Professionals' experiences of imaging in the radiography process – A phenomenological approach

Clinical decisions-making within diagnostic radiography - A scoping review

OBJECTIVES

To describe and synthesise literature on clinical decision-making within diagnostic radiography, to uncover the important elements, and to identify knowledge gaps for further investigation. The scoping review question was: How do diagnostic radiographers make clinical decisions?

KEY FINDINGS

Radiographers make clinical decisions before, during and after examinations. The primary source of information radiographers use is the clinical request, however, if they doubt something, they rely on their colleague's points of view rather than evidence-based practice. Many elements must be considered in the clinical decision-making process; however, lack of autonomy, sparse information on the clinical requests, and lack of time affect the process, which can lead to a barrier to effective decision-making.

CONCLUSION

Clinical decisions are made based on many different elements before, during, and after examinations in combination with different types of knowledge, as well as technical and organisational aspects within radiography clinical practice.

IMPLICATION FOR PRACTICE

There is a need to focus on giving more attention to developing the decision-making elements. In addition, there must be more focus on improving intra-professional work between radiographers and radiologists to facilitate radiographers' opportunities to act on their clinical decisions.

A stake in the game: Can radiographer image interpretation improve X-ray quality? A scoping review

BACKGROUND

Image quality is an important factor in imaging optimisation and diagnosis. Many determinants of image quality are controlled by the radiographer; therefore, radiographer-led strategies may be key to improving X-ray image quality. This review examines the literature on radiographer-led diagnostic evaluation to establish its potential to improve X-ray image quality.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews and the Joanna Briggs Institute Manual for Evidence Synthesis Scoping Review were used to review studies relevant to the impact of radiographer-led diagnostic evaluation on image quality. CINHAL, Embase, Scopus, Web of Science and Medline databases were searched for relevant articles. Search terms synonymous with radiographer, commenting, and image quality were used and studies that examined any type of radiographer-led image interpretation and its relationship to image quality in X-ray based modalities were reviewed.

RESULTS

Fourteen studies that met the inclusion criteria were reviewed. All the studies reviewed unanimously reported a positive association between radiographer image interpretation and image quality in X-ray based modalities. Five emerging themes were identified to be responsible for the improvement in image quality: increased understanding of image quality requirements, improved technical skills, enhanced ability to utilise supplementary imaging and repeats, collaborative upskilling of colleagues, and a complementary interaction between diagnostic and radiographic skills that serves to enhance image quality.

CONCLUSIONS

The findings demonstrate that radiographer image interpretation is a useful strategy to optimise the quality of X-ray examinations.

IMPLICATIONS FOR PRACTICE

The findings highlight a new avenue to improve X-ray quality in the clinical environment and support evidence-based uptake of preliminary image evaluation systems. These findings also support the integration of radiographer commenting alongside technical image quality in teaching curricula.

Radiology image interpretation services in a low-resource setting: Medical doctors' experiences and the potential role of radiographers

INTRODUCTION

Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers.

METHODS

A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9).

RESULTS

Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system.

CONCLUSION

Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges.

IMPLICATIONS FOR PRACTICE

There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers.

Radiography-An etymological and semantic concept analysis from the perspective of radiographic science

INTRODUCTION

Concepts are cornerstones in science, and their determination is a prerequisite for understanding their substance and meaning. Radiography as a concept is not straightforward nor simple to understand, and there are different interpretations depending on the scientific perspective. To develop truthful knowledge of radiography from the perspective of the discipline, a determination of the subject and substance of radiography is required and thereby is a precursor for theory development. The aim of this study was to investigate the etymological and semantic meaning of radiography from the radiography science perspective.

METHODS

An etymological and semantic analysis has been applied according to Koort and Eriksson's theoretical model. Dictionaries published between 2004 and 2021 were used.

RESULTS

The findings show that etymologically, radiography is formed by compounding the words 'radio' and 'graphy', originating historically from Latin and Greek. The semantic analysis revealed that the substance of radiography consisted of four characteristics that are the basic substance of radiography. The characteristics were X-ray and radiation, human beings-opaque objects, process including an act and art and images.

CONCLUSION

This study clarifies the substance and meaning of radiography as a subject from the perspective of radiography science. The subject and substance consisted of the four basic characteristics that all are vital and required to understand the concept of radiography. The characteristics revealed that radiography science is based on scientific knowledge and carrier of properties of meaning that provide a fundamental understanding of radiography science.

