Evidence-based radiography

Evidence-based practice (EBP) offers the integration of the best research evidence with clinical knowledge and expertise and patient values. EBP is a well known term in health care. This paper discusses the implementation of EBP into radiography and introduces the term evidence-based radiography. Evidence-based radiography is radiography informed and based on the combination of clinical expertise and the best available research-based evidence, patient preferences and resources available.In Norway, EBP in radiography is being debated and radiographers are discussing the challenges of implementing EBP in both academic and clinical practice. This discussion paper explains why EBP needs to be a basis for a radiography curriculum and a part of radiographers' practice. We argue that Norwegian radiographers must increase participation in research and developing practice within their specific radiographic domain.     

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.     

Clinical effectiveness: how much do radiographers know about it and what do they think of the concept?

Purpose: The dual concepts of evidence-based practice (EBP) and clinical effectiveness have become ever more important in the health service in recent years. In order that suitable initiatives can be derived and future policy shaped and evaluated it is important that the current level of knowledge and attitudes towards the concepts are recorded. The current study aimed to examine these in a representative sample of radiographers.Methods: A total of 138 individual radiographers selected at random from the population of radiographers within Wales were approached and requested to complete a postal questionnaire. Of those approached, 76 completed and returned the questionnaire.Results: Individuals considered themselves to be lacking in certain key skills essential for evidence-based practice. Specifically, these appeared to be related to the more ‘technical’ research-related skills and there was limited evidence that individuals were undertaking many of these components. However, attitudes towards EBP and clinical effectiveness were, by and large, positive.Conclusion: The current underlying culture provides a firm foundation for the necessary education and encouragement required for the fuller implementation of evidence based practice in radiographers.     

Medical imaging and informed consent – Can radiographers and patients agree upon a realistic best practice?

IntroductionFor radiographers, gaining informed consent with our patients represents a challenging undertaking. Reconciling the need to gain meaningful consent with time pressures represents one challenge, as does differing expectations of how risk communication should be undertaken. Different methods and thresholds of risk disclosure are considered, with the aim of finding a realistic best practice.MethodsA cross-sectional study of radiographers and members of the public was undertaken. Participants were asked their preferences for how they would like to receive ionising radiation risk information. This included the health care professional(s) most suited to provide the information, the media through which the information was delivered, and the technique for delivering the information. In addition, participants were asked to consider hypothetical scenarios in which they were a patient receiving an ionising radiation examination, and to give the threshold of ionising radiation cancer risk which they would consider material. These scenarios considered variations in the cancer-onset time, and the accuracy of the test.ResultsOne hundred and twenty-one (121) radiographer participants and one hundred and seventy two (172) members of the public met the inclusion criteria and completed the survey. There was strong agreement in the most appropriate media, and person, to disclose risk, as well as what represents a significant risk. There was considerable agreement in risk delivery technique. However, some of the agreed-upon strategies may be challenging to achieve in clinical practice.ConclusionRadiographers and patients fundamentally agree upon risk communication strategies, but implementing some strategies may prove clinically challenging.     

Exploration of Ghanaian radiographers’ reporting of suspected physical abuse amongst children

IntroductionThe success of the child protection process is dependent on rapid actions by healthcare professionals who encounter a child in possible need of protection and make appropriate referrals to statutory agencies. Clear rules that promote inter-professional working among health professionals is necessary to enhance child protection.AimTo explore the internal factors leading to bystander attitude towards reporting of suspected physical abuse amongst Ghanaian radiographers.MethodsTwenty radiographers across Ghana who have encountered suspected child physical abuse during practice interviewed. Data was collected using qualitative methodology using semi-structured interviews. Participants were radiographers who were selected using purposive sampling. Data was thematically analysed and managed with NVivo version 10. Themes developed formed the basis of the discussion.ResultsParticipants reported barriers such as training deficits, lack of knowledge in reporting regulations, and the absence of a framework or structures in place to guide suspected physical abuse (SPA) management. The results showed that the majority of participants were ignorant of the role of the social worker in identified cases of SPA. Additionally, there was no teamwork in the majority of the hospitals in the management of suspected physical abuse.ConclusionsParticipants’ behaviour towards child protection was congruent with the situation where an individual would assess the consequences of an action. Fear, lack of direction and collaboration characterised the management of suspected physical abuse.Implication for practiceThe timely identification of child abuse is key to providing the necessary intervention for the child. However, the mere identification of abuse would be of no use to the child when no action was taken by radiographers handling the case as a result of impediments on their way.     

