Radiographic Practice Research Articles

A survey of digital radiography practice in four South African teaching hospitals: an illuminative study

Purpose:The purpose of this study was to assess radiographer familiarity and preferences with digital radiography in four teaching hospitals and thereafter make recommendations in line with the migration from screen film to digital radiography.Materials and methods:A questionnaire was designed to collect data from either qualified or student radiographers from four teaching hospitals. From the four teaching hospitals, there were a total of 205 potential respondents. Among other things, responses regarding experiences and preferences with digital radiography, quality control procedures, patient dose, advantages and disadvantages of digital radiography were sought. The information collected was based on self-reporting by the participants. The study is exploratory in nature and descriptive statistics were generated from the collected data using Microsoft Excel 2007 and StatsDirect software.Results:Sixty-three out of 205 (31%) radiographers from all the four radiology centers responded to the circulated questionnaire. Only 15% (8) of the qualified radiographers had 4 or more years of experience with digital radiography compared to 68% (36) for the same amount of experience with screen-film radiography. Sixty-one percent (38) of the participants had been exposed to digital radiography during their lectures while at university. A small proportion, 16% (10) of the respondents underwent formal training in quality control procedures on the digital X-ray units they were using. Slightly more than half (55%) of the participants felt it was easier for them to retake an image in digital radiography than in screen film radiography.Conclusion:The results of this survey showed that the participants are familiar with digital radiography and have embraced this relatively new technology as shown by the fact that they can identify both its advantages and disadvantages as applied to clinical practice. However, there are minimal quality control procedures specific to digital radiography being undertaken as such there is need for formal education, continuing education and manufacturer training with respect to quality control as institutions make the transition from conventional screen film radiology to digital radiology.

Good radiographic practice: The Nigerian experience and the CEC recommendations

A survey of 25 hospitals in Nigeria has been conducted to assess the level of compliance to the Commission for European Communities (CEC) criteria for good radiographic practice in four adult radiographic examinations. Chest, skull, abdominal and lumbar spine radiographic examinations were assessed. Using a simple scoring system of ‘0’ for unfulfilled and ‘1’ for fulfilled criteria, the results show an average compliance level of 50 ± 8% for chest, 57 ± 8% for skull, 56 ± 10% for abdomen and 51 ± 7% for lumbar spine radiography. Findings show that the level of compliance could be corrected by the adoption of quality control programmes in the country.

The lived experience of newly qualified radiographers (1950–1985): An oral history of radiography

The preparedness for practice of newly qualified healthcare professionals (including radiographers) has been the focus of attention in recent years as the practice environment continues to place great demands on its workforce. This paper reports an aspect of the findings from an oral history project on the career history of radiographers conducted as an academic research investigating the changes that have occurred in radiography and the impact these have had on the profession and the practice of radiography. The main focus of this paper is the lived experience of the informants of the oral history project as newly qualified radiographers. The findings are discussed in the context of current practice environment and developments in radiography.Analysis of the textual materials generated from informants' oral historical accounts, suggest radiographers trained in this time frame perceived their training as ‘fit for purpose. The findings further suggest there is a general norm of ‘get-on-with-it’ as a coping strategy which is still prevalent in the profession today. The paper concludes by drawing on lessons that can be learned from the lived experiences of radiographers' oral historical accounts.

Factors influencing students' choices in considering rural radiography careers at Makerere University, Uganda

Introduction The Faculty of Medicine, Makerere University is the oldest health professions training institution in East Africa having started in 1924. The radiography degree course started in 2001 and Makerere remains the only institution in the East African region offering this degree course. The faculty adopted a Problem based Learning/Community based education curriculum in order to stimulate students' interests to consider working in rural areas. Attracting and retaining radiographers and other health professionals in rural areas is a recognized problem in Uganda and overseas and strategic actions to enhance the rural health workforce and its ability to deliver the required services are paramount. A range of factors in different domains can be associated with recruitment and retention. By consulting students, some of these factors can be identified and addressed. Methodology It was a descriptive exploratory study involving 31 students. Data was collected through a questionnaire and focus group discussions. Results 58% of the students reported that they would consider rural radiography practice while 42% would not. Key motivational factors cited to work in rural areas were; attractive salaries/incentives, community based training curricular, opportunities for further training and well equipped rural health facilities. Conclusion This study has shown that students would consider working in rural areas provided the working conditions are improved upon.

