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\begin{document}

\title{ASSESSMENT OF THE APPLICATION OF RADIATION PHYSICS KNOWLEDGE DURING
CLINICAL TRAININGS AMONG CLINICAL RADIOGRAPHY STUDENTS IN UNIVERSITY OF
NIGERIA, ENUGU CAMPUS}



\author[1]{Majani Edward}%
\author[2]{Atuoha Ernest}%
\author[2]{Chukwu Emmanuel Nnaemeka}%
\author[2]{Chiawolam Chiemela}%
\affil[1]{University of St Francis Leach College of Nursing}%
\affil[2]{University of Nigeria Faculty of Medical Sciences}%


\vspace{-1em}



  
  \date{June 05, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
\textbf{Introduction:} Despite a reported understanding of basic
radiation physics principles, students face barriers that hinder
effective translation of this knowledge into clinical practice,
potentially leading to suboptimal outcomes.The objectives of this
cross-sectional descriptive research are to assess the level of
radiation physics knowledge among clinical radiography students,
evaluate their ability to apply this knowledge in clinical settings,
identify barriers hindering successful application, and provide
recommendations for improved integration. \textbf{Material and method:}
The study was conducted among clinical students (4 \textsuperscript{th}
year and 5 \textsuperscript{th} year) of the department of radiography
and radiological sciences, University of Nigeria, Enugu campus, Enugu
state. The study design was a cross-sectional descriptive study which
enables to collect data at a specific point in time. The study
population comprised of students who are currently in 4
\textsuperscript{th} and 5 \textsuperscript{th} year in the department
of medical radiography and radiological sciences. The population has a
total number of 500 students. All clinical radiography students who are
willing to participate in this research were included in this research
\textbf{Results:} Among 220 participants from the University of
Nigeria's Department of Radiography and Radiological Sciences, 81.4\%
expressed thorough teaching of radiation physics during pre-clinical
training, while 68.3\% reported an excellent understanding. However,
64.3\% cited disinterest due to perceived complexity, 42.0\% noted a gap
between theoretical teaching and practical application, and 84.6\%
mentioned a lack of fear of radiation's biological effects. Suggestions
for improvement included a dedicated curriculum (90.0\%), increased
teaching duration (69.7\%), expert involvement (95.10\%), hands-on
training (95.5\%), interactive learning methods (93.2\%), and
collaborative training approaches (95.0\%). \textbf{Conclusion:} This
research underscores the importance of refining radiation physics
education to bridge theory and practice effectively.%
\end{abstract}%



