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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017
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AFRICA
A radiologist from New Zealand corroborated this view stating:
‘It is assumed that the doctors understand about radiation,
but this isn’t the case’ (R).
Education and training in radiation safety
There was a distinct difference between cardiologists and
radiologists in their training in radiobiology and radiation
physics. The cardiologists receive very little or no formal training
in these subjects while radiologists have it as part of their core-
training curriculum.
‘I think as postgraduates they [radiology registrars] get
enough training on radiation safety. I would like to see
it [radiation safety] as part of every imaging congress for
the staff because it is often neglected. But if you have an
imaging congress, that must be part of it; to remind all the
people at the congress about radiation protection. I think
that will go a far way already in reminding them about
safety measures and radiation protection. And then in
our normal academic programme to just make sure that it
receives enough attention’ (R).
‘Perhaps [there should be] a short course on the amount
of exposure that there is you get in relation to how much
work you do. You know, a couple of lectures or a lecture on
that. Uhmm and to ... implement that into the [cath] lab. But
that’s what I think should be done; I had no training about
radiation whatsoever, not … in any way’ (AC).
‘Cause they [cardiologists] didn’t do physics, they haven’t
done like physics, like part of our training is physics and [it
is in] the exam, it is not part of their training. I don’t know
if they actually are aware of it [the effects of radiation]’ (R)
reflecting on cardiology training in radiation safety.
‘I think it [radiation physics] should be highlighted as
something [that should] at least be done at the first year’ (R),
in response to training in radiation safety for doctors using
ionising radiation as a modality.
Junior and recently qualified cardiologists expressed
concern that they were using a modality that could have dire
consequences to their long-term health, but were not being
trained in how to safely use radiation.
‘We don’t really have training, it is just like we do self-
study for physics’ (AC) fellow.
The paediatric cardiology heads of departments that participated
in the study unanimously expressed the opinion that it was an
important but neglected aspect of the content of their training
programmes. They generally held the view that more could
and should be done to improve the training and awareness
on the topic. They however expressed the concern that their
departments were not necessarily equipped to do such training
and that other departments such as medical physics should
assist with this training. (After the interview with the PC quoted
below, a question on radiation safety was asked in the CMSA
examinations for paediatric cardiology in April 2016.)
‘I’ve been an examiner in paediatric cardiology for a
while. For over 10 years I haven’t seen a question about it
[radiation safety]. So, it’s not of importance and nobody
discusses it. So, there should be training and it should be in
the curriculum…’ (PC).
‘It [radiation safety] is something that we’ve never
discussed or ever brought up in a meeting until you came
along actually. How do we incorporate that when we train
our fellows? I don’t remember ever been told anything by my
consultants with regards to radiation safety for myself when
I was being trained. Maybe we can add some training because
at the moment there isn’t any. There’s no training!’ (PC).
Adult cardiology heads of department (HOD) were divergent on
their views. They recognised that radiation safety was important
and lacking in their programmes, but did not think that the
current training programme needed re-evaluation. They were
concerned that the volume of work was already too much for
the cardiology fellows.
‘Ja, it’s hard to uhhh, cardiology is vast on its own. Adding
a section on radiation is asking a bit much. But I think
uhhmm, in the syllabus, that we give, you know there is a
syllabus, a cardiologist syllabus for the trainees. Somewhere
in that syllabus it should emphasise the fact or some
knowledge should be given around radiation and the issues
about radiation’ (C) HOD.
Participants reflected that education and training was however
not a once-off exercise and that frequent and constant reinforcing
was needed.
‘I do think education does have a very important role if
one is making people aware. I would hope that you would
then gradually improve their performance in the lab but it is
something I think needs reinforcing regularly because I’ve
seen very experienced operators still behaving badly in the
cath lab. I’ve seen it a huge amount. And so, I think we just
have to keep reinforcing good practice and keep educating
them’ (R) UK.
The role of senior professionals in fostering a
culture of education and training
At one training institution, the head of adult cardiology was very
dismissive of the topic. This HOD was reluctant to participate
in the study, stating that a more junior cardiologist should be
interviewed. Despite explaining the nature of the study and
stating that we were interested in hearing his/her voice as HOD
on training in radiation safety, the HOD was still not interested
in participating in the study. This created the impression that
the HODs of some training units were not interested in the
topic. This dismissive attitude towards radiation safety was also
recognised by other participants in the study:
‘Yes, yes they [heads of departments] are shocking yes. No,
no, no that’s exactly true and that’s certainly true and I can
promise you that is not just in South Africa. That will be all
over ja’ (R) UK.
Discussion
The increasing utilisation of ionising radiation for diagnostic,
therapeutic and interventional procedures necessitates great
vigilance in using the modality. This strengthens the case for
interventionalists to be adequately trained in the use of radiation.
Improving knowledge on the effects of ionising radiation on the
health of patients and operators requires improved access to
training and education on the topic. The literature consistently
cites that formalising radiation safety and training in the
curriculum is essential for improving and maintaining radiation
safety practices for interventionalists.
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