Radiographers' self-assessed level and use of competencies-a national survey

Use of Smart Glasses (Assisted Reality) for Western Australian X-ray Operators' Continuing Professional Development: A Pilot Study

Previous studies have explored use of smart glasses in telemedicine, but no study has investigated its use in teleradiography. The purpose of this study was to implement a six-month pilot program for Western Australian X-ray operators (XROs) to use smart glasses to obtain assisted reality support in their radiography practice from their supervising radiographers, and evaluate its effectiveness in terms of XROs' competence improvement and equipment usability. Pretest-posttest design with evaluation of the XROs' competence (including their X-ray image quality) and smart glasses usability by XROs in two remote centers and their supervising radiographers from two sites before and after the program using four questionnaire sets and X-ray image quality review was employed in this experimental study. Paired t-test was used for comparing mean values of the pre- and post-intervention pairs of 11-point scale questionnaire and image quality review items to determine any XROs' radiography competence improvements. Content analysis was used to analyze open questions about the equipment usability. Our study's findings based on 13 participants (11 XROs and 2 supervising radiographers) and 2053 X-ray images show that the assisted reality support helped to improve the XROs' radiography competence (specifically X-ray image quality), with mean post-intervention competence values of 6.16-7.39 (out of 10) and statistical significances (p < 0.001-0.05), and the equipment was considered effective for this purpose but not easy to use.

Radiographers' perception of patient safety culture in radiology

INTRODUCTION

Radiographers play a central role in patient safety because of their knowledge of and responsibilities in relation to the imaging process. To maintain safe care, the workplace must create a safety culture that enables sustainable safety work.

AIM

This study aims to describe radiographers' perceptions of the patient safety culture in radiology units in Sweden.

METHODS

The Swedish Hospital Survey of Patients' Safety Culture (S-HSOPSC) was used to gather descriptive data from 171 Swedish registered radiographers working in five radiology clinics distributed across 15 units. Fifty-one questionnaire items and one open-ended question were analysed, comprising perceptions of the overall safety grade, the frequency of number of reported risks and events, and 14 composites regarding patient safety dimensions.

RESULTS

The radiographers' concerns surrounding the patient safety culture in their workplaces related to weaknesses regarding the safety dimensions "Staffing", "Frequency of error reporting", "Organizational learning - continuous improvement" and "Executive management support for patient safety". They perceived "Teamwork within the unit" to be a strength.

CONCLUSION

Despite some weaknesses in the patient safety culture, the radiographers perceived that the overall patient safety level was good, in part because of their ability to spot risks in time. The executive management, however, needed to improve their feedback on safety measures; and another reason for some weaknesses in the patient safety culture could be staffing issues such as lack of time for meetings for continuous improvement. Managers and leaders have a great responsibility to establish a patient safety culture through support and good leadership.

IMPLICATIONS FOR PRACTICE

An understanding of what creates a safety culture is important to prevent patient safety incidents.

Radiographers' experience of preventing patient safety incidents in the context of radiological examinations

AIM

To describe factors that prevent patient safety incidents in connection with the radiological examination from the radiographer's perspective.

BACKGROUND

Radiology plays an important role in the care chain and involves diagnostic examinations and treatments using various radiation sources and different techniques. Risks for patient safety incidents exist in every phase of a radiological examination. Appropriate use of medical imaging requires a multidisciplinary approach involving staff of different categories to meet the medical objectives and the patient's care needs. In accordance with a Safety-II approach, it is therefore important to understand why things go right and ensure that they do by supporting the conditions for right things to happen.

DESIGN

A qualitative study with a descriptive design.

METHODS

Semi-structured interviews were conducted with 17 radiographers. The data were analysed using theoretical thematic analysis based on the Systems Engineering Initiative for Patient Safety model.

RESULTS

The analysis yielded 20 sub-themes, which describe different success factors contributing to patient safety.

CONCLUSION

Proactive work should focus on collaboration and sharing the necessary knowledge, internally and externally, for care in connection with the radiological examination. The radiological and peri-radiographic knowledge should include monitoring the patient's safety needs before, during and after the radiological examination. The referring clinician has a central role in writing relevant referrals and the radiographer's competence is crucial in monitoring the patient's safety needs. A good patient safety culture is required and working with standards is important.

