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Woznitza N, Ghimire B, Devaraj A, Janes SM, Piper K, Rowe S, Bhowmik A, Hayes N, Togher D, Arumalla N, Skyllberg E, Au-Yong ITH, Geary S, George B, Sheard S, Ellis S, Shah Z, Maughn S, Duffy SW, Baldwin D. Impact of radiographer immediate reporting of X-rays of the chest from general practice on the lung cancer pathway (radioX): a randomised controlled trial. Thorax 2023; 78:890-894. [PMID: 36351688 PMCID: PMC10447363 DOI: 10.1136/thorax-2022-219210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022]
Abstract
The National Optimal Lung Cancer Pathway recommends rapid progression from abnormal chest X-rays (CXRs) to CT. The impact of the more rapid reporting on the whole pathway is unknown. The aim of this study was to determine the impact of immediate reporting of CXRs requested by primary care by radiographers on the time to diagnosis of lung cancer. METHOD People referred for CXR from primary care to a single acute district general hospital in London attended sessions that were prerandomised to either immediate radiographer (IR) reporting or standard radiographer (SR) reporting within 24 hours. CXRs were subsequently reported by radiologists blind to the radiographer reports to test the reliability of the radiographer report. Radiographer and local radiologist discordant cases were reviewed by thoracic radiologists, blinded to reporter. RESULTS 8682 CXRs were performed between 21 June 2017 and 4 August 2018, 4096 (47.2%) for IR and 4586 (52.8%) for SR. Lung cancer was diagnosed in 49, with 27 (55.1%) for IR. The median time from CXR to diagnosis of lung cancer for IR was 32 days (IQR 19, 70) compared with 63 days (IQR 29, 78) for SR (p=0.03).8258 CXRs (95.1%) were reported by both radiographers and local radiologists. In the 1361 (16.5%) with discordance, the reviewing thoracic radiologists were equally likely to agree with local radiologist and radiographer reports. CONCLUSIONS Immediate reporting of CXRs from primary care reduces time to diagnosis of lung cancer by half, likely due to rapid progress to CT. Radiographer reports are comparable to local radiologist reports for accuracy. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN21818068. Registered on 20 June 2017.
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Affiliation(s)
- Nick Woznitza
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
- Radiology Department, Homerton University Hospital NHS Foundation Trust, London, UK
- Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Bhagabati Ghimire
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Anand Devaraj
- Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Keith Piper
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Susan Rowe
- Radiology Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Angshu Bhowmik
- Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Natasha Hayes
- Radiology Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Daniel Togher
- Radiology Department, Homerton University Hospital NHS Foundation Trust, London, UK
- Radiology, Epsom and Saint Helier Hospital NHS Trust, London, UK
| | - Nikita Arumalla
- Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
- Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Erik Skyllberg
- Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Iain T H Au-Yong
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Susan Geary
- Radiology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, UK
| | - Bindu George
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Sheard
- Radiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Zoheb Shah
- Wolfson Institute of Preventive Medicine, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Sue Maughn
- NHS England and NHS Improvement London, London, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - David Baldwin
- School of Medicine, University of Nottingham, Nottingham, UK
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Elshami W, Abuzaid MM, McConnell J, Baird M. Changing the model of radiography practice: Challenges of role advancement and future needs for radiographers working in the UAE. Radiography (Lond) 2022; 28:949-954. [PMID: 35841689 DOI: 10.1016/j.radi.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/04/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The radiographers' role in the United Arab Emirates (UAE) is focused on image acquisition with a willingness to accept advanced practice roles after appropriate education and training. Radiographers working in the UAE are highly motivated and ambitious to achieve those internationally identified levels of professional recognition and opportunities for role advancement. This study investigates the radiographers' perspectives, perceptions and hopes for role advancement in the UAE. METHODS A qualitative research study design using Focus Group Discussions (FGD) was used to elicit the perceptions of radiographers. Participants were radiographers working in the hospitals and clinics supervised by the Ministry of Health and Prevention. Participants were asked about the recognized tasks defined as advancement roles, needs for roles clinically, challenges and requirements to prepare radiographers to participate in extended/developed roles. The discussions were audio recorded and later transcribed by an independent research assistant. Thematic analysis was used for data analysis RESULTS: 29 radiographers participated in the FGDs, and 83% (n = 24) were interested in role advancement. FGD revealed that their current practice showed some informal extended role that may promote career progression. The most significant challenges identified by participants was their knowledge level as provided by the current curriculum and the need for education and licensing body support to accommodate change. CONCLUSION The study identified a need for education and licensing body support to enable change in roles by radiographers, through improving radiographer knowledge and experience for role advancement. IMPLICATIONS FOR PRACTICE To sustain role advancement, formal intense training and education are necessary, normally above bachelor's degree level. Furthermore, establishing standards, licensing organizations/professional bodies should be part of the transformation of the profession to enable internationally recognized models to be followed.
