Radiographic Practice Research Articles

Board game to enhance teaching and learning in the Radiographic Technique module

Gamification is used encourage the learner to participate in a competitive activity, to encourage engagement and desire to learn. In the Radiographic Practice module, students learn three core radiography performance standards; professionalism, technique and clinical performance. To address these standards, a pilot radiography board game was developed to determine its effectiveness at improving engagement and interest with learning material and its use as a teaching and learning tool. A qualitative, explorative descriptive research design was used, involving focus group interviews with the radiography students. The students recommended some changes and adjustments on the game design and dynamics. They further described the board game as a fun activity and demonstrated that it was possible to learn whilst engaging with the subject material and group discussions. The board game enabled the students to apply critical thinking skills and be introduced the concept of professionalism in the clinical setting.

An Evaluation of Image Acquisition Techniques, Radiographic Practice, and Technical Quality in Neonatal Chest Radiography

BackgroundNeonatal chest radiography is a frequently performed diagnostic examination, particularly in preterm infants where anatomical and/or biochemical immaturity impacts on respiratory function. However, the quality of neonatal radiographic images has been criticized internationally and a prevailing concern has been that radiographers (radiologic technologists) fail to appreciate the unique nature of neonatal and infant anatomical proportions. The aim of this study was to undertake a retrospective evaluation of neonatal chest radiography image acquisition techniques against key technical criteria. MethodsOne hundred neonatal chest radiographs, randomly selected from those acquired in 2014, were retrospectively evaluated. Inclusion criteria for radiograph were as follows: anterior-posterior supine; within 30 days of birth; and with all preprocessed collimation boundaries visible. Image evaluation was systematically undertaken using an image assessment tool. To test for statistical significance, Student's t-test, χ2 test, and logistic regression were undertaken. ResultsOnly 47% of the radiographs were considered straight in both upper and lower thoraces. The cranial collimation border extended beyond the upper border of the third cervical vertebra in 30% of cases, and the caudal border extended below the lower border of the first lumbar vertebra in 20% of cases, suggesting high possibility of neonatal overirradiation. Upper thorax rotation was significantly associated with head position (χ2 = 10.907; P < .001) as has been stated in many published textbooks internationally, but arm position had no apparent influence on rotation of the upper thorax (χ2 = 5.1260; P = .275). Birth weight was associated with accurate midline centering of central ray (logistic regression; OR = 1.0005; P = .009; CI, 1.00139–1.000957) with greater accuracy observed in images of neonates with higher birth weight. ConclusionThis study has highlighted areas for neonatal chest radiography improvement. Importantly, the findings bring into question commonly advocated radiographic techniques relating to arm positioning and assessment of rotation while confirming the importance of other technical factors. These findings begin the work toward developing the evidence base to underpin neonatal chest radiograph acquisition, but further prospective work and multicenter/multinational data comparison are required to confirm the findings.

Improving the patient experience by modifying computed tomography (CT) colon pre-procedure information within an advanced practice radiography role

Improving the patient experience by modifying computed tomography (CT) colon pre-procedure information within an advanced practice radiography role

Experience using the ‘Shetty test’ for initial foot and ankle fracture screening in the Emergency Department

ObjectiveThe indiscriminate practice of radiographs for foot and ankle injuries is not justified, and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty test in our area. Material and methodA cross-sectional observational study by applying the Shetty test to patients seen in the emergency department. ResultsWe enrolled 100 patients with an average age of 39.25 years (16–86 years). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: four were false-positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). ConclusionsThe Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test.

I062] The roles of radiographers in medical imaging and radiotherapy in Europe

Very fast development of technologies in medical imaging and therapy has changed the role of radiographer in Europe. Over the past ten years education and necessary skills and competencies for radiographers has become more similar in most EU countries due to input of EFRS Educational Wing, but there are still rather significant differences in the roles of radiographers between countries. Role expansion is often initiated by external and internal factors that lead to advanced practice for radiographers. However, there is also a limiting factor that functions as a barrier for development of radiographer’s role and mainly that is connected to resistance when radiologists/medical physicists object to image interpretation or performance of particular methods or procedures like ultrasound and radiotherapy treatment planning, or when the required education and training to support such roles is not available. This presentation aims to highlight the current status of radiographers in Europe with a particular focus on opportunities in medical imaging and radiotherapy related to quality control and radiation protection.

Survey to describe variability in early onset scoliosis cast practices.

