Minimization Strategy of Radiation Impact on Radiation Workers:

Columbia Asia Medan Hospital in 2018

Justinus Tambunan

, Felix Kasim

, Saiful Batubara

Columbia Asia Hospital, Medan, Indonesia

Faculty of Public Health Deli Husada Health Institute, Deli Tua, Indonesia

Faculty of Agriculture Universitas Islam Sumatera Utara,Medan, Indonesia

Keywords: policy, radiation, compliance, radiation protection

Abstract : The Radiology Services Unit is one of the supporting medical installations, using ionizing radiation sources

to diagnose the presence of a disease in the form of anatomical features displayed in the radiographic film.This

study aims to obtain in-depth information about the existence of a policy from Management that related to X-

Ray Radiation Protection and compliance of workers in carrying out their tasks in accordance with the rules

applicable in the use of Personal Protective Equipment and compliance with the system of justification,

optimization and limitation for safety workers.Descriptive qualitative research is to obtain or describe the

reality of the events studied so that objective data that will be obtained by way of in-depth interview and focus

group discussion as well as direct observation in the field.Policy is a rule that must be executed properly and

consistently in the field of radiation sources work, where the radiation has adverse effect to the workers, the

policies concerning to the standards of equipment, procedures, referrals, use of Personal Protective Equipment

and exercises. These policies must be obeyed by the workers for the safety from radiation and the impact can

be minimized properly and effectively.

1 INTRODUCTION

The use of ionizing radiation, including X-

rays in medicine, both for therapy and diagnostics is

common. Since the discovery of X-rays by Wilhelm

Conrad Roentgen in 1895 and the production of the

first radiographic equipment for clinical diagnostic

use, the basic principle of radiography has not

changed at all, namely producing an image on a

receptor film with a radiation source from an X-ray

beam that is experiencing absorption and attenuation

when passing through various organs or parts of the

body. (Lukman, 1991 in The use of ionizing radiation,

including X-rays in medicine, both for therapy and

diagnostics is common. Since the discovery of X-rays

by Wilhelm Conrad Roentgen in 1895 and the

production of the first radiographic equipment for

clinical diagnostic use, the basic principle of

radiography has not changed at all, namely producing

an image on a receptor film with a radiation source

from an X-ray beam that is experiencing absorption

and attenuation when passing through various organs

or parts of the body. (Lukman, 1991 in Sugiratu,

2012).

Radiology services must pay attention to aspects

of radiation safety. In addition to providing benefits,

these activities can also cause dangers to radiation

workers, the general public and the environment. The

danger that can be caused by the use of ionizing

radiation is the emergence of harmful radiation

effects for patients, workers and the general public.

Some of the effects of radiation on humans are:

a. Deterministic Effect

This effect arises in unusual conditions, for

example in conditions of radiation accidents

(acute radiation exposure), so there will be a

large number of cells that die, while the cell

replacement process is not balanced, so it will

greatly affect the body system.

b. Stochastic Effect

The effect of radiation does not completely

result in cell death, but can also change the cell.

In general, these changes will not significantly

affect the cell so that there will be no observable

effect, but it is possible that the changed cell can

affect the control system in the cell, which in

turn will cause the cell to divide faster than

Tambunan, J., Kasim, F. and Batubara, S.

Minimization Strategy of Radiation Impact on Radiation Workers: Columbia Asia Medan Hospital in 2018.

DOI: 10.5220/0009516003950402

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 395-402

ISBN: 978-989-758-460-2

395

normal cells. If these abnormal cells invade

normal tissue, they are called malignant cells

and the result of this is cancer. Cancer does not

appear immediately after people are exposed to

radiation but requires a long calm time. The

quiet time depends on the type of cancer but can

vary from two years (leukemia) to thirty years

or more for other types of cancer. In other

words, the smaller the radiation dose a person

receives, the less likely the effect will appear.

c. Hereditary Effects (Heredity effect)

If one reproductive cell (either a sperm cell or

an egg cell) is damaged by radiation, then there

is a possibility that this damage affects the first

offspring or offspring in the next generation. This

type of effect is known as the Heredity effect and

because it appears based on probability it is

grouped into stochastic effects. The risk of this

type of heredity effect is far less than the risk of

getting cancer (Sugiratu, 2012).

Based on this background above, researchon The

Strategy of Minimizing radiation on radiation

workers at Columbia Asia Medan Hospital in 2018,

was intended to be known.

X-ray radiation protection for worker safety and

related information will discuss protection in work

that complies with applicable regulations regarding

the use of personal protective equipment and is

related to the justification, optimization, and

limitations in radiation systems.

