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.     

The radiology workforce's response to the COVID-19 pandemic in the Middle East,North Africa and India

IntroductionThis study aimed to investigate the response of the radiology workforce to the impact of the coronavirus disease 2019 (COVID-19) pandemic on professional practice in India and eight other Middle Eastern and North African countries. It further investigated the levels of fear and anxiety among this workforce during the pandemic.MethodsA quantitative cross-sectional study was conducted using an online survey from 22 May-2 June 2020 among radiology workers employed during the COVID-19 pandemic. The survey collected information related to the following themes: (1) demographic characteristics, (2) the impact of COVID-19 on radiology practice, and (3) fear and (4) anxiety emanating from the global pandemic.ResultsWe received 903 responses. Fifty-eight percent had completed training on infection control required for handling COVID-19 patients. A large proportion (79.5%) of the respondents strongly agreed or agreed that personal protective equipment (PPE) was adequately available at work during the pandemic. The respondents reported experiences of work-related stress (42.9%), high COVID-19 fear score (83.3%) and anxiety (10%) during the study period.ConclusionThere was a perceived workload increase in general x-ray and Computed Tomography imaging procedures because they were the key modalities for the initial and follow-up investigations of COVID-19. However, there was adequate availability of PPE during the study period. Most radiology workers were afraid of being infected with the virus. Fear was predominant among workers younger than 30 years of age and also in temporary staff. Anxiety occurred completely independent of gender, age, experience, country, place of work, and work status.Implications for practiceIt is important to provide training and regular mental health support and evaluations for healthcare professionals, including radiology workers, during similar future pandemics.     

How to safely and sustainably reorganise a large general radiography service facing the COVID-19 pandemic

ObjectivesThis paper aims to share our experience in reorganising our general radiography service during the coronavirus disease (COVID-19) pandemic from the viewpoint of a large tertiary referral medical centre.Key findingsRe-organization of the radiography workforce, patient segregation, and modification of routine radiographic practices are key measures to help radiographic services deal with the COVID-19 pandemic. Specific emphasis on deploying more mobile radiographic units, segregating equipment, developing consistent image acquisition workflows, and strict adherence to infection control protocols are paramount to minimize the possibility of in-hospital transmission and ensure a safe environment for both patients and staff. Streamlining communication channels between leadership and ground staff allows quick dissemination of information to ultimately facilitate safe provision of services.ConclusionCOVID-19 has drastically altered the way general radiography teams provide services. The institution of several key measures will allow hospitals to safely and sustainably provide radiographic services. To date, there have been zero incidences of radiographer healthcare worker transmission within our institution during the course of work.Implication for practiceRadiographers are facing the challenge of providing high-quality services while simultaneously minimizing pathogen exposure to staff and patients. Our experience may lend support to other radiographic services responding to the COVID-19 outbreak and serve as a blueprint for future infectious disease outbreak contingency plans.     

A qualitative analysis of radiography students' reflective essays regarding their experience of clinical placement during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic significantly impacted healthcare services and clinical placement for healthcare students. There is a paucity of qualitative research into radiography students’ experiences of clinical placement during the pandemic.MethodStudents in stages three and four of a 4-year BSc Radiography degree in Ireland wrote reflective essays regarding their experience of clinical placement during the COVID-19 healthcare crisis. Permission was granted by 108 radiography students and recent graduates for their reflections to be analysed as part of this study. A thematic approach to data analysis was used, allowing themes to emerge from the reflective essays. Two researchers independently coded each reflective essay using the Braun and Clarke model.ResultsFour themes were highlighted; 1) Challenges associated with undertaking clinical placement during the pandemic, such as reduced patient throughput and PPE-related communication barriers; 2) Benefits of clinical placement during the pandemic, in terms of personal and professional development and completing degree requirements to graduate without delay; 3) Emotional impact and 4) Supporting students in clinical practice. Students recognised their resilience and felt proud of their contribution during this healthcare crisis but feared transmitting COVID-19 to family. Educational and emotional support provided by tutors, clinical staff and the university was deemed essential by students during this placement.ConclusionsDespite the pressure hospitals were under during the pandemic, students had positive clinical placement experiences and perceived these experiences to have contributed to their professional and personal growth.Implications for practiceThis study supports the argument for clinical placements to continue throughout healthcare crisis periods, albeit with additional learning and emotional support in place.Clinical placement experiences during the pandemic prompted a deep sense of pride amongst radiography students in their profession and contributed to the development of professional identity.     

