Detection of incidental adrenal nodules on computed tomography by radiographers

IntroductionThis research investigated whether radiographers’ age, qualifications, shift rotations and years of post-qualification experience as a radiographer affect the detection rate of incidental adrenal nodules, also known as adrenal incidentalomas in Malta. Additionally, local statistics of adrenal incidentaloma findings were evaluated.MethodsThis research consisted of two phases and employed a non-experimental, cross-sectional quantitative approach. Phase 1 comprised of a self-designed data collection sheet to retrospectively determine the occurrence of recalled computed tomography (CT) examinations resulting from an adrenal incidentaloma finding during a six-month period between July 2020 and December 2020. In phase 2, a self-designed questionnaire with anonymised CT scan images (n = 30) displayed on ViewDex (Viewer for Digital Evaluation of X-ray images) was prospectively completed by CT radiographers (n = 23) to identify adrenal incidentalomas on the images.ResultsIn phase 1, adrenal incidentalomas were present in 1.4% of contrast-enhanced CT (CECT) examinations (n = 12139), out of which, 79.8% were not acknowledged by the radiographers on the initial scans and patients had to be recalled for a dedicated adrenal CT scan. In phase 2, a statistically significant (p < 0.05) relationship was determined between the radiographers’ qualifications, shift rotations and years of post-qualification experience as a radiographer, with their detection rate of adrenal incidentalomas.ConclusionFindings suggest that radiographers’ qualifications, shift rotations and years of post-qualification experience were found to be statistically significant factors affecting their detection rate of adrenal incidentalomas. These could have contributed to one of the reasons for recalling patients, which in turn results in an added burden to both the patient and the Radiology Department.Implications for practiceDetection of adrenal incidentalomas by radiographers has a direct impact on clinical practice. If identified during the initial CT examination and a further delay scan is performed, this will benefit patients by reducing the risks of additional radiation and potential risks from contrast media administration; prompt diagnosis and treatment. While the Radiology Department benefits in terms of cost effectiveness, work load and appointment scheduling.     

Radiographers' assessment of referrals for CT and MR imaging using a web-based data collection tool

IntroductionThere is limited research related to the radiographers' role in assessing of radiology referrals to justify imaging. This study investigated radiographers' compliance with guidelines in the assessment of CT and MRI referrals and factors that influenced their performance.MethodsThis research was facilitated by the EFRS Research Hub at ECR 2019. Five radiology referral scenarios for CT and/or MRI were distributed to radiographers, as determined by their scope of practice, who volunteered at the Research Hub. A web-based data collection tool was used. The radiographers were required to determine the appropriateness of each referral, highlight any concerns and recommend suitable investigations if applicable. Linear regression analysis was used to determine whether postgraduate qualification, grade/role of the radiographer and use of guidelines influenced the radiographers' performance in assessing the referrals.ResultsParticipants originated from 24 countries (n = 51 CT, n = 40 MRI), the majority originating from the UK, Ireland, Italy, Spain, Norway and Austria. Responses consistent with guidelines were 58% and 57% for CT and MRI, respectively. Possession of an MSc qualification in CT was a significant factor of influence for a higher consistency with guidelines (p = 0.02) in CT. Employment as a radiographer in a lead professional role and/or educator was a significant factor of influence for a higher consistency with guidelines in MRI (p = 0.01).ConclusionA total of 58% for CT and 57% for MRI of the radiographers' responses complied with guidelines. Factors such as postgraduate education and leading professional roles are associated with better performance.Implications for practiceConsidering qualifications, experience and managerial role is vital before radiographers are delegated task of justifying CT and MR Imaging.     

Concordance between a gastrointestinal consultant radiologist,a consultant radiologist and qualified reporting radiographers interpreting abdominal radiographs

