Evidence based medical imaging (EBMI)

Knowledge, attitude, understanding and implementation of evidence-based practice among Jordanian radiographers

INTRODUCTION

Evidence-based practice (EBP) has gained attention globally from healthcare professionals and researchers. The aim of this study was to assess Jordanian diagnostic radiographers' knowledge, attitude, education/knowledge, and skills related to EBP; and identify specific terms related to EBP.

METHODS

A paper-based, self-administered questionnaire with two sections was used. The first section included 11 socio-demographic questions and the second section contained 56 questions regarding EBP categorized under seven distinct subscales. The data were imported into SPSS for analysis.

RESULTS

Responses were received from 203 radiographers, most of them 135 (66.5%) aged 21-30 years. The majority of radiographers agreed or strongly agreed that the application of EBP is necessary for radiography practice, and 129 (63.6%) of radiographers learned the foundations of EBP as part of their academic preparation. Less than half of the participants stated that they completely understood the research terminology listed in the survey. Most participants had access to the internet and research databases, 79.3% (n = 161). The majority of participants, 63.1% (n = 128) stated that they always used their personal experience, as a source to make a clinical decision in radiography practice. The most common barrier to the implementation of EBP was insufficient time (63.5%, n = 129).

CONCLUSION

This study showed that despite the positive attitude, and beliefs of radiographers toward EBP, and access to information resources, radiographers still need a higher level of confidence in their ability to engage in and implement EBP; including increased education to support the research skills needs to search and interpret publications.

IMPLICATIONS FOR PRACTICE

The findings of this study may help inform restructure of the undergraduate radiography curriculum, training programs or other interventions required to promote or facilitate the adoption of EBP in Jordan.

Radiographic technique modification and evidence-based practice: A qualitative study

INTRODUCTION

Evidence-based practice in radiography is an emerging practice, due to a lack of evidence. Beyond the diagnostic requirements of the examination, imaging technique decisions are guided by the radiographer's tertiary education and clinical experience. Imaging technique decisions should include all aspects of evidence-based practice: research-based evidence, patient circumstances and clinical experience. Previous research suggests radiographers do to not fully engage with the latter, which may jeopardise progress in the field and lead to outdated practices and suboptimal outcomes for patients. This study aimed to examine the motivators and influences involved in radiographers' decision-making when modifying imaging acquisition techniques.

METHODS

An exploratory descriptive, inductive qualitative interview-based design was used with a convenience sample of radiographers from three public hospital sites in Queensland. Twelve one-on-one semi-structured interviews were performed via video conference, the data were analysed through thematic analysis.

RESULTS

Five themes emerged from the data: advancement of technology; experience rather than evidence; radiology's influence on radiographic practice; information sources; and image quality. The pursuit of image quality was the key motivator and criterion that influenced radiographers' choices in imaging technique modification. Interviewees did not engage routinely with research-based evidence, preferring to rely on empirical observations and professional experience.

CONCLUSION

The exclusion of research-based evidence can lead to outdated and ineffective clinical decisions. Further work is needed to promote more research in the field of radiography and increase the willingness and capacity of radiographers to follow the principles of evidence-based practice.

Creating person-al space for unspoken voices during diagnostic medical imaging examinations: a qualitative study

Background

There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space.

Methods

We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient’s journey into, through and out of an imaging encounter.

Results

The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers’ decisions on how to conduct a particular examination and how to get patient cooperation. Participants’ well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients’ vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients’ personal lives, concerns and pressures – their person-al ‘baggage’ – shaped their experience of the imaging encounter.

Conclusion

To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice.

Radiation therapists and the Internet: a perspective from Australia

The Internet is an important information source for health practitioners; yet little is known of how radiation therapists (RTs) are currently using this vast information resource for their professional learning. In 2007, a four-page postal survey was sent to a random sample of 1,142 Medical Radiation Science practitioners with a response rate of 32.8%, which included 76 RTs. This paper reports and analyses the questionnaire responses from RTs on the use of the Internet to update their professional knowledge and issues affecting accessibility to the Internet in the workplace. This research provides an initial data set on the professional use of Internet-based tools and resources by Australian RTs. It has been shown that the Internet is an important information source widely used by RTs as they search the Internet (89%), access specific web pages (85%), use e-mail (84%) and listservs (49%) to update their professional knowledge. Although all RTs reported Internet access within their workplace, a number of factors have been identified which at present limit accessibility of current quality health and medical information through the Internet to RTs. A large number of RTs were unaware of Internet-based resources, such as Cochrane Library (48%) and GoogleScholar (42%), which support evidence-based practice (EBP) and research. RTs in teaching environments had greater access to computers with Internet access than their colleagues in non-teaching environments (p = 0.044). More RTs in the private sector (22%) reported they had ‘no’ access to the Internet in their workplace than their public sector colleagues (4%, p = 0.037). In addition, RTs in metropolitan workplaces had greater access to protected time during work hours for professional reading or study than their non-metropolitan colleagues (p = 0.000). These issues of non-uniformity of resources across workplaces and knowledge gaps within the profession must be addressed so that all RTs can avail themselves of high quality resources available through the Internet that support them in implementing EBP and meeting the mandatory requirement of updating their professional knowledge.

The research agenda and the role of the therapeutic radiographer: The College of Radiographers perspective

This article reflects on the influences on current radiotherapy practice and the key role that Therapeutic Radiographers have in the management of cancer care and the delivery of treatments. In particular the Cancer Reform Strategy is discussed which clearly highlights the many challenges related to cancer. Changes in societal and scientific understanding will demand that the most appropriate and evidence-based care is provided for patients, underscoring the need for evidence through research, to underpin every aspect of daily work if patient outcomes are to continue to improve. In October 2005, the Society and College of Radiographers published: ‘Research and the Radiography Profession—A Strategy and Five Year Plan’. This is an ambitious document, which sets out expectations for the appreciation and use of substantiated research involvement at all levels of practice. Sections of this document and the relevance to radiotherapy practice are discussed. Alongside this, the career progression model for radiography continued to be driven forward with support from the Department of Health. This model describing higher levels of practice for radiographers, at advanced and consultant levels, clearly identified research as a key requirement for the profession. The guidance document in 2006, from the Society and College of Radiographers ‘Positioning Therapeutic Radiographers within Cancer Services: Delivering Patient Centred Care’, further articulated these expert roles, in response to the changing drivers within cancer and across the radiotherapy pathway. In conclusion, research must become a fundamental component of everyday radiotherapy practice as it will verify professional standards of care and sustain the future of the profession. To contribute to the wider cancer agenda it is imperative that all therapeutic radiographers, from practitioner to consultant level, participate in and lead research.