\sloppy


\textbf{Introduction}

Since the discovery of X-rays, the use of the principles and methods of
physics in medicine has contributed to the improvement of human health.
Physics-based techniques have been progressively developed and optimized
with the aim to support physicians to formulate prompt diagnoses and to
set up the effective treatments of several diseases. Thus, the basic
understanding of radiation physics is important when dealing with
radiation considering its benefits as well as associated health
effects.(1)Medical physics is a rapidly developing specialty of physics,
concerned with the application of radiation to diagnosis and treatment
of human disease. In contrast to other physics specialties, such as
nuclear physics, solid-state physics, and high-energy physics, studies
of modern medical physics attract a much broader base of professionals
including graduate medical doctors doing their residency in medical
imaging, radiography students in diagnostic imaging and therapeutic
radiation oncology, students in biomedical engineering, and students in
radiation safety and radiation dosimeter educational programs.(2) All
these professionals have a common desire to improve their knowledge of
the physics that underlies the application of radiation in diagnosis and
treatment of disease because these professionals are responsible for the
safe and accurate delivery of radiation to patients, as well as the
proper use of imaging equipment for diagnostic purposes. Therefore, it
is crucial to assess the application of radiation physics knowledge
during their clinical training. (2)Clinical training is a fundamental
component of undergraduate programs in radiography, radiation therapy,
and nuclear medicine. It provides students with the opportunity to apply
the theoretical knowledge acquired in the classroom to real-world
clinical settings. During clinical training, students work under the
supervision of experienced professionals, gaining hands-on experience
and refining their skills. It is during this period that the application
of radiation physics knowledge becomes crucial for safe and effective
patient care.(3)Radiation is a fact of life: all around us, all the
time. Radiation is simply defined as an energy moving in the form of
waves or streams of particles. Understanding radiation requires basic
knowledge of atomic structure, energy and how radiation may interacts
with cells in the human body. There are many kinds of radiation all
around us. When people hear the word radiation, they often think of
atomic energy, nuclear power and radioactivity, but radiation has many
other forms. Sound and visible light are familiar forms of radiation;
other types include ultraviolet radiation (that produces sun tanning),
infrared radiation (a form of heat energy), and radio and television
signals. (4)All these electromagnetic waves do different things (For
example, light waves make things visible to the human eye, while heat
waves make molecules move and warm up, and x rays can pass through a
person and land on film, allowing us to take a picture inside someone's
body). They however have some things in common: they all travel in
waves. This property makes it possible to measure the different kinds by
wavelength which enables us to tell the kinds of radiation apart from
each other. Furthermore, the way the energy is radiated makes it
relatively straightforward to detect and measure and inferences can be
made about its source. The properties of the energy emitted will
determine the way it interacts with matter and therefore its measurement
technique and requirements for regulation.(4)However, the intricateness
of radiation medicine is the presence of possible hazards to its users
amidst its overwhelming benefits and advances when there are
deficiencies in knowledge of proper use. Fear of radioactivity and
radiation exist in the larger population in spite of the increased use
of radiation significantly in medicine, and the military, food
preparation, power generation and industries due largely to a lack of
knowledge on this subject. This therefore justifies the need to
diligently incorporate basic physics and radiation physics into the
curriculum of all preclinical medical students in their first year of
study and further advanced courses (like radiobiology, radiation
protection and dosimetry) for preclinical students of medical
radiography and radiological sciences in their 2\textsuperscript{nd} and
3\textsuperscript{rd} year of study. Determining the harmful effects of
the typically low doses of radiation received in routine daily
activities is a very difficult science field. Further, as new
technologies emerge that utilize the physical properties of radiation,
the health effect data from exposure can be incomplete which heightens
levels of anxiety among a wider population. Electromagnetic radiations
are far too small to see directly, even with the most powerful optical
microscopes, but atoms do interact with matter and living tissues and
under some circumstances emit light in ways that reveal their internal
structures in amazingly fine detail. This suggests why its possible
hazards are not easily detected before they grow into obvious ailments
that overwhelms the users. The invisibility of these particles makes it
easy for medical imaging students/staffs to neglect the basic practices
of radiation protection towards themselves and their clients (patients)
like collimation, use of grid mechanism during exposure of body parts
thicker than 10cm, accurate selection of exposure factors that will
produce images of diagnostic quality thus avoiding cases of repeats,
inverse square law practice for radiation protection, gonadal shielding
in examinations where the gonads are not the area of interest, basic
quality assurance tests for machines in the department, the measurement
of absorbed doses of radiation during work hours and a lot more which
assures their safety in the clinical settings.(5)Therefore, this study
assessed the varying levels of application of radiation physics
knowledge among clinical students during clinical posting, to ascertain
the correlation (if any) that exists between the knowledge gained in
radiation physics and the safe/optimal practice of their profession. The
application of radiation physics is crucial in medical imaging
techniques such as X-rays, computed tomography (CT), magnetic resonance
imaging (MRI), and nuclear medicine, as well as in radiation therapy
treatments. It encompasses a broad range of concepts, including
radiation safety, dose calculation, image quality optimization, and the
understanding of the interactions between radiation and matter. However,
the existing assessment methods in clinical training programs often
focus primarily on theoretical knowledge rather than practical
implementation.(6)Radiation physics, though a fundamental component of
medical imaging and radiation therapy is largely neglected among
clinical students and practitioners. There is a lack of comprehensive
evaluation methods to gauge the proficiency and practical implementation
of this knowledge among students in real-world clinical scenarios. This
deficiency hampers the ability of educators and institutions to
accurately assess the competence and preparedness of future healthcare
professionals in utilizing radiation physics principles effectively and
safely. (6)Without a comprehensive assessment of the application of
radiation physics knowledge during clinical trainings, there is a risk
of students lacking the necessary skills to interpret and utilize
radiation-related information effectively. This may result in suboptimal
image quality, improper radiation dose administration, compromised
patient safety, and inefficient treatment planning. Additionally, the
absence of standardized evaluation methods may lead to inconsistencies
in assessing students' proficiency across different educational
institutions, hindering the establishment of a benchmark for competence
in this critical area.(6) Therefore, it is imperative to address this
problem by developing a robust and standardized assessment framework
that accurately measures the application of radiation physics knowledge
during clinical trainings. This framework should encompass both
theoretical understanding and practical skills, providing a
comprehensive evaluation of students' abilities to apply radiation
physics principles in clinical settings. By doing so, educators and
institutions can ensure that undergraduate students receive adequate
training and feedback to bridge the gap between theoretical knowledge
and its practical implementation, ultimately improving the overall
competent of future healthcare professionals in the field of radiation
physics. (7)The aim of this study is to assess the application of
radiation physics knowledge during the clinical training of clinical
radiography students of UNEC in the various radiation medicine
departments (conventional radiography, computed tomography, radiation
therapy, nuclear medicine, etc.)

