Opening the debate on MRI practitioner education – Is there a need for change?

Radiographer training for screening of patients referred for Magnetic Resonance Imaging: A scoping review

INTRODUCTION

Strict safety practices are essential to ensure the safety of patients and staff in Magnetic Resonance Imaging (MRI). Training regarding the fundamentals of MRI safety is well-established and commonly agreed upon. However, more complex aspect of screening patients, such as image review or screening of unconscious patients/patients with communication difficulties is less well discussed. The current UK and USA guidelines do not suggest the use of communication training for MRI staff nor indicate any training to encourage reviewing images in the screening process. This review aims to map the current guidance regarding safety and patient screening training for MRI diagnostic and therapeutic radiographers.

METHODS

A systematic search of PubMed, Trip Medical database and Radiography journal was conducted. Studies were chosen based on the review objectives and pre-determined inclusion/exclusion criteria using the PRISMA-ScR framework.

RESULTS

Twenty-four studies were included in the review, which identified some key concepts including MRI safety training and delivery methods, screening and communication, screening of unconscious or non-ambulatory patients and the use of imaging.

CONCLUSION

Training gaps lie within the more complex elements of screening such as the inclusiveness of question phrasing, particularly to the neurodivergent population, how we teach radiographers to screen unconscious/unresponsive patients and using imaging to detect implants.

IMPLICATIONS FOR PRACTICE

The consequences of incomplete or inaccurate pre-MRI safety screening could be the introduction of unexpected implants into the scanner or forgoing MRI for a less desirable modality. The development of enhanced training programs in implant recognition using imaging and communication could complement existing training.

New Zealand and Australian MRI technologists' (radiographers) MRI safety knowledge and confidence levels

INTRODUCTION

The MRI technologist (radiographer) is at the frontline of MRI safety decision-making and has the primary responsibility to provide high quality, efficient and safe patient care in the MRI environment. As MRI technology advances and new safety issues emerge, this study aimed to provide a snapshot of the preparedness of MRI technologists in New Zealand (NZ) and Australia to practise confidently and safely.

METHOD

An online questionnaire, administered via Qualtrics and covering a range of MRI safety topics, was distributed in 2018 via the New Zealand MR Users Group, the MRI Australia-NZ Group Facebook, and relevant professional bodies.

RESULTS

A total of 312 MRI technologists attempted the questionnaire, with 246 surveys being fully completed. Of these, 61% (n = 149) were in Australia, 36% (n = 89) in NZ, and 3% (n = 8) from other countries. Findings indicated that current MRI education is preparing MRI technologists in NZ and Australia to practise safely. However, while these technologists are confident in their MRI safety decision-making, accuracy levels within some groups need addressing.

CONCLUSION

To develop a consistent level of safe practice, it is proposed that a minimum level of MRI-specific education is defined and mandated to practise. Continuing professional development focussing on MRI safety must be encouraged and, if audited as part of registration, could also be mandated. Implementation of a supporting regulatory framework similar to NZ is recommended for other countries.

IMPLICATIONS FOR PRACTICE

All MRI technologists are responsible for the safety of their patients and staff. Employers must support and ensure MRI-specific education has been completed. Ongoing engagement in MRI safety events provided by MRI safety experts, professional bodies and/or universities is essential to remain up-to-date.

Graduate radiographers' experience of learning MRI practice: A pilot study using constructivist grounded theory methodology

INTRODUCTION

Traditionally radiographers, specialising in MRI practice, would have first worked in a general imaging department, however due to the shortage of MRI radiographers within the UK, opportunities have now arisen for graduate radiographers to enter MRI practice directly. There are no requirements to undertake formal MRI qualifications or competency frameworks for UK MRI practitioners. Consequently, training is often conducted in house by other MRI practitioners and is not regulated or audited. The aim of this pilot study was to explore graduate radiographers' experiences of learning MRI practice.

METHODS

A constructivist grounded theory methodology was implemented.  Purposeful sampling was employed, and participants were recruited via social media. Participants (n3) had all entered MRI practice directly from graduation within the last 5 years and were currently working in the UK. Data was collected through semi-structured interviews, undertaken virtually and audio recorded. Analysis of the data was conducted using the constructivist grounded theory process, as set out by Charmaz and NVivo software was used to manage the data.

RESULTS

Five core categories emerged from the data, 1) aspirations to enter MRI practice, 2) engaging in the learning process, 3) influences of the learning environment, 4) confidence in competence, 5) identification of the need for further learning. These core categories describe the stages of the participants' experience of learning MRI practice.

CONCLUSION

The results of this pilot study demonstrate the pathway taken by graduate MRI radiographers through their MRI educational experience. Undergraduate placements, within MRI, influenced their choice to enter MRI practice, however it did not sufficiently prepare them and further education was necessary. All the participants were provided with a structure to their learning and assessment of competence was required, although the complexity of which varied between participants. Despite feeling competent to undertake MRI imaging examinations all participants sought out opportunities to engage with more formalised MRI radiographer education. Consequently, there may be a need for a standardised national training programme for MRI radiographers to ensure consistency of training and assessment. Further research with a larger participant size is required to consolidate these findings.

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.

Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role

INTRODUCTION

Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers.

METHOD

A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied.

