european journal of radiology -...

Aprc

LDa

b

c

2

a

ARRA

KRMRREA

1

rpo

(

h0

European Journal of Radiology 86 (2017) 135–142

Contents lists available at ScienceDirect

European Journal of Radiology

journa l homepage: www.e lsev ier .com/ locate /e j rad

wareness of radiation protection and dose levels of imagingrocedures among medical students, radiography students, andadiology residents at an academic hospital: Results of aomprehensive survey

orenzo Faggioni (MD PhD) a,∗, Fabio Paolicchi (RT PhD) a, Luca Bastiani (PhD) b,avide Guido (PhD) c, Davide Caramella (MD) a

Department of Diagnostic and Interventional Radiology, University of Pisa, Via Roma 67, 56100, Pisa, ItalyInstitute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124, Pisa, ItalyUnit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2,7100, Pavia, Italy

r t i c l e i n f o

rticle history:eceived 7 June 2016eceived in revised form 14 August 2016ccepted 29 October 2016

eywords:adiation protectionedical students

adiology residentsadiography studentsducation and trainingcademic hospital

a b s t r a c t

Purpose: To evaluate the awareness of radiation protection issues and the knowledge of dose levelsof imaging procedures among medical students, radiology residents, and radiography students at anacademic hospital.Material and methods: A total of 159 young doctors and students (including 60 radiology residents, 56medical students, and 43 radiography students) were issued a questionnaire consisting of 16 multiplechoice questions divided into three separated sections (i.e., demographic data, awareness about radiationprotection issues, and knowledge about radiation dose levels of common radiological examinations).Results: Medical students claimed to have at least a good knowledge of radiation protection issues morefrequently than radiology residents and radiography students (94.4% vs 55% and 35.7%, respectively;P < 0.05), with no cases of perceived excellent knowledge among radiography students. However, theactual knowledge of essential radiation protection topics such as regulations, patient and tissue suscep-tibility to radiation damage, professional radiation risk and dose optimisation, as well as of radiationdoses delivered by common radiological procedures was significantly worse among medical studentsthan radiology residents and radiography students (P < 0.05). Those latter significantly outperformedradiology residents as to knowledge of radiation protection issues (P < 0.01). Overall, less than 50% of

survey respondents correctly answered all questions of the survey.Conclusions: Radiology residents, radiography students and medical students have a limited aware-ness about radiation protection, with a specific gap of knowledge concerning real radiation doses ofdaily radiological examinations. Both undergraduate and postgraduate teaching needs to be effectivelyimplemented with radiation safety courses.

© 2016 Elsevier Ireland Ltd. All rights reserved.

. Introduction

The recent dramatic evolution and increased use of ionising

adiation-based diagnostic modalities such as multidetector com-uted tomography (CT) has led to a multiplication of the numberf examinations and hence of the overall radiation exposure to

∗ Corresponding author.E-mail addresses: [email protected], [email protected]

L. Faggioni).

ttp://dx.doi.org/10.1016/j.ejrad.2016.10.033720-048X/© 2016 Elsevier Ireland Ltd. All rights reserved.

the population, with CT currently accounting for about 50% of thetotal radiation burden for medical purposes [1,2]. This situation hasraised concerns in the scientific community about the potential sideeffects on patients, with particular reference to radiation-relatedcancer and death [2,3]. Moreover, several papers have recentlyshown a small, but significant increase of cancer risk in children andyoung patients with previous exposure to CT scans [3–5], paralleled

by a measurable increase in radiation-induced DNA damage follow-ing several radiologic examinations that correlates with radiationdose [6,7]. In this setting, a full awareness of radiation protectionissues and a proper knowledge of the radiation doses delivered by

dx.doi.org/10.1016/j.ejrad.2016.10.033http://www.sciencedirect.com/science/journal/0720048Xhttp://www.elsevier.com/locate/ejradhttp://crossmark.crossref.org/dialog/?doi=10.1016/j.ejrad.2016.10.033&domain=pdfmailto:[email protected]:[email protected]/10.1016/j.ejrad.2016.10.033

1 rnal o

tio

vutEmissrsoattapirrfparatea

cpi

2

2

RpTldwsgaPora

3jw

•

•

36 L. Faggioni et al. / European Jou

he various imaging modalities are essential to make sure that allnvolved professionals adhere to up-to-date appropriateness andptimisation criteria [8].

