Radiography Department Research Articles

Challenges Faced by Radiography Students During Clinical Training

Background: Clinical training forms part of the requirements of every radiography student, for the award of Bachelor’s degree at the University of Ghana. The effectiveness of clinical training is responsible for the competency level that would be demonstrated by qualified radiography students. However, the capabilities of department to provide adaptive and well managed clinical training for undergraduate students have been reported as a limiting factor. Aim: The purpose of the study was to identify challenges facing the student radiographers during clinical training. Methods: The study was a quantitative one which employed a descriptive survey approach. The survey comprised of levels 300 and 400 students of the department of radiography which gathered forty-two (42) participants. A questionnaire was used to collect data for the study. Data obtained was summarized as frequencies, percentages, means and standard deviations using SPSS version 16.0. Results: The study revealed challenges faced by radiography students such as the gap between theory and practices, inadequate exposure to certain specialized procedures and time allotted to each treatment room. Conclusion: The study showed that clinical training can be enhanced by providing enough equipments and clinical areas for students, also films and cassettes must be made available before the date and time of clinical training. Finally, the theory aspects of clinical training must be in tune with the practice to enhance effective learning experience by students.

Comparison of the perceived image quality between two digital imaging systems for neonatal bedside radiography – A case study

BackgroundChest X-rays are performed daily in the neonatal intensive care and high care units. The skill of the radiographer is critical for obtaining the best image quality and limiting the patient's radiation exposure. The literature states that indirect flat panel detectors produce images of superior quality in comparison to computed radiography systems. At Steve Biko Academic Hospital a decision was made to revert from the direct digital radiography (DR) system to the computed radiography (CR) system, due to poor image quality experienced. MethodThe case study objective was to conduct a comparative analysis describing key technical factors contributing to image quality. The analysis entailed retrospectively comparing the images obtained during 2010 and 2011. An image analysis form was utilised in evaluating the technical aspects of the image. A total of 160 images were viewed by 16 participants sampled from the radiography, radiology and paediatric departments. The participants were asked to re-evaluate two of their allotted images after five days to determine their reliability. ResultsFindings were that the DR system provides significantly better image quality than the CR system (p < 0.05) for all the technical factors evaluated. However technical improvements are recommended. A wide variance in intra-observer reliability was also found. ConclusionThis case study demonstrated that DR images were considered to be superior to CR images. Recommendations include: a standardised technique for imaging the neonates; optimisation of the imaging software for the digital detectors, improved feedback systems in terms of exposure index values, and the training of radiographers and referring physicians in technical image analysis.

Energy efficiency in the radiography department: An Irish perspective

BackgroundPrevious research has demonstrated that individual radiology departments do not use energy efficiently. Such studies have commented that radiologists hold a ‘unique role’ in the promotion of ‘eco-friendly’ radiology departments. Improving energy efficiency can save both energy and money and can therefore be viewed as a means of tackling – albeit on a minor scale – both global economic and environmental issues. The current research aimed to present an Irish perspective of radiology energy efficiency and more specifically the radiography department – a department primarily staffed by radiographers. MethodOut-of-hours end-use energy surveys were undertaken in four Irish departments. Ancillary electrical equipment and lighting, if any, not powered off were recorded and the energy such equipment consumes in the out-of-hours setting annually was quantified. Additionally, all desktop and workstation displays – regardless of their power-state – were recorded for comparison both between studied departments and to previous research. ResultsA range of equipment including desktop and workstation displays, computers and CR plate readers are left on in closed departments. Lighting is not powered off in radiography departments, notably within X-ray suites and changing rooms. Estimated annual savings in individual radiography departments ranges from 6656 kWh to 27,542 kWh and €1095.58 – €4533.41 (£865.50 – £3581.39). ConclusionIrish radiography departments are energy inefficient and radiographers, as the primary staff in this area, have a role in the promotion of improved radiology energy efficiency. This study focused on radiography departments, but improvements are also likely to be achievable in the wider hospital.

