Abstract

Objective: Ionizing radiation, which is utilized in radiation therapy, is one of the mainstays of cancer treatment. It is used to eliminate cancer cells while causing the least possible harm to surrounding healthy tissues. Exposure to ionizing radiation poses significant hazards to healthcare workers, including nursing staff in radiotherapy departments. In order to reduce risks and safeguard both patients and employees, radiation safety procedures such as the use of protective equipment, shielding, and monitoring must be implemented. Despite these safeguards, psychological issues such as stress, anxiety, and burnout are common among nursing staff.

Methods: A systematic review was conducted to explore the psychological impacts of radiation safety protocols on nursing staff. PRISMA guidelines were followed, with a literature search across Google Scholar, PubMed, and Web of Science from 2000 to 2024. Studies included impacts on mental health such as anxiety, stress, and burnout. Data extraction focused on psychological impacts, safety measures, and coping strategies.

Results: Out of the 602 initial records, 58 studies met the inclusion criteria, highlighting common psychological challenges such as stress, anxiety, and exhaustion associated with radiation safety protocols. Both short-term and long-term exposure to radiation significantly contribute to heightened anxiety levels. Furthermore, organizational culture and the quality of staff training serve as critical determinants of psychological well-being.

Conclusion: Nursing staff in radiotherapy are concerned about the psychological strain brought on by radiation safety procedures. Institutions should consider mental health support to build a resilient workforce in radiotherapy departments. Modern safety technologies, organizational support, and appropriate training are essential for reducing anxiety and enhancing the well-being of staff.

Keywords: radiation safety procedures, psychological effects, stress, anxiety, radiation treatment, nursing staff

Copyright and license

Copyright © 2026 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Lochana S, Hettiarachchi SN. Management of psychological impacts of radiation safety protocols on nursing staff in radiotherapy departments. Northwestern Med J. 2026;6(1):359-68. https://doi.org/10.54307/2026.NWMJ.128

