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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 5
| Issue : 1 | Page : 16-21 |
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Awareness and knowledge of radiation in common radiological investigation and associated risks among medical students in Saudi Arabia: A cross-sectional study
Sultan T Alturki1, Malek Khalid Albusair2, Khalid M Aljalajel2, Abdulelah S Alshahrani2, Mohammed S Albadrani2, Arwa A Alhuwaymil3, Abdulrahim S Almotairy4
1 Medical Imaging Department, King Fahad Medical City, Riyadh, Saudi Arabia
2 College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
3 College of Medicine, Almaarfa University, Riyadh, Saudi Arabia
4 Medical Imaging Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| Date of Submission | 21-Nov-2019 |
| Date of Acceptance | 30-Nov-2019 |
| Date of Web Publication | 30-Dec-2019 |
Correspondence Address:
Dr. Malek Khalid Albusair
College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijas.ijas_31_19
Background: According to previous similar studies, health-care professionals have limited knowledge about radiation doses, and their related risks with medical imaging examinations are deficient. With a proper level of knowledge, future doctors can play a significant role in attributing to patient safety regarding ionizing radiation.
Objective: The objective of the study was to estimate and establish a national parameter of awareness and knowledge regarding ionizing radiation doses and its accompanying adverse effects among medical students in Saudi Arabia.
Participants and Methods: This cross-sectional study was done during the academic year 2018–2019. An online survey was distributed to collect the needed data. Students were asked to estimate the most commonly used radiological studies' radiation doses to see if students are aware that the magnetic resonance imaging and ultrasound are nonionizing imaging studies.
Results: A total of 518 students responded, the mean ± standard deviation (SD) age of studied students was 22.64 ± 1.92, 62.5% were males, and 40% of studied students were 5th-year medical students. About 5.3% of the students were very confident in their knowledge of the ionizing radiation dose, 27.2% were moderately confident, 36.5% not really confident, and 21% do not know. Most of the students, 49.6%, do not know exactly the risk of inducing fatal cancer from an abdominal computed tomography scan. About 63.7% of the students said that children are the most sensitive group to radiation. The total knowledge mean score was 2.25 (SD: ±1.97, median: 2, range: 0–8). We found a significant correlation between the total knowledge score and age, sex, university, and academic year, all with P = 0.001.
Conclusion: The assessment of students' awareness of ionizing radiation exposures in diagnostic imaging demonstrates that there is a low level of confidence in the knowledge of the ionizing radiation dose and low total knowledge mean score; this advocates introducing the radiation protection instruction into the undergraduate medical curriculum.
Keywords: Associated risks, knowledge score, medical students, radiation protection
How to cite this article:
Alturki ST, Albusair MK, Aljalajel KM, Alshahrani AS, Albadrani MS, Alhuwaymil AA, Almotairy AS. Awareness and knowledge of radiation in common radiological investigation and associated risks among medical students in Saudi Arabia: A cross-sectional study. Imam J Appl Sci 2020;5:16-21 |
How to cite this URL:
Alturki ST, Albusair MK, Aljalajel KM, Alshahrani AS, Albadrani MS, Alhuwaymil AA, Almotairy AS. Awareness and knowledge of radiation in common radiological investigation and associated risks among medical students in Saudi Arabia: A cross-sectional study. Imam J Appl Sci [serial online] 2020 [cited 2023 May 28];5:16-21. Available from: https://www.e-ijas.org/text.asp?2020/5/1/16/274296 |
| Introduction | |  |
Recently, the number of radiological investigations were rapidly increasing in parallel with improvements in medical technology.[1] There have been raising interest in physician knowledge of medical radiation. Regardless, it seems physicians consistently underestimate doses.[2] Recently, efforts by both vendors and societies were carried out to reduce radiation doses and sensitize users and patients to the issues of radiological protection.[3]
In the past decade, various studies have investigated physicians from varying specialties and backgrounds on their knowledge regarding ionizing radiation dose and associated risks, and most studies have demonstrated disappointing results.[4],[5] Although researches regarding medical students' knowledge of ionizing radiation have been previously studied, the specific area of awareness among medical students regarding radiation doses related to different diagnostic imaging modalities and cancer risk associated with such an exposure has been minimally investigated.[6]
A review of previously published studies showed that health-care professionals have inadequate knowledge regarding radiation doses and associated risks with medical imaging examinations, with health-care professionals having various levels of knowledge about ionizing radiation doses of various imaging procedures and its associative risks, but generally, the overall awareness level is low.[7]
With a proper level of knowledge, future doctors can play a significant role in attributing to patient safety regarding ionizing radiation. Therefore, we aim in this study to assess knowledge and awareness regarding ionizing radiation in medical students throughout Saudi Arabia.