Problem-solving abilities of radiography students at a South African university

Background. Developing the problem-solving skills of student radiographers is imperative for encouraging critical thinking and allowing them to work efficiently in an era of rapidly advancing technology. Students’ ability to demonstrate these skills was studied so that the Department of Radiography, at a comprehensive university in South Africa, could develop a more explicit curriculum to facilitate these competencies. Objective. To assess problem-solving skills of third-year radiography students at a comprehensive South African university. Methods. The study employed a descriptive exploratory design. The participants’ responses to vignettes (in the form of clinical scenarios) were analysed using a Likert scale and action verbs developed for evaluating evidence of problem-solving skills and providing quantitative data. Field notes were made while analysing responses to each question, providing qualitative data. Results. The findings indicate that the majority of participants demonstrated a minimal ability to problem solve in a vignette. This implies that to improve problem-solving skills of student radiographers, there is a need for curriculum adjustment to nurture and encourage this competency. Conclusion. Facilitators need to be taught methods to integrate problem solving into the curriculum, and learning material must be adjusted to accommodate problem solving for this skill to become part of the programme outcomes.

Pediatric Dental Patients’ Attitudes to Rubber Dam

To explore young patients' experiences of rubber dam (RD) and determine how personal and clinical factors may influence opinions. A self-completed questionnaire was developed to capture pediatric patients' experiences of treatment under RD in a hospital setting. Patients' acceptance of RD and perceptions of how well it was explained to them were recorded on a 10cm Visual Analogue Scale (VAS), where zero represented the most negative score. The following clinical variables were also recorded: type of RD; procedure undertaken; use of local anaesthetic and procedure duration. One hundred children (52 male, 48 female) with a mean age of 11.8 years (SD = 2.29; range 7-17 years) participated Overall, acceptance of RD was satisfactory (mean VAS = 5.0). Patients were happy with the explanation of why RD was used (mean VAS = 7.7). The type of RD, use of local anaesthetic, procedure undertaken and duration of the procedure did not significantly influence acceptance levels. However RD was significantly less acceptable to patients who underwent radiographic examination whilst wearing the RD (P < 0.05, t-test). Nearly five times as many patients expressed concern at being seen wearing RD when taken to the radiography department (39.2%, n = 20/51), compared to those who were reportedly self-conscious about RD when treated only on the paediatric dentistry clinic (8.2%, n = 4/49). The use of RD appears acceptable physically and psychologically to most pediatric patients, however visibility of the RD to others was a potential concern to some children.

Radiographer use of anatomical side markers and the latent conditions affecting their use in practice

BackgroundPatient safety is a primary concern within the NHS. It has been reported that anatomical side marker (ASM) use in radiography does not meet the ‘best practice’ standard. Case reports suggest this may be a contributing factor to adverse events in healthcare. PurposeThis study aimed to investigate the latent conditions contributing to poor ASM practice; communities of practice, time of image acquisition and competing priorities with collimation practice. MethodProxy variables of projection and laterality were used to measure communities of practice. ASM practice on 330 examinations (170 lumbar spine, 160 finger) was retrospectively observed using a data collection tool. Aggregate scores were calculated from the two images in each examination. Data was analysed using descriptive statistics, chi-square tests (projection) and Mann–Whitney U tests (laterality, time of acquisition and collimation practice). Results‘Best practice’ ASM use was met on one examination. Correct ASM were observed within the primary collimation in 32.0% images. Projection, laterality and collimation practice were associated with ASM use. Time of acquisition was not found to be associated. DiscussionCommunities of practice and competing priorities impact on ASM use. Logistic regression to determine a primary latent condition was not possible. However, comparison with previous research suggests this is likely to be specific to each radiography department. ConclusionLatent conditions are associated with poor ASM practice. These must be identified and addressed in each individual radiography department, to improve patient safety and uphold NHS Constitutional standards.

DÖME: revitalizing a low-background counting chamber and developing a radon-tight sample holder for gamma-ray spectroscopy measurements

There was an emerging need at the Nuclear Analysis and Radiography Department of the Centre for Energy Research, Hungarian Academy of Sciences, Budapest to be able to perform low level radioactivity measurements of various samples from in-beam activation and from environmental studies. Important aspects of reusing the low-background chamber called DOME, which had been unused for some years, were the development of an easily reusable radon-tight sample container and the setup of a measurement system capable of counting extended samples in close-in geometry. As a result of our efforts a special sample container made of HDPE (High-density Polyethylene) was developed, and it is proved that the probability of a radon loss larger than the 2 % of its radioactive decay constant is <95 %. Due to the lack of reference samples, containing the same radionuclides as the unknown sample, the absolute method of measuring the activity concentration of nuclides in the sample had to be applied, which implied the reliable determination of the full-energy peak efficiency. A method called efficiency transfer combined with the correction for true coincidence summing effects is proven to be providing appropriate results and applied.

