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Radiation protection knowledge among radiologists in northwest Spain
Conocimientos en materia de radioprotección en radiólogos del noroeste de España
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Macía-Suárez, E. Sánchez-Rodríguez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Macía-Suárez" "email" => array:1 [ 0 => "david.macia.suarez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." 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Such an increase has been especially significant during the last 10–15 years, since over 10 million radiological examinations are conducted each day in the world.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> Limiting the dose of cumulative radiation could lead to a loss of diagnostic quality in the imaging studies,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> which is somehow ironic if we think that, in many countries, exposure to ionizing radiation both for the general population and labor exposure – but not for medical examinations, has already been restricted. As a consequence, patients may be receiving doses above the limits established for the employees and not being told anything about it.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> With the approval of European regulations,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> the centers and personnel in charge have the obligation of informing the patients and registering all sorts of datasets on the doses of radiation administered. Considering the justification, optimization, and restriction of dose and reference levels established by the International Commission on Radiological Protection (ICRP),<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> it seems like a perfect time to assess the degree of commitment and knowledge of radiologists on this issue. This has been the goal of this study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">During a regional scientific meeting held back in October 19, 2016 on radioprotection, one anonymous face-to-face survey was conducted among the participant radiologists before the start of the meeting. Prior to conducting the survey, the radiologists who attended were informed on the goal of the questionnaire and its foreseeable future publication, taking the return of the questionnaire covered as the informed consent to collaborate. Nonetheless, the regional ethics committee was consulted, and it ruled that the return of the survey per se was enough authorization to participate. The survey consisted of 14 questions including personal demographic data (work experience, level of education), subjective knowledge on radioprotection and technical issues (type of optimization, use of protectors during the routine clinical practice and questions on the dose of radiation administered in some of the most commonly used techniques both in plain X-rays and computed tomography [CT] scanners). An example of these questions is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. All questionnaires were supervised in order to ensure that the answers were given without any external help. Both confidentiality and anonymity were maintained according to the Declaration of Helsinki.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted using free software (code R, version 3.0.0). In the first place, one descriptive study was conducted. In order to detect any possible associations among variables, both the Pearson's chi-square test and the Fisher's exact test were conducted. Seven (7) of the questions had one (1) correct answer only. With such tests, one new variable was created with values between 0 and 10 based on the correct answers given. For example, a value of 10 meant that the radiologist surveyed answered correctly to seven (7) questions, and a value of 0 that he did not answer correctly to any of the questions. When it comes to the remaining answers, the surveyed radiologists were categorized based on their years of experience, level of knowledge, type of specialized training, and clinical practice of each and every one of them. In order to detect any possible inter-group differences, an analysis of variance (ANOVA) and Levene's test of homogeneity of variances were conducted using the Student's <span class="elsevierStyleItalic">t</span> test as a comparative of the values measured among the different groups.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 63 questionnaires were returned out of the 65 that were handed out. Most of the radiologists surveyed had few years of experience (from 0 to 4 years of experience: 30; from 4 to 10: 14; from 10 to 20: 8; over 20: 11) and regarded their own level of knowledge as low (high: 2; moderate: 28; low: 32; does not know or does not answer (DK/DA): 1). Most said they used CT scanners often or always (always or very often: 22; often: 32; only when they are on call: 6; never: 2; DK/DA: 1) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and X-rays (always or very often: 17; often: 26; only when they are on call: 10; never: 9; DK/DA: 1). Most surveyed radiologists (25) use bismuth protectors occasionally (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and, in general, the protocols to conduct CT scans are optimized based on criteria from one radiophysicist or another radiologist (26), or the manufacturer (22) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). When grouping the seven (7) questions with one correct answer only, a new variable was created with values between 0 and 10. A value of 10 indicated that the radiologist surveyed answered correctly to the seven (7) questions, and a value of 0 suggests he did not give any correct answers. When conducting an analysis based on the years of experience, training, and on how often the radiologists worked with CT scans or X-rays, no statistically significant differences were seen. Only when data were segmented based on the level of knowledge that the radiologists thought they had is when statistically significant differences can be seen (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Since only two (2) surveyed radiologists said they had a high level of knowledge, only two (2) categories were taken into consideration: high or moderate level, and low level. Assuming the variabilities were the same in the two (2) groups, the Student's <span class="elsevierStyleItalic">t</span> test was conducted for the comparison of the means. One <span class="elsevierStyleItalic">p</span> value of 0.018 was obtained so there are important statistical reasons to believe that the level of knowledge is higher in the group of radiologists who said they had a high or moderate level of knowledge than in the group of radiologists who said they had a low level of knowledge (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The actual European legislation<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> in force in all member states since last February 6, 2018, is based on the ALARA (“as low as reasonably achievable”) principle<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> when it comes to the application of the doses of radiation. It also requires the creation of one individualized registry of doses not only for every patient but also for the personnel involved in the control and application of the doses. When it comes to the diagnostic imaging services this role is the ultimate responsibility of radiologists.