RESULTS

Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers.

CONCLUSION

Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge.

IMPLICATIONS FOR PRACTICE

Role development and changes in education for therapeutic radiographers.

IPEM topical report: guidance on the use of MRI for external beam radiotherapy treatment planning. Phys Med Biol 2021;66:055025. [PMID: 33450742 DOI: 10.1088/1361-6560/abdc30]

This document gives guidance for multidisciplinary teams within institutions setting up and using an MRI-guided radiotherapy (RT) treatment planning service. It has been written by a multidisciplinary working group from the Institute of Physics and Engineering in Medicine (IPEM). Guidance has come from the experience of the institutions represented in the IPEM working group, in consultation with other institutions, and where appropriate references are given for any relevant legislation, other guidance documentation and information in the literature. Guidance is only given for MRI acquired for external beam RT treatment planning in a CT-based workflow, i.e. when MRI is acquired and registered to CT with the purpose of aiding delineation of target or organ at risk volumes. MRI use for treatment response assessment, MRI-only RT and other RT treatment types such as brachytherapy and gamma radiosurgery are not considered within the scope of this document. The aim was to produce guidance that will be useful for institutions who are setting up and using a dedicated MR scanner for RT (referred to as an MR-sim) and those who will have limited time on an MR scanner potentially managed outside of the RT department, often by radiology. Although not specifically covered in this document, there is an increase in the use of hybrid MRI-linac systems worldwide and brief comments are included to highlight any crossover with the early implementation of this technology. In this document, advice is given on introducing a RT workload onto a non-RT-dedicated MR scanner, as well as planning for installation of an MR scanner dedicated for RT. Next, practical guidance is given on the following, in the context of RT planning: training and education for all staff working in and around an MR scanner; RT patient set-up on an MR scanner; MRI sequence optimisation for RT purposes; commissioning and quality assurance (QA) to be performed on an MR scanner; and MRI to CT registration, including commissioning and QA.

Computer based simulation in CT and MRI radiography education: Current role and future opportunities

OBJECTIVE

The use of Computer-based simulation (CBS), a form of simulation which utilises digital and web based platforms, is widely acknowledged in healthcare education. This literature review explores the current evidence relating to CBS activities in supporting radiographer education in CT and MRI.

KEY FINDINGS

Journal articles published between 2010 and 2020 were reviewed (n = 663). The content was evaluated and summarised with the following headings; current utility, overview of CBS types, knowledge acquisition and evaluation, and student perspective. CBS utility in CT and MRI radiography education is limited. Its current use is for pre-registration education, and the interfaces used vary in design but are predominantly used as a preclinical learning tool to support the training of geometric scan planning, image acquisition and reconstruction, and associated technical skills. CBS was positively acknowledged by student radiographers; based on its inherent flexibility, self-paced learning and the ability to practice in a safe environment. Nonetheless, the educational validation of CBS in CT and MRI education pertaining to knowledge and skill acquisition has not been fully assessed through rigorous academic assessments and metrics.

CONCLUSION

The current use of CBS in CT and MRI education is limited. The development of software programmes with functionality and capability that correlates with current clinical practice is imperative; and to enable more research in CBS utility to be undertaken to establish the efficacy of this pedagogical approach.

IMPLICATIONS FOR PRACTICE

Due to limited placement opportunities, the use of simulation is increasing and evolving; in line with the approach to design and deliver high quality Simulation Based Education (SBE) in Diagnostic Radiography education. The continued development, utility and evaluation of CBS interfaces to support student radiographers at pre and post registration level is therefore essential.

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.

Keeping Up with the Hybrid Magnetic Resonance Linear Accelerators: How Do Radiation Therapists Stay Current in the Era of Hybrid Technologies?

The benefits of integrating magnetic resonance imaging (MRI) into radiotherapy planning have long been extolled, first appearing in the literature as early as 1986. Most often described as a tool to be used when registered to a planning computed tomography to improve target and organ at risk delineation, the use of MRI for on-board image guidance and as a sole imaging modality throughout the entire radiotherapy pathway is quickly becoming a reality for appropriately selected patient populations in academic centres throughout the world. With the commercialization of these integrated magnetic resonance - radiotherapy delivery systems, an MRI-only workflow will prove beneficial, with MRI being used for treatment planning, localization, and on-treatment plan adaptation. Despite these technological advancements, recent surveys indicate uptake of MRI in radiotherapy as a routine practice has proven challenging. Reasons cited for this slow uptake were primarily related to health economics and/or accessibility. Furthermore, these surveys, like much of the academic literature, shy away from focusing on safe, sustainable staffing models enabled by comprehensive and appropriate education and training. In stark contrast to conebeam computed tomography guided therapy, magnetic resonance - radiotherapy systems are currently being operated by teams of physicians, radiographers, and physicists because of the diverse and complex tasks required to deliver treatment. The pace of innovation in RT remains high and unfortunately the window of opportunity to implement appropriate education continues to narrow. It is vital that we establish a framework to future-proof our profession. In the era of magnetic resonance-guided radiotherapy, we have yet to address the question of how to devise a consensus on the requisite knowledge, skills, and competence for radiation therapists and therapy radiographers using and/or operating MRI that provides guidance, without becoming prohibitively costly or time consuming.