CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

The utilization of ionizing radiation in modern medical procedures has revolutionized

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

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

Recognizing these unique vulnerabilities, international organizations such as the International

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

Thus, while ionizing radiation remains an indispensable tool in paediatric healthcare, its
application must be guided by a deep understanding of children's unique susceptibility to its
harmful effects and a steadfast commitment to best practices in radiation protection (Huang,
2016; Dauer, 2017). As advancements in imaging and therapeutic technologies continue to
evolve, it becomes increasingly important for healthcare providers to stay abreast of current
guidelines, continually update their knowledge, and foster a culture of safety that prioritizes
the well-being of the most vulnerable patient populations (Frush & Applegate, 2015; Kamp,
2020).Radiographers play a critical role in the safe delivery of radiation through diagnostic
imaging and therapeutic procedures. They are tasked with implementing radiation protection
principles that minimize patient exposure without compromising image quality or treatment
effectiveness (Vano, 2017). The principle of ALARA—“As Low as Reasonably
Achievable”—remains the cornerstone of paediatric radiation protection practice, ensuring
that every radiation exposure is justified and optimized (European Commission, 2018).

Radiographers, therefore, are not merely technical operators but are essential guardians of
patient safety within the broader healthcare system, particularly when it comes to paediatric
patients whose vulnerability to ionizing radiation demands heightened vigilance (Vano, 2017;
Kiljunen, 2018). Their role encompasses a broad spectrum of responsibilities that include
patient education, careful selection of imaging parameters, strict adherence to standardized
protocols, and active collaboration with radiologists, referring physicians, and medical
physicists to ensure that imaging studies are both clinically justified and optimally performed
(Seuri, 2018). By engaging in continuous education and training on radiation protection
updates and technological innovations, radiographers enhance their competency to tailor
imaging protocols according to patient size, age, and clinical indications, thus embodying the
principle of personalized radiology (Seuri, 2018; European Society of Radiology, 2021).

The application of the ALARA principle is particularly vital in paediatric imaging where
there is no truly "safe" threshold of ionizing radiation; instead, every dose carries a stochastic
risk that must be minimized to the greatest extent feasible (European Commission, 2018;
Vano, 2017). This necessitates a strategic approach to imaging that includes the use of dose-
reduction technologies such as automatic exposure control, tube current modulation, iterative
reconstruction techniques, and the employment of alternative, non-ionizing imaging
modalities such as ultrasound and magnetic resonance imaging (MRI) whenever clinically
appropriate (Brady, 2021; Kanal, 2020). Radiographers must exercise critical judgment in
balancing the need for diagnostic accuracy against the imperative to reduce radiation
exposure, ensuring that high-quality diagnostic images are obtained with the lowest
reasonable dose (Franz, 2022).

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

In addition to technical and communicative competencies, radiographers must also advocate

for institutional policies that prioritize radiation safety through the establishment of paediatric
-specific imaging protocols, regular auditing of radiation doses, and participation in
multidisciplinary quality improvement initiatives (Kamp, 2020; Brady, 2021). Establishing
diagnostic reference levels (DRLs) for paediatric procedures, benchmarking practice against
national and international standards, and incorporating radiation dose monitoring software
into routine practice are critical strategies to ensure ongoing quality assurance and patient
protection (European Commission, 2018; ICRP, 2021).
As paediatric imaging technologies continue to evolve—introducing innovations such as
spectral CT, low-dose fluoroscopy, and advanced image reconstruction algorithms—the role
of the radiographer will inevitably expand to include expertise in new modalities and greater
involvement in protocol development and dose optimization research (Franz, 2022; Mahesh,
2019). A proactive commitment to professional development will therefore be essential in
maintaining the highest standards of paediatric radiation protection, ensuring that
radiographers remain at the forefront of safe, effective, and compassionate imaging care
(European Society of Radiology, 2021; Kanal, 2020).

Ultimately, the future of paediatric imaging rests heavily on the shoulders of those who
operate within it daily. Radiographers, as vital members of the healthcare team, must not only
apply existing knowledge and techniques but also drive innovation and advocacy efforts that
advance a culture of radiation safety for children worldwide (Kiljunen, 2018; Strauss, 2019).
By doing so, they will continue to uphold the delicate balance between leveraging the life-
saving benefits of ionizing radiation and protecting the youngest and most vulnerable
members of society from its potential harms.

