Submitted: 06 Sep 2023
Revised: 28 Oct 2023
Accepted: 28 Oct 2023
First published online: 21 Nov 2023
EndNote EndNote

(Enw Format - Win & Mac)

BibTeX BibTeX

(Bib Format - Win & Mac)

Bookends Bookends

(Ris Format - Mac only)

EasyBib EasyBib

(Ris Format - Win & Mac)

Medlars Medlars

(Txt Format - Win & Mac)

Mendeley Web Mendeley Web
Mendeley Mendeley

(Ris Format - Win & Mac)

Papers Papers

(Ris Format - Win & Mac)

ProCite ProCite

(Ris Format - Win & Mac)

Reference Manager Reference Manager

(Ris Format - Win only)

Refworks Refworks

(Refworks Format - Win & Mac)

Zotero Zotero

(Ris Format - FireFox Plugin)

Abstract View: 305
PDF Download: 228
Full Text View: 141
Avicenna J Care Health Oper Room. 1(3):79-83. doi: 10.34172/ajchor.25

Original Article

Assessment of Knowledge, Awareness, and Practice of Procedures for Protecting Operating Room Personnel From Ionizing Radiation: A Cross-sectional Investigation Using a Questionnaire

Masoud Jabbari , * ORCID logo
Department of Radiology Technology, School of Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
*Corresponding author: Masoud Jabbari, Email: masoudjabari@yahoo.com


Background: This study aimed to look into operating room staff members’ knowledge, attitudes, and practices related to radiation safety. We identified the relationship between their demographic variables and knowledge, attitudes, and practices.

Methods: A questionnaire was filled out by 210 employees who worked in the operating rooms of the public hospitals in Birjand between August 2022 and March 2023. Scores on knowledge, attitudes, behaviors, and demographic data were gathered, and the data were analyzed using SPSS, version 22.0. Statistical analyses were completed utilizing descriptive statistics tests, including the independent t-test, the one-way ANOVA with a significant level (P<0.05), and a Chi-square test.

Results: The results demonstrated no statistically significant difference (P>0.05) in the knowledge level of operating room personnel towards radiation protection for both genders, age, and type of employment, but work experience and academic degree represented significant differences (P<0.05).

Conclusion: The results revealed the operating room staff’s ignorance of the dangers of radiation exposure. Most of them failed to take the appropriate safety measures to reduce their radiation exposure. The findings enable healthcare educators to design and create relevant educational programs that could support businesses in creating a safe work environment and teach healthcare personnel the value of taking personal responsibility for adhering to radiation protection regulations.

Keywords: Knowledge, Awareness, Practice, Operating room, Radiation protection


© 2023 The Author(s); Published by Hamadan University of Medical Sciences.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Please cite this article as follows: Jabbari M. Assessment of knowledge, awareness, and practice of procedures for protecting operating room personnel from ionizing radiation: a cross-sectional investigation using a questionnaire. Avicenna J Care Health Oper Room. 2023; 1(3):79-83. doi:10.34172/ajchor.25


Using X-rays for diagnosis in medical centers and units such as radiology and surgery is widely growing. Despite useful applications and practical benefits, X-rays would cause serious, irreversible, and harmful effects on people who deal with radiation if recommended radiation protection protocols were neglected and not performed. Ionizing radiation such as X-rays raises the possibility of damaging DNA and cancer risk in nurses and others who are in contact with radiation during surgery in the operating room (1).

One of the imaging methods in the operating room is fluoroscopy or C-ARM device utilized in numerous surgical procedures, including angiography, neurosurgery, urology, and orthopedics (2). Radiation is generated and scattered in the operating room environment due to sequential exposure during surgery. It is necessary to observe specific radiation safety guidelines while working with operating room nurses. According to previous studies conducted in the field of radiation protection, the lack of knowledge of the personnel about the radiation and protection against the possible effects has irreparable consequences and can cause life and financial losses for the personnel, the patient, and the hospital (3-8). Many of the harmful effects of radiation can be minimized by increasing the level of knowledge, attitude, and practice of personnel (9).