References

  1. Baskar R, Lee KA, Yeo R, Yeoh KW. Cancer and radiation therapy: Current advances and future directions. Int J Med Sci. 2012; 9(3): 193-9. https://doi.org/10.7150/ijms.3635
  2. Chen HHW, Kuo MT. Improving radiotherapy in cancer treatment: Promises and challenges. Oncotarget. 2017; 8(37): 62742-58. https://doi.org/10.18632/oncotarget.18409
  3. Downing J. Radiotherapy nursing: understanding the nurse’s role. Nurs Stand. 1998; 12(25): 42-3. https://doi.org/10.7748/ns.12.25.42.s49
  4. Health S. Radiation protection guidance for hospital staff. Stanford. 2017; 1-62.
  5. George J, Shafqat N, Verma R, Patidar AB. Factors influencing compliance with Personal Protective Equipment (PPE) Use Among Healthcare Workers. Cureus. 2023; 15(2): e35269. https://doi.org/10.7759/cureus.35269
  6. Sodickson A, Baeyens PF, Andriole KP, et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology. 2009; 251(1): 175-84. https://doi.org/10.1148/radiol.2511081296
  7. Mayles P, Nahum A, Rosenwald JC. Practical radiation protection in radiotherapy. In: Mayles P, Nahum A, Rosenwald JC, editors. Handbook of Radiotherapy Physics: Theory and Practice. 2007; 1257–83. https://doi.org/10.1201/9781420012026
  8. Najjar R. Radiology’s ionising radiation paradox: Weighing the indispensable against the detrimental in medical imaging. Cureus. 2023; 15(7): e41623. https://doi.org/10.7759/cureus.41623
  9. Goula A, Chatzis A, Stamouli MA, 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. https://doi.org/10.3390/ijerph182413380
  10. Raise-Abdullahi P, Meamar M, Vafaei AA, et al. Hypothalamus and post-traumatic stress disorder: A review. Brain Sci. 2023; 13(7): 1010. https://doi.org/10.3390/brainsci13071010
  11. Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). Health effects of security scanners for passenger screening (based on X-ray technology). 2012. Available at: http://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_036.pdf
  12. Brooks AL, Hui TE, Couch LA. Very large amounts of radiation are required to produce cancer. Dose Response. 2007; 5(4): 263-74. https://doi.org/10.2203/dose-response.07-013.Brooks
  13. Babapour AR, Gahassab-Mozaffari N, Fathnezhad-Kazemi A. Nurses’ job stress and its impact on quality of life and caring behaviors: A cross-sectional study. BMC Nurs. 2022; 21(1): 75. https://doi.org/10.1186/s12912-022-00852-y
  14. Kohli D, Padmakumari P. Self-care, burnout, and compassion fatigue in oncology professionals. Indian J Occup Environ Med. 2020; 24(3): 168-71. https://doi.org/10.4103/ijoem.IJOEM_201_19
  15. Zhang Z, Lu Y, Yong X, Li J, Liu J. Effects of occupational radiation exposure on job stress and job burnout of medical staff in Xinjiang, China: A cross-sectional study. Med Sci Monit. 2020; 26: e927848. https://doi.org/10.12659/MSM.927848
  16. Cao X, Zhang H, Li P, Huang X. The Influence of mental health on job satisfaction: Mediating effect of psychological capital and social capital. Front Public Health. 2022; 10: 797274. https://doi.org/10.3389/fpubh.2022.797274
  17. Hunter D, Wright C, Pearson S. Employing positive psychology to improve radiation therapy workplace culture. J Med Radiat Sci. 2019; 66(2): 139-44. https://doi.org/10.1002/jmrs.321
  18. Wang M, Wang L, Lu C. Nurses’ sense of organizational support, Self-esteem and perceived professional benefits: A mediating model. Nurs Open. 2023; 10(4): 2098-106. https://doi.org/10.1002/nop2.1457
  19. Baskar R, Dai J, Wenlong N, Yeo R, Yeoh KW. Biological response of cancer cells to radiation treatment. Front Mol Biosci. 2014; 1: 24. https://doi.org/10.3389/fmolb.2014.00024
  20. Valentin J, Ortiz-Lopez P, Andreo P, et al. Prevention of accidental exposures to patients undergoing radiation therapy. Ann ICRP. 2001; 30: 1-70.
  21. Liu H, Chang JY. Proton therapy in clinical practice. Chin J Cancer. 2011; 30(5): 315-26. https://doi.org/10.5732/cjc.010.10529
  22. Vaismoradi M, Tella S, A Logan P, Khakurel J, Vizcaya-Moreno F. Nurses’ adherence to patient safety principles: A systematic review. Int J Environ Res Public Health. 2020; 17(6): 2028. https://doi.org/10.3390/ijerph17062028
  23. Thomadsen B, Lin SW, Laemmrich P, et al. Analysis of treatment delivery errors in brachytherapy using formal risk analysis techniques. Int J Radiat Oncol Biol Phys. 2003; 57(5): 1492-508. https://doi.org/10.1016/s0360-3016(03)01622-5
