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Chilanga CC, Lysdahl KB. The radiographers' opinion on assessing radiological referrals. Radiography (Lond) 2024; 30:605-611. [PMID: 38330893 DOI: 10.1016/j.radi.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Radiographers have a fundamental duty to assess radiological referrals and ensure imaging is justified. This study constitutes the third part of a broader research on radiographers' assessment of referrals. The study examines the opinions of radiographers on the matter, as articulated in their own words. METHODS A questionnaire with closed and open-ended questions was designed, validated, and distributed to radiographers following activities organised by the International Society of Radiographers and Radiological Technologists (ISRRT). This third part covers the participants' free-text comments about radiographers' assessment of referrals. Qualitative, inductive content analysis was used to report findings involving three phases: 1) Preparation, 2) Organisation where two authors individually coded and categorised the emerged themes, and 3) Reporting, were the authors compared, reviewed, and defined the meanings of the themes and sub-themes. RESULTS Five main themes Opportunity, Competency, Work environment, Role perception and Significance emerged, shaped as descriptive, normative, and prospective statements. In opportunities the respondents (descriptively) depicted the importance of their position and challenges faced, including lack of adequate clinical information in referrals. Competencies concerned whether they have the required knowledge and skills for the task. In work environment the respondents viewed themselves as partners and collaborators with radiologists and referrers but expressed that unclear regulations could challenge their task. In role perception, the respondents expressed (normatively) that assessing referrals is vital for professional self-esteem and radiographers' responsibility. Significance covers the importance of assessing referrals for different aspects relating to quality of services. CONCLUSION Radiographers expressed high engagement towards tasks of assessing referrals. To support radiographers in this role, it is crucial to establish clear regulations, better organisation of departmental processes and provide adequate training. IMPLICATIONS FOR PRACTICE Radiology departments should actively explore strategies of incorporating the radiographers' resources and core position in the process of assessing referrals, in a consistent and effective manner.
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Affiliation(s)
- C C Chilanga
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Pb 235, 3603 Kongsberg, Norway.
| | - K B Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Pb 235, 3603 Kongsberg, Norway
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Pearce B, Nguyên VNB, Cowling C, Pinson JA, Sim J. Australian radiographer roles in the emergency department; evidence of regulatory compliance to improve patient safety - A narrative review. Radiography (Lond) 2024; 30:319-331. [PMID: 38128248 DOI: 10.1016/j.radi.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Using a narrative approach, this paper aims to determine the extent of Australian radiographers' regulatory compliance to improve patient safety when performing appendicular X-ray and non-contrast brain computed tomography (CT) in the Emergency Department (ED). KEY FINDINGS A narrative review explored relevant literature and key regulatory policy. Ten documents were identified, three main themes were developed related to the radiographer roles in X-ray request justification, dose optimisation and preliminary image evaluation (PIE). Radiographers were equally aware of justification and optimisation pre and post the introduction of a Medical Code of Practice. The collective PIE accuracy of radiographers remained unaffected by changes in mode of PIE delivery and regulatory factors but varied based on the anatomical region. CONCLUSION While current Australian regulations mandate radiographer request justification, dose optimisation and PIE, the degree of compliance by Australian radiographers remains uncertain. Current literature provides evidence that radiographers can improve patient care and safety through justification, optimisation, and PIE delivery. Change in workplace practice, supported by key stakeholders including radiologists, is essential to integrate radiographers' functions into routine ED clinical practice. Further research is required to audit radiographers' regulatory compliance to improve patient safety. IMPLICATIONS FOR PRACTICE Patient safety in ED can be improved with timely and accurate diagnosis provided by radiographers. Radiographers have a professional obligation to adhere to the capabilities and standards for safe medical radiation practice defined by Australian regulations. Therefore, radiographers must justify the X-ray request, optimise the radiation dose where appropriate and communicate urgent or unexpected findings to the referrer.
