staff as the patients would report complaints, according to Dr. Emad moussa from Alnoor hospital, some staff members are not well trained for positioning the patients and performing the procedures that are required in the radiology department especially for mammography, Dr.
Mohammed hashim from Burjeel hospital said that they perform X-rays on average of 250-300 patients per day, and it is very important that the staff also informs the patients on these procedures, for example most patients don’t know that MRI can be done daily and causes no harm to the body because it emits 0 radiation, while CT scan is the most harmful procedure to the body as it is 10 times as powerful as an X-ray and can be done maximum twice a year. Dr.
Emad also stated that doctors who ask for unnecessary repeated radiology procedures undergo an investigation from Health Authority of Abu Dhabi (HAAD) and is closely monitored, they might even lose their medical practice license if it wasn’t for a legitimate reason.
On the other hand he also stated that all staff including doctors and nurses must serve 50 hours annually of training and education in order to renew their medical practice license, as this is a legal requirement set by HAAD.
In this respect, the respondents showed the need for regular trainings to equip hospital staff with the necessary knowledge to handle radiation-based technology and operations effectively to avoid beyond-the threshold exposure. Mufti (2000) asserts that lack of enough knowledge and training is an
obstacle that affects the ability of hospital staff to work effectively on radiology-based operations.
Presence of Control Measures: The research findings found out that 90% of the hospitals adhered to radiation control measures effectively; however, they added that there was need to improve the level of radiation control in their hospitals. According to the study, 10% of the hospitals represented did not have effective radiation control measures. When asked whether there were attempts to improve the radiology departments in their hospitals, 80% of the respondents said that the hospital administrations were willing to improve the radiology departments, but it was taking long to put in place such measures.
The study’s results indicated that 90% of the radiology departments in the hospitals regularly utilized the use of protective equipment while handling radioactive materials. The respondents reported that hospital staff performing radiation procedures wore protective wears. The protective wears include:
Water proof gloves
Protective gowns
Overshoes
The study also found out that 70% of the hospitals performed constant routine dose monitoring of the staff exposed to radiation in controlled areas. The hospital staff undergoing constant radiation dose monitoring included doctors, nurses, radiopharmacists, radiologists and nuclear medicine technologists, they were wearing dose meter badges in all the hospitals visited during the research, those badges are checked every 2 months according to Dr.
Mohannad by the manufacturing company or major governmental hospitals like al Mafraq hospital, if the dose meter shows higher than recommended doses, the hospital will undergo an investigation to find out where are the stray radiations coming from, and higher health authorities will be informed to take control in such situations. The 30% who reported lack of constant routine dose monitoring of hospital staff attributed this to negligence on the part of the radiology departments.
Moreover, the study found out that safety devices for preventing radiation exposure were utilized in 90% of the hospitals on a regular basis like calibration of the machines, yearly checking on protective equipment, leakage tests, and preventive maintenance according to Dr. Mohannad. In general, the respondents reported the following safety devices as standard prevention and control devices for radiation exposure in radiology room:
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Beam lighting switches
Contamination monitor
Door interlocks
Syringe shields
Forceps
Tongs
When asked about the control measures they would want to implement in their hospitals to prevent radiation effects, the respondents presented the following suggestions:
Effective waste disposal of radioactive materials
Regular trainings
Regular routine personnel monitoring
Radiology facility modifications
Setting of radiation safety programs
Incident and accident analysis reports
Regular assessment of radiation instruments These procedures are usually performed by a radiation protection officer which by law is required by each hospital to have. The study’s findings showed that there was no need for hospitals in Abu Dhabi to worry too much about investing more in effective radiation control measures, but there is always room for improvements. In particular, this was supported by Aichinger et.al. 2 who argued that hospital personnel are exposed to high doses of radiation because of lack of adequate radiation control measures. But in the case of UAE, all hospitals reported that HAAD was monitoring them regularly and very strict about this matter, otherwise the hospital won’t be opened for public and would be shut down until all the mistakes are fixed.
