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West Indian Medical Journal

Print version ISSN 0043-3144

West Indian med. j. vol.63 no.1 Mona Jan. 2014

 

ORIGINAL ARTICLES

 

Effects of ionizing radiation on respiratory function tests and blood parameters in radiology staff

 

Efectos de las Radiaciones ionizantes en las pruebas de función respiratoria y los parámetros de la sangre del personal de radiología

 

 

M SayginI; S YasarII; M KayanII; UG BalciIII; K ÖngelIV

IDepartment of Physiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
IIDepartment of Radiodiagnostics, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
IIIDepartment of Family Medicine, İzmir Tepecik Education and Research Hospital, İzmir, Turkey
IVDepartment of FamilyMedicine, Faculty of Medicine, İzmir Katip Çelebi University, İzmir, Turkey

Correspondence

 

 


ABSTRACT

AIM: To evaluate pulmonary function tests and blood parameters and their relationship with sociodemographic data for radiology staff continuously exposed to ionizing radiation.
SUBJECTS AND METHOD: Thirty-eight personnel from Suleyman Demirel University Training and Research Hospital, Radiology Unit, were included in this study. Sociodemographic data were evaluated by a questionnare that was developed by the researchers. Height and weight measurements were performed with a standard scale and meter. Routine blood parameters and spirometric lung function measurements of the cases were recorded. Statistical significances were determined by independent t-test, analysis of variance (ANOVA), bivariate correlation and Kruskal-Wallis tests using SPSS 18.0.
RESULTS: The mean age was 32.42 ± 5.5 years; 19 patients (50%) were male and 19 patients (50%) were female. Body mass index (BMI) was calculated as 25.68 ± 0.47 for men and 24.58 ± 1.13 for women. Forced vital capacity (FVC), forced expiratory volume in the 1st second (FEV1), peak expiratory flow (PEF) and maximum mid-expiratory flow (FEF25-75) showed statistically significant differences between gender (p < 0.01). In addition, FEV1 and FEF25-75 also demonstrated statistically negatively significant difference with the type of task (p < 0.05). A statistically significant negative difference was found between FEF25-75 value and time to start smoking (p < 0.05). Among FVC, FEV1, PEF and FEF25-75 values and alcohol usage, statistically significant positive difference was detected (p < 0.05). Statistically significant positive difference was found among FVC, PEF and FEF25-75 values and sports activity (p < 0.05). According to BMI groups, statistically significant positive difference with FVC, FEV1 and PEF values were found (p < 0.05). Statistically significant correlations were found among FVC value and haemoglobin level (Hgb), haematocrit level (Hct) and mean corpuscular volume (MCV), among FEV1 value and Hgb, MCV, among PEF value and red blood cell count (RBC), Hgb, Hct, MCV, red cell distribution width (RDW), and between FEF25-75 value and MCV.
CONCLUSION: Although respiratory functions of radiology staff are affected by many factors, continuous exposure to ionizing radiation is one of the important parameters. Radiology staff should be informed about factors that negatively affect the respiratory functions.

Keywords: Ionizing radiation, radiation, radiology staff, respiratory function tests


