Improving the quality of radiological examinations: effectiveness of an internal participatory approach

Using a digital transformation framework to explore the experiences of radiographers in the use of digital radiography in a low-resource setting

INTRODUCTION

Digital radiography (DR) systems have revolutionised radiographers' experiences, particularly those accustomed to analogue methods. Despite the advantages, DR poses challenges due to its cost and technical requirements, especially in low-resource settings. Zambia, predominantly reliant on analogue systems, is gradually transitioning to DR. Understanding radiographers' experiences with DR is crucial for leveraging its benefits. Therefore, this study aimed to explore the experiences of Zambian radiographers with DR using the digital transformation framework (DTF).

METHODS

This qualitative method employed a descriptive phenomenological approach to interview 14 radiographers from five governmental hospitals in the Copperbelt province of Zambia. Interviews were conducted face-to-face, digitally audio-recorded, transcribed, and analysed using Colaizzi's (1978) phenomenological framework and Natural Language Processing (NLP).

RESULTS

Following data analysis, three main themes were developed: education and training in DR, departmental workflow in DR, and challenges of DR. The findings revealed predominantly positive experiences among radiographers using DR, with improved patient waiting times, image quality, workflow efficiency, and job satisfaction. However, challenges such as technological adaptation and system breakdowns were identified.

CONCLUSION

The study highlighted the positive experiences of radiographers during the initial implementation of DR in Zambian medical facilities. Although challenges exist, the findings suggest that they can be overcome by improving infrastructure and training, thereby maximising the benefits of DR.

IMPLICATION OF PRACTICE

The positive experiences demonstrated by radiographers in implementing DR in Zambian medical facilities indicate that targeted training and infrastructure improvements can enhance workflow efficiency, image quality, and overall patient care.

Framework for health care quality and evidence-based practice in radiology departments: A regional study on radiographer's perceptions

INTRODUCTION

The main goals of this study were to describe, in an integrated and multidimensional way, the conditions related to the quality of care in radiology departments from Algarve (Portugal), to assess the perspective of radiographers on the use of scientific evidence in clinical practice and to validate a model that characterizes the conditions for continuous improvement.

METHODS

A cross sectional study was performed in four radiology departments from public and private healthcare facilities from Algarve region (Portugal). A paper-based survey was sent to all radiographers to assess the quality systems implemented in their radiology departments and their perspective on the use of scientific evidence in clinical practice.

RESULTS

In total, 62 radiographers (61.4%) completed the survey. The quality dimensions that obtained the highest degree of compliance were the existence of quality assurance and improvement activities (43.0%), existence of standards in clinical practice of radiographers (42.7%) and the existence of special provisions (37.6%). The quality dimension related to patient's involvement was the one with the lowest level of compliance. Moreover, from the radiographers perspective, positive responses were obtained related to evidence-based actions (83.0%), sources of evidence (76.0%) and the significance of research activities (74.0%).

CONCLUSION

These findings suggest that a new framework based on four factors (Support for Information; Organizational Capability to Technical Quality of Care; Patient Involvement and Evidence-Based Radiology), should be considered in the establishment of strategic policies that better define the provision of diagnostic procedures and professional practices in radiology departments from Algarve region, based on quality improvement systems and better patient safety.

IMPLICATIONS FOR PRACTICE

There is a need to include patients in the decision-making process, to involve radiographers in quality assurance and improvement activities and to implement quality monitoring mechanisms within radiology departments under study.

Inter-rater reliability in quality assurance (QA) of pediatric chest X-rays

PURPOSE

The goal of the study is to determine the inter-rater agreement on multiple factors that were utilized to evaluate the quality of pediatric chest X-ray exams from different levels of healthcare provision in an African setting.

METHODS

The image quality of pediatric chest X-rays from 3 South African medical centers of varying level of healthcare service were retrospectively assessed by 3 raters for 12 quality factors including: (1) absent body parts; (2) under inspiration; (3) patient rotation; (4) scapula in the way; (5) patient kyphosis/lordosis; (6) artefact/foreign body; (7) central vessel visualization; (8) peripheral vessels visualization; (9) poor collimation; and (10) trachea and bronchi visualization; (11) post-cardiac vessel visualization; and (12) absent or wrong image orientation. Analysis was performed using the Brennan--Prediger coefficient of agreement for inter-rater reliability and Cochran's Q statistic and McNemar's test for inter-rater bias.

RESULTS

1077 X-rays were reviewed. The least difference between observers in the frequency of the errors was noticed for factors (1) absent body parts and (12) absent or wrong image orientation with almost perfect agreement between raters. κ score for these two factors among all raters and between each pair of raters was more than 0.95 with no significant inter-rater bias. Conversely, there was poor agreement for the remaining factors with the least agreed on being factor (3) patient rotation with a κ score of 0.23. This was followed by factors (2) under inspiration (κ score of 0.32) and factors (4) scapula in the way (κ score of 0.35) respectively. There was significant inter-rater bias for all these three factors.

CONCLUSION

Many of the factors used to assess the quality of a chest X-ray in children demonstrate poor reliability despite mitigation against variations in training, standard quality definitions and level of healthcare service provision. New definitions, objective measures and recording tools for assessing pediatric chest radiographic quality are required.