Radiology technicians are exposed to contamination on a daily basis in Jordan’s Health Ministry hospitals, amid violations of medical devices’ technical conditions and weak health and safety procedures.
Despite his hospitalization, radiologist Omar Al-Radayda unfortunately passed away a month and a half after we interviewed him while undergoing his bone cancer treatment, and he did not live long enough to read this investigation.
Al-Radayda worked in Jordanian Health Ministry hospitals for 19 years, during which he was witness to the disregard of health and safety measures, putting those technicians at risk due to mishandling of medical devices, their methods of use protocols and the general guidelines for handling radioactive equipment.
Understaffed, Overworked and Unprotected: Jordanian X-Ray Operators Exposed to Radioactive Material (Promo)
685Diagnostic Radiology and Nuclear Medicine and Licensed Radiology DepartmentsHave worked for
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Dr. Khaled Rababaa, head of the radiology department at the Hashemite University, states that in the event of continuous exposure to radiation, a genetic mutation may occur on the DNA strip of the person, causing them cancer.
Abnormal exposure to radiation results in mutated cells on the body, such as uncontrolled bone cancer cells, which can be fatal.Radiation Protection Officer
The Radiation Protection Officer is the qualified technician in facilities with radioactive material and is the designated person to oversee the application of radiological and hazardous material protection systems, and is the man tasked to assist in providing advice on health and safety precautions.
The Jordanian Ministry of Health, in a written response, confirmed the implementation of approximately 300 visits and equipment checks at these facilities annually. Additionally, the ministry has implemented three radiation protection training courses, with the participation of 60 technicians with over 15 years of service.
During 2019, the examinations confirmed five employees at the radiology departments of the Ministry of Health hospitals were diagnosed with various diseases. This included thyroid cancer, bone cancer and bronchial diseases. During the interviews, the employees pointed to the weak preventative controls of the Ministry of Health over the safety of their departments and the safe use of their medical equipment.
Dr. Ahmed Suwaidat, head of the radiology department at Jerash Government Hospital, believes that the Ministry of Health’s oversight is insufficient. He adds that “the goal is to eliminate the use of medical devices that do not comply with best practices protecting users from all hazards or leaks.”
Dr. Suwaidat is not convinced about the ministry’s claims that there are no hazardous leaks and that all facilities and machinery comply with best practices and health standards.
The Jordan Standards and Metrology Institution confirmed when asked about the compliance of radiology equipment with health standards at Jordanian hospitals, that the institution has no quality and health controls mandate for the equipment there.
In a chance encounter, Saleh Samreen, a radiology technician at the Department of Chest Diseases and Tuberculosis at Al-Bashir Hospital, discovered that he had developed thyroid cancer. He had met a doctor working on a thyroid study that gave him a medical examination and asked him to perform additional checks and scans.
Samreen confirms that “the department was suffering from a surplus of referrals (approximately 300 to 400 per day)” which exposes technicians to more radiation. This is in contravention of the standard radiation level limit system recommended by the International Radiological Protection Association.
According to the hospital’s Director Dr. Mahmoud Zureikat, 86 radiologists work at the Al-Bashir Government Hospital. The hospital usually receives 1,200 to 1,600 referrals a day. Further, those technicians are sometimes re-assigned to work at other hospitals to fill any shortages of technicians.
Samreen was devastated to find out that cancer is not included in the list of diseases eligible for retirement and compensation; such as heart diseases and back injuries. Despite being subjected to three catheter operations, eight spinal fractures, curvature in his back leading to a change in height (he is now 158cm down from 171cm), and extreme weight loss (24kg), Samreen was not entitled to an increase in his pension because cancer is not considered a “liability”.
Samreen’s application for early retirement, after 26 years of employment at the Ministry of Health, was initially denied. Samreen was then forced to submit medical reports with the help of the head of the Radiology Department to help him retire in order to avoid exposure to more health risks given his condition.
Dr. Khaled Rababaa indicates that the ideal work cycle for radiology technicians ranges between 10-15 years and should not exceed that in order to avoid cumulative exposure to radiation. Further, Dr. Rababaa considers this to be a dangerous profession when taking into account the age of the radiology technicians.
