Comparison on Awareness of Radiation Hazards among Females of Different Age Group

Background: Radiation is a source of energy which travels through materials. The ionising radiation produce free radicals from an atom with the electron removal. X-ray is the most common ionizing radiation helping in diagnosis. There is an increase in the use of radiation in diagnosis, procedural along with surgical treatment where radiologists and the patients should be aware of the radiation hazards and its ill effects. The aim of our study is to analyse the radiation hazards awareness among females of various age groups. Materials and Methods: The study was done as an online setting; the responses were obtained from 103 female participants from the Chennai sub population. A self-structured questionnaire comprising about 18 yes or no types of questions were prepared in google forms and circulated as a link to the participants. The responses were exported to google sheets and data was retrieved Original Research Article Joshua et al.; JPRI, 33(52B): 174-185, 2021; Article no.JPRI.77143 175 and analysed in SPSS software version 26. The results were obtained from SPSS software. Results: From the results analysed, 74.76% have undergone X ray or any procedures but only few (25.24%) did not undergo any diagnostic procedures. 71.84% of them were aware that all radiation is hazardous whereas the rest (28.16%) were not aware. 88.35% of them accepted that bone marrow and child’s thyroid tissue are more sensitive to radiation but few (11.65%) did not accept it. 71.84% of the participants of females of age group 20-40 years were more aware than females of 40-60 years age group (16.50%) that bone marrow, the child's thyroid is the sensitive tissue affected by radiation. Chi square test was done and the association was found to be not statistically significant with P-value .236 (P = .05). Chi square test was done to check awareness of thyroid cancer caused mainly through radiations between the two age groups of females and the association was found to be not statistically significant with p-value is .703 (P = .05). Conclusion: Within the limits of the study, the females of age group 20-40 years have higher levels of awareness than females of age group 40-60 years.


INTRODUCTION
Radiation is the energy that comes from a source and travels through various materials and space. The ionising radiation is the radiation with sufficient energy to remove an electron from an atom or molecule and produces free radicals. The most common ionising radiation is X rays which is used extensively in diagnostic procedures [1]. Ionising radiation has biological damaging effects either affecting cells directly or indirectly through production of free radicals and they lead to DNA (Deoxyribo Nucleic Acid) damage of single or double stranded breaks, DNA protein cross links. Both dentists and patients are at high risk of stochastic effects as it has no dose threshold [2]. There is an increase in the use of radiation in diagnosis, procedural along with surgical treatment where radiologists and the patients should be aware of the radiation hazards and its ill effects [3]. Exposure to medical radiation increases risk of bone marrow suppression, cataract, infertility, birth deformities and several types of cancer, especially thyroid carcinoma. It also causes foetus anomalies like microcephaly, cleft palate. The awareness and knowledge about radiation hazards may differ based on occupational roles and levels of training [4]. The awareness created among low economic status people may be low whereas it is different for higher economic individuals. The general principle of radiation protection, pro post by ICRP (International Commission on Radiological Protection), is based on justification, optimisation and dose limitation and also follows RSO (Radiation Safety Officer), RSC (Radiation Safety Committee), 10-day rule concept [5,6].
There is much research work done on creating and knowing the awareness of radiation hazards, like the previous work by Hamarsheh A, 2012 [7] where a questionnaire was prepared and circulated to 163 physicians in 2 hospitals. The study concluded that only one third of physicians had received radiation protection courses during their undergraduate study, only 6.1% of them were able to identify ALARA (As Low as Reasonably Achievable) principle but 98.2% were not over the safe dose limit according to international recommendations. The participants lacked proper awareness and knowledge. There was a need to increase their knowledge and awareness among physicians. Similarly, the work by Bhavana Agarwal, etal,2015 [8,9] was done on awareness on radiation safety measures in dental clinics were assessed on 163 dental practitioners of CDE (Continuing Dental Education) and the results showed only 2.45% of them had thorough knowledge, 49.07% had moderate knowledge and 48.46% had poor knowledge. More emphasis should be placed on radiation hazards and its protection techniques from the UG (Under Graduate) curriculum.
The study by Aysegul Yurt, et al., 2014 [10,11] was done through a questionnaire which was given to physicians, nurses, technicians, about 92 participants took part in the study where their level of knowledge about ionising radiation was found to be weaker. In statistical comparison between the groups, the level of knowledge of physicians was found to be significantly higher than the other groups. The study demonstrates that general knowledge of radiation, its protection, health risks and doses are insufficient among health workers (professionals). Another study by BS Aravind, et al.,2016 [12-14] was done by questionnaire-based study among 300 dental practitioners. Among them, 80.3% of them were found to have separate sections for radiographic examination in their clinics, but only 9.7% of them followed the protocol and 6.7% of them were not using safety measures. The awareness level on radiation hazards and safety was acceptable but their knowledge with patient and personal safety was highly lacking [15].
The awareness of radiation and its hazardous effects were very low among the public over recent years [16][17][18][19][20]. The lacunae found on the past research works were the items of the questionnaire were different and it did not involve the awareness created among particular gender, especially females. There is an urgent need to create and impose awareness among the public, especially women who have a high incidence of getting cancers. So, the aim of the study is to compare the awareness level of radiation hazards between females of age 20-40 years and 40-60 years.

