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Survey on the Knowledge of Dental Radiology among Some Dental Hygiene Students and Satisfaction with Virtual Reality-Based Learning Media during Dental Radiographic Practice Using VR
Int J Clin Prev Dent 2024;20(4):136-143
Published online December 31, 2024;  https://doi.org/10.15236/ijcpd.2024.20.4.136
© 2024 International Journal of Clinical Preventive Dentistry.

Da-Hui Kim, Cheon-Hee Lee

Department of Dental Hygiene, Andong Science College, Andong, Korea
Correspondence to: Cheon-Hee Lee
E-mail: arisu0515@hanmail.net
https://orcid.org/0000-0002-3203-8025
Received December 2, 2024; Revised December 16, 2024; Accepted December 24, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: This study aims to investigate the characteristics related to radiology education and use, including basic knowledge of radiation, self-awareness of knowledge level, recognition of the risks of dental radiation, anxiety about dental radiation exposure, perception of policies related to dental radiation, and satisfaction with virtual reality (VR)-based learning media for dental radiographic practice. Additionally, it seeks to provide foundational data for identifying learning directions and priorities when teaching dental hygiene students about dental radiographic practice.
Methods: From March 2 to December 31, 2024, 200 dental hygiene students were divided into two groups. Traditional dental radiographic practice using a phantom and radiographic equipment was compared to VR-based dental radiographic practice. Data were collected and analyzed to evaluate the efficacy of VR-based education media.
Results: Awareness of radiation exposure positively correlated with the perceived realism of the VR practice environment (r=0.190), perceptions of virtual patient practice (r=0.145), and satisfaction with learning media (r=0.178). Realism perception in the VR practice environment positively correlated with perceptions of virtual patient practice (r=0.755) and learning media satisfaction (r=0.732). Perceptions of virtual patient practice also positively correlated with learning media satisfaction (r=0.694).
Conclusion: Although dental hygiene students possess knowledge about radiation safety management, their practical application is inadequate. Effective measures are necessary to address their high levels of anxiety about radiation hazards.
Keywords : VR-based, dental radiography, radiation safety management, dental radiation risks
Introduction

With advancements in modern medical technology, the use of radiology in diagnosis and treatment is increasing, alongside heightened awareness of dental care, leading to a continuous rise in oral radiography [1]. Consequently, both radiology professionals and patients visiting dental medical institutions face increasing opportunities for radiation exposure [2].

Currently, oral radiographic tasks in dental medical institutions are performed by dentists, dental hygienists, and radiologists under the supervision and direction of dentists [3]. According to Article 2, Clause 1, Section 6 of the Enforcement Decree of the Medical Technicians Act, dental hygienists are allowed to perform intraoral diagnostic radiographic tasks at health or medical institutions that meet safety management standards [4]. Research has shown that dental hygienists are primarily responsible for radiographic tasks in dental institutions [5].

Radiation used in dentistry is often considered low-level and harmless due to the minimal X-ray doses involved. However, the cumulative use of substantial radiation doses in medical fields cannot be overlooked [6]. Even low-dose radiation exposure can increase the likelihood of stochastic effects such as cancer and leukemia over the long term, as well as deterministic effects such as skin lesions, hair loss, white blood cell reduction, infertility, cataracts, and fetal impact. This underscores the need to manage occupational radiation exposure and enforce proper safety management of radiation-generating devices in dental institutions, alongside fostering accurate perceptions of radiation safety among dental professionals [7].

Virtual reality (VR) is being applied across various fields, including industrial safety training, exercise programs, vocational training, clinical medicine, rehabilitation, and design. Its application in education is especially notable due to VR’s features of manipulation, visualization, and interaction. These features align with experiential theories and allow for individualized, collaborative, and problem-solving learning within networked virtual environments. VR applications are expanding from safety training in industrial sectors to home-based exercise programs, vocational training for baristas, and design fields that require artistic sensibility [8,9].

