Radiation Monitoring Using Personal Dosimeter Devices in Terms of Long-Term Compliance and Creating a Culture of Safety.

Introduction Radiation-emitting devices are commonplace in the hospital with their ability to produce imaging for diagnoses, However, they hold a risk for device operators due to radiation exposure. Hospital systems have programs where physicians exposed to radiation are required to wear dosimeters to help record total radiation over time. Dosimetry readings over standardized recommendations can lead to hospital image issues and disciplinary action for physicians. This study aimed to discover the true values recorded on dosimeters with radiation exposure and discuss effective ways to encourage compliance with dosimeter usage. Methodology The study was completed over a course of 12 months with physicians from three different hospitals. Selection criteria included physicians considered to be "radiation workers" including those who operate x-ray machines, fluoroscopy units, unsealed and sealed isotopes, or those exposed to other sources of gamma or high-energy beta radiation. Two Plan-Do-Study-Act (PDSA) cycles were implemented. The first cycle was the first six months of the study and the second cycle was the second six months of the study. The first PDSA cycle had planned dosimeter reading check-ins every month. After this cycle ended, physicians were sent a survey anonymously asking if they had ever intentionally left behind their dosimeter. In the second PDSA cycle, a planned policy change was put into action where penalties for physicians who went over the recommended dosage were stopped. A monthly educational meeting where a discussion on the risks of radiation as well as protective mechanisms was implemented instead. The same monthly check-ins for dosimeter reading monitoring were employed again with the same survey regarding dosimeter adherence and usage being sent out at the end of the second cycle. Run charts were created to determine whether the policy change showed statistically significant differences in dosimetry readings. Results Protocol changes led to statistically significant (p<0.05) differences in radiation exposure recorded throughout the hospital systems. The primary PDSA cycle readings showed that hospital systems one (n=118), two (n=71), and three (n=32) had readings of 3.90 mSv, 2.55 mSv, and 2.02 mSv, respectively, which were all under the annual recommended dose limit of 10 mSv maximum per six months. However, an average of 94.4% (n=221) of physicians across all hospitals admitted to not using the dosimeter. In the second PDSA cycle after the policy change, the radiation doses were higher with an increase in the average cumulative dose at hospital system one of 255%, 328% at system two, and 323% at system three. Hospital systems one and two were both over the yearly limit of 20.0 mSv (7.70 mSv over for system one and 1.86 mSv over for system two) while system three remained under. The number of physicians who stated they always used the dosimeter during the second PDSA cycle increased to 83.9% in-hospital system one, 90.2% in-hospital system two, and 93.8% in-hospital system three. Conclusion Creating a culture of safety is critical for physician compliance. A comfortable work environment without unreasonable consequences creates an environment where physicians can focus on their health and safety while also doing what is in the workplace's best interest. This culture can best be made with more collaboration between administrative staff and workers to create a trustworthy experience in hospital systems.