Adherence to Radiation Protection Principles among Operating Room Students: Implications for Clinical Recommendations and Educational Interventions

Adherence to Radiation Protection Principles among Operating Room Students: Implications for Clinical Recommendations and Educational Interventions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adherence to Radiation Protection Principles among Operating Room Students: Implications for Clinical Recommendations and Educational Interventions Sina Ghasemi, Hossein Khosravi, Behzad Imani, Naeeme Shabani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4999824/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Due to the increasing use of ionizing radiation in the operating room environment, concerns about the potential risks of this type of radiation have increased. Therefore, this study aimed to investigate the level of knowledge, attitudes, and performance of last semester operating room nursing and anesthesia students toward radiation protection principles for their presence in the clinical educational environment. Methods This cross-sectional study was conducted at Hamadan University of Medical Sciences in 2024. In this study, students were selected via the census sampling method. The data related to the study were collected from valid questionnaires concerning the participants’ level of knowledge, attitudes, and performance toward ionizing radiation. Additionally, the data analysis was conducted at the descriptive and inferential statistics level via SPSS version 16 software. Results Students' knowledge, attitudes, and performance in both operating room nursing and anesthesia were moderate. Additionally, the mean attitude score toward protective principles was significantly greater among operating room nursing students than among anesthesia students (P value = 0.023). Furthermore, a positive and significant correlation was found between students' grade point average (GPA) and their scores on knowledge and attitudes toward protective principles (r = 0.449, P value = 0.000 and r = 0.648, P value = 0.000, respectively). Conclusion This study revealed an insufficient level of knowledge among the mentioned students regarding ionizing radiation. As a result, training courses should be conducted to increase students' knowledge and attitudes toward the risks of ionizing radiation, thereby improving their safety in the clinical educational environment. Clinical Trial Number: Not applicable. Operating room nursing Anesthesia Education Radiation protection Awareness Perception Figures Figure 1 Introduction Currently, radiology is the cornerstone of clinical diagnosis and effective patient management in the medical sciences [ 1 ]. The ability of ionizing radiation to penetrate soft tissue to capture images that the human eye cannot see is essential in the branches of medical sciences [ 2 ]. The increase in the speed of modern imaging technologies is perceived as a double-edged sword because of the various radiation risks it poses [ 3 ]. On the other hand, universities must protect students' safety and security by educating them [ 4 ]. The operating room environment, which is considered a specialized clinical environment for operating room nursing and anesthesia students, is a high-risk environment due to various factors [ 5 ]. Individuals in the operating room are exposed to multiple risks, such as chemical and biological toxins, carcinogenic substances, and ionizing and nonionizing radiation [ 5 ]. The exposure of individuals to ionizing radiation is inevitable due to the use of radiology imaging technology, especially fluoroscopy with a C-Arm device, during orthopedic and spinal surgeries and implant placements in the operating room environment [ 6 ]. High-dose ionizing radiation (X-ray) has both deterministic and stochastic effects. These types of radiation can cause severe and irreversible damage, such as blood cancer and genetic injuries [ 7 ]. Ionizing rays can directly and indirectly damage DNA and living cells by creating free radicals, considered uncharged and unstable molecules [ 8 ]. These unstable radicals, to stabilize, can produce new toxic substances, such as hydrogen peroxide, in living tissues and other cellular alternations [ 9 ]. Therefore, the reasonable and optimal use of new medical imaging technologies, knowledge, and appropriate adherence to protection principles is crucial [ 8 ]. Generally, radiation protection principles refer to a set of measures aimed at minimizing the exposure of patients and healthcare personnel to ionizing radiation to reap the benefits of radiography while ensuring complete safety for the patient [ 3 ]. In performing all medical imaging techniques, three principles are applied: justification, optimization, and dose limitation, where the optimization principle serves to increase individuals' knowledge about the effects of radiation exposure [ 10 ]. To reduce the risk of radiation exposure, medical science students should have comprehensive knowledge of protective protocols against radiation exposure. This knowledge should be provided to students throughout their educational period in college [ 3 ]. In addition to providing proper education, the role of nursing managers in utilizing management skills and effective leadership styles in empowering staff, supporting them, and enhancing the quality of care can be impactful [ 11 ]. Holding training courses and upgrading employees by nursing managers, such as courses in radiation protection, organizational development, and increasing productivity, will follow [ 12 ]. Previously published studies have shown that healthcare professionals and students in various medical science fields have limited knowledge about ionizing radiation and protective principles against it [ 13 , 14 ]. In the past, training on the principles of working with radiation was not considered essential in the curriculum of medical science students. However, given its significant importance, currently, in some countries, such as Japan, the relevant educational council deems learning the principles of working with radiation and familiarizing oneself with the potential risks essential for better professional performance of nurses and healthcare personnel [ 15 ]. In this context, assessing the level of knowledge of medical science students and healthcare personnel and conducting radiation protection (RP) courses can help reduce the exposure of specialists and patients to ionizing radiation [ 10 ]. Determining people's knowledge, attitudes, and performance concerning radiation protection across different fields can help healthcare policymakers better manage and improve awareness, attitude modification, and performance. Most studies on ionizing radiation awareness and familiarity with protective principles have focused on specialists, physicians, and personnel. However, there have been no studies in Iran or other countries on the level of awareness among students of surgical technology and anesthesia due to their constant presence in the operating room environment and exposure to X-rays during orthopedic and spinal surgeries. Additionally, similar studies have focused primarily on assessing individuals' level of knowledge and attitudes. In contrast, in this study, students' performance was also examined alongside their knowledge and attitudes. Therefore, to investigate the necessary training for providing correct knowledge to students and healthcare personnel regarding radiation and its principles, the present study aimed to clarify the level of perception, attitudes, and performance of operating room nursing and anesthesia students toward protective principles against ionizing radiation. Materials and Methods Study Design and Participants The present cross-sectional study was conducted in 2024 at Hamadan University of Medical Sciences. The statistical population included Hamadan University of Medical Sciences operating room nursing and anesthesia students, among whom 70 students were selected by the census sampling method and based on the inclusion criteria. Students were selected based on entrance criteria, including being in the last semester of operating room nursing and anesthesia and being willing to participate in the study. Additionally, students' participation in extra courses on learning the principles of working with radiation and C-Arm machines compared with others was considered an exit criterion for this study. Collecting Data In this research, two questionnaires were used for data collection as follows: The demographic information questionnaire included questions about age, gender, field of study, student's grade point average (GPA), academic semester, and number of credits passed by the student. The second part consisted of a questionnaire comprising 30 questions regarding attitudes, knowledge, and performance in the field of observing protective measures for patients and radiographers. The questions in this questionnaire included risks of ionizing radiation, the ALARA principle, permissible radiation dose limits, the role of film processing conditions, the role of different parts of the X-ray machine (collimator, filter, intensifying screen) in the patient and radiographer dose, the use of Bucky film, the use of protective equipment, and performing blood tests for health assessment of radiographers, as well as a survey about specific patient conditions. The reliability and validity of this questionnaire have been confirmed in previous studies. In the study by Karami and colleagues, the validity and reliability of the questionnaire were determined via the content validity method with several professors, and on the basis of the results of the Cronbach's