An exploratory study of radiographer's perceptions of radiographer commenting on musculo-skeletal trauma images in rural community based hospitals

AimThis study sought to explore the perceptions of community hospital based radiographers in North East Scotland regarding the practice of radiographer commenting on musculo-skeletal trauma images.MethodA purposive sample of radiographers (n = 8) were recruited from community hospitals throughout the North-east of Scotland. A qualitative, exploratory study was conducted employing semi-structured interviews consisting of one focus group and two individual interviews. The interviews were audio recorded and transcribed in full to allow thematic analysis of the data using a framework adapted from Pope and Mays (2006).Main findingsThis study revealed that the practice of radiographer commenting in the community provides a valuable front line opinion on musculo-skeletal trauma image appearances to enhance diagnostic outcomes for patients and streamline their care pathway. The appreciation shown from inter-professional colleagues for this practice induced feelings of professional pride and job satisfaction in the sample group. All participants expressed a desire to undertake additional training to allow progression from radiographer commenting to radiographer reporting of musculo-skeletal trauma images.Perceived barriers to the practice of radiographer commenting were time constraints and a lack of support with regards to continuing professional development (CPD) opportunities and mentorship from radiology colleagues.ConclusionThe practice of radiographer commenting in the community setting should be supported by ongoing training, and radiologist involvement in mentoring could provide radiographers with a valuable support mechanism. The voice of all radiographers regarding this extended role must be heard by professional leaders to ensure that the skills and education required for radiographer commenting are provided and subsequent patient care is not compromised.     

Autism-friendly MRI: Improving radiography practice in the UK,a survey of radiographer practitioners

IntroductionAutistic individuals undergoing magnetic resonance imaging (MRI) examinations may face significant challenges, mainly due to sensory overload and MRI environment-related limitations. This study aimed to explore radiographers’ perspectives and experiences regarding MRI scanning of autistic individuals.MethodsData collection was achieved using a specifically designed mixed methods questionnaire on Qualtrics. The snowball technique was used. This UK-wide survey was electronically distributed by three main recruitment agencies between December 2020 and February 2021.Results130 valid responses were received. A lack of relevant training and knowledge related to autism was noted. Effective communication, optimisation and customisation of the MRI examination, and MRI environment adjustments facilitated the completion of a safe and effective MRI examination. Poor patient-radiographer communication, unavailability of Special Educational Needs (SEN) experts, lack of specialised radiographer training and lack of specific guidelines were identified as the main barriers to successful MRI examinations.ConclusionAlthough routine MRI safety and patient care rules will apply, MRI scanning of autistic individuals requires customisation and reasonable adjustments in communication, environment, and training of clinical teams. In addition, guidelines should be established to be used as a reference point to improve clinical practice. The adjustments proposed by radiographers were all consistent with the interventions in the wider literature.Implications for practiceMRI practice for personalised care of autistic individuals should be aligned with current evidence, to customise communication and offer workflow and environmental adjustments. Formal training related to autism, integrated within radiography academic curricula and better co-ordination and communication of interdisciplinary teams would provide the necessary skill mix to deliver safe, high quality MRI scans with optimal experience for autistic service users and their carer(s).     

MRI reporting radiographers - A survey assessment of number and areas of practice within the United Kingdom

IntroductionThe aim of this study was to determine a baseline assessment of the national picture of MRI reporting radiographers within the United Kingdom.MethodA questionnaire was utilised using both open and closed questions, the twenty questions were based on four main themes of those in training, those trained, those no longer reporting and post qualification sign off and expectations. The questionnaire was sent out to multiple special interest and MRI specific groups.ResultsResponses were received from 46 trusts (n = 46) between September 2019 and May 2020. The majority of respondents were from English Trusts (n = 40/46). 31 radiographers from 21 different trusts were training in MRI reporting with the majority of those training to report thoraco-lumbar spines and knees. 80 radiographers from 38 trusts had completed training with 77 of those being trained at one south of England University. 57 radiographers from 35 trusts were in practice with the majority of these reporting thoraco-lumbar spines and knees.ConclusionThis survey provides an insight into the current status of MRI reporting radiographers in the UK. Although courses have been available since 2003, numbers are still low and there are significant geographical and working practice variations. Defined standards of practice and the implementation of a central register would benefit both those in practice and those looking to implement a MRI reporting radiographer service.Implications for practiceThis study gives some baseline evidence of the number and scope of practice of MRI reporting radiographers in the UK.     

Evidence-based radiography: A new methodology or the systematisation of an old practice?