RESUMEN

OBJETIVO: Evaluar las pruebas de función pulmonar y parámetros de sangre y su relación con los datos sociodemográficos para el personal de radiología continuamente expuesto a la radiación ionizante.
SUJETOS Y MÉTODO: Este estudio incluyó treinta y ocho miembros del personal de la Unidad de Radiología del Hospital de Docencia e Investigación de la Universidad Suleyman Demirel. Los datos sociode-mográficos se evaluaron mediante un formulario que fue desarrollado por los investigadores. Se realizaron mediciones de la altura y el peso con un metro y una escala estándar. Se registraron los datos de rutina sobre los parámetros de sangre y las mediciones de la función pulmonar espirométrica de los casos. La respectiva importancia estadística fue determinada mediante la prueba t independiente, análisis de varianza (ANOVA), correlación bivariada y pruebas de Kruskal-Wallis utilizando SPSS 18.0.
RESULTADOS: La edad promedio fue de 32.42 ± 5,5 años; 19 pacientes (50%) eran varones y 19 pacientes (50%) eran mujeres. El índice de masa corporal (IMC) se calculó como 25.68 ± 0.47 para los hombres y 24.58 ± 1.13 para las mujeres. La capacidad vital forzada (CVF), el volumen espiratorio forzado en el primer segundo (VEF1), el flujo espiratorio máximo (FEM), y los valores del flujo espiratorio medio máximo (FEMM25-75) mostraron diferencias negativas estadísticamente significativas entre géneros (p < 0.01). Además, el VEF1 y el FEMM25-75 también mostraron diferencias negativas estadísticamente significativas en relación con el tipo de la tarea (p < 0.05). Se halló una diferencia negativa estadísticamente significativa entre el valor de FEMM25-75 y el tiempo del inicio del hábito de fumar (p < 0.05). Se detectó una diferencia positiva estadísticamente significativa entre los valores de CVF, VEF1, FEM y FEMM25-75, y el hábito de consumir alcohol (p < 0.05). Se detectó una diferencia positiva estadísticamente significativa entre los valores de CVF, FEM y FEMM25-75, y las actividades de deporte (p < 0.05). Según los grupos de IMC, se halló una diferencia positiva estadísticamente significativa positiva entre los valores de CVF, VEF1, y los valores de FEM (p < 0.05). Se hallaron correlaciones estadísticamente significativas entre el valor de CVF y el nivel de la hemoglobina (Hgb), el nivel de hematocrito (Hct) y el volumen corpuscular medio (VCM); entre el valor de VEF1 y Hgb, VCM; entre el valor de FEM, y el conteo de glóbulos rojos (CGR), Hgb, Hct, VCM, y la distribución de los glóbulos rojos;y entre el valor de FEMM25-75 y VCM.
CONCLUSIÓN: Aunque las funciones respiratorias del personal de radiología son afectadas por muchos factores, la exposición continua a la radiación ionizante es uno de los parámetros importantes. El personal de radiología debe ser informado acerca de los factores prevenibles que afectan negativamente las funciones respiratorias.

Palabras claves: Radiación ionizante, radiación, personal de radiología, pruebas de la función respiratória


 

 

INTRODUCTION

X-rays are a type of electromagnetic ionizing radiation used for diagnostic purpose in radiology due to their high penetration power and low specific ionization (1). Ionizing radiation, by transferring energy to the cells and tissues, starts biological events leading to a series of reactions ranging from cell interactions to biological damage (1–4).

Biological effects of radiation generated at the cellular level may occur within seconds but may also develop during a 20–30-year period (5). As a result of radiation exposure, cell death , degradation of DNA, development of malignancy and genetic damage can occur (6). Irradiation-induced damage can be repaired by the organism, can remain unrepaired or can be abnormally repaired (7).

Radiation workers are the people who are exposed to the highest amount of radiation in society. The effects of longterm intermittent exposure to low radiation doses and chronic irradiation may appear after many years, causing a series of fatal diseases and other negative effects. The reason for this may be related with not being able to repair the present damage until the next irradiation and therefore accumulation of the damage during these periods (2). Cancer may develop as a result of an interaction of a single ionizing particle which was previously damaged and was unable to repair itself. In addition, hereditary disorders in the next generations can be found in these persons (8).

According to the basic law of radiobiology, sensitivity to radiation, ranked from the most sensitive to the most resistant is as follows: rapidly dividing, undifferentiated most sensitive cells, erythroblasts (erythrocyte main cells), intestinal crypt cells, primary sperm cells and epidermal basal cells. As cells are differentiated, despite continuing rapid proliferation, sensitivity decreases. Lymphocytes are non-dividing cells after passing into the blood circulation and although they are highly differentiated, they are sensitive to radiation (9).

During therapeutic and diagnostic medical procedures, the upper extremities of medical staff are especially highly exposed to X-rays.

In this study, radiology staff working in the Suleyman Demirel University Training and Research Hospital who are constantly exposed to ionizing radiation were subjected to the investigation of the relationship among ionizing radiation, pulmonary function and blood parameters.

 

SUBJECTS AND METHOD

Thirty-eight staff members from the Radiology Unit of Suleyman Demirel University Training and Research Hospital were included. Before the administration of the survey, staff members who agreed to participate were verbally informed about the content of the study. This was a cross-sectional study and all staff members working in the department were included. Sociodemographic data were evaluated by a questionnare that was developed by the researchers. In this survey, demographic data, smoking, alcohol usage and exercise level were evaluated. Height and weight measurements were made with standard scales and measuring cylinder. Body mass index (BMI) was calculated as weight in kilograms divided by the square of the height in metres. Personal dosimetries were evaluated by Turkish Atomic Energy Agency (TAEA).

