Retrospective evaluation of exposure indicators: a pilot study of exposure technique in digital radiography

Radiation Protection among South African Diagnostic Radiographers-A Mixed Method Study

ABSTRACT

Worldwide, radiographers' radiation protection practices vary. In South Africa, evidence of diagnostic radiographers' suboptimal radiation protection practices has been reported, but the reasons for these practices and suggestions to improve practices were lacking. Therefore, this study explored radiation protection among South African diagnostic radiographers. This study used an explanatory, sequential, mixed-method approach. Data were collected in three phases. Phase I, the quantitative phase, used an online questionnaire and respondents from Phase I interested in participating in Phase II, the qualitative phase, were interviewed, yielding 13 in-depth semi-structured telephone interviews. In Phase III, eight radiography managers co-constructed change strategies to optimize radiation protection in South Africa in two focus group interviews. Radiation protection was suboptimal despite diagnostic radiographers having a good attitude, subjective norm and perceived behavioral control toward radiation protection and optimal radiation protection knowledge. Varying attitudes to radiation protection, lack of resources, and support from radiography management and healthcare teams contributed to suboptimal radiation protection practices. Radiography managers suggested increasing radiation protection awareness, ameliorating the diminished stature of the radiographer in the healthcare team, and increasing the availability of optimal quality resources. South African diagnostic radiographers' radiation protection knowledge was optimal, but the implementation of radiation protection varied and was influenced by multiple factors. A radiation protection culture supported by management is advocated to optimize radiation protection. However, ultimately radiation protection practices are incumbent on the individual radiographers' choice to practice radiation protection.

South African radiographers' radiation protection practices, a qualitative study

INTRODUCTION

Radiation protection is multifarious, and consequently, a radiographers' application of radiation protection is multifaceted. Studies have shown varying radiation protection practices among radiographers. The first quantitative phase of this explanatory, sequential mixed-method study used the theory of planned behaviour to explore South African radiographers' radiation protection behaviour. Overall, South African radiographers' attitudes to radiation protection, subjective norm, perceived behavioural control, and radiation protection intention was high. This second phase of the study aimed to explore the reasons for South African radiographers' radiation protection practices.

METHODS

This study used an exploratory and descriptive qualitative approach. Data was collected through 13 in-depth semi-structured telephone interviews. Thematic analysis was used in order to uncover original phenomena. Data saturation was achieved and the study adhered to trustworthiness and ethical measures.

RESULTS

Thematic analysis identified two themes. The participants had the appropriate radiation protection knowledge, but radiation protection compliance remained a personal choice. Impediments such as feeling rushed during imaging of trauma and challenging patients, patients knowledge of radiation protection, resources, imaging referrals, inadequate training when transitioning from analogue to digital radiography and managerial support contributed to radiation protection compliance. Strategies such as further education, research and a change in mindset were suggested to further foster radiation protection compliance.

CONCLUSION

Even though participants' knowledge of radiation protection aligned with the legislated guidelines, limited internalising of the knowledge resulted in compliance being a personal choice. Participants reflected on their insouciant attitude and observed a similar attitude in their radiographer colleagues. Patient and work-related impediments were identified to contribute to radiation protection compliance. Strategies to further foster compliance were suggested.

IMPLICATIONS FOR PRACTICE

Understanding the reasons for radiographers' choice in radiation protection will allow the development of strategies that foster optimum application of radiation protection practises. Developing a radiation protection culture that enhances personal compliance supported by education and evidence should be considered.

Using the theory of planned behaviour to determine radiation protection among South African diagnostic radiographers: a cross-sectional survey

Introduction

The use of ionising radiation in medicine accounts for the majority of radiation exposure from artificial sources. Therefore, all measures to safeguard against unnecessary radiation exposure must be taken. As radiographers are central to radiation protection, this study aimed to determine South African radiographers’ attitude towards radiation protection, subjective norm and perceived behavioural control concerning radiation protection.

Methods

This quantitative cross‐sectional study used an online theory of a planned behaviour radiation protection questionnaire shared through social media platforms from August 2019 to February 2020. Diagnostic radiographers registered with the Health Professions Council of South Africa and employed at radiology departments in South Africa were invited to participate in the study.

Results

Four hundred and seventeen radiographers in South Africa responded to the questionnaire. The majority of respondents (90%, n = 376) plan to use radiation protection; however, only 16% continuously used radiation protection in the past. Respondents felt that using radiation protection was extremely good (72.2%), pleasant (47%), beneficial (74.1%), rewarding (55.2%) and worth the time (52.5%); 57% of respondents indicated that using radiation protection takes longer to complete the examination. Respondents report that approval from patients (43.5%), patients’ family (32%), radiographer coworkers (31%), radiology managers (47%) and radiologists (43.9%) is very much important to them.

Conclusion

The study shows that even though fewer respondents use radiation protection at present, most respondents plan and intend to use radiation protection measures. Respondents felt that radiation protection was good and beneficial, with some respondents feeling that radiation protection is not worth the time, which coincide with lengthening the examination. Overall, South African radiographers’ attitudes towards radiation protection, subjective norm, perceived behavioural control and radiation protection intention were high.

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.

Optimising default radiographic exposure factors using Deviation Index

INTRODUCTION

Radiographers have a duty to ensure that radiation doses to patients are as low as reasonably achievable. With digital technologies, exposure factors which achieve the optimum balance between image noise and patient dose must be sought. In digital radiography, Deviation Index (DI) values provide the radiographer with feedback on the appropriateness of individual exposures but can also be tracked as part of a departmental quality assurance programme.

METHODS

In November 2017, exposure logs were extracted from six digital radiography (DR) x-ray systems, collated and analysed. Five examinations were identified which frequently produced DI values outside the manufacturer's recommended Optimal Range (-3 to +2). Incremental improvements were made to the default exposure settings for these examinations via a cyclical process of modification and re-evaluation. A full data collection exercise was then repeated in April 2019.

RESULTS

At baseline, 10,658 out of 29,637 (36.0%) exposures had DI values outside the manufacturer's recommended Optimal Range, but for some individual examinations the proportion was as high as 547 out of 725 (74.5%). Following multiple optimisation cycles, the overall proportion of examinations outside the Optimal Range had fallen to 7611 out of 26,759 (28.4%). Default milliampere-seconds (mAs) values for these examinations were reduced by between 22% and 50%.

CONCLUSION

A marked reduction in patient doses can be achieved through a departmental programme of DI value monitoring and targeted optimisation of default exposure settings.

IMPLICATIONS FOR PRACTICE

DI values should be routinely monitored as part of routine quality assurance programmes. Radiographers have a responsibility to ensure that they possess a clear understanding of DI values and that appropriate exposure settings are selected for each individual patient.