alpha test, the reliability was determined to be 0.76 [ 16 ]. Implementation of the study After obtaining permission from the Ethics Committee of Hamadan University of Medical Sciences, students who met the inclusion criteria were invited to participate in the study. After providing their consent and satisfaction, the researchers explained the study's objectives to them and distributed the questionnaires to them. Each student took approximately 20 minutes to complete the questionnaires. The confidentiality of the participants' information was assured. Statistical analysis Finally, data analysis was conducted via SPSS, version 16.0 (SPSS Inc., Chicago, Ill., USA) software, with a significance level of 0.05. First, the assumption of normality of the data was checked via the Kolmogorov‒Smirnov test. Descriptive statistics included the frequency, percentage, mean, and standard deviation. Fisher's exact test and independent t-tests were used to compare the frequency distributions of qualitative and quantitative demographic characteristics between the students. Additionally, the Pearson correlation coefficient was used to determine the relationships between the grades obtained from the questionnaire and their demographic characteristics. Results This study examined 70 last-semester students in the operating room for nursing (n = 35) and anesthesia (n = 35). Additionally, 33 participants (47.14%) were male, and 37 participants (52.86%) were female. The mean ± standard deviation of the age of the students was 22.74 ± 1.25 years. Additionally, the mean GPA of the students based on the score was 17.49 ± 0.65. According to Fisher's exact test, there was no statistically significant difference in terms of sex between the two groups of operating room nursing and anesthesia students (P value = 0.811). Furthermore, the independent t test results between the mean age and GPA of students in the operating room and anesthesia groups did not significantly differ. The significance levels were 0.186 and 0.776, respectively (Table 1). Table (1): Mean and standard deviation of age and GPA of students by field of study Field of Study Mean Standard deviation P-value Age Operating room nursing 22.94 1.23 0.186 Anesthesia 22.54 1.26 Grade Point Average Operating room nursing 17.51 0.66 0.776 Anesthesia 17.47 0.64 Based on our findings, the means ± standard deviations of the total scores of students' knowledge levels regarding radiation protection methods among operating room nursing and anesthesia students were 5.40 ± 2.64 and 4.71 ± 2.46, respectively. Additionally, the means ± standard deviations of the total scores of students' attitudes toward radiation protection methods among operating room nursing and anesthesia students were 5.82 ± 2.68 and 4.42 ± 2.35, respectively. Moreover, the means ± standard deviations of the total score of their performance level in the two groups were 5.82 ± 1.09 and 5.71 ± 1.07, respectively (Table 2). Table (2): The mean scores of students' level of knowledge, attitude, and performance regarding the principles of radiation protection by field of study and gender Variable Mean (Standard deviation) Field of Study P-value Gender P-value Operating room nursing Anesthesia Male Female Knowledge 5.40 (2.64) 4.71 (2.46) 0.266 3.87 (2.59) 6.10 (2.05) 0.000 Attitude 5.82 (2.68) 4.42 (2.35) 0.023 3.48 (2.12) 6.59 (2.07) 0.000 Performance 5.82 (1.09) 5.71 (1.07) 0.661 5.54 (1.06) 5.97 (1.06) 0.098 The independent t-test results revealed a statistically significant relationship between the scores of students' attitudes toward radiation protection principles among operating room nursing and anesthesia students (P value = 0.023). There was no statistically significant relationship between the mean scores of knowledge level and performance of students between the operating room nursing and anesthesia groups. However, the average score among operating room nursing students was greater than that among anesthesia students. Furthermore, Table 2 shows the mean scores and standard deviations of students' knowledge level, attitudes, and performance regarding radiation protection principles based on gender. According to the results of this table, the mean scores of knowledge level and attitudes toward radiation protection principles among female students were significantly higher than those among male students (P value < 0.001). However, no statistically significant difference was observed in the performance level scores of the students in terms of these principles between the male and female students (P value = 0.098). The results indicate a statistically significant relationship between the overall GPA of all the students and the mean scores of their knowledge level and attitudes toward radiation protection principles, such that there is a positive and significant correlation between the students’ GPA and the mean scores of their knowledge level and attitudes toward radiation protection principles (P value = 0.000). However, statistical analyses revealed no relationship between the GPA and the grade obtained from students' performance concerning radiation protection principles (P value = 0.059). Furthermore, among operating room nursing students, there was a significant positive correlation between their GPA and their level of knowledge and attitudes toward radiation protection principles (r = 0.575 and r = 0.677, respectively) (p value = 0.000). However, among anesthesia students, only a significant and positive correlation was found between their attitude level and GPA (r = 650) (p-value = 0.000) (Table 3). Table (3): Correlation coefficients of the scores of knowledge level, attitude, and performance towards the principles of radiation protection with grade point average and age of students Variable Field of Study Knowledge Attitude Performance r P-value r P-value r P-value Grade Point Average Operating room nursing 0.575 * 0.000 0.575 * 0.000 0.142 0.416 Anesthesia 0.309 0.070 0.650 0.000 0.314 0.066 Total 0.449 * 0.000 0.648 0.000 0.227 0.098 Age Operating room nursing 0.205 0.237 0.272 0.114 0.361 * 0.033 Anesthesia -0.250 0.148 -0.208 0.230 -0.120 0.491 Total 0.005 0.970 0.085 0.482 0.127 0.296 Concerning the variable of the students' age, no significant correlation was found between the ages of all the students and their levels of knowledge, attitudes, and performance. However, among operating room nursing students, only a significant and positive correlation was found between their performance level with respect to radiation protection principles and their age (r = 0.361) (P = 0.033). No significant correlation was found among anesthesia students regarding age, knowledge level, attitudes or performance. Discussion The use of modern medical imaging technology plays a vital role in the diagnosis and management of diseases. The ability of these methods to provide necessary information in the shortest possible time is widely increasing in various surgical procedures, especially orthopedic and spinal surgeries. However, facing the risks of using ionizing radiation via various imaging methods and adhering to protective protocols by personnel and students, in addition to their level of knowledge, can depend on multiple factors, such as their education level, current training policies for individuals, and the tools available for their training and practice [ 10 ]. Considering the limited studies on the level of knowledge, attitudes, and performance of students in these fields toward ionizing radiation, we resorted to research conducted on students in other medical science disciplines to investigate and compare our results with those of other studies in this area. On the basis of our findings, considering the score range between zero and ten, the levels of knowledge, attitudes, and performance of operating room nursing and anesthesia students were average. In line with this result, in research conducted by Cheki et al., the level of knowledge of radiology students about radiation protection principles was also average [ 17 ], which may be due to They are more familiar given that they receive more education due to the nature of their profession. However, a study conducted in Norway on final-year medical students indicated a low level of knowledge among students regarding the risks associated with ionizing radiation [ 18 ]. These results can be justified, considering that radiology students have more information about the principles of protection against ionizing radiation than do students in other disciplines. Additionally, in research conducted by Faggioni et al., the students' level of knowledge regarding the principles of radiation protection in several fields of medical sciences was fragile [ 19 ]. In line with these findings, Salih et al. reported that final-year nursing students' level of awareness and knowledge was poor [ 20 ]. In addition, a study in Iran revealed that the level of knowledge among operating room staff regarding principles of protection against radiation was low, and their performance was average [ 21 ]. The abovementioned issues indicate a fundamental concern at different levels of education in various medical science disciplines regarding the ineffectiveness of teaching radiation protection principles. This lack of knowledge can lead to misconceptions and behaviors that may affect the health services provided. Additionally, the lack of knowledge among students can potentially lead to unnecessary prescription of ionizing radiation imaging tests in the future [ 18 ]. This can also result in inadequate patient education for various procedures, resulting in diverse challenges. Furthermore, these issues can impact legal matters such as obtaining informed consent from