The demand for compliance to carry out

Radiation Safety Management is carried out to protect

patients, workers, community members, and the

environment from the dangers of radiation, as

stipulated in Perka BAPETEN No. 08 of 2011. The

regulation is by the theory of compliance (compliance

theory). According to Dr.Cialdini in the theory of

compliance, there are six principles that affect

compliance, one of which is closely related to the

radiation safety management system is the principle

of Commitment and Consistency, where in running a

system a strong commitment is needed to achieve

optimal results in minimizing the impact of radiation

and carried out consistently and thoroughly.

2 LITERATURE

X-rays are produced from X-ray tubes, which are a

tool to produce free electrons, accelerate and finally

hit a target (Batan, 2011) where X-rays are emitted

electromagnetic waves with very short wavelengths

and are categorized as one of the radiation ionizing

which can interact with biological cells and can cause

adverse effects on these cells. Therefore as a radiation

worker must comply with all forms of policy that

have been determined in terms of radiation

utilization.

The current radiation protection philosophy

dopted by the International Commission on Radiation

Protection (ICRP) in a statement governing radiation

dose limitation, which essentially follows:

a. An activity will not be carried out unless it has

a positive advantage compared to risk, known as

the justification principle

b. Radiation exposure is sought at the lowest

possible level (as lowas reasonably achievable,

ALARA), taking into account economic and

social factors, known as optimization principles.

c. Individual doses may not exceed the limits

recommended by the ICRP for a particular

environment, known as the principle of

limitation.

3 RESEARCH METODHS

This research was conducted in a descriptive

qualitative way to find out or describe the reality of

the events under study making it easier for writers to

obtain objective data using the action research

approach. Where in the data collection by means of

in-depth interviews (Indepth Interview) of key

informants and focus group discussions as well as

direct observation in the field of research related to

the Minimization of the Impact of Radiation on

Radiation Workers at Columbia Asia Medan Hospital

in 2018.In collecting data collected from in-depth

interviews with 3 informants as informants and 1

focus group discussion. In interviews and group

discussions the key words taken (coding) related to

the hazard factors of radiation so that the results of

these keywords can be analyzed in the discussion so

that the results obtained can create a strategy to

minimize the impact of the radiation hazards.

4 RESULTS AND DISCUSSION

In the results of the study, researchers explained the

interview process to all informants regarding the

extent of the Strategy. Minimization of the impact of

Radiation on radiation workers at Columbia Asia

Medan hospital. When conducting interviews from

sources of information, there are several key points

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

396

that are very dominant in taking steps - very

influential in suppressing radiation so that it does not

have a high impact on radiation workers

including:Policy and Compliance

.

In interviews that were found from all

informants, field observations and data search,

Columbia Asia Medan Hospital was also

complemented by policies from the central level of

Columbia Asia Indonesia in the form of Central

Policy CA-C / Rad / 01 / ID concerning the Scope of

Radiology Services, Central Policy CA -C / Rad / 04

/ ID regarding Inspection and Investigation Requests,

Central Policy CA-C / Rad / 09 / ID regarding

Equipment Maintenance.

 Columbia Asia Medan

Hospital is also equipped with several Standard

Operating Procedures (SOPs) relating to the

applicable Policy that have been established from the

Columbia Asia Indonesia Center, which are SPO

Radiology Services for Inpatients, SPO Radiology

Services for Outpatients, SPO Radiology Services for

Patients in the Emergency Unit, SPO Radiology

Equipment Maintenance, SPO Radiation Protection

in General, SPO CT Scan, SPO Mammography, SPO

General X-Ray. All SPOs are related to the

implementation of routine procedures in the

Radiology Section. From the completeness of

radiology facilities and infrastructure, the three

informants explained that the radiological

infrastructure facilities especially those related to

personal protection from radiation exposure are very

complete, but the compliance of the workers

themselves will use the personal protective

equipment and also when carrying out their duties in

the utilization of radiation. But in practice in the field

based on the focus group discussion, the informant

revealed the existence of non-compliance of the

officers in the use of Personal Protective Equipment,

following excerpts from the discussion of the opinion

group of Informant 4 implied that the officer was

inconsistent in the use of personal protective

equipment

... we should use it because we haven't used it

all this time ...

Likewise, this was corroborated in the interview

obtained from informant 2 about the use of personal

protective equipment whose impression was very

difficult to control the officer in terms of the use of

personal protective equipment such as the interview

informant 2

"If that is their negligence depends on each

individual. But if we have recommended it like that,

they don't want to use it, it might be individual

individuals. We can't do anything. "

In addition, officers must also comply with

the rules set by Bapeten No.8 of 2011 in terms of the

principle of justification where the officer performs

his duties if there is a radiological request referral

from a doctor and also as determined by applicable

regulations from the parent company of Columbia

Asia contained in Columbia Asia Central Policy CA-

C / Rad / 04 / ID regarding "Request for Examination

and Investigation / Ordering Tests and

Investigations" point 1 which contains Radiology

tests can only be ordered by a medical doctor /

Radiology Examination can only be instructed by a

medical doctor . But in the recognition of

Radiographers who carry out their duties in the

fieldset forth in group discussions there are only those

who examine without a referral from the sending

doctor. By looking at the excerpts from the discussion

results it can be concluded that the radiology service

system has not yet run optimally in terms of the

justification principle. And this is found in the field is

a patient who came not from the outpatient and

inpatient clinical services at Columbia Asia Hospital

but came directly from outside with various reasons

such as photo control that had previously been done.