An evaluation of the experiences of radiography students working on the temporary HCPC register during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has changed the world's perspective and had a profound impact on all those residing in the United Kingdom, resulting in unprecedented changes being made to the education and training of healthcare students. Universities and practice partners had to respond quickly and work in close collaboration with their wider system partners, Health Education England and the Department of Health, to ensure the changes made within the Health and Care Professions Council (HCPC) emergency measures were implemented.The aim was to explore the experiences of final year diagnostic and therapeutic radiography students who joined the HCPC temporary register during phase one of the COVID-19 pandemic.MethodsThis study was informed by a phenomenological approach, in which a purposeful sample of seventeen participants comprising of nine students, six practice educators and two academics were chosen to participate. Semi-structured interviews and focus groups were conducted to collect the data via a virtual platform.ResultsThe results highlighted three themes, professionalism and transition to registration, benefits and challenges of working through a pandemic, and emotional impact. Students described how they gained confidence and competence during their time on the temporary register and suggested that professional bodies could consider curriculum changes to encompass a final transitional placement similar to their experience. They said they had been well supported but felt a sense of loss having been denied the normal rite of passage associated with completion of their course and graduation.ConclusionThe results provide insight into how students, practice educators and academics transformed their practice to meet the necessary requirements whilst working during the first phase of the COVID-19 pandemic. They highlight the importance of having good support mechanisms in place and the rewards and challenges for students joining their professional register early.Implications for practiceSome consideration could be made to changing the curriculum in the future to allow for early temporary registration and paid Band 4 final placements for students working as assistant practitioners.     

An evaluation of the experiences of academics and practice educators who supported radiography students working on the temporary HCPC register during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has had a profound impact on all those residing in the United Kingdom, resulting in unprecedented changes being made to the education and training of healthcare students. Universities and practice partners had to respond quickly and work in close collaboration with Health Education England, to ensure the changes brought in by the Health and Care Professions Council (HCPC) emergency measures were implemented.The aim of this study was to explore the experiences of staff supporting final year diagnostic and therapeutic radiography students who joined the HCPC register early during phase one of the COVID-19 pandemic.MethodsThis study was informed by a phenomenological approach, in which a purposeful sample of eight participants comprising of six practice educators (PEs) and two academics. Semi-structured interviews and focus groups were conducted to collect the data via a virtual platform.ResultsThe results highlighted three themes, Competence and the transition to registration, Support mechanisms and Communication. Both academics and PEs described how they observed the new registrants gaining confidence and competence during their time on the temporary register and suggested that professional bodies could consider curriculum changes to encompass a final transitional placement similar to their experience. They suggested that having robust support mechanisms and communication in place are essential for the success of this initiative.ConclusionThe results provide insight into how PEs and academics supported new registrants to meet the necessary requirements of the HCPC register whilst working during the first phase of the COVID-19 pandemic. They highlight the importance of having robust support mechanisms and good communication in place to achieve this.Implications for practiceSome consideration could be made to changing the curriculum in the future to allow for early temporary registration and paid Band 4 final placements for students working as assistant practitioners.     

Transitioning into the workforce during the COVID-19 pandemic: Understanding the experiences of student diagnostic radiographers

IntroductionThe COVID-19 pandemic, with associated pressures on healthcare services and workforce, had implications for final year Diagnostic Radiography students completing their training and transitioning into employment. The aim of this study was to explore their experience as novice practitioners starting work and integrating into the workforce during a time of national crisis.MethodsFive early career Diagnostic Radiographers, eligible to join the temporary HCPC register, were recruited. One to one interviews were completed online exploring their thoughts, feelings and experiences. Participants had the option of using photographs to aid communication.ResultsInterviews were transcribed, emerging themes identified and coded. Four main themes emerged specifically related to the COVID-19 pandemic, (i) perceived challenges associated with joining the workforce, (ii) managing expectations and unexpected outcomes during transition, (iii) adapting to changes in systems and structures, (iv) sense of uncertainty relating to professional identity. The impacts were experienced beyond the work environment into social and personal lives. Participants demonstrated resilience as they adapted to their shifting lives and drew on the support of clinical colleagues and University academics for help. They did report feelings of concern and anxiety. The participants all expressed a sense of feeling valued and supported in their new roles.ConclusionThe Pandemic was unprecedented and created uncertainty in terms of workforce requirements. This study highlights the personal impact and professional responses of novice practitioners, who felt a sense of duty and care to help support the NHS and others.Implications for practiceThis will help in the understanding of the transition of student into employment and what wider support needs to be in place prior, during and after this phase.     