Radiographers' self-perceived competencies after attending postgraduate courses in CT and MRI

INTRODUCTION

Postgraduate education in computed tomography (CT) and magnetic resonance imaging (MRI) varies globally. Multiple factors affect the development of associated core skills and competencies for these specialist roles. Previous research has highlighted that different teaching standards and methods may influence radiographers' confidence and competencies. Nonetheless, there is limited knowledge of skill development and capabilities in post-registration roles. Hence, the aim of this research was to explore radiographers' self-perceived competencies before, during and after successful completion of postgraduate study.

METHODS

Radiographers enrolled on the CT and MRI courses voluntarily completed questionnaires at three time points. As part of the last survey, questions were added to evaluate their perceptions of the courses' impact on their clinical and professional practice. Descriptive statistics, Wilcoxon matched pairs signed rank and Friedman tests, were performed to analyse results across the different time points.

RESULTS

53 students completed the baseline survey, with initial perceived areas of weakness being lack of knowledge relating to CT or MR technology, cross-sectional anatomy and pathology. Follow up surveys, highlighted a significant increase in self-described competence in technical knowledge, literature appraisal and image viewing skills. As a result of completing the course, students described favourable changes to their departmental practices and their own continuing professional development (CPD). Challenges detailed included but not limited to lack of study time provided by employers, and the demands of balancing studies and work commitments.

CONCLUSION

Postgraduate education has value and positively impacts radiographers and their clinical departments. The courses enabled the radiographers, including those experienced in CT and or MRI to develop skills they could translate into clinical practice, thereby contributing towards service delivery.

IMPLICATIONS FOR PRACTICE

Post graduate education has the potential to enhance self-perceived competency in aspects of CT and MRI practice.

MRI physics and technical issues: Where do Italian radiographers search for information?

INTRODUCTION

Our aim was to investigate the means radiographers and radiographers in training (RTrs) use to seek information on magnetic resonance imaging (MRI) physics and technical issues.

METHODS

An estimated 3000 radiographers and RTrs were reached by e-mail. We proposed an online survey with eight English-language multiple choice questions investigating how often radiographers have doubts about MRI physics or technical issues, where and what kind of information they search for, and on which websites. The statistical χ² test was used.

RESULTS

We obtained 300 answers from European professionals (228 radiographers, 72 RTrs) from 9 European countries, with 288 of 300 (96%) responses coming from Italy. Within the Italian respondents, 41% of RTrs have doubts about MRI physics versus 56% of radiographers (p = 0.028). Basic MRI sequences details are more searched by RTrs (36%) than radiographers (22%) (p = 0.088), as well as clinical protocols (64% versus 44%, p = 0.054). Radiographers and RTrs mostly search on the Internet (74% versus 81%, p = 0.404); "older colleagues" are more frequently asked for information by RTrs (27% versus 61%, p = 0.001), they consult the "MRI manufacturer" less frequently (11% versus 34%, p = 0.001); and 66% of radiographers and 72% of RTrs search "in mother-language and English" (p = 0.590). For clinical protocols RTrs prefer the website mriquestions.com (17% versus 44%, p = 0.001). Websites most used were: mriquestions.com (41%), radiopaedia.org (31%), and mrimaster.com (13%). In addition, 30 respondents mentioned using the Italian site fermononrespiri.com.

CONCLUSION

Italian radiographers and RTrs frequently search for information about MRI physics and technical issues, with slight differences between groups regarding sources and clinical protocols. Protocol setting, and MRI physics and sequences seem to be the main limitations of RTr knowledge. To remedy this gap, more time on training/university lectures and a rethinking of the practical training activities is required.

Knowledge of CT exposure parameters among Norwegian student radiographers

BACKGROUND

Improvements in the competency levels of student radiographers in computed tomography examinations (CT) are important due to the increasing number of these examinations being undertaken in imaging departments. The present study assesses the knowledge of student radiographers regarding CT exposure parameters.

