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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 18-23

Awareness and knowledge of the practice of therapy radiographers among radiography students - A cross-sectional study


1 Department of Radiotherapy, Lagos University Teaching Hospital (LUTH), Nigeria
2 Lagos State University Teaching Hospital (LASUTH), Nigeria

Date of Submission07-Apr-2020
Date of Acceptance15-Sep-2020
Date of Web Publication2-Feb-2021

Correspondence Address:
Dr. Mohammad Habeebu
Department of Radiotherapy, Lagos University Teaching Hospital, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_26_20

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  Abstract 


Background: Cancer is a public health problem affecting all categories of people worldwide and radiation therapy is often the mainstay of management. A successful radiotherapy treatment requires well-skilled professionals such as radiation oncologist, therapy radiographers, and medical physicist. Radiography is an indispensable heart of modern medicine, in the diagnosis and management of diseases. This study was conducted to determine the level of awareness and knowledge of the practice of therapy radiographers among radiography students. Methods: This study was a descriptive cross-sectional study conducted among radiography students in College of Medicine, University of Lagos over a period of 3 months. Results: Majority of the respondents (44.9%) were within the age range of 21–25 years. Majority of the respondents (91.7%) had not had clinical posting on radiotherapy. A few students, 33 (21.2%) had encountered a therapy radiographer during clinical posting. Majority of the respondents (89.7%) had never heard about a therapy radiographer. A minority (19.2%) of the respondents indicated that they would like to be therapy radiographers. Majority of the respondents (44.2%) had no interest because think they do not make good money (9.6%), because they did not know what it entailed (lacked knowledge) (16.0%), and because of the perceived high risk of radiation dose (25.6%). Conclusion: This study revealed that radiography majority of radiography students are not aware nor have the knowledge of the practice of therapy radiographers. There is also a lack of interest in these students in becoming therapy radiographers.

Keywords: Cancer, radiography, radiotherapy, therapy radiographer


How to cite this article:
Habeebu M, Aminu A, Akpochafor M, Adeneye S, Salako O, Agaga LA, Irurhe N, Adeoluwa A. Awareness and knowledge of the practice of therapy radiographers among radiography students - A cross-sectional study. J Clin Sci 2021;18:18-23

How to cite this URL:
Habeebu M, Aminu A, Akpochafor M, Adeneye S, Salako O, Agaga LA, Irurhe N, Adeoluwa A. Awareness and knowledge of the practice of therapy radiographers among radiography students - A cross-sectional study. J Clin Sci [serial online] 2021 [cited 2021 Feb 28];18:18-23. Available from: https://www.jcsjournal.org/text.asp?2021/18/1/18/308595




  Introduction Top


Cancer is a public health problem affecting all categories of people worldwide and radiation therapy is often the mainstay of management. According to the World Health Organization, cancer is one of the leading causes of death worldwide, the second common cause of death in developed countries and the third leading cause of death in developing countries[1] and it is estimated that about 55% of these cancer patients would receive radiation therapy.[2] A successful radiotherapy treatment requires well-skilled professionals such as radiation oncologist, therapy radiographers and medical physicist.[2] Radiography is an indispensable heart of modern medicine which involves the use of ionizing radiation and other forms of radiation energy in the diagnosis and management of human diseases.[3]

Radiography is currently a 5-year undergraduate course of study in Nigeria leading to B.Sc., Radiography and this course is available in only seven universities namely; University of Calabar, University of Nigeria, University of Lagos, University of Maiduguri, Bayero University, Nnamdi Azikwe University and Usman Dan Fodio University.[3]

Radiographers are regulated professionals that play a vital role in the health-care system. They are entitled to hold one of the titles; diagnostic radiographer or therapeutic radiographer.[4] Diagnostic radiographers are involved in procedures that help facilitate diagnosis and monitoring of diseases. Examples of machines used by diagnostic radiographers include X-ray, ultrasound, fluoroscopy, computed tomography (CT), magnetic resonance imaging, nuclear medicine, mammography, these machines use either small dose of ionizing radiation or nonionizing radiation.[4] The therapeutic radiographers however, use high energy radiation to damage cells' DNA (majorly cancerous) and destroy their ability to divide and grow using a wide range of technical equipment.[4] Together both diagnostic and therapeutic radiography professional provide essential services every year to millions of people.

