Observation and Institutional Ethnography: Helping Us to See Better

Impact of intelligent virtual and AI-based automated collimation functionalities on the efficiency of radiographic acquisitions

INTRODUCTION

Intelligent virtual and AI-based collimation functionalities have the potential to enable an efficient workflow for radiographers, but the specific impact on clinical routines is still unknown. This study analyzes primarily the influence of intelligent collimation functionalities on the examination time and the number of needed interactions with the radiography system.

METHODS

An observational study was conducted on the use of three camera-based intelligent features at five clinical sites in Europe and the USA: AI-based auto thorax collimation (ATC), smart virtual ortho (SVO) collimation for stitched long-leg and full-spine examinations, and virtual collimation (VC) at the radiography system workstation. Two people conducted semi-structured observations during routine examinations to collect data with the functionalities either activated or deactivated.

RESULTS

Median exam duration was 31 vs. 45 s (p < 0.0001) for 95 thorax examinations with ATC and 94 without ATC. For stitched orthopedic examinations, 34 were performed with SVO and 40 without SVO, and the median exam duration was 62 vs. 82 s (p < 0.0001). The median time for setting the ortho range - i.e., the time between setting the upper and the lower limits of the collimation field - was 7 vs. 16 s for 39 examinations with SVO and 43 without SVO (p < 0.0001). In 109 thorax examinations with ATC and 112 without ATC, the median number of system interactions was 1 vs. 2 (p < 0.0001). VC was used to collimate in 2.4% and to check the collimation field in 68.5% of 292 observed chest and other examinations.

CONCLUSION

ATC and SVO enable the radiographer to save time during chest or stitched examinations. Additionally, ATC reduces machine interactions during chest examinations.

IMPLICATIONS FOR PRACTICE

System and artificial intelligence can support the radiographer during the image acquisition by providing a more efficient workflow.

Twelve tips for how institutional ethnography (IE) is conducted in health professions education research

Institutional ethnography (IE), a term coined by sociologist Dorothy Smith, explores the nuances of institutions and their complex relationships in sociology. IE is an approach to studying and analysing social organization, and it provides a more holistic understanding of 'invisible' relationships that govern institutions and how those relationships interact with each other. Health sciences researchers in patient care, patient experience, and allied health professionals have recently become more interested in the use of this methodology and how to incorporate it into their research. However, in health professions education (HPE) there is little use of IE. We hypothesize this may be because of limited practical knowledge of this methodology. This paper serves as an introduction to the use of IE in HPE, describing the differences between IE and traditional ethnographies, recognizing the common pitfalls when utilising IE, and incorporating texts into IE. While ethnographies may be daunting to researchers less familiar with these approaches, the tips in this paper will provide an introduction and help educators and researchers successfully navigate the use of IE in health profession scholarship and education.

Using Qualitative Methods to Understand the Interconnections Between Cities and Health: A Methodological Review

Objective: Using different perspectives and methods to investigate the links between the urban phenomenon and health is critical in an urbanizing world. This review discusses qualitative methods in the context of urban health research. Methods: We conducted a narrative review following these steps: We identified the qualitative data collection, analysis and sampling methods that could be more relevant for the problems researched in the urban health field. We conducted searches for methodological articles and other documents about those methods. We included some influential materials and examples of empirical urban health studies using those methods. Results: We included 88 studies and identified several qualitative data gathering, analysis and sampling methods relevant for urban health researchers. We present those methods, focusing their strengths and limitations, and providing examples of their use in the field of urban health. These methods are flexible and allow in-depth analysis of small samples by collecting and analyzing rich and nuanced data. Conclusion: This article should contribute to a better understanding of how, and when, qualitative methods may improve our knowledge on urban health.

Legislatively Excluded, Medically Uninsured and Structurally Violated: The Social Organization of HIV Healthcare for African, Caribbean and Black Immigrants with Precarious Immigration Status in Toronto, Canada

African, Caribbean and Black immigrants face persistent legislative barriers to accessing healthcare services in Canada. This Institutional Ethnography examines how structural violence and exclusionary legislative frameworks restrict the right to HIV healthcare access for many Black immigrants. We conducted semi-structured interviews with Black immigrants living with HIV (n = 20) and healthcare workers in Toronto, Canada (n = 15), and analyzed relevant policy texts. Findings revealed that exclusionary immigration and healthcare legislation shaping and regulating immigrants' right to health restricted access to public resources, including health insurance and HIV healthcare and related services, subjecting Black immigrants with precarious status to structural violence. Healthcare providers and administrative staff worked as healthcare gatekeepers. These barriers undermine public health efforts of advancing health equity and ending HIV "while leaving no one behind." We urge continued policy reforms in Canada's immigration and healthcare systems regarding HIV care access for Canada's precarious status immigrants.