Action research in radiography: What it is and how it can be conducted

Research designs of publications in radiography professional journals - A modified bibliometric analysis

INTRODUCTION

Evidence based practice relies on availability of research evidence mostly through peer-reviewed journal publications. No consensus currently exists on the best hierarchy of research evidence, often categorised by the adopted research designs. Analysing the prevalent research designs in radiography professional journals is one vital step in considering an evidence hierarchy specific to the radiography profession and this forms the aim of this study.

METHODS

Bibliometric data of publications in three Radiography professional journals within a 10-year period were extracted. The Digital Object Identifier were used to locate papers on publishers' websites and obtain relevant data for analysis. Descriptive analysis using frequencies and percentages were used to represent data while Chi-square was used to analyse relationship between categorical variables.

RESULTS

1830 articles met the pre-set inclusion criteria. Quantitative descriptive studies were the most published design (26.6%) followed by non-RCT experimental studies (18.7%), while Randomised Controlled Trials (RCT) were the least published (1.0%). Systematic reviews (42.9%) showed the highest average percentage increase within the 10-year period, however RCTs showed no net increase. Single-centre studies predominated among experimental studies (RCT = 88.9%; Non-RCT = 95%). Author collaboration across all study designs was notable, with RCTs showing the most (100%). Quantitative and qualitative studies comparatively had similar number of citations when publication numbers were matched. Quantitative descriptive studies had the highest cumulative citations while RCTs had the least.

CONCLUSION

There is a case to advocate for more study designs towards the peak of evidence hierarchies such as systematic reviews and RCT. Radiography research should be primarily designed to answer pertinent questions and improve the validity of the profession's evidence base.

IMPLICATION FOR PRACTICE

The evidence presented can encourage the adoption of the research designs that enhances radiography profession's evidence base.

Artificial intelligence education for radiographers, an evaluation of a UK postgraduate educational intervention using participatory action research: a pilot study

BACKGROUND

Artificial intelligence (AI)-enabled applications are increasingly being used in providing healthcare services, such as medical imaging support. Sufficient and appropriate education for medical imaging professionals is required for successful AI adoption. Although, currently, there are AI training programmes for radiologists, formal AI education for radiographers is lacking. Therefore, this study aimed to evaluate and discuss a postgraduate-level module on AI developed in the UK for radiographers.

METHODOLOGY

A participatory action research methodology was applied, with participants recruited from the first cohort of students enrolled in this module and faculty members. Data were collected using online, semi-structured, individual interviews and focus group discussions. Textual data were processed using data-driven thematic analysis.

RESULTS

Seven students and six faculty members participated in this evaluation. Results can be summarised in the following four themes: a. participants' professional and educational backgrounds influenced their experiences, b. participants found the learning experience meaningful concerning module design, organisation, and pedagogical approaches, c. some module design and delivery aspects were identified as barriers to learning, and d. participants suggested how the ideal AI course could look like based on their experiences.

CONCLUSIONS

The findings of our work show that an AI module can assist educators/academics in developing similar AI education provisions for radiographers and other medical imaging and radiation sciences professionals. A blended learning delivery format, combined with customisable and contextualised content, using an interprofessional faculty approach is recommended for future similar courses.

Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review

Background

Pressure on emergency departments (EDs) from increased attendance for minor injuries has been recognised in the United Kingdom. Radiographer-led discharge (RLD) has potential for improving efficiency, through radiographers trained to discharge patients or refer them for treatment at the point of image assessment. This review aims to scope all RLD literature and identify research assessing the merits of RLD and requirements to enable implementation.

Methods

We conducted a scoping review of studies relating to RLD of emergency care patients requiring projection radiography of minor musculoskeletal (MSK) injuries. MEDLINE, Embase and CINAHL, relevant radiography journals and grey literature were searched. Articles were reviewed and the full texts of selected studies were screened against eligibility criteria. The data were extracted, collated and a narrative synthesis completed.