patients for surgical procedures. This approach can expose patients to various risks and challenges because patients, without receiving accurate information from healthcare professionals, may be unable to make informed decisions regarding alternative treatments based on the advantages and disadvantages of each method. Our study revealed that operating room nursing students have significantly greater attitudes than anesthesia students do. In this context, in the study by Alavi et al., the field of study of individuals was also considered one of the predictors of individuals' knowledge level regarding radiation protection principles [ 22 ]. This difference can be explained by the educational curriculum and the direction of training in working with C-Arm machines by operating room nursing students, who have taken courses such as medical physics and familiarized themselves with the basics of radiology, which are not included in the radiography curriculum, may have higher scores as a result. Therefore, on the basis of our study findings and other research, it is recommended that educational units or specific courses, such as RP courses, be considered for students in various fields, especially those present in the operating room environment. Guidelines for using these types of radiation to utilize these technologies confidently for patient treatment should be established. Previous studies have shown that clinical training courses in the field of radiation protection principles significantly impact students' knowledge and performance regarding these principles [ 23 ]. In our study, a significant difference was found in the level of knowledge and attitudes between male and female students, with women reporting higher levels. However, no significant difference was found in performance regarding safety principles based on gender. In line with the results of our study, Aspasia Goula et al. reported a significant relationship between individuals' gender and their attitudes toward radiation protection principles. They observed that women had more misconceptions than male employees did. In this study, fear and stress among women regarding pregnancy in the future and the continuous risks of fluoroscopy and its effects on the fetus were considered reasons for the misconceptions and attitudes of female personnel [ 24 ]. In contrast, in the research of Kahkhaei and Sarani, among operating room staff, men had a higher level of awareness and lower performance than women did [ 21 ]. In this regard, Asadian and Zarghani concluded no significant relationship exists between gender, knowledge, attitudes, and performance and radiation protection principles [ 25 ]. In their study of radiology students, Felayani et al. reported no significant relationship between students' level of knowledge and awareness and their gender [ 26 ]. These findings were consistent with the results of the studies by Cheki et al. [ 17 ] and Shabani et al. [ 10 ]. The reason for this discrepancy could be attributed to differences in the study population, the academic disciplines of the students, and the countries where the research was conducted, which affect how people are educated. The findings of our study demonstrated a significant and positive relationship between GPA and the level of knowledge and attitudes toward radiation protection principles among operating room nursing students. Additionally, this relationship was also present among anesthesia students regarding their GPA and attitudes. However, in this study, the Pearson correlation test results did not reveal a significant relationship between the age of operating room nursing or anesthesia students and their attitudes toward or knowledge of radiation protection principles. In line with the results of our study, in the study by Jabari, no correlation was observed between the knowledge and performance of operating room personnel and their age and educational level [ 27 ]. Furthermore, Amjadi et al. reported no correlation between individuals' demographic variables and their knowledge and awareness of radiation protection principles [ 28 ]. In line with this result, in the study by Sundaran Kada, no relationship was found between the age of medical students and their knowledge and knowledge [ 18 ], suggesting that age cannot be considered a predictive factor for students' level of knowledge, attitudes, or performance. On the basis of the findings of the present study, organizing training courses and incorporating coursework familiarizing students with the principles of working with ionizing radiation into the operating room nursing and anesthesia curriculum could be considered essential. Additionally, studies have shown that increasing students' knowledge can significantly reduce their stress and anxiety while working with ionizing radiation [ 15 ]. Therefore, specific training courses that include the necessary knowledge of the biological effects of radiation, the justification of exposure, the optimization of implementation methods, and the advantages and disadvantages of each technique are recommended. These courses can play a significant role in reducing students' stress and mitigating the risks associated with exposure to ionizing radiation. Limitations and recommendations Some of the limitations and shortcomings of this study include its cross-sectional nature. Another limitation of this study was the use of self-report measures, and incorrect answers could influence the responses. Therefore, the participants were assured of the confidentiality of the questionnaires. Additionally, the limited research population compared with the previous semester's operating room nursing and anesthesia students at Hamadan University of Medical Sciences was another limitation of this study that could impact the generalizability of its results. Owing to the level of knowledge and awareness of operating room nursing and anesthesia students, various training courses on the principles of radiation protection should be held at universities, and their effectiveness should be evaluated in future studies. Additionally, owing to the low number of students in these fields in each faculty, further studies should be conducted in this area, and their results should be compared with those of the present study. Conclusion Based on the results of the current study, the level of knowledge, attitudes, and performance of operating room nursing and anesthesia students toward protective principles is insufficient. Therefore, to minimize unnecessary exposure and ensure that operating room personnel understand the correct principles of working with radiation, nursing managers, department officials, and educational policymakers need to prioritize training on radiation safety principles. A fundamental effort is required to provide a more robust education and acquire greater RP in universities. Proper KAP and continuous training can easily prevent many types of radiation-related harm for both interventionalists and patients. Taking part in in-service training programs is crucial for cultivating positive RP attitudes. Creating a culture that emphasizes self-care is essential for improving performance. Declarations Ethical Considerations The study was approved by the Ethics Committee of Hamadan University of Medical Sciences with the code (IR.UMSHA.REC.1402.677). All participants were informed about the purpose of the study and informed consent to conduct the research was obtained. Also, the research units were assured of the confidentiality of the information. Consent for publication Not applicable. Conflict of interest There are no conflicts of interest. Author details 1 Sina Ghasemi. Student Operating Room (MSc), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran. 2 Hossein Khosravi. Assistant Professor of Medical Physics, Department of Radiology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran. 3 Behzad Imani. Associate Professor, Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran. 4 Naeeme Shabani. MSc Student in Critical Care Nursing, Department of Medical Surgical Nursing, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran. Orcid: 0009-0002-2652-4841 Funding The study was funded by Vice-chancellor for Research and Technology, Hamadan University of Medical Sciences . Author Contribution S.Gh. and H.kH. conceptualized the study and developed the study protocol. B.I. oversaw the investigations and conducted analyses. S.Gh. wrote the main manuscript text. N.Sh. provided resources for data collection and performed data collection. Acknowledgments This study results from a research plan approved by Hamadan University of Medical Sciences. We would like to express our gratitude to the Research and Technology Vice-Chancellor of Hamadan University of Medical Sciences for the financial support of this study in the form of project number 140211109876. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. References Khan MO, Khan MS, Janjua O, Ali A, Hussain S. Knowledge of radiation legislation and radiation exposure in common radiological investigations among final year medical students, foundation doctors, specialist radiology registrars and radiographers at a UK university teaching hospital. BJR| Open. 2018;1(1):20180014. Almohaimede AA, Bendahmash MW, Dhafr FM, Awwad AF, Al-Madi EM. Knowledge, attitude, and practice (KAP) of radiographic protection by dental undergraduate and endodontic postgraduate students, general practitioners, and endodontists. International journal of dentistry. 