METHODS

The level of knowledge related to CT exposure parameters was evaluated using a twenty-one-item questionnaire that was distributed to final-year student radiographers. The questionnaire consisted of questions around CT exposure parameters and either allowed respondents to answer "true," or "false" or choose a response from a range of responses where only one answer was correct. Correct answers were given one mark, while no mark was given for an incorrect answer. The score out of possible 21 was converted to a percentage, with a higher percentage signifying greater knowledge.

RESULTS

Seventy-two students completed and returned the questionnaire, resulting in a 71% response rate. The mean score was 53%. Only 33% of students correctly identified that kilovoltage peak (kVp) should be increased when patients have metallic implants, and milliampere seconds (mAs) should be increased as body part thickness increases. No one answered all the questions correctly. There was no significant knowledge difference between students who had CT facilities on campus and those that did not.

CONCLUSION

Overall, student radiographers' knowledge of CT exposure parameters was reported to be satisfactory.

Patients' and radiographers' experiences of dose reducing abdominal compression in radiographic examinations-A qualitative study

Aim

To describe patients' and radiographers' experiences of abdominal compression using conventional and patient-controlled compression methods.

Design

Qualitative descriptive design.

Methods

Forty-five patients who had used both a conventional and a patient-controlled compression device answered questionnaires. Five radiographers were interviewed. The data-collection took place between September 2015 and February 2017. Data were analysed by qualitative content analysis.

Results

Patient-controlled compression was preferred by slightly more patients because of fear of pain due to excessively hard pressure, maintaining control over the pressure and shorter duration. It was more comfortable, and patients felt they could participate in the examinations. Conventional compression was preferred by some because of more stable pressure and uncertainty of own capacity to provide the optimal compression. Discomfort was more often mentioned concerning the conventional compression method. The radiographers experienced the patient-controlled method as less time-consuming and more comfortable, but uncertainty about correct compression technique and its effect on radiation dose and image quality was reported.

X-ray operators' self-perceived competence, barriers and facilitators in general radiography practice in Western Australia

INTRODUCTION

Australian X-ray operators (XROs) are health workers qualified with a limited radiography licence to perform basic radiography examinations in rural areas of Australia. However, no previous study explored Western Australian (WA) XROs' radiography practice. The purpose of this study was to investigate WA XROs' self-perceived competence in the general radiography practice, and barriers and facilitators to their competence for determination of appropriate strategies to improve quality and safety of the radiographic service provided by them.

METHODS

Institutional review board approval and informed consent from participants were obtained. Interviews were conducted with the WA XROs to obtain demographic information and identify their self-perceived competence in the general radiography practice, and the barriers and facilitators to their competence. A thematic analysis was used to analyse the interview data.

RESULTS

A total of nine interviews were conducted (eight nurses and one paramedic). Participants indicated that they felt highly competent in patient care in radiography and adequately competent in the production of diagnostically acceptable images. The self-perceived barriers include overload of responsibilities, a lack of continuing professional development, and inadequacy of communication, support and XRO courses. The facilitators, post-qualification/course training, support in undertaking examinations, primary professional roles and a small population of the rural and remote areas were identified.

CONCLUSION

Based on interview data from nine WA XROs, the perception is that they have competence adequate for providing an acceptable quality radiographic service.

IMPLICATIONS FOR PRACTICE

A continuous XRO course review, and provision of a video conference support channel, an online XRO networking forum and additional XROs and/or radiographers working with XROs undertaking the radiography examinations were perceived as the appropriate strategies to improve the WA XROs' radiography practice. However, these require financial and/or managerial support from governments.

Geometric validation of a computer simulator used in radiography education

Objectives

The radiographical process of projection of a complex human form onto a two-dimensional image plane gives rise to distortions and magnifications. It is important that any simulation used for educational purposes should correctly reproduce these. Images generated using a commercially available computer simulation widely used in radiography education (ProjectionVR^TM) were tested for geometric accuracy of projection in all planes.

Methods

An anthropomorphic skull phantom was imaged using standard projection radiography techniques and also scanned using axial CT acquisition. The data from the CT was then loaded into the simulator and the same projection radiography techniques simulated. Bony points were identified on both the real radiographs and the digitally reconstructed radiographs (DRRs). Measurements sensitive to rotation and magnification were chosen to check for rotation and distortion errors.