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Affiliation(s)
- W Elshami
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - M M Abuzaid
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - J McConnell
- Yorkshire Imaging Collaborative, United Kingdom.
| | - M Baird
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Sevens T, McGivern T. Reporting radiographer academy training model; an evaluation of the impact for trainees and clinical service. Radiography (Lond) 2022; 28:798-803. [PMID: 35221214 DOI: 10.1016/j.radi.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Demand on imaging services continues to increase on a background of complex issues and barriers to care. Collaborative cross organisational working through the development of imaging networks is recommended to address these issues including managing reporting workloads. Standardisation of reporting practices and collaborative cross region reporting radiographer training has been recommended to be supported by a regional reporting radiographer academy model to achieve these aims. This research explores the perceptions of trainees and their managers/mentor who undertook radiographer academy training model with a view to integrated imaging network formalisation in the region. METHODS An online questionnaire was designed to capture qualitative and quantitative data with three phases; 1) trainees perception of the academy model, 2) trainees perception of the differences in training models and 3) the perceptions of the managers/mentors related to the academy model. RESULTS There were overwhelmingly positive opinions of the academy training model from both cohorts in this study, with the two main benefits emerging being the protected study time away from clinical departments and minimal disruption to clinical services due to reduced onus on the local mentors. Peer support was also highlighted as a positive aspect of the model which would facilitate future integrated imaging network working. CONCLUSION The academy model has been well received by both cohorts in this study with positive outcomes highlighted and the model being seen as promoting and facilitating integrated imaging network working between departments. The small sample size of the study requires consideration when extrapolating the results to wider academy models, however some themes may be applicable. IMPLICATIONS FOR PRACTICE Investment in the reporting radiographer academy model is justified and provides a practical alternative to the traditional model.
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Affiliation(s)
- T Sevens
- South Yorkshire & Bassetlaw Integrated Care System, United Kingdom.
| | - T McGivern
- South Yorkshire & Bassetlaw Integrated Care System, United Kingdom.
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Cain G, Pittock LJ, Piper K, Venumbaka MR, Bodoceanu M. Agreement in the reporting of General Practitioner requested musculoskeletal radiographs: Reporting radiographers and consultant radiologists compared with an index radiologist. Radiography (Lond) 2022; 28:288-295. [PMID: 35000869 DOI: 10.1016/j.radi.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study assessed the inter-observer agreement of reporting radiographers and consultant radiologists compared with an index radiologist when reporting General Practitioner (GP) requested musculoskeletal radiographs. The potential effect of discordant reports on patient management and outcome was also examined. METHODS Three reporting radiographers, three consultant radiologists and an index radiologist reported on a retrospective randomised sample of 219 GP requested musculoskeletal radiographs, in conditions simulating clinical practice. A speciality doctor in radiology compared the observers' reports with the index radiologist report for agreement and assessed whether any discordance between reports was clinically important. RESULTS Overall agreement with the index radiologist was 47.0% (95% CI, 40.5-53.6) and 51.6% (95% CI, 45.0-58.1) for the consultant radiologists and reporting radiographers, respectively. The results for the appendicular and axial skeleton were 48.6% (95% CI, 41.3-55.9) and 40.9% (95% CI, 27.7-55.6) for the radiologists, and 52.6% (95% CI, 45.2-59.8) and 47.7% (95% CI, 33.8-62.1) for the radiographers, respectively. The difference in overall observer agreement between the two professional groups with the index radiologist was not statistically significant (p = 0.34). Discordance with the index radiologist's reports was judged to be clinically important in less than 10% of the observer's reports. CONCLUSION Reporting radiographers and consultant radiologists demonstrate similar levels of concordance with an index radiologist when reporting GP requested musculoskeletal radiographs. IMPLICATIONS FOR PRACTICE These findings contribute to the wider evidence base that selected radiographers with appropriate postgraduate education and training are proficient to report on musculoskeletal radiographs, irrespective of referral source.