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Affiliation(s)
- B Pearce
- Peninsula Health: Frankston Hospital, Frankston, Victoria, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia.
| | - Van N B Nguyên
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - C Cowling
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - J-A Pinson
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - J Sim
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
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Ståhlbrandt H, Björnfot I, Cederlund T, Almén A. CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples. Insights Imaging 2023; 14:134. [PMID: 37530862 PMCID: PMC10397157 DOI: 10.1186/s13244-023-01483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES The numbers of computed tomography (CT) and magnetic resonance imaging (MRI) examinations per capita continue to increase in Sweden and in other parts of Europe. The appropriateness of CT and MRI examinations was audited using established European appropriateness criteria. Alternative modalities were also explored. The results were compared with those of a previous study performed in Sweden. METHODS A semi-automatic retrospective evaluation of referrals from examinations performed in four healthcare regions using the European appropriateness criteria in ESR iGuide was undertaken. The clinical indications from a total of 13,075 referrals were assessed against these criteria. The ESR iGuide was used to identify alternative modalities resulting in a higher degree of appropriateness. A qualitative comparison with re-evaluated results from the previous study was made. RESULTS The appropriateness was higher for MRI examinations than for CT examinations with procedures classed as usually appropriate for 76% and 63% of the examinations, respectively. The degree of appropriateness for CT was higher for referrals from hospitals compared to those from primary care centres. The opposite was found for MRI examinations. The alternative modalities that would result in higher appropriateness included all main imaging modalities. The result for CT did not show improvement compared with the former study. CONCLUSIONS A high proportion of both CT and MRI examinations were inappropriate. The study indicates that 37% of CT examinations and 24% of MRI examinations were inappropriate and that the appropriateness for CT has not improved in the last 15 years. CRITICAL RELEVANCE STATEMENT A high proportion of CT and MRI examinations in this retrospective study using evidence-based referral guidelines were inappropriate. KEY POINTS ∙ A high proportion of CT and MRI examinations were inappropriate. ∙ The CT referrals from general practitioners were less appropriate that those from hospital specialists. ∙ The MRI referrals from hospital specialists were less appropriate that those from general practitioners. ∙ Adherence to radiological appropriateness guidelines may improve the appropriateness of conducted examinations.
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Affiliation(s)
| | - Ida Björnfot
- Department of Radiology, Länssjukhuset Ryhov, 551 85, Jönköping, Sweden
| | - Torsten Cederlund
- Department for Authorisation of Radiation Applications, Swedish Radiation Safety Authority, 171 16, Stockholm, Sweden
| | - Anja Almén
- Department for Radiation Protection and Environmental Assessment, Swedish Radiation Safety Authority, 171 16, Stockholm, Sweden.
- Medical Radiation Physics, Department of Translational Medicine, Malmö, Lund University, 205 02, Malmö, Sweden.
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Clarke JA, Akudjedu TN, Salifu Y. Vetting of medical imaging referrals: A scoping review of the radiographers' role. Radiography (Lond) 2023; 29:767-776. [PMID: 37244140 DOI: 10.1016/j.radi.2023.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Vetting and treatment verification, are now an expectation of threshold radiography competencies at qualification. Radiographer-led vetting contributes to the expedition of patients' treatment and management. However, the current state and the role of the radiographer in vetting medical imaging referrals remains unclear. This review aims to explore the current state and associated challenges to a radiographer-led vetting and offer directions for future research by addressing knowledge gaps. METHOD The Arksey and O'Malley methodological framework was employed for this review. This includes a comprehensive search using key terms relating to radiographer-led vetting across relevant databases: Medline, PubMed, AMED and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles were screened for eligibility and information extracted and analysed descriptively to map the available evidence. RESULTS 1149 studies were identified with 12 articles included for this review after duplicates were removed. The findings indicate existence of some radiographer-led vetting activities in practice; however, the scope of this practice is associated with a large variance across settings. Key challenges relating to radiographer-led vetting include referral selectivity, medical professional dominance, and lack of clinical indication on referrals. CONCLUSION Radiographers vet various categories of referrals depending on jurisdictional policies and more clarity in regulation, advanced practice training and change in workplace culture is needed to support radiographer-led vetting. IMPLICATION FOR PRACTICE Radiographer-led vetting should be championed across settings through formalised training to widen the scope of advance practice and career progression pathways for radiographers as a means of ensuring optimal use of resources.
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Affiliation(s)
- J A Clarke
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK; Ashford and St. Peter's Hospital Radiology Department, Guilford Road, Chertsey, Surrey, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Science, Bournemouth University, Bournemouth, UK
| | - Y Salifu
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK.