This responsibility extends beyond the individual radiographer's practice to a broader

professional commitment to research, education, and policy development in paediatric
radiation protection (Vano, 2017; European Society of Radiology, 2021). Radiographers must
actively engage in research initiatives that seek to refine imaging protocols, develop
innovative dose-reduction techniques, and assess the long-term outcomes of radiation
exposure in children, thereby contributing valuable data that inform evidence-based practice
and regulatory standards (Brady, 2021; Kanal, 2020). By participating in multidisciplinary
research collaborations, radiographers can influence the trajectory of paediatric imaging
towards greater safety, efficacy, and patient-centred care (Einstein, 2020).

Moreover, education and professional development serve as critical pillars for sustaining and
enhancing the culture of radiation safety. Radiographers must prioritize lifelong learning,
enrolling in continuous professional development (CPD) programs, attending specialized
paediatric imaging workshops, and obtaining certifications that emphasize radiation
protection competencies (Franz, 2022; Mahesh, 2019). Educational curricula in radiography
training institutions should be continually updated to incorporate the latest evidence and
technological advancements, ensuring that new generations of radiographers enter the
workforce with a robust understanding of paediatric -specific imaging needs (Seuri, 2018;
Strauss, 2019).

Advocacy efforts are equally important. Radiographers must position themselves as vocal
advocates for the integration of radiation protection principles into all facets of paediatric
healthcare delivery (Frush & Applegate, 2015; Dauer, 2017). This includes lobbying for the
allocation of resources towards modern, low-dose imaging equipment, supporting public
awareness campaigns like "Image Gently," and working collaboratively with healthcare
administrators and policymakers to institutionalize best practices in radiation safety
(European Commission, 2018; Brady, 2021). By championing these causes, radiographers
help ensure that radiation protection is not merely an operational consideration but a deeply
embedded value within healthcare systems.

Institutional leadership plays a pivotal role in empowering radiographers to fulfil these

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

Furthermore, global collaborations and harmonization of paediatric radiation protection

standards are necessary to address disparities between regions and institutions (Vano, 2017;
Kiljunen, 2018). Organizations such as the World Health Organization (WHO), the
International Commission on Radiological Protection (ICRP), and the European Society of
Radiology (ESR) have a crucial role in promoting international guidelines, providing training
resources, and supporting low- and middle-income countries in establishing safe imaging
practices for children (ICRP, 2021; European Society of Radiology, 2021). Radiographers
can contribute meaningfully to these efforts by participating in international forums, research
collaborations, and knowledge exchange programs that collectively work toward a safer
global paediatric imaging landscape.

In this evolving healthcare environment, the ethical responsibility of radiographers cannot be

overstated. Beyond technical competence, they must embody a moral commitment to protect
vulnerable paediatric patients, advocating for imaging decisions that are genuinely in the
child's best interest and ensuring that every exposure is clinically justified (Frush &
Applegate, 2015; Dauer, 2017). This ethical stance requires courage and professionalism,
particularly in situations where there may be pressure to perform non-essential imaging
studies or where resource limitations might compromise best practices (Einstein, 2020;
Brady, 2021).

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

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

Furthermore, the shortage of specialized paediatric radiographers and medical physicists

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

In therapeutic contexts, particularly paediatric radiotherapy, the stakes are even higher. The
precise targeting of malignant tissues while sparing adjacent healthy organs is critical to
prevent severe long-term side effects such as growth abnormalities, neurocognitive deficits,
and secondary malignancies (Vasconcelos, 2021; Ladra & Yock, 2021). However, achieving
this level of precision demands advanced imaging for planning, sophisticated treatment
delivery systems like proton therapy, and highly skilled personnel—all of which are often
lacking in low- and middle-income countries (Kumar, 2020).

The implementation of individualized shielding techniques, patient immobilization devices,

and image-guided radiotherapy (IGRT) protocols remains suboptimal in many regions,
further increasing the likelihood of inadvertent exposure of healthy tissues (Kumar, 2020;
Vasconcelos, 2021). Moreover, the financial burden associated with procuring and
maintaining paediatric-specific radiotherapy equipment can limit accessibility, relegating
children to facilities with inadequate technology that compromises both treatment efficacy
and safety (Franz, 2022).

Addressing these challenges requires a multifaceted approach that includes policy-level

interventions, institutional commitment, and targeted capacity-building initiatives (Ofori,
2020; European Society of Radiology, 2021). Governments and healthcare organizations
must prioritize investment in paediatric-appropriate imaging and radiotherapy technologies
while simultaneously fostering partnerships with international bodies to facilitate knowledge
transfer, technical training, and infrastructure development (Donadille, 2019; Mawuli, 2022).

