Diagnostic radiographers’ experience of COVID-19, Gauteng South Africa

IntroductionAs of July 2020, South Africa (SA) had the fifth highest number of COVID-19 infections in the world, with the greatest contributor of these infections, being the province of Gauteng. Diagnostic radiographers in Gauteng providing chest CT, chest radiograph and MRI services are frontline workers experiencing these unprecedented times. Therefore, this study undertook to explore diagnostic radiographers’ experiences of COVID-19.MethodsA qualitative approach using an asynchronous opened-ended online questionnaire was used to explore diagnostic radiographers’ experiences of COVID-19. Responses from purposively sampled diagnostic radiographers in Gauteng SA, underwent thematic analysis.ResultsSixty diagnostic radiographers representing both the private and public health sector responded to the questionnaire. Thematic analysis revealed three themes: new work flow and operations, effect on radiographer well-being and radiographer resilience.ConclusionBesides experiencing a shift in their professional work routine and home/family dynamics, diagnostic radiographers’ well-being has also been impacted by COVID-19. Adapting to the “new way of work” has been challenging yet their resilience and dedication to their profession, providing quality patient care and skill expertise is their arsenal to combat these challenges.Implications for practiceUnderstanding the impact of COVID-19 on diagnostic radiographers will allow radiology departments’ management, hospital management, professional bodies and educational institutions to re-evaluate provision of resources, training, employee wellness programs as well as policies and procedures.     

The impact of the Covid-19 pandemic on the mental health and work morale of radiographers within a conventional X-ray department

IntroductionThere is a plethora of literature that has described the negative impact of the COVID-19 pandemic on the mental health of healthcare staff worldwide. Our aim was to investigate the physical and mental demands of mobile x-ray imaging on radiographers during the first wave of the COVID-19 pandemic, within a local NHS Trust.MethodsA total of 16 participants from 1 NHS Trust took part within this study. Both quantitative and qualitative data was obtained through an online survey. Statistical data was obtained via the Trust Radiology Information System (RIS). Data was gathered for the thirteen weeks from 23rd March to 21st June 2020 (the first wave); direct comparison was made to the same period in 2019.ResultsThree key themes emerged from the data. These include mental health challenges/work morale in Radiology, demand of mobile imaging and departmental and Trust-wide mental health support. Results indicate a high demand in mobile imaging which has made a significant difference in the working life of some radiographers.ConclusionThe COVID-19 pandemic has significantly affected the mental health of a proportion of radiographers at this Trust. Results indicate high workload and demand in mobile imaging has made a significant difference to the working life of radiographers, specifically the ones who were relatively newly qualified.Implications for practiceTwo key interventions are proposed from this study. The first one is to provide and promote mental health support within radiology departments. The second is to encourage dual working on mobile x-ray examinations to help manage the emotional and physical burden.     

First year student radiographers’ perceptions of a one-week simulation-based education package designed to increase clinical placement capacity

IntroductionThe radiography workforce is short-staffed and under increasing pressure to meet service pressures. Combined with the impact of Covid-19, where student face-to-face clinical time was abruptly halted for safety, there is cause to change the pedagogical approach to teaching diagnostic radiography to students, increasing capacity and ensuring the continuance of qualifying radiographers to support the profession. This paper shares the perceptions of first year student radiographers on a one-week simulation-based education package designed to replace one week of clinical placement experience.MethodsTwo cohorts of first-year radiography students engaged in a one-week simulation-based education package. Simulations increased in complexity throughout the week and included conventional imaging techniques, mobile and theatre radiography, and cross-sectional imaging. Thirty-six students consented to the thematic analysis of their reflective blogs.ResultsFive themes emerged from the data: feeling anxious, understanding and skill development, building confidence, communication, and patient-centred care.ConclusionThe simulation package had a positive impact on students learning, no matter the stage at which it was incorporated into their clinical placement block. Students engaged well with the activities and saw value in the experience. The findings indicate that the simulation-based education package is a suitable replacement for one week of clinical placement, supporting skills development in students and providing increased placement capacity.Implications for practiceA successful, engaging simulation-based education package is presented, which first year student radiographers perceived as a suitable replacement for one-week of clinical placement. Further research into the acceptability of use of simulation-based education packages in second- and third-year student radiographers would be a useful next step.     

