What is competence? A new model for diagnostic radiographers: Part 1

Purpose: The aim of the study was to establish a model of competence for newly qualified diagnostic radiographers which would be acceptable to a number of key stakeholders. Both the current and future roles of radiographers were considered. The research is published in two parts. Part 1 describes the background to the study, its methods and the results. Part 2 (published in the next issue) discusses the findings and considers the implications for professional practice and research.Methods: A wide-ranging Delphi survey was undertaken, using a panel of experts. Representatives from all areas of the U.K. were invited to participate. After a pilot study, three postal rounds of the survey were followed by a focus group meeting. In view of the importance in reaching agreement on professional standards, only those competences, which reached 80% level of consensus, were retained.Results: At the outset, 51 experts were invited to participate: the average response rate over three rounds was 85%. The panel agreed on a primary role statement for diagnostic radiographers and commented on the timescale after qualification when a radiographer could be considered to be 'competent'. One hundred and sixty two statements of competence were developed, grouped into nine categories. The panel also made a number of predictions about the future role of radiographers.Conclusion: The data provided evidence on the nature of competence and the relationship to the role of new diagnostic radiographers. Part 2 will discuss the findings and make recommendation for future research.     

Reporting radiographers in Norway – A qualitative interview study

IntroductionA number of Norwegian radiographers have attended an advanced programme of education and training in musculoskeletal reporting, some in the UK and some in Norway. The aim of this study was to examine how reporting radiographers, radiologists and managers experienced the education, competence, and role of reporting radiographers in Norway. To our knowledge, the role and function of reporting radiographers in Norway has not yet been explored.MethodsThe study had a qualitative design and was based on eleven individual interviews of reporting radiographers, radiologists, and managers. The participants represented five different imaging departments from four hospital trusts in Norway. The interviews were analyzed using inductive content analysis.ResultsThe analysis identified two main categories: “Education and training”, and “The reporting radiographer”. The subcategories were: “Education”, “Training”, “Competence”, and “The new role”.The study found the program to be demanding, challenging, and time-consuming. However, the reporting radiographers described it as motivating because they gained new competence. The competence of reporting radiographers was regarded as adequate. The participants found that reporting radiographers had a unique competence in both image acquisition and reporting, and they were described as a missing link between radiographers and radiologists.ConclusionReporting radiographers are experienced as an asset for the department. Reporting radiographers not only contribute to musculoskeletal imaging reports but are also important for collaboration, training, and professional development in imaging, and in collaborating with orthopedics. This was seen to increase the quality of musculoskeletal imaging.Implications for practiceReporting radiographers are a valuable resource in image departments, especially in smaller hospitals where the shortage of radiologists is noticeable.     

Fibrous dysplasia and McCune–Albright syndrome: Imaging for positive and differential diagnoses,prognosis, and follow-up guidelines

Purpose

The radiologist plays a critical role at all steps of the management of patients with fibrous dysplasia (FD) and McCune–Albright syndrome (MAS). The development of a standardized approach to the management of FD/MAS is crucial given the low incidence and multiple clinical presentations of these conditions. Our aim was to develop recommendations for bone imaging in FD/MAS management.

Materials and methods

The establishment of National Reference Centers in France as part of a Health Ministry program for orphan diseases has triggered the development of recommendations for the clinical management of FD/MAS. We used a well-established robust methodological approach involving an extensive literature review by a multidisciplinary working group (20 healthcare professionals) and scoring by a peer-review group (20 healthcare professionals different from the 20 previous ones). There were four phases: a systematic literature review, drafting of initial recommendations, peer-review of this initial draft, and drafting of the final recommendations.

Results

Fifty-seven specific recommendations are provided as key points for the diagnosis, prognosis, and follow-up of patients with FD/MAS. Issues of special interest are highlighted in the discussion, and areas in which future research is needed are identified.

Conclusion

We believe the dissemination of these recommendations within the radiology community may facilitate communication between radiologists and other healthcare providers, thereby substantially improving the management of patients with these rare but potentially disabling conditions.     

