Exploring the Publics’ Risk Perception of Ionizing Radiation

Dannalyn D. Ibañez

Background of the Study

The use of medical imaging is increasing wherein approximately 3.3 billion out of

5 billion imaging procedures worldwide use ionizing radiation (Best, Skelding, Mehran,

et al., 2011). This includes general diagnostic radiology, computed tomography (CT)

scans, interventional radiology, fluoroscopy, radiation therapy and nuclear medicine. CT

scans constitute 15% of radiological examinations in all medical procedures, 75% of

medically administered radiation dose and 40% of the total radiation dose (Brenner &

Hall, 2007; Soye & Peterson, 2008). As cited by Dewar (2013), according to the

International Atomic Energy Agency, several medical specialties outside radiology such

as general surgery, orthopedic surgery, vascular surgery, gastroenterology, and

anesthesiology are also using these imaging procedures involving ionizing radiation.

The use of x-rays and other ionizing radiation in medical procedures is increasing

rapidly (Szarmach et al., 2015). With the increasing application of ionizing radiation to

medical procedures, the public’s risk perception of ionizing radiation became a primary

concern. Some patients perceived the risk of radiation so high that they would refuse

pertinent diagnostic imaging tests if they are informed of the associated risks(Ricketts,

Baerlocher, Asch, & Myers, 2013; Freudenberg & Beyer, 2019).

In the study of Naqvi, Batool, Rizvi & Farhan (2019), result revealed a poor level

of knowledge regarding the procedure and the harmful effects of x-ray imaging, while

42% of the population was unaware of the term ‘radiation’. A study in Nigeria reported a

higher percentage of patients (86.7%) who did not know about the dangers of x-ray

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associated with imaging procedures (Sin, et al., 2013; Busey, et al., 2013). In addition,

80% of the respondents underestimated the contribution of medical diagnostic

procedures (Evans et al., 2015).Several studies indicated the discrepancy in the risk

perception of ionizing radiation between the general public and the experts(Slovic.,

1996; Su et al., 2016;Yoshida & Honda, 2017). Experts’ perception of medical x-rays

and natural radiation is significantly higher than in general populations, while for nuclear

waste and an accident at a nuclear installation, experts have lower risk perception than

the general population (Perko, 2014). On the other hand, it is evident that not only

patients but many physicians outside nuclear medicine and radiology are laypersons

with regard to these specialties (Freudenberg & Beyer, 2019). Physicians and medical

students had misconceptions about the use of ionizing radiation in a number of

radiologic examinations (Ricketts, Baerlocher, Asch, & Myers, 2013). With the

numerous inconsistencies in the publics’ perceptions of ionizing radiation, several

studies advocated communication strategies and techniques to lessen their

apprehension of ionizing radiation (Lam, Larson, Eisenberg, Forman, Lee, 2015; Shyu &

Sodickson, 2015).

According to Carlstrom, Woodward, & Palmar (2000) the original Conjoint

Expected Risk (CER) Model by Yates & Stone (1992) has been described as one of the

most viable models to describe single-dimensional risk appraisal, however, it is difficult

to apply to domains, such as health and technology risks. They introduced a simplified

model which is the Simplified CER Model. The Simplified CER model is a linear

combination of probability of harm, benefit, expected benefit, expected harm, and status

quo. Aside from the aforementioned factors, Psychometric Model and Socio-cultural

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differences also play a role in the subject of risk perception. Weber and Hsee (1999)

provided another culture level explanation of cross-national differences in risk

perception, based on differences in collectivism-individualism. In a similar study, as

cited by Oltedal, Moen, and Rundmo (2004), in Cultural Theory, perceived risk is closely

tied to cultural adherence and social learning. Depending on whether one

is socially participating and which groups one belongs to, one will focus on

different kinds of risks. On the other hand, psychometric model was used to understand

the public's risk and benefit and perceptions (Perko, 2014; Hooi, Loi, & Chuah, 2018;

Wolff, Larsen, & Ogaard, 2019), however, researches within this paradigm has found

out that the perceptions of the risks of hazards have little to do with possible outcomes

and their probabilities. Also, these models that were used pertaining to risk perceptions

were published almost twenty (20) years ago, which may not be applicable in the

millennial age.