Based on the literature review, few studies have been conducted to evaluate the knowledge, attitude, and practice of operating room personnel about radiation protection. Therefore, a comprehensive evaluation of all aspects of radiation protection in the operating room personnel could be useful in planning to prevent and reduce the possible risks of ionizing radiation. This cross-sectional descriptive study was designed and implemented with the aim of investigating the knowledge, attitude, and practices of operating room personnel in Birjand in the field of radiation protection in terms of economic, health, human, and ethical considerations.


Personnel employed in operating rooms of hospitals affiliated with Birjand University of Medical Sciences (Imam Reza, Valiasr, and Razi) were the subjects of this study from August 2022 to March 2023. The size of the entire community in this research was extremely large. For this reason, using Cochran’s formula, the minimum sample size was determined by considering the standard deviation of 0.05 and the error of 0.5. The implementation stages of the work began after obtaining permission from the Ethics Committee of our university. A questionnaire was used to measure knowledge, attitude, and practice. To evaluate the validity of the questionnaire, quantitative and qualitative contents were tested using content validity index and content validity ratio approaches. Its validity was confirmed by consulting with 6 experts in the fields of medical physics, radiation health, and operating rooms. To check the reliability, using the test-by-test method, the questionnaire was given to 10 employees in a preliminary study. This work was repeated two weeks later, and when Pearson’s correlation coefficient was calculated, the final questionnaire version’s overall reliability was found to be high (r = 0.81, P < 0.001). After checking the reliability and validity, the questionnaire was divided into the surgery departments of Imam Reza, Valiasr, and Razi Hospitals in Birjand. To comply with the principles of ethics, the questionnaire was designed anonymously. The questionnaire included 41 questions, the first part of which consisted of demographic information questions, including age, gender, level of education, employment status, and work experience, as well as a section on general radiation protection that discusses the as low as reasonably available (ALARA), film badges, dose limitations for occupational exposure, and the wearing of lead aprons during exams principle. There were 10, 16, and 14 questions pertaining to knowledge, attitude, and practice, respectively. After collecting the data, the necessary control actions were taken on the answers (including errors in completing the questionnaire or not recording the answers). The collected information was entered into and analyzed using SPSS software (version 22), with descriptive statistics tests, including an independent t-test, a one-way analysis of variance with a significant level (P< 0.05), and a chi-square test.


Overall, 210 people participated in answering the questionnaire questions, and five questionnaires were removed from the collected data due to incomplete answers. The results showed that about 64.9% of the participants were females. The majority of them had a bachelor’s degree (84.4%) and work experience above 10 years (52.7%), and their employment status was unofficial (54.1%). Most of the participants (64.4%) were in the age group of 30-40 years. The demographic information for this study is provided in Table 1. The frequency distribution of operating room personnel in the studied hospitals is illustrated in Figure 1, and the highest frequency is related to Razi Hospital with 86 questionnaires.

Table 1. Characteristics of the Study Participants’ Demographics
Variable Subgroup Frequency %
Age Under 30 years5225.4
30-40 years13264.4
Above 40 years2110.2
Gender Male 7235.1
Female 13364.9
Work experienceUnder 10 years9747.3
Above 10 years10852.7
Degree Associate 115.4
Master’s degree and physician2110.2
Type of employmentOfficial 9445.9
Figure 1.

Frequency Distribution of Data in the Investigated Teaching Hospitals

Most participants (61.9%) had low awareness of the fundamentals of radiation protection, according to the results regarding their level of knowledge. The findings of this research concerning performance and attitude demonstrated that the majority of participants (58.5%) had an average performance related to compliance with the principles of radiation protection, but about 64.9% of the studied population had a weak attitude towards radiation protection laws (Table 2). The knowledge score of operating room personnel (mean ± standard deviation) at Razi hospital was calculated as 66 ± 14, which is the highest score among the studied hospitals. Figure 2 displays the average knowledge, attitude, and practice of operating room staff in different hospitals.

Table 2. Knowledge, Practice, and Attitude of Operating Room Staff Regarding Compliance With Radiation Safety
Variable Level (%) Frequency % Mean±SD
Knowledge Desirable (above 60)3517.18.7 ± 2.1
Medium (40-60)4321
Weak (under 40)12761.9
PracticeDesirable (above 60)2713.29.6 ± 2.6
Medium (40-60)12058.5
Weak (under 40)5828.3
AttitudeDesirable (above 60)2411.78.3 ± 2.1
Medium (40-60)4823.4
Weak (under 40)13364.9

Note. SD: Standard deviation.