MO‐A‐116‐01: TG151: Radiographic System Quality Control

Quality control (QC) in medical imaging is often viewed as a series of infrequent, detailed evaluations of a piece of medical imaging equipment by a qualified medical physicist (QMP). The day‐to‐day operational process is largely neglected absent regulatory or accreditation requirements. However, QC should be viewed as an ongoing process that occurs on an image‐by‐image basis. Ongoing QC was inherent in the screen‐film imaging workflow, where rejected image rates were calculated by counting rejected films and improperly exposed films resulted in images that were too dark or light and were repeated out of necessity, and the rejected films counted. During the early years of the shift to digital imaging in radiography, ongoing QC was largely abandoned, owing to both a perceived lack of need and difficulty in performing ongoing QC with early digital imaging systems, which lacked standardized exposure indicators and tools for counting rejected images.The QC process involves key personnel in the imaging department, including the radiologist, radiologic technologist, and QMP. The radiologist administers and oversees the QC program, which is carried out by the radiologic technologist. The radiologic technologists collects and analyzes data, and results that are outside the acceptance levels for the QC program are investigated, and corrective action taken to bring these results back to an acceptable level. The QMP consults with the radiologist in the design and implementation of the QC program, works with the technologist to triage problems, and carefully evaluates the imaging equipment on a regular basis for proper calibration, function, and compliance with applicable regulations. The continued need for ongoing QC in digital radiography has been highlighted in the scientific literature, and Task Group 151 was charged with recommending consistency tests designed to be performed by a QMP, or a radiologic technologist under the direction of a QMP, to identify problems with an imaging system that need further evaluation by a QMP, including a fault tree to define actions that need to be taken when certain fault conditions are identified. The focus of the final report of TG 151 was the ongoing QC process, including rejected image analysis, ongoing exposure analysis, and artifact identification. These three QC tasks are vital for the optimal operation of a department performing digital radiography.Learning Objectives:1. Learn methods for performing rejected image analysis in digital radiography, including learning trends and patterns that are common2. Learn methods for performing ongoing exposure analysis in digital radiography, including learning trends and patterns that are common3. Understand how to incorporate ongoing QC into your radiography department

SU‐E‐I‐38: How to CT a Horse Using a CT Scanner Built for Human Imaging

Purpose: Veterinary medicine teaching hospitals within the United States include fully functioning radiography departments which contain a full host of modern medical imaging capabilities, including standard CT scanners, MR imagers, digital radiography, ultrasound, and nuclear imaging systems. These systems, initially designed for human use, are employed daily in both diagnostic and research imaging studies on non‐human patients. Imaging animals of different species and breeds often presents unique challenges not encountered in human imaging studies. In this work we present a case study of the clinical procedure used for performing an equine CT scan at the Boren Veterinary Teaching Hospital. Methods and Materials: For equine CT procedures, the animal is first anesthetized, loaded on a gurney and transported to prep room. In the prep room it is transferred onto a specially designed large‐animal CT table and positioned for imaging. Next, it is transported to the CT suite where the large‐animal table is docked with the scanners CT couch. The CT scanners couch is then used to drive the large‐animal table and move the animal as the helical CT scan is performed. For our case study, the head and neck of the horse was scanned as part of a study to image a large sinus carcinoma. Conclusion: The equine CT procedure took approximately 30 minutes to complete. Between eight to ten people are need to help stabilize, move, position, and lift the horse at different steps in the process. For this talk we will present a step‐by‐step description of the entire procedure, showcasing the unique challenges encountered when scanning large animals. Conclusion: The specialized needs and challenges of these imaging studies have led to many new procedural and engineering solutions, which are necessary to make scanning large animals on a CT scanner built for human imaging possible.

