The effects of PACS on radiographer's work practice

Understanding reasons for image rejection by radiologists and radiographers

INTRODUCTION

A core element of a radiographer's role is the decision on whether a radiograph is sufficient for diagnosis, or a repeat examination is needed. Studies illustrate the disagreement on the diagnostic value of radiographs between radiographers and radiologists, which may influence repeat examinations. This study investigates if parameters contributing to image quality are possible determinants to explain the difference between professions.

METHODS

A total of 74 radiographers and radiologists from three different countries assessed three data sets (chest PA, hip HBL, c-spine lateral), each containing 25 radiographs. All observers scored image quality in terms of anatomical visualisation, positioning, collimation, detector exposure and judged the diagnostic value using the ACR RadLex classification. All assessments were performed on a clinically relevant display. Visual grading characteristics were used to compare image quality evaluations between groups.

RESULTS

Radiographers scored the visualisation of anatomical structures lower than radiologists though the difference was not statistically significant. A difference in classification using the RadLex categories - with radiographers rejecting more radiographs - was demonstrated. Only the subjective evaluation of the detector exposure correlated statistically with RadLex ratings. There was no difference between radiographers and radiologists when reviewing patient positioning and collimation.

CONCLUSION

Radiographers and radiologists agree on the visualisation of anatomical structures, but radiographers are more critical towards the diagnostic value. Within the criteria studied, the evaluation of anatomical structures does not explain the difference. Radiographs have a higher change of being rejected if the observer (subjectively) assessed the detector exposure as inappropriate. This correlation is stronger for radiographers.

Radiographers' perception on task shifting to nurses and assistant nurses within the radiography profession

INTRODUCTION

The radiography profession is challenged by greater responsibilities and shortage of educated radiographers. Implementation of task shifting is one strategy to deal with the current situation in health care. The aim of this studiy was to evaluate radiographers' perception of assistant nurses and nurses carrying out tasks that traditionally were undertaken within the radiography profession in a Swedish context.

METHODS

An electronic questionnaire was distributed to radiographers at eleven hospitals in Sweden. The questionnaire included background questions and questions about radiographers' perception about task shifting to nurses and assistant nurses. The respondents rated their agreement level regarding task shifting on a five-point Likert scale. Data was statistically evaluated in SPSS using Mann Whitney U test.

RESULTS

Sixty-five radiographers participated in the study. Most radiographers responded negatively to task shifting to nurses (72%) or assistant nurses (65%). Most radiographers disagree that nurses should perform mammography screening or work within interventional radiography, while the attitude towards nurses calculating glomerular filtration rate was more positive. A majority disagree regarding assistant nurses performing conventional radiographs, informing the patient about contrast media administration or inserting peripheral intravenous catheters, while there was a positive attitude towards assistant nurses preparing patients for examinations. The attitude towards task shifting was not influenced by age, however radiographers with less working experience were more positive to task shifting in general.

CONCLUSION

A majority of the radiographers had a negative attitude towards task shifting to nurses and assistant nurses. The radiographers were more positive to hand over tasks related to patient care and administrative tasks than technical related tasks within the profession.

IMPLICATIONS FOR PRACTICE

Knowledge about radiographers' perception on task shifting within the profession is essential when planning and implementing strategies for task shifting in the clinical settings.

Ethnographic mosaic approach for health and rehabilitation practitioners: an ethno-radiographic perspective

This methodological commentary focuses on the use of ethnography for health and rehabilitation practitioners. In recent years, ethnography has become a methodology of choice amongst diagnostic radiography researchers at uncovering phenomena pertinent to the clinical setting. This paper adds to the evidence base by providing not only a methodology account from two experienced researchers, but also offers a paradigmatic approach to ethnography that incorporates qualitative and quantitative approaches. It details an alternate ideological discourse in alignment with the role of a diagnostic radiographer, which can be replicated in other disciplines and thus offering an array of empirical opportunity for prospective health and rehabilitation practitioners.IMPLICATIONS FOR REHABILITATIONThis paper provides an introduction into the use of ethnography for health and rehabilitation practitioners.The authors reflect on the value of ethnography in order to satisfy a researcher's aims and objectives.The authors provide an "umbrella strategy" that can be used by other prospective health and rehabilitation researchers.It is argued here that this methodology offers an alternate strategy of uncovering new ideas and research data.

A review of visual ethnography: Radiography viewed through a different lens

INTRODUCTION

The objective of this article is to provide a short review of the research methodology 'visual ethnography'.

