This paper aims to evaluate the existing knowledge and attitudes of radiographers in Australia and Saudi Arabia regarding the Computed Tomography dose for pediatric patients. This research mainly digresses to answer the question, what are the current knowledge and attitudes of the radiographers toward CT dose in pediatric imaging? This research used mixed methodologies in order to gain an in-depth investigation of the variables explored in this research. The researchers designed a quantitative survey and qualitative interview in order to describe the current knowledge and attitudes of radiographers regarding the topic of research.
Furthermore, the researchers performed an interview among a subset of participants in the research using an interview tool. Description of Participants Population Distribution. The participants for this study came from two countries, namely, Kingdom of Saudi Arabia and Australia. The participants came from distributed locations in the two countries. They came from a total of 8 hospitals in Saudi Arabia and 7 hospitals in Australia. The total number of radiographers from Saudi Arabia is 71; and fifty-six or 74 per cent of them were included in the study.
In Australia, the total number of radiographers is 83; and fifty or 60% of them were included in the study. The difference in the number of samples taken from each country is not statistically significant. This indicates that the researcher was able to maintain population equivalence in terms of sample population number for this study. This is important because a significantly different sample number provides room for doubting the validity and reliability of the study (Boswell & Cannon, 2007). Sample Population Age. The age bracket of the majority of radiographers comes from 20-29 years old in both Australian and Saudi Arabian radiographers.
There are also a number of participants from other age groups in 31-40 years old and above 40 years old. This indicates that all age groups are represented in the sample population with majority of the participants coming from the youngest age bracket. Also, this shows that there is an equal age distribution among participants for both countries even though there are more participants aged 40+ years old participants in Australia than in Saudi Arabia. Sample Population Gender. Equal gender distribution was observed in Saudi Arabia while female participants were 1.
7 times greater than males in Australia. Statistically, there was no significant difference (p = 0. 17) in gender distribution in Australian and Saudi Arabian radiographers. No studies were found to describe the impact of gender on survey outcomes. Our survey was intended to assess the knowledge and attitude of participants performing pediatric CT procedures. We assume that gender will have little or no impact on the outcome of this survey. Qualifications. In terms of objectifying the knowledge of radiographers, we asked the entry level of participants in taking the job position as radiographers.
It was found that the time taken for the young radiographers to come into workforce in Saudi Arabia would be shorter since majority (? 50%) of them hold diploma as their basic medical imaging qualification compared to degree (69%) as basic qualification in Australia. The distribution of the qualifications of the participants (figure 4. 2) demonstrates the early entry in workforce of Saudi Arabian participants with just adequate knowledge to perform the task but may not be able to analyze or intervene the critical implications of CT radiation on pediatric patients.
The significant difference in this characteristic of participants in the two countries can be inferred to have a similar significant difference in the existing knowledge and attitudes of radiographers from the two countries. Work Experience. Among the participants from Australia, majority have a working experience of 1-5 years. On the other hand, majority of the participants from Saudi Arabia have a working experience of 1-5 years (38. 8%) and 6-10 years (30. 6%). This tells us that Saudi Arabia have more senior working radiographers than Australia.
This can be attributed to the fact that Saudi Arabian radiographers have earlier entry to the workforce than the Australian radiographers who need to finish and earn a degree first before they can work. In line with this, Saudi Arabian radiographers have more experience in terms of working with CT scans hence, it can be inferred that the length of their experience may have an effect on their existing knowledge and attitudes toward work. Factors that may affect existing knowledge Knowledge of individuals can be influenced by a number of factors.
Knowledge can be related to educational background, length of work experiences, and involvement in discussions and education regarding the most current evidence-based researches and protocols. Educational Background. Educational background gives a person the foundational knowledge and basic concepts and skills to perform ones’ roles and responsibilities. Deducing from Dreyfus’ model of skill acquisition, this can be identified as the novice (Eraut, 1994). The novice does not have any clinical experience in terms of handling the equipments in the hospital, etc.
Nevertheless, the person is equipped with the theoretical knowledge and rules to follow for work implementation. On this note, the educational background of the participants in this study is determined by their qualification for entry to work as radiographers. Referring to the previous discussion on qualifications, Australian radiographers need a degree while Saudi Arabian radiographers need a diploma to work as radiographers. Latter in the discussion, we will discuss if this factor has a possible relation to the existing knowledge of the participants. Length of Work Experience.