PurposeTo investigate paediatric orthopaedists’ cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing.MethodsA casting survey was distributed to all paediatric orthopaedists in Children’s Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45).ResultsA majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists’ decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients.ConclusionsFuture multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible.Level of EvidenceV, Expert opinion

Is a nurse consultant impact toolkit relevant and transferrable to the radiography profession? An evaluation project

IntroductionConsultant posts were developed to strengthen strategic leadership whilst maintaining front line service responsibilities and clinical expertise. The nursing profession has attempted to develop tools to enable individuals to evaluate their own practice and consider relevant measurable outcomes. This study evaluated the feasibility of transferring such a nursing ‘toolkit’ to another health profession. MethodThis evaluation was structured around a one-day workshop where a nurse consultant impact toolkit was appraised and tested within the context of consultant radiographic practice. The adapted toolkit was subsequently validated using a larger sample at a national meeting of consultant radiographers. ResultsThere was broad agreement that the tools could be adopted for use by radiographers although several themes emerged in relation to perceived gaps within the nursing template, confirming the initial exercise. This resulted in amendments to the original scope and a proposed new evaluation tool. ConclusionThe impact toolkit could help assess individual and collaborat ive role impact at a local and national level. The framework provides consultant radiographers with an opportunity to understand and highlight the contribution their roles have on patients, staff, their organisation and the wider profession.

The Practice of Chest Radiography Using Different Digital Imaging Systems: Dose and Image Quality

Introduction: The study was undertaken to evaluate the practice of chest radiography using different digital imaging systems and its influence on dose and image quality. Materials and Methods: The study was carried out in two hospitals from March 2016 to June 2016. Sixty ambulatory patients aged 21 to 60 years who were able to cooperate without difficulty and weighed between 60 to 80 kg were selected randomly. The active matrix flat panel imagers technology was employed in the direct radiography (DR) system for Hospital A, whilst Hospital B used the single read out computed radiography (CR) system. The dose area product (DAP) meter was utilized in measuring the entrance surface air kerma. The chest radiographs were evaluated by two radiologists. Results: The mean entrance surface doses (ESDs) for posteroanterior chest in Hospital A (0.098 mGy) was lower than that obtained in Hospital B (0.161 mGy). However, the ESDs at both centres were lower than the recommended value by the International Atomic Energy Agency (IAEA; 0.3 mGy). The quality of the images for chest radiography in both hospitals was adequate to make a diagnosis with ESDs and effective doses lower than those recommended by IAEA and United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Conclusion: The study serves to highlight the practice of chest radiography with two different systems and its influence on image quality and dose. It can be concluded that there were significant differences in image quality and radiation dose for chest radiography practice using CR and DR.

Experiencia con la aplicación del test de Shetty para el despistaje inicial de fracturas del pie y tobillo en el área de Urgencias

ObjectiveThe indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. Material and methodA cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. ResultsWe enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). ConclusionsThe Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test.

Good Practice in Radiography: Dos and Don'ts.

Good Practice in Radiography: Dos and Don'ts.

Use of radiography in small animal practice in the UK and Republic of Ireland in 2013

Radiography is an essential diagnostic tool in small animal practice. A major transition is currently underway from film screen to digital systems. However, there is limited published research detailing the...

General radiographic attributes of optically stimulated luminescence dosimeters: A basic insight

We report the ubiquitous radiographic characteristics of optically stimulated luminescence dosimeters (OSLD) so called nanoDot OSLDs (Landauer Inc., Glendwood, IL). The X-ray irradiations were performed in free air ambiance to inspect the repeatability, the reproducibility, the signal depletion, the element correction factors (ECFs), the dose response and the energy dependence. Repeatability of multiple readouts after single irradiation to 10 mGy revealed a coefficient of variation below 3%, while the reproducibility in repeated irradiation-readout-annealing cycles was above 2%. The OSL signal depletion for three nanoDots with simultaneous irradiation to 20 mGy and sequential readouts of 25 times displayed a consistent signal reduction ≈0.5% per readout with R2 values over 0.98. ECFs for individual OSLDs were varied from 0.97 to 1.03. In the entire dose range under 80 kV, a good linearity with an R2 exceeding 0.99 was achieved. Besides, the percentage difference between OSLD and ion-chamber dose was less than 5%, which was superior to TLD. The X-ray photon irradiated energy response factors (between 0.76 and 1.12) in the range of 40–150 kV (26.1–61.2 keV) exhibited significant energy dependence. Indeed, the nanoDot OSLDs disclosed good repeatability, reproducibility and linearity. The OSLDs measured doses were closer to ion-chamber doses than that of TLD. It can be further improved up to ≈3% by applying the individual dosimeter ECF. On top, the energy dependent uncertainties can be minimized using the energy correction factors. It is established that the studied nanoDot OSLDs are prospective for measuring entrance dose in general radiographic practices.