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Sitareni M, Karera A, Amkongo M, Daniels E. Justification of radiological procedures: Radiographers' experiences at two public hospitals. J Med Imaging Radiat Sci 2023; 54:312-318. [PMID: 36964063 DOI: 10.1016/j.jmir.2023.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Justification is a process conducted by the radiographer in consultation with the radiologist to evaluate radiological procedures ordered by doctors. The main purpose for justifying all radiologic procedures is to assess the benefits and risks of a requested radiographic procedure and determine whether exposure will continue. Furthermore, justification helps to prevent unnecessary radiation exposure and reduce the chances of harmful effects of ionizing radiation. OBJECTIVES The study aimed to explore the experiences of radiographers regarding the justification of radiological procedures at two public hospitals in Namibia METHODS: This study made use of a qualitative, exploratory design. A total number of 13 purposefully selected radiographers from radiology departments in two tertiary public - hospitals in Namibia were interviewed using a semi-structured interview guide and audio recorder. All interviews were conducted face-to-face until data saturation was achieved. Data were analysed using Atlas.ti Windows (version 9.0 using Tesch's 8-step method of qualitative data analysis to generate themes and subthemes. FINDINGS The participants experienced an enhancement of patient care through enhanced radiation protection and optimised patient care. They also experienced defunct communication systems through deficient communication between radiographers and referrers, professional role conflict and incomplete referrals. CONCLUSION The study revealed that the justification of radiological procedures was linked to both negative and positive experiences. Enhanced patient-centred care was a positive experience related to the radiographers' job responsibilities. The defunct communication support system was a negative experience as it related to the limited availability and utilisation of communication systems that are meant to enhance and support justification by radiographers. The study recommends an in-depth study to quantify unjustified procedures in these two hospital departments. Continuous professional development focusing on justification and referral protocols must be conducted jointly between radiographers and referrers to create awareness and a platform for shared decision-making models.
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Affiliation(s)
- Martha Sitareni
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, Windhoek, Namibia
| | - Abel Karera
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, Windhoek, Namibia.
| | - Mondjila Amkongo
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, Windhoek, Namibia.
| | - Edwin Daniels
- University of Namibia, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, Department of Radiography, Windhoek, Namibia.
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Bushra A, Sulieman A, Edam A, Tamam N, Babikir E, Alrihaima N, Alfaki E, Babikir S, Almujally A, Otayni A, Alkhorayef M, Abdelradi A, Bradley DA. Patient's effective dose and performance assessment of computed radiography systems. Appl Radiat Isot 2023; 193:110627. [PMID: 36584412 DOI: 10.1016/j.apradiso.2022.110627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Computed tomography is widely used for planar imaging. Previous studies showed that CR systems involve higher patient radiation doses compared to digital systems. Therefore, assessing the patient's dose and CR system performance is necessary to ensure that patients received minimal dose with the highest possible image quality. The study was performed at three medical diagnostic centers in Sudan: Medical Corps Hospital (MCH), Advance Diagnostic Center (ADC), and Advance Medical Center (AMC). The following tools were used in this study: Tape measure, Adhesive tape, 1.5 mm copper filtration (>10 × 10 cm), TO 20 threshold contrast test object, Resolution test object (e.g., Huttner 18), MI geometry test object or lead ruler, Contact mish, Piranha (semiconductor detector), Small lead or copper block (∼5 × 5 cm), and Steel ruler, to do a different type of tests (Dark Noise, Erasure cycle efficiency, Sensitivity Index calibration, Sensitivity Index consistency, Uniformity, Scaling errors, Blurring, Limiting spatial Resolution, Threshold, and Laser beam Function. Entrance surface air kerma (ESAK (mGy) was calculated from patient exposure parameters using DosCal software for three imaging modalities. A total of 199 patients were examined (112 chest X rays, 77 lumbar spine). The mean and standard deviation (sd) for patients ESAK (mGy) were 2.56 ± 0.1 mGy and 1.6 mGy for the Anteroposterior (AP) and lateral projections for the lumbar spine, respectively. The mean and sd for the patient's chest doses were 0.1 ± 0.01 for the chest X-ray procedures. The three medical diagnostic centers' CR system performance was evaluated and found that all of the three centers have good CR system functions. All the centers satisfy all the criteria of acceptable visual tests. CR's image quality and sensitivity were evaluated, and the CR image is good because it has good contrast and resolution. All the CR system available in the medical centers and upgraded from old X-ray systems to new systems, has been found to work well. The patient's doses were comparable for the chest X-ray procedures, while patients' doses from the lumbar spine showed variation up to 2 folds due to the variation in patients' weight and X-ray machine setting. Patients dose optimization is recommended to ensure the patients received a minimal dose while obtaining the diagnostic findings.