COVID-19 in the radiology department: What radiographers need to know

ObjectivesThe aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases.Key findingsMedical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive.ConclusionAs radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital, as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan.Implications for practiceAt the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments.     

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.     

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.     

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.     

Remote scanning support in magnetic resonance imaging: Friend or foe?

IntroductionRecent advances in technology have seen the introduction of remote scanning capabilities become a reality for departments, allowing staff to remotely access, observe and even scan without being by the scanner side. The COVID-19 pandemic has accelerated use of remote working which also aligns with the direction of travel for healthcare more widely. However for technology to succeed it needs to be acceptable for use by radiographers in clinical practice.MethodsFollowing trial of a remote scanning technology, a group of radiographers were surveyed for their views on its use in practice. The survey was based on the Technology Acceptance Model as well as providing opportunity for open feedback on views regarding the technology.ResultsPerceived ease of use was high but appears to have little influence over overall intention to use. Perceived usefulness was lower and demonstrated correlations with attitude towards and intended use of the remote technology, suggesting that this is a key area to address which would positively impact on acceptance. Other considerations that would help support effective implementation were highlighted with the majority stating the technology as friend rather than foe.ConclusionAs an early evaluation of practitioner views on remote scanning within MRI, the results highlight the areas that would benefit from further development before further roll out in practice. A clear vision of its use and robust governance is needed to effectively support its implementation and acceptance by radiographers.Implications for practiceIntroducing remote scanning technology has potential to support training and share skills of experienced radiographers across multiple locations. It has the potential to transform the way MRI departments work and increase safer supervision to enable wider utilization of the support workforce.     

Un año completo de pandemia COVID-19 y su impacto en la Unidad de Radiología Intervencionista

ObjectivesTo describe the impact of the Covid-19 pandemic on the interventional radiology unit at our hospital in the first year of the pandemic.Material and methodsThis prospective observational study included 83 consecutive patients with confirmed SARS-CoV-2 infections who underwent an interventional radiology procedure in the period comprising March 13, 2020 through March 13, 2021. We describe the repercussions of the situation on the unit's total activity, as well as on its activity during the different phases of the pandemic.ResultsTechnical and clinical success were achieved in 96.43% and 82.14% of cases, respectively. During follow-up throughout the year, 68 patients remained alive and 15 died from their underlying disease. No complications related with interventional procedures occurred, and activity declined by only 12% in comparison with the same period in the previous year (2019-2020, without COVID). Similarly, the decrease in relative value units and radiology activity units was only 13% and 12%, respectively.ConclusionThe Covid-19 pandemic has been a challenge in our daily work, leading to an overall decrease in the number of procedures. Nevertheless, the interventional radiology unit has been actively involved in caring for Covid-19 patients, performing a wide variety of necessary procedures. Following a series of specific measures and protocols has enabled us to perform interventional radiology procedures safely during the pandemic.     

A survey on the research awareness and readiness among radiographers in Singapore General Hospital (SGH)

AimResearch is a key component of evidence-based medical imaging. Good knowledge and attitude towards research is important in implementing the paradigm shift from the traditional model of practice to evidence-based practice. The aim of this study was to ascertain the attitude, level of awareness and knowledge of radiographers about research. Potential barriers might also be identified so that programmes and schemes could be developed to raise the profile of research in clinical practice.MethodsA 20-item scale self-completion questionnaire was designed and distributed to radiographers in the Department of Diagnostic Radiology, SGH. The questionnaire consisted of questions pertaining to years of working experience, specialization of practice, role/involvement in any research, training needs and identification of potential barriers to research.ResultsThe final response rate was 67% (N = 114). Although the involvement in research is 39% (N = 44), the radiographers strongly believed that it is essential for them to participate in research to develop themselves and the profession, as well as to improve the quality of care delivered to patients. The main identified perceived barriers to research included lack of time, resources and heavy clinical workload. Sixty-four percent (N = 73) of participants indicated that provision of courses would improve their research skills, such as research methodology, biostatistics, literature critique, and a lack of these could be some of the reasons for low research involvement among radiographers.ConclusionsThe data suggest that positive attitudes, institutional support and provision of research related courses are needed to increase radiographers' involvement in research.     

