CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

The utilization of ionizing radiation in modern medical procedures has revolutionized healthcare,
providing clinicians with sophisticated tools for the accurate diagnosis and effective treatment of
a wide range of medical conditions (Frush & Applegate, 2015). Diagnostic imaging modalities
such as X-rays, computed tomography (CT), and therapeutic interventions like radiotherapy have
greatly enhanced the ability of medical professionals to detect and manage diseases at earlier and
more treatable stages, thereby improving patient outcomes (Frush & Applegate, 2015; Hart &
Wall, 2019). However, while the clinical benefits of ionizing radiation are undeniable, its
application, particularly among vulnerable groups such as paediatric patients, necessitates
meticulous attention to radiation safety protocols to mitigate potential adverse effects (Mettler,
2017).

Children are particularly sensitive to the harmful effects of ionizing radiation for several
compelling biological and physiological reasons. First, paediatric patients possess rapidly
dividing cells that are inherently more susceptible to radiation-induced DNA damage compared
to the relatively slower cellular turnover observed in adults (Huang, 2016). This heightened
cellular activity increases the likelihood that mutations caused by radiation exposure will be
propagated, potentially leading to carcinogenesis over time (Huang, 2016). Furthermore, given
their longer remaining lifespan, children have a substantially greater window of time during
which latent radiation-induced effects, such as malignancies or genetic abnormalities, may
manifest (Dauer, 2017). This extended period of risk underscores the critical importance of
minimizing radiation exposure during paediatric imaging and therapy, adhering strictly to the
principles of justification, optimization, and dose limitation as outlined et al Moreover, several
epidemiological studies have demonstrated a correlation between radiation exposure in
childhood and an elevated incidence of malignancies such as leukaemia, thyroid cancer, and
brain tumors later in life (Mathews, 2017; Belson, 2019). The biological mechanisms underlying
this increased vulnerability include not only the higher mitotic rate of paediatric tissues but also
the differential sensitivity of various organs at different stages of development, with some organs
exhibiting peak radio sensitivity during early childhood (UNSCEAR, 2020). Consequently, the
practice of paediatric radiology and radiotherapy demands a greater level of vigilance, expertise,
and adherence to child-specific radiation protection measures compared to adult procedures
(Kamp, 2020).

Recognizing these unique vulnerabilities, international organizations such as the International

Commission on Radiological Protection (ICRP) and the World Health Organization (WHO) have
emphasized the need for special protective strategies in paediatric radiological practices. These
include the use of tailored imaging protocols, age- and size-specific dose adjustments,
application of shielding devices, and thorough justification of each radiological procedure to
ensure that the expected clinical benefits outweigh the potential radiation risks (ICRP, 2021;
WHO, 2016). Failure to implement such measures adequately not only places paediatric patients
at an unnecessary risk of harm but also contravenes established ethical and professional
standards in medical practice (Einstein, 2020).

Radiographers play a critical role in the safe delivery of radiation through diagnostic imaging
and therapeutic procedures. They are tasked with implementing radiation protection principles
that minimize patient exposure without compromising image quality or treatment effectiveness
(Vano, 2017). The principle of ALARA “As Low as Reasonably Achievable”—remains the
cornerstone of paediatric radiation protection practice, ensuring that every radiation exposure is
justified and optimized (European Commission, 2018).

Radiographers, therefore, are not merely technical operators but are essential guardians of patient
safety within the broader healthcare system, particularly when it comes to paediatric patients
whose vulnerability to ionizing radiation demands heightened vigilance (Vano, 2017; Kiljunen,
2018). Their role encompasses a broad spectrum of responsibilities that include patient
education, careful selection of imaging parameters, strict adherence to standardized protocols,
and active collaboration with radiologists, referring physicians, and medical physicists to ensure
that imaging studies are both clinically justified and optimally performed (Seuri, 2018). By
engaging in continuous education and training on radiation protection updates and technological
innovations, radiographers enhance their competency to tailor imaging protocols according to
patient size, age, and clinical indications, thus embodying the principle of personalized radiology
(Seuri, 2018; European Society of Radiology, 2021).
The application of the ALARA principle is particularly vital in paediatric imaging where there is
no truly "safe" threshold of ionizing radiation; instead, every dose carries a stochastic risk that
must be minimized to the greatest extent feasible (European Commission, 2018; Vano, 2017).
This necessitates a strategic approach to imaging that includes the use of dose-reduction
technologies such as automatic exposure control, tube current modulation, iterative
reconstruction techniques, and the employment of alternative, non-ionizing imaging modalities
such as ultrasound and magnetic resonance imaging (MRI) whenever clinically appropriate
(Brady, 2021; Kanal, 2020). Radiographers must exercise critical judgment in balancing the need
for diagnostic accuracy against the imperative to reduce radiation exposure, ensuring that high-
quality diagnostic images are obtained with the lowest reasonable dose (Franz, 2022).

