الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Use of ionizing radiation in medical imaging for diagnostic and interventional purposes has risen dramatically in recent years with a concomitant increase in exposure of patients and health workers to radiation hazards; medical and dental X-rays now constitute the major manmade sources of radiation exposure.
While reports from studies demonstrated dramatic rise in the prevalence of adverse health effects following exposure to ionizing radiation over the past two decades, the documented evidence of poor knowledge of radiation safety among various cadres of health workers at risk of occupational exposure shows the enormity of the problem at hand. Ionizing radiation may affect gastrointestinal system, central nervous system, gonads or even whole body. These effects may appear as a somatic effect or in next generation as a genetic effect.
Interestingly, the early biochemical modifications, which occur during or shortly after the radiation exposure, were thought to be responsible for most of the effects of ionizing radiation in mammalian cells. However, oxidative changes may continue to arise for days and months after the initial exposure presumably because of continuous generation of reactive oxygen (ROS) and nitrogen (RNS) species. Remarkably, these processes occur not only in the irradiated cells but also in their progeny. Such information may be of relevance when the expansion of imaging technology is considered. All radiology field workers require appropriate monitoring, as well as protection tools and equipment. They must also receive education and training appropriate to their jobs.
Aim of the study:
This study aims to promote the health of health care workers occupationally exposed to ionizing radiation at diagnostic radiology department, Zagazig university hospitals with the following
objectives:
1- To assess oxidative stress.
2- To recognize the occupational health problems.
3- To assess the use of radiation safe measures.
4- To assess knowledge and practice of workers toward radiation hazards and radiation protection at diagnostic radiology department, Zagazig university hospitals.
Subjects and methods:
To achieve these objectives, a comparative cross-sectional study was conducted among 31 health care workers exposed to ionizing radiation at diagnostic radiology department, Zagazig university hospitals. Another group of 31 health care workers selected from outpatient clinics (clinical pathology department) not exposed to diagnostic ionizing radiation and considered as a control group.
The exposed group in the study were subjected to a structured questionnaire which was used to collect information about Some socio¬demographic characteristics e.g: age, sex, job, marital status and duration of work. Knowledge about radiation health hazards: (Nausea, vomiting, diarrhea (NVD), Dermal effects, Cataract, Bone marrow (BM) suppression, Sterility, Teratogenicity & Cancer). Knowledge about radiation dose and monitoring of exposure:(Knowledge about TLD (Thermoluminescent dosimeter), about radiation exposure dose, about periodicity & about periodic examinations: e.g. chest x- ray, CBC & others including dermal and eye examinations. Knowledge about Personal protective equipment (PPE): (Eye googles, Lead apron, Lead gloves, Thyroid cola & Gonadal shield).
To assess the practice among health care workers of exposed group, a check list was used to assess the practice and use of personal protective equipment.
Laboratory investigations were done for both groups by measuring Superoxide Dismutase (SOD) activity level in blood samples to assess antioxidant status and Lipid Peroxide (Malondialdehyde) in blood samples to assess oxidative stress status. CBC was done to assess the hematological effect among the studied groups.
Evaluation of radiation exposure of exposed group as they were wearing film badge through their work shift and these films had been counted and read in Egyptian Atomic Energy Authority (EAEA). Environmental exposure was measured every three months. Annual cumulative effective dose was measured among exposed group.
Results:
The results of present study showed the that exposed and control groups were comparable as regards age, sex, occupation marital status, eating habits and duration of work. Majority of the participants in both groups were married, females and often eat fruits and vegetables. There was high statistically significant difference between both groups regarding occupation.
As regard knowledge among the exposed group, all of exposed group reported that sterility, teratogenic and cancer were the most common health hazards of ionizing radiation according to their knowledge.93.5% of them had adequate knowledge regarding ionizing radiation health hazards. All of exposed group reported knowledge about thermolumiscent dosimeter (TLD), periodicity and complete blood picture (CBC) as a periodic examination .100 % of them had adequate knowledge regarding exposure dose and its monitoring. All of exposed group reported that lead apron and lead gloves were the most common personal protective equipment (PPE) according to their knowledge.87.1% of them had adequate knowledge regarding ionizing radiation personal protective equipment.
The results of this study showed that in all diagnostic radiology department there were doors and walls consist of lead material and there was radiation safety officer. 90.3 % 0f health care workers wore lead gloves during work and none of them wore gonad shield (0%) during work. 74.2% of them had adequate personal practice. There was no correlation between total knowledge and total personal practice.
Regarding environmental exposure of exposed group, the annual cumulative effective dose of ionizing radiation exposure ranges from (0.21 – 0.27) mSv with mean (0.23 ± 0.02) mSv among exposed group.
from the results of this study, it was noticed that malondialdehyde (MDA) was significantly higher (p-value < 0.01) among exposed group compared to control groups, while the level of superoxide dismutase (SOD) is significantly lower (p-value < 0.01) among exposed group compared to control group. The abnormal levels of Malondialdehyde (MDA) and Superoxide Dismutase (SOD) were significantly higher among exposed group compared to control group (p-value = 0.000).
As regard CBC measures among the studied groups, red blood cells (RBCs) and hemoglobin (Hb) were statistically significantly lower among exposed group compared with control group (p<0.05). There was statistically significant difference among studied groups regarding prevalence of anemia (p<0.05). Among exposed group, 71% of them were anemic, 9.7% of them had leucopenia and 3.2 % of them had thrombocytopenia.
The study results showed there was negative correlation between the level of Malondialdehyde (MDA) and levels of hemoglobin (Hb) and Superoxide Dismutase (SOD), while there was positive correlation between the level of Superoxide Dismutase (SOD) and levels of hemoglobin (Hb) (p-value = 0.000).
There was significant negative correlation between level of Superoxide Dismutase (SOD) and duration of work and environmental exposure and between level of hemoglobin (HB) and age and duration of work. There was significant positive correlation between level of Malondialdehyde (MDA) and duration of work and environmental exposure among exposed group. There was no correlation between some socio demographic characteristics eg: age and levels of Hemoglobin (Hb)& Malondialdehyde (MDA) & Superoxide Dismutase (SOD) among control group.
This study also showed that the level of malondialdehyde (MDA) is not significantly related to eating of fruits and vegetables (p-value >0.05). The Superoxide dismutase (SOD) is significantly related to eating of fruits and vegetables (p-value <0.05). The most significant predictor of oxidative stress among the exposed group was the duration of work.
Conclusion:
It was concluded from this study that, health care workers had various health hazards related to exposure to diagnostic ionizing radiation. Exposure to ionizing radiation induced oxidative stress which play important role in radiation related health effects. Anemia was the most common hematological health hazards among the exposed group in this study. The awareness level of the health care workers about the radiation protection principles was relatively good. Radiation exposure was found to be within the normal average.
Recommendations:
Educational training programs about ionizing radiation hazards and protection practices should be obligatory to all health care workers. Provide complete PPE with high quality for all health care workers to increase controls of diagnostic ionizing radiation hazards and enforce compliance of all health care workers with safety regulations of ionizing radiation. Ensure performance of periodic lab investigations and diagnostic procedures for all health care workers to provide early detections of symptoms related to diagnostic ionizing radiation hazards.
CONCLUSION
The study concluded that, health care workers had various health hazards related to work with diagnostic ionizing radiation. Exposure to ionizing radiation induced oxidative stress plays important role in radiation related health effects. Anemia was the most common hematological health hazards among the exposed group in our study.
The awareness level of the health care workers about the radiation protection principles was relatively good. Radiation exposure was found to be within the normal average.