A model to correct for short‐run inefficiencies in economic evaluations in healthcare

Important assumptions that underlie cost-effectiveness analysis (CEA) are that production technologies are convex and that production processes always perform at constant returns to scale. However, in the short run these assumptions are likely to be violated. Therefore, CEAs might overestimate cost-effectiveness in the short run. To come up with a more precise cost-effectiveness outcome, we present a model that is able to correct the long-run incremental net benefit (INB) for short-run inefficiencies. This provides decision makers with a more realistic view of the expected efficiency gains. This model starts by determining the initial efficiency losses inflicted by inflexible resources. Then the model is made dynamic in order to adjust the efficiency losses by allowing for refilling and writing off freed capacity. Finally, the model calculates the length of the short-run time frame in which such efficiency losses exist, and a correction term with which the usual long-run INB should be adjusted to account for short-run inefficiencies. The model is applied to two cases: dialysis and digitizing a radiography department. The dialysis case shows moderate short-run efficiency losses while in the radiography case short-run efficiency losses are sufficiently large to cause a switch in cost-effectiveness from favorable to inefficient in the short run.

フィルムレス環境下における一般撮影検像システムの構築‐正確で迅速な新しいワークフローの構築‐

When medical records went digital at our hospital, we also went filmless. In the general radiography department, we were forced to change the workflow, so we created a new one. We introduced a system of quality assurance for images between consoles and PACS. As our original improvement, we added to the system a function to automatically narrow down patient images and a function to automatically sort images. We divided quality assurance for images into 1st and 2nd quality assurance and defined and managed it. In addition, we measured the time for each process of the workflow with and without film use. We compared 10 cases of chest and abdomen radiographs with 10 cases of bone radiographs. As a result, by using this system of quality assurance for images, we were able to cut three minutes from each examination, leading to quicker work.

People as a Source of Breakthrough Innovation

The product visions are startling—jackets with cell phones and MP3 players, multimedia furniture, a radiography department where patients design the scanning experience. With these and other examples, Stefano Marzano articulates Philips Design's human-centered techniques for exploring the frontiers of creativity—strategies that blend an in-depth understanding of markets, the firm's special competencies, and the interface with consumers.

Consulting with Young People About Healthcare. Part I: Experience of the Hospital Environment

The NHS policy in the UK recommends that the built hospital environment should cater for the needs of younger and older children, adolescents and carers. However, previous studies have indicated that addressing the needs of such a wide age range is a challenge, and that the hospital design and systems are typically more appropriate for children of a younger age rather than adolescents. The aim of the present study was to explore how adolescents, who had not been regular patients, experience the hospital environment and their interactions with staff. Using qualitative methodology, we explore the responses of four young individuals who participated in an innovative filmed hospital intervention study documentary. Results suggest that a pediatric ward designed specifically for adolescents was experienced positively by participants. Other areas of the hospital serving a wide age range of patients (e.g., the emergency and radiography departments) were not experienced as positively. Implications for hospital design, staff training and future research using multimedia approaches are explored.

Image rejects/retakes--radiographic challenges

A general held position among radiological personnel prior to digitalisation was that the problem of image rejects/retakes should more or less vanish. However, rejects/retakes still impose several challenges within radiographic imaging; they occupy unnecessary resources, expose patients to unnecessary ionizing radiation and may also indicate suboptimal quality management. The latter is the main objective of this paper, which is based on a survey of international papers published both for screen/film and digital technology. The digital revolution in imaging seems to have reduced the percentage of image rejects/retakes from 10-15 to 3-5 %. The major contribution to the decrease appears to be the dramatic reduction of incorrect exposures. At the same time, rejects/retakes due to lack of operator competence (positioning, etc.) are almost unchanged, or perhaps slightly increased (due to lack of proper technical competence, incorrect organ coding, etc.). However, the causes of rejects/retakes are in many cases defined and reported with reference to radiographers' subjective evaluations. Thus, unless radiographers share common views on image quality and acceptance criteria, objective measurements and assessments of reject/retake rates are challenging tasks. Interestingly, none of the investigated papers employs image quality parameters such as 'too much noise' as categories for rejects/retakes. Surprisingly, no reject/retake analysis seems yet to have been conducted for direct digital radiography departments. An increased percentage of rejects/retakes is related to 'digital skills' of radiographers and therefore points to areas for extended education and training. Furthermore, there is a need to investigate the inter-subjectivity of radiographers' perception of, and attitude towards, both technical and clinical image quality criteria. Finally, there may be a need to validate whether reject/retake rate analysis is such an effective quality indicator as has been asserted.