Spirometric measurements and complete blood tests of the staff were performed periodically. Respiratory functions of the staff participating in the study were taken with 120 B SİBELMED DATOSPİR mode spirometer. The spirometric measurements were recorded together with the survey data. Tests related to airway functions were:

1. Simple spirometric tests, vital capacity (VC)
2. Forced vital capacity: a) forced vital capacity (FVC), forced expiratory volume in the 1st second (FEV1), maximum midexpiratory flow (FEF25–75%) and peak expiratory flow [PEF] (10).

Blood parametres of the staff participating in the study were measured by a complete blood count device and white blood cell count (WBC), red blood cell count (RBC), haemoglobin level (Hgb), haematocrit level (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), red cell distribution width (RDW) and platelet count (PLT) were recorded.

Statistical analysis was performed by SPSS 18.0 for Windows. Normal distribution of data and homogeneous variances were tested. For the statistical analysis, one way analysis of variance (ANOVA), independent t-test, bivariate correlation and Kruskal-Wallis tests were used.

 

RESULTS

In the study, 38 staff members (19 females and 19 males) from the Radiology Unit of Suleyman Demirel University Training and Research Hospital were included. Demographic characteristics of the staff, age ranges, working time in the Radiology Unit, marital status, weekly working hours and other findings are given in the Table.

 

 

According to the results provided by TAEAfrom the personal dosimetry readings, with two months intervals in a year, highest ionizing radiation dose was 11.85 mSv and lowest dose was 0.1 mSv. In the study, the arithmetic mean of the lowest and highest exposure dose was found out as 0.75 mSv and the doses above this mean value was considered as high doses and below this mean value was considered as low doses. Thus, it was found that 31 of the radiology staff were exposed to ionizing radiation with doses lower than 0.75 mSv, while seven of the radiology staff were exposed to the doses higher than 0.75 mSv in a year.

Mean values of the respiratory function test parameters were evaluated. Results were as follows; FVC (L) 3.94 ± 0.80 (min: 2.61 – max: 6.07), FEV1 (L) 3.18 ± 0.69 (min: 1.98 – max: 4.89), FEV1/FVC (%) 80.64 ± 5.93 (min: 65.94 – max: 87.97), PEF (L/s) 6.47 ± 2.29 (min: 2.66 – max: 11.69), FEF25-75 (L/s) 3.22 ± 0.94 (min: 1.28 – max: 4.89).

Moreover, mean values of the parameters were evaluated according to gender.Mean values of the respiratory function test parameters for female staff were as follows: FVC (L) 3.37 ± 0.44 (min: 2.61 – max: 4.00), FEV1 (L) 2.69 ± 0.46 (min: 1.98 – max: 3.35), FEV1/FVC (%) 79.59 ± 7.08 (min: 65.94 – max: 87.97), PEF (L/s) 4.67 ± 1.22 (min: 2.66 – max: 7.00), FEF25-75 (L/s) 2.68 ± 0.77 (min: 1.28 – max: 3.76). For male staff: FVC (L) 4.42 ± 0.73 (min: 3.46 – max: 6.07), FEV1 (L) 3.59 ± 0.58 (min: 2.83 – max: 4.89), FEV1 /FVC (%) 81.53 ± 4.77 (min: 70.36 – max: 87.39), PEF (L/s) 8.00 ± 1.81 (min: 4.21 – max: 11.69), FEF25-75 (L/s) 3.68 ± 0.84 (min: 2.05 – max: 4.89).

Mean values of blood parameters for all staff were recorded as: WBC (103/µL) 7.88 ± 2.30 (min: 5.50 – max: 15.40), WBC (103/µL) 4.80 ± 0.58 (min: 2.91 – max: 5.80), Hgb (g/dL) 14.36 ± 1.89 (min: 9.20 – max: 17.70), Hct (%) 41.78 ± 5.69 (min: 26.20 – max: 55.50), MCV (fL) 86.91 ± 5.21 (min: 77.20 – max: 95.10), MCHC (g/dL) 33.86 ± 3.27 (min: 16.50 – max: 37.20), RDW (%) 13.57 ± 1.08 (min: 12.20 – max: 16.40) and PLT (103/µL) 233.77 ± 53.85 (min: 135 – max: 348).