</p><p id="par0030" class="elsevierStylePara elsevierViewall">During the last few years, there have been surveys conducted among physicians,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5–7</span></a> many of them including radiologists,<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">8–12</span></a> in an attempt to evaluate their level of knowledge on radioprotection measures. Overall, results have been disappointing. As far as these authors know, the number of studies specifically conducted with radiologists on this regard has been scarce. Back in 2014, a study conducted in Norway<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a> among radiologists and radiology technologists revealed that both professionals have a higher level of knowledge on radiation than referring clinicians, but there is still room for improvement in their knowledge of radioprotection. Another study<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> that compared radiologists to other physicians showed similar results. An example of this lack of knowledge on radioprotection measures was seen in one survey conducted among 780 technicians in Italy back in the year 2016<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a> that showed that 30% of the survey respondents did not know that all professionals (radiologists, technicians, physicians) could be penalized for not optimizing or indicating the studies properly. Although we have not found any similar surveys conducted among radiologists during our review, it seems evident that there is a lack of commitment in the diagnostic imaging services on this regard.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The present study explores the same aspects shown by other researchers in clinical trials: the training in radioprotection measures is scarce,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> and it should be increased not only during working life, but also while the specialists are being trained.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> One of the most interesting facts from this study is the age of the participants (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). More than half of them (53.6%) were being trained as specialists and another 25% were in the first 10 years of their careers. It is important to emphasize here that yet despite how important radioprotection is both clinically and legally, most participants (57.1%) said their knowledge on this issue was scarce. This percentage is as high as 66.7% particularly in radiologists under training, which is especially relevant after confirming that the level of knowledge grows higher when more training in radioprotection is received.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a> However, radioprotection is often ignored in certain training centers,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> and a study conducted among 173 residents from Emory University<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> confirmed the need to increase training on this issue, also among radiology residents whose results were only slightly better than the average.</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Although the study conducted by Chun-sing et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> showed better results with more experienced respondents, in the present study no differences in the correct answers given based on professional experience were reported. A similar result was seen among the residents of the aforementioned study,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a> since no differences based on the years of experience were reported either. Nevertheless, it is odd enough to see that there is an apparent correlation between the years of experience and the level of knowledge that radiologists believe they have; to put this to the test, two (2) different tests were conducted: the Pearson's chi-square test (<span class="elsevierStyleItalic">p</span>: 0.04687) and Fisher's exact test (<span class="elsevierStyleItalic">p</span>: 0.02261), which is why we have reasons to believe that both variables are correlated (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><p id="par0045" class="elsevierStylePara elsevierViewall">In any case, and as we explained above, there is a statistically significant correlation between the level of knowledge that the surveyed radiologists believe they had and their results in radioprotection (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). That is to say, it is not a matter of years of experience, but rather this association lays between the level of knowledge that radiologists believe they have and the actual knowledge they do have, and apparently this proportion increases with experience. This is especially relevant if we think that 32 out of the 63 surveyed respondents (almost half of them) believed they had a low level of knowledge, which confirms what other studies have already shown<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7,13</span></a> on the need to increase training in radioprotection in general. It has been confirmed<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6,16</span></a> that more training in radioprotection increases the level of knowledge; as a matter of fact, the latest legislation on this issue requires completing periodic courses.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3,14,17</span></a> An example of this can be seen if data are analyzed based on the answers given; out of the 22 radiologists who say they always or very often work with CT scanners, only 10 (45.45%) say they always use bismuth protectors on the irradiated region, even 4 (18.18%) admit they barely use them. These percentages drop to 3.13% and 28.13%, respectively, in the group of radiologists who only work occasionally (for example due to temporary rotations) with CT scanners. Of the total of surveyed radiologists, 31.13% did not know or want to answer this question while 3.13% admitted they did not know this kind of protector or whether it was available (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). This is especially relevant if we think that CT scans associate higher doses of radiation than the most common conventional radiographic imaging modalities.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a> Although we the authors are clearly in favor of using this type of protectors, we should remember here that there is still controversy on whether to use them or not,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> which may justify the disappointing results.</p><p id="par0050" class="elsevierStylePara elsevierViewall">However, yet despite the multiple strategies of dose reduction implemented,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> the recommendations to use the lowest possible doses (the ALARA principle), and the existing optimization protocols,<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4,22</span></a> only 31.82% of the survey respondents who work, almost exclusively with CT scanners, use criteria-based optimized protocols (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). We should remember here that the use of this type of criteria and protocols is mandatory according to the actual legislation.