2020;2020. Rai S. Study of Knowledge on Radiation Hazards and Radiation Protection among Medical College Students in Coastal Karnataka. Int J Cur Res Rev| Vol. 2021;13(10):74. Beik Khourmizi M, Saidi F, Khorrami F, Hadavi M. Evaluation of Operating Rooms students’ satisfaction about their Field of Study and Views on Job Future. Res Med Educ. 2020;12(1):62–9. Azarabad S, Zaman S, Nouri B, Valiee S. Frequency, causes and reporting barriers of nursing errors in the operating room students. Res Med Educ. 2018;10(2):18–27. Jenkins NW, Parrish JM, Sheha ED, Singh K. Intraoperative risks of radiation exposure for the surgeon and patient. Annals Translational Med. 2021;9(1). Calabrese EJ, Selby PB. Background radiation and cancer risks: A major intellectual confrontation within the domain of radiation genetics with multiple converging biological disciplines. J Occup Environ Hyg. 2023;20(12):621–32. Maharjan S, Parajuli K, Sah S, Poudel U. Knowledge of radiation protection among radiology professionals and students: A medical college-based study. Eur J Radiol open. 2020;7:100287. Iannucci J, Howerton LJ. Dental radiography-E-book: principles and techniques. Elsevier Health Sciences; 2016. Shabani F, Hasanzadeh H, Emadi A, Mirmohammadkhani M, Bitarafan-Rajabi A, Abedelahi A, et al. Radiation protection knowledge, attitude, and practice (KAP) in interventional radiology. Oman Med J. 2018;33(2):141. Raesi R, Bakhtiari E, Abbasi Z, Saghari S, Bokaie S, Hushmandi K, et al. Selected Leadership Style of Nursing Manager from the Perspective of Nurses Caring for Patients COVID-19. J Military Health Promotion. 2021;2(1):277–85. Raesi R, Farajzadeh Z, Saadatjoo SA. The Effect of Leadership Development Program Based on the Concept-mapping Method on the Components of Leadership Style in Headnurses. J Nurs Educ (JNE). 2018;7(1):27. Alkhaldi WF, Alsehli MD, Alammari RO, Esailan MM, Abdulrazaq A, Althobaiti AMA, et al. Investigation of Awareness Level Concerning Radiation Dose and Associated Risks among Medical Students in KSA. Cross-Sectional Study; 2023. Al Khalifa M, Alghanem S, Mohamad AA. Awareness of radiation dose and incurred risk among clinicians at a tertiary care hospital in Bahrain. J Bahrain Med Soc. 2023;35(1):42–50. Yoshida M, Iwamoto S, Okahisa R, Kishida S, Sakama M, Honda E. Knowledge and risk perception of radiation for Japanese nursing students after the Fukushima Nuclear Power Plant disaster. Nurse Educ Today. 2020;94:104552. Gharibi F, Elahimanesh F. Evaluation of level of knowledge, attitude and performance of Radiologists in Sanandaj city regarding radiation protection in 2014. Sci J Nurs Midwifery Paramedical Fac. 2017;2(4):24–32. Cheki M, Farzanegan Z, Tahmasbi M, Karami A. Determination of the Last Semester Radiology Technology Students’ Knowledge About Radiation Protection, Radiation Exposure and Cancer Risk of Diagnostic Examinations With Lonizing Radiation. Jundishapur Sci Med J. 2021;20(3):226–35. Kada S. Awareness and knowledge of radiation dose and associated risks among final year medical students in Norway. Insights into imaging. 2017;8:599–605. Faggioni L, Paolicchi F, Bastiani L, Guido D, Caramella D. Awareness of radiation protection and dose levels of imaging procedures among medical students, radiography students, and radiology residents at an academic hospital: results of a comprehensive survey. Eur J Radiol. 2017;86:135–42. Salih S, Nordin MN, Alkatheeri A, Nasser A, Saif M, Abdallah Z, et al. Assessment of Nursing Students’ Awareness toward Ionizing Radiation: Cross-Sectional Study. Nurs Rep. 2023;13(2):855–64. Kahkhaei FR, Sarani H. Surgical technologists’ knowledge and performance about radiation protection in Zahedan educational hospitals. A descriptive-analytical study. J Educ Health Promotion. 2020;9(1):283. Alavi SS, Dabbagh ST, Abbasi M, Mehrdad R. Medical radiation workers’ knowledge, attitude, and practice to protect themselves against ionizing radiation in Tehran Province, Iran. J Educ health promotion. 2017;6. Zainudin NHM. Radiation Safety Awareness Among Nursing Students in Universiti Sultan Zainal Abidin (UniSZA): A Survey Study. Asian J Med Biomed. 2023:183–93. Goula A, Chatzis A, Stamouli M-A, Kelesi M, Kaba E, Brilakis E. Assessment of health professionals’ attitudes on radiation protection measures. Int J Environ Res Public Health. 2021;18(24):13380. Asadian S, Zarghani H. Evaluation of knowledge, attitude, and performance of radiographers towards radiation protection in Southern Khorasan Province, Iran. Iran J Med Phys. 2018;15(4):222–5. Felayani F, Wibowo AS, Al Amin K. Knowledge and Awareness Regarding Radiation Safety among Radiology Study Program Students. Jurnal EduHealth. 2023;14(04):133–40. Jabbari M. Assessment of knowledge, awareness, and practice of procedures for protecting operating room personnel from ionizing radiation: a cross-sectional investigation using a questionnaire. Avicenna J Care Health Operating Room. 2023;1(3):79–83. Amjadi A, Ghanei Gheshlagh R, Abdolmohammadi J. dehvan f. Job Satisfaction and its Relationship to Radiation Protection Knowledge, Attitude and Practice. Sci J Nurs Midwifery Paramedical Fac. 2022;8(2):92–100. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4999824","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":356259727,"identity":"99264790-38a1-497d-ba2b-f30f2beec3bb","order_by":0,"name":"Sina Ghasemi","email":"","orcid":"","institution":"Hamadan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sina","middleName":"","lastName":"Ghasemi","suffix":""},{"id":356259728,"identity":"6fbf695c-a825-49fd-a55b-5af5ce7198ae","order_by":1,"name":"Hossein Khosravi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIie2RsQrCMBCGTwLnEulazeArpAiKiPgqkUKnOvkCASFr576Fk5NDIWBfQVDELp0cnMQhg60OgmDUzSHfcOQOPu4/AuBw/CEcEB8vQrKqZo9GfKeg+FUByp+KjQFgdDybQ5fn9NLZmn0XmvoIxfq9MpSYB6maB0vdWrGZKgNJIw6itATLmoq1pGiki1qRuiEhrm6xBLwr1IhJuqAli42eSO/0ScENoyimCaHIYtRT6X/aojFqp0qECcHeaKZ0qPySZ1YlV33/bMRYebrYVcHGiRcWxdWiAHkd1N9kExwOh8PxBTefok7gz/jC0QAAAABJRU5ErkJggg==","orcid":"","institution":"Hamadan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Hossein","middleName":"","lastName":"Khosravi","suffix":""},{"id":356259729,"identity":"63fbfbd7-7752-4079-9478-3a2eed202cc3","order_by":2,"name":"Behzad Imani","email":"","orcid":"","institution":"Hamadan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Behzad","middleName":"","lastName":"Imani","suffix":""},{"id":356259730,"identity":"725f200b-747f-45e9-8945-d52a41aba66d","order_by":3,"name":"Naeeme Shabani","email":"","orcid":"","institution":"Hamadan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Naeeme","middleName":"","lastName":"Shabani","suffix":""}],"badges":[],"createdAt":"2024-08-29 20:11:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4999824/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4999824/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67174763,"identity":"2433b57d-83e8-47ec-a784-b4d90b11e46e","added_by":"auto","created_at":"2024-10-22 04:45:48","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":172575,"visible":true,"origin":"","legend":"\u003cp\u003eThe theoretical framework of the research\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4999824/v1/69c1bf10d8de9e808f11f740.jpeg"},{"id":72173838,"identity":"b3b13b01-ff60-4a86-907f-60722e307244","added_by":"auto","created_at":"2024-12-23 11:32:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":599834,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4999824/v1/cbcc2f7c-ce87-4cdd-bb0d-44730b261bf2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adherence to Radiation Protection Principles among Operating Room Students: Implications for Clinical Recommendations and Educational Interventions","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCurrently, radiology is the cornerstone of clinical diagnosis and effective patient management in the medical sciences [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The ability of ionizing radiation to penetrate soft tissue to capture images that the human eye cannot see is essential in the branches of medical sciences [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The increase in the speed of modern imaging technologies is perceived as a double-edged sword because of the various radiation risks it poses [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. On the other hand, universities must protect students' safety and security by educating them [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe operating room environment, which is considered a specialized clinical environment for operating room nursing and anesthesia students, is a high-risk environment due to various factors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Individuals in the operating room are exposed to multiple risks, such as chemical and biological toxins, carcinogenic substances, and ionizing and nonionizing radiation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The exposure of individuals to ionizing radiation is inevitable due to the use of radiology imaging technology, especially fluoroscopy with a C-Arm device, during orthopedic and spinal surgeries and implant placements in the operating room environment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. High-dose ionizing radiation (X-ray) has both deterministic and stochastic effects. These types of radiation can cause severe and irreversible damage, such as blood cancer and genetic injuries [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Ionizing rays can directly and indirectly damage DNA and living cells by creating free radicals, considered uncharged and unstable molecules [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These unstable radicals, to stabilize, can produce new toxic substances, such as hydrogen peroxide, in living tissues and other cellular alternations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, the