Therapeutic radiographers constitute large proportion of the multidisciplinary radiotherapy team, working alongside clinical oncologists, medical physicists, and engineers. They are extensively involved in all stages of the patients' radiotherapy journey starting at prediagnosis, through all subsequent stages; patient consent, pretreatment preparation and planning, treatment delivery, patient management during treatment, follow-up, management, and care of patients after treatment.[5]

However, not much about therapy radiography is taught in B.Sc., Radiography, hence, not many undergraduates are exposed to therapy radiography. The knowledge of radiotherapy will inspire the interest of undergraduate to specialize in therapy radiography. Hence, this study was conducted to determine the level of awareness and knowledge of the practice of therapy radiographers among radiography students.


  Methodology Top


This study was a cross-sectional study conducted over 3 months, among radiography students in College of Medicine, University of Lagos.

Sample size estimation

Using the Taro Yamane's formula, the sample size was estimated to be 114 (where n = 114; N = 159 and e = 0.05).

Sampling technique

Convenience, nonprobability sampling was used to select participants.

Inclusion criteria

All radiography students in College of Medicine, University of Lagos from level 200 to level 500.

Exclusion criteria

The researcher excluded radiography students in level 100.

Instrument for data collection

The research instrument to be used will be a semi-structured questionnaire. The questionnaire used for this study was designed and modified by a radiation oncologist with the assistance of a therapy radiographer in Lagos University Teaching Hospital (LUTH). The questionnaire was divided into SIX sections (A-F) and there were 44 items on the questionnaire.

Data analysis

Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) and were summarized using descriptive statistics of mean, standard deviation, frequency, percentages, pie charts, bar charts, and histogram.

Ethical consideration

Ethical clearance was obtained from the Research Ethics Committee of College of Medicine, University of Lagos. The purpose of the study was also explained to the participant and consent obtained, they were assured that all information obtained would be treated with utmost confidentiality.


  Results Top


A total of 159 questionnaires were distributed with 156 returned giving a response rate of 98.1%. The sex distribution showed that females (51.3%) were slightly more than the males (48.1%). Majority of the respondents (44.9%) were within the age range of 21–25 years. Respondents in 300 level (28.9%) were more than other respondents, while the lowest was 200 level (18.6%). Majority of the respondents were Christians (58.9%) and Yoruba (73.1%) ethnicity [Table 1].
Table 1: Sociodemographic data of respondents (n=156)

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Majority of the participants (81.4%) had had lectures on radiation biology, dosimetry, and radiation protection. Majority (81.4%) had taken basic therapeutic skills (BTS). Some students, 42 (26.9%) had had lecture on radiotherapy/oncology. Only 1.9% of all those who had lectures on radiation biology, dosimetry, radiation protection, BTS, and radiotherapy/oncology said they were taught by a therapy radiographer, 56.4% were not taught by a therapy radiographer while 26.9% did not have an idea who taught them these courses. Majority of the respondents (91.7%) had not had clinical posting on radiotherapy, even though according to the university's curriculum they should have had their clinical posting in their 2nd semester of their 3rd year (300 level). Despite the curriculum, students in their 3rd year do not get posted for clinical postings by the university due to some unknown reasons. Only 46.8% had encountered a cancer patient during clinical posting. A few students, 33 (21.2%) had encountered a therapy radiographer during clinical posting. Majority of the respondents who had encountered therapy radiographers during clinical posting encountered them in LUTH (10.3%), 5.1% in Eko Hospital and 2.6% in Lagos State University Teaching Hospital [Table 2].
Table 2: Level of education in radiography (n=156)