General training about radiation protection should be pro-ided starting from undergraduate courses and followed by specificpdate courses, as requested by the Guidelines on radiation pro-ection education and training of medical professionals in theuropean Union no. 175 (2014), which has set the standard ofinimum knowledge expected from each and every practitioner

nvolved in radiation protection [9]. In the past decade, severaltudies conducted on selected cohorts of referring physicians andtaff radiologists and technologists unveiled an alarming lack ofadiation protection knowledge among them. In particular, a sub-tantial amount of professionals resulted to be underestimating theverall radiation doses associated with various imaging modalities,nd in some cases, they were even unable to correctly differen-iate between ionising and non-ionising radiation-based imagingechniques [10–12]. Such disappointing findings warrant a system-tic, comprehensive evaluation of the knowledge of basic radiationrotection issues needed for daily practice by students in train-

ng (such as medical students, radiography students, and radiologyesidents), in an attempt to gain insight about the current status ofadiation protection education among those who will order, per-orm or interpret medical imaging examinations in their futurerofessional life. In this perspective, the advantages of creating

positive radiation safety culture in the higher education andesearch sectors have been outlined, with continuous educationnd testing for all people involved (including students duringheir training period) being key to optimise performance, minimiserrors, and protect the entire workforce as well as the general publicnd the environment [13–15].

The aim of our work is to assess the degree of subjectively per-eived knowledge and effective knowledge of essential radiationrotection and dose assessment topics across a population of med-

cal students, radiography students and radiology residents.

. Material and methods

.1. Data collection

Data were obtained from a survey conducted in a group ofadiology residents and undergraduate students by a multidisci-linary “dose team” between January 1 and December 31, 2015.he survey was designed to assess the knowledge of dose exposure

evels and awareness of radiation protection among radiology resi-ents, medical students, and radiography students. Questionnairesere distributed on the occasion of university classes that medical

tudents attend during the 5th year of their six-year course, radio-raphy students during the 2nd year of their three-year course,nd radiology residents during their five-year course, respectively.rior to the survey, participants had been informed that the resultsf the questionnaire would be stored in a database and used foresearch purposes only. Participation to the survey was voluntarynd completely anonymous.

A total of 159 young doctors and students (radiology residents7.74%, medical students 35.22%, radiography students 27.04%)

oined the survey. This latter was divided into three sections, ofhich:

Section 1 (Demographics and Perceived radiation protectionskills) contained the demographic data of each survey partici-

pant, as well as including their degree of training and perceivedradiation protection knowledge;Section 2 (Radiation protection awareness) was focused onassessing: (1) radiation standards (2) susceptibility to radiation

f Radiology 86 (2017) 135–142

damage, (3) regulations, (4) knowledge about professionals witha higher exposure risk, (5) tissues more susceptible to injury fromionising radiation, (6) diseases caused by radiation damage, and(7) knowledge about dose optimisation;

• Section 3 (Knowledge about radiation dose levels) investigatedspecific topics, such as: (1) average dose of a postero-anteriorchest X-ray (considered as a common reference unit to compareradiation exposure from different radiological examinations); (2)background radiation dose absorbed by the general population;(3) lumbar spine X-ray dose; (4) mammography dose (bilateral,two projections per side); (5) chest CT dose; (6) pelvic mag-netic resonance imaging (MRI) dose; (7) 18-fluorodeoxiglucosepositron emission tomography-computed tomography (18F-FDGPET-CT) dose; (8) abdominal ultrasound (US) dose; (9) myocardialscintigraphy dose (2-day protocol with 99mTC-sestamibi) [16].

All questions of Sections 2 and 3 were formulated in a multiplechoice format with five to six options and one only correct answer.One mark was assigned for each correct answer and zero marks foreach wrong or missing answer, respectively (Appendix).

2.2. Statistical analysis

A descriptive analysis of the sample was performed. Categoricalvariables were expressed as percentages, and continuous variablesas mean and standard deviation, respectively. The total question-naire score and the two subscales (Radiation Protection and DoseAssessment) were expressed as median and interquartile ranges(IQR) and displayed on box-plot diagrams.

The score differences related to three questionnaire sec-tions among the three groups (radiology residents, medicalstudents, radiography students) were evaluated using the Kruskal-Wallis test. Post-hoc analysis was performed using pairwiseMann–Whitney tests with Bonferroni correction. The questionnairereliability was assessed in terms of internal consistency by meansof the Cronbach’s alpha (�) coefficient [mean and 95% confidenceintervals (CI95)].

A P-value less than 0.05 was set as threshold for statistical sig-nificance. Statistical analysis was carried out using software (SPSSversion 23.0, http://www-01.ibm.com/software/analytics/spss).

