Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

62 / 80

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017 196 AFRICA
Perceptions of radiation safety training among
interventionalists in South Africa
André Rose, William Ian Duncombe Rae
Abstract
Exposure to ionising radiation may have deterministic and
stochastic health effects, which include skin changes, chro-
mosomal aberrations, cataracts and carcinomas. Formalised
training in radiation safety and protection improves knowl-
edge on the subject and facilitates greater compliance in safety
practices. This qualitative study included 54 interventionalists
(adult and paediatric cardiologists, and interventional radiolo-
gists). The participants were purposively selected and inter-
viewed to explore their perceptions about radiation safety. A
thematic analysis of the transcripts was done using a deductive
and inductive approach. Findings showed participating cardi-
ologists had less knowledge about radiation safety than partic-
ipating radiologists. Cardiologists reported little or no formal
training on radiation safety and did not display a culture of
radiation safety. There was no consensus on how the training
gap should be addressed. There is a perceived need to change
and enhance the radiation safety culture among intervention-
ists, and the participants proffered some ideas. These included
the need for re-curricularisation of cardiologists’ training to
create awareness of radiation safety practices.
Keywords: radiation safety training, interventionalists’ training,
radiation awareness, occupational radiation safety, cardiology
training
Submitted 2/11/16, accepted 13/5/17
Published online 23/5/17
Cardiovasc J Afr 2017; 28: 196–200
DOI: 10.5830/CVJA-2017-028
Continuous improvements are taking place in radiological
imaging technology, with an accompaning reduction in radiation
exposures required for imaging.1 There has however also been
an increase in patient load, and fluoroscopic procedures are
becoming more complex and taking longer to perform.2,3 This
consequently increases radiation exposure to operators.
Evidence is mounting that even at low-dose exposure, there
are important biological consequences.4 Ionising radiation can
produce detrimental biological effects, which include acute
and chronic skin effects, chromosomal abnormalities, various
carcinomas and cataracts.5-7 The effects of radiation exposure
may be deterministic or stochastic.8 It is therefore imperative
that health professionals working with ionising radiation are
adequately informed and trained on the dangers associated with
using this modality, so they can protect themselves better. 9
Adequate understanding of the effects of occupational
radiation exposure and vigilant radiation safety practices among
interventionists are essential to protect the health of this group
of healthcare professionals. It is concerning that interventional
cardiologists need to make decisions about radiation use for their
patients and protection for themselves with the level of training
they receive in radiobiology and radiation physics.9 The required
knowledge level may be effectively achieved by incorporating
changes in their training curriculum and in on-going continued
medical education (CME) programmes, as is evidenced by
radiology training programmes.1
Training and formal lectures targeted at developing a culture
of radiation safety are crucial to developing a culture of
radiation safety.10 Radiation physics and radiobiology is part of
the curriculum for radiology registrars in South Africa. They are
examined on these topics in their Part I examination, but have no
subsequent examination on these topics.11
Rehani argues that the intensity of radiation used
by interventional cardiologists is no less than that used by
interventional radiologists and for this reason, the two disciplines
should have similar training in radiobiology and radiation
physics.12 This is however not practical at present in South Africa
and requires an alternative approach to improving radiation
safety knowledge, awareness and practice in non-radiologist
clinicians.12
Interventionalists are highly skilled doctors. In South Africa,
there is a dearth of skilled medical personnel and an even greater
shortage of highly skilled interventionalists. The demand for this
skill is not being met by the output of subspecialists qualifying. 13
It is therefore crucial to protect the health of those already in
service and those who will enter the field. Adequate training
is not just about developing skills acumen, but also instilling
vigilant radiation safety practices, and this can be entrenched
through the formal training curriculum. Influencing changes in
a curriculum is challenged by various factors, such as prevailing
perceptions from the fraternity.
The aim of this article was to report on the perception of
South African interventionalists on radiation education and
safety training.
Methods
This was a qualitative study in which we conducted group and
in-depth interviews. Qualitative research aims to capture the
specific voice of the participants on this topic by producing
rich insights into the experiences, values and understanding of
participants on the matter.14
Department of Community Health, University of the Free
State, Bloemfontein, South Africa
André Rose, MB BCh, MMed,
Department of Medical Physics, University of the Free
State, Bloemfontein, South Africa
William Ian Duncombe Rae, MB BCh, PhD