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Affiliation(s)
- G Cain
- Radiology Department, Colchester Hospital, Turner Road, Colchester CO4 5JL, UK.
| | - L J Pittock
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury CT1 1QU, UK
| | - K Piper
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury CT1 1QU, UK
| | - M R Venumbaka
- Radiology Department, Colchester Hospital, Turner Road, Colchester CO4 5JL, UK
| | - M Bodoceanu
- Radiology Department, Colchester Hospital, Turner Road, Colchester CO4 5JL, UK
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Wuni AR, Botwe BO, Akudjedu TN. Impact of artificial intelligence on clinical radiography practice: Futuristic prospects in a low resource setting. Radiography (Lond) 2021; 27 Suppl 1:S69-S73. [PMID: 34400083 DOI: 10.1016/j.radi.2021.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Current trends in clinical radiography practice include the integration of artificial intelligence (AI) and related applications to improve patient care and enhance research. However, in low resource countries there are unique barriers to the process of AI integration. Using Ghana as a case study, this paper seeks to discuss the potential impact of AI on future radiographic practice in low-resource settings. The opportunities, challenges and the way forward to optimise the potential benefits of AI in future practice within these settings have been explored. KEY FINDINGS Some of the barriers to AI integration into radiographic practice relate to lack of regulatory and legal policy frameworks and limited resource availability including unreliable internet connectivity and low expert skillset. CONCLUSION These barriers notwithstanding, AI presents a great potential to the growth of medical imaging and subsequently improving quality of healthcare delivery in the near future. For example, AI-enabled radiographer reporting has a potential to improving quality of healthcare, especially in low-resource settings like Ghana with an acute shortage of radiologists. In addition, futuristic AI-enabled advancements such as synthetic cross-modality transfer where images from one modality are used as a baseline to generate a corresponding image of another modality without the need for additional scanning will be of particular benefit in low-resource settings. IMPLICATIONS FOR PRACTICE The urgent need for inclusion of AI modules for the training of the radiographer of the future has been suggested. Recommendations for development of AI strategies by national societies and regulatory bodies will harmonise the implementation efforts. Finally, there is need for collaboration between clinical practitioners and academia to ensure that the future radiography workforce is well prepared for the AI-enabled clinical environment.
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Affiliation(s)
- A-R Wuni
- Department of Imaging Technology and Sonography, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - B O Botwe
- Department of Radiography, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
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Luo W, Jia L, Zhang JW, Wang DJ, Ren Q, Zhang W. Andrographolide Against Lung Cancer-New Pharmacological Insights Based on High-Throughput Metabolomics Analysis Combined with Network Pharmacology. Front Pharmacol 2021; 12:596652. [PMID: 33967748 PMCID: PMC8097142 DOI: 10.3389/fphar.2021.596652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Andrographolide (Andro) has known to treat various illnesses such as colds, diarrhea, fever and infectious diseases. However, the effect mechanism of Andro is still unclear. Therefore, we used high-throughput metabolomics analysis to discover biomarkers, metabolic profiles and pathways to reveal the pharmacological action and effective mechanism of Andro against lung cancer. The metabolic effects of Andro on lung cancer animal was explored by ultra-performance liquid chromatography-triple-time of flight/mass spectrometry (UPLC-TOF/MS) analysis. Our results showed that Andro exhibited significant protective effects against lung cancer. Compared with control group, a total of 25 metabolites biomarkers was identified in urine of model animals, which 18 of them were regulated toward the normal direction after Andro treatment, and network pharmacology analysis showed that they were related with 570 proteins. Biological pathways analysis showed that the 11 metabolism pathways were regulated by Andro treatment in lung cancer mouse, and amino acid metabolism and arachidonic acid metabolism have great potential as target pathways for Andro against lung cancer. It revealed that high-throughput metabolomics combined with network pharmacology analysis provides deeply insight into the therapeutic mechanisms of natural product for promoting medicine development and disease treatment.