IntroductionRadiographers can accurately report musculoskeletal and chest radiographs, but there is paucity of research comparing the performance of reporting radiographers (RRs) with consultant radiologists when interpreting and reporting abdominal radiographs. This study assessed interobserver agreement in the clinical setting between reporting radiographers and a consultant radiologist compared to an expert gastrointestinal radiologist in a District General Hospital. Major discordant reports affecting patient management were also examined.Methods126 abdominal radiographs reported by 3 RRs in clinical practice were randomly selected and reported by a consultant radiologist and index gastrointestinal radiologist. The reports of the RRs and consultant radiologist were compared against the reports made by the index radiologist for agreement by a colorectal consultant surgeon. All 126 reports were scored as being in either complete agreement, minor disagreement or major disagreement which would have resulted in a change to patient management.ResultsThere was no significant difference in overall agreement between the consultant radiologist (CR) and RRs when compared to the index radiologist (CR: n = 90/126, 71.4% and RRs: n = 94/126, 74.6%. p = 0.57). Major disagreements were found, but there was no significant difference between both groups (CR: n = 23/126, 18.3% and RRs: n = 17/126, 13.5%. p = 0.30).ConclusionRRs can report abdominal radiographs to a comparable level of agreement as a consultant radiologist in the clinical setting. There was no significant difference in reports deemed to affect patient management.Implications for practiceThis study addresses the gap in assessing the performance of RRs reporting abdominal radiographs. This small scale study indicates that radiographers could provide additional support in the reporting of abdominal radiographs. This would help to reduce radiologist workload and enhance the role of the reporting radiographer.ClassificationAgreement between reporting radiographers and radiologists interpreting and reporting abdominal radiographs.     

A study to explore opinions and attitudes of Saudi Arabian MR professionals on the current status of routine MR scanner quality assurance testing in the Kingdom of Saudi Arabia

IntroductionInternationally it is recommended that quality assurance (QA) testing of MR systems is the responsibility of MR professionals to ensure efficient scanner performance. This study aims to explore the opinions and attitudes of MR professionals in the Kingdom of Saudi Arabia (KSA) regarding the current status of routine QA testing within MRI departments.MethodsA qualitative approach was adopted, with MR professionals working in public, semi-public and private hospitals in the KSA invited to participate in this interview-based study. A total of 52 individual semi-structured interviews were conducted with purposive sampling of MR radiographers and medical physicists based at 19 major centres across the three main geographical regions in the KSA. Data went through duration of coding following qualitative data analysis framework based on Miles and Huberman's philosophical underpinnings.ResultsThe findings demonstrated that 89.5% (n = 17) of the MRI departments surveyed rely on the service provided by the equipment vendor in order to ensure ongoing MR scanner performance. Overall, the level of MR radiographer participation in weekly MR scanner QA testing was low (13.3%, n = 3). Lack of legal requirement, professional organisation and knowledge were highlighted as the principal factors limiting radiographer involvement in the weekly MR QA in the KSA.ConclusionThe results of this study support the establishment of a legal requirement and national policy in order to encourage radiographers in the KSA to take an active role in MRI QA testing to enable suboptimal MR scanner performance to be identified before it becomes clinically evident.     

Radiology departmental policy compliance with Swedish guidelines regarding post-contrast acute kidney injury for examinations with iodinated contrast media

IntroductionGuidelines concerning intravenous iodinated contrast media (CM) during computed tomography (CT) examinations are important to follow to minimize the risk for post-contrast acute kidney injury (PC-AKI). The purpose of this study was to investigate the radiology departmental policy compliance with Swedish guidelines concerning PC-AKI.MethodsIn February 2020, an electronic survey was distributed to the responsible radiographer at 41 radiology departments in all university hospitals and medium-sized hospitals in Sweden. The questions focused on routines around renal functional tests, individualized contrast administration and handling of patients with diabetes mellitus taking metformin.ResultsThe response rate was 83%. Seventy-six percent (n = 26) of radiology departments calculated estimated glomerular filtration rate (eGFR) from serum creatinine prior to CM administration, but only 24% (n = 8) followed the recommendation to calculate eGFR from both serum creatinine and cystatin C. For acute/inpatients, 55% (n = 18) followed the recommendation that renal functional tests should be performed within 12 h before CM administration. For elective patients, 97% (n = 33) followed the recommendation to have eGFR newer than three months which is acceptable for patients with no history of disease that may have affected renal function. Approximately 80% of the radiology departments followed the recommendation that CM dose always should be individually adjusted to patient eGFR. Seventy-six percent (n = 26) followed the recommendation to continue with metformin at eGFR ≥ 45 ml/min.ConclusionCompliance with the national guidelines was high regarding routines around renal functional tests, dose adjustment of CM and metformin discontinuation. Improvements can be made in using both cystatin C and serum creatinine for eGFR calculations as well as ensuring renal function tests within 12 h for acute/inpatients with acute disease that may affect renal function.Implications for practiceThis study raises awareness of the importance of adhering to guidelines in healthcare. To have knowledge about the current level of compliance regarding PCI-AKI is important to maintain and develop effective clinical implementation of guidelines. The variation in practice seen in this study emphasizes the need of more effective implementation strategies to ensure adherence with best practice.     