Training programs specifically focused on paediatric radiation protection should be

mandatory for all radiographers involved in paediatric imaging and therapy. These programs
must emphasize not only the technical aspects of dose optimization and shielding but also
ethical considerations, effective communication with paediatric patients and their caregivers,
and the psychological aspects of managing children in clinical settings (Franz, 2022;
Ayinmode, 2021). Only through a concerted and sustained effort at every level—individual,
institutional, and systemic—can the current gaps in paediatric radiation protection be bridged,
ensuring that all children, irrespective of geography or economic status, receive the safest and
highest quality of care.

In Nigeria and many other developing countries, the pursuit of optimal radiation protection
practices in paediatric healthcare continues to face significant challenges. Critical barriers
such as inadequate infrastructure, limited availability of paediatric-specific imaging
equipment, and insufficient professional development opportunities for radiographers
collectively undermine efforts to ensure the safe use of ionizing radiation in children
(Adejumo, 2022). In numerous healthcare facilities, radiographers are often compelled to
work with outdated machines that lack modern dose-reduction features, making it difficult to
align imaging practices with international safety standards. Compounding this issue is the
weak enforcement of radiation safety regulations, which results in inconsistent adherence to
protocols designed to minimize unnecessary exposure (Adejumo, 2022; Ofori, 2020).

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

Given these pervasive challenges, it becomes increasingly imperative to systematically

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

In conclusion, bridging the gap between recommended radiation protection practices and
their implementation in Nigeria and similar developing countries requires a concerted, multi-
level approach. Strengthening infrastructure, enforcing regulatory standards, and prioritizing
paediatric-specific education for radiographers are fundamental to safeguarding the well-
being of children exposed to ionizing radiation. Through systematic evaluation and targeted
interventions, it is possible to create a safer paediatric imaging and therapeutic environment
—one that upholds the principles of radiation protection and secures better health outcomes
for the most vulnerable populations (Adejumo, 2022; Aliyu, 2021; Olowookere, 2023).

1.2 Statement of the Problem

Despite the established risks associated with ionizing radiation, paediatric patients continue to
be exposed to doses that exceed recommended safety thresholds due to poor adherence to
radiation protection protocols. In many clinical settings, particularly in resource-constrained
environments, the adoption of radiation safety measures tailored for children remains
suboptimal. Radiographers often rely on adult imaging parameters, failing to adjust exposure
settings appropriately for the smaller size and heightened sensitivity of paediatric patients.
Furthermore, the absence or improper use of protective devices such as lead aprons, thyroid
shields, and gonadal shields compounds the risk of unnecessary exposure. Inadequate training
and limited emphasis on paediatric radiation safety during professional development
programs further exacerbate these lapses, leaving children particularly vulnerable to both
immediate and latent health complications associated with radiation exposure. Given
children's longer life expectancy, even minor exposures can accumulate significant biological
effects over time, highlighting the critical need for stringent adherence to established
radiation protection guidelines.

In therapeutic contexts, particularly in the radiotherapy management of childhood cancers,

the principles of radiation protection are frequently compromised. Radiotherapy, while life-
saving, carries significant risks if not meticulously planned and executed with paediatric-
specific considerations. In many institutions, treatment planning systems may not be
adequately calibrated for paediatric anatomy, leading to less precise targeting of tumours and
inadvertent irradiation of healthy developing tissues. Outdated or poorly maintained
equipment further increases the likelihood of radiation misadministration, while the absence
of comprehensive, multidisciplinary collaboration between oncologists, medical physicists,
and radiographers can result in critical gaps in treatment delivery. These deficiencies often
manifest in serious, lifelong consequences for paediatric patients, including the development
of secondary malignancies, impairment of physical growth, cognitive deficits, and other
developmental disorders. The long-term burden of such adverse outcomes not only affects
individual patients and their families but also places an additional strain on already
overstretched healthcare systems.

