Radiographic Practice Research Articles

Antero-posterior (AP) pelvis x-ray imaging on a trolley: Impact of trolley design, mattress design and radiographer practice on image quality and radiation dose

IntroductionPhysical and technical differences exist between imaging on an x-ray tabletop and imaging on a trolley. This study evaluates how trolley imaging impacts image quality and radiation dose for an antero-posterior (AP) pelvis projection whilst subsequently exploring means of optimising this imaging examination. MethodsAn anthropomorphic pelvis phantom was imaged on a commercially available trolley under various conditions. Variables explored included two mattresses, two image receptor holder positions, three source to image distances (SIDs) and four mAs values. Image quality was evaluated using relative visual grading analysis with the reference image acquired on the x-ray tabletop. Contrast to noise ratio (CNR) was calculated. Effective dose was established using Monte Carlo simulation. Optimisation scores were derived as a figure of merit by dividing effective dose with visual image quality scores. ResultsVisual image quality reduced significantly (p < 0.05) whilst effective dose increased significantly (p < 0.05) for images acquired on the trolley using identical acquisition parameters to the reference image. The trolley image with the highest optimisation score was acquired using 130 cm SID, 20 mAs, the standard mattress and platform not elevated. A difference of 12.8 mm was found between the image with the lowest and highest magnification factor (18%). ConclusionThe acquisition parameters used for AP pelvis on the x-ray tabletop are not transferable to trolley imaging and should be modified accordingly to compensate for the differences that exist. Exposure charts should be developed for trolley imaging to ensure optimal image quality at lowest possible dose.

Advanced and extended scope practice of diagnostic radiographers in Scotland: Exploring strategic imaging service imperatives

IntroductionThe development of diagnostic imaging services manifests features specific to the Scottish environment, in particular development of the radiographic workforce through implementing skills mix and role developments to enhance outcomes for patients. A component of a College of Radiographers Industry Partnership Scheme (CoRIPS) supported study, this research investigates perspectives of strategic service managers with Health Board responsibility for service delivery. MethodA questionnaire survey was administered to strategic service managers across Scotland (N = 14), followed up with telephone interviews. There was a return rate of 57% (n = 8) for the questionnaires and n = 4 agreed to be interviewed. Data collected related to radiographer roles across their Board area; awareness and understanding of service development issues and features as well as perspective on opportunities and barriers in the context of Scottish Government policy, workforce logistics, attitudes and inter-professional relationships. ResultsThe results indicate evidence of financial, logistical and political barriers to service evolution, offset by a sense of optimism that scope for beneficial change may be approaching. There are a range of significant initiatives in place and an appetite exists to pursue the development of radiographer roles and skill mix for the benefit of service users more generally. ConclusionThe difficulties in achieving change are well understood and there are basic issues related to finance and industrial relations. There are also however, cultural elements to contend with in the form of attitudes demonstrated by some radiographers and significantly, the radiological community whose influence on the practice of independently regulated radiographers seems incongruent.

Overview of the radiographers\u2019 practice in 65 healthcare centers using digital mammography systems in Portugal

PurposeTo assess current practices in digital mammography (DM) in Portuguese healthcare providers using digital systems. To investigate compliance with European standards regarding mean glandular dose and quality control practice and to identify optimisation needs.MethodsTwo questionnaires, targeted at breast radiographers and chief radiographers, were designed and applied in 65 imaging departments offering DM. Questions fielded were focused on the staff profile and technical/clinical practice.ResultsPrior to starting their activity in DM, 70% (82 out of 118) of the respondents received training in DM. The practice in 29 out of 59 providers was established by the manufacturers’ recommendations for image acquisition. Variations were observed between radiographers who belong to the same provider namely the selection of exposure parameters such as the target-filter combination and automatic mode. The use of the manual exposure mode was reported for imaging breast implants (44%) and surgical specimens (22%). The main causes of repeat examinations were skin folding (21%) and absence of pectoral muscle (PM) (20%).ConclusionsThe study revealed opportunities to optimise radiographers’ practice in DM regarding the selection of exposure parameters. A robust and consistent training programme in DM and established local protocols can help to reduce the variations observed and improve clinical practice.Main Messages• Radiographers adopted different practices selecting AEC modes and T/F combinations.• Radiographer practice is more consistent using DR than using CR systems.• The main causes for rejecting images were the visibility of skin folding and PM absence.• Radiographers were partly unaware of the dose indicator.• Radiographers’ training needs: QC, interventional procedures and breast dose optimisation.

