Journal of King Saud University – Science 33 (2021) 101402

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Journal of King Saud University – Science

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Original article

An assessment of occupational effective dose in several medical

departments in Saudi Arabia
Yazeed Alashban ⇑
Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: To assess occupational effective dose in fourteen different medical departments in Saudi Arabia
Received 12 December 2020 during 2018–2019.
Revised 7 February 2021 Methods: Thermoluminescent dosemeters (TLD-100) made of Harshaw detector crystal of LiF:Ti,Mg
Accepted 3 March 2021
were used to estimate effective doses for 1,375 medical workers. These TLDs are made of Harshaw
Available online 13 March 2021
detector crystal of LiF:Ti,Mg with an estimated tissue equivalence (Zeffective) of 8.15 and density of
2.65 g/cm3. TLDs were analyzing using Harshaw model 6600 plus TLD reader along with WinREMS soft-
Keywords:
ware.
Dose limit
Effective dose
Results: The annual mean effective doses for the workers in 2018 and 2019 remained in the range of
Radiation protection 0.27–0.96 and 0.34–1.24 mSv respectively. The annual collective doses for all workers in 2018 and
Occupational exposure 2019 were found to be 591 and 847 person-mSv respectively. More than 93% of the workers received
Ionizing radiation an effective dose of less than 1 mSv. A comparison of occupational dose values among the studied depart-
ments revealed that workers in the nuclear medicine and cardiac catheterization exposed to the highest
annual effective doses.
Conclusion: In compliance with the ALARA principle, the occupational doses were distributed with a low
dose range in mind. In general, the dose values for this study are an indication of an adequative radiation
practices mainly due to reducing radiation leakage by using better manufacturing equipment, improving
the effective radiation protection policies, developing a highly effective radiation protection equipments,
and having access to the latest radiology literature.
Ó 2021 The Author(s). Published by Elsevier B.V. on behalf of King Saud University. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction Otherwise, medical workers and patients shall be exposed to a high

amount of radiation, which will lead to dangerous health effects
It is critical to apply protective and preventive measures such as cataract development and cancer (IAEA, 2014; Venneri
when dealing with ionization radiation for medical procedures. et al., 2009; Ciraj-Bjelac et al., 2010; Fazel et al., 2009; Muirhead
et al., 2009). An occupationally exposed worker is a term that refers
Abbreviations: IAEA, International Atomic Energy Agency; ICRP, International to an employee who is exposed to ionization radiation from their
Commission on Radiological Protection; MOH, Saudi Ministry of Health; RPP, work place. The radiation dose is estimated by measuring the col-
Radiation Protection Program; TLD, Thermoluminescent dosimeter; KFMC, King lective radiation exposure received by the employee (Szewczak
Fahad Medical City; OR, Operation room; Cath Lab, Cardiac catheterization lab; CSD, et al., 2013).
Communication and swallowing disorders; ER, Emergency; DR, Diagnostic radiol-
The International Commission on Radiological Protection (ICRP)
ogy; IR, Interventional radiology; NM, Nuclear medicine; MP, Medical physics;
OBGYN, Obstetrics and gynecology; RT, Radiotherapy; SE, standard error; ANOVA, provides recommendations regarding the radiation protection
An analysis of the variance test; ALARA, As low as reasonably achievable. practices for ionizing radiation, including dose limits for medical
⇑ Address: King Saud University, Riyadh 11451, Saudi Arabia staff. The ICRP publication 103 recommends taking all practical
E-mail address: [email protected] efforts to keep the radiation exposure as low as is reasonably
Peer review under responsibility of King Saud University. achievable (ALARA) (IAEA, 1996). This is the essential principle
for radiation protection. Internationally, medical radiation workers
account for around 50% of the exposed population to ionizing radi-
ation (ICRP, 1991). Radiation monitoring is the key tool in radiation
Production and hosting by Elsevier protection practices to estimate the occupational radiation dose

https://doi.org/10.1016/j.jksus.2021.101402
1018-3647/Ó 2021 The Author(s). Published by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Y. Alashban Journal of King Saud University – Science 33 (2021) 101402