However, there is a notable scarcity of empirical research evaluating the extent to which
radiographers in Nigeria comply with radiation protection standards in both diagnostic
imaging and therapeutic radiology for paediatric patients. Existing studies have largely
focused on adult populations or generalized radiation safety practices without isolating the
unique vulnerabilities and needs of children. Consequently, there remains a critical gap in
understanding the specific challenges faced by radiographers in implementing paediatric-
focused radiation protection in real-world settings. This absence of targeted data hinders the
development of effective, evidence-based interventions, training curricula, and policy
frameworks that could strengthen paediatric patient safety. Without a clear picture of current
practices, opportunities for meaningful improvements are lost, and children continue to bear
the preventable burden of excessive radiation exposure. Addressing this knowledge gap is
therefore imperative to inform future strategies that will prioritize the safety and well-being
of paediatric patients undergoing diagnostic and therapeutic radiologic procedures.

1.3 Objectives of the Study

The main objective of this study is to evaluate radiation protection practices among
radiographers in paediatric imaging and therapy involving ionizing radiation.

Specific objectives are to:

1. To assess the level of compliance of radiographers with established radiation

protection guidelines during paediatric diagnostic imaging and therapeutic
procedures.
2. To determine the levels of ionizing radiation received by paediatric patients during
various diagnostic and therapeutic radiologic procedures.
3. To analyse the effectiveness of protective measures such as shielding, dose
optimization, and justification protocols employed in paediatric radiology and
radiotherapy.
4. To compare radiation exposure levels across different imaging modalities (e.g., X-ray,
CT, fluoroscopy) and therapeutic settings in paediatric practice.
 5. To evaluate the knowledge and training of radiographers regarding paediatric-specific
radiation protection principles and best practices.
6. To investigate the potential long-term risks associated with repeated exposure to
ionizing radiation among paediatric patients undergoing diagnostic or therapeutic
interventions.

1.4 Research Questions

1. To what extent do radiographers comply with radiation protection guidelines

during paediatric diagnostic and therapeutic procedures?

2. What are the levels of ionizing radiation doses received by paediatric patients
across different radiologic procedures?

3. How effective are protective measures, such as shielding, dose optimization,

and justification protocols, in minimizing paediatric radiation exposure?

4. How do radiation exposure levels compare among different imaging

modalities (e.g., X-ray, CT, fluoroscopy) and therapeutic interventions in
paediatric settings?

5. What is the level of knowledge and extent of training that radiographers

possess concerning paediatric radiation protection?

6. What are the potential long-term health risks associated with repeated
exposure to ionizing radiation in paediatric patients?

1.5 Research Hypotheses

H₀₁: There is no significant level of non-compliance among radiographers regarding

radiation protection guidelines in paediatric diagnostic and therapeutic procedures.

H₀₂: There is no significant difference in the radiation doses received by paediatric patients
across different radiologic and therapeutic procedures.
H₀₃: Protective measures such as shielding, dose optimization, and justification protocols do
not significantly reduce paediatric radiation exposure.

H₀₄: There is no significant variation in radiation exposure levels between different imaging
modalities and therapeutic settings in paediatric care.

H₀₅: Radiographers' level of knowledge and training does not significantly influence
compliance with paediatric radiation protection guidelines.

H₀₆: Repeated exposure to ionizing radiation does not significantly increase long-term health
risks in paediatric patients.

1.6 Significance of the Study

This study is fundamentally important because it seeks to improve radiation safety practices
for paediatric patients who are highly vulnerable to the harmful effects of ionizing radiation.
By identifying gaps in current radiation protection measures, the study will ultimately
enhance the quality of care provided to children undergoing diagnostic imaging and
radiotherapy. Improving these practices will help minimize radiation-induced complications,
safeguard developing organs, and reduce the long-term risk of secondary cancers and
developmental impairments in paediatric patients.

Radiographers stand to benefit greatly from this research as it will provide a clear assessment
of their compliance with paediatric radiation protection standards. The findings will serve as
a guide for professional development by highlighting specific areas where knowledge and
skills need to be strengthened. This will encourage the adoption of child-specific protocols,
reinforce the principles of ALARA (As Low As Reasonably Achievable), and promote a
more cautious approach to paediatric imaging and therapy.

Healthcare institutions, including hospitals and diagnostic centres, will also find value in the
study’s outcomes. The evidence generated will help them to review and upgrade their
operational procedures, ensuring that paediatric radiation safety measures are systematically
implemented and monitored. This improvement will enhance institutional credibility, patient
trust, and overall compliance with national and international healthcare quality standards.
Furthermore, the study will be instrumental for policymakers and regulatory bodies tasked
with overseeing radiation safety in healthcare facilities. By providing empirical data on
current practices, the study will support the development of more robust, context-specific
regulations and policies geared towards paediatric radiation protection. It will also inform
strategic decisions around resource allocation, capacity building, and enforcement
mechanisms within the healthcare sector.