Through work experience, the individual possesses a more holistic approach in dealing with situations. The novice will move from a level of rigid theoretical application to an application of abstract principles gained from lived experience, hence becoming more knowledgeable and competent (Eraut, 1994). In line with this, it can be seen that more radiographers from Saudi Arabia have longer working experiences than radiographers from Australia. This gives us the idea that since radiographers from Australia have longer education and later entry than radiographers from Saudi Arabia, they have shorter work experiences.
We can make this comparison because our baseline age bracket for majority of them is 20-29 years old, which is the age bracket for individuals who are fresh graduates and beginning workers. We will discuss later the possible relation of length of work experience on the existing knowledge of the participants. Continuing Education. Continuing education is a way to refresh and update knowledge of workers, in this case the radiographers, to continue being effective and competent professionals (Muhogora et al. , 2003).
Radiographers can be involved in continuing education by being updated with the present and existing protocols for CT scan dosage and imaging procedures that are implemented in their respective hospitals. They can keep up by being actively involved in the development of protocols. This is the best way to be knowledgeable and in sync with the details and requirements of implemented policies. Moreover, this also increases the likelihood of strict implementation of policies because they are firsthand involved in the policy-making.
Else, radiographers should at least be informed regarding updates through announcements that there are changes in existing protocols. For widespread dissemination, workshop trainings and seminars are often used to communicate recent updates and to solicit support and advocacy from radiographers themselves. If not, we take the risk of poor participation because the key stakeholders for information and implementation are not fully involved and directly tapped in the activity.
Frequency of CT protocols update. Majority of the respondents (55. 1%) from Australia stated that CT scan protocols are updated anytime. This indicates a possible flexibility in the governing body that proposes, discusses, and implements changes in the policies. This is a good point in the revelation that policies can be changed anytime. A loophole in this statement is that we may ask what if the lack of a fixed schedule or time frame for evaluating and re-evaluating protocols may result in dormancy.
However, note that the next frequent answer is monthly update in protocols for Australian radiographers. This gives us the idea that there is a frequent updating of protocols in Australia that radiographers need to keep up with in order to keep their knowledge updated. On a different note, this also tells us that there is a possible chance of increased problems in terms of implementation of policy because radiographers may not be able to familiarize themselves with implemented policies if changes are too frequent. On the other hand, radiographers (33.
9%) from Saudi Arabia state that their CT protocols are updated every year. This time frame is less frequent in comparison to that of Australian CT scan protocol update. This gives us the idea that Saudi Arabian radiographers are given ample time to understand and implement correctly the changes made in the policies. There is also a greater reference time from which changes are based on- that is one year of implementation of existing policies. In line with this, Moss and McLean (2006) stressed the importance of protocol reviews.
Protocol reviews are meant to evaluate if existing policies aid in reaching the desired outcomes which is to decrease the radiation exposure of pediatric patients and limit it to a reasonably achievable dose. Hence, updating protocols is a very important step in ensuring the adherence of radiographers to existing rules. It also gives the health care system a feedback on how policies can further be improved based on current evaluation and health care outcomes. Involvement in CT scan protocol discussions.
For both Australian and Saudi Arabian radiographers, survey showed that involvement of radiographers in the discussions of CT scan protocols is very unusual. This means that the group of radiographers is not represented during policy-making. This finding tells us that the people who are in direct handling of CT scan imaging equipment and directly responsible for delivering CT doses are not consulted during making of such important policies related to the current health concern. Evidence-based CT scan protocols.
Majority of the participants from Saudi Arabia and Australia agree that CT scan protocols implemented in their hospitals are evidence-based. This tells us that if implementation of these are fully understood and complied accordingly by radiographers, then CT practice is geared toward evidence-based practice. However, as discussed in the literature review, Soye and Paterson discussed that there are several gaps in the translation of evidence-based protocols and actual practice of radiographers. However, these can be addressed through trainings and workshops regarding the topic.
Policies on explaining CT radiation impact on pediatric patient. Survey results revealed that Saudi Arabian radiographers ensure that the caregiver understands the impact of CT radiation on the patient, while Australian radiographers lack in policies that will guide them in explaining and making parents and caregivers of pediatric patients understand the impact of radiation. This tells us that the adequacy of policies regarding CT radiation is very important. Without existing policies to address this concern, radiographers will not be guided in their practice of CT scan imaging of pediatric patients.