Justification of radiographic examinations: What are the key issues?

Justification of radiographic examinations is the practice of evaluating requested radiological examinations to assess for clinical merit and appropriateness based on clinical notes and patient information. This implies that justification in radiography requires the evaluation of requested examinations, the justification of exposures being applied and determining whether patients fit the recommended criteria for the procedure. Medico‐legal requirements by the professional registration body, the Medical Radiation Practice Board of Australia (MRPBA), identify justification as an advocated and obligatory practice for radiographers. Yet, justification remains an inconsistent practice implemented amongst Australian radiographers. This review aims to identify associated barriers inhibiting the consistent practice of justification and the hesitance by radiographers in practicing justification responsibilities. It also recommends a change in workplace culture which encourages radiographers to accept a more autonomous role that cultivates critical thinking, reflection and research‐informed decision making as justification will ultimately benefit patients.

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

IntroductionThis 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. MethodsUsing 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. ResultsIt 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. ConclusionThese 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.

Assessment of whole-body occupational radiation exposure in industrial radiography practices in Bangladesh during 2010-2014

Presently, ten industrial radiography facilities are operating in Bangladesh using X-ray or gamma-ray sources. During the last 5-year, 14 industrial radiography facilities were received individual monitoring service using thermoluminescent dosimeters (TLDs) from the Health Physics Division (HPD), Atomic Energy Centre, Dhaka under Bangladesh Atomic Energy Commission. HPD is the only individual monitoring service provider in Bangladesh due to external sources of ionizing radiation. The number of monitored industrial radiography facilities ranged from 7 to 14 while the number of worker ranged from 72 to 133 during the study period. The annual average effective doses received from external radiation in industrial radiography workers and the distributions of the annual effective doses by dose intervals are presented. The distribution of the occupational doses shows that the majority (about 75 %) of workers received doses below 1 mSv for the last 5-years. Even though, very few workers (about 1%) received doses higher than average annual dose limit (20 mSv), but no workers received doses higher than 100 mSv in 5 consecutive years. The average annual effective dose of industrial radiography workers in Bangladesh is higher than the corresponding values in Tanzania, Greece, Poland, Australia, UK and lower than in Bosnia and Herzegovina, USA and Canada. However, the average annual effective dose is comparable to the corresponding values in China, Brazil, Germany and India. The status and trends in occupational doses show that radiation protection situation at the majority of the workplace were satisfactory. In spite of that, additional measures are required due to big differences observed in the maximum individual doses over the last 5-year.

Radiographic Practices &amp; The Use of Apex Locators In Endodontic Treatment In Mumbai – A Comparison of Perceptions Between Endodontists &amp; Other Dental Practitioners.

Aims and Objective: The aim of our study was to assess the attitudes of general practitioners, endodontic specialists & other specialists in and around Mumbai in relation to the use of electronic apex locator and the radiographic practices prevailing among them for root canal therapy. Materials and Methods: A cross-sectional contact survey was conducted including 400 dental professionals in and around Mumbai who performed endodontic procedures. A specially prepared format exclusively designed for recording all the required relevant general information and information related to working length determination method was used as a tool for data collection.Data was tabulated in excel sheet and analyzed using SPSS 22.0 software. Discussion and Conclusion: From the survey, it was observed that the Endodontists employed apex locators and RVG more frequently than their colleagues’ in general dental practice and this finding was statistically significant. It was also observed that there was a reticence amongst older practitioners to adopt more recent techniques. There is a very apparent deficit in the knowledge of potential benefits of using Electronic Apex Locators in routine endodontic treatment.

