Patient obesity and the practical experience of the plain radiography professional: On everyday ethics, patient positioning and infelicitous equipment

Bourdieu's field theory applied to the story of the UK radiography profession: A discussion paper

OBJECTIVES

There are many suggestions offered within the literature to decide if a job type is a profession, some using tick box type trait and characteristics analyses to compare the actions and qualities of individuals to a predefined list. However, there is no specific way to resolve what makes or defines a profession. Writers in many disciplines, including radiography, have used these different models, sometimes with conflicting results. This paper explores the use of Bourdieu's replacement of the concept of profession with that of a 'field', meaning a network of occupants with common attributes, in this case radiographers, in an attempt to resolve this issue.

FINDINGS

In the UK, radiography practitioners and professional bodies generally use the term profession to describe radiography, and this paper explores a defence of the term for radiography. Using Bourdieu's field theory not only helps define a profession, but also explains the difficulties at the boundaries of professions, and the work needed to protect a profession as a credible entity.

CONCLUSION

This paper supports the argument that radiography is a profession when using Bourdieu's field theory. Radiography continues to work to maintain its status by increasing its symbolic capital by increasing the research output and evidence base of the profession and through role extension.

IMPLICATIONS FOR PRACTICE

Radiographers can perhaps be assured that radiography is a profession when using Bourdieu's field theory. This paper shows how theoretical frameworks and concepts from outside radiography can be used to support new ways of thinking within the profession.

Elgazzar A. Potential Pitfalls of Steatopygia on Bone Scintigraphy and the Added Value of Single Photon Emission Computed Tomography and Single Photon Emission Computed Tomography/Computed Tomography

OBJECTIVES

The aims of the study were to assess the prevalence of steatopygia on bone scintigraphy of obese patients and to evaluate its effect on the appearance of the lumbar spine, and the added benefit of single photon emission computed tomography (SPECT) and SPECT/computed tomography (SPECT/CT) in overcoming possible artifacts.

METHODS

Patients with BMI ≥30 who underwent bone scintigraphy between 2016 and 2019 were included. Three nuclear medicine consultants reviewed the studies to determine whether significant steatopygia was present, and whether it resulted in attenuation of underlying lumber spine and crease edge artifact. SPECT or SPECT/CT images were reviewed to evaluate their impact on diagnosis.

RESULTS

56 out of the 100 patients were noted to have steatopygia on planar images. Among the group of 80 obese patients, 50% showed steatopygia, while in the group of 20 morbidly obese patients, 80% showed steatopygia. 32 of the 56 patients with steatopygia had significant attenuation at the lower lumber vertebrae. Nine of these patients showed crease edge artifact. SPECT and SPECT/CT clarified the scintigraphic abnormalities noted in all patients including those with edge artifact alleviating diagnostic difficulty. Among the 9 patients with edge artifact, 6 patients showed normal appearance on SPECT/CT images while three showed true abnormalities.

CONCLUSIONS

Steatopygia is common on bone scintigraphy of obese patients, higher in females and morbidly obese patients. Obesity-related artifacts in bone scintigraphy, including attenuation effect and edge artifact, are common in this patient group. SPECT or SPECT/CT improves the diagnostic accuracy by overcoming the effects of steatopygia seen on planar images.

Stress, a reflective self and an internal locus of control: On the everyday clinical placement experiences of older undergraduate radiographers in the UK

INTRODUCTION

Extant evidence indicates that the stresses experienced by younger undergraduate radiographers and their older counterparts vary considerably. Much of this difference has, however, emerged from analyses of the academic component of a radiography degree whereas little work has focused to date upon the specific business of clinical placement. Given this, the research herein reports findings from a qualitative study of how older undergraduate radiography students in the UK assemble their stress and stressors around clinical placement.

METHODS

An Interpretative Phenomenological Analysis was employed. N = 6 older undergraduate students undergoing their final year placement were purposively recruited from a variety of hospitals. With full institutional ethical approval, a semi-structured interview was conducted with each participant.

RESULTS

Four superordinate themes emerged. These were: (1) Self-identity and perceived competence; (2) Understaffing, instability and affect; (3) Episodic experience and feeling 'thrown-in'; (4) Unpreparedness for the challenging patient. Critically, each theme describes an interaction between stressor, experience of stress and self.

CONCLUSION

While familiar stressors were apparent, the older participating students actively made sense of them in terms of their manageability. This provides a strong contrast with existing literature, which tends to imply a more externalised locus of control among (largely younger) students.

IMPLICATIONS FOR PRACTICE

Stress in the NHS is a continuing issue and there is a clear rationale for further investigation to ascertain the level of clinical support available and to determine whether further improvements could assist students on clinical placement. Collaboration between academic institutions and clinical sites would allow open discussion around clinical stress experienced by radiography students, with locus of control a potential point of focus, fostering a proactive partnership approach to stress-management and identification of difficulties before they exacerbate.