In line with this, discussion in the literature review tells us that even physicians lack adequate knowledge regarding dosages of common diagnostic procedures. In this inadequacy, Seeram (2009) discusses that radiographers are expected to fill in the gap of ensuring that proper dosages of radiation are given in case doctors are not able to fulfill this role. Similarly, existing literature tells us that dose awareness is low among professionals. This finding is similar to the survey results among radiographers from Australia.
This finding suggests that there is a need to further empower the radiographers in the field of CT dosage through improving policies on this topic as well. In line with this, Mettler emphasized that basic education only provides as so far as theoretical knowledge and fundamental concepts. However, pediatric doses in radiation exposure are not well discussed during undergraduate studies because these issues are better tackled during the professional years. In this situation, policies serve as a theoretical leverage for professional radiographers to ensure their safe practice and quality service to pediatric patients.
Existing Knowledge Explanation of radiation doses. In both countries, participants agreed that they explain radiation doses to parents or caregivers of pediatric patients. This tells us that there is an existing proactive effort from radiographers regarding the need to explain radiation doses to the child’s significant others. Henwood (2003) discusses that some of the activities of radiographers are not holistic in relation to CT radiation doses and measures to ensure decreased exposure among pediatric patients.
Thus, it is not enough that radiographers explain the radiation dose to caregivers. What is more important is their understanding of the topic itself and the significance of explaining these to parents. This understanding can be seen in their effort to ensure that parents themselves understand the concept of radiation dosage. This leads us to their perception of how parents are able to understand the concept of radiation dosage and the risks these bring to a pediatric patient. Informing parents regarding CT imaging risk among pediatric patients.
Based on the results of the survey, more radiographers in Saudi Arabia inform the parents regarding the risk involved during CT imaging brought about by radiation exposure of pediatric patients. This finding can be related to the fact that there are more policies that guide the practice of radiographers in Saudi Arabia; hence, there more radiographers who explain and inform parents regarding the risks of CT imaging. This tells us that policies are indeed important in the knowledge formation and consequent practice of radiographers regarding CT imaging.
Aside from this, Jacob, Vivian, and Steel (2004) revealed that there are few radiologists and radiographers who are knowledgeable regarding the risks of CT imaging as concluded from the results of the study they conducted in UK. As Muhogora (2006) emphasized, training and establishment of protocols are important in knowledge formation. This tells us that the lack of training and established protocols in Australia in comparison to Saudi Arabia also resulted in the lower rates of radiographers who explain the risks of pediatric CT imaging among parents or caregivers.
Understanding of radiation risk. Majority of the respondents from Australia believe that only less than 20% of parents understand their explanation of radiation risks. On the other hand, respondents from Saudi Arabia believe a better understanding formed in the parents when given explanations regarding radiation risk. Almost the same percentages of respondents believe that 21-40% and 41-60% of parents understand the risks of radiation exposure.
These figures can possibly reflect the understanding of Australian and Saudi Arabian radiographers as well. It can be assumed that when an individual is able to grasp fully the concepts and details of a certain topic, then he will be able to relay the information fully to another person. Moreover, he will be able to device a method that will help the other person to understand his or her explanation. In line with this, Australian radiographers have less number of participants who inform parents regarding radiation risks.
It follows that they also have a lesser understanding of radiation risks because they are not able to make other people understand the concepts in comparison to radiographers from Saudi Arabia. Participants from Saudi Arabia have more participants who inform parents regarding radiation risks possibly because they have greater understanding of the concept. This finding is similar to the survey conducted by Bulas, Goske, Applegate, & Wood (2009) in which it was found that there is low understanding of radiation risks among professionals.
This shows that even professionals, especially radiographers, who are supposedly knowledgeable regarding the risks associated with CT imaging are no more knowledgeable than lay people. Thus, we expect that they will also not be able to communicate understanding of radiation risks to the parents or caregivers through the information they give. Radiation doses. Estimates for radiation dosage during CT imaging are very important. The results of the survey showed that respondents from Australia perceive radiation dose as lower for the head, chest, and abdomen in comparison to the respondents from Saudi Arabia.
Furthermore, Australian and Saudi Arabian radiographers scored radiation dosage for head and chest as similarly high while radiation dosage for abdomen is lower for Australians. This tells us that there is an increased risk for radiation exposure among patients in Saudi Arabia because they perceive radiation doses as higher. In line with this, the Australian Institute of Radiography advocates for the welfare and safety among patients (2003). This is manifested in the presence of perceived low dosage of radiation exposure for pediatric patients among Australian radiographers.