Risk assessment in the industrial radiography practice in India using probabilistic approach

Industrial gamma radiography utilises appropriate radioisotopes housed in the radiography devices which provide shielding from the ionising radiations, for imaging of the weld joints and castings. The radiography devices are operated manually by rotating the control unit to project the gamma source outside the shielding, in a projection sheath. Deviation from the standard operating procedures or malfunctioning of the gamma radiography equipment may result in potential exposure to occupational workers. Probabilistic safety assessment has been carried out to calculate the probabilities of potential exposure to occupational workers in industrial gamma radiography practice in India. Fault trees have been designed for failure assessment of radiation area monitoring instruments, the functionality of which is crucial to ensure safe industrial gamma radiography operations. Operational procedures leading to the potential exposure scenarios have been sequenced in the event tree. The probability of most severe potential exposure category is calculated as 3.506E-04 for open field radiography operations and slightly lower value of 1.293E-04 for enclosed radiography operations. Assessment results identify the contributory factors to potential exposure, along with their relative contribution. Results indicate that probability of potential exposure can be reduced by adopting safe work practice by operators and responsible attitude of radiological safety officers towards trainees and untrained persons.

Risk assessment in the industrial radiography practice in India using probabilistic approach

Risk assessment in the industrial radiography practice in India using probabilistic approach

Digital imaging and radiographic practise in diagnostic radiography: An overview of current knowledge and practice in Europe

IntroductionRecent research has identified the issue of ‘dose creep’ in diagnostic radiography and claims it is due to the introduction of CR and DR technology. More recently radiographers have reported that they do not regularly manipulate exposure factors for different sized patients and rely on pre-set exposures. The aim of the study was to identify any variation in knowledge and radiographic practice across Europe when imaging the chest, abdomen and pelvis using digital imaging. MethodsA random selection of 50% of educational institutes (n = 17) which were affiliated members of the European Federation of Radiographer Societies (EFRS) were contacted via their contact details supplied on the EFRS website. Each of these institutes identified appropriate radiographic staff in their clinical network to complete an online survey via SurveyMonkey. Data was collected on exposures used for 3 common x-ray examinations using CR/DR, range of equipment in use, staff educational training and awareness of DRL. Descriptive statistics were performed with the aid of Excel and SPSS version 21. ResultsA response rate of 70% was achieved from the affiliated educational members of EFRS and a rate of 55% from the individual hospitals in 12 countries across Europe. Variation was identified in practice when imaging the chest, abdomen and pelvis using both CR and DR digital systems. There is wide variation in radiographer training/education across countries. ConclusionThere is a need for standardisation of education and training including protocols and exposure parameters to ensure that there is continued adherence to the ALARA principle.

Can placing lead-rubber inferolateral to the light beam diaphragm limit ionising radiation to multiple radiosensitive organs?

IntroductionThis article investigates a practical method of reducing the impact of scattered radiation during a lateral radiographic projection of the elbow. The light beam diaphragm (LBD) is generally accepted to limit ionising radiation using horizontal and longitudinal lead shutters, yet this article evidences further dose limitation by placing lead-rubber inferolateral to the LBD device. MethodsUsing an anthropomorphic phantom and arm construction scattered radiation was recorded at multiple radiosensitive organs. A 15 cc ionisation chamber (model 10100 AT TRIAD) was placed on each radiosensitive organ (eye, thyroid, breast, testes, spleen and ovaries) measuring exposure rate (μGy/s). Dose readings were recorded before and after the placement of lead-rubber inferolateral to the LBD. A paired two sample t-test was undertaken affirming how likely dose limitation was attributable to chance (p < 0.05). ResultsDescriptive and inferential statistics demonstrate dose reduction to radiosensitive organs (right eye 53%, right breast 53%, left eye 39%, thyroid 13%, left ovary 9%, testes 6%, left breast 3% and spleen 2%) upon placement of the lead-rubber inferolateral to the LBD. The paired two sample t-test demonstrated statistically significant dose limitation (t = 2.04, df = 7, p = 0.04) thus significant for radiographic practice. ConclusionPlacement of lead-rubber inferolateral to the LBD limits dose to multiple radiosensitive organs. Right (53%) and left (39%) eye lens, right breast (53%), thyroid (13%), left ovary (9%), testes (6%), left breast (3%) and spleen (2%) statistically demonstrate dose limiting opportunities to patients.