(Bhatt et al., 2008). In order to assess radiation risks and create pro- 3. Results
tective measures, most governments and organizations require an
estimated occupational dose for workers who receive more than TLDs were used to monitor 660 and 715 medical workers in
10% of radiation dose limit (Muhogora et al., 2013; Tian et al., 2018 and 2019 respectively. The number of workers in each
2008; UNSCEAR, 2000). department is listed in Table 1. In both years, the highest number
In Saudi Arabia, the Radiation Protection Program (RPP) of the of workers were within the operation room department, followed
Ministry of Health (MOH) has been in place since 1986. Its mission by the diagnostic radiology department. The mean effective dose
is to provide protection to workers, patients, and the public from is an indicator of which of these medical departments’ workers
the risks of ionizing radiation exposure (Mora and Acuna, 2011). were exposed to the highest radiation exposure. Fig. 1 illustrates
Further, the RPP is responsible for measuring and analyzing the the mean effective doses for all the medical departments’ workers
personal radiation dosemeters for all workers in all healthcare in 2018 and 2019. Similarly, Fig. 2 shows the collective effective
facilities affiliated with the Ministry in various regions of the doses for all the medical departments’ workers during the study
Kingdom. period. The annual collective doses for all workers in 2018 and
According to the 2014 report by the IAEA on Radiation Protec- 2019 were found to be 591 and 847 person-mSv respectively.
tion and Safety of Radiation Sources: International Basic Safety The annual mean effective doses for the workers in 2018 and
Standards, Hp (10) represents the deep dose (whole-body), Hp 2019 remained in the range of 0.27–0.96 and 0.34–1.24 mSv
(0.07) represents the shallow dose (skin/extremities), and Hp (3) respectively. The annual mean effective dose (averaged over the
represents eye lens dose (IAEA, 2014). study period) is shown in Fig. 3. The results show that workers
King Fahad Medical City (KFMC), established in 2004 and work- in the cardiac catheterization department received the highest
ing under the umbrella of the Ministry of Health, is the largest effective dose average over the study period, followed by the
medical city in Saudi Arabia and is located in Riyadh. It has four nuclear medicine workers.
specialized hospitals and four subspecialized centers. KFMC con-
tains the main hospital, a children’s specialized hospital, a
women’s specialized hospital, and a rehabilitation hospital. Fur- 4. Discussion
thermore, it has a national neurosciences institute, the King Sal-
man health center, a comprehensive cancer center, and an In 2018, the comparison of mean effective dose values among
obesity, endocrine, and metabolism center (ICRP, 2012). Annually, the studied departments revealed that the highest values lie within
KFMC has the capability to treat more than 50,000 inpatients and the nuclear medicine workers, followed by the cardiac catheteriza-
more than 2,000,000 outpatients (KFMC, 2020). tion workers. In 2019, the cardiac catheterization personnel
received the highest mean effective dose, followed by the nuclear
medicine personnel. Unlike other medical workers, nuclear medi-
2. Materials and methods cine personnel handle a large amount of radioactive material, with
a radiation activity in the order of GBqs. This usually happens
A retrospective study was carried out on the occupational radi- when they use unsealed radioactive sources and during the radio-
ation dose for 1,375 medical workers in King Fahad Medical City pharmaceutical preparation. Moreover, they remain in very close
during 2018–2019. These workers occupied the following depart- proximity to the patients during radiopharmaceutical injections.
ments: operation room (OR), cardiac catheterization lab (Cath Likewise, the occupational dose during the cardiac catheterization
Lab), communication and swallowing disorders (CSD), dentistry, procedures is relatively high due to the presence of the workers
emergency (ER), endoscopy, diagnostic radiology (DR), interven- besides the patients while the x-ray beam is ‘‘on” for a long period
tional radiology (IR), nuclear medicine (NM), medical physics of time. These factors account for the increase in the radiation dose
(MP), obstetrics and gynecology (OBGYN), radiotherapy (RT), gas- among the nuclear medicine and the cardiac catheterization work-
troenterology, and urology. ers compared to the other medical workers in other departments.
A whole-body thermoluminescent dosemeters (TLDs) were However, the results showed that no single occupational dose
assigned to all the workers with a bar-coded number that repre- exceeded the annual dose limit of 20 mSv in any of the fourteen
sented their identity and their period of use. The workers were departments during 2018–2019.
recommended to wear the TLD under their lead apron on their An analysis of the variance test (one-way ANOVA) was per-
upper torso, in order to reflect the whole-body dose. These TLDs formed to find out if there were statistically significant differences
(TLD-100) are made of Harshaw detector crystal of LiF:Ti,Mg in the mean effective doses between each departments’ workers.
with an estimated tissue equivalence (Zeffective) of 8.15 and
density of 2.65 g/cm3. For calibration and quality control (QC)
analysis, 90Sr/90Y, with a radiation activity of 0.50 mCi, was used. Table 1
Number of workers in each department in 2018 and 2019.
Every three months, the RPP in KFMC is responsible for collect-
ing the TLDs and analyzing them using Harshaw model 6600 Medical Department Workers in 2018 Workers in 2019
plus TLD reader (Thermo Electron Corporation, Ohio, USA) along Operation Room 197 215
with WinREMS software. The reader had a sensitivity range of Cath Lab 77 66
10 lGy to 1 Gy, with a linearity of less than 5%. The preheated CSD 8 12
Dentistry 61 61
temperature of the time temperature profile was 120 °C with an
Emergency 19 21
acquisition temperature rate of 20 °C/s up to 350° C. The reading Endoscopy 18 51
system utilized a purified nitrogen supply at a pressure range of DR 93 102
35 to 95 psi, with an ideal flow rate mode of 28 l/h (1 scfh). The IR 37 36
radiation protection department in KFMC is responsible for NM 14 14
MP 17 16
reporting these results to the radiation protection program OBGYN 13 14
(RPP) in the Ministry of Health. The TLD readings were analyzed RT 64 65
using the Statistical Package for the Social Sciences (SPSS) Soft- Gastroenterology 8 8
ware, Version 20 (SPSS Inc., Chicago, IL) at a 95% confidence Urology 34 34
Total number of workers 665 715
interval.
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Y. Alashban Journal of King Saud University – Science 33 (2021) 101402