reasonable and optimal use of new medical imaging technologies, knowledge, and appropriate adherence to protection principles is crucial [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGenerally, radiation protection principles refer to a set of measures aimed at minimizing the exposure of patients and healthcare personnel to ionizing radiation to reap the benefits of radiography while ensuring complete safety for the patient [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In performing all medical imaging techniques, three principles are applied: justification, optimization, and dose limitation, where the optimization principle serves to increase individuals' knowledge about the effects of radiation exposure [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. To reduce the risk of radiation exposure, medical science students should have comprehensive knowledge of protective protocols against radiation exposure. This knowledge should be provided to students throughout their educational period in college [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition to providing proper education, the role of nursing managers in utilizing management skills and effective leadership styles in empowering staff, supporting them, and enhancing the quality of care can be impactful [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Holding training courses and upgrading employees by nursing managers, such as courses in radiation protection, organizational development, and increasing productivity, will follow [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePreviously published studies have shown that healthcare professionals and students in various medical science fields have limited knowledge about ionizing radiation and protective principles against it [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In the past, training on the principles of working with radiation was not considered essential in the curriculum of medical science students. However, given its significant importance, currently, in some countries, such as Japan, the relevant educational council deems learning the principles of working with radiation and familiarizing oneself with the potential risks essential for better professional performance of nurses and healthcare personnel [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this context, assessing the level of knowledge of medical science students and healthcare personnel and conducting radiation protection (RP) courses can help reduce the exposure of specialists and patients to ionizing radiation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDetermining people's knowledge, attitudes, and performance concerning radiation protection across different fields can help healthcare policymakers better manage and improve awareness, attitude modification, and performance. Most studies on ionizing radiation awareness and familiarity with protective principles have focused on specialists, physicians, and personnel. However, there have been no studies in Iran or other countries on the level of awareness among students of surgical technology and anesthesia due to their constant presence in the operating room environment and exposure to X-rays during orthopedic and spinal surgeries. Additionally, similar studies have focused primarily on assessing individuals' level of knowledge and attitudes. In contrast, in this study, students' performance was also examined alongside their knowledge and attitudes. Therefore, to investigate the necessary training for providing correct knowledge to students and healthcare personnel regarding radiation and its principles, the present study aimed to clarify the level of perception, attitudes, and performance of operating room nursing and anesthesia students toward protective principles against ionizing radiation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThe present cross-sectional study was conducted in 2024 at Hamadan University of Medical Sciences. The statistical population included Hamadan University of Medical Sciences operating room nursing and anesthesia students, among whom 70 students were selected by the census sampling method and based on the inclusion criteria. Students were selected based on entrance criteria, including being in the last semester of operating room nursing and anesthesia and being willing to participate in the study. Additionally, students' participation in extra courses on learning the principles of working with radiation and C-Arm machines compared with others was considered an exit criterion for this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCollecting Data\u003c/h2\u003e \u003cp\u003eIn this research, two questionnaires were used for data collection as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe demographic information questionnaire included questions about age, gender, field of study, student's grade point average (GPA), academic semester, and number of credits passed by the student.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe second part consisted of a questionnaire comprising 30 questions regarding attitudes, knowledge, and performance in the field of observing protective measures for patients and radiographers. The questions in this questionnaire included risks of ionizing radiation, the ALARA principle, permissible radiation dose limits, the role of film processing conditions, the role of different parts of the X-ray machine (collimator, filter, intensifying screen) in the patient and radiographer dose, the use of Bucky film, the use of protective equipment, and performing blood tests for health assessment of radiographers, as well as a survey about specific patient conditions. The reliability and validity of this questionnaire have been confirmed in previous studies. In the study by Karami and colleagues, the validity and reliability of the questionnaire were determined via the content validity method with several professors, and on the basis of the results of the Cronbach's alpha test, the reliability was determined to be 0.76 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eImplementation of the study\u003c/h2\u003e \u003cp\u003e After obtaining permission from the Ethics Committee of Hamadan University of Medical Sciences, students who met the inclusion criteria were invited to participate in the study. After providing their consent and satisfaction, the researchers explained the study's objectives to them and distributed the questionnaires to them. Each student took approximately 20 minutes to complete the questionnaires. The confidentiality of the participants' information was assured.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eFinally, data analysis was conducted via SPSS, version 16.0 (SPSS Inc., Chicago, Ill., USA) software, with a significance level of 0.05. First, the assumption of normality of the data was checked via the Kolmogorov‒Smirnov test. Descriptive statistics included the frequency, percentage, mean, and standard deviation. Fisher's exact test and independent t-tests were used to compare the frequency distributions of qualitative and quantitative demographic characteristics between the students. Additionally, the Pearson correlation coefficient was used to determine the relationships between the grades obtained from the questionnaire and their demographic characteristics.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study examined 70 last-semester students in the operating room for nursing (n\u0026thinsp;=\u0026thinsp;35) and anesthesia (n\u0026thinsp;=\u0026thinsp;35). Additionally, 33 participants (47.14%) were male, and 37 participants (52.86%) were female. The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation of the age of the students was 22.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 years. Additionally, the mean GPA of the students based on the score was 17.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65. According to Fisher's exact test, there was no statistically significant difference in terms of sex between the two groups of operating room nursing and anesthesia students (P value\u0026thinsp;=\u0026thinsp;0.811).\u003c/p\u003e \u003cp\u003eFurthermore, the independent t test results between the mean age and GPA of students in the operating room and anesthesia groups did not significantly differ. The significance levels were 0.186 and 0.776, respectively (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(1): Mean and standard deviation of age and GPA of students by field of study\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eField of Study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperating room nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGrade Point Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperating room nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on our findings, the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations of the total scores of students' knowledge levels regarding radiation protection methods among operating room nursing and anesthesia students were 5.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64 and 4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46, respectively. Additionally, the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations of the total scores of students' attitudes toward radiation protection methods among operating room nursing and anesthesia students were 5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68 and 4.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35, respectively. Moreover, the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations of the total score of their performance level in the two groups were 5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09 and 5.