Understanding Risk in Radiation Practices

Abstract

newlineUnderstanding Risk in Radiation Practices: A Study of newline Diagnostic Radiology and Radiotherapy Practices in North-East newline India and Mumbai newline Abstract newline The application of ionizing radiation in medicine for the diagnosis of ailments and the newline treatment of cancer has remained the highest use of radiation in any field since its discovery newline in the 1890s. In India, the use of radiation in both diagnostic radiology and radiotherapy is on newline the rise. There are more than fifty thousand diagnostic radiology facilities in India and about newline four hundred and eighty radiotherapy facilities. newline In India, the framework of regulation of these facilities derives from the Atomic Energy Act, newline 1962, and the rules made under it. The Atomic Energy Regulatory Board(AERB) was newline established in 1983 to execute the regulatory functions under this framework. India being a newline member state of international organisation on radiation such as International Commission on newline Radiological Protection(ICRP) and International Atomic Energy Agency (IAEA), attempts newline also to include the guidelines and recommendations of these international organisations in the newline regulatory framework of radiation safety. newline However, contemporary practices have faced many challenges such as the controversial newline arguments on the linear no threshold dose model for the estimation of radiation risk, newline familiarity with the complexities of advanced imaging and treatment modalities, risk newline communication, human factors and non-compliances with regulatory requirements. newline The objective of this dissertation is to examine the adequacy of radiological protection newline systems in diagnostic radiology and radiotherapy facilities in the North-East (NE) and newline Mumbai. We further attempt to understand the influence of risk perception, risky work newline behaviour, and risk communication in the implementation of regulatory requirements for newline radiological protection systems in these facilities. newline In diagnostic radiology, we select thirty diagnostic radiology facilities from each of the two newline regions. However, in radiotherapy, we choose nine radiotherapy facilities, each from NE andvi newline Mumbai, as the maximum number of radiotherapy facilities in the NE with three years newline experience, was only nine at the initiation of our study. We selected these different study sites newline as there are significant gaps between them due to their varying proximity to the headquarters newline of the regulator, their geographical location, availability of service agencies, and their newline differing levels of development. newline We developed a semi-structured questionnaire for the collection of data. It consisted of four newline parts- (1) assessment of the status of radiological protection systems (2) assessment of work newline behaviour (3) assessment of professional up-gradation of the knowledge of workers and (4) newline their risk perception, work behaviour and communication. newline The dissertation argues that the reasons why facilities tend to deviate from national and newline international safety requirements are complex and intertwined amongst the various actors newline involved in the practice. The existence of the required infrastructures alone is not enough to newline ensure the adequacy level of radiological protection systems. It also significantly depends on newline how radiation risk is perceived, understood, and managed within the framework of the newline facility. The implementation of regulatory requirements for establishment of adequate newline radiological protection in the facilities demands the collective and co-operative or newline collaborative behaviour of the various actors involved. Some of our recommendations newline emerging from the findings of the study include maintaining consistent and continuous newline communication between facilities and regulator, conduct of knowledge up-gradation newline programmes to translate the regulatory requirements in an easy and understandable for newline implementation, inclusion of social and behavioural factors in the regulatory inspection newline modules, and motivating the facilities to implement fully regulatory requirements on a newline voluntary basis. newline Keywords: diagnostic radiology, radiotherapy, radiation safety, regulator, risk perception