Medical educators and training institutions are another critical group that will benefit from
this study. The results will highlight curriculum gaps related to paediatric radiation safety,
prompting the integration of updated, evidence-based content into radiography training
programmes. This will ensure that emerging radiographers are well-prepared to meet the
specific needs of paediatric patients safely and effectively.

Parents and guardians, though indirectly, will benefit from the improved safety standards that
this study seeks to promote. Increased assurance that their children are receiving medical
imaging and therapeutic services with minimal radiation risks will enhance their confidence
in healthcare providers and empower them to advocate for safer practices when necessary.

Lastly, researchers and academicians will find this study a valuable addition to the limited
body of literature on paediatric radiation protection in Nigeria and similar low-resource
settings. It will open new avenues for future research, encourage comparative studies, and
deepen the academic discourse on strategies to safeguard paediatric populations against the
risks of ionizing radiation.

1.7 Scope of the Study

This study focuses specifically on evaluating the adherence of radiographers to radiation

protection practices in paediatric diagnostic imaging and therapeutic radiology within
selected healthcare facilities in Nigeria. It covers both diagnostic procedures, such as X-rays,
computed tomography (CT), and fluoroscopy, as well as therapeutic procedures like
radiotherapy for childhood cancers. By examining both domains, the study aims to present a
comprehensive understanding of how radiation protection protocols are applied across the
spectrum of paediatric care involving ionizing radiation.
The study will assess the levels of ionizing radiation doses received by paediatric patients
during these procedures and evaluate the extent to which protective measures—such as
shielding, dose optimization, collimation, and application of the ALARA principle—are
implemented. It will also investigate whether paediatric-specific protocols are used during
imaging and treatment sessions or if adult protocols are inappropriately adapted, leading to
potential overexposure in children.

Radiographers’ knowledge, training, and experience in paediatric radiation protection form

another critical focus of the study. It will explore the relationship between professional
competence and the compliance rate with established safety guidelines. Additionally, the
study will examine the influence of independent variables such as the type of procedure,
imaging modality, equipment settings, and protocol adherence on the radiation dose received
by paediatric patients.

The study population will consist of radiographers and paediatric patients across selected
diagnostic and radiotherapy centres. Control variables like the age and weight of paediatric
patients, type of medical condition, and equipment technical parameters (such as kVp, mAs,
and exposure time) will be accounted for to ensure accurate interpretation of the findings.

However, the study is geographically limited to healthcare facilities within Nigeria,

particularly focusing on urban and semi-urban centres where both diagnostic and therapeutic
radiology services for children are available. It does not extend to adult patients, veterinary
radiology, or non-ionizing imaging techniques like ultrasound or MRI. The scope is further
confined to assessing current practices without implementing or testing specific interventions
during the study period.

Through this defined scope, the study aims to generate evidence that will inform practice
improvement, policy formulation, targeted training initiatives, and ultimately contribute to
enhancing paediatric radiation safety standards in Nigeria.

1.8 Operational Definition of Terms

Radiation Protection:
In this study, radiation protection refers to the deliberate application of safety measures,
techniques, and procedures aimed at minimizing the exposure of paediatric patients to
ionizing radiation during diagnostic imaging and therapeutic treatments, while ensuring the
effectiveness of the medical intervention.

Paediatrics:
Paediatrics, for the purpose of this study, is defined as the branch of medicine concerned with
the diagnosis, treatment, and overall health care of individuals from birth through
adolescence (0–18 years), particularly in contexts involving exposure to ionizing radiation.

Radiographers:
Radiographers are healthcare professionals trained and licensed to carry out diagnostic
imaging examinations and therapeutic radiation procedures. In this study, they specifically
refer to those responsible for applying radiation protection protocols during paediatric
imaging and therapy.

Ionizing Radiation:
Ionizing radiation in this study refers to high-energy electromagnetic waves or particles (such
as X-rays and gamma rays) used in medical settings, capable of removing electrons from
atoms and potentially causing biological damage to living tissues.

Diagnostic Exposure:
Diagnostic exposure refers to the ionizing radiation dose received by paediatric patients as a
result of undergoing imaging procedures such as conventional X-rays, computed tomography
(CT) scans, and fluoroscopic examinations for diagnostic purposes.