Dr. Mohanned and Dr. Emad also informed us that ever since Federal Authority for Nuclear Regulation (FANAR) has taken control alongside HAAD, the medical field of UAE improved significantly in the last 7 years.
Facility Design: The researcher sought responses on the quality of facility design from the different hospitals represented in the study. The study’s results showed that 70% of the respondents were keen on the frequent utilization of quality equipment for radiation operations. By contrast, 30% of the respondents pointed out that their institutions were not keen on regular utilization of latest technologies.
Those who admitted to the utilization of new and latest equipment argued that this played a crucial role in preventing exposure to radiation for both patients and hospital staff like Burjeel hospital as Dr.
Mohammed stated that they are up to date. The study also found out that 67% of the hospitals
represented had special rooms set for the hospitalization of patients who received doses of radiopharmaceuticals. Like Al noor hospital, Dr.
Emad asserted that they were important in shielding patient-care staff from radiation exposure, patients who undergo such procedures arrive in a different waiting rooms that is separated from the waiting area of normal patients, it also has separate ventilation from the rest of the hospital, and they can check in into isolated room that has isolated sewage system (as the urine and feces of patients is radioactive as well), and these sewage systems lead to special plants to be treated before dumped. The respondents who reported the lack of such special rooms expressed their desire to forward the implementation of the same. The researcher found out from the respondents that effective control measures to prevent radiation exposure where partially hindered by poor facility designs in radiology departments. In fact, this revelation is supported by Martin and Sutton
10 by highlighting on the importance of adequate shielding material whenever radiation facilities and equipment are being considered in hospitals. But most hospitals reported that this matter was monitored by HAAD, the facility design and condition of the radiology department rooms play a crucial role in protecting the staff and patients from any stray rays that may come out of the operation room. Dr. Ali reported that even if there was a slight crack in the door, any further activities will be shut by HAAD until the facility is in a proper condition to function.
The level of staff knowledge on radioactivity was found to be a significant point to consider in assessing the level of a hospital’s preparation in preventing and controlling radiation exposure. From the study’s results, most of the respondents pointed out that hospital staffs serving in the radiology department had adequate knowledge on radioactivity and effective operations on radioactive procedures.
This shows that most hospitals in Abu Dhabi, the UAE had their staff well equipped with sufficient knowledge and expertise in handling radiation-based technology and procedures. For the respondents who reported inadequate staff knowledge in handling radiation-based technology, suggestions of more training of the staff indicated their commitment towards improving safety in radiology-based procedures. These findings corroborate with a study by Yurk, Cavusoglu and Gunay 18, who argue that knowledge about radiological procedures among health care professionals is important in preventing beyond-threshold radiation exposure.
7 Adherence to control measures was found to be an imperative component of addressing cases of acute radiation exposure to persons in hospitals in the UAE. The revelation from 20% of the respondents that they did not have adequate control measures to provide hospital staff and patients with possible radiation exposures was an indication that this is an area worth considering. Control measures to prevent radiation are extremely important, given that increased usage of radiology-based technology in the UAE is increasing the vulnerability of exposure.
Routine monitoring, protective wears and the usage of safety devices in the hospitals indicated the willingness and readiness of the radiology departments in those hospitals to prevent radiation exposure and, thus reduce the adverse effects associated with radiation on people. The suggestions by the participants on how to improve their hospitals’ control measures shows that through deliberate efforts, it is possible to reduce hospital- based radiation effects. Ploussi and Efstathopoulos
13, affirm the arguments brought out by the study’s findings by asserting that creating a protection culture in radiology rooms is vital in the effective management of radiology-based technologies and procedures.
The usage of quality equipment and special rooms for patients undergoing radiological treatment were found to be instrumental components of reducing the susceptibility of radiation exposure in hospitals in Abu Dhabi, the UAE. Most of the respondents reported that their radiology departments were regularly equipped with quality instruments to perform radiology-based procedures. A study by Adhikari, Jha and Galan 1 highlight that the quality of radiology facility and design contributes greatly in enhancing control measures and preventing excessive exposure to radiation. The desire of the respondents to forward best practices and implement the same to enhance their capacity to control radiation in hospitals was a big step in the effective management of radiation levels in hospitals in the UAE. In this respect, hospital administrators in Abu Dhabi and the greater UAE should adopt best control practices to reduce radiation exposure.