Furthermore, informed consent and communication with the child’s caregivers form a pivotal
part of the radiographer’s responsibility. Transparent dialogue regarding the benefits, risks, and
protective measures involved in paediatric imaging fosters trust, reduces anxiety, and aligns the
healthcare team with the family in safeguarding the child’s well-being (Einstein, 2020; Dauer,
2017). Educational initiatives, such as the “Image Gently” campaign, have highlighted the
importance of empowering healthcare providers and parents alike with knowledge about
radiation risks and safety practices, emphasizing a collaborative approach to paediatric
radiological care (Frush & Applegate, 2015; Strauss, 2019).

As paediatric imaging technologies continue to evolve—introducing innovations such as spectral

CT, low-dose fluoroscopy, and advanced image reconstruction algorithms—the role of the
radiographer will inevitably expand to include expertise in new modalities and greater
involvement in protocol development and dose optimization research (Franz, 2022; Mahesh,
2019). A proactive commitment to professional development will therefore be essential in
maintaining the highest standards of paediatric radiation protection, ensuring that radiographers
remain at the forefront of safe, effective, and compassionate imaging care (European Society of
Radiology, 2021; Kanal, 2020).

Institutional leadership plays a pivotal role in empowering radiographers to fulfil these expanded
responsibilities. Healthcare organizations must foster a culture that prioritizes radiation safety
through the provision of up-to-date equipment, the implementation of standardized paediatric
imaging protocols, and the establishment of multidisciplinary radiation safety committees
(Kamp, 2020; European Society of Radiology, 2021). Regular internal audits, peer reviews, and
incident reporting mechanisms are essential tools that support a transparent and continuous
quality improvement process (ICRP, 2021; Franz, 2022).

Despite international recommendations and guidelines, several studies indicate a gap in the
adherence to radiation protection protocols among radiographers, especially in low-resource
settings (Donadille, 2019). In paediatric radiology, lack of adequate training, absence of child-
specific protocols, and limited availability of paediatric-appropriate equipment further exacerbate
the risk of unnecessary radiation exposure (Ofori, 2020). Additionally, therapeutic exposures in
paediatric oncology—such as radiotherapy—require precise planning and shielding to avoid
damage to developing tissues and organs (Vasconcelos, 2021).

The gap between recommended radiation safety practices and their real-world implementation is
particularly pronounced in under-resourced healthcare environments, where infrastructural and
systemic challenges prevail (Ofori, 2020; Donadille, 2019). Many radiology departments in such
settings continue to rely on outdated equipment that lacks dose-reduction technologies, making it
difficult to optimize imaging parameters for paediatric patients (Mawuli, 2022). Even when
newer equipment is available, inadequate maintenance, limited user training, and absence of
standard operating procedures tailored for children undermine efforts to minimize radiation
exposure (Ayinmode, 2021).

Furthermore, the shortage of specialized paediatric radiographers and medical physicists

compounds the issue. In many facilities, general radiographers with limited paediatric-specific
training are tasked with imaging children, often without sufficient understanding of the unique
anatomical and physiological differences that necessitate adapted imaging protocols (Ofori,
2020; Vasconcelos, 2021). This gap in expertise can lead to inappropriate technique selections—
such as using adult exposure settings on paediatric patients—which significantly elevates
radiation doses without a corresponding diagnostic benefit (Franz, 2022).

1.2 JUSTIFICATION OF THE STUDY

A significant concern in paediatric imaging within these contexts is the frequent adoption of
adult imaging protocols for children, a practice largely borne out of necessity due to the absence
of tailored paediatric procedures (Aliyu, 2021). Adult protocols, typically designed for larger
body masses and different physiological characteristics, often result in unnecessary radiation
doses when applied to smaller, more radiosensitive paediatric patients. This mismatch not only
heightens the risk of radiation-induced conditions but also compromises the diagnostic quality of
images, as adult settings may not adequately capture the fine anatomical details necessary for
accurate paediatric diagnosis (Aliyu, 2021; Franz, 2022). Without systematic efforts to adapt
imaging parameters based on patient size, age, and clinical indications, the core principles of
justification and optimization, central to radiation protection, are severely undermined.

Given these pervasive challenges, it becomes increasingly imperative to systematically evaluate

the level of adherence to established radiation protection measures by radiographers, both in
diagnostic and therapeutic settings (Olowookere, 2023). Regular assessments would not only
provide crucial evidence on current practice gaps but also inform policy development aimed at
strengthening radiation safety frameworks. Furthermore, such evaluations would highlight the
pressing need for continuous professional education and the establishment of structured
paediatric imaging protocols that are contextually appropriate (Olowookere, 2023). Evidence
generated from these evaluations would be instrumental in guiding resource allocation, ensuring
that investments are strategically directed towards upgrading equipment, enhancing training
programs, and fostering a culture of safety consciousness among healthcare providers.

The bridging the gap between recommended radiation protection practices and their
implementation in Nigeria and similar developing countries requires a concerted, multi-level
approach. Strengthening infrastructure, enforci