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Affiliation(s)
- A Bushra
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - A Sulieman
- Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O.Box 422, Alkharj 11942, Saudi Arabia.
| | - A Edam
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - N Tamam
- Physics Department, College of Science, Princess Nourah bint Abdulrahman University, P.O Box 84428, Riyadh, 11671, Saudi Arabia
| | - E Babikir
- Radiologic Technology Program, Allied Health Department, College of Health and Sport Sciences, University of Bahrain, Bahrain
| | - N Alrihaima
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - E Alfaki
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - S Babikir
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - A Almujally
- Department of Biomedical Physics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Otayni
- Radiology Department, King Khaled Hospital and Prince Sultan Center for Health Care, Ministry of Health, Alkharj, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O Box 10219, Riyadh, 11433, Saudi Arabia
| | - A Abdelradi
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - D A Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK; Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
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Chilanga CC, Lysdahl KB. Ethical impact of suboptimal referrals on delivery of care in radiology department. JOURNAL OF MEDICAL ETHICS 2022; 48:1020-1025. [PMID: 34429384 DOI: 10.1136/medethics-2021-107335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles of non-maleficence, beneficence, Autonomy and Justice as an analytic framework.Suboptimal referrals can cause harm by hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patient benefits from the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patient autonomy is compromised from the lack of information needed to facilitate benefit-risk communication. Finally, suboptimal referrals challenge justice based on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct.
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Affiliation(s)
- Catherine Chilute Chilanga
- Health and Social Sciences- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Kristin Bakke Lysdahl
- Health and Social Sciences- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
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Zhang X, Zheng Y, Bai X, Cai L, Wang L, Wu S, Ke Q, Huang J. Femoral image segmentation based on two-stage convolutional network using 3D-DMFNet and 3D-ResUnet. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107110. [PMID: 36167001 DOI: 10.1016/j.cmpb.2022.107110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/05/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The femur is a typical human long bone with an irregular spatial structure. Femoral fractures are the most common occurrence in middle-aged and older adults. The structure of human bone tissue is very complex, and there are significant differences between individuals. Segmenting bone tissue is a challenging task and of great practical significance. METHODS Our research is based on segmenting and the three-dimensional reconstruction of femoral images using X-ray imaging. The currently commonly used two-dimensional fully convolutional network Unet has the problem of ignoring spatial position information and losing too much feature information. The commonly used three-dimensional fully convolutional network 3D Unet has the problem of ignoring spatial position information and losing too much feature information. For the problem of many model parameters, we proposes a two-stage network segmentation model composed of 3D-DMFNet and 3D-ResUnet networks and trains the network in stages to segment the femur. One stage is used to detect the coarse segmentation of the femur range, and one stage is used for the fine segmentation of the femur so that the training speed is fast and the segmentation accuracy is moderate, which is suitable for detecting the femur range. RESULTS The experimental dataset used in this paper is from The Second Affiliated Hospital of Fujian Medical University, which consists of 30 sets of femur X-ray images. The experiment compares the accuracy and loss value of Unet and the two-stage convolutional network. The image shows that the two-stage convolutional network has higher accuracy. At the same time, this paper shows the effect of the two-stage coarse segmentation and fine segmentation of medical images. Subsequently, this paper applies the model to practice and obtains the model's Dice, Sensitivity, Specificity and Pixel Accuracy values. After comparative analysis, the experimental results show that the two-stage network segmentation model composed of 3D-DMFNet and 3D-ResUnet network designed in this paper has higher accuracy, intuitiveness, and more application value than traditional image segmentation algorithms. CONCLUSION With the continuous application of X-ray images in clinical diagnosis using femoral images, the method in this paper is expected to become a diagnostic tool that can effectively improve the accuracy and loss of femoral image segmentation and the three-dimensional reconstruction.
