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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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Pio L, Gentilino V, Macchini F, Scarpa AA, Lo Piccolo R, Conforti A, Ratta A, Guanà R, Molinaro F, Costanzo S, Riccipetitoni G, Lisi G, Midrio P, Tocchioni F, Cobellis G, Volpe A, Zolpi E, Morandi A, Ciardini E, Vella C, Grella MG, Sergio M, Guida E, Nanni L, Ceccanti S, Di Benedetto V, Cheli M, Garzi A, Nobili M, Gabriele V, Boroni G, Incerti F, Zampieri N, Cacciaguerra S, Ceccarelli PL, Escolino M, Briganti V, Gori D, Esposito C, Gamba P, Gennari F, Inserra A, Dall'Igna P, Romeo C, Bagolan P, Bleve C, Chiarenza F, Morini F, Pelizzo G, Torre M. Congenital lung malformations: a nationwide survey on management aspects by the Italian Society of Pediatric Surgery. Pediatr Surg Int 2024; 40:53. [PMID: 38340215 DOI: 10.1007/s00383-024-05635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Over the years, congenital lung malformations (CLM) management remains a controversial topic in pediatric thoracic surgery. The Italian Society of Pediatric Surgery performed a national survey to study the current management variability among centers, trying to define national guidelines and a standardized approach of children with congenital lung malformations. METHODS Following a National Society approval, an electronic survey including 35 items on post-natal management was designed, focusing on surgical, anesthesiology, radiology and pneumology aspects. The survey was conducted contacting all pediatric surgical units performing thoracic surgery. RESULTS 39 pediatric surgery units (97.5%) participated in the study. 13 centers (33.3%) were classified as high-volume (Group A), while 26 centers (66.7%) were low volume (Group B). Variances in diagnostic imaging protocols were observed, with Group A performing fewer CT scans compared to Group B (p = 0.012). Surgical indications favored operative approaches for asymptomatic CLM and pulmonary sequestrations in both groups, while a wait-and-see approach was common for congenital lobar emphysema. Surgical timing for asymptomatic CLM differed significantly, with most high-volume centers operating on patients younger than 12 months (p = 0.02). Thoracoscopy was the preferred approach for asymptomatic CLM in most of centers, while postoperative long-term follow-up was not performed in most of the centers. CONCLUSION Thoracoscopic approach seems uniform in asymptomatic CLM patients and variable in symptomatic children. Lack of uniformity in surgical timing and preoperative imaging assessment has been identified as key areas to establish a common national pattern of care for CLM.
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Affiliation(s)
- Luca Pio
- Pediatric Thoracic and Airway Surgery, IRCCS Giannina Gaslini, Genoa, Italy.
- Department of Surgery, MS133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
| | - Valerio Gentilino
- Unit of Pediatric Surgery, Woman and Child Department, Filippo del Ponte Hospital-ASST Sette Laghi, Varese, Italy
| | | | | | - Roberto Lo Piccolo
- Department of Emergency, Critical Area and Pediatric Surgery, Meyer University Children's Hospital, University of Florence, Florence, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
| | - Alberto Ratta
- Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy
| | - Riccardo Guanà
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Giovanna Riccipetitoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Lisi
- Department of Pediatric Surgery "Spirito Santo", Hospital of Pescara "G. D'annunzio", University Chieti-Pescara, Pescara, Italy
| | - Paola Midrio
- Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy
- Pediatric Surgery, University of Padua, Padua, Italy
| | - Francesca Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Giovannii Cobellis
- Unit of Pediatric Surgery, Salesi Children's Hospital, Marche Polytechnic University, Ancona, Italy
| | - Andrea Volpe
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Padua, Italy
| | - Elisa Zolpi
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Claudio Vella
- Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Maria Giovanna Grella
- Department of Pediatric Surgery, Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Maria Sergio
- Policlinico Universitario di Palermo, Palermo, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Lorenzo Nanni
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Silvia Ceccanti
- Pediatric Surgery Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | | | - Maurizio Cheli
- Department of Paediatric Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alfredo Garzi
- Dipartimento di Chirurgia Pediatrica e Robotica, Università di Salerno, Salerno, Italy
| | - Maria Nobili
- Pediatric Surgery Unit, University of Foggia, Foggia, Italy
| | | | - Giovanni Boroni
- Department of Pediatric Surgery, Azienda Ospedaliera Spedali Civili, Brescia, Italy
| | - Filippo Incerti
- Department of Pediatric Surgery, Umberto Bosio Center for Digestive Diseases, The Children Hospital AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Nicola Zampieri
- Woman and Child Hospital, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | | | | | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Padua, Italy