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Affiliation(s)
- Wen Luo
- Respiratory Department, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China
- Department of Respiratory and Critical Care, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Li Jia
- Department of Respiratory and Critical Care, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Jia-Wen Zhang
- Department of Respiratory and Critical Care, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Dong-Jie Wang
- Department of Respiratory and Critical Care, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Qiu Ren
- Department of Respiratory Medicine, Heilongjiang Provincial Hospital, Harbin, China
| | - Wei Zhang
- Department of Respiratory and Critical Care, First Affiliated Hospital, Harbin Medical University, Harbin, China
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Stevens BJ, Skermer L, Davies J. Radiographers reporting chest X-ray images: Identifying the service enablers and challenges in England, UK. Radiography (Lond) 2021; 27:1006-1013. [PMID: 33875356 DOI: 10.1016/j.radi.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The chest x-ray (CXR) is the most commonly performed x-ray examination in England, UK. Reporting radiographers provide a cost-effective and safe solution for managing CXR backlogs, but not all Trusts support this service development. This study aimed to establish the service enablers and challenges associated with training and employing radiographers to report CXR images in acute hospital sites in England, UK. METHODS Approval for this electronic survey was granted in 84 of 146 (58%) Trusts approached. The survey was open for 10 weeks during August to October 2020, comprising of qualitative and quantitative questions. Data was exported in to an Excel spreadsheet where manual thematic analysis was performed. Descriptive statistics were also generated. RESULTS Sample size was 75 (89% response rate). Thirty-three departments (44%) had at least one trainee. Most departments (n = 53, 71%) employ at least one CXR reporting radiographer. A total of 121/160 (76%) radiographers report CXRs. Number of reporting sessions shows progression. Factors enabling training and employment arise from service improvements, financial pressures, and developing the workforce. The main challenges relate to staffing issues with a number of associated sub-themes. A small faction indicated lack of radiographer interest to report CXRs due to litigation worries; possibly uncovering a new and emerging issue. CONCLUSION Enablers and challenges associated with radiographers reporting CXRs are similar to previous studies. The growth of CXR reporting radiographers and reporting sessions indicates a continuing reliance on radiographers to contributing to managing CXR backlogs. IMPLICATIONS FOR PRACTICE It is recommended that potential trainees are explicitly informed of the legal protection that will be provided, to prevent accountability concerns impacting on the continuing progression in this area of advanced practice.
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Affiliation(s)
- B J Stevens
- Radiology, Manor Hospital, Walsall Healthcare NHS Trust, Moat Road, Walsall West Midlands, WS2 9PS, UK.
| | - L Skermer
- Radiology, Manor Hospital, Walsall Healthcare NHS Trust, Moat Road, Walsall West Midlands, WS2 9PS, UK
| | - J Davies
- Radiology, Manor Hospital, Walsall Healthcare NHS Trust, Moat Road, Walsall West Midlands, WS2 9PS, UK
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Otty Z, Brown A, Sabesan S, Evans R, Larkins S. Optimal Care Pathways for People with Lung Cancer- a Scoping Review of the Literature. Int J Integr Care 2020; 20:14. [PMID: 33041731 PMCID: PMC7528692 DOI: 10.5334/ijic.5438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 09/08/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Much of the existing work around implementation of cancer optimal care pathways (OCP) has either focused exclusively on the clinical elements of care or has targeted individual stages in the cancer trajectory, rather than using a patient-centred or service delivery lens to inform the integration of care across the continuum. This review aimed to identify and summarise the available literature on lung cancer OCP. METHODS A scoping review was conducted, with literature across multiple databases and grey literature searched. Articles were included if the OCP was being used to manage adult patients with lung cancer and reported on either the development process and outcomes and/or barriers and facilitators associated with optimal care pathway development and/or uptake. RESULTS Of the 381 references screened, 32 articles were included. The lung cancer pathways reviewed varied significantly. A number of themes were identified including the development and implementation of the OCP; the use of quality indicators to audit the OCP; and studies on outcomes of the OCP incorporating timeliness of care delivery, patient experiences and health care utilisation and costs. CONCLUSIONS The limited number of relevant articles found in this review may suggest that an OCP for lung cancer is still in its preliminary stages across the broader health systems.
