Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Public Health (DPH)


Environmental, Occupational, and Geospatial Health Sciences


Brian Pavilonis

Committee Members

P. Christopher Palmedo

Ghada Soliman

Lawrence Dauer

Subject Categories

Public Health


Radiation, isolation, nurses, perceptions, knowledge, shielding, focus groups


Background: The safety challenges encountered when employing ionizing radiation to treat patients and manage radiation exposure and contamination have been well established in previous research. However, little is known about nurses’ understanding of the risks associated with ionizing radiation and how they respond to their own perceptions of risk. Although a wealth of literature shows an association between radiation treatment and negative patient experiences, there remains a lack of understanding of the basis of these perceptions among nurses. Increased ionizing radiation diagnoses and treatment means that nurses are at a higher risk of radiation exposure today than thirty years ago.1 This study focused on unsealed radionuclide therapy, which requires nurses to take a series of safety precautions. Since previous research has found a correlation between nurses’ negative perceptions of radiation exposure and their willingness to provide care, this study aimed to understand inpatient nurses’ perceptions of their radiation exposure risk while delivering care. This understanding will help identify educational material and opportunities to address inpatient nursing concerns.

The research aims to meet the following objectives:

Aim 1: To understand how nursing staff perceives radiation risk, associated feelings, and any impact on practice involving radiation isolation patients.

Aim 2: To examine the knowledge and attitudes of nurses around radiation protection.

Aim 3: To assess lead and clear rolling shields used in radiation isolation rooms through modelling and exposure data.

Methods: For Aim 1, focus groups with open-ended questions allowed for seeking further clarification from participants. Participants were inpatient oncology nurses at Memorial Sloan Kettering (MSK) to enhance the sample’s homogeneity through similar education, radiation training, and experiences. The final sample consisted of 21 inpatient MSK nurses which accounted for 35% of nurses who provided care to patients who need radiation isolation. Three main topics were examined: (a) perceived risk concerns, (b) hospital environment/infrastructure, and (c) radiation safety knowledge and awareness. For Aim 2 a validated online questionnaire was administered to assess nurses’ radiation protection knowledge, perceived threats of working around radiation, occupational nursing characteristics, cognitive radiation protection knowledge, and attitudes regarding institutional radiation, policies, precautions, and exposure. Aim 2 goals assessed the frequency of correct answers and percentage and level of radiation knowledge through SPSS 25.0, whether nursing shifts and caring for radiation patients were related to knowledge and attitudes through Mann-Whitney U-test, and determine whether years of nursing experience, radiation knowledge, and attitudes towards radiation programs were associated with willingness to provide care through Spearman’s correlation. Aim 3 determined how effective the lead and clear rolling shields are at reducing exposure to caretaker and nurses while used during radiation isolation set-up for patients receiving radiopharmaceutical therapies. This study was conducted in standard private hospital rooms to assess the attenuation of rolling shields and radiation exposure. Monte Carlo N-Particle (MCNP) simulations were adopted to model the distribution of radiation within the treatment rooms, ensure that shields were used appropriately, and measure the attenuation differences of rolling shields based on the material. Real-time exposure data worn by caretakers when the lead and rolling shields were in use was evaluated and extrapolated to occupational exposure.

Results: Upon qualitative analysis of the focus group interviews, six themes were identified: (a) nurses’ concern over radiation risk, (b) inconsistencies in radiation isolation infrastructure, (c) radiation safety training deficiencies, (d) misconceptions resulting from the identified inconsistencies, (e) differences in perceptions of radiotherapy between day- and night-shift nurses, and (f) differences between nurses attending to adult- and those attending to pediatric- patient populations. Results were that 77.6% of participants exhibited average knowledge of radiation protection strategies. The central theme identified was the association of radiation concerns with the deficiency of information around radiation protection. Also, there were identifiable gaps in training between daytime and night-shift nurses. Participants expressed interest in learning more about risks associated with radiation exposure and addressing radiation-related emergencies such as leaks, spills, and contamination. Moreover, the nurses called for a standardization of radiation care to enhance their understanding of their roles and reduce variation in care protocols. There were statistical differences between lead and clear shields in terms of average and peak weighted exposures for care providers. Despite these differences, both shields were determined to offer sufficient radiation protection since both resulted in exposure levels below public and occupational dose limits.

Conclusion: This research led to specific conclusions and implications for practice surrounding radiation isolation. The findings revealed that nurses’ negative perceptions of radiation risk adversely impacted care for patients requiring radiation isolation since there were some reservations and unwillingness to provide such care. Some of the perceived barriers were insufficient knowledge surrounding radiation exposure, transmission, fertility risks, and other potential short- and long-term side effects. The lack of information was a significant barrier as it led to fears and misconceptions around radiation exposure. The identified subgroup differences (such as between daytime and night shift nurses and between pediatric and adult patients’ nurses) present significant challenges to providing high-quality radiopharmaceutical therapy. These challenges should be understood to offer support to nurses in order to fully address their concerns when caring for radiation isolation patients and enhance their preparedness to handle emergencies. Also, standardization of treatment protocols and patient care would help create a consistent infrastructure for care provision, eliminating some of the concerns and misconceptions identified. Conducting the study during the COVID-19 pandemic presented a significant challenge but provided valuable insights into overcoming radiation stigma.

Nurses need adequate training on safely handling emergencies due to the increased risk they undertake. Standardization of radiopharmaceutical protocols should be implemented to improve nurses’ safety, reduce variations in care provision, and enhance their understanding of their roles. These concerns would be better addressed by refining the radiation safety curriculum.

When administering high doses of I-131 radiopharmaceutical therapy, rolling lead shields are recommended for use in non-dedicated lead-lined rooms since they allow nursing staff to be in the same room as the patients and maintain exposure levels below regulatory limits. On the other hand, clear rolling shields allow direct line of sight with the patients and offer weight savings. Hence, both clear and lead rolling shields can be used together to limit radiation exposure to caretakers and nurses when providing care.

The findings from this study captured the perspective of nurses regarding the care of patients requiring radiation isolation. The analyses point towards radiation training topics that are not addressed, leading to pre-conceived misconceptions. The study teased apart deficiencies in safety training, operational infrastructure, inconsistent information, and special sub-populations among inpatient nurses. The insights from the study highlighted key areas of clinical and practical interventions to address negative associations around caring for patients in radiation isolation.

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