3. Results

The demographics of the survey participants in terms of age andgender distribution, perceived radiation protection knowledge, andpreviously performed training are reported in Table 1. All 159 par-ticipants completed the questionnaire. Mean age was 29.4, 23.8,and 22.5 years old for radiology residents, medical students andradiography students, respectively. Gender distribution was com-parable across the three categories (43.1%, 48.2%, and 44.2% of malepercentage, respectively; Chi-square test, P > 0.05).

As reported in a previous paper of ours [16], the questionnairewas found to have acceptable internal reliability (� = 0.780; CI950.762 ÷ 0.852) as a measure of knowledge of essential radiationprotection topics. The internal consistency of the questionnaire wasalso assessed separately among the radiology residents, medicalstudents, and radiography students. Cronbach’s � coefficients were0.760 (CI95 0.746 ÷ 0.796), 0.727 (CI95 0.688 ÷ 0.744) and 0.797(CI95 0.696 ÷ 0.835), respectively.

As to the perceived knowledge of radiation protection issues,medical students claimed to have at least a good knowledge

in 94.4% of cases (22.2% excellent, 72.2% good), resulting inthe highest value among the other categories of survey par-ticipants. In fact, radiology residents claimed to have at leasta good knowledge in 55% of cases (5% excellent, 50% good),

http://www-01.ibm.com/software/analytics/spsshttp://www-01.ibm.com/software/analytics/spsshttp://www-01.ibm.com/software/analytics/spsshttp://www-01.ibm.com/software/analytics/spsshttp://www-01.ibm.com/software/analytics/spsshttp://www-01.ibm.com/software/analytics/spsshttp://www-01.ibm.com/software/analytics/spsshttp://www-01.ibm.com/software/analytics/spss

L. Faggioni et al. / European Journal of Radiology 86 (2017) 135–142 137

Table 1Sample demographics (age, gender, and level of radiation protection awareness and training). SD = standard deviation. *F-test statistic by Anova, **Chi-square test, ***Fisher’sexact test. P < 0.05 indicates statistical significance.

Radiology residents (N = 60) Medical students (N = 56) Radiography students (N = 43) P-value

Age (mean; SD) 29.4 (3.3) 23.8 (1.6) 22.5 (3.7) 0.05**

Perceived knowledge (%)Excellent 5.0 22.2 0

138 L. Faggioni et al. / European Journal of Radiology 86 (2017) 135–142

F se levea ts (c). a

4

adbwawtoitdoih

ocsadhw

ig. 1. Distribution of scores related to knowledge of radiation protection (a), dossessment) among radiology residents, medical students, and radiography studennd maximum values. P-values indicate statistical significance.

. Discussion

Over the last years, the evolution of medical imaging has led to broadening of the clinical indications to several imaging proce-ures, and consequently to a multiplication of imaging requestsy referring clinicians. This is especially true for CT, due to itsidespread availability even in peripheral centres, fast image

cquisition time, and excellent spatial and contrast resolution,hich allows to obtain a wealth of morphological and even func-

ional information from a single one-stop shop study. On thether hand, such progress has spawned concern on the related

ncrease in radiation exposure to patients and the overall popula-ion, prompting efforts towards a systematic reduction of radiationoses through the development of dose-saving tools [17] and theptimisation of radiological resources, including dose auditing and

nitiatives aimed to improve radiation protection culture amongealthcare operators [18–20].

To the best of our knowledge, this is the first report of a surveyn the basic aspects of radiation protection (both subjectively per-eived and objectively tested through a structured questionnaire)imultaneously involving medical students, radiology residents

nd radiography students all studying or working in the same aca-emic hospital. Strikingly, medical students resulted to have theighest perceived knowledge on radiation protection issues (100%,ith 22.2% of them self-rating as excellent), but reported the worst

l assessment (b), and overall knowledge (i.e. radiation protection and dose levelBox plot diagrams show the distribution of median, interquartile range, minimum

scores in objective tests (12.5% of 100% correct answers for gen-eral radiation protection questions, and 0% for average dose levelsof common imaging techniques, respectively). It should be notedthat all medical students involved were attending the fifth year oftheir 6-year undergraduate programme (including both theoreticaleducation and practical training in medical wards since the secondhalf of the third year) at the time of the survey, so that a basicpreparation on the main radiation protection issues as presentedin the questionnaire would have been expected. Yet, such a lackof knowledge was paralleled by a high degree of self-confidence,likely due to a simplistic view about radiation protection topicsthat ultimately led to an overestimation of their own knowledge.A potential explanation for this may be a general understatementof radiation protection culture, which may have been engenderedby a poor knowledge itself as well as by a lack of familiarisationwith such topics during academic training. Such findings are sub-stantially in line with the literature [10,12,21,22], and in particular,Zhou et al. showed that the awareness of ionising radiation fromdiagnostic imaging was lacking among senior medical students andinterns, with as high as 11.3% and 25.5% of respondents believingthat US and MRI involve the use of ionising radiation, respectively