Results

The real radiographs and the DRRs were compared by four experienced observers and measurements taken between the identified bony points on each of the images obtained. Analysis of the mean observations shows that the measurement from the DRR matches the real radiograph +1.5 mm/-1.5 mm. The Bland Altman bias was 0.55 (1.26 STD), with 95% limits of agreement 3.01 to -1.91.

Conclusions

Agreement between the empirical measurements is within the reported error of cephalometric analysis in all three anatomical planes. The image appearances of both the real radiographs and DRRs compared favourably.

Advances in knowledge

The commercial computer simulator under test (ProjectionVR^TM) was able to faithfully recreate the image appearances of real radiography techniques, including magnification and distortion. Students using this simulation for training will obtain feedback likely to be useful when lessons are applied to real-world situations.

Validation of the educational effectiveness of a mobile learning app to improve knowledge about MR image quality optimisation and artefact reduction

Aim

The aim was to design an app-based eLearning tool to provide radiographers with information about the physical basis of MR artefacts and practical elimination or/and minimisation strategies to optimise image quality, and to evaluate the impact of a smartphone app on radiographers’ knowledge.

Methods

The study used the comparison-experimental approach (pre- and post-test). Thirty-five MR radiographers independently reviewed a prepared series of MR images (n = 25). The participants were requested to identify image quality related errors, to specify error-correction strategies and to score how confident they were in their responses. Participants were then divided into experimental (n = 19) and control cohorts (n = 16). The app was provided to the experimental cohort for 3 months; after this period both cohorts re-reviewed the MR image datasets and repeated their identification of image quality errors.

Results

The results showed a statistically significant difference between control and experimental cohorts relative to participants’ pre- to post-test knowledge level. For the experimental cohort, years of experience, qualification and type of hospital were not associated with radiographer knowledge level and confidence in recognising the presence of an image quality error, naming the error and specifying appropriate correction strategies (p > 0.05).

Conclusion

The study identified the potential of the smartphone app as an effective educational tool to support MR radiographers’ knowledge in recognising and characterising MR image quality errors.

Key Points

• A high level of knowledge to optimise MR image quality is crucial.

• Ongoing education in image quality optimisation is required.

• The potential role of app as an effective educational tool is identified.

Assessment of radiographers' competences from the perspectives of radiographers and radiologists: a cross-sectional survey in Lithuania

BACKGROUND

Assessing radiographers' clinical competence is of major importance in all medical imaging departments, and is a fundamental prerequisite for guaranteeing professional standards in both nursing care and radiography. Despite the fact that self-assessment has been reported to be the most common form of competence evaluation only several studies defining the radiographers' self-assessment of clinical competencies were identified. The aim of the study was to evaluate radiographers' professional competence from the perspectives of radiographers and radiologists by applying the Radiographers' Competence Scale (RCS).

METHODS

The study was conducted in university hospitals of Lithuania. We used the original instrument designed by Swedish researchers - the Radiographers' Competence Scale (RCS) consisting of two domains: A "Nurse-initiated care" and B "Technical and radiographic processes". The study involved in all 397 respondents; radiographers (250) and radiologists (147) working in departments of diagnostic radiology. Each competence was evaluated twice - the level on a 10-point scale, and the frequency of practical application on a 6-point scale.

RESULTS

The overall level of the radiographers' competence and the frequency of its use in practice were evaluated high or very high by both respondent groups. The radiographers attributed the highest evaluations to such competences as "Encouraging and supporting the patient" and "Collaborating with other radiographers", while the lowest evaluations were attributed to "Guiding the patient's relatives" and "Empowering the patient by involving him/her in the examination and treatment" competences. The radiologists attributed the highest evaluations to such competences as "Collaborating with radiologists" and "Independent carrying out of the radiologist's prescriptions", while the lowest evaluations - to the same competences as the radiographers did. Irrespectively of the work experience and age, the radiographers gave significantly higher ratings to all competences that the radiologists did (p < 0.001).

CONCLUSIONS

Both groups of the respondents attributed high or very high evaluations to the competences in both the "Nurse-initiated care" and the "Technical and radiographic processes" domains.