Radiographers as doctors: A profile of UK doctoral achievement

IntroductionRadiography aspires to be a research active profession, but there is limited information regarding the number of individuals with, or studying for, a doctoral award. This study aims to profile UK doctoral radiographers; including their chosen award, approach and employment status.MethodThis was a prospective cohort study utilising an electronic survey. No formal database of doctoral radiographers existed therefore a snowball sampling method was adopted. The study sample was radiographers (diagnostic and therapeutic) based in the UK who were registered with the Health and Care Professions Council (HCPC) and who held, or were studying for, a doctoral award.ResultsA total of 90 unique responses were received within the timescale. The respondents comprised 58 females (64.4%) and the majority were diagnostic radiographers (n = 71/90; 78.9%). The traditional PhD was the most common award, although increasing numbers were pursuing Education or Professional Doctorates. An overall increase in doctoral studies is observed over time, but was greatest amongst those working in academic institutions, with 63.3% of respondents (n = 57/90) working solely within a university, and a further 10% employed in a clinical–academic role (n = 9/90).ConclusionThis study has demonstrated that radiography is emerging as a research active profession, with increasing numbers of radiographers engaged in study at a doctoral level. This should provide a platform for the future development of academic and clinical research.     

Radiographer Perspectives on current occurrence and management of claustrophobia in MRI

IntroductionMagnetic Resonance Imaging (MRI) is well known to be a source of anxiety for patients, commonly appearing as claustrophobia. One of the main reasons for this is due to the physical nature of the scanner itself. Despite technological improvements, there is lacking evidence on whether these improvements have resulted in a reduction in claustrophobia and anxiety in the clinical setting. Background anxiety associated with the current COVID-19 pandemic may also have shown an increase in prevalence. Therefore, the aim of this study was to survey MRI radiographers on their perspectives on the occurrence and management of claustrophobia in modern day clinical practice.MethodsFollowing ethical approval, an online survey was used to gather the opinions of MRI radiographers. This used closed ranking questions as well as open responses to gain insight into how this issue may be presenting in practice, preferences in management, and barriers to providing support.ResultsResponses provide an up-to-date view on how radiographers perceive both displays of anxiety and associated impacts on patient outcome, the considered sources of anxiety, the use and effectiveness of support strategies, barriers to providing this support, and views on how COVID-19 has impacted on practice.ConclusionThe study provides a current view from radiographers on their experience of claustrophobia in practice. It shows that this remains a regular part of practice within the modality. Therefore, for MRI radiographers managing this is an essential component of their role. Communication and interaction with the patient are recognised as important, although time is a barrier to always being able to provide patient centred care.Implications for practiceOngoing support is needed for both patients and radiographers to improve experience within MRI.     

Strong semantic segmentation for Covid-19 detection: Evaluating the use of deep learning models as a performant tool in radiography

IntroductionWith the increasing number of Covid-19 cases as well as care costs, chest diseases have gained increasing interest in several communities, particularly in medical and computer vision. Clinical and analytical exams are widely recognized techniques for diagnosing and handling Covid-19 cases. However, strong detection tools can help avoid damage to chest tissues. The proposed method provides an important way to enhance the semantic segmentation process using combined potential deep learning (DL) modules to increase consistency. Based on Covid-19 CT images, this work hypothesized that a novel model for semantic segmentation might be able to extract definite graphical features of Covid-19 and afford an accurate clinical diagnosis while optimizing the classical test and saving time.MethodsCT images were collected considering different cases (normal chest CT, pneumonia, typical viral causes, and Covid-19 cases). The study presents an advanced DL method to deal with chest semantic segmentation issues. The approach employs a modified version of the U-net to enable and support Covid-19 detection from the studied images.ResultsThe validation tests demonstrated competitive results with important performance rates: Precision (90.96% ± 2.5) with an F-score of (91.08% ± 3.2), an accuracy of (93.37% ± 1.2), a sensitivity of (96.88% ± 2.8) and a specificity of (96.91% ± 2.3). In addition, the visual segmentation results are very close to the Ground truth.ConclusionThe findings of this study reveal the proof-of-principle for using cooperative components to strengthen the semantic segmentation modules for effective and truthful Covid-19 diagnosis.Implications for practiceThis paper has highlighted that DL based approach, with several modules, may be contributing to provide strong support for radiographers and physicians, and that further use of DL is required to design and implement performant automated vision systems to detect chest diseases.     

