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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 30  |  Issue : 2  |  Page : 116-120

Attitude and awareness about radiation protection among dental surgeons in North Karnataka: A questionnaire study


1 Department of Oral Medicine and Radiology, S.B Patil Dental College and Hospital, Bidar, Karnataka, India
2 Consultant Radiologist, Hyderabad, Telangana, India

Date of Submission22-Feb-2017
Date of Acceptance17-Feb-2018
Date of Web Publication16-Jul-2018

Correspondence Address:
Dr. Rajeshwari Javali
Department of Oral Medicine and Radiology, S.B Patil Dental College and Hospital, Naubad, Bidar - 585 402, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_2_17

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   Abstract 


Aim and Objectives: To assess the attitude and awareness about radiation protection among dental surgeons in North Karnataka. Materials and Methods: The study participants comprised 200 dental practitioners (general and specialist) in North Karnataka. The information was collected from each participant through structured questionnaires regarding attitude and awareness towards radiation protection. Pearson correlation coefficient test was used to assess the validity and reliability of questionnaire, and any P ≤ 0.05 was considered as statistically significant. Results: Among 200 dentists, 98.5% of the dentists considered clinical examination of patients before taking radiograph, almost 51% of the dentists explained to the patient about radiation risks/benefits before the radiographic exposure, but 56.5% of the dentists did not take informed consent of the patient before acquiring radiograph. Nearly 81% of the dentists were aware that collimator was used in X-ray unit/machine. Approximately 70.5% of the dentists stood behind the lead shield when they were not using lead apron. Majority of the dentists did not use lead apron and thyroid collars during radiographic examination, and 60% of the dentists got the radiography equipment periodically checked. Conclusion: The current study shows the utmost need for further implementation of radiation protection principles among dental surgeons in North Karnataka. Majority of them did not practice radiation protection procedures. Emphasis on radiation safety, mandatory continuing professional education, and development of radiographic selection criteria is recommended.

Keywords: Awareness, dental surgeons, radiation protection


How to cite this article:
Javali R, Dantu R. Attitude and awareness about radiation protection among dental surgeons in North Karnataka: A questionnaire study. J Indian Acad Oral Med Radiol 2018;30:116-20

How to cite this URL:
Javali R, Dantu R. Attitude and awareness about radiation protection among dental surgeons in North Karnataka: A questionnaire study. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2019 Jul 19];30:116-20. Available from: http://www.jiaomr.in/text.asp?2018/30/2/116/236722




   Introduction Top


Radiation has become a part of modern living, reaching every segment of our society. All individuals are exposed to ionizing radiation, both from natural and man-made radiation sources. Radiation is the transmission of energy through space and matter. There are several forms of radiation, including ionizing and nonionizing. X-rays are ionizing radiation used extensively in medical and dental practice. Even though they provide useful information and aid in diagnosis, they have the potential to cause harmful effects. In dentistry, it is mainly used for diagnostic purposes, and in a dental set-up, usually the practicing dentist exposes, processes, and interprets the radiograph. Even though such exposure is less, it is critical to reduce exposure to the dental personnel and patients to prevent the harmful effects of radiation.[1]

Biological hazards are classified based on occurrence probability into: nonstochastic and stochastic effect. Nonstochastic or deterministic, wherein there is determined dose above which the damaging insults start to appear.[2] The radiographic examination carried out in all fields of medical services and dental services contributes to the promotion of health, both individually and nationally. Radiographic examination plays an essential part of dental practice. Certain amount of radiation is inevitably delivered to the patients, it should be as low as reasonably achievable (ALARA). Dental practice has its own way of radiation exposure. The practicing dentist differs from medical colleagues as he exposes, processes, and interprets the radiograph. Though the exposure is minimal, it is very important to reduce the radiation to avoid the accumulated dose to the dentist in their lifetime. International Commission for Radiation Protection (ICRP) is the regulatory body which lays down norms for radiation protection at the international level. In India, the Atomic Energy Regulatory Board (AERB) provides the norms for radiation protection. AERB recommends norms for permissible doses of radiation from X-ray tubes, the shielding required for the walls of an X-ray tube room, the lead equivalent shielding apparel to be worn by radiation workers, and also lays down safe dose limits for radiation workers and for the general public.