Factors associated with the goal commitment of radiography departments' staff in organizational change

Purpose The aim of the study is to examine factors associated with the goal commitment of radiography departments' staff. The associations studied are (1) organizational change, (2) work-related factors, (3) psychosocial work environment, and (4) intention to leave. Method The follow-up study was performed between 2005 and 2007 in co-operation with 10 radiography departments of two Finnish municipalities. In 2005 the response rate was 60% ( n = 97/163) and in 2007 it was 49% ( n = 73/150). Results The goal commitment had dropped during the organizational change from 3.96 in 2005 to 3.60 in 2007 (scale 1–5) ( p = 0.001). Best predictors for the goal commitment of radiography departments' staff were having children (OR 4.4) and perceiving functional environment clearly (OR 2.6). Correlation between the goal commitment and intention to leave of the staff was −0.32 ( p = 0.01). Conclusion From the viewpoint of the commitment of the radiography departments' staff, the trend of uniting quite independent health care units into larger entities seems not to be beneficial. This study reveals that commitment to one's work unit is most of all a question of stability and job security. This is a fact the leadership of the radiography departments should take into account, appreciate and support to assure the tenure and productivity of their workforce.

Disc calibration for digital templating in hip replacement

Digital radiography is becoming widespread. Accurate pre-operative templating of digital images of the hip traditionally involves positioning a calibration object at its centre. This can be difficult and cause embarrassment. We have devised a method whereby a planar disc placed on the radiographic cassette accounts for the expected magnification. Initial examination of 50 pelvic CT scans showed a mean hip centre distance of 117 mm (79 to 142) above the gluteal skin. Further calculations predicted that a disc of 37.17 mm diameter, placed on the cassette, would appear identical to a 30 mm sphere placed at the level of the centre of the hip as requested by our templating software. We assessed accuracy and reproducibility by 'reverse calibration' of 20 radiographs taken three months after hip replacement using simultaneous sphere and disc methods, and a further 20 with a precision disc of accurate size. Even when variations in patient size were ignored, the disc proved more accurate and reliable than the sphere. The technique is reliable, robust, cost effective and acceptable to patients and radiographers. It can easily be used in any radiography department after a few simple calculations and manufacture of appropriately-sized discs.

Radiation Protection in Diagnostic Radiology: More Intense Communication is Required

The article on radiation protection in diagnostic radiology constitutes an important scientific contribution. Details of individual dosimetric terms are explained in an exemplary fashion. All reported estimates are based primarily – as mentioned in the article – on the experiences of the nuclear bombs dropped on Japan in World War II. These calculations are bound to be rough estimates as the radiation doses and types at the time were different to those used in diagnostic radiology today. The reported tables are for orientation purposes, and it should be mentioned that a substantial variation in range exists which is mainly user dependent. The factor 400 for a thoracic computed tomography scan seems high, whereas in abdominal CT, more than 10 mSv can occur, depending on the number of the examined phases (1). Data are missing on catheter investigations (cardiac catheter, percutaneous transluminal coronary angioplasty), image guided treatments (vertebroplasty and kyphoplasty, intraoperative radiology), and modern methods (CT colography, cardiac CT, high resolution CT of the lung). The doses of all these investigations are often not known to referring doctors (2). Many unpredictable factors exist with regard to the attributable mortality risk (3). The absolute numbers may be correct under the given circumstances, but they are suitable merely for comparing exposure practices in the different countries. With regard to potential deaths or malignancies due to radiography, it needs to be kept in mind that investigations using ionizing radiation are usually done on severely ill patients who are often of advanced age. The authors emphasized the need for intensive communication between referrers and specialists – this is of crucial relevance. Radiation protection should start earlier than in the radiography department! The correct indication with set requirements and radiation-sparing investigation techniques will result in a dose reduction in the individual as well as in the population. In radiation protection, 1 g of cerebral matter weighs more than 1 tonne of lead (Felix Wachsmann, 1965).

