We conducted a cross-sectional study on “protection of patients and the environment through the optimization of radiological safety in Kinshasa hospitals in the DRC: Proposals for pedagogical and didactic remediation in the learning process at higher and university levels for the optimization and sustainability of radiation protection”.

Twenty-three Kinshasa hospitals with radiology services constituted the site of our surveys.

Radiologist and non-radiologist health professionals from Kinshasa health structures with radiology services and concerned by the research constituted our target population.

We conducted a survey in Kinshasa hospitals with a sample of 400 health professionals, including 100 radiologists, to assess the level of implementation of radiation protection principles in order to propose, where necessary, pedagogical and didactic remediation in initial training that can enable learners, future health personnel, to acquire the knowledge and skills required for maximizing and sustaining radiological safety. The sample size was calculated based on the Slovin formula to adjust the size according to the finite population (total number of health professionals in Kinshasa). We also used weighted stratified sampling to determine the number of health professionals to be surveyed by category (Radiologist or non-radiologist).

In addition to aspects related to the knowledge and practices of health personnel regarding compliance with radiation protection principles, the radiophysical parameters used in the different services were collected to determine the degree of irradiation of the services with regard to the standards of the International Commission on Radiological Protection (ICRP).

The entrance doses obtained in each radiology unit of the concerned Kinshasa hospitals were compared to those of the ICRP, which serve as diagnostic reference levels (DRLs). For this purpose, the Wilcoxon test was useful as it involved comparable parameters with paired data to allow us to compare the scores of the surveyed hospitals and those of the International Commission on Radiological Protection. The chi-square test also allowed us to analyze the proportions of health personnel in relation to knowledge and practices on radiation protection optimization.

The results obtained will allow proposing pedagogical and didactic remediation in radiation protection teaching at higher and university levels to enable learners, future hospital health personnel, to demonstrate competencies in radiation protection in professional life for the optimization of radiological safety.

On this issue, the relevant provisions were made so as not to harm the respondents. Thus, we were obliged to:

Table 1 informs us that many of the surveyed individuals from health structures in the city of Kinshasa were non-radiologists, accounting for 75%.

Table 2 indicates that the vast majority of surveyed health structures in the city of Kinshasa were from the public sector, accounting for 65.2%.

Based on Table 3 , in Kinshasa health structures, there is a statistically significant difference between radiologist health personnel who have knowledge about radiation effects compared to those of other categories (P < 0.05).

With regard to Table 4 , in Kinshasa health structures, a statistically very significant difference was noted between radiologists who have knowledge of radiation protection standards compared to non-radiologists (P < 0.05).

According to Table 5 , there is a statistically very significant difference between health professionals who know the radiation protection principle related to their category and those who do not (P < 0.05).

With regard to Table 6 , concerning the analysis of knowledge of radiologist and non-radiologist health personnel on ICRP DRLs in Kinshasa structures, there is a statistically significant difference (P < 0.05).

With regard to Table 7 , there is no statistically significant difference between radiologists and non-radiologists in their knowledge of the main source of artificial irradiation in Kinshasa health structures (P > 0.05).

These results indicate that capacity building is needed for practicing radiologist personnel, and a restructuring of the radiation protection program is necessary for health science students at higher education and university levels.

According to Table 8 relating to the analysis of the degree of contribution to radiation protection optimization in Kinshasa structures, there is a statistically significant difference between radiologists and other health personnel (P < 0.05).

According to Table 9 , two out of the 23 surveyed radiology services in Kinshasa health structures were found to be irradiating for adults, which represents 9%.

According to Table 10 , eleven out of the 23 surveyed radiology services in Kinshasa health structures were found to be highly irradiating, which represents 48%.

Many of the surveyed individuals from health structures in Kinshasa were non-radiologists, accounting for 75%, and the vast majority of surveyed health structures in Kinshasa were from the public sector, at 65.2% ( Table 1 and Table 2 ). These results are similar to those found by Bope et al. in their research on evaluating the knowledge of radiologist versus non-radiologist health personnel on radiation protection optimization conducted in Bukavu, South Kivu, DRC [10] .

In Kinshasa health structures, there is a statistically significant difference between radiologist health personnel who have knowledge about radiation effects compared to those of other categories (P < 0.05)

In view of Table 4 , in the health facilities of Kinshasa, a statistically very significant difference was noted between radiologists with knowledge of radiation protection standards compared to non-radiologists (P < 0.05). These results do not align with those of Brise H. et al. in their article: “Recording the exposure dose in radiological reports: why? how?” [11] [12]

However, these data corroborate those of Bope Kwete M et al. (2014) in their article [13] . There is also a statistically very significant difference between health professionals who know the radiation protection principles related to their category and those who do not. Similarly, regarding the analysis of knowledge of radiologist and non-radiologist health personnel on ICRP DRLs in Kinshasa structures, there is a statistically significant difference (P > 0.05).

Although radiologists have knowledge, practical implementation poses a problem for all categories of personnel. This situation is likely due to pedagogical and didactic deficits recorded during initial training, which is why we have proposed related remediation to address this lack of know-how in future health personnel in Kinshasa hospitals.

Both surveyed radiologists and non-radiologists are unaware of the main source of artificial irradiation. Regarding the analysis of the degree of contribution to radiation protection optimization in Kinshasa structures, there is a statistically significant difference between radiologists and other health personnel (P < 0.05). Two out of 23 surveyed radiology services in Kinshasa health structures were found to be irradiating for adults (9%), and eleven out of 23 surveyed radiology services were found to be highly irradiating for children (48%). The pediatric population is more sensitive to radiation exposure than adults. This increased sensitivity varies with age, with younger individuals at higher risk [14] . Scientific studies have also shown that the occurrence of radiogenic tumors in children varies more than in adults and depends on the type of tumor, the child’s age, and age at exposure. These studies on radiosensitivity differences between children and adults have shown that children are more sensitive to developing thyroid, brain, skin, and breast cancers, as well as leukemias [15] - [17] .

The majority of surveyed radiologist health personnel in Kinshasa province noted that more than 40% of requested radiology examinations are confirmed to be unjustified. Like those in South Kivu and Kongo Central, to avoid frustrating patients who have already been reassured by referring doctors or nurses about the justification for the examinations, they feel obligated to examine them, rightly or wrongly. Also, all radiologist health personnel in Kinshasa do not know how to evaluate the degree of irradiation in their services. They attribute this major task to other bodies such as the Nuclear Studies Center of Kinshasa (CREN-K) and the National Commission for Protection against Ionizing Radiation (CNPRI), even though self-evaluation of services should be within their competencies.

These results indicate that capacity building is needed for practicing radiologist personnel, but especially a restructuring of the radiation protection program at the university level, incorporating aspects related to dosimetric evaluation. Pedagogical and didactic remediation at higher education and university levels are also essential to enable health science students, future health personnel, to acquire the knowledge and skills required for optimizing patient and environmental safety.

To teach radiation protection, it is essential to adopt appropriate educational and didactic strategies to facilitate understanding and ensure the integration of good practices. Here are some proposals [17] - [19] :

1) Early and progressive integration of radiation protection

2) Interactive educational approaches

3) Use of digital tools

4) Practical and contextualized training

5) Reinforcement of regulatory and ethical aspects

6) Formative assessments

7) Promoting safety culture

8) Expected results

These combined strategies will produce competent radiologists, aware of the risks associated with ionizing radiation; and capable of making informed decisions to optimize the safety of patients, medical staff and the public.