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07, respectively (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(2): The mean scores of students' level of knowledge, attitude, and performance regarding the principles of radiation protection by field of study and gender\u003c/p\u003e \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 96px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 528px;\"\u003e\n \u003cp\u003eMean (Standard deviation)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 240px;\"\u003e\n \u003cp\u003eField of Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 168px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eOperating room nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eAnesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e5.40 (2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e4.71 (2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3.87 (2.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6.10 (2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eAttitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e5.82 (2.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e4.42 (2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e3.48 (2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e6.59 (2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003ePerformance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e5.82 (1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e5.71 (1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e5.54 (1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e5.97 (1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cp\u003eThe independent t-test results revealed a statistically significant relationship between the scores of students' attitudes toward radiation protection principles among operating room nursing and anesthesia students (P value\u0026thinsp;=\u0026thinsp;0.023). There was no statistically significant relationship between the mean scores of knowledge level and performance of students between the operating room nursing and anesthesia groups. However, the average score among operating room nursing students was greater than that among anesthesia students.\u003c/p\u003e \u003cp\u003eFurthermore, Table\u0026nbsp;2 shows the mean scores and standard deviations of students' knowledge level, attitudes, and performance regarding radiation protection principles based on gender. According to the results of this table, the mean scores of knowledge level and attitudes toward radiation protection principles among female students were significantly higher than those among male students (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, no statistically significant difference was observed in the performance level scores of the students in terms of these principles between the male and female students (P value\u0026thinsp;=\u0026thinsp;0.098).\u003c/p\u003e \u003cp\u003eThe results indicate a statistically significant relationship between the overall GPA of all the students and the mean scores of their knowledge level and attitudes toward radiation protection principles, such that there is a positive and significant correlation between the students\u0026rsquo; GPA and the mean scores of their knowledge level and attitudes toward radiation protection principles (P value\u0026thinsp;=\u0026thinsp;0.000). However, statistical analyses revealed no relationship between the GPA and the grade obtained from students' performance concerning radiation protection principles (P value\u0026thinsp;=\u0026thinsp;0.059). Furthermore, among operating room nursing students, there was a significant positive correlation between their GPA and their level of knowledge and attitudes toward radiation protection principles (r\u0026thinsp;=\u0026thinsp;0.575 and r\u0026thinsp;=\u0026thinsp;0.677, respectively) (p value\u0026thinsp;=\u0026thinsp;0.000). However, among anesthesia students, only a significant and positive correlation was found between their attitude level and GPA (r\u0026thinsp;=\u0026thinsp;650) (p-value\u0026thinsp;=\u0026thinsp;0.000) (Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;(3): Correlation coefficients of the scores of knowledge level, attitude, and performance towards the principles of radiation protection with grade point average and age of students\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eField of Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ePerformance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGrade Point Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperating room nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.575\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.575\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.449\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperating room nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.361\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eConcerning the variable of the students' age, no significant correlation was found between the ages of all the students and their levels of knowledge, attitudes, and performance. However, among operating room nursing students, only a significant and positive correlation was found between their performance level with respect to radiation protection principles and their age (r\u0026thinsp;=\u0026thinsp;0.361) (P\u0026thinsp;=\u0026thinsp;0.033). No significant correlation was found among anesthesia students regarding age, knowledge level, attitudes or performance.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe use of modern medical imaging technology plays a vital role in the diagnosis and management of diseases. The ability of these methods to provide necessary information in the shortest possible time is widely increasing in various surgical procedures, especially orthopedic and spinal surgeries. However, facing the risks of using ionizing radiation via various imaging methods and adhering to protective protocols by personnel and students, in addition to their level of knowledge, can depend on multiple factors, such as their education level, current training policies for individuals, and the tools available for their training and practice [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Considering the limited studies on the level of knowledge, attitudes, and performance of students in these fields toward ionizing radiation, we resorted to research conducted on students in other medical science disciplines to investigate and compare our results with those of other studies in this area.\u003c/p\u003e \u003cp\u003eOn the basis of our findings, considering the score range between zero and ten, the levels of knowledge, attitudes, and performance of operating room nursing and anesthesia students were average. In line with this result, in research conducted by Cheki et al., the level of knowledge of radiology students about radiation protection principles was also average [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which may be due to\u003c/p\u003e \u003cp\u003eThey are more familiar given that they receive more education due to the nature of their profession. However, a study conducted in Norway on final-year medical students indicated a low level of knowledge among students regarding the risks associated with ionizing radiation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These results can be justified, considering that radiology students have more information about the principles of protection against ionizing radiation than do students in other disciplines. Additionally, in research conducted by Faggioni et al., the students' level of knowledge regarding the principles of radiation protection in several fields of medical sciences was fragile [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In line with these findings, Salih et al. reported that final-year nursing students' level of awareness and knowledge\u003c/p\u003e \u003cp\u003ewas poor [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition, a study in Iran revealed that the level of knowledge among operating room staff regarding principles of protection against radiation was low, and their performance was average [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe abovementioned issues indicate a fundamental concern at different levels of education in various medical science disciplines regarding the ineffectiveness of teaching radiation protection principles. This lack of knowledge can lead to misconceptions and behaviors that may affect the health services provided. Additionally, the lack of knowledge among students can potentially lead to unnecessary prescription of ionizing radiation imaging tests in the future [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This can also result in inadequate patient education for various procedures, resulting in diverse challenges. Furthermore, these issues can impact legal matters such as obtaining informed consent from patients for surgical procedures. This approach can expose patients to various risks and challenges because patients, without receiving accurate information from healthcare professionals, may be unable to make informed decisions regarding alternative treatments based on the advantages and disadvantages of each method.