Results

Seven studies with varying study designs were included in the review. The small number of studies was possibly due to a generally low research uptake in radiography. The main outcome for four studies was reduced length of stay in ED, with recall and re-attendance to ED a primary outcome in one study and secondary outcome for two other studies. The potential for increased efficiency in the minor MSK pathway patient pathway and capacity for ED staff was recognised. Radiographers identified a concern regarding the risk of litigation and incentive of increased salary when considering RLD. The studies were broadly radiographer focussed, despite RLD spanning ED and Radiology.

Conclusion

There were a low number of RLD active radiographers, likely to be motivated individuals. However, RLD has potential for generalisability with protocol variations evident, all producing similar positive outcomes. Understanding radiography and ED culture could clarify facilitators for RLD to be utilised more sustainably into the future. Cost effectiveness studies, action research within ED, and cluster randomised controlled trial with process evaluation are needed to fully understand the potential for RLD.

The cost effectiveness of RLD may provide financial support for training radiographers and increasing their salary, with potential future benefit of reduction in workload within ED. RLD implementation would require an inter-professional approach achieved by understanding ED staff and patient perspectives and ensuring these views are central to RLD implementation.

Peer review in MRI: A quality improvement programme and pilot study

INTRODUCTION

The aim of this pilot study was to implement a peer review programme to evaluate MRI images and protocols, with the goal of improving quality and standardising protocols.

METHOD

A plan-do-check-act method of action research was adopted. A checklist was designed and two radiographers scored the images (Optimal, Diagnostic or Suboptimal). A sample of five Lumbar Spine examinations were selected and reviewed on two separate occasions, one month apart. A consultant radiologist also scored the selected examinations.

RESULTS

There was excellent intra-rater reliability for both observers. At first assessment, Cohen's weighted Kappa analysis indicated moderate inter-rater agreement (0.457) rising to substantial agreement (0.606) at second assessment. Variations in sequence parameter settings by the radiographers were noted. Feedback via educational sessions were implemented and enhancement of protocols were made.

CONCLUSIONS

Radiographers manipulate many parameters during MRI examinations, and image quality can be degraded if sequences are not optimised. This may lead to misinterpretation. Initial results suggest peer review can result in improved image quality, better protocols, and improved staff confidence. There are opportunity costs involved in releasing staff from clinical work and time and resources required for image appraisal training, however we suggest this model can be extended to other departments and modalities as a healthcare improvement initiative.

IMPLICATIONS FOR PRACTICE

Initial results suggest peer review processes performed by radiographers can result in improvement to protocols and image quality in MRI. With appropriate training, radiographers can implement and undertake appraisal of image quality in MRI as part of clinical governance. The purpose of feedback must be made clear, and good professional relationships should be forged to allow candid and supportive feedback with a focus on development and education.

An analysis of bibliometric data exploring factors affecting research capacity amongst HCPC registered radiographers in England

INTRODUCTION

Pre-existing studies argue, radiographers are "apathetic" when it comes to research. However, labelling everyone as such seems a gross simplification of a multifaceted issue; especially as current evidence tends to err towards the anecdotal, subjective or is compared to similar professions. Considering this, the SCoR periodically issues a Research Strategy, recognising the necessity to embed/improve research-capacity across all levels of the profession. The aim of this study is to ascertain factors characteristically influencing research-capacity amongst HCPC-registered radiographers in England.

METHODS

A purposeful sample of 5 years' bibliometric data from the journal 'Radiography.' A critical and thematic analysis followed based on current peer reviewed journals and grey literature.

RESULTS

Of 374 eligible articles and 143 research-active authors (published 2 + articles), collaborations prominently featured (74.9%) across 19 international partnerships. HCPC registrants in England were principal investigator(s) in 49.20% of cases and registrants affiliated with the journal/publisher generally published more than non-affiliates. Preferred topic-areas included 'Education & Research' and 'Technical Practice.' Males published more than females (M = 5.13/F = 3.45). Average length of practice equalled 22.93 years. Outputs mostly originated from HEIs (62.07%), but contributions varied (mean = 10.05/std.deviation = ±17.09); modestly correlating high-REF scoring HEIs (r = 0.330); however, regional workforce ratio(s) proved the strongest indicator (r = 0.601).