This means that there is a nationwide implementation of this advocacy framework that despite the lack in number of policies that support explanation and other pertinent information regarding radiation risks, Australia pushed for the key or core aspect of minimizing radiation exposure- that is reducing the radiation dosage itself during implementation. In line with this, the absence of a nationwide or widely accepted code of ethics for practice regarding radiation dosage in Saudi Arabia may have resulted in the perceived high radiation dosage for patients.
This tells us that the policies are specific to certain hospitals only and there is no implementation yet of a policy that involves reduction of radiation dosage itself in addressing the concern of radiation risk among pediatric patients. Dose intervention and frequency of intervention for pediatric CT. Survey results showed that a significant difference in which more radiographers (95. 7%) from Australia participate in dose intervention as compared to radiographers from Saudi Arabia (72. 7%).
Referring to our previous discussion regarding radiation doses, there is a higher dosage perception among Saudi Arabian radiographers than Australians. This means that there should have been more dose interventions for CT in Saudi Arabia because supposedly they encounter higher radiation doses prescribed for pediatric patients. This finding is similar to the results of Soye and Paterson in which radiographers often overlook pediatric radiation doses. This results in the lack of intervention to change or lower the dose for this population who are at a vulnerable age and at increased risk for radiation exposure.
Similarly, Lee et al. (2004) reveals that radiologists are not able to accurately estimate radiation doses even though they have been professionals for a long time. This is congruent with the results that length of experience does not determine expertise and knowledge regarding the radiation risks. Referring to our previous discussion regarding the length of work experience, Saudi Arabian radiographers have longer work experiences than Australians. However, the results of this study showed that the length of work experience does not necessarily result in a stronger knowledge base.
This finding is similar to the results of the study conducted by Shiralkar et al. (2003) in which seniority is inversely proportional to knowledge. This tells us that continuing education is still the key to a stronger knowledge base among professionals as suggested by authors (Muhogora et al,, 2003). Frequency of dose intervention. Majority of Australian radiographers (81. 8%) intervene with radiation dose ‘everytime’ in comparison to the Saudi Arabians. This can be attributed to the fact that there are no existing policies on reducing radiation dosage in Saudi Arabia.
The focus of their policies is awareness regarding radiation risks but there are no proactive efforts yet to reduce actual radiation dosages. Thus, even when radiographers from Saudi Arabia see higher dose range, they do not have the ability and knowledge to reduce the dosage because they do not have adequate knowledge regarding this. This finding may seem conflicting with the previous discussion. However, a critical analysis of this tells us that the cause for this inadequacy among Saudi Arabian radiographers is the gap between evidence-based protocols and its translation into actual practice.
This result is similar with that of Soye and Paterson’s findings. Risk for cancer as a result of CT scan. Results showed a significant difference in the perceived risk or danger for cancer between the two groups in which more Australian radiographers (93%) believe that cancer is a health risk of CT imaging in comparison to those who share the same opinion among Saudi Arabian radiographers (78%). This finding is higher in comparison to the results of the study conducted by different authors (Lee et al. , 2004; Heyer et al.
, 2009; Thomas et al. , 2006) in which all the studies showed that a very low percentage of physicians have knowledge of the ALARA principle in CT imaging. This finding tells us that radiographers are more knowledgeable than physicians in terms of radiation dosages. Hence, they need to be equipped with the most current knowledge regarding delivering the lowest radiation amount that will deliver correct images during CT procedures. This is needed to fill in the gap of inadequate knowledge among doctors. Rate of understanding risk of cancer.
Accordingly, more Australian radiographers perceive a greater level of knowledge than Saudi Arabian radiographers. Again, this shows us conflicting findings in which there are more Saudi Arabians who are able to inform parents and caregivers regarding radiation risks but they have a lower rate of perceived risk for cancer. This suggests that Saudi Arabian radiographers only explain radiation risks to parents or caregivers as part of the policies implemented in their hospital, but they do not fully understand this concept.
This finding is similar to the results of the study conducted by Bulas et al. (2009) in which a lack of understanding of radiation risks is present among health professionals. This all boils down to a holistic approach in the reduction of radiation exposure in which a full understanding of radiation risk will lead to enhanced optimization strategies (IAEA, 1996). Still, the best way to minimize radiation exposure is to train individuals toward a continuing education approach as suggested by Muhogora et al. and other authors. Justified pediatric CT scans.