IMPLICATIONS FOR PRACTICE

Investigating the subject, substance and meaning of radiography as a concept can become the base for further theoretical, contextual and practical understanding and support in the development of theory in radiography science.

On the edge of decision-making in trauma care: A focus group study on radiographers' experiences of interprofessional collaboration

INTRODUCTION

The temporary trauma teams in trauma alerts consist of a diverse group of unique professionals requiring interprofessional collaboration and coordination to achieve efficient, high-quality care. The uncertain situation and complex care environment impose high demands on team dynamics such as individual attitudes and team behaviours. Within interprofessional teams, interaction and coordination reflect the collective success of collaboration and the achievement of goals. Interactions with radiographers have increased in trauma teams given computed tomography's prominent role in providing crucial knowledge for decision-making in trauma care. This study aimed to explore radiographers' experiences of interprofessional collaboration during trauma alerts.

METHOD

The study was designed with focus group methodology, including 17 radiographers participating in five focus groups, analysed with an inductive focus group analysis.

RESULTS

An overarching theme, "On the edge of decision-making", emerged along with three sub-themes: "Feeling included requires acknowledgement", "Exclusion precludes shared knowledge", and "Experience and mutual awareness facilitate team interaction".

CONCLUSIONS

Interprofessional collaboration from the radiographer's perspective within trauma teams requires a sense of inclusion and the ability to interact with the team. Exclusion from vital decision-making obstructs radiographers' comprehension of situations and thereby the interdependence in interprofessional collaboration.

IMPLICATIONS FOR PRACTICE

Common platforms are needed for knowledge sharing and team practices, including radiographers' areas of responsibility and relational coordination to foster interprofessional relationships. Through these means interdependence through awareness and shared knowledge can be facilitated on trauma teams.

Radiographers' decision-making processes in the movement of pain-afflicted adult trauma patients in planar diagnostic imaging

INTRODUCTION

The need to balance pain management and radiographic image quality is at the forefront of patient care in diagnostic radiography. This study aimed to identify the decision-making that radiographers employ when undertaking planar diagnostic imaging for pain-afflicted adult trauma patients and the factors that influence these decisions.

METHODS

A virtual focus group interview was undertaken with six experienced Australian radiographers using a realistic scenario and questions based on it. Thematic analysis was employed to explore how radiographers approached planar diagnostic imaging of trauma patients and what influenced decisions regarding patient movement.

RESULTS

Five key factors in radiographers' decision-making were identified: assistance from the multidisciplinary team, understanding the patient, pain reduction methods, the patient being informed and radiographer competence. Radiographers were found to further utilise professional knowledge of image interpretation and anatomy and physiology, in conjunction with interpersonal capabilities, to undertake radiographic examinations.

CONCLUSION

The decision-making process that informs the movement of pain-afflicted adult trauma patients is multifactorial, aligning with the broad healthcare principles of multidisciplinary teamwork, holistic management of the patient and professional knowledge and practice. Further research is needed to explore correlations with different patient groups to validate this research.

Preparedness to assume professional roles: experiences of recently qualified radiographers: A qualitative study

INTRODUCTION

Recently qualified health workers including radiographers struggle with workplace integration. Similarly, in our local context, undocumented complaints were received from the various heads of departments and radiologists regarding recently qualified radiographers' ability to fully assume their professional roles. In light of the complaints, this study sought to explore and describe the lived experiences of recently qualified radiographers from one local University on their readiness to assume their professional roles.

METHODS

A qualitative, descriptive research design with a phenomenological approach was used to conduct the study. Ten (10) diagnostic radiographers who graduated between 2018 and 2020 from the local university were sampled using the snowball sampling technique. Telephonic interviews were conducted using a semi-structured interview guide. Data were analysed using Tesch's open coding method.

RESULTS

The findings of this study have shown a combination of positive and negative experiences by recently qualified radiographers. The positive experiences (satisfactory work engagement) emanate from increased confidence and creativity, responsibility consciousness and teamwork. Negative experiences (reality shock and professional role conflict) emanated from excessive workload, patient care impediments, the burden of student supervision and lack of professional trust.

CONCLUSION

Though the recently qualified radiographers from our local University experienced some contextual challenges upon assuming their professional roles, they appeared well-prepared for their clinical roles. Standardised induction and mentorship programmes should be implemented to facilitate the transition process from student to qualified radiographer.