Figure 2.

Comparison of Knowledge, Attitude, and Practice of Operating Room Personnel Regarding Compliance With the Principles of Radiation Protection in Hospitals

The level of knowledge of the operating room personnel regarding compliance with the principles of radiation safety is according to different parameters (Table 3), based on which there is a noteworthy correlation between the degree of knowledge of the operating room staff and the level of education (P = 0.03) and work experience (P = 0.01) observed separately. People who had a bachelor’s degree in the operating room had a higher level of knowledge about the principles of radiation protection than people who had an associate’s degree, and people who were employed in the last ten years had a high level of knowledge about radiation protection.

Table 3. The Relationship Between Knowledge and Demographic Information
Variable Subgroup Mean Score (From 20) Standard Deviation P Value
Age Under 30 years6.75 ± 3.20.316
30-40 years11.2 ± 4.22
Above 40 years10.9 ± 2.21
Gender Male11.36 ± 3.040.214
Female8.96 ± 1.12
Work experienceUnder 10 years6.63 ± 1.140.01*
Above 10 years11.07 ± 1.87
Degree Associate5.32 ± 3.210.03*
Bachelor9.66 ± 2.23
Master degree and physician16.4 ± 4.23
Type of employmentOfficial10.9 ± 2.10.18
Unofficial8.36 ± 2.04

Note. * Significantly difference (P < 0.05).

Table 4 presents the operating room staff’s current performance status with regard to adhering to radiation protection principles. Based on the results, a significant relationship was observed between the performance of the operating room personnel and the level of education (P = 0.04), so that the senior experts working in the operating room with an average score of 14.4 performed better than the operating room associates with an average score of 5.72.

Table 4. The Relationship Between Practice and Demographic Information
Variable Subgroup Mean Score (From 20) Standard Deviation P Value
Age Under 30 years6.43 ± 4.20.475
30-40 years10.2 ± 5.13
Above 40 years12.9 ± 3.21
Gender Male10.36 ± 4.170.304
Female6.96 ± 2.14
Work experienceUnder 10 years5.71 ± 1.140.152
Above 10 years9.14 ± 1.87
Degree Associate5.32 ± 2.210.04*
Bachelor3.26 ± 2.11
Master degree and physician14.4 ± 3.10
Type of employmentOfficial12.9 ± 2.10.18
Unofficial6.36 ± 2.4

The attitude of the operating room personnel regarding compliance with radiation protection principles is provided in Table 5. The findings indicated that there was no statistically significant relationship between the attitude of the research units regarding compliance with the principles of radiation protection and age, gender, work experience, education level, and type of employment.

Table 5. The Relationship Between Attitude and Demographic Information
Variable Subgroup Mean Score (From 20) Standard Deviation P Value
Age Under 30 years8.75 ± 1.200.316
30-40 years10.2 ± 2.02
Above than 40 years9.9 ± 2.34
Gender Male9.36 ± 3.120.214
Female10.96 ± 1.40
Work experienceUnder 10 years8.36 ± 1.140.412
Above 10 years10.07 ± 1.87
Degree Associate7.72 ± 4.140.512
Bachelor7.66 ± 2.23
Master degree and physician15.4 ± 4.23
Type of employmentOfficial8.75 ± 1.200.18
Unofficial10.2 ± 2.02


The purpose of this study was to ascertain the radiation protection practices, attitudes, and knowledge of operating room staff employed by Birjand University of Medical Sciences affiliated hospitals. The results obtained in order to achieve data regarding the level of awareness and knowledge of operating room staff about the risks of radiation and compliance with radiation protection revealed that the majority of personnel in surgical departments of hospitals have a weak knowledge score about radiation protection.

The evaluation of the knowledge of operating room personnel about radiation protection demonstrated that the average knowledge score was higher in men than in women. Although gender did not have a significant effect on knowledge, the results showed that the knowledge score of male personnel in radiation protection was better than that of females. In a similar study conducted by Keshtkar et al, it was found that age, gender, and university degree have no significant impact on the knowledge and practice of radiographers and operating room personnel (9). In their study, Rassin et al found a lack of knowledge about the dangers of radiation (10). Dehghani et al reported that there is no significant difference between gender and awareness of radiation risks (11).