Patients’ perception of care during special radiological examinations

ABSTRACTBackgroundPatients’ perception of care is considered to influence their satisfaction with the service provided. However, this has received minor attention in radiography practice in Nigeria with no quantitative study from available literature search.MethodA total of 200 self-completion questionnaires were delivered to four radiology departments within the north-eastern states of Nigeria (50 to each centre). The questionnaires included questions on patient demographics as well as ordinal scales for patients to rate their care on various indices and a 10 visual analogue scale to rate their overall satisfaction, while an open-ended question was used to assess patients’ expectation of radiology staff. 142 questionnaires (71%) were returned. Both descriptive and inferential statistics were done. Tests were two-tailed with p < 0.05 indicating statistical significance.ResultsPatients’ perception of care correlated significantly with patients’ satisfaction.ConclusionGood staff-patient interaction and proper organisational behaviour could improve patients’ perception of care.

The research agenda and the role of the therapeutic radiographer: The College of Radiographers perspective

AbstractThis article reflects on the influences on current radiotherapy practice and the key role that Therapeutic Radiographers have in the management of cancer care and the delivery of treatments. In particular the Cancer Reform Strategy is discussed which clearly highlights the many challenges related to cancer. Changes in societal and scientific understanding will demand that the most appropriate and evidence-based care is provided for patients, underscoring the need for evidence through research, to underpin every aspect of daily work if patient outcomes are to continue to improve. In October 2005, the Society and College of Radiographers published: ‘Research and the Radiography Profession—A Strategy and Five Year Plan’. This is an ambitious document, which sets out expectations for the appreciation and use of substantiated research involvement at all levels of practice. Sections of this document and the relevance to radiotherapy practice are discussed. Alongside this, the career progression model for radiography continued to be driven forward with support from the Department of Health. This model describing higher levels of practice for radiographers, at advanced and consultant levels, clearly identified research as a key requirement for the profession. The guidance document in 2006, from the Society and College of Radiographers ‘Positioning Therapeutic Radiographers within Cancer Services: Delivering Patient Centred Care’, further articulated these expert roles, in response to the changing drivers within cancer and across the radiotherapy pathway. In conclusion, research must become a fundamental component of everyday radiotherapy practice as it will verify professional standards of care and sustain the future of the profession. To contribute to the wider cancer agenda it is imperative that all therapeutic radiographers, from practitioner to consultant level, participate in and lead research.

The radiographic processing practice in dentistry: a qualitative analisys

Buscando possíveis causas para a falta de qualidade das radiografias realizadas no curso, foram entregues questionários abertos a todos os professores de Odontologia da ULBRA, campus Torres/RS, com 5 questões envolvendo seus conhecimentos sobre processamento radiográfico. Participaram da pesquisa os 16 professores que devolveram o questionário respondido. Utilizou-se para a análise dos dados a Análise de Conteúdo de Bardim, situada no Grupo dos Métodos Lógicos-Semânticos. A organização da análise de dados coletados ocorreu em três momentos: a préanálise, a exploração do material e os tratamentos dos resultados. A grande maioria dos professores que aprendeu a utilizar o método visual na sua graduação (13) continua processando as radiografias da mesma maneira até hoje. Os resultados da pesquisa mostram que não existe uma padronização em relação ao método de processamento utilizado em todas as disciplinas do curso. Além disso, etapas do processamento como o tempo de permanência no fixador, banho final, secagem e armazenagem não foram citadas pela maioria dos professores nos questionários. É necessária a conscientização da importância de ocorrerem mudanças, inicialmente por parte dos professores das diferentes áreas clínicas da Odontologia, para que os alunos possam continuar processando as radiografias, como corretamente ensinado na disciplina de radiologia durante todo o seu curso de graduação e vida profissional, não desprezando nenhuma etapa do processo.

Rheumatoid arthritis: a novel radiographic projection for hand assessment

Rheumatoid arthritis (RA) is the most common form of inflammatory disease, affecting 1-2% of the population. Posteroanterior (PA) and Brewerton projections are well established in radiographic practice for scoring and monitoring RA, but there is little evidence to demonstrate the diagnostic efficacy of these techniques. This work, by varying the positioning of a cadaveric hand, investigates whether an alternative radiographic projection could yield greater diagnostic information than the traditional techniques. Phase I of the study evaluated moving the hand 15 degrees from the anteroposterior position and then in 5 degrees increments in four directions: medial rotation, lateral rotation, flexion of the wrist and extension of the wrist. Phase II of the study took the optimum projections from Phase I and further manipulated these positions in a direction at right angles to the original position. Images were scored based on joint space visualisation in 29 joints. Results demonstrated that significantly higher diagnostic efficacy was evident with 15 degrees lateral rotation of the hand or 15 degrees flexion at the wrist compared to the Brewerton projection. Either projection is recommended, but on the basis of patient comfort, the latter of these novel positions, now known as the UCD projection, was chosen as the optimum procedure to replace the Brewerton projection. The value of using cadavers for the establishment of optimum radiographic procedures is highlighted.

Ｘ線撮影用ポジショニングドールの有用性の検討‐単純Ｘ線撮影実習の施行および診療放射線技師を対象とした調査を通して‐

The effectiveness of a positioning doll for radiography training (XPD) and acquiring the techniques of radiography was evaluated through performing radiography practice for the students in our school of radiological technologists and a questionnaire for radiological technologists. We made a ranking test composed of a five-grade evaluation system of the 39 students for the techniques of radiography before and after the practice, and questionnaires about the XPD were given to the same students after the practice. The questionnaires about affinities between human bodies and the XPD and effectiveness of the XPD for the education of students were also carried out in six radiological technologists to examine the effectiveness of the practice of radiography by using the XPD. The rankings of the students after the practice were significantly higher than those before the practice (p <0.01), and 85% of the students rated the practice using the XPD as useful for them in acquiring the techniques of radiography. Seventy-eight percent of the radiological technologists rated it useful for student education in radiography. In conclusion, it was suggested that practice using the XPD was effective in helping students to acquire the techniques of radiography. We would like to develop supplementary tools for fixing the XPD and using the practice of radiography in many ways and in new directions in the future.

Reproducible X-Ray Projection Geometry in Endodontic Practice

INTRODUCTION: Clinical application of radiography in endodontic practice is affected by reproducibility in the orientation of the x-ray source, image receptor and object. The inability of dentists to locate intra oral films or sensors in appropriate positions in different cases can cause complications in the performance of endodontic therapy. Commercially available film holder (endoray) and conventional imaging methods seem to be insufficient and difficult to perform. The purpose of this investigation was to develop a novel and easily performed device for endodontic radiography and to asses its reproducibility and accuracy in vitro. MATERIALS AND METHODS: The present work surveys and evaluates the design steps of a newly constructed film holder with modified bite block and a beam guiding device, in an attempt to perform a diagnostic study. References wires and balls were attached on the film holder and to the alveolar crest of maxillary molar region inserted in the conventional phantom for measuring the projection errors relative to the film holder and repositioning .One hundred and twenty radiographs of a conventional phantom were taken by one of the authors and by two dental students using the novel device and Endoray. RESULTS: The %95 CI for precision of radiologist and one of the students was less than 8 (7.313 ± 0.1989) .The %95 CI for precision of the other student was less than 12 (10.941 ± 0.4217). There was no significant difference (p= 0.679), regarding the interoperator precision, between radiologist and first student. There was significant difference between second student and the others (p<0.05). No significant difference was noted between the radiographs achieved by the Endoray and new device. CONCLUSION: The novel device appears to be a potential means of obtaining reproducible radiographs in endodontic practice. Further research is needed however, to study in vivo aspects, reproducibility and accuracy.

Research in medical imaging and the role of the consultant radiographer: A discussion

This article examines the need for research in radiography as a means to provide the evidence base for radiographic practice. The review examines the role of the consultant radiographer in providing potential research leadership and outlines possible avenues for research. The article uses three main themes to set out its proposals: • The need for patient focus. • The need for a greater mix of research methods and, specifically, more studies which utilise qualitative methods. • The need for consultant leadership in research and some potential studies. The article concludes by arguing the need for a greater academic community in radiography with consultant radiographers stepping up to play their part in that community.

Factors influencing the development and implementation of advanced and consultant radiographer practice – A review of the literature

United Kingdom (UK) government policy, which has focused on modernising the NHS and making it more responsive to patients' needs, has, in fact, created significant service demand. The Department of Health (DoH) committed itself to changing and improving the organisation and delivery of health care through professional role development and blurring of traditional professional boundaries. In 2000, the DoH announced an intention to create consultant allied health professional posts to facilitate career development opportunities for expert and experienced staff. There are currently 31 consultant radiographers in the UK who have been appointed to new posts, and 2 trainees. Such posts are created subject to a formal approval panel process as laid down by the DoH. This paper will begin by outlining the current scope of radiographic consultant practice and advanced clinical roles in the UK. Key factors that have facilitated the development and implementation of such roles will then be explored and discussed. It will also consider what specific factors can inhibit innovative change and whether there appears to be any perceived threats to the current momentum of change.

The concept of advanced radiographic practice: An international perspective

Advanced radiographic practice has been the focus of much discussion and debate over the last decade, not only in the United Kingdom where advanced practitioner roles are now recognised within the national career framework, but also internationally. Yet, despite almost simultaneous professional movement towards advanced radiographic practice philosophy and ideals in many countries, international collaboration on this development has been minimal. This paper marks a growing international dialogue in this field. It discusses the theoretical concepts of advanced radiographic practice and the development of advanced practitioner roles, incorporating evidence and ideas from differing international perspectives and debates progress towards a potential unified global advanced practice identity.

Imaging: Practice radiography How to improve image quality: Part 2

Imaging: Practice radiography How to improve image quality: Part 2

Imaging: Practice radiography: How to improve image quality: Part 1

Imaging: Practice radiography: How to improve image quality: Part 1

Characteristics of good practice — how to be a good radiographer

AbstractThe study's objective was to define the characteristics of ‘good practice’ in radiography.Method Observations of six radiographers performing CT examinations on patients, and in‐depth interviews with four radiographers. Interviews and observations are analysed using Kvale's phenomenological method.Results Radiographers perform examinations differently. Differences are especially apparent in regard to how they relate to their patients. The radiographers viewed their job in three different ways: those who saw radiography as a technical job; those ambivalent as to whether the job is of a technical or a relational nature; and those who sought to utilise technique via the patient. Good radiography is characterised by the combination and integration of technical and patient‐oriented actions.Discussion The results of this study challenge the profession's view of its own practice and the overall value criteria to employ when evaluating radiographic practice.

Defining and assessing critical thinking skills for student radiographers

Developing critical thinking skills is a key aim of higher education and is important in preparing student radiographers for their future careers in clinical practice. The aim of this paper was to attempt to devise and assess six key components of critical thinking appropriate for radiographic practice. Each of the six components was divided into three dimensions and a Critical Thinking Skills Scoring Chart (CTSSC) devised to assess students' written performance against each dimension. Scores revealed that approximately 30% of students were rated as good and approximately 10% of students were rated as poor in each component, although there was some variability between different dimensions. It is suggested that educators need to encourage and support students to develop their critical thinking skills by reviewing their curriculum to clearly define specific skills and ensure that they are appropriately taught and assessed.

Adherence to Radiography Guidelines for Low Back Pain: A Survey of Chiropractic Schools Worldwide

Objective This study describes instruction provided at chiropractic schools worldwide on the use of spine radiography and compares instruction with evidence-based guidelines for low back pain. Methods Individuals responsible for radiology instruction at accredited chiropractic schools throughout the world were contacted and invited to participate in a Web-based survey. The survey included questions on the role of conventional radiography in chiropractic practice and instruction given to students for its use in patients with acute low back pain. Results Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that “routine radiography should be used prior to spinal manipulative therapy,” 29 (91%) disagreed that there “was a role for full spine radiography for assessing patients with low back pain,” and 29 (91%) disagreed that “oblique views should be part of a standard radiographic series for low back pain.” However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there “is a role for radiography in acute low back pain in the absence of ‘red flags’ for serious disease.” Conclusions This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. However, there appears to be a disparity between some schools and existing evidence with respect to the role of radiography for patients with acute low back pain without “red flags” for serious disease. This may contribute to chiropractic overutilization of radiography for low back pain.

Methodological approaches to evaluating the practice of radiographers’ interpretation of images: A review

Recent initiatives to modernise the National Health Service describe how improving pay structures and staff working lives can be achieved in the form of advanced practitioner and consultant posts. Role development in Radiography represents a fundamental change to professional practice of radiographers and is subject to the provisions of the statutory and professional codes of conduct which govern such practice. In Diagnostic Radiography the response to Government initiatives has led to a change in practice so that radiographers in these new posts provide reports for a variety of imaging modalities. At the same time as there have been changes in the practice of Radiography, the discipline of evidence-based medicine has emerged. Changes in clinical practice should be underpinned by evidence from research. The purpose of this paper is to discuss the methodological approaches used to conduct research that evaluates one of the most salient areas of development in Radiography practice, that is the role of radiographers as advanced or consultant practitioners when interpreting plain radiographs. We begin by discussing what an evaluation is and two broad approaches for conducting health services research, and then appraise the evidence about radiographer reporting in the context of these methods of evaluation. We then suggest future considerations about the methodological approaches to evaluating radiographer reporting practice and identify where there are evidence gaps and the need for further research to inform evidence-based Radiography.

Evaluation of exposure parameters in plain radiography: a comparative study with European guidelines

Typical distribution of exposure parameters in plain radiography is unknown in Portugal. This study aims to identify exposure parameters that are being used in plain radiography in the Lisbon area and to compare the collected data with European references [Commission of European Communities (CEC) guidelines]. The results show that in four examinations (skull, chest, lumbar spine and pelvis), there is a strong tendency of using exposure times above the European recommendation. The X-ray tube potential values (in kV) are below the recommended values from CEC guidelines. This study shows that at a local level (Lisbon region), radiographic practice does not comply with CEC guidelines concerning exposure techniques. Further national/local studies are recommended with the objective to improve exposure optimisation and technical procedures in plain radiography. This study also suggests the need to establish national/local diagnostic reference levels and to proceed to effective measurements for exposure optimisation.