Impact of the COVID-19 pandemic on clinical radiography practice in low resource settings: The Ghanaian radiographers’ perspective

IntroductionThe COVID-19 pandemic has altered the professional practice of all healthcare workers, including radiographers. In the pandemic, clinical practice of radiographers was centred mostly on chest imaging of COVID-19 patients and radiotherapy treatment care delivery to those with cancer. This study aimed to assess the radiographers’ perspective on the impact of the pandemic on their wellbeing and imaging service delivery in Ghana.MethodsA cross-sectional survey of practising radiographers in Ghana was conducted online from March 26th to May 6th, 2020. A previously validated questionnaire that sought information regarding demographics, general perspectives on personal and professional impact of the pandemic was used as the research instrument. Data obtained was analysed using Microsoft Excel® 2016.ResultsA response rate of 57.3% (134/234) was obtained. Of the respondents, 75.4% (n = 101) reported to have started experiencing high levels of workplace-related stress after the outbreak. Three-quarters (n = 98, 73.1%) of respondents reported limited access to any form of psychosocial support systems at work during the study period. Half (n = 67, 50%) of the respondents reported a decline in general workload during the study period while only a minority (n = 18, 13.4%) reported an increase in workload due to COVID-19 cases.ConclusionThis national survey indicated that majority of the workforce started experiencing coronavirus-specific workplace-related stress after the outbreak. Albeit speculative, low patient confidence and fear of contracting the COVID-19 infection on hospital attendance contributed to the decline in general workload during the study period.Implications for practiceIn order to mitigate the burden of workplace-related stress on frontline workers, including radiographers, and in keeping to standard practices for staff mental wellbeing and patient safety, institutional support structures are necessary in similar future pandemics.     

An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors

ObjectiveTo investigate MR radiographers' current knowledge base and confidence level in relation to quality-related errors within MR images.MethodThirty-five MR radiographers within 16 MRI departments in the Kingdom of Saudi Arabia (KSA) independently reviewed a prepared set of 25 MR images, naming the error, specifying the error-correction strategy, scoring how confident they were in recognising this error and suggesting a correction strategy by using a scale of 1–100. The datasets were obtained from MRI departments in the KSA to represent the range of images which depicted excellent, acceptable and poor image quality.ResultsThe findings demonstrated a low level of radiographer knowledge in identifying the type of quality errors and when suggesting an appropriate strategy to rectify those errors. The findings show that only (n = 7) 20% of the radiographers could correctly name what the quality errors were in 70% of the dataset, and none of the radiographers correctly specified the error-correction strategy in more than 68% of the MR datasets. The confidence level of radiography participants in their ability to state the type of image quality errors was significantly different (p < 0.001) for who work in different hospital types.ConclusionThe findings of this study suggest there is a need to establish a national association for MR radiographers to monitor training and the development of postgraduate MRI education in Saudi Arabia to improve the current status of the MR radiographers' knowledge and direct high quality service delivery.     

Optimizing patient care in radiology through team-working: A case study from the United Kingdom

ObjectivesTo investigate how changes in service delivery within the radiology department of an acute district general hospital optimized imaging services for patients and referrers through a strong emphasis on team-working.MethodsData related to service delivery was collected for three consecutive years and interrogated by imaging modality and reporting practitioner (radiologist, reporting radiographer, sonographer) to explore how workload had changed over the cycle.ResultsDepartmental activity demonstrated consistent increases, both overall (13.3%) and for most modalities (MRI 43.7%, CT 22.8%) for the study period (March 2010–March 2013). Overall trend suggested significantly shorter waiting times (CT 0.7 weeks, MRI 1.3 weeks, non-obstetric ultrasound one week; all modalities p = 0.001). Some modality variation in reporting times was apparent, with CT (p = 0.06) and MRI (p = 0.01) decreasing but there was an increase in X-ray reporting times (p = 0.001). Reporting radiographers and sonographers reported the majority of X-ray and non-obstetric ultrasound interpretations (59% and 52%, respectively). A radiographer-led neonatal reporting service was implemented and the urology patient pathway redesigned. Effective team-working produced savings of three full-time consultant radiologist posts.ConclusionRadiologists and radiographers, working together, can deliver an effective service. Innovation, staff development and redesign of patient pathways, have produced significant improvements.     

What motivates radiographers to start working with research?