However, the primary objective of this study is to estimate and establish a national parameter of awareness and knowledge regarding ionizing radiation doses and its accompanying adverse effects among medical students in Saudi Arabia.
| Participants and Methods | | |
This is a cross-sectional descriptive study conducted during the academic year 2018–2019. An online survey was distributed to collect data to address the knowledge and awareness of ionizing radiation levels and related risks among medical students in Saudi Arabia and the level of confidence regarding their knowledge toward ionizing radiation and its related doses and adverse effect.
Our survey consists of questions regarding radiation dosage and the hazards associated with it. Assuming a single chest X-ray is equivalent to one unit of radiation, students were asked to estimate the most commonly used radiological studies' radiation doses to see if students are aware that the magnetic resonance imaging (MRI) and ultrasound are nonionizing imaging studies.
All questions were multiple-choice question questions with number of choices ranging from four to six, including a “do not know” response, only one option was considered the correct answer.
In the process of analyzing answers, only the correct answers were rewarded one point. However, the responses were graded out of nine, which represents a significant knowledge regarding ionizing radiation.
In addition, the survey addressed a question that if the students have taken any lectures regarding ionizing radiation as part of their curriculum. In addition, the survey had a question regarding taken a clinical rotation in radiology either intra-curriculum or electively. The survey also included demographic oriented questions such as age, gender, university, and in which university year they are.
Statistical analysis
Data were analyzed utilizing SPSS software Statistics (release 20.0, Armonk, NY, USA: IBM Corp) for Windows v.20.
Quantitative data were expressed as means ± standard deviation (SD), median, and range. Qualitative data were represented as numbers and percentages. The data were tested for normality with the use of the Shapiro–Wilk test. The nonparametric Mann–Whitney test, Kruskal–Wallis test, and Spearman's correlation were used for data that were not normally distributed. A 5% level was chosen as a level of significance in all statistical tests used in the study.
| Results | | |
A total of 518 students responded, the mean ± SD age of studied students was 22.64 ± 1.92, 62.5% were males, 41.7% from King Saud University (KSU), and 40% of studied students were 5th year medical students [Table 1]. About 50.7% of the participants do not know what is the approximate radiation dose, in mSv, of a posteroanterior chest X-ray, 15.3% of students were very confident in their knowledge of the ionizing radiation dose, 27.2% were moderately confident, 36.5% not really confident, and 21% do not know. Most of the students, 49.6%, do not know exactly the risk of inducing fatal cancer from an abdominal computed tomography (CT) scan. About 63.7% of the students said that children are the most sensitive group to radiation [Table 2]. The total knowledge mean score was 2.25 (SD: ±1.97, median: 2, and range 0–8) [Table 3]. Regarding the relation between total knowledge score and sociodemographic variables, it is clear that the highest mean score (2.94 ± 2.13) was reported by KSU students and by the 5th year students (2.96 ± 2.08) [Table 4]. We found a significant relation between the total knowledge score and age, sex, university, and academic year all with P = 0.001 [Table 5]. | Table 1: Distribution of the studied patients by sociodemographic (n=518)
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 | Table 2: Distribution of the studied patients by the knowledge of radiation in common radiological investigation (n=518)
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 | Table 4: The relation between total knowledge score and sociodemographic variables
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| Discussion | | |
Radiology plays a significant role in modern medicine. Many of the diagnostic and interventional radiology procedures involve exposure to ionizing radiation. Although overall the benefits of imaging outweigh the associated risks of radiation, there is a growing concern over the adverse biological effects of ionizing radiation on living organisms. Radiation is considered to have dose-dependent adverse effects on the human body, in particular, increasing the risk of cancer. A review of previously published studies showed that health-care professionals have inadequate knowledge regarding radiation doses and associated risks with medical imaging examinations.[8],[9] Many studies have also revealed that medical students have a poor knowledge of radiation dose and its associated risks.[10],[11] This is a cross-sectional study conducted among 518 of medical students in Saudi Arabia. We aim in this study to assess knowledge and awareness regarding ionizing radiation in medical students throughout Saudi Arabia. Our study reported that the total knowledge mean score was 2.25 (SD ± 1.97, median: 2, and range: 0–8), 15.3% of the students were very confident in their knowledge of the ionizing radiation dose, 27.2% were moderately confident, 36.5% not really confident, and 21% do not know. In Riyadh, a cohort study was conducted on medical students at Almaarefa Colleges, Kingdom of Saudi Arabia, and reported that the average student score of knowledge of ionizing radiation improved from 47% to 78%, representing a gain of 31% in knowledge (P = 0.01); this results demonstrated that medical students were deficient regarding their knowledge toward ionizing radiation, diagnostic imaging, and radiation safety.[12]