MATERIALS AND METHODS
The study was done as an online setting which is a prospective observational study. The study includes large amounts of data that can be stored and is cost effective and easy to handle and the options may not be available to the participant and the participant's truthfulness cannot be tested. The questionnaire was circulated to 272 females between 20-60 years of age from the Chennai sub-population, of which 147 responded and only 103 respondents gave non-biased responses, the rest 44 respondents gave biased responses. The responses were obtained from 103 female participants with inclusion criteria of females within 20-60 years of age and exclusion criteria of females less than 20 years and above 60 years of age, male participants were excluded was used.
A self-structured questionnaire comprising about 18 yes or no type of questions were prepared in google forms. The questionnaire was validated by the senior lecture guide and circulated as a link to the participants. The responses were exported to google sheets and data was retrieved and analysed in SPSS (Statistical Package for the Social Sciences) software version 26. The statistics test that was used is descriptive statistics from SPSS software. The method of representation of output variables was a bar graph. The independent variables of the study were height, weight, skin tone and dependent variables are radiation hazards, awareness, females, age. The results were obtained from SPSS software.

RESULTS
From 103 female respondents from 20-60 years of age, 74.76% of them have undergone X ray or any procedures but only few (25.24%) did not undergo any diagnostic procedures. 71.84% of them were aware that all radiation is hazardous whereas the rest (28.16%) were not aware. 88.35% of them accepted that bone marrow and child's thyroid tissue are more sensitive to radiation but few (11.65%) did not accept it. 80.58% of them were aware of exposure to radiation received per year from natural background and few (19.42%) are not aware of this actual fact. 78.64% of the participants were aware that they receive 10-20 mSV from diagnostic radiology but few (21.36%) are not aware of it. About 84.47% of them are aware of the symptoms of radiation sickness but only a few of about 15.53% are not aware of these symptoms. About 78.64% of them knew that one CT scan can emit as much as 200 chest X-rays but 21.36% of them did not know it. 72.82% of them about were aware of the risk of damage from X-rays but 27.18% are not aware of it. 90.29% of them were aware that beta and gamma radiation can penetrate skin and damage the cells inside but only about 9.71% are not aware of the fact.
About 91.26% of them are aware that gamma radiation from radioactive decay elements could be hazardous to living beings but few about 8.74% are not aware of it. About 56.31% would not undergo diagnostic imaging in absence of medical indication for personal doubts, but nearly 43.69% of them would undergo them. The participants were asked about whether mammograms are recommended for women above 40 years, about 67.96% have this thought but 32.04% don't have it. 62.14% of them are aware of the safety dose limit for fetuses but 37.86% were not aware of it. About 86.41% of the participants are aware of the pregnancy birth defects caused by radiation but 13.59% were not aware, during the first trimester the radiation causes microcephaly, cleft palate was accepted by 80.58% of them. The cause of thyroid cancer is mainly due to radiations was agreed by 67.96% of the females, leukaemia was caused due to hazardous effects of radiation was accepted by 68.93% and the skin cancer was caused by mainly UV radiations accepted by 83.50% of the females of both age group (Table 1).    Fig. 7. The graph shows the correlation of awareness of skin cancer being caused mainly by UV radiations between the two age groups of females. X axis gives the age group and Y axis gives the percentage of the responses. Green colour bar indicates the yes type answer and the orange colour bar depicts the no type answer from the participants. Majority of the participants (65.05%) of females of age group 20-40 years were more aware than females of 40-60 years age group (18.45%). Chi square test was done and the association was found to be not statistically significant. P-value is .334 and it is not statistically significant Generally, from the results analysed it is well understood that females of the younger age group (20-40 years) are more aware than the older age group (40-60 years). About 59.22% of the females of age group 20-40 years have undergone diagnostic imaging procedures particularly X ray than 15.53% of 40-60 years age group which in correlation shows no significant difference. The younger age group are well aware that all radiations are hazardous from 58.25% of them than the older age group 13.59% of them. The awareness of receiving radiation from natural background was higher for females of the younger age group about 65.05% than the other age group. The symptoms of radiation sickness were asked for awareness, females of younger age groups (66.02%) were aware, but these results don't have statistical significance between females of different age groups. Majority of the younger age group (41.75%) would not undergo diagnostic imaging for personal doubt where they are more aware than females of the older age group (14.56%). The awareness of radiation dose during the first trimester, recommendation of mammograms for females above 40 years, the penetrating effect of beta, gamma radiation and effect of CT scan proves that females of 20-40 years age group have higher levels of awareness than females of 40-60 years age groups.