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Affiliation(s)
- Zulfiquer Otty
- Townsville Cancer Centre, Townsville University Hospital, Townsville, QLD, AU
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, AU
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, AU
| | - Amy Brown
- Townsville Cancer Centre, Townsville University Hospital, Townsville, QLD, AU
| | - Sabe Sabesan
- Townsville Cancer Centre, Townsville University Hospital, Townsville, QLD, AU
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, AU
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, AU
| | - Rebecca Evans
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, AU
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, AU
| | - Sarah Larkins
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, AU
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, AU
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Malalasekera A, Dhillon HM, Shunmugasundaram C, Blinman PL, Kao SC, Vardy JL. Why do delays to diagnosis and treatment of lung cancer occur? A mixed methods study of insights from Australian clinicians. Asia Pac J Clin Oncol 2020; 17:e77-e86. [PMID: 32298539 DOI: 10.1111/ajco.13335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/29/2020] [Indexed: 12/14/2022]
Abstract
AIMS Delays in lung cancer diagnosis and treatment can impact survival. We explored reasons for delays experienced by patients with lung cancer to identify themes and strategies for improvement. METHODS We used national timeframe recommendations and standardized definitions to identify General Practitioners and specialists caring for 34 patients who experienced delays in our previous Medicare data linkage study. Clinicians participated in a survey and interview, including qualitative (exploratory, open-ended questions) and quantitative (rating scales) components. Exploratory content analysis, cross-case triangulation, and descriptive statistics were performed. Krippendorff's coefficient was used to assess level of agreement between clinicians and patients, and among clinicians, on perceived delays. RESULTS Overall, 27 out of 50 (54%) eligible clinicians participated (including 11 respiratory physicians and seven medical oncologists). Dominant themes for perceived causes of delay included referral barriers, limited General Practitioner (GP) awareness of subtle clinical presentations, insufficient radiology interpretation, and lack of cancer coordinators. "Unavoidable" delays may occur due to clinical circumstances. Awareness and uptake of referral and timeframe guidelines were low, with clinicians using professional networks over guidelines. There was no consistent agreement on perceived delays between patients and clinicians, and among clinicians (Krippendorff's coefficient .03 [P = .8]). CONCLUSIONS Strategies for minimizing avoidable delays include efficient GP to specialist referral and more lung cancer coordinators to assist with patient expectations and waitlist management. Clinicians' reliance on experience, rather than guidelines, indicates need to review guideline utility. Raising awareness of benchmarks and unavoidable barriers may recalibrate perceptions of "delays" to diagnosis and treatment of lung cancer.