VR educational materials are particularly active in healthcare professions, including content for dental surgery training, virtual patient care, and autism education. Simulated training programs for emergency room staff and educational design strategies in primary and secondary education are also areas of focus [10,11]. Despite VR’s vast potential in education, its application remains limited, primarily involving content that supports the delivery of curriculum knowledge to achieve academic goals. In university education, VR experiences are largely limited to content exploration rather than immersive interaction. However, there are challenges to adopting VR educational materials in medical and healthcare training. Radio-logy programs, for example, face limitations due to high equipment costs and ethical concerns regarding human exposure to radiation. Yet, the effective use of alternative educational tools can enhance learning outcomes. VR environments allow repeated practice of clinical tasks, improving task performance and proficiency, maintaining practice equipment, and preparing for emergency situations. By replicating healthcare environments in virtual spaces, VR offers realistic experiences with various devices, boosting engagement and efficacy. Research shows that dental hygienists’ higher knowledge and attitudes toward radiation defense correlate with better safety practices [12]. Studies indicate that knowledge about radiation safety management positively influences attitudes and practices, while inadequate safety training heightens anxiety about radiation exposure [13]. This study investigates the knowledge, awareness, and perceptions of dental hygiene students regarding radiation education, exposure, and policy. It also examines satisfaction with VR-based learning media to provide fundamental data for improving dental radiographic practice education. Ultimately, it aims to enhance perceptions of dental radiography and contribute to effective radiation policy development.

Materials and Methods

1. Subjects

From March 2 to December 31, 2024, this study compared traditional dental radiography practice using phantoms and radiographic equipment with VR-based practice. The study focused on 200 dental hygiene students enrolled in a dental radiography course. Participants were recruited through online announcements, and consent forms were obtained after explaining the study’s purpose and ethical considerations. Ques-tionnaires were completed independently, and no financial incentives were provided. Of 210 responses, 200 were included in the final analysis after excluding incomplete question-naires.

2. Measurement tools

The survey for this study used the structured questionnaire used in previous studies, modified and supplemented by the research [14] to suit the actual circumstances. The questionnaire included 5 questions about the general characteristics of the research subjects, 6 questions about basic knowledge about radiation, 2 questions about awareness of radiation knowledge level, 5 questions about risks and anxiety about radiation exposure, and 2 questions about awareness of radiation-related policies [15] 15 questions on the sense of presence of the virtual practice environment during VR-based practice classes, 5 questions on trainee students’ perception of virtual patients, and 5 questions on learning media for dental radiography using VR. Student satisfaction consists of 21 questions [16]. All questions were measured on a 5-point Likert scale with 5 points being ‘strongly agree’, 4 points being ‘agree’, 3 points being ‘average’, 2 points being ‘disagree’, and 1 point being ‘strongly disagree’, and the average value was calcu-lated. Cronbach’s α values confirmed the reliability of the scales: radiation risk perception (0.890), VR environment realism (0.981), virtual patient perceptions (0.963), learning media satisfaction (0.989), radiation safety knowledge (0.737), radiation safety practice (0.840), and anxiety about radiation risks (0.907).

3. Data analysis

Descriptive statistics were calculated for general characteristics, basic radiation knowledge, and self-awareness of knowledge levels. Differences in perceptions of VR practice environment realism, virtual patient perceptions, learning media satisfaction, and radiation exposure awareness were analyzed using t-tests and ANOVA, with Scheffé post hoc tests. Correlations were analyzed using SPSS Statistics ver. 24.0 (IBM Corp., Armonk, NY, USA), with a significance level of p<0.05.

Results

1. General characteristics

Among the participants, 195 (97.5%) were female, 110 (55.0%) were third-year students, and 142 (68.6%) were under 25 years old. A total of 142 (71.0%) participated in radiation safety education, and 125 (60.4%) had clinical practice experience. Basic radiation knowledge revealed the highest agreement respondents, 199 (99.5%) with the statement, “X-rays used for patient examination in hospitals are a type of radiation,” while 129 (65.7%) disagreed that “radiation and radioactivity are the same.” In terms of the perceived level of radiation knowledge, 101 respondents (50.5%) answered “average” to the statement “People don’t know much about radiation,” and 104 respondents (52.0%) answered “average” to the statement “I don’t know much about radiation,” showing a high proportion of such responses (Table 1).