The results of the study have significant policy and practice implications. The study’s results indicate the relevant authorities came up with policies that govern the implementation of radiation control measures.
Rules and regulations from the Ministry of Health and the Environment in the UAE are instituted to improve the current status on radiation exposure and control.
Existing regulations should be reinforced and their effectiveness assessed to enhance the quality of lives of patients and hospital staff. According to international regulations and laws on radiology, the hospitals in Abu Dhabi can uphold a safety culture by:
Encourage individual and collective dedication to protection and safety at all levels of radiology.
Promoting the participation of hospital personnel and their representatives in the formation and implementation of policies, rules and processes dealing with safety in radiology-based procedures.
Promoting adherence to international regulations on radiology.
Setting up of effective emergency protocols according to international radiology standards.
The result’s findings are an indication that different governmental agencies in the UAE are merging efforts to ensure that the environmental effects of radiation are managed effectively. In practice, the study’s findings are fundamental in helping heads of radiology departments in Abu Dhabi, the UAE to improve their responsibility in ensuring that safety is enhanced while undertaking radiology-based procedures in hospitals. Furthermore, the study challenges radiologists and other health care professionals to increase their awareness and knowledge on radiology to reduce and control radiation exposure levels.
CONCLUSION
The study on the factors contributing to radiation exposure and control measures in hospitals in Abu Dhabi, UAE, produced results that are significant in establishing a solid ground on the issue. It is evident that radiation in hospitals in the UAE has been a major subject that requires effective control measures to address effectively. It is from this assertion that the study was conducted. The results found out that lack of knowledge among staff members working in radiology departments in Abu Dhabi hospitals affected their capacity to prevent and control the level of exposure control. It was also noted from the study that adequate knowledge and expertise played a crucial role in effective management of radiation levels in hospitals. Thus, regular training of hospital staff working in radiology departments was seen as an important control measure in reducing the exposure and effects of radiation. Moreover, the presence of control measures in hospitals in the UAE
8 play a vital role in improving the capacity of hospital staff to prevent radiation exposure and effects.
Routine monitoring and the use of safe devices, as evidenced in the study, are fundamental in equipping hospitals in the UAE with the right resources for effective control of radiation levels. It is evidently clear that without such measures, it is not possible for hospital personnel to control radiation levels effectively. The design of radiology facilities is also significant in ascertaining the level of exposure and control of radiation in hospitals. Quality facility designs and radiology equipment goes a long way in preventing beyond-threshold radiation levels.
The government of the UAE in conjunction with the Ministry of Health has a responsibility to ensure that
the safety of radiology departments is of top priority.
This will create a way for the formulation and implementation of viable regulations aimed at reducing high levels of radiation exposure. In addition, hospital administrators have a responsibility to ensure that the staff working in the radiology departments has the necessary resources needed to implement such standards and regulations. In essence, improving radiation control deems it necessary for the radiology departments in hospitals in the UAE to adhere to the best practices aimed at the effective management of radiation exposure and control.
Fig. 1. Pie chart on the level of knowledge on radioactivity
Fig.2. Pie chart on control measures
Fig. 3. Pie chart on Facility design 80
20
Knowledge on Radioactivity
1st Qtr 2nd Qtr
88 18
Control Measures
1st Qtr 2nd Qtr
80 20
Facility Design
1st Qtr
9 ACKNOWLEDGMENT
The authors would like to give a special thanks to the Heads of radiology departments who gave us permission to be used as a reference, and took the time off their busy schedules to help in conducting this research, the cooperation and support gave us a glimpse of how this field was shaped based on integrity and dedication. Our appreciation goes to all who participated in this survey whether they were kept confidential or have been mentioned by name, I have a great gratitude towards:
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