CONCLUSION

No "one-size-fits all" approach to research-capacity applies; multiple variables affect capacity/activeness. Many seem contingent on extrinsic factors e.g. regional locale, organisational type and culture/support. Personal/professional influences included career status, length of qualification and gender. Future strategies may benefit from refinement; mindful of the dynamics influencing the heterogeneity of the current workforce. Recommendations are that future strategies/studies may benefit from more specific targeting.

Self-Reported Competence and Impact of Research Training among Medical Radiography Graduates from a Developing Country

INTRODUCTION

Research output from radiographers in developing countries is generally low. This could be attributable to a lack of basic research skills. One way of improving this is research training for undergraduate radiography students. The objective of this study was to assess the self-reported competence of graduate radiographers regarding the research skills obtained during their undergraduate training, as well as the impact of this research training to their work.

METHODS

A cross-sectional descriptive survey was sent to 70 radiography graduates who had received research training. Data from the radiography graduates were collected electronically using self-administered questionnaires. The questionnaire responses were tallied, counted, and analysis was carried out using MS Excel.

RESULTS

The response rate of the radiographers was 71.4%. 70% of the radiographers were males, and 30% were females. 70% of the radiographers reported being competent in identifying a research problem, and 80% rated themselves as competent in formulating a research question. 44% reported being competent in appraising relevant literature, and 64% were able to formulate appropriate conclusions and recommendations from their research work. 76% of the radiographers were involved in some research activities in their places of work, and 50% of them expressed willingness to continue engaging in research activities.

CONCLUSIONS

Most of the graduate radiographers who participated in this study reported being competent in research skills attained, with over 50% willing to continue engaging in research activities.

Participatory action research into implementing open access in musculoskeletal X-ray: Management and staff perspectives

INTRODUCTION

Neighbouring Trusts have implemented open access (walk-in) services to shorten waiting times in x-ray. Despite this, staff perceptions of their effectiveness have not yet been studied. This study forms the initial baseline evaluation phase of wider participatory action research investigating the implementation of an open access service for general practitioner musculoskeletal x-ray referrals. Staff perceptions regarding effectiveness of the current service were gathered, including their opinions regarding the effectiveness of open access services.

METHODS

Qualitative data were obtained via three semi-structured interviews with radiology management and two (cross-site) staff focus groups over a 2 month period. Template analysis was used to interpret the data with the aid of NVIVO 11 to facilitate analysis.

RESULTS

Template analysis uncovered several drivers for changing the current service including waiting times, external pressures, patient choice and administrative delays. 'Flexibility' was the key theme to arise during discussion regarding the effectiveness of the current service. Potential for improved access was highlighted as a major benefit to the implementation of open access, however 'workload', 'staffing' and 'communication' were all identified as potential barriers to its implementation.

CONCLUSION

Although several staff members were satisfied with current service several drivers for change were identified that need to be addressed in order to truly deliver a service that fulfils the patients' needs. Results will inform the wider participatory action research that will investigate the barriers to implementing an open access service and identify whether this is indeed a suitable method of addressing the drivers for change.

Doctoral profile of the medical radiation sciences: a baseline for Australia and New Zealand

INTRODUCTION

Research is critical to evidence-based practice, and the rapid developments in technology provide opportunities to innovate and improve practice. Little is known about the research profile of the medical radiation science (MRS) profession in Australia and New Zealand (NZ). This study provides a baseline of their doctoral activity.

METHODS

A cross-sectional survey of MRS professionals in Australia and NZ holding a doctorate or undertaking doctoral studies, was performed using an online tool (Bristol Online Survey® , Bristol, UK). A chain-referral sampling technique was adopted for data collection. An email invitation with a link to the survey was generated and distributed through email and social media. The survey contained questions related to participant demographics, doctoral status, qualification route, funding and employment.

RESULTS

There were 63 responses to the survey comprising 50.8% diagnostic radiographers (DRs; n = 32), 23.8% radiation therapists (RTs; n = 15), with the remaining 25.4% (n = 16) equally split between sonographers and nuclear medicine technologists (NMTs). A total of 40 (63.5%) of respondents had completed their doctoral qualification. In NZ, only DRs held a doctoral award constituting 0.3% of DRs and 0.2% of the total registered MRS population. In Australia, there was a greater proportion of doctoral NMTs (n = 8/1098; 0.7%) than RTs (n = 15/2394; 0.6%) and DRs (n = 27/12,001; 0.2%).