The dentist needs to be aware of radiation protection measures and the radiation dosage received daily to protect themselves and their patients from the harmful effects of radiation. There are about approximately 200 dentists in north Karnataka. Until now, no data is available regarding awareness of radiation hazards and radiation protection practices among dental surgeons in north Karnataka. Therefore, a questionnaire study was designed to gain insight into the knowledge, approach, awareness, and attitude of dentists in north Karnataka towards quality care and radiation protection.


   Materials and Methods Top


A questionnaire study was carried out among 200 dental surgeons in North Karnataka. A specially prepared structured questionnaire was used to assess the attitude and awareness about radiation protection among dental surgeons in North Karnataka. The participants were randomly selected to obtain an even geographical distribution throughout the north part of Karnataka, India. The questionnaires could be returned by mail or in-person. The dentists were informed about the anonymous processing of the questionnaires. A total of 13 questions were included. Statistical analysis was performed using Pearson correlation coefficient test to know the validity of the questionnaire and any P ≤ 0.05 was considered statistically significant.


   Results Top


Of all the 200 dentists enrolled in the study, 98.5% considered clinical examination and patient's history necessary before prescribing dental radiographs [Table 1]. It was observed that 57% of the dental surgeons came across patients who questioned about their personal radiation safety [Table 2]. Almost 51% of the dentists explained to the patient about radiation risks/benefits before the radiographic exposure, ensuring complete understanding of the property of X-rays to the patient [Table 3]. However, majority of the dentists (56.5%) failed to acquire informed consent of the patient before prescribing dental radiograph [Table 4] and [Figure 1].
Table 1: Do you consider clinical examination and patient's history before you prescribe dental radiographs?

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Table 2: Do you come across patients who question about radiation safety?

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Table 3: Do you explain radiation risk/benefit to patients before acquiring radiograph?

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Table 4: Do you take informed consent of the patient before acquiring radiograph?

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Figure 1: Informed consent of the patient before acquiring radiograph

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Approximately half of the dental surgeons (50%) used film holding instrument to stabilize the intraoral image receptor, 29.5% patients used their digits to stabilize, and 17.5% operator themselves stabilized the intraoral image receptors during the radiographic exposure [Table 5] and [Figure 2].
Table 5: How is the image receptor (film/sensor) held in the patient's oral cavity during the exposure?

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Figure 2: Image receptor (film/sensor) held in the patient's oral cavity during the exposure

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It is inferred from this study that approximately 81% of the dentists were aware that collimator was used in X-ray unit/machine, with 43.0% and 38% of the dentists using rectangular collimator and round collimator in the X-ray unit, respectively [Table 6].
Table 6: Are you aware that collimator is used in X-ray unit/machine

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Short cone was preferred by 59% of the dentists while long cone was preferred by 33.5% of the dentists [Table 7].
Table 7: What is the length of the cone (position indicating device) used in your clinic?

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A less percentage of the dentists (33%) used lead aprons and thyroid collars to cover their patients during radiographic examination while 66% did not [Table 8].
Table 8: Do you use lead aprons and thyroid collars to cover your patients during radiographic examination?

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Only 41% of the dentists used lead apron and thyroid collars to protect them during the radiographic examination neglecting their own protection [Table 9] and [Figure 3]. A considerable percentage (70.5) of the dentists stood behind the lead shield [Table 10] when exposing the patient to X-rays and 74% of them stood at a 6-feet distance from the source of X-rays [Table 11]. A majority of the participants (60%) calibrated their X-ray machines every year [Table 12].
Table 9: Do you cover yourself with lead apron and thyroid collars during the radiographic examination?

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Figure 3: Dentists using lead aprons and thyroid collars during the radiographic examination

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Table 10: Do you stand behind the lead shield when not using lead apron?

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Table 11: If not using protective barrier how far do you stand away from the patient during the radiographic examination?

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Table 12: Do you get the radiography equipment periodically checked?