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Affiliation(s)
- Xiaolu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China.
| | - Yiqiang Zheng
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Xiaoming Bai
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Liquan Cai
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Liangming Wang
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Shiqiang Wu
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Qingfeng Ke
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, China
| | - Jianlong Huang
- Faculty of Mathematics and Computer Science, Quanzhou Normal University, Quanzhou, Fujian 362000, China; Fujian Provincial Key Laboratory of Data Intensive Computing, Quanzhou 362000, China; Key Laboratory of Intelligent Computing and Information Processing, Fujian Province University, Quanzhou 362000, China.
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Chilanga CC, Olerud HM, Lysdahl KB. The value of referral information and assessment - a cross sectional study of radiographers' perceptions. BMC Health Serv Res 2022; 22:893. [PMID: 35810310 PMCID: PMC9271238 DOI: 10.1186/s12913-022-08291-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Radiology professionals are frequently confronted with referrals containing insufficient clinical information, which hinders delivery of safe and quality medical imaging services. There is however lack of knowledge on why and how referral information is important for radiographers in clinical practice. This study explores what purposes referral information is used/ useful for the radiographers, and the benefits of involving them in assessing referrals. Methods A cross sectional study was conducted of radiographers recruited through the International Society of Radiographers and Radiological Technologists (ISRRT) networks. A questionnaire was developed and distributed consisting of 5-point Likert scale questions on a) use/usefulness of referral information for 12 listed purposes and b) the benefits of radiographers assessing referrals for 8 possible reasons. The questionnaire was validated using a test–retest reliability analysis. Kappa values ≥0.6 were accepted. SPSS software was used for data analysis and chi-square tests to determine associations between using referral information and background variables. Results Total respondents were 279 (n = 233 currently in clinical practice and n = 46 in other positions). The participants in clinical practice ranked high all 12 listed purposes for use of referral information, and all except one received ≥60% ‘frequent’/‘very frequent’ responses. Use for patient identification purposes received the highest score (97% ‘frequently’/‘very frequently’ responses), followed by ensuring imaging of the correct body region (79% ‘very frequently’ responses). Radiographers not currently working in clinical practice ranked the ‘usefulness’ of listed items similarly. Significant associations between frequent use of referral information and education level were not observed, and only three items were significantly associated with modality of practice. All items on benefits of radiographers assessing referrals received ≥75% ‘agree’/‘strongly agree’ scores. The items ranked highest were promotes radiographers’ professional responsibility and improves collaboration with radiologists and referring clinicians, with 72 and 67% strongly agreed responses, respectively. Conclusion Radiographers use referral information frequently for several purposes. The referral information is needed for justifying and optimising radiological procedures, hence crucial for ensuring patient safety and high-quality services. This further emphasis why radiographers perceive several benefits of being involved in assessing the referral information.
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Affiliation(s)
- Catherine Chilute Chilanga
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway USN, Pb 235, 3603, Kongsberg, Norway.