X-ray examination to measurement radiation doses of patients in three Erbil hospitals

Thermo luminescent dosimeters (TLDs) have been used to measure the entrance surface doses (ESDs) of patients undergoing pelvis, abdomen and lumbar spine diagnostic X-ray examinations in Erbil. A total of three public hospitals and 171 patients were included in this investigation. The ages of the patients involved were from 40 years to 85 years, while their weights ranged from 64 kg to 73 kg. Mean, of ESDs are reported. The results showed that in most cases, for each of the examinations, the individual ESD values are found to be comparable with, and higher than, those from Ghana and Tanzania, respectively. The ranges found in this work are high and this indicates more attention needs to be given to X-ray facilities in the country. This also suggests that radiographic departments need to review their radiographic practices in order to bring their doses to optimum levels. Effective doses were also calculated from the ESD values. The radiographic parameters used for all the patients were also compared with the European criteria. It is recommended that the tube filtration at one hospital be increased. The importance of good regulatory activities and trained personnel is stressed in this work. Apart from the fact that the data provided inthis work will be useful for the formulation of national guidance levels, they also provide patient dosimeter information on healthcare level countries.

Trends that have influenced the Swedish radiography profession over the last four decades

IntroductionThe expansion of the radiography profession in recent decades has widened the scope of radiographic practice. This has raised questions about which trends have had an impact on the profession over the years. The study aim was to explore trends that have influenced the radiography profession over the last four decades. MethodsA qualitative design was used. Eleven focus group interviews inspired by the Scenario Planning Method were conducted at 11 diagnostic radiology departments in public hospitals in Sweden. The target group consisted of 48 registered radiographers. To analyse the data, qualitative content analysis was used. ResultsThematic data analysis revealed three broad categories; technological development and radiation doses, current status of the radiography profession and specialisation leading to expert knowledge. Each category derived from two or three sub-categories. ConclusionThe results demonstrate significant trends of influences on the radiography profession in Sweden over the last four decades. New methods and technology and control of radiation doses have had a favourable effect on the development of the radiography profession. Nevertheless, current status such as shortage of radiographers has had an adverse way. Specialisation leading to expert knowledge has an influence on career advancement and a specialist education regulated by the law, might be a prerequisite for the development of the radiography profession.

The risk of conventional X-RAY for abdominal examination at different Erbil hospitals

Thermo luminescent dosimeters (TLDs) have been used to measure the entrance surface doses (ESDs) of patients undergoing abdomen diagnostic X-ray examinations in Erbil. A total of three public hospitals and 286 patients were included in this investigation. The ages of the patients involved were from 40 years to 85 years, while their weights ranged from 64 kg to 71 kg. Mean, of ESDs are reported. The results showed that in most cases of the examinations, the individual ESD values are found to be comparable with, and higher than, those from Ghana and Tanzania, respectively. The ranges found in this work are high and this indicates more attention needs to be given to X-ray facilities in the country. This also suggests that radiographic departments need to review their radiographic practices in order to bring their doses to optimum levels. Effective doses were also calculated from the ESD values. The radiographic parameters used for all the patients were also compared with the European criteria. It is recommended that the tube filtration at one hospital be increased. The importance of good regulatory activities and trained personnel is stressed in this work. Apart from the fact that the data provided in this work will be useful for the formulation of national guidance levels, they also provide patient dosimeter information on healthcare level countries.

Compassion in healthcare: a concept analysis

AbstractBackgroundCompassion and compassionate care are central to radiographers’ professional policy and practice and are congruent with the core values of the National Health Service Constitution. The term compassion however is over-used, ambiguous and vague. This work sought to explore and provide contextual understanding to the term compassion in healthcare.MethodWalker and Avant’s eight-step model was used as the framework for the concept analysis. Data collection utilised a number of resources including online databases: Medline, CINAHL complete, Scopus, PubMed, PsycINFO, ScienceDirect, Cochrane and DARE; dictionaries, social media, Internet sources, books and doctoral theses. In all, 296 resources were included in the review.ResultsThe concept analysis distinguishes the defining characteristics of compassion within a healthcare context, allowing for associated meanings and behaviours to be outlined aiding understanding of compassion. Compassion in healthcare requires five defining attributes to be present: recognition, connection, altruistic desire, humanistic response and action.ConclusionThe findings identify the complexity of the term and subjective nature in which it is displayed and in turn perceived. The concept analysis forms the basis of further research aiming to develop a healthcare explicit definition of compassion within healthcare, specifically cancer care and radiography practices. Lucidity will enhance understanding, facilitating active engagement and implementation into practice.