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The main limitation of this study probably lays at the selection of the surveyed radiologists. This was not a randomized trial, and conducting the survey was voluntary during a workday when radioprotection measures were being discussed. This may imply that the survey respondents were more aware of this and that their level of knowledge was susceptible of improvement. However, yet despite of this, the results obtained do not leave too much room for complacency, and it seems logical to think that a survey conducted among radiologists less aware of this issue would not obtain more positive results.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Another limitation is that the sample is relatively small, although it is also true that we barely found similar surveys in the medical literature specifically conducted among radiologists, and those conducted among groups of clinicians that included radiologists did not show significantly larger samples either.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In sum, the results from this survey reveal statistically significant differences based on the level of knowledge that radiologists believe they have when they answer questions on radioprotection. Results also show that there is a significant room for improvement in the level of knowledge on this regard. All seems to suggest the need to increase both the training and the level of commitment of the radiology services in the application of radioprotection strategies. Doing so is not only our duty, but also our responsibility.</p><p id="par0070" class="elsevierStylePara elsevierViewall">As far as the authors know, the present study is the first one ever conducted in Spain with radiologists only, and it is one of the surveys with the largest samples ever put together of such specialists within the scarce amount of studies ever conducted among radiologists.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">This research has received no public or private funding, or from non-profit organizations.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Authors</span><p id="par0080" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study: DMS</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0090" class="elsevierStylePara elsevierViewall">Study idea: DMS</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Study design: DMS, ESR</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0100" class="elsevierStylePara elsevierViewall">Data mining: DMS</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: ESR, DMS</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Statistical analysis: ESR</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Reference: DMS</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0120" class="elsevierStylePara elsevierViewall">Writing: DMS</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks: ESR</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1060317" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1009163" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1060318" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1009164" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Authors" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-11-06" "fechaAceptado" => "2018-01-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1009163" "palabras" => array:3 [ 0 => "Radiology" 1 => "Radiation exposure" 2 => "X-rays" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1009164" "palabras" => array:3 [ 0 => "Radiología" 1 => "Exposición a la radiación" 2 => "Rayos X" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To estimate radiologists’ level of knowledge of and their implication in radioprotection.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An anonymous and supervised survey was conducted during a work meeting.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 65 questionnaires handed out, 63 were returned. In general, the radiologists surveyed considered their level of knowledge to be low, and it was statistically demonstrated (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018) that the level of knowledge they believed they had was related to the number of correct answers. The level of knowledge that radiologists believed they had was also related (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) with the years of experience, and it was higher in the more experienced radiologists.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is an important margin of improvement in knowledge about radiation protection.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estimar el nivel de conocimientos de los radiólogos y su implicación en el uso de medidas de radioprotección.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó una encuesta anónima y supervisada durante una reunión de trabajo.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 65 cuestionarios facilitados, se devolvieron 63. En líneas generales, los radiólogos consideraron su nivel de conocimientos como bajo, y quedó estadísticamente demostrado (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,018) que el nivel de conocimientos que creían tener guardaba relación con el número de respuestas correctas. También guardaba relación (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05) con los años de experiencia, y era más alto en aquellos más experimentados.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Hay un importante margen de mejora en el nivel de conocimientos en materia de radioprotección.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Macía-Suárez D, Sánchez-Rodríguez E. Conocimientos en materia de radioprotección en radiólogos del noroeste de España. Radiología. 2018;60:320–325.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3034 "Ancho" => 3167 "Tamanyo" => 1043224 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Survey.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 769 "Ancho" => 1423 "Tamanyo" => 39498 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Work with computed tomography (CT) scanners.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1327 "Ancho" => 1412 "Tamanyo" => 65404 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Use of bismuth protectors.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 927 "Ancho" => 1443 "Tamanyo" => 42531 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Optimization of protocols to conduct computed tomography (CT) scans.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1269 "Ancho" => 1421 "Tamanyo" => 46804 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Level of knowledge that radiologists believe they have.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1369 "Ancho" => 1415 "Tamanyo" => 67844 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Correlation between the years of experience and the level of knowledge that radiologists believe they have.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Social and ethical aspects of radiation risk management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. 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