[12]. It is worth noting that in this latter paper, interns from threeteaching hospital performed significantly better than fourth to sixthyear medical students, underscoring the importance of systematicexposure to real-life training. Moreover, O’Sullivan et al. showed

L. Faggioni et al. / European Journal of Radiology 86 (2017) 135–142 139

F phy sq aire). C

toaatpci

ig. 2. Descriptive statistics of radiology residents’, medical students’, and radiograuestions from 1 to 4; b, questions from 5 to 7 of Section 2 of the survey questionn

hat medical students attending yearly modules of clinical radi-logy education over their 5-year undergraduate programme had

significantly greater awareness of radiation exposures associ-ted with diagnostic imaging examinations than students followinghe regular programme [23], suggesting that continuous radiation

rotection education may be more effective at providing medi-al students with adequate radiation protection skills. Anyway, its clear that such understatement of radiation protection educa-

tudents’ answers to survey questions about general radiation protection issues (a,orrect answers are boxed. IR = ionising radiation.

tion might have dangerous consequences, potentially resulting inan increased number of inappropriate requests for imaging tests,unnecessary higher radiation exposure to patients (as well as tooperators, in case of interventional procedures), and extra health-care costs [13,23–25].

On the other hand, radiology residents and radiography studentspossessed a significantly better knowledge of radiation protec-tion issues, yet their perceived degree of knowledge was lower

140 L. Faggioni et al. / European Journal of Radiology 86 (2017) 135–142

Table 2Overall distribution of answers to questions about the dose of natural background radiation and commonly performed imaging examinations given by radiology residents,medical students, and radiography students. Values are expressed in terms of equivalent number of postero-anterior (PA) chest radiographs. Correct answers are highlightedin shaded bold.

Which is the average dose for a PA chest radiograph?

100 mSv

Radiology residents 8.5 57.6 28.8 1.7 3.4 0.0Medical students 2.0 56.0 24.0 18.0 0.0 0.0Radiography students 2.3 76.7 18.6 0 2.3 0.0

If a PA chest radiograph counts as 1 unit, how much is the average dose due to natural background radiation in Italy?0 1–10 10–50 50–100 100–500 >500

Radiology residents 1.8 35.1 26.3 12.3 24.6 0.0Medical students 3.8 26.4 30.2 17.0 18.9 3.8Radiography students 0.0 7.0 34.9 44.2 14.0 0.0

If a PA chest radiograph counts as 1 unit, how much is the average dose due to a lumbar x-ray examination?0 1–10 10–50 50–100 100–500 >500


If a PA chest radiograph counts as 1 unit, how much is the average dose due to mammography (bilateral, two projections each, i.e. four images in total)?0 1–10 10–50 50–100 100–500 >500


If a PA chest radiograph counts as 1 unit, how much is the average dose due to a noncontrast chest CT examination?0 1–10 10–50 50–100 100–500 >500


If a PA chest radiograph counts as 1 unit, how much is the average dose due to a pelvis MRI examination?0 1–10 10–50 50–100 100–500 >500

Radiology residents 100 0.0 0.0 0.0 0.0 0.0Medical students 67.3 3.6 5.5 12.7 7.3 3.6Radiography students 97.7 0.0 0.0 2.3 0.0 0.0

If a PA chest radiograph counts as 1 unit, how much is the average dose due to a whole body PET-CT examination?0 1–10 10–50 50–100 100–500 >500


If a PA chest radiograph counts as 1 unit, how much is the average dose due to an abdominal ultrasound examination?0 1–10 10–50 50–100 100–500 >500

Radiology residents 100 0.0 0.0 0.0 0.0 0.0Medical students 91.1 1.8 0.0 3.6 3.6 0.0Radiography students 97.7 0.0 2.3 0.0 0.0 0.0

If a PA chest radiograph counts as 1 unit, how much is the average dose due to a myocardial scintigraphy (2-day protocol with 99mTc-sestamibi)?0 1–10 10–50 50–100 100–500 >500