IntroductionThis study aimed to investigate the motivation and barriers of clinical radiographers to work with research in a Danish clinical setting.MethodsThe project was designed as a mixed method explorative study, including survey and focus group interviews. A paper based survey was distributed to clinical radiographers, with a bachelor's degree (few with a diploma in Radiography), at three departments of radiology. The survey collected data on motivation, challenges, and barriers in relation to research in clinical practice. Thematic analyses were performed according to the nature of the survey and used to categorize statements. The focus group interview included five managing radiographers (3 with a bachelor's degree) who formed part of the clinical management at their respective departments.ResultsThe survey resulted in 39 responses with an overall response rate of 56%. The majority of clinical radiographers were female (69%, n = 27) and 12 were male.Most radiographers (77%, n = 30) reported interest in research projects and 89% of them (n = 27) found it difficult to dedicate time to research projects next to the clinical work.ConclusionThe study increases the understanding of the motivation and current barriers to start working with research in clinical settings including dependent and independent projects. Clinical radiographers reported to have interest in research. Improvements should focus on department culture, skills, and management support. Clinical Radiographers can be motivated when the departments offer training and support, the projects are relevant to clinical practice and research working hours are provided.Implications for practiceThe study offers an insight into current perspectives and obstacles for clinical radiographers in relation to research. The literature on the perception and interest in research by clinical radiographers and managers is limited and further investigation of the field is warranted.     

Assessment of isocenter alignment during CT colonography: Implications for clinical practice

IntroductionOptimization of image quality and patient radiation dose is achieved in part by positioning the patient at the isocenter of the CT gantry. The aim of this study was to establish whether there was increased isocenter misalignment (IM) in CT colonography (CTC) scans by comparing patient position during the prone part of a CTC to patient position during renal stone protocol CT (CT-KUB) and patient position during the supine part of a CTC to patient position during abdominopelvic CT (CT-AP).MethodsTwo hundred and twenty two consecutive outpatient adult CTC studies performed between January and December 2016 were retrospectively analyzed. Automated dose-tracking software was used to quantify IM in the x and y planes. Renal stone CT-KUB (n = 100) and standard CT-AP (n = 100) were used as comparison studies.ResultsIM during CTC was significantly greater in the y-axis compared with the x-axis for both prone (p = 0.002) and supine (p < 0.001) scanning. IM was significantly greater during prone CTC compared with CT-KUB (p = 0.008) and during supine CTC compared with CT-AP (p = 0.0001). IM was shown to be slightly greater in studies performed by more experienced radiographers (p = 0.04). IM was not associated with patient age, gender or size (p > 0.05 for all).ConclusionIsocenter misalignment is greater during CT colonography compared with CT-KUB or CT-AP. Strategies for improving patient positioning could include radiographer education and automated patient centering solutions.     

Agreement between expert thoracic radiologists and the chest radiograph reports provided by consultant radiologists and reporting radiographers in clinical practice: Review of a single clinical site

IntroductionTo compare the clinical chest radiograph (CXR) reports provided by consultant radiologists and reporting radiographers with expert thoracic radiologists.MethodsAdult CXRs (n = 193) from a single site were included; 83% randomly selected from CXRs performed over one year, and 17% selected from the discrepancy meeting. Chest radiographs were independently interpreted by two expert thoracic radiologists (CTR1/2).Clinical history, previous and follow-up imaging was available, but not the original clinical report. Two arbiters compared expert and clinical reports independently. Kappa (Ƙ), Chi Square (χ²) and McNemar tests were performed to determine inter-observer agreement.ResultsCTR1 interpreted 187 (97%) and CTR2 186 (96%) CXRs, with 180 CXRs interpreted by both experts. Radiologists and radiographers provided 93 and 87 of the original clinical reports respectively. Consensus between both expert thoracic radiologists and the radiographer clinical report was 70 (CTR1; Ƙ = 0.59) and 70 (CTR2; Ƙ = 0.62), and comparable to agreement between expert thoracic radiologists and the radiologist clinical report (CTR1 = 76, Ƙ = 0.60; CTR2 = 75, Ƙ = 0.62). Expert thoracic radiologists agreed in 131 cases (Ƙ = 0.48). There was no difference in agreement between either expert thoracic radiologist, when the clinical report was provided by radiographers or radiologists (CTR1 χ = 0.056, p = 0.813; CTR2 χ = 0.014, p = 0.906), or when stratified by inter-expert agreement; radiographer McNemar p = 0.629 and radiologist p = 0.701.ConclusionEven when weighted with chest radiographs reviewed at discrepancy meetings, content of CXR reports from trained radiographers were indistinguishable from content of reports issued by radiologists and expert thoracic radiologists.     