- Pediatric Surgery, Department of Women's and Children's Health, Padua University, Padua, Italy
| | - Fabrizio Gennari
- Department of Pediatric General Surgery, Regina Margherita Children's Hospital, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Alessandro Inserra
- General Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Patrizia Dall'Igna
- Department of Emergencies and Organ, Transplantation Azienda Ospedaliero-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
- University of Bari, Bari, Italy
| | - Carmelo Romeo
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital-Research Institute, Rome, Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Morini
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Vittore Buzzi" Children's Hospital, Milan, Italy
| | - Michele Torre
- Pediatric Thoracic and Airway Surgery, IRCCS Giannina Gaslini, Genoa, Italy
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Garba I, Engel-Hills P, Davidson F, Ismail A. Knowledge of computed tomography dose optimisation and justification among CT users and referring physicians: A single hospital study. J Med Imaging Radiat Sci 2023; 54:644-652. [PMID: 37596237 DOI: 10.1016/j.jmir.2023.07.019] [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: 03/13/2023] [Revised: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Radiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging. OBJECTIVE To determine radiographers' and radiologists' awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians. METHODS Radiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval. RESULTS The response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited. CONCLUSION The study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.
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Affiliation(s)
- I Garba
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, South Africa.
| | - P Engel-Hills
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, South Africa
| | - F Davidson
- Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, South Africa
| | - A Ismail
- Department of Radiology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano, Nigeria
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Saban M, Sosna J, Singer C, Vaknin S, Myers V, Shaham D, Assaf J, Hershko A, Feder-Bubis P, Wilf-Miron R, Luxenburg O. Clinical decision support system recommendations: how often do radiologists and clinicians accept them? Eur Radiol 2022; 32:4218-4224. [PMID: 35024948 DOI: 10.1007/s00330-021-08479-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the acceptance and reliability of clinical decision support system (CDSS) imaging referral scores (ESR iGuide). METHODS A pilot study was conducted in a tertiary hospital. Four different experts were invited to rate 40 simulated clinical cases on a 5-level scale, for the level of agreement with the ESR iGuide's recommended procedures. In cases of disagreement, physicians were asked to indicate the reason. Descriptive measures were calculated for the level of agreement. We also explored the degree of agreement between four different specialists, and examined the cases in which clinicians disagreed with ESR iGuide best practice recommendations. RESULTS The mean rating of the four experts for the 40 clinical simulated cases was 4.17 ± 0.65, median 4.25 (on a scale of 1-5). All four raters totally agreed with the system recommendation in 75% of cases. No significant relationship was found between the degree of agreement and the number of indications and the patient's age or gender. In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement for the rating of the 40 simulated cases between the four experts was 77.28%. There were a total of 20 disagreements out of 160 cases with the ESR iGuide, of which 7 were among the two radiologists. CONCLUSIONS CDSS can be an effective tool for guiding the selection of appropriate imaging examinations, thus cutting costs due to unnecessary imaging scans. Since this is a pilot study, further research on a larger scale, preferably at national level, is required. KEY POINTS • The average of the mean rating of the four experts was 4.17 ± 0.65, median 4.25, on a scale of 1-5 where 5 represents total agreement with the CDSS tool. • In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement between the four experts was 77.28%. • Radiologists had fewer disagreements with the recommendations of the CDSS tool than other physicians, indicating a better fit of the support system to radiology experts' perspective.
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Affiliation(s)
- Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel.
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Clara Singer
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Sharona Vaknin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Dorit Shaham
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Assaf
- Emergency Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alon Hershko
- Internal Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Paula Feder-Bubis
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel.,School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
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