\textbf{Materials and methods}

The study was conducted among clinical students
(4\textsuperscript{th}year and 5\textsuperscript{th} year) of the
department of radiography and radiological sciences, University of
Nigeria, Enugu campus, Enugu state. The study design~was~a
cross-sectional descriptive study which enables to collect data at a
specific point in time. The study population comprised of students who
are currently in 4\textsuperscript{th} and 5\textsuperscript{th} year in
the department of medical radiography and radiological sciences. The
population has a total number of 500 students. All clinical radiography
students who are willing to participate in this research were included
in this research. The minimum sample size (n) for this study was
obtained using the statistical formula proposed by Taro Yamane {[}21{]}
for a known population, the minimum sample size is 220 students. A
purposive sampling technique was employed to select the participants for
this study. Purposive sampling was considered appropriate as it allowed
the researchers to select participants who attended their clinical
trainings and had knowledge and experience in radiation physics
application. A total of 220 participants were selected based on their
availability and willingness to participate in the study.An online
questionnaire was~used to collect data from participants. An internal
consistency reliability test (coefficient alpha value greater than or
equal to 0.70 considers the instrument reliable) is used to test for
reliability. The questionnaire is a combination of structured questions
(with close-ended questions) and unstructured questions (with open-ended
questions) depending on which form will be better suited for the
intended response. The closed-ended questions utilized a Likert scale to
measure participants' perceptions and experiences regarding the
application of radiation physics knowledge during their clinical
trainings. The open-ended questions provided an opportunity for
participants to express their opinions and provide additional
insights.Data was collected in one week, from Tuesday to Friday in the
third week of July, 2023. An online questionnaire was generated using
google forms and sent to the group chats of the concerned sample group.
Responses were immediately received in our email handle as soon as the
respondents completely filled it online. When our expected responses
were achieved, we extracted the excel spreadsheet of their responses and
sent it to the SPSS software.

\textbf{Results}

A total of 222 questionnaires was administered to the clinical students
who are in 400L and 500L Medical Radiography, University of Nigeria,
Enugu Campus. A total of 221 out of the 222 questionnaires were
successfully filled and returned. The respondents' answers were analyzed
using descriptive statistics and presented in tables as follows.

\textbf{Table 1: Socio-demographic information of the respondents}

\textbf{(n=221)}\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
\begin{minipage}[b]{0.32\columnwidth}\raggedright\strut
\textbf{Sex}\strut
\end{minipage} & \begin{minipage}[b]{0.32\columnwidth}\raggedright\strut
\textbf{Frequency}\strut
\end{minipage} & \begin{minipage}[b]{0.32\columnwidth}\raggedright\strut
\textbf{Percentage (\%)}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
Male\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
128\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
57.5\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
Female\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
93\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
42.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Age}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
\textless{}20 years\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
05\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
2.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
21-25 years\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
149\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
67.4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
26-30 years\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
61\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
27.6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
31 and above\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
06\strut
\end{minipage} & \begin{minipage}[t]{0.32\columnwidth}\raggedright\strut
2.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\textbf{Year of study}\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
400 level\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
89\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
40.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
500 level\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
132\strut
\end{minipage} & \begin{minipage}[t]{0.30\columnwidth}\raggedright\strut
59.7\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