This study seeks to address the research gap by exploring the different models

for risk perception and identify a new version of risk perception of ionizing radiation that

can identify the factors that affect risk perception of ionizing radiation and at the same

time determine the possible outcomes and probabilities in the current age. These

factors are: risks, benefits, expected risks, expected benefits, sociocultural,

psychometric characteristics. Moreover, this study seeks to explore an under-studied

cultural context which differs from the western countries. Additionally, this study will

serve as a sequel of the previous local study by Ibañez (2017), wherein emotional and

intuitive ability of the students in a particular college were used to determine their

perception of ionizing radiation. It was found out that those respondents with high

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intuitive and emotional test results were not apprehended of ionizing radiation. Lastly,

the result of the study will serve as one of the bases in determining the extent of

knowledge of the public with regards to ionizing radiation in preparation of the country’s

plan to consider nuclear energy because the demand for energy in the Philippines is

expected to increase by 2040. Alfonso Cusi, Secretary of Department of Energy (DOE),

stated that the Philippines is ‘openly considering’ the possibility of introducing nuclear

power as a way to address energy security and equity (Reuters, 2019). In fact, the

government recently signed a memorandum of understanding with Rosatom, a Russian

state atomic company, involving a pre-feasibility study of nuclear plants (The ASEAN

Post Team, 2019). The nuclear energy is a sustainable solution to address the

environmental problem due to the use of fossil fuel in electricity generation (Mallah,

2011). The 9th Sustainable Development Goal (Industry, Innovation, and Infrastructure)

highlighted the importance of science and technology to support technological upgrade,

industrial growth, and research and development (Amano, 2015). It is important to note

that the public should be aware of the risk and benefits of the ionizing radiation so that

the implementation of the nuclear energy will receive full support. According to

Ho,Tsuyoshi, Looi, &Chuah (2019), understanding the public perception is critical in

developing policies for nuclear energy.

In this study, Theory-Development Design in Exploratory-Sequential Approach

will be used. The exploratory-sequential approach is a sequential approach and is used

when the researcher is interested in following up qualitative findings with quantitative

analysis (Edmonds & Kennedy, 2017). This study is of significant value to the general

public, health-care professionals and educators.

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 REVIEW OF RELATED LITERATURE

Radiation

Radiation is defined by the Radiation Effects Research Foundation as a small

(subatomic) particle with kinetic energy that is radiated or transmitted through space.

Radiation may be non-ionizing or ionizing (Naqvi, Batool, Rizvi, & Farhan, 2019). Non-

ionizing radiation emits enough energy to move or excite atoms, while ionizing radiation

emits through energy to change the structure of the atom which can cause biological

harm on cells (Emirates Nuclear Energy Corporation, 2018). Sunburn is a typical

example of ionizing radiation. According to the Physics Society, light, radio, and

microwaves are types of radiation that are called non-ionizing; on the other hand,

examples of ionizing radiation are alpha, beta, x-ray, and gamma ray. They are so-

called ionizing radiation because ionization is involved in the process. Ionization is the

removal from an electron. It occurs when an x-ray passes close to an orbital electron of

an atom and transfer sufficient energy to the electron to remove it from the atom

(Bushong, 2009).

Ionizing Radiation

Many types of radiation are harmless but ionizing radiation can injure humans

(Bushong, 2009). Ionizing radiation is a form of radiation that has sufficient energy to

detach itself from its orbit and cause it to be unstable. According to Center for Disease

Control and Prevention (2015), ionizing radiation is a form of energy that acts by

removing electrons from atoms and molecules of materials that include air, water, and

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living tissue. The ionizing radiation has the ability to ionize the atomic structure of the

substances they pass through. Among the types of ionizing radiation are alpha, beta, x-

rays, and gamma rays (Goodarzi, Anikin, & Pearson, 2016). According to Fachin et al.

(2001), ionizing radiation (IR) imposes risks to human health and the environment.

Furthermore, she said that ionizing radiation at low doses and low dose rates has the

potency to initiate carcinogenesis.

How Radiation Affects Cells

Bergonie and Tribondeau established the link between radiosensitivity and

proliferation in 1906 (Vogi & Foray, 2012). It states that the more sensitive and highly

developing the cells are the more likely it becomes sensitive to radiation which can

cause temporary or permanent damage. The Deoxyribonucleir acid (DNA), a nucleic

acid which serves as command center or control molecule for cell function is a radiation-

sensitive target molecule (Bushong, 2013). Direct damage occurs when the radiation

energy directly breaks DNA bonds, while indirect damage occurs when radiation-

generated radicals break DNA bonds (Bushong, 2013). A cell normally repairs damage

to its DNA, but occasionally the repair process is flawed and this can lead to a change

in genetic material called mutation. Mutations to DNA come in different forms that may

result in multiple negative consequences such as cytotoxic effects, uncontrolled cell

growth, or cell death (Cooper, 2000). These mutations include radiation cancer, blood

disorders such as leukemia, or death. In a chromosome study of 6-thioguanine-resistant

mutants in T lymphocytes of Hiroshima atomic bomb survivors, study revealed that in

DNA-replicating patterns, abnormal X chromosomes showed early replicating patterns,

6
while normal X chromosomes showed late replicating patterns (Kodama, Hakoda,

Shimba, Awa, & Akiyama, 1989). Meanwhile, in a study conducted with the associated

exposure to ionizing radiation from internal emitters, the study revealed that cancer risk

is the largest component of radiation-induced detriment for a general population (Little,

Hall, & Charles, 2007). Furthermore, non-DNA targeted effects of ionizing radiation,

which include genomic instability, and a variety of

bystander mediated adapted response, have raised concerns about the magnitude of

low-dose radiation risk (Kadhim, et al., 2013).