Table 1 . General characteristics

Division Frequency
GenderMale5 (2.5)
Female195 (97.5)
Grade140 (20.0)
250 (25.0)
3110 (55.0)
Age<25142 (68.6)
25≥58 (31.4)
Radiation safety educationParticipation142 (71.0)
Nonappearance58 (29.0)
Clinical practice experienceParticipation125 (60.4)
Nonappearance75 (39.6)
Basic knowledge of radiationRadiation is a type of energy.Participation184 (92.3)
Nonappearance16 (7.7)
Radiation and radioactivity are the same.Participation71 (34.3)
Nonappearance129 (65.7)
Half-life is the period of time required for radioactivity to be reduced by half.Participation154 (77.8)
Nonappearance46 (22.2)
X-rays used when examining patients in hospitals are a type of radiation.Participation199 (99.5)
Nonappearance1 (0.5)
Even in our daily lives, we are exposed to natural radiation.Yes176 (88.0)
No24 (15.0)
The more radiation passes through thick walls, the greater the impact it has on the human body.Yes190 (95)
No10 (2.0)
Radiation knowledge level and awareness levelPeople don’t know much about radiation.Not at all7 (3.5)
Not so15 (7.5)
It’s normal101 (50.5)
Yes69 (33.3)
Very yes8 (34.5)
I don’t know much about radiation.Not at all12 (6.0)
Not so41 (20.5)
It’s normal104 (52.0)
Yes41 (20.5)
Very much so2 (1.0)

Values are presented as person number (%).



2. Perceptions of realism in practice environments, students’ perceptions of virtual patients, and student satisfaction with learning media based on general characteristicsalism

The perception of re practice environment scored high with third-year students (3.29±0.73), students under 25 years old (3.52±0.68), those who did not participate in safety training (3.31±0.62), and those with clinical practice experience (3.29±0.79). However, no significant differences were observed (p>0.05).

For students’ perceptions of virtual patients, high scores were recorded by first-year students (3.29±0.52), students under 25 years old (3.26±0.64), those who did not participate in safety training (3.31±0.62), and those without clinical practice experience (3.22±0.53). Similarly, no significant differences were noted (p>0.05).

Student satisfaction with learning media was high among third-year students (3.47±0.70), students under 25 years old (3.52±0.68), those who participated in safety training (3.47± 0.73), and those with clinical practice experience (3.61±0.75). Again, no significant differences were found (p>0.05) (Table 2).

Table 2 . Differences in variables according to general characteristics (unit: mean±SD)

Division NVirtual practice environment
perception of presence
t or F
(p*)
Virtual patient
perception of practicum students
t or F
(p*)
Satisfaction with learning mediat or F
(p*)
Grade1383.27±0.500.773
(0.258)
3.29±0.520.605
(0.504)
3.35a±0.480.302
(1.205)
2493.20±0.513.16±0.443.41a,b±0.56
31133.29±0.733.18±0.813.47b±0.70
Age<251383.52±0.680.149
(1.449)
3.26±0.640.034
(2.131)
3.52±0.680.149
(1.449)
25≥623.36±0.733.04±0.763.36±0.73
Radiation safety educationParticipation1413.25±0.740.636
(−473)
3.15±0.710.143
(−1.471)
3.47±0.730.877
(0.155)
Nonappearance593.31±0.623.31±0.623.46±0.62
Clinical practice experienceParticipation1213.29±0.790.537
(0.618)
3.18±0.780.619
(−0.499)
3.61±0.750.291
(1.059)
Nonappearance793.22±0.613.22±0.533.41±0.60

Values are presented as mean±standard deviation.

*p-value was taken using t-test and one-way ANOVA statistics. a,bSame letters indicate statistically indifferent by Scheffe multiple comparison.



3. Perception of radiation exposure, perception of radiation risks, and anxiety about radiation exposure

The perception of radiation exposure scored high among second-year students (3.58±0.61), students under 25 years old (3.51±0.65), those who participated in safety training (3.49± 0.66), and those with clinical practice experience (3.49±0.65). However, no significant differences were observed (p>0.05).

Regarding the perception of radiation risks, high scores were recorded by second-year students (3.83±0.63), students under 25 years old (3.81±0.66), those who participated in safety training (3.76±0.70), and those with clinical practice experience (3.73±0.68). Again, no significant differences were found (p>0.05).

Anxiety about radiation exposure was high among second-year students (3.33±0.80), students aged 25 and older (3.39±0.76), those who did not participate in safety training (3.27±0.88), and those with clinical practice experience (3.24±0.89). Similarly, no significant differences were noted (p>0.05) (Table 3).