An audit evaluating angiographic annotations in interventional radiology

Background to the audit: Standard radiography practice stipulates that radiographs be annotated with certain information to facilitate safe and effective interpretation. However, there are no national guidelines outlining standards for labelling angiographic procedures. We aim to audit practice at our institutions to assess consistency of labelling for angiographic examinations.

Dichotomy between theory and practice in chest radiography and its impact on students.

IntroductionIt is important that theory is synchronous with clinical practices that students engage in. Lack of congruence between theory and practice presents serious problems to students. This study was therefore conducted to determine if there was a theory–practice gap in chest radiography during clinical rotations, and any associated causes and effects on radiography students.MethodA descriptive survey design was used to conduct this study from 2 February to 27 July 2014. A semi‐structured questionnaire consisting of open‐ and close‐ended questions was used to purposively collect data from 26 radiography students in Ghana who had completed theory lessons in chest radiography and had either completed or were undertaking clinical rotations in chest radiography.ResultsTwenty‐five (96%) respondents indicated the presence of theory–practice gap in chest radiography during clinical rotations, where differences between theory and clinical practice were observed. Lack of working materials 16 (62%), heavy workload 14 (54%), equipment breakdowns 14 (54%) and supervisory factors 11 (43%) were identified as the causes. Many students (81%) experienced diverse adverse effects such as confusion 10 (38%), poor performance during clinical examinations 6 (23%) and entire loss of interest in the professional training 1 (4%) of this dichotomy.ConclusionDichotomy between theory and practice found in chest radiography has diverse adverse effects on students. Regular feedback on the quality of clinical practice received by students should be encouraged to determine the existence of any gaps between theory and practice in order to promote effective clinical rotation programmes in radiography.

TU-FG-209-08: Distribution of the Deviation Index (DI) in Digital Radiography Practices Across the United States

Purpose: To characterize the distribution of the deviation index (DI) in digital radiography practices across the United States. Methods: DI data was obtained from 10 collaborating institutions in the United States between 2012 and 2015. Each institution complied with the requirements of the Institutional Review Board at their site. DI data from radiographs of the body parts chest, abdomen, pelvis and extremity were analyzed for anteroposterior, posteroanterior, lateral, and decubitus views. The DI data was analyzed both in aggregate and stratified by exposure control method, image receptor technology, patient age, and participating site for each body part and view. The number of exposures with DI falling within previously published control limits for DI and descriptive statistics were calculated. Results: DI data from 505,930 radiographic exposures was analyzed. The number of exposures with DI falling within published control limits for DI varied from 10 to 20% for adult patients and 10 to 23% for pediatric patients for different body parts and views. Mean DI values averaged over other parameters for radiographs of the abdomen, chest, pelvis, and extremities ranged from 0.3 to 1.0, −0.6 to 0.5, 0.8, and −0.9 to 0.5 for the different adult views and ranged from −1.6 to −0.1, −0.3 to 0.5, −0.1, −0.2 to 1.4 for the different pediatric views, respectively (DI data was solicited only for anteroposterior view of pelvis). Standard deviation values of DI from individual sites ranged from 1.3 to 3.6 and 1.3 to 3.0 for the different adult and pediatric views, respectively. Also of interest was that target exposure indicators varied by up to a factor of 6 between sites for certain body parts and views. Conclusion: Previously published DI control limits do not reflect the state of clinical practice in digital radiography. Mean DI and target exposure indicators are targets for quality improvement efforts in radiography.

Benchmarking the performance of fixed-image receptor digital radiography systems. Part 2: system performance metric.