IntroductionEvidence based radiography (EBR) is the logical development of evidence based practice applied to radiography. The aim of this study was to investigate the opinion of a cohort of Portuguese radiographers in Southern Portugal working in public hospitals regarding evidence based practice (EBP), namely about the levels of knowledge about EBR, how they access information and how they use it within daily practice.MethodsA self-administered questionnaire was applied to a sample of 40 radiographers in the Portuguese region of Algarve. This questionnaire was validated for Portuguese speakers using the translation-retranslation method.ResultsThe final response rate was 69% (40/58). Results suggest that most radiographers trained EBR during their undergraduate training. Although, no statistically significant correlations were found in the practice of EBR against participant gender, age, training, career level, reading papers and workplace. The most frequent reason to read papers is the “interest” to do so, and national professional journals are read more often. It was found that radiographers that read scientific papers more frequently know more about research (p = 0.005), understand the importance of research for the professional activity (p = 0.023), and know more on how to conduct research papers (p = 0.034).ConclusionEBR within radiography is not yet well established, and radiographers' have varying viewpoints. Radiographers that read scientific papers more frequently understand better the philosophy behind this concept but it is very important to deepen the knowledge on this area.Implications for practiceWhen practicing radiography based on the best available scientific knowledge, professionals are ensuring the best for patients and for profession. To achieve this, and before taking any action, it is important to evaluate the current situation, and this research presents a way to do so.     

Changing the model of radiography practice: Challenges of role advancement and future needs for radiographers working in the UAE

IntroductionThe radiographers' role in the United Arab Emirates (UAE) is focused on image acquisition with a willingness to accept advanced practice roles after appropriate education and training. Radiographers working in the UAE are highly motivated and ambitious to achieve those internationally identified levels of professional recognition and opportunities for role advancement. This study investigates the radiographers’ perspectives, perceptions and hopes for role advancement in the UAE.MethodsA qualitative research study design using Focus Group Discussions (FGD) was used to elicit the perceptions of radiographers. Participants were radiographers working in the hospitals and clinics supervised by the Ministry of Health and Prevention. Participants were asked about the recognized tasks defined as advancement roles, needs for roles clinically, challenges and requirements to prepare radiographers to participate in extended/developed roles. The discussions were audio recorded and later transcribed by an independent research assistant. Thematic analysis was used for data analysisResults29 radiographers participated in the FGDs, and 83% (n = 24) were interested in role advancement. FGD revealed that their current practice showed some informal extended role that may promote career progression. The most significant challenges identified by participants was their knowledge level as provided by the current curriculum and the need for education and licensing body support to accommodate change.ConclusionThe study identified a need for education and licensing body support to enable change in roles by radiographers, through improving radiographer knowledge and experience for role advancement.Implications for practiceTo sustain role advancement, formal intense training and education are necessary, normally above bachelor's degree level. Furthermore, establishing standards, licensing organizations/professional bodies should be part of the transformation of the profession to enable internationally recognized models to be followed.     

Large differences in education and training of radiographers in Europe and Central Asia: Results from an IAEA coordinated study

IntroductionEducation and training of radiographers is known to be diverse between countries and regions. Under an IAEA project, this work collected data on radiographer education for the Europe and Central Asia region with a particular focus on radiation protection gaps and potential actions.MethodsFollowing piloting, an electronic questionnaire was distributed to all national counterparts for the IAEA Technial Coopearation (TC) Europe region (n = 33 countries) and nominated national representatives. Contacts were additionally invited to a virtual workshop to discuss and rank common problems in education and training of radiographers and to propose potential solutions.ResultsResponses were received from 31 countries, including 14 from the European Union. Just over half of countries reported radiographer education being in higher education with 71% having program durations more than 3 years (range: 1 month-4 years). Programs included a spectrum of both clinical training and radiation protection hours with ten-fold variations noted across the region. Inclusion of core radiation protection topics within curricula varied similarly, as did radiographers’ clinical involvement in both justification and optimisation between countries. Workshop participants identified five common training problems, namely education availability, lack of standardisation, radiation protection course quality, teamwork problems and lack of equipment.ConclusionRadiographer education in the IAEA Europe region is heterogeneous with substantial differences in duration and quality of training programs between countries, which likely impact on quality of patient care delivered. Common problems have been identified and potential solutions proposed to focus quality improvement initiatives.Implications for practiceRadiographer education and training is diverse throughout the IAEA TC Europe region, with likely impacts on radiation protection practices applied. Clinical involvement of radiographers in justification and optimisation differs, potentially limiting adherence to radiation protection principles.     

Factors affecting the ability of radiographers to deliver imaging services in rural parts of Zambia