In this study, it was found that personnel with more than 10 years of work experience perform better on the principles of radiation protection, and the knowledge score of personnel with less than 10 years of work experience was lower. The findings of the present study showed a significant difference between the personnel’s work experience and knowledge. The results further represented that the practice of staff in complying with the principles of radiation protection improves with increased work experience. In a study conducted by Chien et al in China, it was concluded that practice level increases with work experience, but no significant relationship was observed between the time elapsed since the graduation of operating room personnel and their practice level (12). However, their findings are consistent with the findings of this research in terms of the absence of a significant relationship between gender and the level of knowledge, attitude, and practice.

The existing studies in the field of knowledge, attitude, and practice evaluation for radiation protection have been performed on the radiologist community working in radiology departments (13-18). In most of these studies, no significant relationship between the level of knowledge and performance and the gender, age, and type of employment of people has been reported, but the relationship between knowledge and practice and their work experience represented a significant difference. Söylemez et al also found a significant relationship between the level of knowledge, attitude, and practice and the individual’s work experience in the field of radiation protection (19). In another study, a significant difference was observed between the knowledge of young personnel (with under 3 years of work experience) and older personnel. The results of this research confirmed that scientific and experimental information together had a great impact on the performance of personnel in complying with the principles of radiation safety. The operating room personnel sometimes neglect to observe the principles of radiation protection and do not observe even the simplest actions, including the use of a shield apron (20). Totally, it is necessary to continuously train new operating room personnel and transfer the experiences of personnel with high work experience to them. The distinction between these studies is that in our study, a comprehensive questionnaire was designed to precisely assess the operating room staff’s capacity for radiation protection.


The results of this study demonstrated that staff members’ awareness of radiation safety in operating rooms is inadequate. Their behavior and attitude are impacted accordingly. The radiation safety equipment is not used extremely often. We propose making radiation safety lectures mandatory for all staff. Applying and giving the ALARA principle the weight it deserves is essential. In this context, having comprehensive training and radiation safety courses can be beneficial.

Competing Interests

The authors say they have no competing interests.

Data Availability Statement

The data supporting the study’s conclusions will be made available upon request from the corresponding author.

Ethical Approval

This study was approved by the Ethics Committee of Birjand University of Medical Sciences (Ethics No. IR.BUMS.REC.1401.214)


This study received funding and support from Birjand University of Medical Sciences.