In Norway, a descriptive study conducted among 99 undergraduate medical students reported that students demonstrated low levels of knowledge, as mean score of 3.91 out of 11.00, 54 students representing 55% of the sample reported that they have an excellent confidence regarding their knowledge and awareness in radiation dose; 45 students (45%) said that they were not really confident or that they “do not know” and (96%) reported that the knowledge of radiation dose and its associated risks are very important or moderately important.[13] In relation to confidence in knowledge, the previously mentioned study found that students who reported being moderately confident in their knowledge of radiation had significantly higher scores (mean = 4.37, median = 4.00, and SD = 1.57) in comparison with those who reported being unconfident regarding their awareness regarding the subject “(mean score = 3.36), (median = 4), (SD = 1.71, P =. 003).”[13] Another study conducted among 4th–6th year medical students at a Western Australian university reported that the mean score on a knowledge test was 6.0 out of a possible maximum of 19; 23.0% of the medical students thought that they were at least moderately confident in their knowledge of ionizing radiation doses, while 11.2% believed that the knowledge of radiation was either “not really important” or “not important all.”[10] Another study carried out among 192 4th year medical students at the Vancouver-Fraser campus of the University of British Columbia reported that the mean overall score of knowledge of the radiation was 5.96 out of a possible 11, most students (92%) responded that knowledge of the radiation dose of imaging examinations is somewhat essential, 62% reported feeling not very confident or not at all confident, while 38% reported feeling very or somewhat confident in their knowledge of radiation.[14] Another study conducted among 159 young doctors and students (including 60 radiology residents, 56 medical students, and 43 radiography students). Medical students stated that they have a good knowledge in regard of radiation protection issues more than medical imaging residents and radiology students with values of (94.4% vs. 55%) and a value of (35.7%, respectively; P < 0.05). The scores related to the knowledge about radiation doses of radiological procedures were lower, with a score of 4.5 out of 9 for both radiology residents and radiography students and 3.7 out of 9 for medical students, respectively.[15] Zhou et al. found that the awareness of ionizing radiation from diagnostic imaging was deficient among senior medical students and interns, with high as 11.3%, and 25.5% of respondents believed that US and MRI examinations involve the use of ionizing radiation, respectively.[10]
Regarding knowledge of risks associated with radiation dose, in our study, most of the students (49.6%) do not know exactly the risk of inducing fatal cancer from an abdominal CT scan. Another study reported that only 12% of the students correctly responded that there was a risk of fatal cancer for CT abdomen examinations.[13] Another study found that 44% of the participant students correctly identified the risk of inducing fatal cancer from an abdominal CT in an adult.[14] Berrington et al. have reported that in the United States, roughly 29,000 cancers-related cases emerged as a direct result of CT scans examinations back in 2007,[15] with children being more prone to develop malignancies as a consequence of diagnostic imaging that uses ionizing radiation.[9]
Our study reported that 63.7% of the students said that children are the most sensitive group to radiation. Another study reported that 94% of the students correctly identified children as the group most susceptible to the risks associated with radiation dose.[13] However, another study found that all respondents recognized children as the population most sensitive to the effects of radiation; only 24% (N = 15) correctly identified gonads as the most radiation-sensitive tissue.[14] Another study reported over 80% of the study group correctly answered that children were more sensitive to the effects of ionizing radiation than adolescents, adults, or the elderly.[9]
| Conclusion and Recommendations | | |
The assessment of students' awareness of radiation exposure in diagnostic imaging demonstrates the low-level confidence regarding their knowledge toward ionizing radiation dose and low total knowledge mean score; this advocates introducing the radiation protection instruction into the undergraduate medical curriculum.
Financial support and sponsorship
Self.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 11. | Dellie ST, Admassie D, Ewnetu Y. An assessment of final-year medical students and interns awareness of radiation exposure to common diagnostic imaging procedures. Adv Radiol 2014;2014:7. [Doi: 10.1155/2014/426909]. |
| 12. | Rahmatullah TA, Abo Alela KA, Alanazi KS. Medical students knowledge of ionizing radiation and radiation protection in Riyadh Saudi Arabia. Egypt J Hosp Med 2018;70:205-9. [Doi: 10.12816/0043077]. |
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| 14. | Scali E, Mayo J, Nicolaou S, Kozoriz M, Chang S. Senior medical students' awareness of radiation risks from common diagnostic imaging examinations. Can Med Educ J 2017;8:e31-41. |
| 15. | Berrington de González A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009;169:2071-7. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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