10.14.9.5

ctamcrtbgadt

irjtb

Radiology residents 9 5.3 Medical students 3.7 9.3 Radiography students 0.0 2.4

ompared with medical students. Such data may be explained byhe fact that radiology residents and radiography students receive

more focused and intensive radiation protection training thanedical students due to the specialised nature of their academic

ourses, and are in line with the finding by Borgen et al. [26] ofadiologists and radiographers having better knowledge of radia-ion issues and referral guidelines than clinicians. Moreover, it maye supposed that owing to their better radiation protection back-round, radiology residents and radiography students are moreware of, and even somewhat daunted at the complexity of an in-epth radiation protection knowledge such as they will be expectedo master in their future professional life.

To this latter respect, it is worth noting that in our study, train-ng was perceived to be less frequent by radiology residents andadiography students than by medical students. Indeed, all sub-

ects from the three groups attended hospital wards as a part ofheir training, and especially radiography students are expected toe directly involved in technically setting the radiation dose to be

5 14.0 21.1 40.48 18.5 22.2 31.5

14.3 57.1 16.7

delivered to patients, yet most radiography students rated theirtraining on radiation protection issues to occur rarely (46.3%) oreven never (26.8%). Such figures were better for radiology resi-dents, though even among them training was reported to occurrarely in quite a large fraction of cases (38.3%), and never in asmany as 16.7% of cases. Though we did not ask respondents toquantify their training time, the finding of insufficient training wasalso reported in the study by Portelli et al., in which half of radi-ology practitioners and radiographers involved in a survey haddeclared receiving a maximum of 20 h of radiation protection edu-cation and training, which is much less than the recommended30–50 h for radiology practitioners and 100–140 h for radiogra-phers [21].

Taking the objective performance scores of radiographystudents and radiology residents separately, we found that radiog-

raphy students significantly outperformed radiology residents as toknowledge of radiation protection issues (P < 0.01). In their futureprofessional life, radiology residents will be expected to be able to

rnal o

cwcsksoatoadtrfkbtpacomrurawltbdpftorimeroiclaaipp

cerdoiawdpaiett

L. Faggioni et al. / European Jou

hoose the best imaging technique for a given diagnostic query andill be held legally responsible for the justification of imaging pro-

edures along with prescribing physicians, whereas radiographytudents (i.e., future technologists) should gain a comprehensivenowledge of dose levels as they are going to be technically respon-ible for delivering radiation dose to patients. Overall, only 44.2%f radiography students and 31.7% of radiology residents correctlynswered all questions on general radiation protection issues inhe objective test questionnaire, respectively, while as few as 2.3%f radiography students and 5% of radiology residents correctlynswered all questions on radiation dose levels. This was quiteisappointing given the rather low difficulty level of the ques-ionnaire, which was aimed to assess a basic knowledge aboutadiation protection even among students without specialty pro-essional training in radiology, such as medical students. A poornowledge of radiation doses among trainees was also reportedy other authors (with, for instance, only 20% of radiology prac-itioners providing the correct dose estimate for radiation-basedaediatric examinations in a primary paediatric referral centre [21],nd as few as 7% of residents knowing the dose of a postero-anteriorhest X-ray [25]. Actually, general dosimetry information is partf the teaching programme of radiology courses to undergraduateedical students, as well as of the core curriculum of radiology

esidents as recommended by major radiological societies and reg-latory institutions [24,27,28]. Combined with the relatively highate of survey respondents perceiving their training as not frequent,

potential explanation to the above findings may be a trend byorking professionals acting as tutors in their daily activity to over-

ook radiation protection issues. In other terms, it may be likelyhat while radiography students and radiology residents receiveetter theoretical radiation protection teaching than medical stu-ents (as confirmed by their higher scores in objective radiationrotection knowledge tests), they do not get enough educational

eedback and radiation protection skill reinforcement during theirraining time because radiation protection culture within the radi-logical staff is either lacking or undervalued. While action hasecently been taken to improve radiation protection knowledge andts implementation through quality assessment and workflow opti-

isation initiatives in radiology departments [18–20], evidencexists in the literature that radiation protection awareness amongeferring physicians as well as performing radiologists and technol-gists is quite variable and hovers at definitely substandard levels

n a substantial fraction of cases, even at academic or tertiary careentres [29,30]. In this perspective, we believe that one of the chal-enges for promoting the importance of radiation protection culturemong radiological and non-radiological professionals in trainingnd improving their radiation protection skills is to consistentlymplement their learning curricula with specific theoretical andractical modules held by board certified radiologists and medicalhysicists.