Assessment of diagnostic radiographers’ knowledge of work-related health problems and associated effects: A multicentre study in Ghana

IntroductionWork-related health problems (WRHPs) are health conditions peculiar to a group of people or occupations including radiography in a specific work setting. These WRHPs occur as a result of prevailing work conditions which predispose workers to risks of physical or psychological distress.AimThis study assessed the knowledge of WRHPs among practicing radiographers in Ghana and evaluated the sources, causes, effects and preventive measures of WRHPs.MethodsA prospective cross-sectional design incorporating a quantitative data collection approach was used. A questionnaire was used to assess the knowledge and evaluate the effects of WRHPs among two cohorts of 31 practicing radiographers at a regional hospital (RH) and a teaching hospital (TH).ResultsAn average score of 4.2 (SD = 0.4) out of 5 (84.8%) obtained on the knowledge scale indicated very good knowledge of WRHPs among the radiographers. Physical work demands, ergonomic issues, increased workload and stress levels on on-duty radiographers due to sick absence by colleagues, large numbers of daily cases, and extra work without incentives were reported as WRHPs effects mostly experienced by the radiographers. The study also showed no significant difference between gender groups (p = 0.313), years of professional practice experience level (p = 0.319), and academic qualifications (p = 0.287) on knowledge of WRHPs.ConclusionRadiographers working in some referral and teaching hospitals in Ghana demonstrated very good knowledge of WRHPs and identified several effects of WRHPs on professional practice.Implication for practiceThe study concludes that WRHPs predispose radiographers to adverse health conditions, and administrative protocols are required to prevent or mitigate the burden.     

Dose–effect response in image-guided adaptive brachytherapy for cervical cancer: A systematic review and meta-regression analysis

PurposeThis study aimed to integrate and update the dose–effect relationship between volumetric dose and local control for cervical cancer brachytherapy.Methods and MaterialsWe identified studies that reported high-risk clinical target volume (HR-CTV) D₉₀ and local control probability by searching PubMed, Web of Science, and the Cochrane Library databases through Oct 27, 2019. The regression analyses were performed using a probit model between HR-CTV D₉₀, D₁₀₀, intermediate-risk clinical target volume (IR-CTV) D₉₀, and dose to Point A vs. local control probability. Subgroup analyses were performed according to stratification: time of local control, income level of the country or region, stage of cancer, pathology, mean volume of HR-CTV, dose rate, image modality, concurrent chemoradiotherapy proportion, interstitial proportion, and mean overall treatment time.ResultsThirty-three studies encompassing 2893 patients were included. The probit model showed a significant relationship between the HR-CTV D₉₀ value and the local control probability, p < 0.0001. The D₉₀ corresponding to a probability of 90% local control was 83.7 Gy_EQD2,10 (80.6–87.8 Gy_EQD2,10). Of the 33 studies included in our analysis, eight studies, including 1172 patients, reported the IR-CTV D₉₀ value, ranging from 59.1 Gy_EQD2,10 to 72.3 Gy_EQD2,10. The probit model also showed a significant relationship between the IR-CTV D₉₀ value and the local control probability, p = 0.0464. The 60 Gy_EQD2,10 for IR-CTV D₉₀ corresponded to an 86.1% local control probability (82.0%–89.8%).ConclusionsA significant dependence of local control on HR-CTV D₉₀ and IR-CTV D₉₀ was found. A tumor control probability of >90% can be expected at doses >84 Gy_EQD2,10 and 69 Gy_EQD2,10, respectively, based on an updated meta-regression analysis.     

Are English CT departments and radiographers prepared for the morbidly obese patient?

IntroductionMorbid obesity is increasing in England, as is the use of CT scanning. All CT scanners have weight and body width limits. It is imperative that the radiographer performing the scan is aware of these limits, particularly in an emergency. This study aim was to determine whether radiographers are aware of their scanner limits, where they may be able to send a patient who exceeds these limits and whether a formal protocol exists. The secondary aim of the study was to determine capacities of scanners in acute trusts throughout England.MethodsCT radiographers from 86 English Hospital Trusts with Emergency Departments were contacted and asked questions regarding their CT scanners and their practice of CT scanning morbidly obese patients.Results21% of CT radiographers did not know the maximum width capacity of their scanner. Only 24% knew where a nearby larger capacity scanner was located and only 3% had a formal protocol for scanning obese patients. Weight capacities ranged from 147 to 305 kg. Width capacities ranged from 55 to 100 cm. 70% had weight capacity 226 kg or less and 70% had size capacity of 78 cm or less.ConclusionPatients over 226 kg or 78 cm may not be accommodated in most (70%) trusts in England. Lack of knowledge of scanner capacities and alternative scanners for morbidly obese patients could have consequences for these patients, particularly in an emergency. The authors advise that all acute trusts have a protocol regarding CT scanning morbidly obese to prevent delays in accessing imaging.     