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Majority (94.9%) of the respondents had heard about radiotherapy while 92.3% of the respondents knew what radiotherapy was. Majority of the respondents (57.7%) defined radiotherapy as the use of ionizing radiation in the treatment of mainly malignant tumors. Majority of the respondents (64.7%) selected Linear Accelerator, Cobalt 60 and Computed Tomography as equipment used in radiotherapy department. Majority selected oncologist, therapy radiographers and medical physicist as specialists involved in radiotherapy [Table 3].
Table 3: Knowledge of radiotherapy (n=156)

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Majority of the respondents (89.7%) had never heard about a therapy radiographer. Only 5.8% of the respondents could define a therapy radiographer as a radiographer working in the radiotherapy department who positions and delivers radiation dose to the patient, while 39.7% identified the best definition for a therapy radiographer as a person who is part of a multidisciplinary team in radiotherapy department and positions the patient and deliver radiation dose to the patient. Equipment used by the radiographers according to the respondents included; linear accelerator (36.5%), CT (10.3%), cobalt-60 machine (6.4%), and simulator (3.8%). Majority of the participants (57.1%) selected radiography as the prerequisite course for a therapy radiographer. Majority of the participants (60.3%) identified B.Sc., radiography, M.Sc., radiotherapy as the best qualification of a therapy radiographer [Table 4].
Table 4: Awareness and knowledge of a therapy radiographer (n=156)

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Data collected revealed that only 12.8% of the respondents agreed to setting up patients for treatment (positioning and immobilization) as a role of a therapy radiographer, 19.2% of the participants identified simulation, 16% identified treatment planning and only 15.4% identified treatment delivery as roles of a therapy radiographer. Majority of the participants selected injection of contrast as a role of a therapy radiographer. Others identified calculation of dose of radiation (42.3%) and prescription of dose of radiation (34.6%) as roles of a therapy radiographer. Participants also identified wound dressing (5.1%), catheterization (11.5%), holding the pediatric patients in position during treatment (6.4%), and sedating pediatric patients during radiotherapy (15.4%) as roles of a therapy radiographer. In overall, 23.43% of the respondents had adequate knowledge of therapy radiographer while 76.57% had inadequate knowledge of therapy radiographers [Table 5].
Table 5: Knowledge on the practice of a therapy radiographer

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A minority (19.2%) of the respondents indicated that they would like to be therapy radiographers and their reasons included; liked the discipline (5.8%), would like to because it is lucrative and they get a good pay (6.4%). Majority of the respondents (44.2%) had no interest because think they do not make good money (9.6%), because they did not know what it entailed (lack knowledge) (16.0%), would not be radiographer because of the perceived high risk of radiation dose (25.6%), while 8.3% had no specific reason to be or not to be a therapy radiographer. Majority of the respondents (48.1%) did not see a bright future in radiography, 39.7% thought there was an untoward risk to radiography and the risks included cancer (14.1%), exposure to radiation (19.2%) and radiation accident (33.3%). Overall, only 20.7% of the respondents had interest in radiotherapy while 79.3% of the respondents had no interest [Table 6].
Table 6: Level of interest in radiotherapy (n=156)

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  Discussion Top


The study on the awareness and knowledge of the practice of therapy radiographers to my knowledge after several searches has not been conducted before.

Cancer treatment is a multidisciplinary effort which involves radiation oncologists, medical physicists, therapy radiographer, maintenance engineers, mold room technicians, dosimetrists, dieticians, physiotherapist, and social workers.[6] Deficiency in any of the core units of the multidisciplinary can stop treatment, render equipment underutilized or cause suboptimal care of patients.

Workforce development is as important as procurement of radiotherapy equipment for radiotherapy clinics. There are only 18 therapy radiographers in the country. There is need of additional RTs per simulator, brachytherapy machine, treatment planning system, and one supervisor.[6],[7],[8] Efforts were made locally to convert diagnostic radiographers to therapy radiographers at the National Hospital, Abuja, but lack of proper syllabus and competent trained certified trainers marred these efforts.

The shortage of therapy radiographers (RTTs) is a major problem in achieving prompt and optimal cancer care as it also limits the total number of patients that can be treated daily, with a resultant long waiting time. Until this study, the level of interest of radiography students in this aspect of radiography has been unexplored. The level of interest of radiography student is a function to the increase of therapy radiographer to solve the problem of the shortage in the country.