\u003c/p\u003e \u003cp\u003eOur study revealed that operating room nursing students have significantly greater attitudes than anesthesia students do. In this context, in the study by Alavi et al., the field of study of individuals was also considered one of the predictors of individuals' knowledge level regarding radiation protection principles [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This difference can be explained by the educational curriculum and the direction of training in working with C-Arm machines by operating room nursing students, who have taken courses such as medical physics and familiarized themselves with the basics of radiology, which are not included in the radiography curriculum, may have higher scores as a result. Therefore, on the basis of our study findings and other research, it is recommended that educational units or specific courses, such as RP courses, be considered for students in various fields, especially those present in the operating room environment. Guidelines for using these types of radiation to utilize these technologies confidently for patient treatment should be established. Previous studies have shown that clinical training courses in the field of radiation protection principles significantly impact students' knowledge and performance regarding these principles [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, a significant difference was found in the level of knowledge and attitudes between male and female students, with women reporting higher levels. However, no significant difference was found in performance regarding safety principles based on gender. In line with the results of our study, Aspasia Goula et al. reported a significant relationship between individuals' gender and their attitudes toward radiation protection principles. They observed that women had more misconceptions than male employees did. In this study, fear and stress among women regarding pregnancy in the future and the continuous risks of fluoroscopy and its effects on the fetus were considered reasons for the misconceptions and attitudes of female personnel [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In contrast, in the research of Kahkhaei and Sarani, among operating room staff, men had a higher level of awareness and lower performance than women did [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this regard,\u003c/p\u003e \u003cp\u003eAsadian and Zarghani concluded no significant relationship exists between gender, knowledge, attitudes, and performance and radiation protection principles [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In their study of radiology students, Felayani et al. reported no significant relationship between students' level of knowledge and awareness and their gender [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These findings were consistent with the results of the studies by Cheki et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and Shabani et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The reason for this discrepancy could be attributed to differences in the study population, the academic disciplines of the students, and the countries where the research was conducted, which affect how people are educated.\u003c/p\u003e \u003cp\u003eThe findings of our study demonstrated a significant and positive relationship between GPA and the level of knowledge and attitudes toward radiation protection principles among operating room nursing students. Additionally, this relationship was also present among anesthesia students regarding their GPA and attitudes. However, in this study, the Pearson correlation test results did not reveal a significant relationship between the age of operating room nursing or anesthesia students and their attitudes toward or knowledge of radiation protection principles. In line with the results of our study, in the study by Jabari, no correlation was observed between the knowledge and performance of operating room personnel and their age and educational level [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Furthermore, Amjadi et al. reported no correlation between individuals' demographic variables and their knowledge and awareness of radiation protection principles [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In line with this result, in the study by Sundaran Kada, no relationship was found between the age of medical students and their knowledge and knowledge [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], suggesting that age cannot be considered a predictive factor for students' level of knowledge, attitudes, or performance.\u003c/p\u003e \u003cp\u003eOn the basis of the findings of the present study, organizing training courses and incorporating coursework familiarizing students with the principles of working with ionizing radiation into the operating room nursing and anesthesia curriculum could be considered essential. Additionally, studies have shown that increasing students' knowledge can significantly reduce their stress and anxiety while working with ionizing radiation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, specific training courses that include the necessary knowledge of the biological effects of radiation, the justification of exposure, the optimization of implementation methods, and the advantages and disadvantages of each technique are recommended. These courses can play a significant role in reducing students' stress and mitigating the risks associated with exposure to ionizing radiation.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and recommendations\u003c/h2\u003e \u003cp\u003eSome of the limitations and shortcomings of this study include its cross-sectional nature. Another limitation of this study was the use of self-report measures, and incorrect answers could influence the responses. Therefore, the participants were assured of the confidentiality of the questionnaires. Additionally, the limited research population compared with the previous semester's operating room nursing and anesthesia students at Hamadan University of Medical Sciences was another limitation of this study that could impact the generalizability of its results. Owing to the level of knowledge and awareness of operating room nursing and anesthesia students, various training courses on the principles of radiation protection should be held at universities, and their effectiveness should be evaluated in future studies. Additionally, owing to the low number of students in these fields in each faculty, further studies should be conducted in this area, and their results should be compared with those of the present study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the results of the current study, the level of knowledge, attitudes, and performance of operating room nursing and anesthesia students toward protective principles is insufficient. Therefore, to minimize unnecessary exposure and ensure that operating room personnel understand the correct principles of working with radiation, nursing managers, department officials, and educational policymakers need to prioritize training on radiation safety principles. A fundamental effort is required to provide a more robust education and acquire greater RP in universities. Proper KAP and continuous training can easily prevent many types of radiation-related harm for both interventionalists and patients. Taking part in in-service training programs is crucial for cultivating positive RP attitudes. Creating a culture that emphasizes self-care is essential for improving performance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cb\u003eEthical Considerations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The study was approved by the Ethics Committee of Hamadan University of Medical Sciences with the code (IR.UMSHA.REC.1402.677). All participants were informed about the purpose of the study and informed consent to conduct the research was obtained. Also, the research units were assured of the confidentiality of the information.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict of interest\u003c/strong\u003e \u003cp\u003eThere are no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthor details\u003c/h2\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003e Sina Ghasemi. Student Operating Room (MSc), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran. \u003csup\u003e2\u003c/sup\u003e Hossein Khosravi. Assistant Professor of Medical Physics, Department of Radiology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran. \u003csup\u003e3\u003c/sup\u003e Behzad Imani. Associate Professor, Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran. \u003csup\u003e4\u003c/sup\u003e Naeeme Shabani. MSc Student in Critical Care Nursing, Department of Medical Surgical Nursing, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran. Orcid: 0009-0002-2652-4841\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study was funded by Vice-chancellor for Research and Technology, Hamadan University of Medical Sciences .\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.Gh. and H.kH. conceptualized the study and developed the study protocol. B.I. oversaw the investigations and conducted analyses. S.Gh. wrote the main manuscript text. N.Sh. provided resources for data collection and performed data collection.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eThis study results from a research plan approved by Hamadan University of Medical Sciences. We would like to express our gratitude to the Research and Technology Vice-Chancellor of Hamadan University of Medical Sciences for the financial support of this study in the form of project number 140211109876.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhan MO, Khan MS, Janjua O, Ali A, Hussain S. Knowledge of radiation legislation and radiation exposure in common radiological investigations among final year medical students, foundation doctors, specialist radiology registrars and radiographers at a UK university teaching hospital. BJR| Open. 2018;1(1):20180014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmohaimede AA, Bendahmash MW, Dhafr FM, Awwad AF, Al-Madi EM. Knowledge, attitude, and practice (KAP) of radiographic protection by dental undergraduate and endodontic postgraduate students, general practitioners, and endodontists. International journal of dentistry. 