X-ray dose training: are we exposed to enough?
Introduction
A recent letter to the Editor of the British Medical Journal raised concern that knowledge of radiation exposures among health professionals, especially doctors, is inadequate.1., 2. The present study was undertaken to investigate whether this was the case in Derriford Hospital, Plymouth, a large District General Hospital.
Training in radiation protection should occur both before and after basic medical qualification. The EC Medical Exposure Directive (MED) states that, “Member States shall encourage the introduction of a course on radiation protection in the basic curriculum of medical and dental schools”.3 This training should include all the basic radiation protection knowledge needed by the prescriber (a medical doctor, dentist or other health professional who is entitled to refer individuals for medical exposure to a practitioner, in accordance with national requirements). Prescribers (referred to as ‘Referrers’ in the Ionizing Radiation (Medical Exposures) Regulations 2000,4 (IR(ME)R 2000)) should be educated in the basic aspects of radiation protection, especially justification and optimisation which, of course, includes doses and their effects (though the IR(ME)R 2000 regulations do not themselves reiterate these responsibilities). Medical schools should cover the main topics of patient protection such as biological effects, justification of medical exposures, risk-benefit analysis and typical doses per examination. Despite this doctors seem unsure of doses.
After the introduction of the IR(ME)R 2000 regulations,4 it is now the responsibility of the practitioners to justify an individual medical exposure. This should be based on knowledge of the hazard of exposure and the clinical benefit, as judged from the information supplied by the referrer. The referrer has the advantage of knowing the patient, and in practice can considerably influence the practitioner's decision by their method of presentation of selected clinical details. If the referrer has inadequate knowledge of radiation exposure and consequent risks to patients, patients may be investigated, using high-dose examinations where a lower risk alternative would have sufficed. The regulations intend that, regardless of the level of knowledge of the referrer, the practitioner acts as a safeguard. We believe this safeguard, dependent as it is on the clinical details supplied by the referrer, is not perfect. It is further compromised if the practitioner's knowledge of dose is sub-optimal.
The present study assessed the knowledge of radiation exposure doses and risks among both referrers and practitioners, and correlated attendance at a radiation protection course and knowledge of radiation dose and risk.
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Methods
A simple questionnaire in multiple-choice format with a total of 11 questions (Fig. 1) was formulated. This was distributed amongst doctors at Derriford Hospital, Plymouth, UK, a 1285-bed hospital serving a local population of 450,000 with tertiary neurosurgical, cardiac and renal services, in addition to a regional cancer centre serving a population of about 2 million. A total of 240 questionnaires were returned of 375 questionnaires sent out. These were from 21 pre-registration house
Results
Only 66 doctors (27.5%) attained the 45% pass mark. The median mark was three out of 11 (Fig. 2). Approximately 38% of doctors knew the annual terrestrial radiation dose in Plymouth. Fewer doctors (22.5%) knew the dose of radiation absorbed during a chest radiograph. Only 15.4–25.8% of doctors knew the doses relative to a chest radiograph of various more complex procedures involving ionizing radiation (Fig. 3). Surprisingly, some doctors thought that magnetic resonance angiography (28% of
Discussion
In accordance with the study of Gower-Thomas et al.,1 the present study demonstrated a lack of basic knowledge of radiation exposures amongst IR(ME)R 2000 practitioners and referrers. Although under the IR(ME)R 2000 regulations4 it is not stated that the referrer must know the effective radiation dose of tests, their training at medical school and beyond should describe radiation doses of common procedures. The European Union has published guidance on education and training in radiation
Acknowledgements
The authors thank Mr Steve Ebdon-Jackson and Mrs P Burnstead for reviewing the paper and providing valuable comments.
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