Multicenter survey on the adherence of operating theater staff to safety means

against ionizing radiation

Summary
The objective of this work was to evaluate the adhesion of the personnel of the operating
room to the means of safety against the ionizing radiations.To meet this objective, we
conducted a multicenter study. The data collection was carried out by a self-administered
questionnaire to the personnel of the operating theaters of three hospitals in
Morocco.disposingan image amplifier. The data collected showed that:78% of personnel
indicate that wearing a personal dosimeter at themoment of the intervention under imagery is
necessary, only 16% of the personnel indicate that theyTHEwear at the time of the
intervention under imaging. No one in our series'declared that'She received monthly and
annual dosimetric measurements. For the use ofmeans of protection,45% of operating theater
staff only use the lead apron during imaging interventions, 25%of the professionalIuse the
distance,And, 6% usedntTHEleaded apron and thyroid cover as a means of protection.
Regarding knowledge of the means that considerably reduces exposure to ionizing radiation,
75% of staff are unaware that distance considerably reduces exposure to ionizing radiation,
33% of staffconsideredthe leaded apron and 42% of the professional have nohaveintno idea.
As for the fundamental principles of radiation protection, only 22% of respondents affirm the
three principles, 17% announce two principles, the majority of which affirm the
optimizationand the rationale. Our worka dawake poor adherence by professionals to the
means of protection against the risks associated with exposure to ionizing radiation in the
operating room,influenced by personal and organizational factors.
Key words : Radiology Intervtional, Block Ooratorical,Risk Radiologic,Radioprotection.
1 Introduction

Medical practices exposing professionals to ionizing radiation,are evolving.

Especially,interventional radiology, which is now a source of indisputable benefits for patients
(Lands, 2018 ; Apple tree, 2017),but recognized as a practice likely to lead to significant
exposure to ionizing radiation for the personnel as well as for the patient (INRS, 2011 ; Amy
Berrington, 2004).

Blthough, the X-rays delivered byIluminance amplifierare conconsidered low doses, with
valuesless than 100 mGy (ICRP, 2021), Andthe link between exposure to low doses of X-rays
and an increased risk of radiation-induced canceris controversial(AndrewWojcik, 2019), this
linkhas been established by several major international institutions and by numerous
international reports or publications(NAP, 2006 ; Brenner, 2003 ; Wall, 2006). In this
direction,the CommissionIinternationalProtection Rradiological(ICRP)esteemhave, for
radiological protection purposes, that knowledge of fundamental cellular processes, coupled
with data concerning the dose-effect relationship, comforthaveent the opinion that in the low
dose range, it is scientifically plausible to assume that the incidence of carcinogenic or
hereditary effects increases in proportion to the increase in the equivalent dose received by the
organs and THE concerned tissues (ICRP, 2007).

The luminance amplifier is used according to various incidences, as well as the technical
acquisition parameters are very varied and the heterogeneous exposure times can range from a
few seconds to several minutes, even a few hours. From there, it seems that the complexity of
the radioguided acts and the duration of exposure to ionizing radiation require a mastery and a
level of training and qualification of the professionals working in the operating room, in
addition to the availability of suitable equipment for protection against radiationionizing.

As a result, the frequencyradiological practices withinn of the operating room Whokeeps

getting stronger requiredstrict compliance with radiation protection. A subject which, par
excellence, is becoming a concern in the world and which we see becoming more and more
common in Morocco.In effect :the use of ionizing radiation in the operating roompar
professionalsnon formed And unskilledin the field of radiation protectiongenerates
theprotection issueprofessionals and patientsagainst the adverse effects of radiation,hence the
need to question theinfluencing factorstheremasteryof these practicesso as not to transform a
real profit inconvenience for the professionaland the patient.
Our present study is part of a general reflection on radiation protection. Shewas carried out,
the main objective of which was to assess adherence to radiation protection means by
personnel working in the operating room, as well as radiation protection practices.The
objective was also to raise the awareness of professionals in the operating theater to the
interest of radiation protection in order to solidify the system of vigilance and protection
against the harmful effects of radiation.ionizing.

Methodology

Type and place of study

The study is quantitative descriptive multi typecentered, aimed at evaluating membership

ofProfessionals working in the operating roomradiation protection means and procedures.
This study took place at three hospitals in Morocco,of whichof the operating theaters had an
image intensifierAndreserved for operations ofTraumatology,ofurology andofneurosurgery.