Sources of Ionizing Radiation

According to Center for Disease Control and Prevention (2015), ionizing radiation

comes from radioactive atoms wherein majority occurs naturally in the environment.

Sources of ionizing radiation are either natural- cosmic, terrestrial, inhalation, and

ingestion; or artificial- medical, atmosphere testing, industrial, and nuclear (Canadian

Nuclear Safety Commission, 2019). Medical x-rays are the most popular sources of

ionizing radiation because of its diagnostic and therapeutic benefits. X-rays are used for

surgery, radiation therapy, and diagnostic treatments (Al-Hadeethi, Sayyed,

Mohammed, & Rimondini, 2019). According to the World Health Organization (2016)

exposure to ionising radiation is inherent in daily life and the average worldwide

exposure from all sources is ~3 mSv/year; natural background radiation exposure

contributes to ~2.4 mSv/year, and medical imaging and therapeutics is the largest man

made source of exposure and contributes to ~0.6 mSv/year.

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Accidents that Contributed to the Negative Perception of Ionizing Radiation

Disasters and nuclear accidents have provided a great deal of information with

regard to the effect of ionizing radiation to human population and the environment. The

aftermath represented the ideal scientific conditions for studying large population with

strong statistical significance. Not only the effects on humans pertaining to diseases

were studied but also the perceptions of the public with regard to nuclear energy were

gathered. These are the Nagasaki and Hiroshima bombings, Chernobyl accident, and

the Fukushima meltdown.

Hiroshima Bombings

Hiroshima and Nagasaki in Japan are the only cities in the world that have

experienced an atomic bomb attack (Yamamura, 2013). The detonation of atomic

bombs over the Japanese cities of Hiroshima and Nagasaki in August 1945 resulted in

horrific casualties and devastation. With the explosions of the atomic bombs, an intense

flash of light accompanied by thermal radiation spread over Hiroshima and Nagasaki

causing flash burns and eye injuries and people who were close to the blast site were

incinerated (Hoenig, 2019). According to the Genetics Society of America,

approximately 200,000 people died in the bombings and their immediate aftermath,

mainly from the explosive blast, the firestorm it sparked, and from acute radiation

poisoning. The long-term effects of radiation exposure also increased cancer rates in

the survivors. The Life Span Study examined 120,000 irradiated survivors and non-

8
irradiated individuals, and was one of the first large studies to conclude the linkages

between solid cancer incidence and ionizing radiation exposure (Osaza, 2012).

Chernobyl Accident

The Chernobyl Nuclear Power Plant (ChNPP) accident marks the largest,

uncontrolled radioactive release in history. This release consisted of large amounts of

radioactive I-131, Cs-134 and Cs137 deposited near the plant in Ukraine, as well as

deposition in two neighboring countries: Belarus and Russian Federation (UNSCEAR,

2011). On April 26, 1986, a routine safety test was performed to determine whether the

plant’s still-spinning turbines can produce enough electricity to keep coolant

pumps running during the brief gap before the emergency generato rs kick in, in

the event of a power failure. However, this safety test brought about the reactor’s

destruction (Greenspan, 2015). The Chernobyl disaster killed 31 people directly,

including 28 workers and firefighters who died of acute radiation poisoning during

the cleanup. Experts believe it likewise caused thousands of premature cancer

deaths, though the exact number is disputed. To this day, the area around the

plant remains so contaminated that it’s officially closed off to human habitation.

One study recommended that since it is difficult to conclude that the current mutation

rates are solely due to radiation exposure, therefore, further research is required and as

well as a better understanding of the response of nonhuman biota to both acute,

chronic, and acute followed by chronic radiation exposure to better distinguish these

effects (Nazir, et al., 2018).

Fukushima Meltdown

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 A gigantic tsunami waves struck northeastern Japan on March 11, 2011 as a

consequence of the 9.0 earthquake magnitude (Miura, et al., 2011) which caused a

severe accident at Fukushima Daiichi Nuclear Power Plant (FDNPP), owned by the

Tokyo Electric Power Company (TEPCO) (IAEA, 2011). The tsunami disabled the

cooling systems at the power plant, resulting in nuclear meltdown. Following the

accident, large quantities of radioactive nuclides were released, including radioactive

cesiumin the atmosphere (Hirose, 2012). Radiocesium or cesium-137 is a type of

radioactive material that is known to have significant adverse effects on populations

which causes harm via various environmental vectors (Cruz, 2019).Radiocesium also

polluted the marine environment. One study revealed a strong contrast of radiocesium

contamination levels and mechanisms between marine and freshwater fish in natural

habitats; and a close relation between 137Cs accumulation in river salmon and

contamination of prey items in forest ecosystems in the near proximity to Fukushima

(Wada, 2019). Aside from air and water pollution, psychological stress and psychiatric

symptoms were also observed from the evacuees brought by anxiety and depression

from the traumatic incident (Maeda, Murakami, & Oe, 2019).