Our study has some limitations. Firstly, we performed a singleentre study, which prevented us from making comparisons andventually finding out any differences among medical students,adiography students and radiology residents from different aca-emic institutions. While this could be an interesting extension ofur present work that might warrant further investigation, teach-

ng curricula for students of the three aforementioned categoriesre harmonised in agreement to national and European bylaws,hich should contribute to mitigate potential inter-institutional

iscrepancies. Secondly, our survey sample was not large com-ared with other studies [10,12,25], but can be deemed to be ofverage size [21,30] and was sufficient to detect statistically signif-

cant differences among the three groups. Thirdly, unlike Portellit al. [21], we did not ask the survey respondents to give a quan-itative estimation of the hours spent in their radiation protectionraining, because this would have been quite complicated for med-

f Radiology 86 (2017) 135–142 141

ical students (whose radiation protection training usually occurson various occasions other than at radiology departments and istherefore unavoidably more dispersed in both time and space),potentially leading to inconsistent findings. Fourthly, we did notinclude a gold standard group of experts (such as radiation physi-cists or board certified radiologists) for comparison, because wefeel that the complexity of radiation protection as a whole mattermakes it difficult to identify a single professional category as a validreference standard.

5. Conclusions

Our findings indicate that medical students near the end oftheir undergraduate career tend to overestimate their own knowl-edge of radiation protection issues as assessed by means of a basiclevel survey, yet their radiation protection skills are significantlyworse compared with radiology residents and radiography stu-dents participating to the same survey. On the other hand, thoselatter believe that their radiation protection background and train-ing is not enough for their future professional needs, and theirobjective radiation protection knowledge still reveals significantflaws. Despite the recently increased sensitivity of the medicalcommunity and radiology vendors towards building a strongerradiation protection culture, further efforts are needed to ensurethat radiation protection effectively becomes an essential part ofthe professional skills of all healthcare providers involved. This isthe recommended approach to safeguard patients’ and operators’safety and optimise resources, both inside and outside the radio-logical environment.

Funding information

This research did not receive any specific grant from fundingagencies in the public, commercial, or not-for-profit sectors.

Appendix A. Supplementary data

Supplementary data associated with this article can be found,in the online version, at http://dx.doi.org/10.1016/j.ejrad.2016.10.033.

References

[1] F.A. Mettler Jr., M. Bhargavan, K. Faulkner, et al., Radiologic and nuclearmedicine studies in the United States and worldwide: frequency, radiationdose, and comparison with other radiation sources—1950–2007, Radiology253 (2009) 520–531 http://dx.doi.org/10.1148/radiol.2532082010.

[2] R. Smith-Bindman, J. Lipson, R. Marcus, et al., Radiation dose associated withcommon computed tomography examinations and the associated lifetimeattributable risk of cancer, Arch. Intern. Med. 169 (2009) 2078–2086 http://dx.doi.org/10.1001/archinternmed.2009.427.

[3] D.L. Miglioretti, E. Johnson, A. Williams, et al., The use of computedtomography in pediatrics and the associated radiation exposure andestimated cancer risk, JAMA 167 (2013) 700–707 http://www.dx.doi.org/10.1001/jamapediatrics.2013.311.

[4] H. Baysson, N. Journy, T. Roué, H. Ducou-Lepointe, C. Etard, M.O. Bernier,Exposure to CT scans in childhood and long-term cancer risk: a review ofepidemiological studies, Bull. Cancer 103 (2016) 190–198 http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003.

[5] J.D. Mathews, A.V. Forsythe, Z. Brady, et al., Cancer risk in 680,000 peopleexposed to computed tomography scans in childhood or adolescence: datalinkage study of 11 million Australians, BMJ 21 (2013), 346:f2360 http://www.dx.doi.org/10.1136/bmj.f2360.

[6] M.A. Kuefner, M. Brand, C. Engert, S.A. Schwab, M. Uder, Radiation inducedDNA double-strand breaks in radiology, Rofo 187 (2015) 872–878 http://www.dx.doi.org/10.1055/s-0035-1553209.