Fig. 1. Mean effective doses for all the medical departments’ workers in 2018 and 2019.

Fig. 2. Collective effective doses for all the medical departments’ workers in 2018 and 2019.

The test reveals statistically significant differences in the mean tion dose. In general, the dose values for this study are an indica-
effective doses between the departments’ workers in 2018 (F tion of improved radiation practices when compared studies
(13,630) = 6.58, p = 0.00) and in 2019 (F (13,682) = 6.65, p = 0.00). conducted in previous years. This is mainly due to many factors,
The results show an increase in the annual mean effective dose such as: reducing radiation leakage by using better manufacturing
from 2018 to 2019 by 22% mainly due to the increase of radiation equipment, improving the effective radiation protection policies,
procedures. To assess the significance of this increase, the annual developing a highly effective radiation protection equipments,
mean effective dose in both years were statistically compared and having access to the latest radiology literature (Linet et al.,
using a two-tailed independent sample t-test at a = 0.05. The 2010). These implemented factors considerably reduced the annual
results suggest that the annual mean effective dose in 2018 doses making KFCM a reference center for the radiation safety
(M = 0.48, SD = 0.45) are significantly less than the annual mean practice in Saudi Arabia.
effective dose in 2019 (M = 0.59, SD = 0.67), t (1378) = 3.42, The only limitation of this study is that it did not specify the
p = 0.001. effective dose for each occupational group (i.e., radiologists, tech-
The comparative analysis of mean effective annual doses in nologists, nurses, or medical assistants). This mainly due to that
diagnostic radiology, nuclear medicine, and radiotherapy is illus- the database of the RPP does not include the occupational posi-
trated in Table 2. Regardless of the differences in the data range, tion for all medical workers. Starting from 2020, RPP will update
the table provides a rough assessment of the occupational radia- its policy to include the occupational position of each worker in

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Y. Alashban Journal of King Saud University – Science 33 (2021) 101402

Fig. 3. The annual mean effective dose (averaged over 2018 and 2019) for all the medical departments.

Table 2
Comparative analysis of effective doses in diagnostic radiology nuclear medicine and radiotherapy for different countries (Rasooldeen, 2020; UNSCEAR, 2008; Weizhang et al.,
2005; Masood et al., 2012; Kamenopoulou et al., 2000).

Data range Country DR (mSv) NM (mSv) RT (mSv)

2000–2002 Canada 0.75 2.11 0.76
2000–2002 Chile 4.39 14.78 2.40
1992–1994 Kuwait 1.56 0.96 1.35
1996–2000 China 1.50 1.20 0.90
1997–1998 Greece 2.72 1.82 3.63
2007–2011 Pakistan 0.52 1.12 0.88
2018–2019 Current study 0.53 0.62 0.50

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