This is part two of a two-part study in benchmarking system performance of fixed digital radiographic systems. The study compares the system performance of seven fixed digital radiography systems based on quantitative metrics like modulation transfer function (sMTF), normalised noise power spectrum (sNNPS), detective quantum efficiency (sDQE) and entrance surface air kerma (ESAK). It was found that the most efficient image receptors (greatest sDQE) were not necessarily operating at the lowest ESAK. In part one of this study, sMTF is shown to depend on system configuration while sNNPS is shown to be relatively consistent across systems. Systems are ranked on their signal-to-noise ratio efficiency (sDQE) and their ESAK. Systems using the same equipment configuration do not necessarily have the same system performance. This implies radiographic practice at the site will have an impact on the overall system performance. In general, systems are more dose efficient at low dose settings.

Does radiography advanced practice improve patient outcomes and health service quality? A systematic review

To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.

‘Cranking up’, ‘whacking up’ and ‘bumping up’: X-ray exposures in contemporary radiographic practice

This article explores the use of X-ray exposures following the introduction of direct digital radiography (DDR). Radiographers are central to delivering optimum levels of ionising radiation whilst maintaining sound image quality for radiological interpretation. Yet do radiographers utilise X-ray exposures appropriately? An ethnographic methodology provides insight of two general radiographic environments in the United Kingdom (UK) using participant observation and semi-structure interviews. A central theme uncovered as part of a Doctorate of Philosophy (PhD) study was the lack of autonomy concerning X-ray exposures within the general imaging environment. The findings highlight ‘how radiographers behave’. For example, some radiographers do not alter ‘pre-set’ X-ray exposures, arguably failing to produce images of optimum diagnostic quality. Secondly, radiographers acknowledge ‘whacking up’, ‘cranking up’ and ‘bumping up’ X-ray exposures ensuring image production. In conclusion this article provides an original insight into the attitudes and behaviours of radiographers regarding X-ray exposures in contemporary practices using DDR. Dose and image optimisation are central tenets of radiographic practice that may be hindered in contemporary practices.

Advanced and extended scope practice of radiographers: The Scottish perspective

PurposeThe impact of changing roles, skill mix and a shortage of consultant radiologists on the profession of diagnostic radiography is not clearly understood in Scotland although the anecdotal perspective suggests the situation in many areas does not equate to that of England. MethodA questionnaire survey was administered to ‘lead diagnostic radiographers’ across all Health Boards in Scotland and this was supplemented with telephone interviews. ResultsThe implementation of skill mix initiatives and particularly advanced/extended scope practice was found to be geographically variable with limited evidence of change in some areas. Lack of effective funding and backfill for training was found to be a major barrier to change, although it was also acknowledged that opposition from some professional groups could be a major factor. ConclusionAlthough there is some optimism and evidence of accelerating change, development of the radiographic workforce in Scotland does not in general compare favourably to the findings of Price et al., in 2007. The reasons are multi-factorial including fiscal, professional and geographical elements.

Knowledge of practising radiographers of the supraspinatus outlet projection for shoulder impingement syndrome in the Eastern Cape, South Africa

Background/AimThere are many projections in plain film imaging to demonstrate the specific aspects of the anatomy of the shoulder. However, reproducing the required projections can be challenging especially if radiographers are not familiar with the projections and their evaluation criteria. The aim of the study was to explore and describe the knowledge of practising radiographers regarding the supraspinatus outlet projection for shoulder impingement syndrome. MethodA quantitative, exploratory and descriptive design was followed. The population served as the sample and included all the practising radiographers in the public and private hospitals of a metropolitan municipality in the Eastern Cape, South Africa. A total of 84 respondents completed the structured, self-administered questionnaire. ResultsThe data revealed that in many cases, the majority of radiographers in the study, due to inadequate knowledge levels would not be able to produce an optimal radiographic image of the supraspinatus outlet. The results of the chi-squares indicated statistically significant differences (p < 0.05) between public and private hospitals regarding certain aspects of the scapular Y projection and SOP. ConclusionIt was found that the radiographers in the study had inadequate knowledge of scapular Y projections and SOPs in relation to SIS. Therefore, it is essential to ensure that radiographers are updated on their knowledge of radiographic practice on a continuous basis.