Fulfill this so as not to be bumped into regulations and

authorized to enter examination services to all

sections including radiological examinations, the

radiology department requests the assistance of

hospital doctors to conduct examinations to include

radiology services for the smooth flow of radiology

services at Columbia Asia Medan Hospital in

accordance with Central Columbia Asia CA-C / Rad

/ 04 / ID Policy on "Request for Examination and

Investigation / Ordering Tests and Investigations"

point 3 whose contents are OTC (over the counter)

cases without an appropriate requisition shall be

screened by an in-house doctor before the

investigation is carried out / OTC (over the counter)

cases without proper application will be screened by

an in-house doctor before the examination is carried

out.

From the results obtained in the study, in

terms of radiology equipment maintenance went well

and consistently in carrying out regular and

continuous calibrations. And the use of individual

personnel measuring instruments is also consistent in

their use and measured in the BPFK laboratory (Balai

Safeguard Health Facilities) running well and the

results obtained in measurements during 2017 the

results are still in the safe zone and below 20 mSv /

Minimization Strategy of Radiation Impact on Radiation Workers: Columbia Asia Medan Hospital in 2018

397

year as the following table. The human body is

exposed to large doses of nuclear radiation will

experience acute radiation syndrome (ARS) or

radiation poisoning that can lead to death. The

severity and symptoms that arise depends on how

much nuclear radiation is absorbed by the body. The

amount of radiation absorption depends on the

strength of the radiation energy and the distance of

the body to the radiation source. Signs and symptoms

of nuclear radiation poisoning may not appear

immediately when the body is exposed to large

amounts of nuclear radiation. Symptoms may only

appear within a few hours, up to weeks after exposure

to radiation. Nuclear radiation sickness cases have

started to boom since the explosion of the Hiroshima

and Nagasaki atomic bombs in Japan. Even more

devastating was when the Chernobyl nuclear power

plant in Ukraine exploded and devastated the city.

The damaged nuclear reactor released radioactive

iodine and cesum. The material is believed to have

caused hundreds of thousands of Chernobyl nuclear

power plant workers to die, either during the incident

or due to nuclear radiation arising after the incident.

Some types of radiation have enough energy to ionize

the particles. In general, this involves an electron that

is 'thrown' from the electron shell, which will give a

(positive) charge. This is often disruptive in the

biological system, and can cause mutations and

cancer. This type of radiation generally occurs in

radioactive waste and radioactive waste. The three

main types of radiation are found by Ernest

Rutherford, Alpha, Beta, and gamma rays. The

radiation was discovered through a simple

experiment, Rutherford used a radioactive source and

found that the resulting beam hit three different

regions. One of them is positive, one of them is

neutral, and one of them is negative. With this data,

Rutherford concluded that radiation consists of three

rays. He gave names taken from the first three letters

of the Greek alphabet namely alpha, beta, and

gamma. t low doses, body cells exposed to radiation

are still able to recover themselves in a short time.

Damaged cells will only die and be replaced by new

cells. However, at high doses, damaged cells will

multiply to become cancer cells (especially if your

lifestyle supports being exposed to cancer such as

smoking, consumption of carcinogens-prone foods,

and so). Exposure to radiation at high doses in one

time or short term will also cause some symptoms

(called acute radiation syndrome) on your body such

as nausea, vomiting, diarrhea, fever, weakness until

fainting, hair loss, skin flushing, itching, swelling

until burning, pain to convulsions. These symptoms

will certainly be different if you are exposed for a

long time. Sometimes the sensitivity of one's body

also affects the impact of radiation exposure on one's

body. For example, gamma radiation as much as 400

brakes will cause death to someone if exposed to two

different times, with a span of 30 days. However, the

same dose will not even have any effect if we are

exposed for one year in smaller evenly distributed

doses. The radiation we receive at all times, including

radiation for medical purposes, has positive and

negative impacts on human safety and the

environment. The positive effects of radiation on

human safety include being used as a treatment and

the negative effects are dependent on the large dose

received including starting from nausea, vomiting,

dizziness, hair loss, causing cancer, genetically

inherited, and even more dangerous is cause death.

Therefore we must be careful of the dangers it poses,

both to radiation workers and the general public

including patients. Protection against the dangers

posed by radiation is known as radiation protection.