[7] K. Kanagaraj, S. Abdul Syed Basheerudeen, G. Tamizh Selvan, et al.,Assessment of dose and DNA damages in individuals exposed to low dose andlow dose rate ionizing radiations during computed tomography imaging,Mutat. Res. Genet. Toxicol. Environ. Mutagen. 789–790 (2015) 1–6 http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008.

http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1016/j.ejrad.2016.10.033http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1148/radiol.2532082010http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://dx.doi.org/10.1001/archinternmed.2009.427http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1001/jamapediatrics.2013.311http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1016/j.bulcan.2015.11.003http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1136/bmj.f2360http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1055/s-0035-1553209http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008http://www.dx.doi.org/10.1016/j.mrgentox.2015.05.008

1 rnal o

[

[

[

[

[

[

[

[

[

[

[

[

[

[

[

[

[

[

[

[among doctors, J. Med. Imaging Radiat. Oncol. 57 (2013) 8–14 http://www.dx.

42 L. Faggioni et al. / European Jou

[8] P.V. Shaw, P. Croüail, R. Paynter, M. Coeck, Education and training in radiationprotection: improving ALARA culture, J. Radiol. Prot. 35 (2015) 223–227http://www.dx.doi.org/10.1088/0952-4746/35/1/223.

[9] European Commission, Radiation Protection No. 175. Guidelines on radiationprotection education and training of medical professionals in the EuropeanUnion, 2016, http://ec.europa.eu/energy/sites/ener/files/documents/175.pdf,2014 (Accessed 14 08 2016).

10] M. Günalp, B. Gülünay, O. Polat, et al., Ionising radiation awareness amongresident doctors, interns, and radiographers in a university hospitalemergency department, Radiol. Med. 119 (2014) 440–447 http://www.dx.doi.org/10.1007/s11547-013-0374-8.

11] R.K. Lee, W.C. Chu, C.A. Graham, T.H. Rainer, A.T. Ahuja, Knowledge ofradiation exposure in common radiological investigations: a comparisonbetween radiologists and non-radiologists, Emerg. Med. J. 29 (2012) 306–308http://www.dx.doi.org/10.1136/emermed-2011-200481.

12] G.Z. Zhou, D.D. Wong, L.K. Nguyen, R.M. Mendelson, Student and internawareness of ionising radiation exposure from common diagnostic imagingprocedures, J. Med. Imaging Radiat. Oncol. 54 (2010) 17–23 http://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.x.

13] P. Cole, R. Hallard, J. Broughton, et al., Developing the radiation protectionsafety culture in the UK, J. Radiol. Prot. 34 (2014) 469–484 http://www.dx.doi.org/10.1088/0952-4746/34/2/469.

14] T. Coldwell, P. Cole, C. Edwards, et al., The advantages of creating a positiveradiation safety culture in the higher education and research sectors, J. Radiol.Prot. 35 (2015) 917–933 http://www.dx.doi.org/10.1088/0952-4746/35/4/917.

15] R.K. Singh, P. McCoubrie, K. Burney, J.A. Miles, Teaching medical studentsabout radiation protection-what do they need to know? Clin. Radiol. 63(2008) 1344–1349 http://www.dx.doi.org/10.1016/j.crad.2008.06.010.

16] F. Paolicchi, F. Miniati, L. Bastiani, L. Faggioni, A. Ciaramella, I. Creonti, C.Sottocornola, C. Dionisi, D. Caramella, Assessment of awareness aboutradiation protection and knowledge about radiological examination dosesamong Italian radiographers, Insights Imaging 7 (2016) 233–242 http://www.dx.doi.org/10.1007/s13244-015-0445-6.

17] S.P. Raman, P.T. Johnson, S. Deshmukh, M. Mahesh, K.L. Grant, E. Fishman, CTdose reduction applications: available tools on the latest generation of CTscanners, J. Am. Coll. Radiol. 10 (2013) 37–41 http://www.dx.doi.org/10.1016/j.jacr.2012.06.025.

18] E.P. Tamm, X.J. Rong, D.D. Cody, R.D. Ernst, N.E. Fitzgerald, V. Kundra, Quality

initiatives: CT radiation dose reduction: how to implement change withoutsacrificing diagnostic quality, Radiographics 31 (2011) 1823–1832 http://www.dx.doi.org/10.1148/rg.317115027.

19] F. Paolicchi, L. Faggioni, L. Bastiani, S. Molinaro, D. Caramella, C. Bartolozzi,Real practice radiation dose and dosimetric impact of radiological staff

[

f Radiology 86 (2017) 135–142

training in body CT examinations, Insights Imaging 4 (2013) 239–244 http://www.dx.doi.org/10.1007/s13244-013-0241-0.