According to gender, mean values of blood parameters for female staff were: WBC (103/µL) 7.63 ± 1.61 (min: 5.50 – max: 10.70), RBC (103/µL) 4.61 ± 0.38 (min: 3.58 – max: 5.36), Hgb (g/dL) 13.40 ± 1.18 (min: 11.10 – max: 15.90), Hct (%) 39.32 ± 3.98 (min: 32.60 – max: 47.50), MCV (fL) 85.28 ± 5.14 (min: 77.20 max: 92.80), MCHC (g/dL) 32.99 ± 4.27 (min: 16.50 max: 35.80), RDW(%) 13.92 ± 1.15 (min: 12.40 – max: 16.40) and PLT (103/µL) 230 ± 50.06 (min: 135 – max: 324). Mean values of blood parameters for male staff were:WBC (103/µL) 8.12 ± 2.85 (min: 5.50 – max: 15.40), RBC (103/µL) 5.00 ± 0.69 (min: 2.91 – max: 5.80), Hgb (g/dL) 15.33 ± 2.00 (min: 09.20 – max: 17.70), Hct (%) 44.23 ± 6.16 (min: 26.20 – max: 53.50), MCV (fL) 88.53 ± 4.89 (min: 77.80 – max: 95.10),MCHC (g/dL) 34.73 ± 1.46 (min: 32.00 – max: 37.20), RDW(%) 13.22 ± 0.92 (min: 12.20 – max: 16.30) and PLT (103/µL) 237.55 ± 50.06 (min: 140 – max: 348).

Forced vital capacity (d:-,132), FEV1 (d:-,171), PEF (d:-,068) and FEF25-75 (d:-,169) values showed negatively statistically significant differences between gender (p < 0.01). In addition, FEV1 (d:-,258) and FEF25-75 (d:-,324) also demonstrated negatively statistically significant difference with the type of the task (p < 0.05). A statistically significant negative difference was found between FEF25-75 (d:-,333) value and time to start smoking (p < 0.05). Between FVC (d:,245), FEV1 (d:,301), PEF (d:,299) and FEF25-75 (d:,331) values and alcohol usage, statistically significant positive difference was detected (p < 0.05). Statistically significant positive difference was found between FVC (d:,280), PEF (d:,382) and FEF25-75 (d:,239) values and physical activity (p < 0.05). According to BMI, statistically positive significant difference with FVC (d:,324), FEV1 (d:,307) and PEF (d:,411) values were found (p < 0.05). Statistically significant correlations were found among FVC value and Hgb, Hct, MCV; among FEV1 value and Hgb, MCV; among PEF value and RBC, Hgb, Hct,MCV, RDW; and between FEF25-75 value and MCV.

 

DISCUSSION

In this study, pulmonary function tests and blood parameters of the radiology staff exposed to ionizing radiation were investigated. Blood cells that are sensitive to ionizing radiation have been evaluated in many studies. However, respiratory function tests of the radiology staff exposed to ionizing radiation have not been evaluated. The results of this study appear to be the first published data in this area.

Biological effects of radiation generated at a cellular level may occur within seconds and may also develop over a long period (20–30 years). These effects are: slow down or stop in cellular movements, delay or stop in growth , abnormalities in cellular metabolism and cell division [mitotic proliferation] (5). According to the hypothesis of "Radiobiology basic law" developed by Tribondeau Bergonieand in 1906, based on the biological effects of radiation, biological effects observed in irradiated cells are positively correlated with cell proliferation, but inversely proportional to the degree of differentiation (9, 11). Biological effects of radiation on radiology workers, most probably the professionals who are exposed to the highest amount of radiation, occur due to the intermittent exposure to low doses of irradation for long-term periods. These chronic effects would be observed after many years and often cause a series of fatal diseases and other negative effects (8). For radiology staff, even protected from radiation, small doses of radiation show significant risks (12). In the present study, it was observed that parameters related with pulmonary functions and blood were affected by ionizing radiation.

Forced vital capacity, FEV1, PEF and FEF25-75 values showed significant difference according to gender. This result can be explained by the difference in lung volumes and capacities with age, height and gender (13). Depending on specification of task at the radiology unit, staff was classified as nurses, technicians and doctors. According to the annual dosimetry readings, it can be said that the amount of the ionizing radiation varied with the type of the task. These data reveal that technicians are exposed to ionizing radiaition in higher doses and longer periods compared to the others. Therefore, a significant difference was observed in their FEV1 and FEF25-75 values compared to nurses and doctors.