Correlation between musculoskeletal ultrasound, magnetic resonance imaging, arthroscopic and clinical findings in a 30-year-old male with a medial meniscus ganglion: A case report

Summary Objective To date, magnetic resonance imaging (MRI) has been the method of choice to visualize meniscal ganglions; however, an MRI is quite costly. Studies have shown that high-resolution ultrasonography (HRUS) is an alternative form of investigative imaging with comparable accuracy. Aim To present a case where ultrasound was used to diagnose a medial meniscus ganglion and illustrate its usefulness in deciding on the subsequent therapeutic intervention. Design Case report. Setting Radiography department at the Anglo-European College of Chiropractic (AECC), Bournemouth. Subject A 30-year-old student with a 10-month history of right-sided knee pain and clinical suspicion of a medial meniscal cyst and concomitant medial meniscal lesion. Method HRUS of the right knee was used to confirm the clinical diagnosis. Complementary MRI was available. The author was able to observe the subsequent surgical intervention (knee arthroscopy). Result Ultrasound examination confirmed the clinical findings and offered additional information as to the extent of the cyst. Ultrasound could not assist in determining the size or the location of the medial meniscal lesion for which MRI was required. Although this was important for the management of the patient, the decision on the therapeutic procedure (knee arthroscopy) could have been made from the ultrasound findings alone. The MRI findings did not change the method/technique of the planned operative procedure. The arthroscopy confirmed all the MRI findings; additionally, it demonstrated the connection between the meniscal tear and meniscal cyst and a partial detachment of the anterior cruciate ligament at its proximal insertion site. Conclusion HRUS is rapid, low-cost and non-invasive. This case illustrates its reliability and usefulness in the detection, characterization and differentiation of meniscal cysts.

Radiographer emergency department hot reporting: An assessment of service quality and feasibility

Purpose Radiographer reporting has been implemented widely as cold reporting. This study aimed to compare hot and cold reports by the same radiographer to establish whether there was any significant difference in the diagnostic outcome. Method Three experienced radiographers reported 1618 musculoskeletal trauma cases over a 3 month period. These cases were stratified for age (0–17 years; 18–50 years; 51 years+) and a random sample of 400 cases selected (95% confidence interval, 90% power) for delayed reporting. Both reports were independently compared by 2 experienced film readers. Results Radiographs and notes on 391 (97.8%; n = 391/400) cases were located (age range 3 months to 97 years) for cold reporting. The diagnostic outcome of the reports was concordant in 357 cases (91.3%; n = 357/391) and discrepant in 34 cases (8.7%; n = 34/391). Logistic regression performed on age stratified discrepancies indicated that paediatric cases had increased odds of receiving discrepant reports (OR = 3.34; p = 0.005; 95% CI [1.44–7.74]). Hot and cold report agreement was high ( κ = 0.87). McNemar's test demonstrated no significant difference in the report discrepancies ( p = 0.189). Conclusion No significant difference was demonstrated between the diagnostic outcome of radiographer hot reports, issued whilst working within the trauma radiography department at time of patient attendance, and cold reports.

The Red‐dot system in medical imaging: ethical, legal and human rights considerations

AbstractThe Red‐dot system, used extensively overseas, but sporadically in Australia, allows radiographers to bring abnormal images to the attention of the referring medical practitioner, prior to the issuance of a formal radiologist's report.There is much discussion in the public arena as to the increasing workload of medical practitioners, and the role other health professionals may play in easing this burden. In addition, hospital emergency departments across Australia are under pressure to minimise ambulance bypass and patient waiting times, while maintaining optimal diagnostic and treatment standards.The third component to this discussion is some radiographers' general hesitance regarding the Red‐dot system because of legal issues. In addition, there is the issue of many medical practitioners not wanting to give up aspects of their practice, citing a potential decrease in the quality of the health service.Analysis of the legal and human rights literature with respect to the provision of emergency medical services in particular, as well as detailed exploration of the various ethical issues involved with the Red‐dot system indicate to the author that such a system has a significant role to play in the provision of healthcare, particularly where a radiologist's report may be delayed. Additionally, radiographers are able to accept the challenge of contributing to healthcare without fear of legal endangerment in particular, provided they are willing to maintain a level of excellence with respect to their image interpretation skills.The Australian Institute of Radiography (AIR) is correct in listing the ability of radiographers to notify referring doctors of abnormal results and offering opinions on radiographic examinations within their expertise, when requested. It is the conclusion of this paper that use of the Red‐dot system is best practice and as such should be implemented in all radiography departments associated with emergency medicine departments.