Charting the practical dimensions of understaffing from a managerial perspective: The everyday shape of the UK's sonographer shortage

INTRODUCTION

Across the last two decades, ultrasound services in many healthcare sectors have become increasingly pressurised as a consequence of upsurging demand and difficulties in recruiting viable clinicians. Indeed by 2013, the UK government's Migration Advisory Committee had listed sonography as an official 'shortage specialty'. Comparatively little research has to date, however, explored the impacts of this situation upon the departments themselves, and the individuals working therein. The core purpose of this study is, thus, to lend qualitative depth to current understandings of the frontline situation in the UK's ultrasound units, many of which are understaffed, from the perspective of their managers.

METHODS

Using a thematic analysis informed by a Straussian model of Grounded Theory, N = 20 extended accounts provided by ultrasound department leads in public (n = 18) and private (n = 2) units were explored.

RESULTS

Four global themes emerged from the analysis of which the first two (the broadly sociological matters) are described in this paper. Theme 1 addresses how a lack of staff in the broader ultrasound economy has created a troublesome migratory system in contemporary UK ultrasound. Theme 2 addresses how this economy works chiefly to the advantage of the most junior and the most senior clinicians, often leaving mid-career professionals in the borderline impossible situation of having to concurrently occupy both junior and senior roles.

CONCLUSIONS

The findings ideally open up debate on some key practical contingencies of the UK's sonographer shortage, and reflect upon literature regarding the nuanced aspects of a shifting healthcare workplace constitution.

Managing discomfort and developing participation in non-emergency MRI: Children's coping strategies during their first procedure

INTRODUCTION

Building on existing work, this paper aims to develop a detailed analysis of the practical coping strategies developed by children who had not previously experienced an MRI, regarding a non-emergency examination of the brain.

METHODS

Semi-structured interviews with 22 children, aged between eight and sixteen years, were conducted immediately post-procedure. Emergent data were thematically analysed in line with the core precepts of Grounded Theory, and triangulated against interview data with their parents where pertinent.

RESULTS

The primary concern among interviewees related to how they had coped with the discomfort of an unfamiliar medical procedure; this was recurrently managed through a process herein termed Participation Development. This comprised three phases. The first, preparative participation, describes the children's reported attempts to ready themselves for the examination (with parents) ahead of arriving in hospital. The second, enabling participation, describes how the children (with input from parents and radiographers) endeavoured to understand what was to come, and select viable distraction techniques. Finally, sustaining participation describes the children's reports of actualizing their preparations during the examination itself. Where the overall process of participation development was successful, the children reported a sense of mastery, growth and even joy.

CONCLUSION

While much work in the domain portrays children as relatively 'passive' agents during an MRI procedure, the findings herein point to how they can (with varying degrees of success) actively and constructively work with others. This, it is contended, has direct import for the improvement of support, both prior to and within a procedure itself.

Informing radiography curriculum development: The views of UK radiology service managers concerning the 'fitness for purpose' of recent diagnostic radiography graduates

INTRODUCTION

Recent years have seen significant changes in the way medical imaging services are delivered, rapid changes in technology and big increases in the number and ranges of examinations undertaken. Given these changes the study aimed to critically evaluate the fitness for purpose of newly qualified diagnostic radiography.

METHOD

The study employed a grounded theory approach to analyse the interviews of 20 radiology managers from a range of medical imaging providers across the UK.

RESULTS

Four key themes emerged from the analysis. These were: curriculum content and structure review; diversification in the role of the radiographer; professionalism and coping and the reformation of career structures.

CONCLUSION

The results indicate the role of the radiographer is now in a state of flux and challenge radiology managers and educators to design curricula and career structures which are better matched the role of the radiographer in the very rapidly changing technological, organisational and social contexts of modern society.

Leadership and the everyday practice of Consultant Radiographers in the UK: Transformational ideals and the generation of self-efficacy

INTRODUCTION

This paper outlines findings from a broader, two-year project investigating the role of Consultant Radiographers (CRs) in the UK, focussing specifically on the leadership aspect of that role.

METHODS

Using a qualitative-thematic approach, the leadership-related experiences of a purposive sample of six participating CRs are explored, alongside the systems through which they evaluated how successful they had been as leaders.

RESULTS

It is evidenced that many of the ways in which participants describe their own leadership practice, particularly in the intra-team domain, is consistent with the precepts of the Transformational Leadership Model. For example, they highlight how they have asserted positive influence and encouraged collective action and decision-making. However, the experiential focus of the analysis reveals that in specific examples of practice, the transformational approach was not always seen as the most useful route to a productive outcome given constrictions on time and other resources within real professional environments. More 'direct' managerial approaches were sometimes deemed necessary, and at others leadership was reduced to simply 'solving other people's problems'. It was also found that the manner in which participants evaluated their own success as leaders was a practical concern, based in part upon having satisfied 'hard' institutional goals, but also on the more personal business of having affirmatively 'surprised' oneself, or a general sense of feeling trusted by colleagues.

CONCLUSION

These findings may help support CRs in the business of real leadership, not least through better understanding how even apparently mundane outcomes can have significant impacts on professional self-efficacy.