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Affiliation(s)
- Ashanya Malalasekera
- Sydney Medical School, University of Sydney, New South Wales, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, New South Wales, Australia
| | - Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, New South Wales, Australia
| | - Prunella L Blinman
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Steven C Kao
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Sydney Medical School, University of Sydney, New South Wales, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, New South Wales, Australia
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Holland P, Spence H, Clubley A, Brooks C, Baldwin D, Pointon K. Reporting radiographers and their role in thoracic CT service improvement: managing the pulmonary nodule. BJR Open 2020; 2:20190018. [PMID: 33178958 PMCID: PMC7594904 DOI: 10.1259/bjro.20190018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 01/16/2020] [Accepted: 02/25/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The use of cross-sectional imaging in clinical medicine has been a major step forward in the management of many conditions but with that comes the increasing demand on resources and the detection of other potentially significant findings. This, in the context of a shortage of skilled radiologists, means that new ways of working are important. In thoracic CT, pulmonary nodules are a significant challenge because they are so common. Poor and inconsistent management can both cause harm to patients and waste resources so it is important that the latest guidelines are followed. The latter mandate the use of semi-automated volumetry that allows more precise management but is time-consuming. METHODS Reporting radiographers were iteratively trained in the use of semi-automated volumetry for pulmonary nodules by experienced thoracic radiologists. Once trained in this specific aspect, radiographers completed reporting of pulmonary nodules, checked by radiologists. RESULTS Radiographer reporting reduced radiologist time in reporting nodules and measuring their volume. Most of the volumetry was completed prior to the multidisciplinary meeting. This facilitated an increase in the number of patients discussed in 60 min from 15 to 22. Radiographers failed to detect few nodules, although a second read by radiologists is required in any case for other aspects of the reporting. CONCLUSION Reporting radiographers, working with radiologists in a supportive setting, can deliver the radiology in a lung nodule pathway, reducing the time commitment from radiologists and the pulmonary nodule multidisciplinary team members, whilst using this as an opportunity to conduct research.
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Affiliation(s)
- Paul Holland
- Department of Radiology, Nottingham City Hospital Campus, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Hazel Spence
- Department of Radiology, Nottingham City Hospital Campus, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Alison Clubley
- Department of Radiology, Nottingham City Hospital Campus, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Chantel Brooks
- Department of Radiology, Nottingham City Hospital Campus, Nottingham University Hospitals, Nottingham, United Kingdom
| | - David Baldwin
- Department of Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kate Pointon
- Department of Radiology, Nottingham City Hospital Campus, Nottingham University Hospitals, Nottingham, United Kingdom
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Lockwood P. An evaluation of CT head reporting radiographers' scope of practice within the United Kingdom. Radiography (Lond) 2020; 26:102-109. [PMID: 32052789 DOI: 10.1016/j.radi.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study investigated the scope of practice of CT head reporting radiographers in the UK, and to compare adherence to professional body standards. METHODS An online questionnaire was utilized applying both multiple-choice and response (closed questions), and qualitative open question free-text responses. The 30 questions covered four key areas of demographics, the scope of practice, referrals, and ongoing competence, as described in professional body national guidance standards. The questionnaire was disseminated (convenience sampling) via Twitter and email to the National CT Head Reporting Special Interest Group. Responses were transcribed and coded; the results applied descriptive statistics to summarise observations of the study sample. RESULTS The sample of participant response data analysed was n = 54. Most respondents were from England, with a postgraduate certificate award in clinical reporting, and a mean length of 8.3 years of reporting experience. The accepted referral pathway included a wide range of medical and surgical specialities, including both in and outpatients and acute and chronic pathways. Furthermore, 96.2% of the sample had a scope of practice that authorised referral recommendations to a broad and inclusive group of medical and surgical teams, and if required further or repeat diagnostic imaging. To maintain quality and evidence of ongoing competency, all radiographers were involved in audit cycles. CONCLUSION The data collected confirmed the reporting practice within this sample group aligns to national recommended guidance. The data provided key information on the range and variation of individuals scope of practice within age restrictions of patients, examination types, referral teams, and ongoing competency practices. IMPLICATIONS FOR PRACTICE This paper details the scope of practice of CT head reporting by radiographers and the contribution made to the healthcare sector.
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Affiliation(s)
- P Lockwood
- Clinical and Medical Sciences Research Hub, School of Allied Health Professions, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK.