METHOD

The review article will provide a summary of the foundations of visual ethnography, outline the key debates and refer to some of the main authors working in this field.

RESULTS

Visual Ethnography is both a methodology and a method of research. It should be selected for research in radiography when research questions seek to focus upon aspects or elements of a culture. A research plan that is designed using a visual ethnographic approach should be flexible and take into account the requirements of the researcher and research participants. Visual methods of research include the use of various images, for example, photographs, collage, film or drawings. Visual methods are commonly employed together with interviews, conversations and observation. The approach enables researchers to generate new and unique insights into cultures.

CONCLUSION

This review of visual ethnography provides background information that informs an introduction to the methodology. It demonstrates a methodology with the potential to explore culture and expand knowledge of radiography practice.

IMPLICATIONS FOR PRACTICE

The authors suggest that for future studies visual ethnography is a methodology that can expand the paradigm of radiography research.

Ethnography for Radiographers: A Methodological Insight for Prospective Researchers

In recent years, ethnography has become a methodology of choice for exploring radiographic practices. This article adds to the existing evidence base by providing detailed methodological accounts of two experienced researchers. It aims to provide a critical methodological lens to prospective researchers who may also use ethnography as their methodology of choice. The author's reflect on their experiences of utilising ethnography as a methodological approach. Here, accounts of the original tools aligned to undertaking ethnographic research in radiography are discussed and how these can be used to uncover original phenomena. The article identifies the researchers' own positionality and reflexivity as researchers and how this impacted on data collection. In short, this article provides a detailed account of undertaking ethnography as a methodological approach within diagnostic radiography. The experiences documented can provide prospective researchers an insight of the researchers' position within the fieldwork.

[Usefulness of Biological Fingerprints and Template Matching Techniques in Bedside Chest Radiography for Patient Identification and Preventing Filing Mistakes]

The purpose of this study was to investigate whether patients can be identified by using biological fingerprints extracted from bedside chest radiographs and template matching techniques for preventing filing mistakes in a picture archiving and communication system (PACS) server. A total of 400 bedside chest radiographs from 100 male and 100 female patients with current and previous images were used for evaluating patient identification performance. Five biological fingerprints were extracted from 200 previous images using the averaged bedside chest radiographs, produced for each sex and detector size. The correlation values of 200 same patients and 39,800 different patients were calculated as a similarity index, and used for the receiver operating characteristic (ROC) analysis. The patient identification performance was examined by using the correlation index calculated by the summation of correlation values obtained from five biological fingerprints. The sensitivity at 90.0% specificity was calculated using the correlation index. The correlation index for same patients was higher than that for different patients. The area under the ROC curve was 0.974. The patient identification performance was 76.0% (152/200), and the sensitivity at 90.0% specificity was 93.4% (37168/39800). Our results suggest that the proposed method may potentially be useful for preventing filing mistakes in bedside chest radiographs on a PACS server.

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

OBJECTIVES

To describe radiographers' self-assessed level and use of competencies as well as how sociodemographic and situational factors are associated with these competencies, particularly related to work experience.

METHODS

A cross-sectional design was employed. Radiographers (n = 406) completed the self-administered 28-item questionnaire encompassing two dimensions: 'Nurse-initiated care' and 'Technical and radiographic processes'. The level of competencies was rated on a 10-point scale and the frequency of use on a 6-point scale.

RESULTS

Most competencies received high ratings both in terms of level and frequency of use. In 'Nurse-initiated care' the competency 'Adequately informing the patient' was rated the highest, while 'Identifying and encountering the patient in a state of shock' and 'Participating in quality improvement regarding patient safety and care' received the lowest ratings. In 'Technical and radiographic processes' the highest rated competencies were 'Adapting the examination to the patient's prerequisites and needs' and 'Producing accurate and correct images'. The lowest frequency of use was 'Preliminary assessment of images'.

CONCLUSION

The main findings underline the radiographers' high competency in both 'Nurse-initiated care' and 'Technical and radiographic processes'. The lower rated competencies emphasise the importance of continuous professional education and quality improvement.

MAIN MESSAGES

• Assessing radiographers' clinical competencies is fundamental for ensuring professional standards. • Most competencies received high ratings both in the nursing and in the radiographic dimensions. • The highest rated competencies focussed on information and adaptability to the patients needs. • The lowest rated competencies focussed on encountering the patient in shock and image assessments. • Age, years in present position and work place only explained a relatively small part of competency.