An investigation of radiographers' and radiologists' perceptions and attitudes in Kuwait towards extending radiographers’ role in mammography

IntroductionKuwait has a shortage of radiologists, especially in mammography, resulting in increased workload and longer waiting times for women receiving imaging investigations. This study looked at how radiographers and radiologists perceived radiographers’ role extension (RE) in mammography, and whether this could reduce radiologist workload, thereby improving patient service and waiting times.MethodsA single case study design with 10 radiographers (mammographers) and 10 radiologists was undertaken across multiple sites: hospitals, screening clinics and specialist centres in Kuwait. Data included individual semi-structured interviews, documentary analysis and field notes. Perceptions were examined under a theoretical framework, Abbotts’ System of Professions.ResultsTwo main themes were identified, firstly in examining the current role of radiographers in mammography and areas of interest for extending role, this highlighted insufficient knowledge of the concept. The second focused on in-depth understanding of drivers and barriers to RE in mammography, both groups opposed radiographers performing extended tasks without radiologist supervision.ConclusionRadiologists and radiographers' attitudes were influenced by concepts of professional identity and professional identity formation. Insufficient professional knowledge negatively affected the radiographers' readiness to undertake RE in mammography. Radiologists are reluctant to blur boundaries, enabling them to maintain and control jurisdiction of their own profession and that of radiographers, thereby, as discussed in Abbott's theory, limiting impact on workload or waiting times.Implications for practiceWhilst RE is limited, to improve workload and patient waiting times, setting up an educational programme for radiographers specialising in mammography would be an important step to extending the radiographers' role. The study highlighted a need to educate radiographers to undertake breast ultrasound and amend policy to introduce training programmes for radiographers. Radiographer rotation across the various radiographic modalities negatively affected radiographers’ performance, placing well-trained radiographers permanently within the mammography department should improve experience and overall skills.     

Head injury trends and helmet use in skiers and snowboarders in Western Canada, 2008–2009 to 2012–2013: an ecological study

This research explored associations between helmet use and head injuries in snowsports by investigating reported snowsport injuries in Western Canada from 2008–2009 to 2012–2013. The key finding was that increased helmet use (from 69% to 80%) was not associated with a reduction in reported head injuries. Over the study period, the average rate of reported head injuries was 0.2/1000 skier visits, with a statistically significant variation (P < 0.001). The line of best fit showed an non-significant upward trend (P = 0.13). Lacerations were the only subcategory of head injuries that decreased significantly with helmet use. A higher proportion of people who reported a head injury were wearing a helmet than for injuries other than to the head. Skiers were more likely to report a head injury when wearing a helmet than snowboarders (P < 0.001 cf. P = 0.22). There were significant differences in characteristics of helmet and non-helmet wearers. Helmet wearers were more likely to be: young adults (P < 0.001); beginner/novices (P = 0.004); and snowboarders (P < 0.001), but helmet wearing was not associated with gender (P = 0.191). Further research is needed to explore the possible reasons for the failure of helmets to reduce head injuries, for example, increased reporting of head injuries and increased risk-taking combined with over-rating of the helmets' protection.     

Benefit-risk communication in paediatric imaging: What do referring physicians,radiographers and radiologists think,say and do?