IntroductionMedical imaging in healthcare plays a vital role in the assessment, confirmation, and documentation of the course of many diseases and injuries. However, literature reports that the urban population in Sub-Saharan Africa have more access to imaging services than the rural population. This imbalance can affect radiographers working in rural areas. The aim of this study was to explore factors affecting the ability of radiographers to deliver imaging services in rural parts of Zambia.MethodsThis study employed a qualitative exploratory research design. Semi-structured interviews were used to collect data from a stratified and purposive sample of six rural radiographers and three stakeholders [Ministry of Health (MOH), Radiological Society of Zambia (RSZ), and Schools of Radiography] across the country. Data were audio-recorded, transcribed, and subjected to manual thematic analysis.ResultsFour themes emerged following thematic analysis: procurement processes and resources, imaging equipment, job satisfaction, and education and training. Factors, such as donated equipment, the introduction of new imaging services and continuous professional development (CPD) were positive elements that assisted rural radiographers in the delivery of imaging services. However, an unequal distribution of equipment between urban and rural areas, old and obsolete equipment, lack of maintenance and servicing, lack of postgraduate courses, bureaucratic procurement processes, lack of consumables, workload, and low salaries, negatively affected the ability of rural radiographers.ConclusionLack of maintenance and servicing of equipment, as well as bureaucratic procurement processes were the main challenges identified by radiographers to imaging services in rural Zambia. There is a need to decentralise the procurement processes and establish a culture of regular maintenance and servicing of equipment.Implications for practiceThis research highlights the importance of supporting rural radiographers in the delivery of imaging services.     

Exploring the research domain of consultant practice: Perceptions and opinions of consultant radiographers

AimThis paper reports on one part of a larger study. The aim was to explore what the core domain of research means to consultant radiographers in clinical practice and to identify the key factors that facilitate or hinder research activity by this staff group.Design and methodGrounded theory research methodology was employed. This first part of the study involved electronic questionnaires being sent to all those known in consultant radiographer posts in the United Kingdom.ResultsResults indicate there are variations across clinical specialties as to the amount and level of research undertaken by consultant radiographers, and not all agreed that research should be a core domain of consultant practice.Main facilitators to research were noted as: time; skills and knowledge of the researcher; a well defined research question.Main barriers to research were noted as: lack of allocated time; lack of skills/experience; clinical workload.ConclusionResearch is one of the four core domains of consultant allied health professional and nursing roles but, as yet, it is not fully embedded into those of all consultant radiographers. Many consultant radiographers appear to spend more of their time on the ‘clinical expert’ element of their role at the expense of the research domain.This study concludes that there is an urgent need for consultant radiographers to understand that research is one of the four core domains and to recognise the need to embed research into their clinical practice.     

Facilitators for and barriers to radiography research in public healthcare in Nordic countries

IntroductionIt has been suggested that the future of diagnostic imaging relies on engagement in research and evidence-based practice. This implies a role transition from a clinical radiographer to a clinical radiographer-researcher. Clinical radiographers’ stimuli for engaging in research in Nordic countries are unknown. This study aimed to address this gap.MethodsCross-sectional data collection via an online questionnaire on facilitators for and barriers to participation in radiography research was carried out among 507 clinical radiographers in public healthcare in the Nordic countries: Denmark, Finland, Norway and Sweden.ResultsSupport from colleagues (odds ratio [OR] 2.62) and other professionals (OR 2.74), and self-esteem in research skills (OR ≥ 2.21), were facilitators for radiography research. Lack of knowledge and skills to conduct research (OR 2.48) was revealed to hinder radiographers’ participation in research. The absence of a radiography research culture in the workplace explained non-participation in research (OR 1.75).ConclusionThis study revealed significant factors for clinical radiographers’ participation in research.Implications for practiceA strategy for establishing a radiography research culture in healthcare is proposed that is novel for the context. Management support for knowledge development and activity leading to inter-professional research projects across knowledge fields, provision of a radiography research lead and acknowledgement of radiography research among colleagues signify the establishment of the culture. These prerequisites might provide a paradigm change towards not only the symbiosis of a clinical radiographer and an autonomous researcher but also a partner who adds radiography research to evidence-based practice in diagnostic imaging.     

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.     

Radiologist perceptions of radiographer role development in Scotland

AimTo survey the perceptions of the Scottish radiology community in relation to radiographer role development.MethodsA postal questionnaire was sent to all consultant radiologists recorded on the NHS Scotland database of consultants.ResultsResponse rate was 63%. (i) Respondents considered increased professional standing of radiographers, best use of manpower resources, reduced pressure on the service and improved recruitment and retention, as positive advantages of radiographer development. (ii) The potential impact on radiology specialist registrar training, lack of clear medico-legal responsibilities and radiographers recognising the limitations of their abilities were identified as the main areas of radiologist anxiety. (iii) Fifty-seven percent did not consider current post-registration radiography education and training resources adequate to underpin the requirement of developed roles. (iv) Barriers to radiographer development were identified as lack of radiography and radiology staff, suitable education, financial constraints, traditional views and resistance to change. (v) Eighty-two percent reported support for radiographer role development and willingness to participate actively in developments.ConclusionDespite reservations Scottish radiologists are supportive of the development of radiography colleagues, however, guidance is required on the medico-legal and accountability aspects of radiographers assuming new roles. Radiologist involvement in education and training for new roles may increase their confidence and trust in radiographers to work within the limitations of their competency and training.