An evaluation of the impact of digital imaging on radiographic practice and patient doses

Direct digital imaging technology was implemented in all areas in general and mobile radiology at Barts and the Royal London Hospitals in 2012. Evidence from recent radiation incident investigations indicates optimum exposure factors are not consistently selected, with the greater dynamic range of the digital detectors allowing sub-optimal practice. To investigate further patient dose data were extracted from the Radiology Information System for adult chest X-ray examinations in 2014, covering over 50,000 studies in the Trust. Chest X-ray examinations were selected as they are low dose but frequent examinations. The patient dose data were evaluated taking into account X-ray system type and detector performance measurements, and individual cases studies were used to highlight where practice can be improved.

Diagnosing Cervical Spine Injury in Severe Head Injury: A Case for Replacing Plain Radiography With Computed Tomographic Scan of the Cervical Spine

Introduction The diagnosis and management of cervical spine injuries in head-injured patients is problematic due to an altered level of consciousness and the overall critical nature of their injuries. It is a routine practice in most of the hospitals to get plain radiography for detection of bony spinal injuries which can miss some cases of fractures and fracture dislocations. It is imperative not to miss a cervical spine injury in patients with severe head injury. The aim of our study was to find which modality offers the greatest accuracy as the initial diagnostic test among patients suspected of having sustained a cervical spine surgery following severe head injury: plain radiography or computed tomography (CT) of cervical spine. Patients and Methods This is a prospective study conducted on patients with severe head injury. In this study, 50 patients with severe head injuries were investigated by both plain X-rays and CT scan of the cervical spine. In these patients, the level and type of cervical spine injury were compared between plain X-ray and CT scan. Results Plain X-rays detected cervical spine injury in 20%, while CT scan demonstrated spinal injury in 26% of the patients. Four patients of cervical spine fracture missed by plain radiography were diagnosed by CT cervical spine. In one patient in whom plain radiography showed fracture-dislocation at C5—C6 level was found to have degenerative changes at that level. C6—C7 was the most common site of fracture-dislocation (40.0%) followed by C5—C6 (20.0%), C4—C5 (20.0%), and C3—C4 (10.0%). C2 is the most common site of fracture diagnosed by CT scan which was missed by plain radiograph. Conclusion It was concluded that it would be prudent to replace the practice of routine plain radiography with routine use of CT scans for detection of spinal bony injuries.

Obese patients and radiography literature: what do we know about a big issue?

Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for.

A brief survey of infection control practices in intra oral radiography

Worldwide, reports and experiences indicate that there has been extensive re-organisation within diagnostic imaging and radiotherapy departments in response to the COVID-19 pandemic. This was necessary due to changes in workload and working practice guidelines that have evolved during the pandemic. This review provides a comprehensive summary of the global impact of the COVID-19 pandemic on radiography practice, service delivery and workforce wellbeing.A systematic review methodology was adopted to obtain data from primary studies of qualitative, quantitative, and mixed methods designs from databases (PubMed, Science Direct, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and SCOPUS: all 2020 to present). The included articles were subjected to information extraction and results-based convergent synthesis.The electronic database search yielded 10,420 articles after removal of duplicates. Of these, 31 articles met the final inclusion criteria with some (n = 8) fully focussed on radiotherapy workforce and service delivery. The pandemic impact on radiography practice is broadly themed around: training, communication, and information dissemination; infrastructure, technology, and clinical workflow; and workforce mental health and well-being.Globally, most radiographers received inadequate training for managing COVID-19 patients during the initial acute phase of the pandemic. Additionally, there were significant changes to clinical practice, working patterns and perceived increase in workload due to surges in COVID-19 patients and the consequent strict adherence to new infection protocols. These changes, coupled with fear emanating from the increased risk of the workforce to contracting the infection, contributed to anxiety and workplace-related stress during the pandemic.Local pandemic response strategies must be appropriately developed from standard protocols in readiness for safe clinical practice and well-being management training of practitioners.

A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol

IntroductionThis paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a...