As depicted in table 1 below, a total number of 128 males (57.5\%) and
93 females (42.1\%) participated in the study. 5 respondents (23\%) were
within the age range less than 20 years, 149 respondents (67.4\%) were
within 21-25 years, 61 respondents (27.6\%) were within 26-30 years
while 5 respondents (2.7\%) were above 31 years of age. 89 respondents
(40.3\%) are 400level while 132 respondents (59.7\%) were in 500level.

\textbf{Table 2: ASSESSMENT OF THE LEVEL OF RADIATION PHYSICS KNOWLEDGE
AMONG CLINICAL RADIOGRAPHY STUDENTS PRIOR TO THEIR CLINICAL
TRAINING}(\textbf{n=221)}\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
S/N\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{Variables}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
n(\%)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Were you thoroughly taught the basic principles of radiation physics,
radiobiology and radiation protection during your pre-clinical
training?\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
YES 180(81.4)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NO 24(10.9)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NOT SURE 17(7.7)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
2.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Rate your understanding of these basic principles above taught during
your pre-clinical training?\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
POOR 16(7.2)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
FAIR 54(24.4)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
GOOD 119(53.8)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
EXCELLENT 32(14.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
3.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Rate your performance during various assessment tests taken on the
principles of radiation physics, radiobiology and radiation
protection\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
POOR 16(7.2)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
FAIR 54(24.4)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
GOOD 119(53.8)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
EXCELLENT 32(14.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
4.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Do you believe that your current knowledge of radiation physics,
radiobiology and radiation protection is capable of giving you the
necessary skills and safety in the clinic?\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
YES 165(74.7)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NO 23(10.4)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NOT SURE 33(14.9)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
5.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Are you familiar with the basic principles of radiation physics,
radiobiology and radiation protection in all the modalities of medical
imaging (CT, MRI, Radiotherapy, USS, FLUORO, Nuclear Medicine,
etc)?\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
YES 126(57.0)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NO 57(25.8)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NOT SURE 38(17.2)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
6.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Can you now appreciate this knowledge in the diagnosis and treatment of
diseases?\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
YES 170(76.9)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NO 20(9.0)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NOT SURE 31(14.0)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
7.\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
Are you aware of the potential biological effects of ionizing radiation
on staffs and patients?\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
YES 213(96.4)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NO 5(2.3)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
NOT SURE 3(1.4)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 2 demonstrates the level of radiation physics knowledge among
Clinical radiography students prior to their clinical training in
frequencies and percentages. Out of these, 180(81.4\%) stated that they
were thoroughly taught the basic principles of radiation physics,
radiobiology and radiation protection during their pre-clinical
training, 151(68.3\%) reported that they had excellent understanding of
these basic principles above taught during your pre-clinical training,
with associated excellent performance during various assessment tests
taken on them. A total of 165(74.7\%) believe that believe that the
current knowledge of radiation physics, radiobiology and radiation
protection is capable of giving you the necessary skills and safety in
the clinic and 126(57.0\%) responded that they are familiar with the
basic principles of radiation physics, radiobiology and radiation
protection in all the modalities of medical imaging (CT, MRI,
Radiotherapy, USS, FLUORO, Nuclear Medicine, etc.,). Also, 170(76.9\%)
reported that they appreciate this knowledge in the diagnosis and
treatment of diseases and 213(96.3\%) reported that they are aware of
the potential biological effects of ionizing radiation on staffs and
patients.