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   Discussion Top


The effect of ionizing radiation on living system is well known and well documented. The biologic interaction between ionizing radiation and living organism leads to changes in the electron level immediately within a fraction of seconds of the exposure and persist for a varied period of time. Thus, the selection of proper diagnostic criteria to deliver the least possible ionizing radiation to the patient and the personnel is indispensable. Practitioners who administer ionizing radiation must be familiar with the magnitude of radiation exposure encountered in dentistry, the possible risk that such exposure entails, and the methods used to reduce doses. This information provides the necessary background for explaining to concerned patients the benefits and possible hazards involved with the use of X-rays.[3]

In our present study, 98.5% of the dentists considered clinical examination and patient's history necessary before acquiring radiograph. Majority of the patients were already aware of the radiation hazards. Hence, 57% of the dentists came across the patients who questioned them about radiation safety.

Approximately 51% of the dentists had no experience explaining radiation risk/benefit to patients. Dentists should explain the treatment plan to the patient. Patients should be informed of possible untoward results of the treatment as they have the right to refuse the proposed intervention. In our study, 56.5% of the dentists did not take informed consent of the patient before acquiring radiograph. Because of the lack of literature regarding the clinical examination of the patient before prescribing radiographs, patients concern about radiation hazard, explaining risk versus benefit, informed consent, comparison with the other study could not be done. Our study is the first to provide data on the above-mentioned questions in North Karnataka population.

Radiographic film (or any image receptor) should not be held in the oral cavity by the patient or the dental professional. In the present study, half of (50%) the dentists used film holder during exposure; however, in studies conducted in Lucknow [4] and Coorg, India,[5] 70.5% and 78% of dentists, respectively, used film holder during exposure. Our study shows 17.5% of the operators themselves stabilized the intraoral image receptor, which is in close agreement with the study conducted in Turkey [6] where 16.8% of the dentists held the image receptors and in Belgium [7] where 8% of the dentists assisted in holding the radiograph in patient's mouth during the exposure. Our study revealed that 29.5% of the patients held the image receptor using their digits during the radiographic exposure accounting for additional exposure of the digits against the rule of ALARA.

The ADA recommends that the tissue area exposed to the primary X-ray beam should not exceed the minimum coverage consistent with meeting diagnostic requirements and clinical feasibility.[3] In our present study, 81% of the dentists were aware that collimator was used in X-ray unit/machine which is similar to the study conducted in Coorg, India [5] (71.9% of the dentists were aware of collimator). Approximately 43% of the dentists reported the use of rectangular collimator in our study. Similar such studies were also conducted in Sweden [8] (36% dentists used rectangular collimator), Coorg, India [5] (6.3% of dentist used rectangular collimator), Belgium,[7] and Turkey [6] where 6% and 5.5% responders used rectangular collimator, respectively. In our present study, 38% of the participants used round collimator which is in contrast to the study conducted by Choudhry et al. where 96% of the dentists used round collimators.

Two standard focal spot-to-film distances (FSFDs) have evolved over the years for use in intraoral radiography, one 20 cm (8 inches) and the other 41 cm (16 inches). Use of FSFD longer distance results in a 32% reduction in exposed tissue volume. This is because at the greater distance, the X-ray beam is less divergent.[3] In our study, short cone was used by 59% of the dental surgeons and long cone was used by 33.5% of the dental surgeons, which is contrast with the results of the study conducted in Turkey [6] where 43.5% dental surgeons used long cone and 18.2% used short cone.

ADA strongly recommends leaded thyroid collars and lead aprons. Although scatter radiation to the patient's abdomen is extremely low, leaded aprons should be used to minimize patient's exposure to radiation. In our study, only 33% of the dental surgeons used lead aprons and thyroid collars to protect their patients during radiographic examination which is similar to the results of the study conducted in Coorg, India [5] with 40% of the dental surgeons wearing lead apron and in Lucknow [4] with 38.6% of dentist using lead apron. Approximately 66% of the dental surgeons did not use lead aprons and thyroid collars which are in agreement with the results of the study conducted by Swarna et al.[9] and Najla et al. who reported that 88% and 46%, respectively, did not wear a lead apron.

In the present study, 41% of the dentists wore lead apron and thyroid collars during the radiographic examination, and about 70.5% of dentists stood behind the lead shield. Similar studies were conducted in Coorg district, Karnataka, India [5] where 43.8% of dentists stood behind lead shield. Another study was carried out in Belgium [7] and Turkey [6] where only 8% and 11.2% of the dentists, respectively, stood behind lead shield contradicting the findings of our study. Education of dentists in this aspect is deemed essential.

