65 / 80
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017
AFRICA
199
In a study by Sadighm
et al
., they found an increased
awareness about radiation among radiology residents compared
to non-radiology residents.
9
Even though we had not quantified
our findings, we interpreted that radiologists were generally more
knowledgeable on the effects of radiation and safety precautions
compared to cardiologists. We postulate that this is because of
the formalisation of radiobiology and radiation physics in their
training curriculum. It is concerning that this discrepancy exists,
as cardiologists are exposed to similar radiation workloads to
radiologists and the dose exposure is likely to increase as the
complexity of cardiology procedures increases.
12
An effective way to improve the knowledge of radiation
safety is to provide opportunities for education and training
in the subject during specialisation. Limacher
et al
. argues that
the best way to ensure adequate training in radiation safety is
to formalise it in the curriculum.
5
Radiobiology and radiation
physics is mandatory for radiologists in South Africa and is a
formal part of their training programme.
11
This is not the case
for cardiologists in South Africa (personal communication).
Szarmach
et al
. state that radiation safety can only be addressed
by educating all healthcare professionals, irrespective of their
position, and that they need to be trained ‘thoroughly and
systematically’.
23
Reinforcing radiation safety messages and
training optimises radiation safety.
24
The Colleges of Medicine curriculum prescribes radiation
physics and radiobiology as learning outcomes for both
radiologists and cardiologists.
11
From the interviews and from
personal discussions with interventionalists involved with
training specialists, it emerged that there was no standardised
teaching of radiation safety at the various training institutions.
Instruction in the topic ranged from in-house teaching, registrars
or clinical fellows attending short courses, or self-learning on the
topic. Uniformity in content and instruction will facilitate that
interventionalists are adequately trained in this area and that
radiation safety is reinforced across South Africa.
1,23,24
It is inconsistent, and hence ineffective, if the leadership of
a clinical unit does not actively promote radiation safety and
training but expects junior staff to adhere to these principles.
25
The attitude of the HOD of a unit is key to developing a culture
of radiation education and training. Radiation safety as a
priority will not permeate the department if those at the helm
are not recognising it as a priority and championing the cause.
The views expressed by South African interventionalists were
corroborated by at least three international interventionalists.
The views of these international doctors are included to illustrate
that the experience and challenges of training cardiologists and
radiologists in radiation safety are not unique to South Africa.
Developing, strengthening and sustaining a radiation
education and training culture in South Africa among
interventionalists will require changes in their formal training
and deliberate inclusion in their CME programmes. Education is
crucial to establishing a radiation safety culture and will require
buy-in at all levels.
Limitations of the study
The participants were purposively sampled and the findings
are not generalisable to the whole population of South African
interventionists. The participants however reflect the population
of interest and the findings may be transferable in similar settings.
The findings highlight that radiation safety is an important
aspect of training and that it is imperative to adequately train
interventionalists in this field. Further research is needed to
better understand this issue and how to incorporate it into
interventionalists’ training programmes.
Conclusion
Radiobiology and radiation physics is formalised in the training
curriculum for radiologists, resulting in greater awareness about
radiation dangers and greater vigilance in radiation safety
practice. There is a paucity of knowledge about radiation safety
practices among cardiologists in South Africa, and cardiologists
need to be empowered to make more informed decisions about
using ionising radiation, in order to protect themselves and their
patients. This can be achieved by including it in their formal
training curriculum and raising the expected outcomes to that
of radiologists.
We thank Dr Asta Rau and André Janse van Rensberg from the Centre for
Health Systems Research and Development (UFS), who read the manuscript
and offered technical insights into the qualitative methodology. The PhD from
which this study emanated was funded by the Medical Research Council of
South Africa under SAMRC Clinician Researcher Programme. AR received
the Discovery Foundation Scholarship, which funded the data collection of
this project. SA Heart (Free State branch) partially funded data collection
for this project. WIDR receives NRF Rated Researcher Incentive Funding.
References
1.
Le Heron J, Padovani R, Smith I, Czarwinski R. Radiation protection
of medical staff.
Eur J Radiol
2010;
76
(1): 20–23.
2.
Bhargavan M. Trends in the utilization of medical procedures that use
ionizing radiation.
Heal Phys
2008;
95
(5): 612–627.
3.
Smilowitz NR, Balter S, Weisz G. Occupational hazards of interven-
tional cardiology.
Cardiovasc Revasc Med
2013;
14
(4): 223–228.
4.
Shore RE, Neriishi K, Nakashima E. Epidemiological studies of cata-
ract risk at low to moderate radiation doses: (not) seeing is believing.
Radiat Res
2010;
174
: 889–894.
5.
Limacher MC, Douglas PS, Germano G, Laskey WK, Lindsay BD,
Mcketty MH,
et al
. Radiation Safety in the practice of cardiology.
J Am
Coll Cardiol
1998;
31
(4): 892–913.
6.
Venneri L, Rossi F, Botto N, Andreassi MG, Salcone N, Emad A,
et al
.
Cancer risk from professional exposure in staff working in cardiac cath-
eterization laboratory: insights from the National Research Council’s
Biological Effects of Ionizing Radiation VII Report.
Am Hear J
2009
Jan;
157
(1): 118–124.
7.
Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A,
et al
.
Occupational health hazards in the interventional laboratory : time for a
safer environment.
Int J Vasc Interv Radiol
2009;
20
(2): 147–153.
8.
Navarro VCC, Navarro MVT, Maia AF. Assessments of medical expo-
sures during interventional radiology procedures.
Radiat Prot Dosim
2013;
154
(2): 229–236.
9.
Sadigh G, Khan R, Kassin MT, Applegate KE. Radiation safety
knowledge and perceptions among residents: A potential improvement
opportunity for graduate medical education in the United States.
Acad
Radiol
2014;
21
(7): 869–878.
10. Cole P, Hallard R, Broughton J, Coates R, Croft J, Davies K,
et al
.
Developing the radiation protection safety culture in the UK.
J Radiol
Prot
2014;
34
: 469–484.