\textbf{Table 3: EVALUATION OF THE EXTENT TO WHICH UNDERGRADUATE
STUDENTS ARE ABLE TO APPLY RADIATION PHYSICS PRINCIPLES IN CLINICAL
PRACTICE (n=221)}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Application of the knowledge of Radiation physics in clinical
Practice}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
SD n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
D n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
U n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
A n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
SA n(\%)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I apply my knowledge of radiation physics in selection of exposure
factors during clinical trainings\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13(5.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14(6.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
114(51.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
73(53.2)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I apply the ALARA principles of radiation safety during all examination
protocols and procedures in the clinic\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8(3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2(0.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6(2.7)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
100(45.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
105(47.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I can calculate the absorbed radiation dose I receive over a period of
going for postings\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
38(17.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
89(40.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
45(20.4)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
37(16.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
12(17.2)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
My knowledge of radiation physics helps me to accurately justify the use
of grid mechanism while considering patient habitus\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
11(5.0)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8(3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
20(9.0)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
128(57.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
54(24.4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I stand at a safe distance from the patient during every radiation
exposure undertaken in the clinic\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6(2.7)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9(4.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98(44.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
101(45.7)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I communicate the importance of immobility and compliance to my patient
to avoid repeats\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4(1.8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7(3.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
105(47.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
98(44.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
The major cause of repeat I experienced in the clinic results from poor
patient-radiographer communication/poor compliance\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
11(5.0)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24(10.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
29(13.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
112(50.7)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
45(20.4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
My knowledge of radiation physics is limited only to X-ray (Conventional
radiography)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
27(12.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
88(39.8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
30(13.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
57(25.8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
19(8.6)\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

SD = strongly disagree, D = disagree, U = Undecided, A = Agree, SA =
strongly agree

Table 3 demonstrates evaluation of the extent to which undergraduate
students are able to apply radiation physics principles in clinical
practice in frequencies and percentages. A total of 187(84.6\%) apply
knowledge of radiation physics in selection of exposure factors during
clinical trainings, a total 205(92.7\%) apply the ALARA principles of
radiation safety during all examination protocols and procedures in the
clinic, it was noted that 182(82.3\%) stated they cannot calculate the
absorbed radiation dose I receive over a period of going for postings,
199(90.0\%) reported that their knowledge of radiation physics helps
them to accurately justify the use of grid mechanism while considering
patient habitus and 203(91.8\%) stand at a safe distance from the
patient during every radiation exposure undertaken in the clinic. Also,
157(71.1\%) communicate the importance of immobility and compliance to
the patient they attend to in order to avoid repeats, 157(71.1\%) stated
the major cause of repeat experienced in the clinic results from poor
patient-radiographer communication/poor compliance, while 115(52.0\%)
disagreed that their knowledge of radiation physics is limited only to
X-ray (Conventional radiography)

\textbf{Table 4: BARRIERS FACED BY UNDERGRADUATE STUDENTS IN APPLYING}

\textbf{RADIATION PHYSICS KNOWLEDGE DURING THEIR CLINICAL TRAINING.}

\textbf{(n=221)}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Likely barriers to in applying Radiation physics knowledge
during their clinical training}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
SD n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
D n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
U n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
A n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
SA n(\%)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I have no interest in radiation physics because I perceive it as a hard
course with abstract applications\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
49(22.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
93(42.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
36(16.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
32(14.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
11(5.0)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I experience a wide gap between what's been taught in class and what is
applicable in clinical postings\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
21(9.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
72(32.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
37(16.7)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
69(31.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
21(9.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I avoid clinical postings because of fear of the biological effects of
radiation to my health\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
74(33.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
113(51.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
16(7.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9(4.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9(4.1)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I have limited clinical posting experiences because of over population
of students in the clinic\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14(6.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13(5.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
15(6.8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
90(40.7)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
89(40.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I experience difficulties in understanding certain radiation physics
principles and applying them after being taught.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14(6.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
62(28.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
38(17.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
83(37.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24(10.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
There is unavailability of radiation physics/protection resources to aid
applicability\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14(6.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
52(23.5)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
38(17.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
92(41.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
25(11.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
There's poor supervision/guidance for students by practicing
radiographers who ought to ensure that students apply their pre-clinical
knowledge of radiation\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24(10.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
49(22.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
34(15.4)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
88(39.8)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
25(11.3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
I often experience faulty/non-functional equipment during clinical
postings shifts\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
19(8.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
56(25.3)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
33(14.9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
83(37.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
30(13.6)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9.\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
There are Limited opportunities for students to ask questions, seek
clarification or engage in discussion related to radiation physics\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
16(7.2)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
60(27.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
34(15.4)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
83(37.6)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
28(12.7)\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