Population

The study population consisted of professionals, of themedsurgeons andof thenurses. The

exclusion criteria were the person's absence during the survey.

Questionnaire design and data collection

A standardized questionnaire was developed specifically for the needs of the study by a team
composed of a radiologist, a radio physicist, a biophysicienand an epidemiologist.It consisted
of closed multiple-choice questions, formulated around the research question,membership
ofProfessionals working in the operating roomradiation protection means and procedures.A
feasibility study was carried out before the actual submission of the latter to a group of six
people, including three medical specialists and three nurses working in another operating
room. The data was collected during the period from the beginning of Marchto thenice offril
2021.Theyare seizedson the logiciel ExcelAndanalysisesson SPSS software.

Ethical aspects

After having had an authorization by the directors of the health establishments for the
realization of our study at the level of the operating theaters of the three hospitals, the
participants in the study were informed, at the beginning, on the objective of the study and the
methods of data collection so that they can make a free and informed decision to participate.
Theywere also informed of their right not to participate in this research or to withdraw from it
at any time, of the commitment to guarantee the anonymity and confidentiality of the
information collected, and that all the answers obtained are not exploited only within the
framework of our research work.

Results

Of the 79 questionnaires distributed, 67 were completed and collected, representing a

response rate of 85%. Our study population is divided between 32(47.76%)doctors and
33(49.25%)nurses; 29(43.28%)women and 38(56.72%)men, of whom 52.23% and 32.83% of
staff had experience of less than 5 years and between 5 years respectively.yearsAnd 10 years ;
11.94% of participants have been in practice between 10And15 years and only 3% of staff
working in the operating room for more than 15 years.

Re handling theboosterluminance, a rate of 40% of staff oftenaccomplishedntimage

acquisitions under fluoroscopy, same rate (40%)sometimes do themAnd20% don'tsnever do
(Fig. 1).

Tyou go 78% of staff indicate that wearing an individual dosimeter at the time of the
intervention under imaging is necessary (Fig. 2),but only 16% of staff say theyTHEwear at
the time of the intervention under imaging, and84% don't wear themIt isnt not yet (Fig. 3). No
one in our series'said thatShe received monthly dosimetric measurementssand annuals.

Forthe use ofmeans of protection, 45% of operating theater staff only use the leaded apron
during imaging interventions, 25% of staff uuse distance,6% usesntthe leaded apron
andTHEcommon thyroid cachee means of protection, and, 24% of staff do not usentno means
of radiation protection, THE Telescopes, THEscreensAndTHEleaded gloves were not used by
anyone in our series (Fig. 4).

Concerning Iisknowledge about the medium that significantly reduces exposureexposure to

ionizing radiation,75% of staff are unaware that distance significantly reduces exposureion to
ionizing radiation,33% of staff considered the leaded apron and 42%of the professional had
no idea (Fig. 5).As well as,88% among block personneloperativeindicate that the dose
received varies withexposure time and12% indicate that it is not variable.

As for the fundamental principles of radiation protection, only 22% of respondents affirmt the
three principles, 17% announce two principles, the majority of which affirm the
optimizationand justification, the rest 61% of staff confirm a single principle (Fig. 6).

Discussions
During the last years, interventional radiology acts as well as those carried out in the
operating room under radiological guidance with an image intensifier have multiplied.In
parallel, co-ordinated studies on the effects of radiation at low doses have aroused growing
interest and have acquired more and more importance(Burgundian, 2022 ; Jamshidi, 2022).
The results ofthe majority ofisstudiescarried out in this direction convergent to conclude that
sWithout strict compliance with radiation protection rules and procedures, the harmful
radiation-induced effects of ionizing radiation, even at low doses, can be deterministic
effects,essentially cutaneous and ocular; or stochastic, solid cancers or leukaemias.

ReX-ray exposure monitoring means, bwell what,78% of staff indicate that wearing an
individual dosimeter at the time of the intervention under imaging is necessary,only16% of
personnel indicate that they wear personal dosimeters at the time of the intervention under
imaging, wherease 84% do not carrynotfault again non availability of individual dosimeters
for all block personneloperatives. In addition, no one in our series'saidIt isthatShereceived
monthly dosimetric measurements and annual.