Ibrahim Shehadeh had worked in the radiology department of Al-Bashir hospital for 25 years before his passing after being diagnosed with thyroid cancer in 2011.
Shehadeh’s work was marred by many difficulties and problems as reported by his son Ahmed. His father suffered from long working hours, and radiation leaks due to poor maintenance of devices and facilities.
He said that his father contacted the Ministry of Health as well as the head of his department about those issues more than once. However, none of the relevant parties listened to his complaints or concerns.
In terms of radiation exposure, Shehadeh’s son confirms that his father’s radiological scans (which were examined by the investigators) exceeded 50 millisievert. This is the highest permissible limit of radiation according to the International Committee for Radiation Protection (ICRP).
Ibrahim’s story did not end there however, as Ibrahim’s mother stated that the Ministry of Health did not consider his illness a work injury and therefore did not provide any financial compensation. She stressed that the pension received does not cover his wife and five children’s financial needs.
Based on the previous cases, a question may be raised surrounding the extent to which the hospitals associated with the Ministry of Health adhere to the appropriate treatment and health protocols, specifically radiological safety requirements. Further, one may question the adequacy of the provisions made by the Ministry for the general safety requirements for the employees.
Interviewees from the radiology department indicated that there are various issues surrounding the safety requirements, the most important of which is the absence of periodic examinations of the facility and checks for levels of radioactive contamination.
Omar Al-Radayda says, “throughout my year of tenure at the hospital, I would hear that tests and checks have been carried out on the equipment, but during that whole time I had not seen anyone conduct a single test (unless we report a faulty device or a problem with the equipment)”.
According to Article 13 of the insurance regulations for social security, institutions have an obligation to uphold the adequate occupational health and safety standards, and regulation compliant tools at the workplace. Further, they are required to identify, mitigate and prevent occupational hazards by implementing adequate control measures.
Documented policiesImplementing prevention methodsRisk assessments for work facilitiesEmployee efficiencyTraining employeesEmergency preparedness, prevention and responsePeriodic medical checks for employeesContinuously monitoring, developing and evaluating safety and health performanceManaging and documenting the number of work-related injuries; the number of deaths resulting from them; their frequency in the facility; and how this compares to normal levels.
According to the Ministry of Health, there are no official records documenting the number of radiologists whose work has caused them diseases or health issues. The Ministry of Health confirmed through official correspondence the presence of radiation protection measures in hospitals and health centres.
Additionally, they have denied that x-ray devices that do not conform to the required specifications and standards exist, they have denied also that their technicians are at risk of excess exposure (above the Ministry’s standards) to harmful materials. Further, the ministry reiterated its commitment that all technicians follow the appropriate radiation health and safety protection methods.
Dr. Rababaa comments on the dispute between Shehadeh’s (the radiology technician) son and the Ministry of Health. He suggests that the Ministry is playing a role in keeping technicians safe, however this falls short of what is required. He adds that the current number of employees is “insufficient” and “many more should be hired to protect the existing workers against excess exposure by reducing their working hours.”
On the other hand, Dr. Suwaidat does not see any correlation between developing cancer and the prolonged exposure to radiation. Dr. Suwaidat ensures the availability of protection measures and suggests that it is largely up to the employees to adhere to these measures to reduce their exposure to radiation.
Radiology technician Jalal Al-Shraideh who used to work at the Radiology Department of Al-Bashir Hospital confirms that during his 21 years tenure there he had to work 5-6 days per week. This resulted in an issue with his thyroid gland, which had to be later removed. He says that the operating age of the devices and equipment used have put him and his colleagues at risk of radiation leaks.
Radiology Consultant and Executive Director of the King Hussein Cancer Centre Dr. Assem Mansour, confirms that the operating life of these devices from a commercial point of view is limited to 10 years, but this could be extended to 15 years if adequate care and maintenance were applied.
From Dr. Rababah’s perspective, radiography, despite its importance for detecting and diagnosing diseases, can cause damage to human cells.