IntroductionTo assess how referrers and practitioners disclose benefit-risk information about medical imaging examinations to paediatric patients and their parents/guardians; to gauge their confidence in doing so; and to seek their opinion about who is responsible for disclosing such information.MethodsThis study followed on from a previously published study, with a questionnaire distributed in staggered phases to 146 radiographers, 22 radiology practitioners, 55 emergency physicians and 43 paediatricians at a primary paediatric referral centre in Malta. The questionnaire sought details about referrers' and practitioners' practice of disclosing benefit-risk information, as well as their opinion about their confidence and responsibility to do so.ResultsAn overall response rate of 63.2% (168/266) was achieved. Most referrers and practitioners would generally explain the purpose of the imaging examination, with fewer providing benefit-risk information. The content and the approach adopted to communicate benefit-risk information varied, at times considerably. While 75% (123/164) felt that the responsibility to provide benefit-risk information was a shared one between referrers and practitioners, only 32.1% (53/165) reported a high level of confidence in their own ability to do so.ConclusionsOur findings highlight potential knowledge and skills gaps amongst local referrers and practitioners. This needs addressing so as to ensure that paediatric patients and their parents/guardians are provided with adequate, reassuring and consistent information. Additionally, we recommend that local referrers and practitioners come together and develop a consensus document that can offer guidance on how to go about discussing the benefits and risks of paediatric imaging examinations.     

Postural stabilization and balance assessment in Charcot–Marie–Tooth 1A subjects

The aim of the present study was to assess postural stabilization skill in adult subjects affected by Charcot–Marie–Tooth disease (CMT) type 1A. For this purpose ground reaction force (GRF) was measured by means of a piezoelectric force platform during the sit-to-stand (STS) movement, until a steady state erect posture was achieved. Specific indexes to quantify Centre of Mass acceleration, both during postural stabilization and during quiet standing, were computed using a mathematical model. Forty-seven CMT1A subjects were recruited for the study, and the control group was formed by forty-one age- and sex-matched healthy subjects.The results show that CMT1A subjects are less stable than controls during the quiet stance. Greater difficulty (high values of Y_inf, the final instability rate) to maintain erect posture appears to be mainly associated with plantar-flexor muscle weakness, rather than to damage of the proprioceptive system. The worst performances shown by CMT1A subjects in the stabilization phase (high values of I, the global index of postural stabilization performance) seem to be associated with reduced muscle strength and the loss of large sensory nerve fibres.Distal muscle weakness appears to affect both postural stabilization and quiet erect posture. The presented protocol and the analysis of postural stabilization parameters provide useful information on CMT1A balance disorders.     

Postural stabilization and balance assessment in Charcot–Marie–Tooth 1A subjects

The aim of the present study was to assess postural stabilization skill in adult subjects affected by Charcot–Marie–Tooth disease (CMT) type 1A. For this purpose ground reaction force (GRF) was measured by means of a piezoelectric force platform during the sit-to-stand (STS) movement, until a steady state erect posture was achieved. Specific indexes to quantify Centre of Mass acceleration, both during postural stabilization and during quiet standing, were computed using a mathematical model. Forty-seven CMT1A subjects were recruited for the study, and the control group was formed by forty-one age- and sex-matched healthy subjects.The results show that CMT1A subjects are less stable than controls during the quiet stance. Greater difficulty (high values of Y_inf, the final instability rate) to maintain erect posture appears to be mainly associated with plantar-flexor muscle weakness, rather than to damage of the proprioceptive system. The worst performances shown by CMT1A subjects in the stabilization phase (high values of I, the global index of postural stabilization performance) seem to be associated with reduced muscle strength and the loss of large sensory nerve fibres.Distal muscle weakness appears to affect both postural stabilization and quiet erect posture. The presented protocol and the analysis of postural stabilization parameters provide useful information on CMT1A balance disorders.     

A GC–MS method for the determination of furanylfentanyl and ocfentanil in whole blood with full validation

Purpose

Fentanyl analogues are popular in recent years among drug addicts and have been related to many overdoses and deaths worldwide. Furanylfentanyl, ocfentanil, acetylfentanyl and butyrfentanyl are among the most common of these drugs. Methods for the determination of furanylfentanyl and ocfentanil by gas chromatography–mass spectrometry (GC–MS) in biological samples do not exist, and therefore, their development would be extremely useful for routine toxicological analysis.