With respect to the use ofAVERAGEsprotection, more than halfIt is of operating room staff
only use the leaded apron during imaging interventions, as well asonly6% usesntthe leaded
apron and THEthyroid cache as a means of protection, while, THE Ia nets,
THEscreensAndTHEgaleaded nts were onlynotused by anyone in our series.These results
reveal a low use of the means of protection, for lack of non availablityof these means in
sufficient quantity. However, the availability of means of protection, on its own, is not
sufficient to guarantee that they will be systematically used during exposure to ionizing
radiation. Astudytransverse, performed indifferent health sectors in Saudi Arabia aimed to
assess the radiation protection practices of physiciansusing thex-rays in their practices,
revealedIt iswhatuse of a personal dosimeter has been soreported by 58% of
respondentsAndlack of dose monitoring policiesof radiation in their establishments was
declared by 27% (Alshumrani, 2021). In Turkey, a study a show that the rate of use of
individual dosimeters is 46.8% for nurses in the operating room (Adam, 2015). A survey
carried out in hospitals in the United Kingdom concerning the wearing of thyroid shields in
orthopedics showed that 55% of the hospitals included in the study did not have a thyroid
shield. Also despite their availability in 98 hospitals, these thyroid covers were only worn in
16% of hospitals. (Cope, 2002).

For knowledge about the means that significantly reduces exposure to ionizing radiation, the
results of our study showed a low level of knowledge. ANDn effect,75% of personnel are
unaware that distance considerably reduces exposure to ionizing radiation; 33% of
staffconsideredsay that it isthe apron sealed and almost half (42%) of the professional had no
idea. A study carried out in Tunis showed that only thehalf (54%) ofprofessionalsknew
themeans of personal protection (gown, goggles, gloves and sealed thyroid shield),33% knew
the means of monitoring exposure to X-rays and alone26% knew howto carry (Kamoun,
2014).

As for the fundamental principles of radiation protection, only 22% of respondents affirm the
three principles,And61% announce aonlyprinciple, the majority of which claim optimization
and justification, and ignores the principle of limitationwhich mainly concerns workers. In
general, the studies carried out so far on this subject have revealed a lack of appropriate
training in radiation protection for personnel, as well asForthe patient(Housni, 2022 ; Ben
Hammamia, 2018 ; Harmen, 2018; Akanni, 2011).

This handicapped situation is a responsibility shared between professionals, health

establishments and the national authorities responsiblesof safety andofradiological
monitoring. Indeed, professionals do not make requests to have individual dosimeters and this
reflects their underestimation of radiological risks.s. On the other hand, hospitals do not
occupy their rightful place in terms of staff qualification through regular training.Andris, and
providing services with the appropriate tools and means. In addition, the absence of a
radiation dose monitoring policy in operating theaterssby the national bodies responsible for
safety andofradiological monitoring which must programmIt isrcompanions andregular
inspections in the operating room despite the shortage of personnel.All this within the
framework of a strategy ofprevention, includingobjectivesmainsis ofsensitizedr staff in order
to adopt the behaviorsadequatesbasedon the borememberconvenients,as well as,
ofevaluaterthe level ofcompliance with rules and proceduresradiation protection, It ist
encouragIt isrTHEselfgeantshealth establishmentsIt iss to establish a quality
approachinmaterial of theradiation protection of workers, patients, the public and the
environment.

Conclusion :

Overall ourworka unveilingIt is a weakmembership of professionalsof the operating

roommeans of protection againstare risksrelated to exposure to ionizing radiation
Whos'eexplainfor personal and organizational reasons.
A corrective strategy manifesting itselffirst orderbyIimproveation dscientific knowledgeues of
su professionalsr the risks associated with radiation exposure,based onsetting up
toolseducationalAnd of a certificatewhich should be mandatoryForanyone working in the
operating room. Secondly,the endowmentof the operating roommeans of radiation protection
and dosimetric monitoring is essential. In summerthirdsorder, rhave the regulations at thelight
of the evidence, and increate the national dosimetry registry for workers and patientsin order
to guaranteer a strategyefficient and sustainableprevention andradiation exposure
monitoringsionizing.

Figure 1: Distribution of the target population according to their practice of image acquisition
withc the image intensifier

Figure 2 : Rpopulation distributionaccording to their knowledge of the need to wear a

personal dosimeter at the time ofe the intervention under imagery

Figure 3: Dpopulation splitaccording to the wearing of the personal dosimeter at the momentt
of intervention under fluoroscopy

Figure 4 : Rdistribution of the population according totheirusesmeans of protection

Figure 5 : Level of knowledge about the means significantly reduces exposureion to ionizing
radiation

Figure 6 : RIt ispopulation splitaccording to their knowledgeon theis pprinciples of radiation

protection