| | - Hilde Merete Olerud
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway USN, Pb 235, 3603, Kongsberg, Norway
| | - Kristin Bakke Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway USN, Pb 235, 3603, Kongsberg, Norway
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Vassileva J, Zewde NT, Reim M, Holmberg O, Rehani MM. Communication of radiation risk from imaging studies: an IAEA-coordinated international survey. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021524. [PMID: 35320786 DOI: 10.1088/1361-6498/ac6047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this IAEA-coordinated international study was to understand aspects related to the communication of radiation risk from imaging studies, such as how often imaging department personnel and referring physicians are asked about radiation risks in diagnostic imaging, who asks about these risks, how often professionals are able to provide satisfactory answers using qualitative metrics and how often quantitative risk estimates are needed. A web-based questionnaire with ten questions was completed by 386 healthcare professionals from 63 countries from all four continents, including clinicians/referring physicians (42.5%), radiologists or nuclear medicine physicians (26.7%), medical physicists (23.1%), radiographers/radiological technologists (6.2%) and others (1.6%). The results indicate that radiation risk-related questions are largely asked by patients (73.1%) and parents of child patients (38.6%), and 78% of the professionals believe they are able to answer those questions using qualitative metrics such as very small/minimal, small, medium rather than number of cancers likely occurring. The vast majority, with over three times higher frequency, indicated the purpose of knowing previous radiological exams as 'both clinical information and radiation exposure history' rather than 'only clinical information'. Nearly two-thirds of the clinicians/referring physicians indicated that knowing the radiation exposure history of the patient will affect their decision-making for the next exam, as against only about one-fifth who said 'no, it will not affect their decision-making'. The same question, when addressed to radiologists, resulted in a slightly larger fraction of about three-quarters who said 'yes', as opposed to a smaller fraction of about 12% who said 'no, it will not affect their decision-making'. Mapping the present situation of communication of benefits and risks for patients is important and may be the basis of further analysis, regular monitoring and possibly a target for clinical audits. Further studies focused on specific professional groups might help in obtaining á deeper understanding of the need for practical communication tools.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Madan M Rehani
- Massachusetts General Hospital, Boston, MA, United States of America
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Lynham R, Boxall S, Warren J, Lynham A. Paediatric trauma imaging in a regional Queensland hospital: Do we need clearer guidance? Emerg Med Australas 2022; 34:704-710. [PMID: 35243766 DOI: 10.1111/1742-6723.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Paediatric trauma is a major cause of morbidity and mortality in those aged 0-14. Anatomical and physiological differences require a specialised approach to paediatric trauma care. Medical imaging, particularly computed tomography (CT) scans, requires specific consideration because of the consequences of radiation exposure in the paediatric population. The present study compares current practice of CT scan ordering in paediatric trauma patients at a regional Australian hospital against consensus guidelines published in the UK. METHODS A retrospective audit of paediatric trauma CT scans referred from the ED from May 2017 to May 2018 was completed. Details relating to CT scan ordering were reviewed and compliance with the Royal College of Radiologists Paediatric trauma protocols, was determined. Descriptive statistics and χ2 tests comparing those that met and did not meet guidelines were performed. RESULTS A total of 71 CT scans were included with an overall compliance rate of 56.3%. Specific regional compliance was lowest with CT neck at 14%. Patients where a trauma call was initiated were more likely to receive a full body (pan) scan rather than region specific imaging. Compliance improved when paediatric team involvement was documented. CONCLUSIONS Evidence-based guidelines for CT imaging in paediatric trauma are essential to reduce unnecessary radiation exposure for children. The present study has demonstrated that current practice has the potential to be improved and that decisions should involve a multidisciplinary team.
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Affiliation(s)
- Rohan Lynham
- Anaesthesia Department, Whangarei Hospital, Whangarei, New Zealand
| | - Sarah Boxall
- Emergency Department, Mackay Hospital and Health Service, Mackay, Queensland, Australia
| | - Jacelle Warren
- Jamieson Trauma Institute, Metro North Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Lynham
- Jamieson Trauma Institute, Metro North Health, The University of Queensland, Brisbane, Queensland, Australia
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Chilanga CC, Olerud HM, Lysdahl KB. Radiographers' actions and challenges when confronted with inappropriate radiology referrals. Eur Radiol 2022; 32:4210-4217. [PMID: 34989841 PMCID: PMC8732969 DOI: 10.1007/s00330-021-08470-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore radiographers' actions toward inappropriate referrals and hindrances to assessing referrals. METHODS An online survey was distributed to radiographers via the International Society of Radiographers and Radiological Technologists (ISRRT) networks. The questionnaire consisted of 5-point Likert scale questions on radiographers' actions to supplement referral information, actions for unjustified referrals and hindrances to referral assessment. The questionnaire was validated using a test-retest reliability analysis. Kappa values ≥ 0.6 were accepted. SPSS software was used for data analysis and chi-square tests to compare subgroups. RESULTS Total responses received were 279. The most reported actions to supplement missing referral information were to ask the patient or relative, examine the body region of concern and check medical records (73%, 70%, 67%, responded often/always, respectively). The actions when confronted with unjustified referrals were reported equally to consult the radiologist, referring clinician and radiographer (69-68% often/always responses). The hindering factors ranked high (agreed/strongly agreed responses) pertained to inadequate information in referral forms (83%), ineffective communication among healthcare professionals (79%), lack of training (70%) and allocated time (61%). Statistically significant associations were observed for a few actions and hindrances with education level, modality of practice and responsibility to screen imaging referrals. CONCLUSION Radiographers consult colleagues about suspected unjustified referrals. Effective communication pathways, training and time allocation to improve radiographers' skills to assess referrals may enhance appropriate imaging and delivery of quality patient care. KEY POINTS • Radiographers' actions of supplementing missing information in radiology referrals facilitate provision of high-quality health services. • Radiographers' strategy when confronted with inappropriate referrals is to consult radiologists and referring clinicians. • Better inter-professional communication and organisation of tasks can facilitate radiographers' participation in referral assessment to ensure appropriate imaging.