Table 3 . Awareness of radiation exposure (unit: mean±SD)

CharacteristicNRadiation exposure awarenesst or F
(p*)
Radiation hazardt or F
(p*)
Radiation exposure anxietyt or F
(p*)
Grade1383.23±0.740.42
(3.234)
3.42±0.870.018
(4.110)
3.04a±0.830.290
(1.247)
2493.58±0.613.83±0.633.33a,b±0.80
31133.51±0.683.78±0.733.25b±0.92
Age<251383.51±0.650.251
(1.150)
3.81±0.660.703
(−0.372)
3.21±0.860.017
(2.433)
25≥623.39±0.763.52±0.833.39±0.76
Radiation safety educationParticipation1413.49±0.660.682
(0.410)
3.76±0.700.243
(1.171)
3.22±0.880.740
(−0.332)
Nonappearance593.45±0.753.63±0.813.27±0.88
Clinical practice experienceParticipation1213.49±0.650.826
(0.220)
3.73±0.680.814
(0.236)
3.24±0.890.884
(0.146)
Nonappearance793.46±0.733.71±0.813.22±0.86

Values are presented as mean±standard deviation.

*p-value was taken using t-test and one-way ANOVA statistics. a,bSame letters indicate statistically indifferent by Scheffe multiple comparison.



4. Correlation of radiation exposure awareness, perception of presence in virtual practice environments, perception of virtual patient practice, and learning media satisfaction

Radiation exposure awareness showed a positive correlation with perception of presence in virtual practice environments (r=0.190), perception of virtual patient practice (r= 0.145), and learning media satisfaction (r=0.178). Perception of presence in virtual practice environments demonstrated a positive correlation with perception of virtual patient practice (r=0.755) and learning media satisfaction (r=0.732). Addi-tionally, perception of virtual patient practice was positively correlated with learning media satisfaction (r=0.694) (Table 4).

Table 4 . Correlation among variable

CharacteristicRadiation exposure awarenessPerception of presence in virtual practice environmentPerceptions of students in virtual patient trainingSatisfaction with learning media
Radiation exposure awareness1
Perception of presence in virtual practice environment0.190**1
Perceptions of students in virtual patient training0.145*0.755**1
Satisfaction with learning media0.178*0.732**0.694**1

*Correlation is significant at the 0.05 level (2-tailed).

**Correlation is significant at the <0.001 level (2-tailed).


Discussion

With the advancements in medical and biomedical engineering, as well as the increasing public demand for health care, diagnostic and therapeutic techniques using radiation have seen continuous annual growth, driven by the development of new methods [17]. The purpose of dental radiography is to provide an oral examination tool that utilizes radiographic images to more accurately assess the condition of dental roots and alveolar bone, as well as conduct pathological examinations that are challenging to confirm through visual inspection. The International Commission on Radiological Protection (ICRP) emphasizes radiation protection in medicine due to the increasing exposure of people to ionizing radiation from medical procedures [18]. In many cases, individual doses are higher than those from other human activities. The total benefit of medical practices includes not only direct health benefits for the patient but also benefits for their families and society. Although patients are the primary recipients of exposure in medical procedures, consideration must also be given to exposure of healthcare professionals and non-patient members of the public [19,20]. In dentistry, radiographic examinations are widely used for diagnosing oral diseases and planning treatment. Recently, with the rise in income levels, the demand for orthodontics, prosthetics, and implants has increased [21,22]. This trend has led to a surge in the use of intraoral radiography, extraoral radiography, panoramic imaging, and digital radiography. In dental clinics, oral radiographic tasks are performed by dentists and, under their direction and supervision, by dental hygienists, radiologic technologists, and nursing assistants. Studies have found that dental hygienists predominantly handle radiographic tasks in such settings [23,24]. However, failure by dental hygienists to adhere to proper safety management practices may result in repeated exposure to low-dose radiation during their work, posing significant risks and making it difficult to ensure safety against prolonged exposure. When comparing occupational exposure doses over the years, radiologic technologists had the highest exposure, followed by dental hygienists, nurses, physicians, dentists, and other professionals. Research has shown that dental hygienists experience significant anxiety regarding radiation exposure [25]. This psychological anxiety about the side effects of radiation exposure during radiographic tasks may limit their work performance. In a study examining general characteristics of the participants, 195 were female (97.5%), 110 were third-year students (55.0%), and 142 were under 25 years old (68.6%). Participation in radiation safety education was reported by 142 participants (71.0%), and 125 (60.4%) had clinical practice experience. Dental hygienists demonstrated higher knowledge of radiation safety management compared to the average scores in studies by Han [26] and Yoon [7]. In this study, their average score was 3.76±0.70 out of 5, indicating above-average knowledge. Anxiety about radiation hazards was measured at an average of 3.39±0.76, which, while lower than the 4.43±0.71 reported in Yoon’s [7] study, still indicates a noticeable level of concern about radiation exposure. Awareness of radiation exposure showed positive correlations with perceptions of virtual practice environment realism (r=0.190), perceptions of virtual patient practice (r=0.145), and satisfaction with learning media (r=0.178). Furthermore, perceptions of virtual practice environment realism were positively correlated with perceptions of virtual patient practice (r=0.755) and learning media satisfaction (r=0.732), while perceptions of virtual patient practice were correlated with learning media satisfaction (r=0.694). Previous research, such as Jung’s [18] study, indicated a positive correlation between attitudes and radiation anxiety. However, this study found a negative correlation between radiation hazard anxiety and knowledge, suggesting the need for further investigation into radiation hazard anxiety from different perspectives. Studies by Kim [27], Lee [28], Yoon and Yoon [29] indicated that higher knowledge of radiation protection correlates with higher levels of protective behavior. Contrarily, this study found that higher knowledge of radiation safety management did not translate to higher implementation of protective practices. The findings indicate that while dental hygienists possess adequate knowledge of radiation safety management, their practical application of safety practices remains insufficient [22]. This highlights the need for measures to address the root causes and improve radiation safety management. Limitations of this study include its focus on specific regions, limiting the generalizability of the results to all dental hygiene students, and the comparison of phantom-based radiographic methods with VR-based methods. Despite these limitations, this study is significant as it examines the state of radiation safety management following the widespread adoption of digital film and explores anxiety related to radiation hazards. The results provide foundational data for improving radiation safety management environments in dental clinics. Furthermore, this study emphasizes the need to enhance radiation safety education for dental hygiene students. Expanding the use of VR-based classes in radiation safety education can prevent physical and psychological harm from radiation exposure, improve safety management levels, and promote a proper understanding of radiation handling practices.