20] F. Paolicchi, L. Faggioni, L. Bastiani, S. Molinaro, M. Puglioli, D. Caramella, C.Bartolozzi, Optimizing the balance between radiation dose and image qualityin pediatric head CT: findings before and after intensive radiologic stafftraining, AJR Am. J. Roentgenol. 202 (2014) 1309–1315 http://www.dx.doi.org/10.2214/AJR.13.11741.

21] J.L. Portelli, J.P. McNulty, P. Bezzina, L. Rainford, Paediatric imaging radiationdose awareness and use of referral guidelines amongst radiologypractitioners and radiographers, Insights Imaging 7 (2016) 145–153 http://www.dx.doi.org/10.1007/s13244-015-0449-2.

22] M.W. McCusker, C. de Blacam, M. Keogan, R. McDermott, P. Beddy, Survey ofmedical students and junior house doctors on the effects of medical radiation:is medical education deficient? Ir. J. Med. Sci. 178 (2009) 479–483 http://www.dx.doi.org/10.1007/s11845-009-0341-5.

23] J. O’Sullivan, O.J. O’Connor, K. O’Regan, et al., An assessment of medicalstudents’ awareness of radiation exposures associated with diagnosticimaging investigations, Insights Imaging 1 (2010) 86–92 http://www.dx.doi.org/10.1007/s13244-010-0009-8.

24] A. Hertault, B. Maurel, M. Midulla, et al., Editor’s choice—minimizing radiationexposure during endovascular procedures: basic knowledge, literaturereview, and reporting standards, Eur. J. Vasc. Endovasc. Surg. 50 (2015) 21–36http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014.

25] S. Divrik Gökç e, E. Gökç e, M. Coş kun, Radiology residents’ awareness aboutionizing radiation doses in imaging studies and their cancer risk duringradiological examinations, Korean J. Radiol. 13 (2012) 202–209 http://www.dx.doi.org/10.3348/kjr.2012.13.2.202.

26] L. Borgen, E. Stranden, Radiation knowledge and perception of referralpractice among radiologists and radiographers compared with referringclinicians, Insights Imaging 5 (2014) 635–640 http://www.dx.doi.org/10.1007/s13244-014-0348-y.

27] European Training Curriculum for Radiology, http://www.myesr.org/cms/website.php?id=/en/education training/european training curriculum forradiology.htm, 2016 (Accessed 14 08 2016).

28] E.S. Amis Jr., P.F. Butler, ACR white paper on radiation dose in medicine: threeyears later, J. Am. Coll. Radiol. 7 (2010) 865–870 http://www.dx.doi.org/10.1016/j.jacr.2010.04.006.

29] N. Brown, L. Jones, Knowledge of medical imaging radiation dose and risk

doi.org/10.1111/j.1754-9485.2012.02469.x.30] S. Ramanathan, J. Ryan, Radiation awareness among radiology residents,

technologists, fellows and staff: where do we stand? Insights Imaging 6(2015) 133–139 http://www.dx.doi.org/10.1007/s13244-014-0365-x.

http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://www.dx.doi.org/10.1088/0952-4746/35/1/223http://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://ec.europa.eu/energy/sites/ener/files/documents/175.pdfhttp://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1007/s11547-013-0374-8http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1136/emermed-2011-200481http://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2010.02132.xhttp://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/34/2/469http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1088/0952-4746/35/4/917http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1016/j.crad.2008.06.010http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1007/s13244-015-0445-6http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1016/j.jacr.2012.06.025http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1148/rg.317115027http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.1007/s13244-013-0241-0http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.2214/AJR.13.11741http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s13244-015-0449-2http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s11845-009-0341-5http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1007/s13244-010-0009-8http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.1016/j.ejvs.2015.01.014http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.3348/kjr.2012.13.2.202http://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.dx.doi.org/10.1007/s13244-014-0348-yhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.myesr.org/cms/website.php?id=/en/education_training/european_training_curriculum_for_radiology.htmhttp://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1016/j.jacr.2010.04.006http://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1111/j.1754-9485.2012.02469.xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-xhttp://www.dx.doi.org/10.1007/s13244-014-0365-x

Awareness of radiation protection and dose levels of imaging procedures among medical students, radiography students, and ...1 Introduction2 Material and methods2.1 Data collection2.2 Statistical analysis

3 Results3.1 Radiation protection awareness3.2 Knowledge of recommended radiation dose levels for the main imaging procedures

4 Discussion5 ConclusionsFunding informationAppendix A Supplementary dataReferences

european journal of radiology -...

Documents