Radiation oncology teaching provision and practice prior to and during the first wave of the COVID-19 pandemic in medical schools in the United Kingdom and the Republic of Ireland: a cross-sectional survey

Objectives:Radiotherapy is a key cancer treatment modality but is poorly understood by doctors. We sought to evaluate radiation oncology (RO) teaching in medical schools within the United Kingdom (UK) and Republic of Ireland (RoI), as well as any impacts on RO teaching delivery from the coronavirus disease 2019 (COVID-19) pandemic.Methods:A bespoke online survey instrument was developed, piloted and distributed to oncology teaching leads at all UK and RoI medical schools. Questions were designed to capture information on the structure, format, content and faculty for RO teaching, as well as both the actual and the predicted short- and long-term impacts of COVID-19.Results:Responses were received from 29/41 (71%) UK and 5/6 (83%) RoI medical schools. Pre-clinical and clinical oncology teaching was delivered over a median of 2 weeks (IQR 1–6), although only 9 (27%) of 34 responding medical schools had a standalone RO module. RO teaching was most commonly delivered in clinics or wards (n = 26 and 25 respectively). Few medical schools provided teaching on the biological basis for radiotherapy (n = 11) or the RO career pathway (n = 8), and few provide teaching delivered by non-medical RO multidisciplinary team members. There was evidence of short- and long-term disruption to RO teaching from COVID-19.Conclusions:RO teaching in the UK and RoI is limited with minimal coverage of relevant theoretical principles and little exposure to radiotherapy departments and their non-medical team members. The COVID-19 pandemic risks exacerbating trainee doctors’ already constrained exposure to radiotherapy.Advances in knowledge:This study provides the first analysis of radiotherapy-related teaching in the UK and RoI, and the first to explore the impact of the COVID-19 pandemic on radiationoncology teaching.     

Supporting radiography clinical placements in Ireland during the COVID-19 pandemic: The practice educators perspective

IntroductionThe COVID-19 pandemic has significantly impacted healthcare services and the clinical learning environment. Several studies have investigated radiography students' experiences of clinical placement during the pandemic; however, few have investigated the Clinical Practice Educator's (CPEs) perspective. CPEs play a pivotal role in supporting clinical education.MethodA qualitative study was conducted using a purposeful sample of twenty-two CPEs, each working in a different Irish hospital. Four semi-structured focus groups were used to gather data. To maintain reasonable homogeneity, CPEs who were new to the role (n = 8) were assigned a separate focus group from experienced CPEs (n = 14). Inductive thematic analysis was applied.ResultsCPEs experienced role expansion, particularly in managerial and administrative aspects of the role. They described arranging COVID-19 vaccinations locally for radiography students and the complexities of student rostering during the pandemic. CPEs perceived the pandemic to have impacted students' emotional wellbeing with ‘high anxiety levels’ and ‘loneliness’ being reported. They also perceived issues with clinical readiness and the student transition to clinical practice. Many challenges were faced by CPEs including arranging clinical recovery time for numerous students when sites were already at full capacity, fewer learning opportunities due to decreased patient throughput and range of imaging examinations, social distancing constraints, resistance from staff to student placements, and a shortage of staff for student supervision. Flexibility, communication, and multi-level support helped CPEs to fulfil their role.ConclusionThe results provide insight into how CPEs supported radiography clinical placements during the pandemic and into the challenges faced by CPEs in their role. CPEs supported student placement through multi-level communication, teamwork, flexibility, and student advocacy.Implications for practiceThis will aid understanding of the support mechanisms needed by CPEs to provide quality clinical placements.     

A review of the impact of the COVID-19 pandemic on pre-registration medical radiation science education