An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors

OBJECTIVE

To investigate MR radiographers' current knowledge base and confidence level in relation to quality-related errors within MR images.

METHOD

Thirty-five MR radiographers within 16 MRI departments in the Kingdom of Saudi Arabia (KSA) independently reviewed a prepared set of 25 MR images, naming the error, specifying the error-correction strategy, scoring how confident they were in recognising this error and suggesting a correction strategy by using a scale of 1-100. The datasets were obtained from MRI departments in the KSA to represent the range of images which depicted excellent, acceptable and poor image quality.

RESULTS

The findings demonstrated a low level of radiographer knowledge in identifying the type of quality errors and when suggesting an appropriate strategy to rectify those errors. The findings show that only (n = 7) 20% of the radiographers could correctly name what the quality errors were in 70% of the dataset, and none of the radiographers correctly specified the error-correction strategy in more than 68% of the MR datasets. The confidence level of radiography participants in their ability to state the type of image quality errors was significantly different (p < 0.001) for who work in different hospital types.

CONCLUSION

The findings of this study suggest there is a need to establish a national association for MR radiographers to monitor training and the development of postgraduate MRI education in Saudi Arabia to improve the current status of the MR radiographers' knowledge and direct high quality service delivery.

Multiprovider and Patient Perspectives on Conveying Diagnostic Imaging Investigation Results in a South African Public Health Care System

INTRODUCTION

This study explored interaction processes in conveying messages about the results of diagnostic imaging investigations in a public hospital complex in South Africa from the perspective of health care providers and patients.

METHODS

The study was part of a qualitative inquiry into the interaction and communication processes relating to diagnostic imaging investigations in the public health care system. Data collection included individual interviews with 24 patients and 62 health care providers (ie, medical practitioners, specialists, radiologists, registrars, radiographers, and nurses). In addition, 12 focus group interviews were conducted with health care providers. The transcribed data were coded and analysed to identify categories and themes.

RESULTS

Three main themes emerged from the study. The first theme deals with the medical territory, specifically who should interpret and convey the diagnostic results to the patient. The second theme highlights the role of radiographers and nurses in communicating parts of the diagnostic results. The last theme focuses on patient experience, interpretation, and comprehension in the provider-patient communication process.

CONCLUSIONS

The findings provide a multidimensional view about the disclosure of imaging results to patients by medical and nonmedical health care providers. Further research is needed on the role of nonmedical providers in the context of ethical and moral obligation toward patients and the professional restrictions inherent in their scope of practice.

Radiographers' professional knowledge regarding parameters and safety issues in plain radiography: a questionnaire survey

OBJECTIVE

To review the knowledge of radiographers and examine the possible sociodemographic and situational contributors to this knowledge.

METHODS

A questionnaire survey was devised and distributed to a cohort of 120 radiographers. Each questionnaire contained two sections. In the first section, background data, including sex, age, highest academic level, grade point average (GPA), length of time from graduation, work experience as a radiographer and the status of previous refresher course(s), were collected. The second section contained 17 multiple-choice questions concerning radiographic imaging parameters and safety issues.

RESULTS

The response rate was 63.8%. In univariate analytic model, higher academic degree (p < 0.001), higher GPA (r(2) = 0.11; p = 0.001), academic workplace (p = 0.04) and taking previous refresher course(s) (p = 0.01) were significantly associated with higher knowledge score. In multivariate analytic model, however, higher academic degree (B = 1.62; p = 0.01), higher GPA (B = 0.50; p = 0.01) and taking previous refresher course(s) (B = -1.26; p = 0.03) were independently associated with higher level of knowledge. Age, sex, length of time from graduation and work experience were not associated with the respondents' knowledge score.

CONCLUSION

Academic background is a robust indicator of a radiographer's professional knowledge. Refresher courses and regular knowledge assessments are highly recommended.

ADVANCES IN KNOWLEDGE

This is the first study in the literature that examines professional knowledge of radiographers in terms of technical and safety issues in plain radiography. Academic degree, GPA and refresher courses are independent predictors of this knowledge. Regular radiographer professional knowledge checks may be recommended.