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Affiliation(s)
- Catherine Chilute Chilanga
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Pb 235, 3603, Kongsberg, Norway.
| | - Hilde Merete Olerud
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Pb 235, 3603, Kongsberg, Norway
| | - Kristin Bakke Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Pb 235, 3603, Kongsberg, Norway
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Hanna J, Malhotra A, Brauer PR, Luryi A, Michaelides E. A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness. Am J Otolaryngol 2019; 40:102263. [PMID: 31358317 DOI: 10.1016/j.amjoto.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare imaging utilization between patients presenting to the emergency department (ED) with vertigo and dizziness (VDS) who are diagnosed with stroke and benign paroxysmal positional vertigo (BPPV). METHODS All patients presenting to the ED with VDS (January 2014-June 2018) were identified. Those with a discharge diagnosis of stroke and BPPV were analyzed. RESULTS 17,884 patients presented to with VDS. 452 were diagnosed with BPPV and 174 with acute stroke. 55.7% of stroke patients had at least one neurologic symptom beyond VDS, 63.8% had a positive neurologic exam, and 80.5% had either; 90.2% had at least one stroke risk factor (RF). 42.0% of BPPV patients received imaging, of which 24.7% had neurologic symptoms beyond VDS, 16.3% had neurologic exam findings, and 34.2% had either (P < 0.001, as compared to stroke). 43 patients (22.6%) lacked neurologic symptoms, exam findings, and stroke RFs; 40 had an adequate HINTS (head impulse, nystagmus, skew) exam. The most common imaging modality received by BPPV patients was plain CT Head (54.2%), followed by CT/CTA (43.7%), and MRI brain (26.3%). CT head was the initial imaging of choice in 44.7% and CT/CTA in 42.6%. CONCLUSIONS Imaging utilization in BPPV patients presenting with VDS is high. The profile of patients with BPPV that received imaging was substantially more benign than that of stroke patients (a quarter had no neurologic symptoms, exam findings, or stroke RFs). The HINTS exam was underutilized, and computed tomography was heavily utilized despite well-established limitations in diagnosing posterior circulation strokes. This study highlights the need for increased training in the HINTS exam, narrowing of the scope for computed tomography, and a higher threshold for imaging patients with isolated VDS.
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Affiliation(s)
- Jonathan Hanna
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Yale-New Haven Hospital, Yale Cancer Center, New Haven, CT, United States of America
| | - Philip R Brauer
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Alexander Luryi
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, Yale-New Haven Hospital, Yale Cancer Center, New Haven, CT, United States of America
| | - Elias Michaelides
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, Yale-New Haven Hospital, Yale Cancer Center, New Haven, CT, United States of America.
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Sá Dos Reis C, Bennett C, Sun Z. Education and training as a strategy to improve justification of medical imaging referrals in emergency departments. J Med Radiat Sci 2018; 65:173-174. [PMID: 30175452 PMCID: PMC6119734 DOI: 10.1002/jmrs.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Diagnostic imaging pathways are developed to ensure that medical imaging examinations are appropriately selected and referred by clinicians with the aim of justifying the use of imaging modalities for clinical diagnosis. Failing to comply with the imaging pathways or guidelines results in exposing patients to unnecessary ionising radiation due to malpractice of imaging referrals. This editorial provides a comment on a recent study reporting very high percentage of general x-ray imaging referrals which did not or partially met the imaging pathways in an emergency department.
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Affiliation(s)
- Cláudia Sá Dos Reis
- Discipline of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Colleen Bennett
- Discipline of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, Curtin University, Perth, Australia
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