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Murphy A, Ekpo E, Steffens T, Neep MJ. Radiographic image interpretation by Australian radiographers: a systematic review. J Med Radiat Sci 2019; 66:269-283. [PMID: 31545009 PMCID: PMC6920699 DOI: 10.1002/jmrs.356] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/25/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Radiographer image evaluation methods such as the preliminary image evaluation (PIE), a formal comment describing radiographers' findings in radiological images, are embedded in the contemporary radiographer role within Australia. However, perceptions surrounding both the capacity for Australian radiographers to adopt PIE and the barriers to its implementation are highly variable and seldom evidence-based. This paper systematically reviews the literature to examine radiographic image interpretation by Australian radiographers and the barriers to implementation. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to systematically review articles via Scopus, Ovid MEDLINE, PubMed, ScienceDirect and Informit. Articles were deemed eligible for inclusion if they were English language, peer-reviewed and explored radiographic image interpretation by radiographers in the context of the Australian healthcare system. Letters to the editor, opinion pieces, reviews and reports were excluded. RESULTS A total of 926 studies were screened for relevance, 19 articles met the inclusion criteria. The 19 articles consisted of 11 cohort studies, seven cross-sectional surveys and one randomised control trial. Studies exploring radiographers' image interpretation performance utilised a variety of methodological designs with accuracy, sensitivity and specificity values ranging from 57 to 98%, 45 to 98% and 68 to 98%, respectively. Primary barriers to radiographic image evaluation by radiographers included lack of accessible educational resources and support from both radiologists and radiographers. CONCLUSION Australian radiographers can undertake PIE; however, educational and clinical support barriers limit implementation. Access to targeted education and a clear definition of radiographers' image evaluation role may drive a wider acceptance of radiographer image evaluation in Australia.
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Affiliation(s)
- Andrew Murphy
- Department of Medical ImagingSt Paul's HospitalVancouverBCCanada
- Department of Medical ImagingBritish Columbia Children's HospitalVancouverBCCanada
- Faculty of Health SciencesDiscipline of Medical Imaging ScienceThe University of SydneyLidcombeNSWAustralia
| | - Ernest Ekpo
- Faculty of Health SciencesDiscipline of Medical Imaging ScienceThe University of SydneyLidcombeNSWAustralia
| | - Thomas Steffens
- Department of Medical ImagingPrincess Alexandra HospitalBrisbaneQldAustralia
| | - Michael J. Neep
- Department of Medical ImagingLogan HospitalMeadowbrookQldAustralia
- School of Clinical SciencesFaculty of HealthQueensland University of TechnologyBrisbaneQldAustralia
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Immediate reporting of chest X-rays referred from general practice by reporting radiographers: a single centre feasibility study. Clin Radiol 2017; 73:507.e1-507.e8. [PMID: 29246588 PMCID: PMC5903871 DOI: 10.1016/j.crad.2017.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
Aim To investigate the feasibility of radiographer-led immediate reporting of chest radiographs (CXRs) referred from general practice. Materials and methods This 4-month feasibility study (November 2016 to March 2017) was carried out in a single radiology department at an acute general hospital. Comparison was made between CXRs that received an immediate and routine report to determine the number of lung cancers diagnosed, time to diagnosis of lung cancer, time to computed tomography (CT), and number of urgent referrals to respiratory medicine. Results Forty of 186 sessions (22%) were covered by radiographer immediate reporting. Of the 1,687 CXRs referred from general practice, 558 (33.1%) received an immediate report (radiographer or radiologist). Twenty-two (of 36) CT examinations performed were following an abnormal CXR with an immediate report (mean 0.8 scans/week). Time from CXR to CT was shorter in the immediate report group (n=22 mean 0.9 days SD=2.3) compared to routine reporting (n=14; mean 6.5 SD=3.2; F=27.883, p<0.0001). Time to multidisciplinary team (MDT) discussion was shorter in the immediate reporting group (mean 4.1 SD=2.9) compared to routine reporting (mean 10.6; SD=4.5; F=11.59, p<0.0001). No apparent difference was found for time to discussion at treatment MDT. Conclusion It is feasible to introduce a radiographer-led immediate CXR reporting service. Patients can be taken off the lung cancer pathway sooner with the introduction of radiographer immediate reporting of CXRs and this may improve outcomes for patients. A definitive study assessing outcomes is required to determine whether this will have an impact mortality and morbidity for patients. Early lung cancer diagnosis is often limited by insufficient radiology capacity. It is feasible to introduce immediate reporting of chest X-rays from general practice by radiographers. Time to diagnosis of lung cancer can be significantly shortened with immediate chest X-ray reporting.
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