CONCLUSION

Similar to other countries, findings show a very small percentage of doctoral MRS professionals in Australia and NZ. Strategies to engage and support individuals in research, up to and beyond doctoral study, need to be embedded in practice.

Addressing the Patient Experience in a Magnetic Resonance Imaging Department: Final Results from an Action Research Study

INTRODUCTION

Patients undergoing magnetic resonance imaging (MRI) can experience anxiety and claustrophobia. A multimethod action research study was conducted to determine how patient care was currently being delivered in an MRI department and to determine whether this could be improved.

METHODS

This action research study used both quantitative and qualitative methods. Changes were introduced into the department after baseline data collection to address areas for improvement. A survey was conducted of patients to establish their level of satisfaction and/or anxiety and to determine whether this improved during the course of the project. Staff practice was qualitatively observed over the course of the project and observations recorded in a field diary. Finally, focus groups were held with staff.

RESULTS

The project resulted in improved satisfaction and lower anxiety for patients, and increased the amount of patients receiving information compared with the results of a baseline survey. However, these findings were not statistically significant. Among staff, qualitative observations portrayed a renewed focus on the patient in MRI including changes in their actions such as increased use of touch, improved communication, and focused efforts to maintain privacy.

CONCLUSIONS

This study was able to achieve a change in practice through an action research cycle in a MRI department. Over the course of the project, improvements were made to the department, and radiographers changed the way they acted and interacted with patients.

Patient Anxiety and Satisfaction in a Magnetic Resonance Imaging Department: Initial Results from an Action Research Study

PURPOSE

The way patients experience health care is largely dependent on the attitudes and actions of the health care professionals they encounter. In medical imaging, the radiographer is often the biggest provider of patient care. Patients undergoing magnetic resonance imaging (MRI) can experience anxiety and claustrophobia. The aim of this study was to determine current levels of anxiety and satisfaction within an MRI unit.

METHODS

An action research study was conducted in an MRI unit in a large metropolitan hospital. The focus of this study was on improving patient care within the department. The initial phase of this study focused on determining current levels of anxiety and satisfaction within the department. To achieve this, a survey was conducted of patients attending the department for imaging.

RESULTS

Surveys were returned from 120 patients. Overall, the mean anxiety was 2.617 on a 10-point scale (0 = no anxiety, 10 = maximum anxiety; 95% confidence interval, 2.075-3.159; standard deviation, 3). Overall, the mean satisfaction was 8.86 (95% confidence interval, 8.459-9.254; standard deviation, 2.15). There was a statistically significant difference between anxiety for patients who received information and those who did not (information = 2.29, no information = 4.0, P = .045).

CONCLUSIONS

Although the vast majority of patients are satisfied with the care they receive during MRI, anxiety is still an issue. The provision of information has been linked to lower levels of anxiety with these patients. The findings from this survey provide insight as to how patients perceive the MRI department and can be used as a benchmark for future surveys to determine if any changes can be made to further improve satisfaction and anxiety during MRI.

Interventions to reduce anxiety, distress and the need for sedation in adult patients undergoing magnetic resonance imaging: a systematic review

PURPOSE

Adults undergoing MRI scans can experience anxiety, claustrophobia and fear during the scanning experience and, in some cases, require sedation. The aim of this systematic review was to determine what strategies are effective in reducing fear, anxiety and claustrophobia, and the need for sedation in adults undergoing MRI.

METHODS

A quantitative systematic review, according to the methodology of the Joanna Briggs Institute, was carried out. A systematic search of a number of databases was performed. Studies were then screened and critically appraised by two independent reviewers before being included in the review.

RESULTS

In total, 21 studies met the inclusion criteria for the review, which assessed the following interventions: MRI design features, cognitive-behavioural strategies, prone positioning, information, fragrance administration and team training. All of these had some positive impact on outcomes.

CONCLUSION

Healthcare professionals working with adults undergoing MRI may consider some of the strategies included in this review to implement in their practice to reduce anxiety and increase patient comfort while reducing the need for sedation.