ABSTRACT
Since the discovery of x-ray, it has been extensively used in healthcare field. While it is a very useful tool in diagnosis, it could also be a potential threat to human health if not handled properly. Fortunately, the radiation-safety standards were introduced to prevent radiation hazards from occurring. Awareness and education grew, and throughout the 1920s and 30s, more guidelines were developed and various organizations were formed to address radiation protection. Malaysia has passed the Radioactive Substances Act in 1968, and eventually the Malaysian Standard Code of Practice for Radiation Protection (MS 838) was introduced in 1985.
PLANNING
In the early days before radiation-safety standards were introduced, many have suffered various health problems as a result from excessive radiation dose. For example, skin cancer was common in early x-ray workers as a result of working around accelerators. There are also cases when patients with tuberculosis, who were flouroscoped many hundred times during artificial pneumothorax, have an elevated incidence of breast cancer. This was first reported in Nova Scotia, and confirmed by a similar study in New England.
The characteristic of those exposed to radiation varies depending on the amount of exposure they absorbed. For example, exposure of 5-10 rem will results in changes in blood chemistry, nausea (50 rem), and diarrhea (90 rem). Time taken for the sign and symptom to manifest are also varies. For example, exposure of 400 rem will result in death within 2 months, while exposure of 1000 rem will result in death within 1-2 weeks if untreated.
However, the modalities used in diagnostic imaging field only produce radiation in milirems. The range varies according to modalities: conventional x-ray (5-270 mrem), CT scan (200-400 mrem), and fluoroscopy (500-800 mrems). Although the radiation is relatively low, there is no firm basis for setting a "safe" level of exposure above background for stochastic effects.
Stochastic effects are associated with long-term, low-level exposure to radiation. Increased levels of exposure make these health effects more likely to occur, but do not influence the type or severity of the effect. Cancer is considered the primary health effect from radiation exposure. Radiation can cause changes in DNA that ensure cell repair and replacement produces a perfect copy of the original cell. Changes in DNA are called mutations. The mutations can be teratogenic or genetic. Teratogenic mutations are caused by exposure of the fetus in the uterus and affect only the individual who was exposed. Genetic mutations are passed on to offspring.
This assignment will focus on how to make sure that healthcare personnel know about the safety standards and apply it towards patients and themselves. The primary target audiences are the radiographers, radiologists, physicists and nurses, as they play an important role in ensuring the safety of their clients. It also targeted the public to inform them about their rights and safety while undergoing radiographic interventions.
SELECTING CHANNEL
Because the primary audiences are healthcare personnel, the best way to reach to them is by interpersonal communication, such as conducting seminars and courses. It can be optional or obligatory (for example, as a requirement of a promotion). The reason why this channel is the most effective is because it can build skill and stress on the subject’s importance, as well as reinforcing positive behavior change. It’s in a form of two way communication and in this case, can be focused into the radiation protection issue. Therefore, if there is any doubt arising regarding the subject, participants can ask directly to the speakers.
While for public, publications such as newspaper can be used, as well as events such as Hospital Day or Health Fair, for example, a section in the local newspaper to answer question about radiation safety, and a booth or exhibition about the same subject. By using this channel, public’s concern and enquiries can be answered by healthcare personnel themselves. For a long-term campaign, pamphlet can also be used and distributed.
Another form of channel is posters and signage that can be placed throughout the diagnostic imaging department. By using this, basic information about radiation protection and reminder can be constantly viewed and reminded, by both healthcare personnel and public.
DEVELOPING MATERIALS AND PRETESTING
The material should discuss the importance of radiation safety, specification of the proper shielding, how to provide proper shielding to the patient as well as staff, and patient education regarding the subject. It can be presented in the form of paperwork, guidelines, slides presentation, lecture, and printed notes.
The ways of presenting the subject shouldn’t be a problem for the healthcare personnel to understand, as it is presented in an academic manner according to their level of qualification. The early way to test the effectiveness of the subject is by circulating the MS 838 Code of Practice for Radiation Protection. Then, the feedback is collected to see whether they fully understand the subject or is that any need for further clarification.
The materials used should base on the Malaysian Code of Practice for Radiation Protection. However, because the code of practice is passed on 1985, it may need changes and amendments so that it stays current and relevant according to today’s technological advancement. For that matter, the International Atomic Energy Agency (IAEA) Safety Report No. 39 on Applying Radiation Safety Standards in Diagnostic Radiology and Interventional Procedures Using X-Rays (2006) can be used as guidelines together with the Malaysian Code.
The materials should also include the guideline on how to educate the patients and public when they have to undergo certain radiographic examination. This is to train the healthcare personnel to convey the message effectively to the patients and public, so that they will feel secure and safe during the examination.
IMPLEMENTATION
For seminars, it can be conducted as one-day seminar, or weekend course. For more effectiveness, weekend course (2 days) is preferred as it does not obstruct normal working days. The seminar can be conducted in a hotel or resort to attract participants and provide a comfortable accommodation and nice learning environment. Experienced speaker is to be invited to give a clear view and be able to answer participant’s questions.
The drawback of this program is that it needs a lot of money to conduct as to provide a nice location and to invite an experienced speaker. Furthermore, it needs to be organized in a centralized location (as to minimize the cost), so the participants from distant hospital may have some difficulty to come.
Conducting a Hospital Day or Health Fair is one of the ways to inform the public about their rights and safety. It is usually conducted during weekends to attract more people to come. However, the effectiveness of this program relies on the number of people coming, as well as the effectiveness of healthcare personnel in answering public’s concern and questions. Thus, it needs a large coverage of advertisement to inform public about the event, well prepared personnel to answer questions, and the activities must be interactive and fun.
A section in local newspapers can also provide information regarding the subject as well as answering publics’ enquiries. It is similar to publication of pamphlet that can be provided in the waiting area of a hospital. However, it depends on how many people will read the section and pamphlet, and how much they really understand the subject discussed.
Signage in the diagnostic imaging department might be the easiest way of informing healthcare personnel as well as public about the radiation protection. For healthcare personnel, they can be constantly reminded, and patient can also ask for their rights and safety when they see the signage. However, the information inside the signage might be limited and concise.
ASSESSING EFFECTIVENESS
The effectiveness of the program can be assessed by observing the healthcare personnel whether they apply the protection to the patient or not. This can be done by the superior officers, or by asking the patients themselves. As for the public, a survey can be conducted to see whether they have known their rights and safety. If a high percentage of persons surveyed know about the subject, and they can ask about their protection if the healthcare personnel forgot to apply it, then the program has achieved its objectives.
FEEDBACK
However, the feedback of the program is still needed, whether it has achieved its objectives or not. This is to improve the effectiveness of the program and to make future programs more successful. Feedback about the program can be asked directly to the audience after the completion of each program; whether it needs any improvement or lacks any important information. The ways of presenting the subject can also be asked so that in the next session, the subject can be presented in a more clearly way . The number of participants can be measured and improved by the next cycle of the program by better planning and organization.
REFERENCES
1. Radiobiology for Radiologist
2. Standard and Industrial Research Institute of Malaysia, Malaysian Code of Practice for Radiation Protection (1985)
3. International Atomic Energy Agency (IAEA), Safety Report No. 39 on Applying Radiation Safety Standards in Diagnostic Radiology and Interventional Procedures Using X-Rays (2006)
4. http://www.radiationcontrol.utah.gov/XRAY/BERT.htm (22 August 2009)
5. http://www.epa.gov/rpdweb00/understand/health_effects.html#content (22 August 2009)
Since the discovery of x-ray, it has been extensively used in healthcare field. While it is a very useful tool in diagnosis, it could also be a potential threat to human health if not handled properly. Fortunately, the radiation-safety standards were introduced to prevent radiation hazards from occurring. Awareness and education grew, and throughout the 1920s and 30s, more guidelines were developed and various organizations were formed to address radiation protection. Malaysia has passed the Radioactive Substances Act in 1968, and eventually the Malaysian Standard Code of Practice for Radiation Protection (MS 838) was introduced in 1985.
PLANNING
In the early days before radiation-safety standards were introduced, many have suffered various health problems as a result from excessive radiation dose. For example, skin cancer was common in early x-ray workers as a result of working around accelerators. There are also cases when patients with tuberculosis, who were flouroscoped many hundred times during artificial pneumothorax, have an elevated incidence of breast cancer. This was first reported in Nova Scotia, and confirmed by a similar study in New England.
The characteristic of those exposed to radiation varies depending on the amount of exposure they absorbed. For example, exposure of 5-10 rem will results in changes in blood chemistry, nausea (50 rem), and diarrhea (90 rem). Time taken for the sign and symptom to manifest are also varies. For example, exposure of 400 rem will result in death within 2 months, while exposure of 1000 rem will result in death within 1-2 weeks if untreated.
However, the modalities used in diagnostic imaging field only produce radiation in milirems. The range varies according to modalities: conventional x-ray (5-270 mrem), CT scan (200-400 mrem), and fluoroscopy (500-800 mrems). Although the radiation is relatively low, there is no firm basis for setting a "safe" level of exposure above background for stochastic effects.
Stochastic effects are associated with long-term, low-level exposure to radiation. Increased levels of exposure make these health effects more likely to occur, but do not influence the type or severity of the effect. Cancer is considered the primary health effect from radiation exposure. Radiation can cause changes in DNA that ensure cell repair and replacement produces a perfect copy of the original cell. Changes in DNA are called mutations. The mutations can be teratogenic or genetic. Teratogenic mutations are caused by exposure of the fetus in the uterus and affect only the individual who was exposed. Genetic mutations are passed on to offspring.
This assignment will focus on how to make sure that healthcare personnel know about the safety standards and apply it towards patients and themselves. The primary target audiences are the radiographers, radiologists, physicists and nurses, as they play an important role in ensuring the safety of their clients. It also targeted the public to inform them about their rights and safety while undergoing radiographic interventions.