SD = strongly disagree, D = disagree, U = Undecided, A = Agree, SA =
strongly agree

Table 4 demonstrates barriers faced by undergraduate students in
applying radiation physics knowledge during their clinical training in
frequencies and percentages. It was noted that 142 (64.3\%) have no
interest in radiation physics because they perceive it as a hard course
with abstract applications, 93(42.0\%) experience a wide gap between
what they were taught in class and what is applicable in clinical
postings and 187(84.6\%) reported that they do not avoid clinical
postings because of fear of the biological effects of radiation to their
health. A total of 179(81.0\%) of the respondents reported to have
limited clinical posting experiences because of over population of
students in the clinic, 107(48.5\%) experience difficulties in
understanding certain radiation physics principles and applying them
after being taught and 117(52.9\%) agreed that there is unavailability
of radiation physics/protection resources to aid application. Also,
113(50.6\%) of the respondents agreed that there's poor
supervision/guidance for students by practicing radiographers who ought
to ensure that students apply their preclinical knowledge, 113(50.6)
agreed that they often experience faulty/non-functional equipment during
clinical postings shifts, while 113(50.6\%) of the respondents agreed
there are Limited opportunities for students to ask questions, seek
clarification or engage in discussion related to radiation physics.

\textbf{Table 5: METHODS FOR IMPROVING THE INTEGRATION OF RADIATION
PHYSICS KNOWLEDGE IN CLINICAL POSTINGS}

\textbf{(n=221)}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
\textbf{Which of following measures do you believe will further advance
the application of radiation physics among clinical students?}\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
YES n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
NO n(\%)\strut
\end{minipage} & \begin{minipage}[b]{0.19\columnwidth}\raggedright\strut
NOTSURE n(\%)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1.\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Resolve the crisis of over-crowding during clinical rotations\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
199(90.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
21(9.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(0.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Increase the duration of radiation physics education in pre-clinical
classes\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
154(69.7)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
66(29.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(0.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Employ radiation physics experts to handle students in radiation physics
courses (theory and practical)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
210(95.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(4.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(0.5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
4.\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Provide hands-on practical trainings in applying radiation physics
during clinical postings\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
211(95.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8(3.6)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(0.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
5.\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Incorporate interactive learning methods, such as simulations or virtual
reality specially to cushion effects of overpopulation currently
experienced\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
206(93.2)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
13(5.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2(0.9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6.\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Encourage collaboration between radiation physicists, clinical trainers
and clinical students during clinical trainings\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
210(95.0)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
10(4.5)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1(0.5)\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 5 demonstrates recommendations for improving the integration of
radiation physics knowledge in clinical postings in frequencies and
percentages. A total of 199(90.0\%) respondents recommended a
development of a dedicated/achievable radiation physics curriculum with
unlimited access to updated textbooks and reference materials,
154(69.7\%) stated that there should be increase in the duration of
radiation physics education in pre-clinical classes, 210(95.10\%)
suggested the employment of radiation physics experts to handle students
in radiation physics courses (theory and practical). Also, 211(95.5\%)
respondents suggested provision of hands-on practical trainings in
applying radiation physics during clinical postings, 206(93.2\%)
respondents suggested incorporate interactive learning methods, such as
simulations or virtual reality especially to cushion effects of
overpopulation currently experienced, while 210(95.0\%) encouraged
collaboration between radiation physicists, clinical trainers and
clinical students during clinical trainings.

\textbf{Discussion}

In the evaluation of the extent to which clinical radiography students
were thoroughly taught prior to their clinical training, it was revealed
from the results that majority (\textbf{81.4\%} ) of the students
affirms positively and majority of the respondents \textbf{(68.3\%)}
posits that they understand what they were being taught in radiation
physics and performed well when assessed on what they have learnt.
Majority of the respondents \textbf{(74.7\%)} also affirms the
sufficiency of this knowledge acquired during clinical training to
produce the necessary skill they need for their clinical training. This
result agrees with the results of the research conducted by Tejinder et
al(8) where majority of the students possessed variable levels of prior
knowledge of the core Einsteinian concepts, but near level of
intelligibility after the programme.