Methods

A GC–MS method was developed and fully validated for the determination of furanylfentanyl and ocfentanil in whole blood. This method was also suitable for the determination of acetylfentanyl and butyrfentanyl. The method included solid-phase extraction after protein precipitation using acetonitrile, and it was applied during the toxicological investigation of forensic cases. Methadone-d₃ was used as internal standard for the quantification of the analytes.

Results

The limit of detection and limit of quantification values were 0.30 and 1.0 ng/mL for furanylfentanyl and ocfentanil and 0.15 and 0.50 ng/mL for acetylfentanyl and butyrfentanyl, respectively. The calibration curves were linear (R²?≥?0.993) from 1.00 to 100 ng/mL for furanylfentanyl and ocfentanil and from 0.50 to 50.0 ng/mL for acetylfentanyl and butyrfentanyl. The recoveries were not lower than 85%, while accuracies and precisions were not greater than 6.0% (% error) and 8.0% (% relative standard deviation), respectively, for all four fentanyl analogues.

Conclusions

The developed method is the first one in the literature for the detection of furanylfentanyl and ocfentanil in biological fluids by GC–MS, and it provides very high sensitivity comparable to that by liquid chromatography–tandem mass spectrometry.

     

Is it safe for extended-role radiographers to measure migration percentage in children with cerebral palsy?

IntroductionIn the surveillance of children with cerebral palsy, the measurement of migration percentage is used to identify children at risk of hip dislocation. Early identification of children at risk facilitates early intervention with less invasive surgical procedures to prevent further deterioration.The aim of this study is to evaluate the safety of the measurements of migration percentage for surveillance in cerebral palsy by extended-role radiographers by evaluating the reliability and validity of measurements performed by these professionals.MethodsA sample of thirty pelvic x-rays were selected from the local cerebral palsy database. A range of hip displacement was selected including some challenging borderline x-rays. All ten extended-role radiographers completed measurements using TraumaCAD which were repeated at a minimum of 4 weeks.Inter-rater and intra-rater reliability was calculated using intraclass correlation coefficients. The accuracy and safety of the system was evaluated by converting measurements into referral categories (red, amber or green) and cohen's kappa was calculated when categories were compared to measurements to orthopaedic surgeonResultsThe inter-rater reliability between radiographers was 0.938 (95% CI 0.914–0.991). The intra-rater reliability was 0.941 (95% CI 0.931–0.949).The percentage agreement was 94.8% for green, 93.8% for amber and 98.2% for red hips. The weighted kappa value was 0.923 (95% CI 0.889–0.957).ConclusionThe reliability and accuracy of radiographer measurement of migration percentage is excellent. It is safe for radiographers to calculate the migration percentage using semi-automated software for the surveillance of children with cerebral palsy.Implications for practiceWe recommend the measurement of migration percentage may be performed by extended-role radiographers to deliver accurate and reliable measurements for use in cerebral palsy surveillance.     

Cone-Beam Computed Tomography Fusion and Navigation for Real-Time Positron Emission Tomography–guided Biopsies and Ablations: A Feasibility Study

PurposeTo describe a novel technique for multimodality positron emission tomography (PET) fusion–guided interventions that combines cone-beam computed tomography (CT) with PET/CT before the procedure.Materials and MethodsSubjects were selected among patients scheduled for a biopsy or ablation procedure. The lesions were not visible with conventional imaging methods or did not have uniform uptake on PET. Clinical success was defined by adequate histopathologic specimens for molecular profiling or diagnosis and by lack of enhancement on follow-up imaging for ablation procedures. Time to target (time elapsed between the completion of the initial cone-beam CT scan and first tissue sample or treatment), total procedure time (time from the moment the patient was on the table until the patient was off the table), and number of times the needle was repositioned were recorded.ResultsSeven patients underwent eight procedures (two ablations and six biopsies). Registration and procedures were completed successfully in all cases. Clinical success was achieved in all biopsy procedures and in one of the two ablation procedures. The needle was repositioned once in one biopsy procedure only. On average, the time to target was 38 minutes (range 13–54 min). Total procedure time was 95 minutes (range 51–240 min, which includes composite ablation). On average, fluoroscopy time was 2.5 minutes (range 1.3–6.2 min).ConclusionsAn integrated cone-beam CT software platform can enable PET-guided biopsies and ablation procedures without the need for additional specialized hardware.