If leaving the room or making use of some other barrier is impossible, strict adherence to what has been termed the position-and-distance is required according to which the operator should stand at least 6 feet from the patient, at an angle of 90–135 degrees to the central ray of the X-ray beam.[3] In our study, approximately 74% of the dental surgeons followed this rule to an extent as they stood at a distance of about 6 feet away from the source of the X-rays. The ideal position distance was followed by only 34.4% of dentists in another similar study conducted by Asha et al.[5] and only 28.8% of the general dentists followed the rule correctly in a study conducted in Greater Noida [10] which is not in agreement with the findings of the present study.

The X-ray machine must be controlled periodically for following the set regulations. In our study, approximately 60% of the dental surgeons got their X-ray machines calibrated periodically, which is not in agreement with the findings of study carried out in Turkey [6] and Greater Noida [10] where only 16.7% and 19% of the dentists, respectively, reported that their X-ray units had been serviced routinely.


   Conclusion Top


Though exposure to radiation in dentistry is minimal, it is very important to follow the guidelines to minimize the radiation exposure. A special emphasis was made on personal monitoring as well the operating environment as per NCRP (National council on radiation protection and measurements following International Commission for Radiation Protection (ICRP) guidelines while constructing the radiological unit and monitoring the individual exposure is very useful in radiation protection. The current survey emphasizes on the need for further implementation of radiation protection principles among dental surgeons in north Karnataka. Hence, practitioners should be aware of the possible hazards involved with use of X-rays and should strive hard to implement the various protective measures into practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Praveen BN, Shubhasini AR, Bhanushree R, Sumsum PS, Sushma CN. Radiation in Dental Practice: Awareness, Protection and Recommendations. J Contemp Dent Pract 2013;14:143-8.  Back to cited text no. 1
    
2.
Arnout EA, Jafar A. Awareness of Biological Hazards and Radiation Protection Techniques of Dental Imaging- A Questionnaire Based Cross-Sectional Study among Saudi Dental Students. J Dent Health Oral Disord Ther 2014;1:1-7.  Back to cited text no. 2
    
3.
White and Pharoah. Oral Radiology Principles and Interpretation. 5th ed. Missouri: Elsevier publishers; 2004. pp. 55-65.  Back to cited text no. 3
    
4.
Amanpreet K, Neeta M, Deepak U, Shiva Kumar GC, Singh P. Awareness of radiation protection measures of dental imaging among private dental practitioners in Lucknow city- A questionnaire survey. Int J Maxillofac Imaging 2015;1:1-5.  Back to cited text no. 4
    
5.
Asha, Veena SN, Krupashankar R, Kavitha AP, Shobha R. Jijin MJ, et al. Awareness towards radiation protection measures among dental practitioners in Coorg district: A questionnaire study. Int J Dent Health Sci 2015;2:1460-5.  Back to cited text no. 5
    
6.
Ilgüy D, Ilgüy M, Dinçer S, Bayirli G. Survey of dental radiological practice in Turkey. Dentomaxillofac Radiol 2005;34:222-7.  Back to cited text no. 6
    
7.
Jacobs R, Vanderstappen M, Bogaerts R, Gijbels F. Attitude of the Belgian dentist population towards radiation protection, Dentomaxillofac Radiol 2004;33:334-9.  Back to cited text no. 7
    
8.
Svenson B, Petersson A. Questionnaire survey on the use of dental X-ray film and equipment among general practitioners in the Swedish Public Dental Health Service. Acta Odontol. Scand 1995;53:230-5.  Back to cited text no. 8
    
9.
Swarna YM, Devarasan GM, Rajeshwari A, Dheeraj K. J Oral Maxillofac Radiol 2013;1:3.  Back to cited text no. 9
    
10.
Chaudhry M, Jayaprakash K, Shivalingesh KK, Agarwal V, Gupta B, Anand R, et al. Oral Radiology Safety Standards Adopted by the General Dentists Practicing in National Capital Region (NCR). JCDR 2016;10:42-5.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]



 

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