  1. Szarmach A, Piskunowicz M, Świętoń D, Muc A, Mockałło G, Dzierżanowski J, et al. Radiation safety awareness among medical staff. Pol J Radiol 2015; 80:57-61. doi: 10.12659/pjr.892758 [Crossref] [ Google Scholar]
  2. Mahajan A, Samuel S, Saran AK, Mahajan MK, Mam MK. Occupational radiation exposure from C arm fluoroscopy during common orthopaedic surgical procedures and its prevention. J Clin Diagn Res 2015; 9(3):RC01-4. doi: 10.7860/jcdr/2015/10520.5672 [Crossref] [ Google Scholar]
  3. Mojiri M, Moghimbeigi A. Awareness and attitude of radiographers towards radiation protection. Arch Adv Biosci 2022; 2(4):2-5. doi: 10.22037/jps.v2i4.2714 [Crossref] [ Google Scholar]
  4. Shabani F, Hasanzadeh H, Emadi A, et al. Radiation Protection Knowledge, Attitude, and Practice (KAP) in Interventional Radiology. Oman Med J 2018; 33(2):141-147. doi: 10.5001/omj.2018.26 [Crossref] [ Google Scholar]
  5. Awosan KJ, Ibrahim M, Saidu SA, Ma’aji SM, Danfulani M, Yunusa EU, et al. Knowledge of radiation hazards, radiation protection practices and clinical profile of health workers in a teaching hospital in Northern Nigeria. J Clin Diagn Res 2016; 10(8):LC07-12. doi: 10.7860/jcdr/2016/20398.8394 [Crossref] [ Google Scholar]
  6. Mohapatra A, Greenberg RK, Mastracci TM, Eagleton MJ, Thornsberry B. Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg 2013; 58(3):702-9. doi: 10.1016/j.jvs.2013.02.032 [Crossref] [ Google Scholar]
  7. Lee RK, Chu WC, Graham CA, Rainer TH, Ahuja AT. Knowledge of radiation exposure in common radiological investigations: a comparison between radiologists and non-radiologists. Emerg Med J 2012; 29(4):306-8. doi: 10.1136/emermed-2011-200481 [Crossref] [ Google Scholar]
  8. Jentzsch T, Pietsch CM, Stigler B, Ramseier LE, Seifert B, Werner CM. The compliance with and knowledge about radiation protection in operating room personnel: a cross-sectional study with a questionnaire. Arch Orthop Trauma Surg 2015; 135(9):1233-40. doi: 10.1007/s00402-015-2257-z [Crossref] [ Google Scholar]
  9. Keshtkar M, Masoumi H. Evaluation of knowledge and practice of radiographers and operating room personnel about radiation protection: importance of training courses. Front Biomed Technol 2021; 8(4):311-316. doi: 10.18502/fbt.v8i4.7759 [Crossref] [ Google Scholar]
  10. Rassin M, Granat P, Berger M, Silner D. Attitude and knowledge of physicians and nurses about ionizing radiation. J Radiol Nurs 2005; 24(2):26-30. doi: 10.1016/j.jradnu.2005.04.001 [Crossref] [ Google Scholar]
  11. Dehghani A, Ranjbarian M, Mohammadi A, Soleiman-Zade M, Dadashpour-Ahangar A. Radiation safety awareness amongst staff and patients in the hospitals. Int J Occup Hyg 2015; 6(3):114-119. [ Google Scholar]
  12. Chien WT, Chan SW, Morrissey J. The perceived burden among Chinese family caregivers of people with schizophrenia. J Clin Nurs 2007; 16(6):1151-61. doi: 10.1111/j.1365-2702.2007.01501.x [Crossref] [ Google Scholar]
  13. Ramanathan S, Ryan J. Radiation awareness among radiology residents, technologists, fellows and staff: where do we stand?. Insights Imaging 2015; 6(1):133-9. doi: 10.1007/s13244-014-0365-x [Crossref] [ Google Scholar]
  14. Fatahi-Asl J, Tahmasebi M, Karami V. The protection knowledge and performance of radiographers in some hospitals of Ahvaz County. Jentashapir J Health Res 2013; 4(5):405-12. [ Google Scholar]
  15. Maharjan S. Radiation knowledge among radiographers and radiography students. Radiogr Open 2017; 3(1):1-17. doi: 10.7577/radopen.2000 [Crossref] [ Google Scholar]
  16. Horn-Lodewyk J, van der Merwe B, Kali GM, Munro L. Evaluating the knowledge and training of forensic pathologists and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa. Health SA 2022; 27:2014. doi: 10.4102/hsag.v27i0.2014 [Crossref] [ Google Scholar]
  17. Fiagbedzi E, Gorleku PN, Nyarko S, Asare A, Ndede GA. Assessment of radiation protection knowledge and practices among radiographers in the central region of Ghana. Radiat Med Prot 2022; 3(3):146-51. doi: 10.1016/j.radmp.2022.06.001 [Crossref] [ Google Scholar]
  18. Nakhzari Moghadam H, Tohidi FZ, Yazdi Sotoodeh Z, Sargazi V. Evaluation of knowledge and observance of protection and performance of radiologists in medical imaging centers of Zabol hospitals. Int J Early Child Spec Educ 2022; 14(3):3544-8. [ Google Scholar]
  19. Söylemez H, Sancaktutar AA, Silay MS, Penbegül N, Bozkurt Y, Atar M, et al. Knowledge and attitude of European urology residents about ionizing radiation. Urology 2013; 81(1):30-5. doi: 10.1016/j.urology.2012.07.097 [Crossref] [ Google Scholar]
  20. Rezaei Kahkhaei F, Sarani H. Surgical technologists’ knowledge and performance about radiation protection in Zahedan educational hospitals A descriptive-analytical study. J Educ Health Promot 2020; 9:283. doi: 10.4103/jehp.jehp_162_20 [Crossref] [ Google Scholar]