Justification of radiological procedures: Radiographers' experiences at two public hospitals

BACKGROUND

Justification is a process conducted by the radiographer in consultation with the radiologist to evaluate radiological procedures ordered by doctors. The main purpose for justifying all radiologic procedures is to assess the benefits and risks of a requested radiographic procedure and determine whether exposure will continue. Furthermore, justification helps to prevent unnecessary radiation exposure and reduce the chances of harmful effects of ionizing radiation.

OBJECTIVES

The study aimed to explore the experiences of radiographers regarding the justification of radiological procedures at two public hospitals in Namibia METHODS: This study made use of a qualitative, exploratory design. A total number of 13 purposefully selected radiographers from radiology departments in two tertiary public - hospitals in Namibia were interviewed using a semi-structured interview guide and audio recorder. All interviews were conducted face-to-face until data saturation was achieved. Data were analysed using Atlas.ti Windows (version 9.0 using Tesch's 8-step method of qualitative data analysis to generate themes and subthemes.

FINDINGS

The participants experienced an enhancement of patient care through enhanced radiation protection and optimised patient care. They also experienced defunct communication systems through deficient communication between radiographers and referrers, professional role conflict and incomplete referrals.

CONCLUSION

The study revealed that the justification of radiological procedures was linked to both negative and positive experiences. Enhanced patient-centred care was a positive experience related to the radiographers' job responsibilities. The defunct communication support system was a negative experience as it related to the limited availability and utilisation of communication systems that are meant to enhance and support justification by radiographers. The study recommends an in-depth study to quantify unjustified procedures in these two hospital departments. Continuous professional development focusing on justification and referral protocols must be conducted jointly between radiographers and referrers to create awareness and a platform for shared decision-making models.

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.

The value of referral information and assessment - a cross sectional study of radiographers' perceptions

Background

Radiology professionals are frequently confronted with referrals containing insufficient clinical information, which hinders delivery of safe and quality medical imaging services. There is however lack of knowledge on why and how referral information is important for radiographers in clinical practice. This study explores what purposes referral information is used/ useful for the radiographers, and the benefits of involving them in assessing referrals.

Methods

A cross sectional study was conducted of radiographers recruited through the International Society of Radiographers and Radiological Technologists (ISRRT) networks. A questionnaire was developed and distributed consisting of 5-point Likert scale questions on a) use/usefulness of referral information for 12 listed purposes and b) the benefits of radiographers assessing referrals for 8 possible reasons. The questionnaire was validated using a test–retest reliability analysis. Kappa values ≥0.6 were accepted. SPSS software was used for data analysis and chi-square tests to determine associations between using referral information and background variables.

Results

Total respondents were 279 (n = 233 currently in clinical practice and n = 46 in other positions). The participants in clinical practice ranked high all 12 listed purposes for use of referral information, and all except one received ≥60% ‘frequent’/‘very frequent’ responses. Use for patient identification purposes received the highest score (97% ‘frequently’/‘very frequently’ responses), followed by ensuring imaging of the correct body region (79% ‘very frequently’ responses). Radiographers not currently working in clinical practice ranked the ‘usefulness’ of listed items similarly. Significant associations between frequent use of referral information and education level were not observed, and only three items were significantly associated with modality of practice. All items on benefits of radiographers assessing referrals received ≥75% ‘agree’/‘strongly agree’ scores. The items ranked highest were promotes radiographers’ professional responsibility and improves collaboration with radiologists and referring clinicians, with 72 and 67% strongly agreed responses, respectively.

Conclusion

Radiographers use referral information frequently for several purposes. The referral information is needed for justifying and optimising radiological procedures, hence crucial for ensuring patient safety and high-quality services. This further emphasis why radiographers perceive several benefits of being involved in assessing the referral information.

Radiographers' actions and challenges when confronted with inappropriate radiology referrals

OBJECTIVES

To explore radiographers' actions toward inappropriate referrals and hindrances to assessing referrals.

METHODS

An online survey was distributed to radiographers via the International Society of Radiographers and Radiological Technologists (ISRRT) networks. The questionnaire consisted of 5-point Likert scale questions on radiographers' actions to supplement referral information, actions for unjustified referrals and hindrances to referral assessment. The questionnaire was validated using a test-retest reliability analysis. Kappa values ≥ 0.6 were accepted. SPSS software was used for data analysis and chi-square tests to compare subgroups.