2020;2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRai S. Study of Knowledge on Radiation Hazards and Radiation Protection among Medical College Students in Coastal Karnataka. Int J Cur Res Rev| Vol. 2021;13(10):74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeik Khourmizi M, Saidi F, Khorrami F, Hadavi M. Evaluation of Operating Rooms students\u0026rsquo; satisfaction about their Field of Study and Views on Job Future. Res Med Educ. 2020;12(1):62\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzarabad S, Zaman S, Nouri B, Valiee S. Frequency, causes and reporting barriers of nursing errors in the operating room students. Res Med Educ. 2018;10(2):18\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJenkins NW, Parrish JM, Sheha ED, Singh K. Intraoperative risks of radiation exposure for the surgeon and patient. Annals Translational Med. 2021;9(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalabrese EJ, Selby PB. Background radiation and cancer risks: A major intellectual confrontation within the domain of radiation genetics with multiple converging biological disciplines. J Occup Environ Hyg. 2023;20(12):621\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaharjan S, Parajuli K, Sah S, Poudel U. Knowledge of radiation protection among radiology professionals and students: A medical college-based study. Eur J Radiol open. 2020;7:100287.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIannucci J, Howerton LJ. Dental radiography-E-book: principles and techniques. Elsevier Health Sciences; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShabani F, Hasanzadeh H, Emadi A, Mirmohammadkhani M, Bitarafan-Rajabi A, Abedelahi A, et al. Radiation protection knowledge, attitude, and practice (KAP) in interventional radiology. Oman Med J. 2018;33(2):141.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaesi R, Bakhtiari E, Abbasi Z, Saghari S, Bokaie S, Hushmandi K, et al. Selected Leadership Style of Nursing Manager from the Perspective of Nurses Caring for Patients COVID-19. J Military Health Promotion. 2021;2(1):277\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaesi R, Farajzadeh Z, Saadatjoo SA. The Effect of Leadership Development Program Based on the Concept-mapping Method on the Components of Leadership Style in Headnurses. J Nurs Educ (JNE). 2018;7(1):27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkhaldi WF, Alsehli MD, Alammari RO, Esailan MM, Abdulrazaq A, Althobaiti AMA, et al. Investigation of Awareness Level Concerning Radiation Dose and Associated Risks among Medical Students in KSA. Cross-Sectional Study; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Khalifa M, Alghanem S, Mohamad AA. Awareness of radiation dose and incurred risk among clinicians at a tertiary care hospital in Bahrain. J Bahrain Med Soc. 2023;35(1):42\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoshida M, Iwamoto S, Okahisa R, Kishida S, Sakama M, Honda E. Knowledge and risk perception of radiation for Japanese nursing students after the Fukushima Nuclear Power Plant disaster. Nurse Educ Today. 2020;94:104552.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGharibi F, Elahimanesh F. Evaluation of level of knowledge, attitude and performance of Radiologists in Sanandaj city regarding radiation protection in 2014. Sci J Nurs Midwifery Paramedical Fac. 2017;2(4):24\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheki M, Farzanegan Z, Tahmasbi M, Karami A. Determination of the Last Semester Radiology Technology Students\u0026rsquo; Knowledge About Radiation Protection, Radiation Exposure and Cancer Risk of Diagnostic Examinations With Lonizing Radiation. Jundishapur Sci Med J. 2021;20(3):226\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKada S. Awareness and knowledge of radiation dose and associated risks among final year medical students in Norway. Insights into imaging. 2017;8:599\u0026ndash;605.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaggioni L, Paolicchi F, Bastiani L, Guido D, Caramella D. Awareness of radiation protection and dose levels of imaging procedures among medical students, radiography students, and radiology residents at an academic hospital: results of a comprehensive survey. Eur J Radiol. 2017;86:135\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalih S, Nordin MN, Alkatheeri A, Nasser A, Saif M, Abdallah Z, et al. Assessment of Nursing Students\u0026rsquo; Awareness toward Ionizing Radiation: Cross-Sectional Study. Nurs Rep. 2023;13(2):855\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahkhaei FR, Sarani H. Surgical technologists\u0026rsquo; knowledge and performance about radiation protection in Zahedan educational hospitals. A descriptive-analytical study. J Educ Health Promotion. 2020;9(1):283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlavi SS, Dabbagh ST, Abbasi M, Mehrdad R. Medical radiation workers\u0026rsquo; knowledge, attitude, and practice to protect themselves against ionizing radiation in Tehran Province, Iran. J Educ health promotion. 2017;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZainudin NHM. Radiation Safety Awareness Among Nursing Students in Universiti Sultan Zainal Abidin (UniSZA): A Survey Study. Asian J Med Biomed. 2023:183\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoula A, Chatzis A, Stamouli M-A, Kelesi M, Kaba E, Brilakis E. Assessment of health professionals\u0026rsquo; attitudes on radiation protection measures. Int J Environ Res Public Health. 2021;18(24):13380.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsadian S, Zarghani H. Evaluation of knowledge, attitude, and performance of radiographers towards radiation protection in Southern Khorasan Province, Iran. Iran J Med Phys. 2018;15(4):222\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFelayani F, Wibowo AS, Al Amin K. Knowledge and Awareness Regarding Radiation Safety among Radiology Study Program Students. Jurnal EduHealth. 2023;14(04):133\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJabbari M. Assessment of knowledge, awareness, and practice of procedures for protecting operating room personnel from ionizing radiation: a cross-sectional investigation using a questionnaire. Avicenna J Care Health Operating Room. 2023;1(3):79\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmjadi A, Ghanei Gheshlagh R, Abdolmohammadi J. dehvan f. Job Satisfaction and its Relationship to Radiation Protection Knowledge, Attitude and Practice. Sci J Nurs Midwifery Paramedical Fac. 2022;8(2):92\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Operating room nursing, Anesthesia, Education, Radiation protection, Awareness, Perception","lastPublishedDoi":"10.21203/rs.3.rs-4999824/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4999824/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the increasing use of ionizing radiation in the operating room environment, concerns about the potential risks of this type of radiation have increased. Therefore, this study aimed to investigate the level of knowledge, attitudes, and performance of last semester operating room nursing and anesthesia students toward radiation protection principles for their presence in the clinical educational environment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted at Hamadan University of Medical Sciences in 2024. In this study, students were selected via the census sampling method. The data related to the study were collected from valid questionnaires concerning the participants’ level of knowledge, attitudes, and performance toward ionizing radiation. Additionally, the data analysis was conducted at the descriptive and inferential statistics level via SPSS version 16 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents' knowledge, attitudes, and performance in both operating room nursing and anesthesia were moderate. Additionally, the mean attitude score toward protective principles was significantly greater among operating room nursing students than among anesthesia students (P value = 0.023). Furthermore, a positive and significant correlation was found between students' grade point average (GPA) and their scores on knowledge and attitudes toward protective principles (r = 0.449, P value = 0.000 and r = 0.648, P value = 0.000, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed an insufficient level of knowledge among the mentioned students regarding ionizing radiation. As a result, training courses should be conducted to increase students' knowledge and attitudes toward the risks of ionizing radiation, thereby improving their safety in the clinical educational environment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number: \u003c/strong\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Adherence to Radiation Protection Principles among Operating Room Students: Implications for Clinical Recommendations and Educational Interventions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-22 04:45:43","doi":"10.21203/rs.3.rs-4999824/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d01e6fa-888f-4ce9-8a94-54154cd6fae2","owner":[],"postedDate":"October 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T11:24:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-22 04:45:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4999824","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4999824","identity":"rs-4999824","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}