  24. Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2015; 2015(4): CD002892. https://doi.org/10.1002/14651858.CD002892.pub5
  25. Hou J, He Y, Zhao X, et al. The effects of job satisfaction and psychological resilience on job performance among residents of the standardized residency training: a nationwide study in China. Psychol Health Med. 2020; 25(9): 1106-18. https://doi.org/10.1080/13548506.2019.1709652
  26. Hirvonen L, Schroderus-Salo T, Henner A, et al. Nurses’ knowledge of radiation protection: A cross-sectional study. Radiography (Lond). 2019; 25(4): e108-12. https://doi.org/10.1016/j.radi.2019.04.011
  27. Ohno K, Kaori T. Effective education in radiation safety for nurses. Radiat Prot Dosimetry. 2011; 147(1-2): 343-5. https://doi.org/10.1093/rpd/ncr342
  28. Vassileva J, Applegate K, Paulo G, Vano E, Holmberg O. Strengthening radiation protection education and training of health professionals: Conclusions from an IAEA meeting. J Radiol Prot. 2022; 42(1): 10.1088/1361-6498/ac40e9. https://doi.org/10.1088/1361-6498/ac40e9
  29. Pahlevani M, Ebrahimi M, Radmehr S, Amini F, Bahraminasab M, Yazdani M. Effectiveness of stress management training on the psychological well-being of the nurses. J Med Life. 2015; 8(Spec Iss 4): 313-8.
  30. Ueno T, Yamamoto Y, Hayashi T, Tanaka K. A study of psychological support needs of nurses. Japanese J Heal Psychol. 2000; 13: 31-9. https://doi.org/10.11560/jahp.13.1_31
  31. Oluwaseyi J. Peer support and its role in promoting mental health among nursing students. 2024;16.
  32. Ramalisa RJ, du Plessis E, Koen MP. Increasing coping and strengthening resilience in nurses providing mental health care: Empirical qualitative research. Health SA. 2018; 23: 1094. https://doi.org/10.4102/hsag.v23i0.1094
  33. Han SJ, Yeun YR. Psychological intervention to promote resilience in nurses: A systematic review and meta-analysis. Healthcare (Basel). 2023; 12(1): 73. https://doi.org/10.3390/healthcare12010073
  34. Carbone R, Ferrari S, Callegarin S, et al. Peer support between healthcare workers in hospital and out-of-hospital settings: A scoping review. Acta Biomed. 2022; 93(5): e2022308. https://doi.org/10.23750/abm.v93i5.13729
  35. Dawdy K, McGuffin M, Fegan C. Understanding team dynamics to promote team building in a radiotherapy department. J Radiother Pract. 2022; 21(1): 45-50. https://doi.org/10.1017/S1460396920000813
  36. Bragadóttir H, Kalisch BJ, Flygenring BG, Tryggvadóttir GB. The Relationship of nursing teamwork and job satisfaction in hospitals. SAGE Open Nurs. 2023; 9: 23779608231175027. https://doi.org/10.1177/23779608231175027
  37. Sah C, Antwi-Berko R, Agyemang Opoku O, Okudzeto H, Bosiako A. Exploring supportive supervision of nurses in the health care facilities in volta region, Ghana. J Nurs Res Saf Pract. 2023; 3(4): 1-3. https://doi.org/10.55529/jnrpsp.34.1.10
  38. Wang T, Voss JG, Dolansky MA. Promote radiation safety for nurses: A policy perspective. J Radiol Nurs. 2021; 40(2): 179-82. https://doi.org/10.1016/j.jradnu.2020.12.003
  39. Banerjee SC, Manna R, Coyle N, et al. Oncology nurses’ communication challenges with patients and families: A qualitative study. Nurse Educ Pract. 2016; 16(1): 193-201. https://doi.org/10.1016/j.nepr.2015.07.007
  40. Morishima Y, Chida K, Shigeizumi K, Katahira Y, Seto H, Chiba H. Importance of radiation education for nurses. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2012; 68(10): 1373-8. https://doi.org/10.6009/jjrt.2012_jsrt_68.10.1373
  41. Kang HM, Seth P, Ponampalam R, Somanesan S. Case report: Unusual radiation risks in the emergency department − 125I beads. Hong Kong J Emerg Med. 2016; 23(5): 279-84. https://doi.org/10.1177/102490791602300504
  42. Cupitt JM, Vinayagam S, McConachie I. Radiation exposure of nurses on an intensive care unit. Anaesthesia. 2001; 56(2): 183. https://doi.org/10.1046/j.1365-2044.2001.01870.x
  43. Salih S, Nordin MN, Alkatheeri A, et al. Assessment of nursing students’ awareness toward ionizing radiation: Cross-sectional study. Nurs Rep. 2023; 13(2): 855-64. https://doi.org/10.3390/nursrep13020075
  44. Kumagai S, Arai N, Takata T, et al. First experience of 192 Ir source stuck event during high-dose-rate brachytherapy in Japan. J Contemp Brachytherapy. 2020; 12(1): 53-60. https://doi.org/10.5114/jcb.2020.92401