RESULTS

Total responses received were 279. The most reported actions to supplement missing referral information were to ask the patient or relative, examine the body region of concern and check medical records (73%, 70%, 67%, responded often/always, respectively). The actions when confronted with unjustified referrals were reported equally to consult the radiologist, referring clinician and radiographer (69-68% often/always responses). The hindering factors ranked high (agreed/strongly agreed responses) pertained to inadequate information in referral forms (83%), ineffective communication among healthcare professionals (79%), lack of training (70%) and allocated time (61%). Statistically significant associations were observed for a few actions and hindrances with education level, modality of practice and responsibility to screen imaging referrals.

CONCLUSION

Radiographers consult colleagues about suspected unjustified referrals. Effective communication pathways, training and time allocation to improve radiographers' skills to assess referrals may enhance appropriate imaging and delivery of quality patient care.

KEY POINTS

• Radiographers' actions of supplementing missing information in radiology referrals facilitate provision of high-quality health services. • Radiographers' strategy when confronted with inappropriate referrals is to consult radiologists and referring clinicians. • Better inter-professional communication and organisation of tasks can facilitate radiographers' participation in referral assessment to ensure appropriate imaging.

There's nothing plain about projection radiography! A discussion paper

OBJECTIVES

Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers' professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field.

KEY FINDINGS

Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%).

CONCLUSION

By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession.

IMPLICATIONS FOR PRACTICE

Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.

Oncology patients' experience of a routine surveillance CT examination: Relationships and communication

INTRODUCTION

The question of radiographers' capacity to establish short time relationships as well as decoding patients' needs and expectations simultaneously with performing high technological examination frequently arises in the clinical practice. Additionally, the constant focus on technology and the fact that radiographers work in high productive departments accentuates the issue. Patients' experiences with radiology seem to be a neglected area of research and may help to identify areas for improvement in this highly technological and productive field. The purpose of the study was to explore oncology patients' experiences of a routine surveillance CT examination and their need for relationships and communication with the radiographer as part of the CT examination.

METHODS

The study included patients diagnosed with cancer and in need of a CT examination as part of their course of treatment, and 21 semi-structured interviews were conducted. The interviews were analysed using qualitative content analysis. Themes were constructed and narratively reported. To increase validity, the themes were identified, discussed and formulated by the author group.

RESULTS

Four themes were constructed based on the analysis: 1: The professional radiographer, 2. Disease and treatment, 3. The examination environment and 4: While waiting.

CONCLUSION

The lack of focus on radiographers' capacity to establish relations, to consider each patient as an individual human being and being able to show sincere interest and empathy were highlighted. Findings illuminated the patient's need for relationship and communication with the radiographer as part of a CT examination.

Radiographers' perceptions of their professional rights in diagnostic radiography: a qualitative interview study

BACKGROUND

Considering the ethics of each profession is important as inter-professional collaboration increases. Professional ethics creates a basis for radiographers' work, as it includes values and principles, together with rights and duties that guide and support professionals. However, little is known about radiographers' rights when it comes to professional ethics.

THE AIM

The aim of this study was to describe radiographers' perceptions and experiences of their professional rights. The ultimate aim was to increase the understanding of professional ethics in this context and support radiographers' ethical pondering in diagnostic radiography.

METHODOLOGY

A qualitative method was used. Semistructured group interviews with 15 radiographers were conducted in spring 2013 at two publicly provided diagnostic imaging departments in Finland. Data were analysed by inductive content analysis. All the participants were women, and they had worked as radiographers for an average of 18 years.

FINDINGS

Based on our analysis, radiographers' professional rights consisted of rights related to their expertise in radiography and the rights related to working conditions that ensured their wellbeing. Expertise-based rights included rights to plan, conduct and assess radiological care with patient advocacy. Radiographers have the right to contribute to a culture of safe radiation in their organisation and to use their professional knowledge to achieve their main target, which is the safe imaging of patients. Radiographers also have right to work in conditions that support their well-being, including the legal rights stated in their employment contract, as well as their rights concerning resources at work.

CONCLUSIONS

Radiographers' professional rights are an elementary and multidimensional part of their clinical practice. In future, more theoretical and empirical research is needed to deepen the understanding of their rights in the clinical practice and support radiographers on issues related to this aspect of their work.