The aim of this study was to determine the awareness and knowledge of radiography students in the practice of a therapy radiographer. This study was conducted among radiography students in Lagos.

It was observed that majority of the student 92.3% knew what radiotherapy is but only few number of students (32.6%) were aware of the practice of a therapy radiographer and 23.43% of students have knowledge of the practice of a therapy radiographer. From this result, it was observed that majority of students have a theoretical background on radiotherapy but lack practical knowledge of radiotherapy.

The result of this study showed that only few number of students knew the equipment used by a therapy radiographer, 36.5% of students selected Linear accelerator, 10.3% selected CT, 6.4% of students selected Cobalt 60 machine, and 3.8% selected simulators. Majority of students gave no response to the equipment used by a therapy radiographer which means they do not know the equipment used by a therapy radiographer.

It was observed that majority of students have had lectures related to radiotherapy. One hundred and twenty-even (81.4%) of students have had lectures on radiation biology, dosimetry, and radiation protection, 127 (81.4%) have had lectures on BTS and only few students have had lectures on radiotherapy 42 (26.9%) but these courses were not taught by a therapy radiographer. Majority of the students (78.8%) have visited different radio-diagnostic centers on the practice of diagnostic radiography but only three students have had the opportunity to visit radiotherapy clinic for their clinical postings.

The result showed that number of students who would like to practice therapy radiography are few 30 (19.2%). Majority of the students do not want to practice therapy radiography because of the risk of radiation (25.6%), they do not know what it entails to be a therapy radiographer (16%), some students think therapy radiography is stressful, 15% of students think therapy radiography is not lucrative or profitable [Table 7].
Table 7: Summary of the findings

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  Conclusion Top


This study has revealed that in radiography, majority of radiography students are not aware nor have the knowledge of the practice of therapy radiographers. There is also a lack of interest in these students in becoming therapy radiographers. There is therefore a need for an adjustment in the curriculum of radiography students to include clinical posting to radiotherapy centers so that they can get a first-hand, robust knowledge in the role therapy radiographers, particularly in the management of cancers. Radiotherapy posting will also increase the interest of radiography students in therapy radiography and may also increase the number of radiography students that would eventually end up as therapy radiographers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gulland A. Global cancer prevalence is growing at “alarming pace,” says WHO. BMJ 2014;348:g1338.  Back to cited text no. 1
    
2.
Levis CV, Sitas F, Odes RA. Radiation therapy services in South Africa. S Afr Med J 1994;84:349-51.  Back to cited text no. 2
    
3.
Radiographers Registration Board of Nigeria; 2016. Available from: https//:www.rrbn.gov.ng. [Last accessed on 2018 Sep 04].  Back to cited text no. 3
    
4.
Department of Medical Radiography, University of Nigeria; 2015. Available from: https//:unnmmedcollege.org. [Last accessed on 2018 Sep 04].  Back to cited text no. 4
    
5.
The Society and College of Radiographers. The Role of the Radiography Workforce in the Management and Treatment of Cancer Patients; 2014. Available from: https//www.sor.org. [Last accessed on 2018 Sep 04].  Back to cited text no. 5
    
6.
International Atomic Energy Agency. Setting Up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects. Vienna: International Atomic Energy Agency; 2008. p. 6-45.  Back to cited text no. 6
    
7.
Shortt K, Davidsson L, Hendry J, Dondi M, Andreo P. International perspectives on quality assurance and new techniques in radiation medicine: Outcomes of an IAEA conference. Int J Radiat Oncol Biol Phys 2008;71:S80-4.  Back to cited text no. 7
    
8.
Thwaites D, Scalliet P, Leer JW, Overgaard J. Quality assurance in radiotherapy. European Society for Therapeutic Radiology and Oncology Advisory Report to the Commission of the European Union for the 'Europe Against Cancer Programme'. Radiother Oncol 1995;35:61-73.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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