Majority (48%) of Australian radiographers believe that 61-80% of their CT scan requests for pediatrics are justified in comparison to that of Saudi Arabians. This suggests the Saudi Arabians believe that most of their requests for CT pediatric imaging are not justified. In relation to the previous discussion on dose intervention, this tells us that Saudi Arabians indeed recognize the inappropriateness of radiation dosage for pediatric patients but they do not act on this. This resulted in their lower rate of dose intervention compared to Australians.
Frequency of participation in trainings and education. Both groups indicated that workshops and seminars are the most frequent method of training. Self study is not considered as a contributing factor to education. This result is congruent with Scutter and Halketts’s findings in which self-directed studies and updates through journals are not done by radiographers on their own (2003). Moreover, Australian radiographers participate in training and education more frequently than Saudi Arabian respondents.
The difference in this data is significant and this finding can be well related to the existing knowledge of radiographers in both countries. As all studies in the literature review suggested, trainings and establishment of protocols are core components in improving the knowledge base of radiographers. First, the adequacy of policies regarding informing parents regarding radiation risk increased the rate of Saudi Arabian radiographers in this awareness-raising component in comparison to Australian counterparts who have lesser number of policies available.
On the other hand, the more frequent training and education received by Australian radiographers may be inferred as a determining factor in their increased dose intervention action and rate of understanding risk of cancer. These findings tell us that there is indeed a gap in the knowledge base of both Australian and Saudi Arabian radiographers. Nevertheless, these identified gaps in knowledge can be strengthened through enhancement of hospital protocols and encouragement to join activities for continuing education and training.
For Australian radiographers, they lack adequate hospital policies while the Saudi Arabian radiographers lack in training and workshops. This implies that policies should be established and should include mandatory workshops and trainings regarding updates on radiation doses because as results have showed, radiographers would not update themselves on their own. Hence, they need to be required by the hospital policies to attend these training workshops and seminars. Existing Attitudes Results showed that Australian radiographers have more enjoyment than participants from Saudi Arabia.
This indicates that radiographers from Australia have a more positive working attitude than Saudi Arabians. Moreover, Australians and Saudi Arabians have similar attitudes toward the following: • view of CT as future for them • familiarity with CT equipment • confidence with CT equipment • means for accessing resources • wanting to advance skills in pediatric CT Statistical analysis of these findings tells us that there is no significant difference in the attitudes of radiographers from Australia and Saudi Arabia that might have affected their practice toward pediatric CT imaging.
These are not congruent with the results of the study of Scutter and Halkett (2003) and Sim (2000) in which it was shown that strong negative attitudes result in resistance to update knowledge. In this research, survey results showed that there is no significant difference of attitudes in relation to the existing differences in knowledge and beliefs of radiographers from the two groups. This tells us that for these groups of radiographers, there is a need to focus more in improving the knowledge base regarding radiation dose for CT imaging.
The knowledge aspect appeared to have been significantly different between the two. Attitudes, though statistically not different, have little impact on the practice of CT imaging but can be improved as well. Summary Results showed that there is a significant difference in the knowledge base between radiographers from Australia and Saudi Arabia. The main difference in this knowledge can be attributed to the existing health policies or protocols implemented in their hospitals, as well as, the received training and activities for continuing education in both groups.
In Saudi Arabia, radiographers generally revealed that there are a number of policies that guide their explanation of radiation dose to parents of pediatric patients in comparison to Australian counterparts. This increased their ability to inform parents regarding radiation and dose. This also led to their higher perception that parents have a greater understanding of the radiation dose. On the other hand, Australian radiographers engage in more dose intervention activities than Saudi Arabian radiographers. This can be related to their frequent trainings and workshops, as well as, frequent updates of hospital protocols.
These findings are congruent with the results of the studies reviewed and discussed in the chapter for literature review in which training of radiographers and establishment of hospital protocols are needed to improve the knowledge of these health personnel. It follows that these two are the major factors that affected the knowledge base of the radiographers from both groups. Thus, the inadequacy in these aspects also resulted in the lack of knowledge base of radiographers in certain aspects of radiation dose in CT imaging among pediatric patients.
It was also found that there is no existing significant difference among the attitudes of Australian and Saudi Arabian radiographers in some pertinent aspects of CT imaging for pediatric patients. This implies that the attitudes of the radiographers from the two groups are not main contributors to their knowledge and practice of CT imaging. In summary, these findings direct efforts at focusing change and improvement in knowledge base of radiographers in order to minimize radiation exposure among pediatric patients.