SELECTING CHANNEL
Because the primary audiences are healthcare personnel, the best way to reach to them is by interpersonal communication, such as conducting seminars and courses. It can be optional or obligatory (for example, as a requirement of a promotion). The reason why this channel is the most effective is because it can build skill and stress on the subject’s importance, as well as reinforcing positive behavior change. It’s in a form of two way communication and in this case, can be focused into the radiation protection issue. Therefore, if there is any doubt arising regarding the subject, participants can ask directly to the speakers.
While for public, publications such as newspaper can be used, as well as events such as Hospital Day or Health Fair, for example, a section in the local newspaper to answer question about radiation safety, and a booth or exhibition about the same subject. By using this channel, public’s concern and enquiries can be answered by healthcare personnel themselves. For a long-term campaign, pamphlet can also be used and distributed.
Another form of channel is posters and signage that can be placed throughout the diagnostic imaging department. By using this, basic information about radiation protection and reminder can be constantly viewed and reminded, by both healthcare personnel and public.
DEVELOPING MATERIALS AND PRETESTING
The material should discuss the importance of radiation safety, specification of the proper shielding, how to provide proper shielding to the patient as well as staff, and patient education regarding the subject. It can be presented in the form of paperwork, guidelines, slides presentation, lecture, and printed notes.
The ways of presenting the subject shouldn’t be a problem for the healthcare personnel to understand, as it is presented in an academic manner according to their level of qualification. The early way to test the effectiveness of the subject is by circulating the MS 838 Code of Practice for Radiation Protection. Then, the feedback is collected to see whether they fully understand the subject or is that any need for further clarification.
The materials used should base on the Malaysian Code of Practice for Radiation Protection. However, because the code of practice is passed on 1985, it may need changes and amendments so that it stays current and relevant according to today’s technological advancement. For that matter, the International Atomic Energy Agency (IAEA) Safety Report No. 39 on Applying Radiation Safety Standards in Diagnostic Radiology and Interventional Procedures Using X-Rays (2006) can be used as guidelines together with the Malaysian Code.
The materials should also include the guideline on how to educate the patients and public when they have to undergo certain radiographic examination. This is to train the healthcare personnel to convey the message effectively to the patients and public, so that they will feel secure and safe during the examination.
IMPLEMENTATION
For seminars, it can be conducted as one-day seminar, or weekend course. For more effectiveness, weekend course (2 days) is preferred as it does not obstruct normal working days. The seminar can be conducted in a hotel or resort to attract participants and provide a comfortable accommodation and nice learning environment. Experienced speaker is to be invited to give a clear view and be able to answer participant’s questions.
The drawback of this program is that it needs a lot of money to conduct as to provide a nice location and to invite an experienced speaker. Furthermore, it needs to be organized in a centralized location (as to minimize the cost), so the participants from distant hospital may have some difficulty to come.
Conducting a Hospital Day or Health Fair is one of the ways to inform the public about their rights and safety. It is usually conducted during weekends to attract more people to come. However, the effectiveness of this program relies on the number of people coming, as well as the effectiveness of healthcare personnel in answering public’s concern and questions. Thus, it needs a large coverage of advertisement to inform public about the event, well prepared personnel to answer questions, and the activities must be interactive and fun.
A section in local newspapers can also provide information regarding the subject as well as answering publics’ enquiries. It is similar to publication of pamphlet that can be provided in the waiting area of a hospital. However, it depends on how many people will read the section and pamphlet, and how much they really understand the subject discussed.
Signage in the diagnostic imaging department might be the easiest way of informing healthcare personnel as well as public about the radiation protection. For healthcare personnel, they can be constantly reminded, and patient can also ask for their rights and safety when they see the signage. However, the information inside the signage might be limited and concise.
ASSESSING EFFECTIVENESS
The effectiveness of the program can be assessed by observing the healthcare personnel whether they apply the protection to the patient or not. This can be done by the superior officers, or by asking the patients themselves. As for the public, a survey can be conducted to see whether they have known their rights and safety. If a high percentage of persons surveyed know about the subject, and they can ask about their protection if the healthcare personnel forgot to apply it, then the program has achieved its objectives.
FEEDBACK
However, the feedback of the program is still needed, whether it has achieved its objectives or not. This is to improve the effectiveness of the program and to make future programs more successful. Feedback about the program can be asked directly to the audience after the completion of each program; whether it needs any improvement or lacks any important information. The ways of presenting the subject can also be asked so that in the next session, the subject can be presented in a more clearly way . The number of participants can be measured and improved by the next cycle of the program by better planning and organization.
REFERENCES
1. Radiobiology for Radiologist
2. Standard and Industrial Research Institute of Malaysia, Malaysian Code of Practice for Radiation Protection (1985)
3. International Atomic Energy Agency (IAEA), Safety Report No. 39 on Applying Radiation Safety Standards in Diagnostic Radiology and Interventional Procedures Using X-Rays (2006)
4. http://www.radiationcontrol.utah.gov/XRAY/BERT.htm (22 August 2009)
5. http://www.epa.gov/rpdweb00/understand/health_effects.html#content (22 August 2009)
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