Therapeutic Exposure:
Therapeutic exposure in this context describes the intentional delivery of controlled doses of
ionizing radiation to paediatric patients during medical treatments, such as radiotherapy,
aimed at managing or curing diseases like cancer.
References

Adejumo, S. A., Ogunlade, O., & Afolabi, O. (2022). Assessment of radiation protection
practices among radiographers in selected hospitals in Nigeria. African Journal of Health
Sciences, 35(3), 267–275.

Aliyu, G. G., Usman, A., & Yusuf, A. (2021). Evaluation of radiation dose optimization in
paediatric imaging: Challenges in resource-limited settings. West African Journal of
Radiology, 28(1), 23–29.

Amadi, L. O., Nwachukwu, C. C., & Okoye, G. C. (2019). An appraisal of radiation

protection practices among radiographers in South-Eastern Nigeria. Nigerian Journal of
Medical Imaging and Radiation Therapy, 8(1), 15–20.

Berrington de González, A., Kim, K. P., Smith-Bindman, R., & McAreavey, D. (2021).
Radiation protection in paediatric radiotherapy: Global challenges and recommendations.
Paediatric Blood & Cancer, 68(5), e28976.

Dauer, L. T., Thornton, R. H., Hay, J. L., Balter, R., Williamson, M. J., & St Germain, J.
(2017). Fears, feelings, and facts: Interactively communicating benefits and risks of medical
radiation with patients. American Journal of Roentgenology, 208(5), 961–966.

Damilola, A., Akinlade, B. I., & Arogundade, R. A. (2020). Radiation protection practices
among healthcare professionals in Nigeria: A paediatric perspective. Radiography Journal of
Nigeria, 6(2), 45–51.

Donadille, L., Jeukens, C. R. L. P. N., & Jacob, S. (2019). Paediatric imaging and radiation
protection: State of practice and recommendations. European Journal of Radiology, 114,
106–113.

European Commission. (2018). Radiation protection 185: European guidelines on diagnostic

reference levels for paediatric imaging. Luxembourg: Publications Office of the European
Union.
Eze, C. U., Ibeagwa, O. B., & Abonyi, L. C. (2018). Radiation protection practices of
radiographers: A study of South-East Nigeria. Nigerian Journal of Medical Imaging and
Radiation Therapy, 7(1), 11–17.

Frush, D. P., & Applegate, K. (2015). Image Gently: A campaign to promote radiation
protection for children. Paediatric Radiology, 45(5), 465–468.

Huang, B., Law, M. W. M., & Khong, P. L. (2016). Whole-body PET/CT scanning:
Estimation of radiation dose and cancer risk. Radiology, 251(1), 166–174.

International Commission on Radiological Protection (ICRP). (2020). ICRP Publication 143:

Paediatric radiological protection. Annals of the ICRP, 49(1).

Kamp, J. K., Meier, R., & Nyathi, T. (2020). Radiation dose optimisation and paediatric
imaging: Bridging the gap between theory and practice. Radiography, 26(4), e231–e237.

Kiljunen, T., Nieminen, M. T., & Kortesniemi, M. (2018). Radiology personnel’s knowledge
on paediatric patient doses and radiation protection: Survey results. Radiography, 24(2), 154–
158.

Ofori, E. K., Antwi, W. K., & Edusei, P. (2020). Paediatric radiographic technique challenges
in Ghana: A cross-sectional study. BMC Medical Imaging, 20(1), 37.

Olowookere, C. J., Adeniran, S. A., & Afolabi, A. O. (2023). Radiation protection

compliance among radiographers in Nigeria: A paediatric perspective. African Journal of
Medical and Health Sciences, 22(1), 45–52.

Strauss, K. J., & Goske, M. J. (2019). Estimated paediatric radiation dose during CT.
Radiologic Clinics of North America, 57(6), 1069–1082.

Tapiovaara, M., Siiskonen, T., & Savolainen, S. (2016). Patient dose monitoring and
radiation protection in paediatric radiology. Radiation Protection Dosimetry, 169(1-4), 226–
231.

Vasconcelos, J. L. M., de Castro, M. B., & Silva, D. L. (2021). Radiation therapy planning in
paediatrics: Addressing protection and optimization. Reports of Practical Oncology and
Radiotherapy, 26(5), 790–798.

Vano, E., Miller, D. L., & Dauer, L. T. (2017). Patient radiation doses in interventional
radiology: A review. Current Radiology Reports, 5(2), 16.