The disastrous event in the aftermath of the Fukushima nuclear accident became

a worldwide phenomenon. The countries with nuclear power and countries that are

likely to introduce nuclear energy should learn from Fukushima accident to prevent the

same incident (Kosai, 2019). Several studies recommended to improve risk

communication and nuclear safety (Huang et al., 2018), management of both host and

evacuee communities in relocation areas (Kobayashi, 2019), and nuclear regulatory

10
institutional reform, development of stringent regulation and public engagement in policy

making (Kosai, & Yamasue, 2019).

Risk and Risk Perception

Risk is commonly understood as a cognitive evaluation of outcome probability

and outcome severity (Lowenstein, Weber, Hsee, & Welch, 2001; Slovic, 2016). It is

well known that people largely ignore probability and mainly rely on outcome severity

when judging risk. Furthermore, risk is often accompanied by benefits. When a person

voluntarily takes the risk, he or she assumes responsibility of the outcome whether

beneficial or adverse (Hendee, 1990).

According to Darker (2013) risk perceptions are beliefs about potential harm or

the possibility of a loss. The degree of risk associated with a given behavior is

generally considered to represent the likelihood and consequences of harmful effects

that result from that behavior. To perceive risk includes evaluations of the probability

as well as the consequences of an uncertain outcome. There are three dimensions of

perceived risk – perceived likelihood (the probability that one will be harmed by the

hazard), perceived susceptibility (an individual’s constitutional vulnerability to a

hazard), and perceived severity (the extent of harm a hazard would cause). Risk

perceptions are central to many health behavior theories.

According to Ferrer & Klein (2015), risk perceptions can be defined as an

individual’s perceived susceptibility to a threat and a subjective judgment about the

characteristics and/or severity of a certain risk. To determine perceived risk, participants

were asked for each 30 hazards to consider the risk for dying (across all U.S society),

11
as a consequence of this activity or technology wherein they found psychometric scaling

can quantify similarities and differences among groups with regard to risk perception

and attitudes (Slovic, Fischhoff, & Lichtenstein, 1985). Based on the study, they

explored the relationships among risk characteristics to people’s perception of risk and

their desire for risk reduction and regulation.

Risk Perception of Ionizing Radiation

As cited by Latré, Perko, &Thijssen (2017), public opinion is affected by focusing

events.

*The public’s perception received much of the information from the internet wherein

sources are not validated (Maeda, Murakami, & Oe, 2019).

*After the Fukushima accident, the publics’ support for nuclear energy diminished

(Poortinga, Aoyagi, &Pidgeon, 2013; Siegrist &Visschers, 2013).

In the study of Freudenberg and Beyer (2019) with the title Subjective Perception

of Radiation Risk, they found out that in both general and medical context, there are

distinct differences between patients and specialists in their evaluation and perception

of ionizing radiation. The perceptions of patient-as odd as it may seem to experts-forms

a strong basis for the decisions that patients make. One of the recommendations of

their study was to broaden the scope of investigators to include sociologic and

anthropologic aspects would be a fruitful approach.

Theoretical Framework

Conceptual Framework

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Statement of the Problem

1. What is the demographic profile of the respondents?

1.1 Age

1.2 Sex

1.3 Educational attainment

2. What is the general perception of the respondents in the word ‘radiation’?

3. What is the general perception of the respondents in terms of ionizing radiation risk

perception when grouped according to:

3.1 Benefits

3.2 Risks

4. What is the general perception of the respondents in terms of sources of

radiation?

4.1 Background radiation - cosmic radiation

4.2 Medical radiation – ct scan, x-ray procedures, nuclear medicine, radiation therapy

4.3 Radon gas

4.4 Radiation from food – Carbon 14

4.5 Nuclear power

5. Does the demographic profile of the respondents influence their general

perception of ionizing radiation when grouped according to:

5.1 Benefits

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 5.2 Risks

6. What is the overall response of the respondents in terms of the government’s plan

to open a nuclear plant in the Philippines?

METHODOLOGY

Design

In this study, mixed-method research design will be used. The study will utilize the

Theory-Development Design in Exploratory-Sequential Approach. The exploratory-

sequential approach is a sequential approach and is used when the researcher is

interested in following up qualitative findings with quantitative analysis (Edmonds &

Kennedy, 2017).

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