The awareness of the use of this acquired knowledge in the treatment of
diseases and the potential biological effects of ionizing radiation on
staffs and patients was also rated high among the
students\textbf{(76.9\% and 96.4\% respectively).} This significantly
contrast with the study carried out by Rego et al(9) on the effects of
radiation on different organs or living beings, where the awareness
among the students did not display a strong opinion, with average scores
lying between 3.1 and 3.6 against a ten-point scale.

The result on the application of the acquired knowledge of radiation
physical during clinical training revealed that majority of the
respondents apply this knowledge in a variety of ways like, in the
selection of exposure factors, in employing the ALARA principle for
radiation safety of themselves and the patient, and in communicating
with or positioning a patient during examinations to avoid repeat cases.
Majority of the students as well affirmed that their application of this
acquired knowledge cuts across all the various modalities in medical
imaging and not limited to just conventional X-ray imaging.

However, it was noted that majority of the students
\textbf{(77.9\%)}cannot calculate or measure the amount of radiation
they absorb during their clinical rotations. This result agrees with the
study conducted by Rego et al(9) where the average scores between 3.2
and 3.5 against a ten-point scale showed that the students cannot
measure the difference between doses delivered in diagnostic
examinations and doses delivered in therapy. This result indicates that
majority of the students are not aware of the concept of relative
biological effectiveness (RBE). In a certain sense this can be traced
back to the lack of information on doses delivered to patients when a
clinical examination or therapy is performed in Portugal.

The major barriers that presented in the application of their acquired
knowledge during clinical postings was over-crowding of examination
halls during clinical rotations, unavailability of radiation
physics/protection resources, poor supervision/guidance by their
superiors in the clinic, and poor/lack of interactive sessions between
students and their clinical supervisors. This result contrasts with the
study conducted by Young R et al(10) where most radiography students
reported a positive attitude towards clinical supervision (73.3\%),
although a significant minority reported not being confident across
survey items related to the tasks required in supervising students
during their clinical rotations (ranging from 20.7\%--29.1\%).

Suggested structures polled by the respondents to increase the
application of their acquired knowledge during clinical trainings
include; providing hands-on practical trainings in applying radiation
physics during clinical postings, employing radiation physics experts to
handle students in radiation physics courses (theory and practical)
solving the issue of over-crowding during clinical rotations,
Incorporating interactive learning methods, such as simulations or
virtual reality specially to cushion effects of overpopulation currently
experienced and Encourage collaboration between radiation physicists,
clinical trainers and clinical students during clinical trainings. These
suggestions agree with the study carried out by Thea et al(11), in
solving the crisis that graduating nursing students reported that they
have low competence in communication, leadership and delegation skills,
which may be due to lack of sufficient opportunities to practice
communication/leadership skills such as delegation and supervision
during clinical rotations. A near- peer clinical supervision model was
done and the result of this study on twenty-seven first-year (69.2\%)
and 43 third-year (46.7\%) students who completed the questionnaire
noted positive experience and would recommend it to other students,
Third-year students reported gaining confidence, teaching, delegation
and leadership skills.

\textbf{Conclusion}

Incorporating radiation physics knowledge into clinical rotations for
clinical radiography students holds great potential for enhancing their
understanding and practical application of this crucial aspect of their
profession. By following the recommended strategies, educators can
create a more comprehensive and effective learning experience. While
there are limitations to the study, such as sample size and external
factors, the positive impact on students' ability to apply radiation
physics in clinical settings suggests that this approach has significant
educational value.

\textbf{Conflict of Interest}

All authors declared no any conflict of interest

\textbf{Funding Information}

The authors received no funding for this study.

\textbf{Ethical approval:} appropriate ethical approval was obtained
from the department of Medical Radiography and Radiological sciences,
University of Nigeria, Enugu Campus.

\textbf{Patient Informed Consent}

Informed consent was made during the period of study to all
participants\textbf{.}

\textbf{Data availability Statement}

The data used for this study is available upon reasonable request.

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