So that the dose received annually by workers or the

general public does not exceed the dose limit set by

Bapeten. Various efforts have been made to minimize

these hazards so that workers and patients feel safe

doing and subjected to medical measures. Radiation

is energy that is emitted in the form of particles or

waves. Radiation is divided into two types, namely

ionizing radiation (large dose radiation) and non-

ionizing radiation (low dose radiation). The type of

radiation that is at high risk of causing health

problems is ionizing radiation. One can be exposed to

this type of nuclear radiation from nuclear energy

transmitting machines, such as on CT scans and X-

rays, or through nuclear bomb explosions and nuclear

reactor leaks. The impact of exposure to nuclear

radiation in high doses is very deadly. But this rarely

happens in regions or countries that do not use much

nuclear power as a source of electricity. If exposed to

nuclear radiation, be sure to remove all clothing

attached to the body to prevent additional

contamination, and immediately wash the affected

body part or skin with soap and water.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

398

Table 1: Limit Doses of Individual Radiology Officers Columbia Asia Hospital Medan in 2017

Name of the

officer

Jan-

Mar

Apr -Juni Jul-Sept Okt-Des Dose

Amount /

Year

2017

ose determined

/ year by

BAPETEN

mSv

01 Radiologist 1 0,0082 0,0100 0,01 0,01 0,0382 20

02 Radiologist 2 0,034 0,0100 0,0351 0,01 0,0891 20

03 Radiologist 3 0,0090 0,0065 0,01 0,01 0,0355 20

04 Radiografer 1 0,0582 0,0328 0,0358 0,0355 0,1623 20

05 Radiografer 2 0,0723 0,0495 0,0753 0,0501 0,2472 20

06 Radiografer 3 0,0611 0,0553 0,057 0,0771 0,2505 20

07 Radiografer 4 0,0946 0,0213 0,0637 0,0293 0,2089 20

08 Radiografer 5 0,0634 0,0659 0,0661 0,0455 0,2409 20

09 Radiografer 6 0,1835 0,2362 0,0839 0,0863 0,5899 20

10 Radiografer 7 0,0316 0,0300 0,0156 0,369 0,4463 20

11 Radiografer 8 0,0455 0,0560 0,0455 0,0432 0,1902 20

12 Radiografer 9 0,0786 0,0553 0,0668 0,0367 0,2374 20

13 Radiografer 10 0,0306 0,0293 0,0321 0,016 0,108 20

14 Radiografer 11 0,0703 0,0465 0,0585 0,0294 0,2047 20

15 Radiografer 12 0,030 0,0587 0,1825 0,1119 0,3831 20

16 Radiografer 13 0,0288 0,0296 0,0379 0,039 0,1353 20

17 Radiografer 14 0,0750 0,1052 0,063 0,0783 0,3215 20

5 CONCLUSION

Based on the results and discussion of the research

that has been submitted, the conclusions can be

drawn as follows:

1. All radiology measures must refer to the applicable

policy, namely the existence of standardization of

calibrated radiology equipment, the existence of

Standard Procedures in conducting examinations,

referral of sending doctors, use of Personal Protective

Equipment and continuous training.

2. From compliance, Officers do not consistently use

Personal Protective Equipment (PPE), which in

principle every time implementing PPE procedures

must be used as an effort to minimize radiation

hazards.

3. The absence of a provision from theManagement

or Radiology department willlimits of the number of

procedures set for each radiation worker in carrying

out his work.

This conclusion can be illustrated by the

Schematic Relationship Between Components in the

Strategy to Minimize the Impact of Radiation on

Radiation Workers at Columbia Asia Medan

Hospital in 2018.

6 SUGGESTION

Based on the conclusions drawn, it is recommended:

1. All Radiation Workers must better understand the

importance of using Personal Protective Equipment /

Radiation Protection, where radiation is invisible but

has a biological effect on people exposed to radiation.

2. Management should send workers to a special

radiation protection training to be more caring and

responsible again.

3. With an individual NBD (Dose Limit Value) result

below 20 mSv / year, the part should be able to make

a quality achievement target in terms of establishing

Minimization Strategy of Radiation Impact on Radiation Workers: Columbia Asia Medan Hospital in 2018

399

NBD standards in the radiology section called the

Dosing Constrain.

4. Hospital Management, in this case, the Radiology

manager can make a limit on the number of

procedures for workers for the creation of radiation

safety and the achievement of minimization of the

impact of radiation for workers

ACKNOWLEDGEMENTS

My deep thanks to DELI HUSADA Deli Tua Health

Institute for providing the opportunity for all lecturers

on this beloved campus to gain Knowledge in Writing

the Scientific Journal and provide new Experiences in

holding the International Conferences. Hopefully

with the implementation of this activity in the future

I can contribute to the progress of DELI HUSADA

Deli Tua Health Institute.

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APPENDIX

Radiation Unit

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