Side marker creep: have radiographers changed their side marker habits?

The Use of Anatomical Side Markers in General Radiology: A Systematic Review of the Current Literature

OBJECTIVES

The use of an anatomical side marker (ASM) on x-rays, be it digital or radiopaque, is an important quality and safety concept within general radiology. Using radiopaque ASMs is best practice, and lack of any ASMs may have dire consequences in terms of patient safety. To date, there have been no systematic reviews investigating the use of ASMs in clinical practice.

METHODS

A systematic search of electronic databases (CINAHL, the Cochrane Library, Medline, EMBASE, ERIC, and JBI) from inception to March 1, 2018, was undertaken. Gray literature searching (through Google) and pearling was conducted. Methodological quality was assessed using a modified version of the McMaster Critical Appraisal tool for quantitative studies. A customized data extraction tool was developed, which included characteristics of the studies.

RESULTS

Of 624 studies, 7 studies met the eligibility criteria. Despite diverse study designs, collectively, the studies demonstrated that only a small number of x-rays did not include an ASM. On x-rays that did use a radiopaque ASM, most of them were positioned in the primary radiation field. A noticeable shift in practice from the use of radiopaque ASMs to digital ASM was also identified. Multifaceted barriers were reported for the use of ASM in routine clinical practice.

CONCLUSIONS

Although missing ASMs on x-rays were a small feature, findings from this review highlight opportunities for improvement and a need to ameliorate barriers for ASM use.

Investigating perceptions of 'dose creep' amongst student radiographers: A grounded theory study

INTRODUCTION

The dose creep phenomenon is now a widely recognized concept in diagnostic radiography in light of recent technological advancements transnationally. However, this still remains underexplored amongst radiography students preparing to enter the radiography profession. In response, this study explores the perceptions of dose creep amongst undergraduate student radiographers.

METHODS

The methodological approach utilized in this research study was grounded theory. The qualitative approach aimed to uncover findings from a higher education institution in Australia. Six students were recruited and took part in semi-structured interviews. This enabled the exploration of previously uncovered data, leading to the construction of original theory within the clinical and academic environment. The data analysis employed was constant comparative analysis (CCA).

RESULTS

A number of insights emerged from the qualitative data set. For instance, the radiography students understanding of the term 'dose creep' and decision making leading to dose creep in the clinical environment is captured. This is further supported with assessment of image evaluation determining appropriate exposure factor selection and future impact upon graduation as diagnostic radiographers. The findings identify some important learning needs and actions for both clinical and academic settings which may help foster good use of X-ray exposures.

CONCLUSION

This paper concludes by affirming some challenges surrounding optimal exposure selection and the known phenomenon, dose creep. Further, this study identifies the importance of learning and teaching in the clinical environment whereby learned behaviour leads to suboptimum practices.

IMPLICATIONS FOR PRACTICE

This study advances the existing evidence base by providing a unique lens into the knowledge and understanding of dose creep amongst radiography students in both academic and clinical contexts. It is anticipated this paper will help practitioners and educators better understand potential instances of dose creep within the clinical environment.

The Use of Digital Side Markers (DSMs) and Cropping in Digital Radiography

INTRODUCTION

This article explores two phenomena in the general radiography environment-the increasing use of digital side markers (DSMs) by radiographers and the possibility for radiographers to "crop" radiographs post-exposure. This article offers originality by identifying the rationales of radiographers when using digital equipment.

METHODS

This study formed part of a larger ethnographic study undertaken in the United Kingdom (UK). Participant observation and semi-structured interviews were used. Overt participant observation identified cropping and DSM placement within the X-ray room. Semi-structured interviews later supported and/or refuted the rationale for DSMs and cropping clinically.

RESULTS

Two themes are discussed. First, radiographers support the use of DSMs by suggesting that mistakes will happen regardless of using an ASM and/or DSM. Furthermore, it is proposed that ASMs and DSMs can be interchangeably used in practice. Second, radiographers acknowledge the use of cropping ensuring their radiographs resemble "a textbook image." This leads to question the optimum use of collimation in the clinical environment and how it may go unnoticed.

CONCLUSION

This article concludes by recognizing some challenges digital radiography currently provides. The rationale and continuing use of DSMs and cropping of radiographs by radiographers highlights alternate complexities with digital technology in the clinical environment and how we may best overcome such challenges that influence the profession.

Side marker creep: have radiographers changed their side marker habits?

Has side marker use changed with the introduction of digital radiography? This editorial explores this question.