Conclusion

This study was conducted with 200 dental hygiene students from March 2 to December 31, 2024, to compare traditional dental radiology practice education using phantom and X-ray machines with virtual reality (VR)-based dental radiology practice education. The collected data was analyzed, leading to the following conclusions:

1. The participants consisted of 195 females (97.5%), 110 third-year student (55.0%), and 142 students under 25 years old (68.6%). Among them, 142 students (71.0%) participated in radiation safety education, and 125 students (60.4%) had clinical practice experience.

2. The perception of realism in the practice environment was highest among third-year students (3.29±0.73), those under 25 years old (3.52±0.68), those who did not participate in safety education (3.31±0.62), and those with clinical practice experience (3.29±0.79).

3. In terms of students’ perception of virtual patients, first-year students had the highest score (3.29±0.52), followed by those under 25 years old (3.26±0.64), those who did not participate in safety education (3.31±0.62), and those without clinical practice experience (3.22±0.53). Student satisfaction with the learning medium was highest among third-year students (3.47±0.70), those under 25 years old (3.52±0.68), those who participated in safety education (3.47±0.73), and those with clinical practice experience (3.61±0.75), with no significant differences found (p>0.05).

4. Awareness of radiation exposure was highest among second-year students (3.58±0.61), those under 25 years old (3.51±0.65), those who participated in safety education (3.49±0.66), and those with clinical practice experience (3.49±0.65). In terms of radiation hazard awareness, second-year students scored the highest (3.83±0.63), followed by those under 25 years old (3.81±0.66), those who participated in safety education (3.76±0.70), and those with clinical practice experience (3.73±0.68). As for anxiety about radiation exposure, second-year students showed the highest level (3.33±0.80), followed by those over 25 years old (3.39±0.76), those who did not participate in safety education (3.27±0.88), and those with clinical practice experience (3.24±0.89), with no significant differences found (p>0.05) (Table 3).

5. Awareness of radiation exposure showed a positive correlation with the perception of realism in the virtual practice environment (r=0.190), perception of virtual patients (r=0.145), and satisfaction with the learning medium (r=0.178). Percep-tion of realism in the virtual practice environment had a strong positive correlation with the perception of virtual patients (r=0.755) and satisfaction with the learning medium (r=0.732).

The perception of virtual patients also showed a positive correlation with satisfaction with the learning medium (r=0.694). Based on the results of this study, it appears that while dental hygiene students have knowledge about radiation safety management, there is a gap in practical application. Addi-tionally, there is a high level of anxiety regarding radiation hazards, suggesting the need for measures to address and improve these issues.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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