DISCUSSION
The  [31,32] where a question was asked about taking action against MRI scans to be taken for pregnant women causing CNS anomalies of foetus. About 21.51% of them wanted to take action but the rest had lack of concern. Pregnancy birth defects and its awareness needs to be created among the public. They should be acknowledged for the hazardous effects of radiation.
The study by BN Praveen, etal,2013 [1,33] concluded that there is high knowledge and awareness of radiation dose of 20mSV per year caused by diagnostic imaging. The dental practitioners are well aware of radiation dose and safety dose limits. Similarly, the present study also found that there is a high level of awareness for radiation dose where 78.64% were aware (Table 1). Even though the present study stated higher awareness, contradicted by the study of Ryan KL Lee, etal,2012 [34,35] where the nonradiologists of about 77% underestimated the radiation dose and no non-radiologist correctly stated the radiation dose. So, the common public are not aware of the radiation dose. Only radiologists, dental practitioners have awareness when compared to the public. It is not like that, so there is a need to create awareness and impose general knowledge about radiation hazards among females particularly.
Nearly half of the control group believed a chest radiograph would expose them to more radiation than a week of natural background radiation, while 40% said they didn't know. The quantity of radiation in a chest radiograph was overestimated by 57 percent of the research participants, with 17.5% choosing the option that the radiation exposure would be similar to a dosage greater than 1 year of background radiation. The students in the research group had a fair understanding of the risks regarding CT radiation exposure. Only 39% of the research participants and 67% of the controls were aware that CT entailed the use of X-rays [36]. In the present study, the females of age 20-40 years were well aware of the radiation exposure and its associated health risks.
There is an increased awareness among the health care professionals [37][38][39] but not in females of different age groups when compared. The younger female age group (20-40 years) have better knowledge due to knowledge imposition by the learning institutes, media and others. From previous research done, it is well understood that only awareness is created among the medical professionals [40,41] and not in the common public, especially females.
As of now, the awareness among the females of the 20-40 age group is higher than the 40-60 years age group. There is a need to create general awareness irrespective of the age group in future [42][43][44][45]. There should be spread of awareness through social media, health camps, polls, etc., to prevent the increase of cancer rate per year worldwide. The limitations of the study were small scale population, multi-centered trials were not conducted, the participants truthfulness not tested.

CONCLUSION
Within the limits of the study, the females of age group 20-40 years have higher levels of awareness than females of age group 40-60 years. In the future, awareness should be advanced for them particularly females of all age groups including 40-60 years of age which lacked awareness in the present study.

CONSENT
As per international standard or university standard, respondents' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
It is not applicable.