Radiation dose limits according to the International Committee for Radiological Protection
Doses of20 mSv* in a year
distributed on average over five consecutive years (100 mSv in 5 years). In all cases, the doses must not exceed 50 mSv in a single year.Equivalent doses recorded in the eyesof 20 mSv annually
distributed on average for 5 consecutive years (100 mSv in 5 years). In all cases the equivalent doses must not exceed 50 mSv in any single year.An equivalent dose in the limbs or in the skin of(500) mSv per year.*millisievert
If these limits are not respected, the radiology technician will be exposed to a higher level of radiation than those set, and different symptoms will appear that will vary in severity according to the level of exposure.
With high exposure levels, technicians may develop multiple health problems including sterility, blindness, cataracts, and various forms of cancer. Women might also experience premature aging and miscarriages.
Another issue identified by radiologist Basil Al-Wazani since the beginning of his employment in the radiology department, is the non-authoritative and limited role of control officers. He indicates that their role is limited to the regulatory side and the issuance of reports without any executive powers, resulting in meaningless template like reports.
Al-Wazzani added that he developed asthma and chronic chest infections during his work in radiology: “From 1990 to 2005 we processed and developed the photographic films manually due to the absence of specialised employees and any routine maintenance and inspections of the equipment. Additionally, the equipment and their viability were not inspected and harmful exposure was left undetected. We were thus exposed to harmful fumes for extended periods of time due to the shift’s long working hours especially after the removal of the 14 day break period that was previously granted to workers.”
Dr. Rababaa finds that reducing the radiation dose requires reducing the dose exposure time, increasing the distance between the radiation source and the radiologist, and narrowing the radiation beam. Also, thermo-luminescent dosimeters are required for radiologists to measure the amount of exposure they receive on a monthly or annual basis.
The technicians interviewed for this investigation all agreed that Health Ministry hospitals have not committed to renewing or obtaining the appropriate licenses for hospitals (and personnel) within the radiology departments as required by the Radiological and Nuclear Regulatory Authority. Further, those hospitals have failed to abide by the authority’s protection requirements for devices, equipment, workers, and patients as well as their refusal to appoint a Radiation Protection Officer, as recommended by the Authority. The Ministry of Health has denied all the above but failed also to provide any explanation.
– Must have completed a residence period of not less than a year as documented by a certificate from the appropriate body.
– Must hold a radiological license from the authority responsible for therapeutic radiology, diagnostic radiology, and nuclear medicine.
– Must hold a university degree in a relevant subject.
– Must hold a relevant diploma or college level certificate from a qualified institution to work in their specialised field.
– Must pass a training course in their field of specialisation approved by the relevant authority.
– Must pass a training course (approved by the relevant authority) in the health and safety protocols for radiation protection. The course must extend a period of at least 30 hours. Alternatively, they may attach sufficient proof (e.g. safety course qualifications) of their knowledge of radiation protection during their study period.
It is apparent that prior to 2002, the Jordanian curriculum for graduates in this field differed from the policies and procedures applied by the Ministry of Health. The diploma did not include a radiation protection course or equivalent health and safety awareness. The Ministry of Health usually ensured that 97% of its employees have all the necessary licensing requirements to work in the radiology departments, the Ministry aims however to amend the curriculum in line with their health and safety protocols and licenses.
Reports issued by the Radiological and Nuclear Regulatory Commission, which were examined for this investigation, indicated that two hospitals (associated with the Ministry of Health) were non-compliant with the health and safety protocols and had unexplained levels of radiation in their radiographic chambers. The report also requested that work be suspended in the affected department until action is taken to resolve the issues identified.
– Failure to link the warning light signals with the radiology machine to avoid the risk of radiation exposure in several hospitals.
– Storing photographic films inside imaging rooms, despite the fact that it is considered a wrong way to preserve and store film.
– Failure to perform quality checks on radiology equipment, which guarantees patients safety from excessive radiation doses.
– Failure to perform quality checks on radiology equipment, which guarantees patients safety from excessive radiation doses.
Workers in the Radiology Sector in different locations have demanded the establishment of a Union, specially for radiologists or for general technicians, to represent and defend their interests and safety. Their demands include putting a cap on number of service years in radiology departments in keeping with world best practices, and to reinstate the 14 days vacation, that has been suspended.
Radiologists have revealed a variety of health issues through pictures and reports. Their suffering is largely due to repeated exposure to radiation and the absence of necessary protective measures and equipment. As a result they have found themselves without compensation or income for the rest of their lives.
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