  45. International Atomic Energy Agency (IAEA). Radiation protection and safety in medical uses of Ionizing radiation: Specific safety guide. 2018. Available at: https://regelwerk.grs.de/sites/default/files/cc/dokumente/DS399%20STEP%2012.pdf
  46. Lakhwani OP, Dalal V, Jindal M, Nagala A. Radiation protection and standardization. J Clin Orthop Trauma. 2019; 10(4): 738-43. https://doi.org/10.1016/j.jcot.2018.08.010
  47. Dona Lemus OM, Cao M, Cai B, Cummings M, Zheng D. Adaptive radiotherapy: Next-generation radiotherapy. Cancers (Basel). 2024; 16(6): 1206. https://doi.org/10.3390/cancers16061206
  48. Nguyen D, Lin MH, Sher D, Lu W, Jia X, Jiang S. Advances in automated treatment planning. Semin Radiat Oncol. 2022; 32(4): 343-50. https://doi.org/10.1016/j.semradonc.2022.06.004
  49. Rony MKK, Akter K, Debnath M, et al. Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis of artificial intelligence adoption in nursing care. J Med Surgery, Public Heal . 2024; 3: 100113. https://doi.org/10.1016/j.glmedi.2024.100113
  50. Amols HI. New technologies in radiation therapy: Ensuring patient safety, radiation safety and regulatory issues in radiation oncology. Health Phys. 2008; 95(5): 658-65. https://doi.org/10.1097/01.HP.0000326334.64242.46
  51. Giammarile F, Knoll P, Kunikowska J, et al. Guardians of precision: Advancing radiation protection, safety, and quality systems in nuclear medicine. Eur J Nucl Med Mol Imaging. 2024; 51(6): 1498-505. https://doi.org/10.1007/s00259-024-06633-w
  52. Chiang HY, Lee HF, Lin SY, Ma SC. Factors contributing to voluntariness of incident reporting among hospital nurses. J Nurs Manag. 2019; 27(4): 806-14. https://doi.org/10.1111/jonm.12744
  53. Lee CT, Wong JC. Perceived levels of collaboration between cancer patients and their providers during radiation therapy. Can Oncol Nurs J. 2019; 29(2): 110-5. https://doi.org/10.5737/23688076292110115
  54. Bendowska A, Baum E. The Significance of cooperation in interdisciplinary health care teams as perceived by polish medical students. Int J Environ Res Public Health. 2023; 20(2): 954. https://doi.org/10.3390/ijerph20020954
  55. Carayon P, Alvarado C, Hundt A. Reducing workload and increasing patient safety through work and workspace design. 2003. Available at: https://minds.wisconsin.edu/bitstream/handle/1793/69313/r185.pdf?sequence=1&isAllowed=y
  56. Kent W, Hulbert-Williams NJ, Hochard KD. A review of stress management interventions for the oncology nursing workforce: What do we know and what should we be doing differently? Health Psychol Rep. 2020; 9(4): 289-307. https://doi.org/10.5114/hpr.2020.100787
  57. Joo JH, Bone L, Forte J, Kirley E, Lynch T, Aboumatar H. The benefits and challenges of established peer support programmes for patients, informal caregivers, and healthcare providers. Fam Pract. 2022; 39(5): 903-12. https://doi.org/10.1093/fampra/cmac004
  58. Han P, Duan X, Jiang J, Zeng L, Zhang P, Zhao S. Experience in the development of nurses’ personal resilience: A meta-synthesis. Nurs Open. 2023; 10(5): 2780-92. https://doi.org/10.1002/nop2.1556
  59. Omar W, Zaid D, Mohamad N, Ismail Z. Conceptualizing the impact of work-life balance on job satisfaction - can the issues be resolved among nurses? J Emerg Econ Islam Res. 2021; 9(1): 1-15. https://doi.org/10.24191/jeeir.v9i1.9763
  60. Louis F, Marvellous O, Hubert K. Risk factors for mental health challenges among healthcare workers: A comprehensive analysis. 2024.
  61. Gelsema TI, van der Doef M, Maes S, Janssen M, Akerboom S, Verhoeven C. A longitudinal study of job stress in the nursing profession: Causes and consequences. J Nurs Manag. 2006; 14(4): 289-99. https://doi.org/10.1111/j.1365-2934.2006.00635.x
  62. Soriano GP, Yasuhara Y, Ito H, et al. Robots and robotics in nursing. Healthcare (Basel). 2022; 10(8): 1571. https://doi.org/10.3390/healthcare10081571
  63. Červený M, Kratochvílová I, Hellerová V, Tóthová V. Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011-21. Front Psychol. 2022; 13: 936181. https://doi.org/10.3389/fpsyg.2022.936181
  64. Nyström ME, Karltun J, Keller C, Andersson Gäre B. Collaborative and partnership research for improvement of health and social services: Researcher’s experiences from 20 projects. Health Res Policy Syst. 2018; 16(1): 46. https://doi.org/10.1186/s12961-018-0322-0