Maximum mid-expiratory flow (FEF25-75) value reflects the flow rate of the medium and small airways and this parameter decreases in the early stages of obstructive diseases. Sometimes, the reduction may be seen in restrictive diseases (14). Smoking causes toxic and irritant effect in bronchial epithelium and alveoli, an increase in inflammation, mucus production and ciliary dysfunction (15, 16). Smoking is one of the leading factors that causes chronic obstructive pulmonary disease (COPD). The negative effects of smoking are associated with the number of cigarettes smoked. Increased smoking is also directly related with increased COPD incidence (15). Significant correlation between FEF25-75 value and the beginning time of smoking was shown in the study, as mentioned in the literature.

Cikirikcioglu et al showed that asthma attack was triggered by alcohol usage in their study (17). In the pathogenesis of COPD, cigarette smoking, air pollution, lower socio-economic status, occupational exposure, α1-antitrypsin deficiency, alcohol abuse, childhood respiratory diseases and genetic predisposition are known to play a role (18–20). Findings in the study showed that there was a significant difference among alcohol use and FVC, FEV1 and FEF25-75 values. Alcohol usage plays a role in the development of obstruction; in normal subjects FVC is equal to vital capacity (VC), however, in the case of obstruction and bronchiolar collapse, FVC is lower than VC. Forced expiratory volume in the 1st second generally reflects the major airways in the same manner, and bronchospasm, inflammation or loss of elastic tissue caused by various factors such as airway obstruction cause a reduction in FEV1.

When the relationship between FVC and physical activity was evaluated, Dincer et al found vital capacity as 5.12 L for regularly exercising athletes and 4.78 L for sedentary persons (21, 22). In the study by Tasgin and Donmez examining the relationship of exercise on respiratory parameters, PEF and FEF25-75 showed significant difference after sports (23). Mehrotra and colleagues compared pulmonary function tests of athletes engaged in different sports with sedentary persons; the respiratory functions of athletes were higher than those of sedentary persons (24). According to data obtained from the study, about 30% of the staff was engaged in regular sports. It is thought that regular exercise could improve the respiratory function of the radiology staff.

Reduced respiratory function and decreased oxygen carrying capacity may be seen in patients receiving treatment for anaemia (25).

Gundogdu and Eryilmaz, in their study, evaluated PEF values and BMI correlation between obese and non-obese children; they found lower values of PEF for obese compared to non-obese and they observed differences between girls and boys. They mentioned that higher BMI values and lower PEF values in obese children may be the risk factors for lung function decline or reduction of air flow (26). Santana et al investigated the relationship between pulmonary functions, anthropometric variables, body composition and physical performance (r) in a study group including 97 males age 67–78 years, with BMI ranging from 19.8–37.1 kg/m2. They found that there was a possible correlation between height, body weight, BMI and VC, FVC, FEV1 and a negative correlation with FEV1/FVC (27). Gönlügür et al (28) retrospectively screened 479 individuals diagnosed with COPD and revealed a positive correlation between BMI and pulmonary function tests; furthermore, weight loss and loss of pulmonary function were more pronounced in males (28). In our study comparing BMI and PEF values according to BMI grouping, FVC, FEV1 and PEF values were found to be significantly different and these findings were seen to be paralell with the studies of Gundogdu and Eryilmaz (26) and Gönlügür et al (28).

In this study, there was a significantly positive correlation between the functions of the airway dynamic tests FVC, FEV1, PEF, FEF25-75 and Hgb, Hct, MCV and RDW values. These findings may be due to continous exposure to ionizing radiation and consequently its effects on sensitive blood cells. Continuous ionizing radiation could cause anaemia in workers in radiology. As a result, it can be said that anaemia together with respiratory complaints may develop in radiology staff chronically exposed to ionizing radiation.

 

CONCLUSION

Although radiology workers are protected as much as possible, they are exposed to continuous ionizing radiation. Therefore, routine chest X-ray, eye examination, complete blood count and peripheral blood smear were performed in certain periods within this framework. In addition to these routine controls, routine pulmonary function tests should be recommended for higher life expectancy and improved quality of life.

 

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Correspondence:
Dr M Saygin,
Süleyman Demirel Üniversitesi Tip Fakültesi,
Fizyoloji Anabilim Dali Çünür,
Isparta, Turkey.
E-mail: mustafasaygin@sdu.edu.tr