Plausible scenarios for the radiography profession in Sweden in 2025

IntroductionRadiography is a healthcare speciality with many technical challenges. Advances in engineering and information technology applications may continue to drive and be driven by radiographers. The world of diagnostic imaging is changing rapidly and radiographers must be proactive in order to survive. To ensure sustainable development, organisations have to identify future opportunities and threats in a timely manner and incorporate them into their strategic planning. Hence, the aim of this study was to analyse and describe plausible scenarios for the radiography profession in 2025.MethodThe study has a qualitative design with an inductive approach based on focus group interviews. The interviews were inspired by the Scenario-Planning method.ResultsOf the seven trends identified in a previous study, the radiographers considered two as the most uncertain scenarios that would have the greatest impact on the profession should they occur. These trends, labelled “Access to career advancement” and “A sufficient number of radiographers”, were inserted into the scenario cross. The resulting four plausible future scenarios were: The happy radiographer, the specialist radiographer, the dying profession and the assembly line.ConclusionIt is suggested that “The dying profession” scenario could probably be turned in the opposite direction by facilitating career development opportunities for radiographers within the profession. Changing the direction would probably lead to a profession composed of “happy radiographers” who are specialists, proud of their profession and competent to carry out advanced tasks, in contrast to being solely occupied by “the assembly line”.     

Radiographers’ perception on task shifting to nurses and assistant nurses within the radiography profession

IntroductionThe radiography profession is challenged by greater responsibilities and shortage of educated radiographers. Implementation of task shifting is one strategy to deal with the current situation in health care. The aim of this studiy was to evaluate radiographers’ perception of assistant nurses and nurses carrying out tasks that traditionally were undertaken within the radiography profession in a Swedish context.MethodsAn electronic questionnaire was distributed to radiographers at eleven hospitals in Sweden. The questionnaire included background questions and questions about radiographers’ perception about task shifting to nurses and assistant nurses. The respondents rated their agreement level regarding task shifting on a five-point Likert scale. Data was statistically evaluated in SPSS using Mann Whitney U test.ResultsSixty-five radiographers participated in the study. Most radiographers responded negatively to task shifting to nurses (72%) or assistant nurses (65%). Most radiographers disagree that nurses should perform mammography screening or work within interventional radiography, while the attitude towards nurses calculating glomerular filtration rate was more positive. A majority disagree regarding assistant nurses performing conventional radiographs, informing the patient about contrast media administration or inserting peripheral intravenous catheters, while there was a positive attitude towards assistant nurses preparing patients for examinations. The attitude towards task shifting was not influenced by age, however radiographers with less working experience were more positive to task shifting in general.ConclusionA majority of the radiographers had a negative attitude towards task shifting to nurses and assistant nurses. The radiographers were more positive to hand over tasks related to patient care and administrative tasks than technical related tasks within the profession.Implications for practiceKnowledge about radiographers’ perception on task shifting within the profession is essential when planning and implementing strategies for task shifting in the clinical settings.     

Exploring radiographers' experience with mobile X-ray of patients in their homes

IntroductionTo offer citizens with frailty or dementia living in nursing homes or other institutions a less stressful and anxious X-ray examination, a Danish hospital offers to perform the examination in the citizen's residence. This has changed the working procedure for the radiographers performing the examination. The aim of this study was to explore if the radiographers self-perceived competencies have changed whilst working in the mobile X-ray unit and if so, how these competencies are utilised within the department-based medical imaging team.MethodThis study had a qualitative design following a hermeneutic approach. Individual semi structured interviews included nine radiographers, four radiographers working in the mobile X-ray unit and five radiographers working exclusively in the medical imaging team.ResultsRadiographers who worked in the mobile X-ray unit did acquire new competencies such as better communication and creative positioning skills. All nine participants recognised the advantage of sharing experiences and competencies with colleagues, and recommended a formal forum to do so. They sought opportunities for the use of the mobile X-ray unit to be more widespread within their own region, and within the profession.ConclusionThis study indicates that radiographers working with mobile X-ray unit gained new competencies in communication and positioning, but without spread of new knowledge to colleagues in the medical imaging team.Implication for practiceThe use of home-based mobile X-ray is a new way to provide health care services and gain new competencies for the radiographers to focus on patient centred care.     

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.