ObjectiveThe COVID-19 pandemic has changed traditional ways to provide pre-registration medical radiation science (MRS) (medical imaging and radiation therapy) education. This literature review explores the published pre-registration MRS education curriculum adaptations implemented in response to the pandemic and effects of the adaptations on stakeholders.Key findingsEleven articles were identified through a systematic literature search. The included articles covered the pre-registration MRS curriculum adaptations implemented in response to the pandemic in 12 countries of five continents. Through changing content delivery and assessment modes from face-to-face to online, non-practical classes and academic assessments could continue without significant interruptions. However, cancellation/postponement of practical classes and clinical placements was common during COVID-19 lockdown. Simulated learning was used by some institutions to replace some practical classes and placements. Among the stakeholders of MRS education (students, academics and clinical educators), the students were most affected. The main impacts were negative psychological effects and learning experiences. For the academics, they had common concerns about online learning quality and assessment integrity.ConclusionThis review of the early publications in the first year of the pandemic provides an illustration of the MRS curriculum adaptations implemented in five continents covering both English and non-English speaking countries and their effects on the stakeholders as yet. It is expected that more articles on this area will be published over time and hence allowing a more comprehensive review in the future.Implications for practiceThe included articles show provision of wellbeing support, good planning of online content delivery based on sound pedagogical approaches, implementation of computer-based simulation tools suitable for home-based learning environment and use of authentic online assessments would address the impacts on the students and academics.     

COVID-19: A literature review of the impact on diagnostic radiography students

IntroductionCOVID-19 is a highly contagious viral disease declared a global pandemic in March 2020. Throughout the pandemic, radiography students have been working in hospitals on the frontline. The review aimed to search for evidence of the impact COVID-19 has had on diagnostic radiography students and consider whether additional support and learning needs to be implemented.MethodsA literature search strategy applied keywords, BOOLEAN search operators, and eligibility criteria on PubMed, Medline, and Google Scholar databases. Cormack's (2000) critique framework was chosen to methodologically appraise the mixed-method studies to evaluate the quality, validity and rigour.ResultsThe search decisions were displayed in a PRISMA flowchart to evidence the process to identify the found articles comprised of two surveys, two semi-structured interviews and one case study. The findings identified common and reoccurring themes of personal protective equipment, mental wellbeing, accommodation and travel, assessments and learning, and transitioning to registration.ConclusionThe literature suggests that students felt positive impacts of the pandemic, such as being prepared for registration. However, negative effects included the fear of contracting the virus, anxieties of working with ill patients, impracticalities of accommodation and travel during clinical placement, and the adaption to online learning.Implications for practiceClinical staff and universities need to work together to ensure students are mentally and physically supported during the pandemic. Regular meetings and agreed channels of communication with students will allow any issues to be brought to attention and addressed. In addition, employers should recognise that newly qualified radiographers will need extra support.     

COVID-19: A call for mentorship in radiology

During the COVID-19 pandemic, mentorship relationships have undergone significant strain. Sudden changes in the practice environment have caused radiologists to focus their attention to more immediate and essential clinical needs, thus leaving important extracurricular non-clinical endeavors like mentorship by the wayside. However, mentorship is essential more than ever during the pandemic to build strength and resilience in radiology. Specifically, mentorship can foster job resilience, facilitate career development, promote diversity, support wellness, and stimulate future practice growth during this pandemic. Practical actions are described that mentors can follow to help develop and sustain mentorship relationships during the pandemic.SummaryMentorship is critical now during the COVID-19 pandemic to build strength and resilience in radiology.     

Wellness Program Implementation in an Academic Radiology Department: Determination of Need,Organizational Buy-in,and Outcomes

ObjectiveTo implement a multifaceted wellness program in an academic radiology department to prevent burnout and to assess initial outcomes with special focus on the challenges related to the coronavirus disease 2019 (COVID-19) pandemic.MethodsA wellness program was established to address institutional and personal factors of burnout. The program focused on interventions to improve efficiency of practice, provide personal and career support, and create a culture of wellness. The components of the program were designed with input from radiology faculty, and the program was financially supported by the hospital’s physician organization. A survey was performed 6 months after the initiation of the program to determine radiologist engagement and satisfaction. With the onset of the COVID-19 pandemic, a new survey was administered to identify needs of faculty and adjust initiatives. This study was exempt from institutional review board approval.ResultsThe majority of radiologists (79%) agreed or strongly agreed that the wellness program provided opportunities to connect with coworkers. All radiologists agreed that the program was helpful and should be continued. During the COVID-19 pandemic, 49% of physicians requested initiatives focused on well-being, emotional health, and mindfulness to support them during the crisis.ConclusionsThe implementation of a faculty wellness program in an academic radiology department addressed institutional and personal factors of burnout, allowed faculty to connect with coworkers, and was found to be helpful by all radiologists. The COVID-19 pandemic shifted needs to well-being and emotional health initiatives. Follow-up data are necessary to assess its effect on burnout reduction.     

Brachytherapy care during the COVID-19 pandemic: Practice statement from a cancer center in Wuhan,China

PurposeCOVID-19 broke out in late 2019 and rapidly spread around the world and became a pandemic. This highly contagious disease affects routine health care services and patients with cancer who are susceptible to it. Delivering brachytherapy on time is critical for patients with cancer to get better prognosis. The purpose of this study is to present workflow and standard for radiation centers to deliver brachytherapy and avoid cross-infection during the COVID-19 pandemic.Methods and MaterialsThis study combined previous literature and guidelines of precaution with clinical experience in the COVID-19 pandemic.ResultsA workflow covering patients' screening, health care workers’ precaution, training, and other aspects of the whole brachytherapy procedure was established.ConclusionsFrom the reopening of radiation center to mid-May in 2020, there is no hospital infection of COVID-19 in patients or health care workers. This recommendation is effective and helpful to other cancer centers.     

Coronavirus Disease 2019 (COVID-19) Pandemic Shifts Inpatient Imaging Utilization

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on imaging utilization across practice settings. The purpose of this study was to quantify the change in the composition of inpatient imaging volumes for modality types and Current Procedural Terminology–coded groups during the COVID-19 pandemic.MethodsA retrospective study of inpatient imaging volumes in a large health care system was performed, analyzing weekly imaging volumes by modality types (radiography, CT, MRI, ultrasound, interventional radiology, nuclear medicine) in years 2020 and 2019. The data set was split to compare pre-COVID-19 (weeks 1-9) and post-COVID-19 (weeks 10-16) periods. Further subanalyses compared early post-COVID-19 (weeks 10-13) and late post-COVID-19 (weeks 14-16) periods. Statistical comparisons were performed using χ² and independent-samples t tests.ResultsCompared with 2019, total inpatient imaging volume in 2020 post-COVID-19, early and late post-COVID-19 periods, declined by 13.6% (from 78,902 to 68,168), 16.6% (from 45,221 to 37,732), and 9.6% (from 33,681 to 30,436), respectively. By week 16, inpatient imaging volume rebounded and was only down 4.2% (from 11,003 to 10,546). However, a statistically significant shift (P < .0001) in the 2020 composition mix was observed largely comprised of radiography (74.3%), followed by CT (12.7%), ultrasound (8%), MRI (2.4%), interventional radiology (2.3%), and nuclear medicine (0.4%). Although the vast majority of imaging studies declined, few Current Procedural Terminology–coded groups showed increased trends in imaging volumes in the late post-COVID-19 period, including CT angiography chest, radiography chest, and ultrasound venous duplex.DiscussionDuring the COVID-19 pandemic, we observed a decrease in inpatient imaging volumes accompanied by a shift away from cross-sectional imaging toward radiography. These findings could have significant implications in planning for a potential resurgence.     

A novel use for routine CBCT imaging during radiotherapy to detect COVID-19

IntroductionThoracic CT is a useful tool in the early diagnosis of patients with COVID-19. Typical appearances include patchy ground glass shadowing. Thoracic radiotherapy uses daily cone beam CT imaging (CBCT) to check for changes in patient positioning and anatomy prior to treatment through a qualitative assessment of lung appearance by radiographers. Observation of changes related to COVID-19 infection during this process may facilitate earlier testing improving patient management and staff protection.MethodsA tool was developed to create overview reports for all CBCTs for each patient throughout their treatment. Reports contain coronal maximum intensity projection (MIP's) of all CBCTs and plots of lung density over time. A single therapeutic radiographer undertook a blinded off-line audit that reviewed 150 patient datasets for tool optimisation in which medical notes were compared to image findings. This cohort included 75 patients treated during the pandemic and 75 patients treated between 2014 and 2017. The process was repeated retrospectively on a subset of the 285 thoracic radiotherapy patients treated between January–June 2020 to assess the efficiency of the tool and process.ResultsThree patients in the n = 150 optimisation cohort had confirmed COVID-19 infections during their radiotherapy. Two of these were detected by the reported image assessment process. The third case was not detected on CBCT due to minimal density changes in the visible part of the lungs.Within the retrospective cohort four patients had confirmed COVID-19 based on RT-PCR tests, three of which were retrospectively detected by the reported process.ConclusionThe preliminary results indicate that the presence of COVID-19 can be detected on CBCT by therapeutic radiographers.Implications for practiceThis process has now been extended to clinical service with daily assessments of all thoracic CBCTs. Changes noted are referred for oncologist review.