Radiographer's confidence in managing patients with claustrophobia during magnetic resonance imaging

IntroductionClaustrophobia is a major problem experienced by some patients referred for magnetic resonance imaging (MRI). This results in significant costs and delays to healthcare service provision due to appointment cancellations or patients' inability to complete MRI examinations. Radiographers may use several strategies to effectively manage patients with claustrophobia during MRI. This study aimed to determine radiographer's confidence in managing patients with claustrophobia and evaluate the perceived effectiveness of the intervention approaches employed.MethodsWith institutional ethical approval, an online survey was conducted (15th September to 9th November 2020) among Kuwaiti MRI radiographers. The survey was designed to obtain information relating to participant demographics and the perceived confidence of radiographers in their use of interventions to manage claustrophobia during MRI procedures. Data obtained were analysed using the Statistical Package for the Social Sciences (v.26).ResultsA total of 144 valid responses were obtained. Of the respondents, 82% (n = 118) were confident that they could support claustrophobic patients during MRI examinations. Almost all respondents (97.9%, n = 141) employed various claustrophobia reduction and relaxation techniques to improve patient experience and increase scan completion rates. There was a significant association between radiographer’s level of education (r_s = +0.18, p = 0.028) and experience (r_s = +0.33, p < 0.001) with their confidence managing claustrophobic patients. While participating radiographers considered lectures and training the most effective methods to improve their skills in managing such patients, educating claustrophobic patients prior to their MRI scan was the most effective technique for facilitating scan completion.ConclusionKuwaiti MRI radiographers are confident in applying different claustrophobic management techniques to improve patient compliance. Patient education, through supportive discussion, prior to their MRI examination was identified as the most effective intervention for managing claustrophobia.Implications for practicePatient education before MRI examination is necessary to enhance their experience and optimise scan completion rates. In addition, it is essential that MR radiographers develop their practical competence in supporting patients with claustrophobia during their scans.     

Implementing radiographic CT head reporting: The experiences of students and managers

IntroductionIn the face of growing demand in radiology, skill mix initiatives have sought to improve and expand service provision. Within the UK radiographer reporting is now widespread, although the growth in computerised tomography (CT) head reporting has not been as rapid as anticipated. The literature in this area is limited, but case studies have highlighted the successful implementation of this training through new radiographer roles in practice.MethodA cross-sectional survey was developed to elicit information from radiographers and managers on their experiences before, during and after post-graduate training in CT head reporting.ResultsSeventy one responses were received comprising 48 past students (n = 48/111; 43.2%) and 23 service managers (n = 23/67; 34.3%). Key factors for the development were personal continual professional development for students and departmental need for managers. Challenges during training included a lack of study time due to staff shortages and access to radiologist mentors. Only 48.8% of students responding have gone on to use the new skills in practice cited reasons include staff shortages, resistance from radiologists and increase in radiological staffing.ConclusionsThis qualitative study has demonstrated that those trusts who have implemented CT head reporting have evidenced perceptible benefits for both the department and individuals. Those radiographers who are successfully reporting have shown themselves to be highly motivated and persistent in their development.     

The impact of image test bank construction on radiographic interpretation outcomes: A comparison study

IntroductionAssessment of image interpretation competency is commonly undertaken through review of a defined image test bank. Content of these image banks has been criticised for the high percentage of abnormal examinations which contrasts with lower reported incidences of abnormal radiographs in clinical practice. As a result, questions have been raised regarding the influence of prevalence bias on the accuracy of interpretive decision making. This article describes a new and novel approach to the design of musculoskeletal image test banks.MethodsThree manufactured image banks were compiled following a standard academic menu in keeping with previous studies. Three further image test banks were constructed to reflect local clinical workload within a single NHS Trust. Eighteen radiographers, blinded to the method of test bank composition, were randomly assigned 2 test banks to review (1 manufactured, 1 clinical workload). Comparison of interpretive accuracy was undertaken.ResultsInter-rater agreement was moderate to good for all image banks (manufactured: range k = 0.45–0.68; clinical workload: k = 0.49–0.62). A significant difference in mean radiographer sensitivity was noted between test bank designs (manufactured 87.1%; clinical workload 78.5%; p = 0.040, 95% CI = 0.4–16.8; t = 2.223). Relative parity in radiographer specificity and overall accuracy was observed.ConclusionThis study confirms the findings of previous research that high abnormality prevalence image banks over-estimate the ability of observers to identify abnormalities. Assessment of interpretive competency using an image bank that reflects local clinical practice is a better approach to accurately establish interpretive competency and the learning development needs of individual practitioners.     

The changing concept of radiographer's role in UAE: An analysis of radiologists' opinions and acceptance

IntroductionThe role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE.AimThis study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles.MethodsData was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol.ResultsA total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development.ConclusionRadiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training.Implications for practiceGuidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions.