Radiologic Technologists' Perceived Reasons for Inappropriate Imaging.

PURPOSE: To examine whether radiologic technologists' perceptions of imaging appropriateness differed based on their primary imaging modality, work shift, shift length, and primary practice type. METHODS: A national, cross-sectional study was conducted in the fourth quarter of 2019 using a simple, randomized sample of American Society of Radiologic Technologists (ASRT) members. Study participants were employed in health care settings in radiography, computed tomography (CT), mammography, or radiology leadership. Seven potential reasons for inappropriate imaging procedures (ie, patient expectations, provide patient with a feeling of being taken seriously, lack of time, expectations from relatives, compensation for insufficient clinical examination, normal findings would reassure the patient, and fear of lawsuits) were evaluated for relationships with their primary imaging modality, work shift, shift length, and primary practice type. RESULTS: Disparities in perceived reasons affecting imaging appropriateness were found. Providing the patient with a feeling of being taken seriously was related to primary practice type (P = .022). Lack of time was related to primary imaging modality (P = .005) and primary practice type (P = .006). Expectations from relatives was related to primary imaging modality (P = .016) and primary practice type (P = .027). Compensation for insufficient clinical examination was related to primary imaging modality (P < .001), shift length (P = .011), work shift (P = .002), and primary practice type (P < .001). Fear of lawsuits was related to primary imaging modality (P = .001)) and work shift (P = .002). DISCUSSION: The study reveals that radiologic technologists' perceptions of patient-centered factors and defensive medicine-related factors differ among imaging modalities, shift types, and practice settings. However, more research is required to determine why radiologic technologists perceive these reasons to be present, investigate whether providers feel similarly, and determine perceptual alignment with evidence-based guidelines. CONCLUSION: The findings suggest that attention should focus on the appropriateness of CT imaging procedures performed in hospitals during night shifts.

[Cooperation protocol and advanced practice, an evolutionary perspective for the French radiation therapist]. / Protocole de coopération et pratique avancée, une perspective d'évolution pour le manipulateur en radiothérapie français.

For several years, the profession of radiographer has been unattractive and is in search of professional recognition. Increasingly complex therapeutic and diagnostic evolutions forces professionals to develop their skills to ensure quality and safe care for all patients. The primary role of the radiographer is to support patients and to accompany them during their examination or treatment, combining caregiver and technician's roles. Transversal missions and delegation of tasks are inherent to the profession but are not widely recognized. Cooperation between radiotherapy professionals is a response to offer the therapeutic radiographer/radiation therapist (RTT) opportunities in terms of attractiveness, career prospects, and increased skills. In radiotherapy, advanced practice activities already exist in some departments but require regulatory adjustments, in particular regarding the redistribution of the roles of RTT but also the status of these professionals. The formalization of these practices can be largely inspired by the many feedbacks around the world. This article aims to reflect the evolution's perspectives in the career of an RTT and on the valorisation of this profession in the current context.

Evaluation of the quality of mammographic breast positioning: a quality improvement study.

BACKGROUND: Although there are concerns that inadequate breast positioning in mammographic examinations may lead to cancers being missed, few studies have examined the quality of breast positioning, especially in the Canadian context. Our objective was to assess the quality of breast positioning in mammographic examinations in a Quebec-wide representative sample of technologists. METHODS: This quality improvement study was part of a professional inspection launched by the Ordre des technologues en imagerie médicale, en radio-oncologie et en électrophysiologie médicale du Québec among its members. The inspection was conducted between May and July 2017 on a proportionate stratified random sample of all active technologists certified in mammography in Quebec. Each technologist provided images from 15 consecutive mammographic examinations they performed in the previous 6 months. The quality of positioning was then evaluated by senior technologists using a quality assessment tool specifically developed for this inspection. A technologist was deemed to have failed the professional inspection when at least 7 of the 15 mammographic examinations were scored as critical failures. Proportions were calculated accounting for sampling weights and correction for finite population. RESULTS: Among the 520 technologists certified in mammography in Quebec, 76 technologists (14.6%) were randomly selected for the professional inspection and contributed images from 1127 mammographic examinations. Thirty-eight technologists (weighted percentage 50.3%, 95% confidence interval [CI] 37.6% to 63.0%) failed the professional inspection. Overall, 492 mammographic examinations (43.7%, 95% CI 38.6% to 48.8%) had at least 1 image scored as a critical failure. INTERPRETATION: Half of the technologists performing mammographic examinations in Quebec who participated in this study failed the inspection, and a substantial proportion of their mammographic examinations demonstrated critical failures in breast positioning. Overall, our findings are concordant with those of previous studies and highlight the need for additional investigations assessing the quality of breast positioning in mammographic examinations in other jurisdictions.

Development of nuclear medicine image quality assessment criteria for use in a technologist peer review program.

INTRODUCTION/BACKGROUND: A peer learning program includes the process of peer review, which is the act of performing a secondary review of a peer's work using pre-defined criteria. The Technologist Image Quality Assessment Criteria Project (TIQACP) was initiated to develop and evaluate such criteria for use by technologists for assessment of image quality in Nuclear Medicine (NM). METHODS: A NM clinical expert panel was assembled, comprising 14 technologists, radiologists, and educators from five imaging centres and an academic institution with associated medical imaging training programs. Project design was guided by consensus-based methodology that included three phases: (1) image quality assessment criteria development, based on literature search and expert review (2) image quality assessment criteria refinement, based on consensus-building exercises (panel surveys, discussions, ranking exercise, and time trial) (3) external validation performed via a national survey of NM technologists, facilitated by the Canadian Association of Medical Radiation Technologists. RESULTS: The first phase generated 8 key evidence sources, including textbooks, NM journals and guidelines from professional associations that were reviewed by the expert panel leads and led to a preliminary list of 11 criteria. As part of the second phase, the preliminary list was reviewed via online surveys and panel discussions. Preliminary discussions led to an initial expansion of the list to include 18 criteria. This list required an average of 9 min (range: 7-11 min) for review, which was deemed prohibitive by the panel. A ranking exercise identified 'all required anatomy is clearly identified' as the most relevant criteria and 'Image quality demonstrates no breakdown of the radiopharmaceutical' as the least relevant criteria. Panel discussion also highlighted need to eliminate criteria that were not applicable to all settings. These insights led to an updated list of nine criteria organized into four categories. National validation was supported by 47 NM technologists from across Canada. Respondents were in agreement that the criteria reflected the core elements of image quality in NM (94% agree to strongly agree), were familiar (97%) and were relevant to their current practice setting (88%). The final list was thus not changed based on the survey. DISCUSSION/CONCLUSION: The TIQACP utilized an inclusive process that engaged a range of subject matter experts and the broader NM community to ensure buy-in of the final criteria. These criteria have subsequently been embedded in peer review software that has been implemented into a robust peer learning program for technologists designed to promote a culture of continuous improvement and knowledge sharing amongst front-line staff.

Assessing radiation protection knowledge in diagnostic radiography in the Republic of Cyprus. A questionnaire survey.

INTRODUCTION: Radiation protection knowledge is essential for medical personnel in ensuring that the possible risks do not outweigh the benefits of diagnostic imaging. This study aimed to assess the radiation protection knowledge of radiographers in Cyprus. METHODS: A cross-sectional study was carried out among radiographers in Cyprus through the Cyprus Society of Registered Radiologic Technologists & Radiation Therapy Technologists. The study was a quantitative descriptive analysis, using a questionnaire with 22 multiple-choice questions. Analysis of the data was done using the statistical software Stata, by performing mean knowledge score comparisons by different participants' characteristics, using t-test and analysis of variance test. Statistical significance was assumed as a p-value < 0.05. RESULTS: The answers provided for each question indicate that some areas of radiation protection are less known compared to others, as there is quite a wide range of correct-to-incorrect ratios. The analysis based on participant characteristics in relation to overall radiation effects knowledge, identified important determinants, namely the workplace of the participant (p = 0.006), the type of work licence the participant held at the time of the questionnaire (p = 0.024), and the years of clinical experience of the participant (p = 0.021). CONCLUSION: The study showed that the levels of knowledge in radiation protection are of a very good standard. However, work is needed to clarify the specifics of dose limits and the national radiation protection legislation with regards to informing patients about the possible effects of ionising radiation. IMPLICATIONS FOR PRACTICE: The study results indicate the importance of educating radiographers about the requirements of national radiation protection legislation and how this new knowledge can be linked with practise.

Improving Mammography Quality Through EQUIP.

On January 1, 2017, the U.S. Food and Drug Administration launched an initiative to improve mammography image quality. This initiative, called the Enhancing Quality Using the Inspection Program, or EQUIP, entails a series of questions that have become part of annual mammography facility inspections required under the Mammography Quality Standards Act. This article examines the EQUIP initiative, discusses the initiative's early results, and explores the criteria for quality mammography images, with a focus on optimal positioning and compression.

Clinical effectiveness of a sonographer-led, cardiologist-interpreted stress echocardiography service in the rapid access stable chest pain clinic.

AIMS: To assess the clinical effectiveness of a sonographer-led, cardiologist-interpreted stress echocardiography (SE) service in a rapid access stable chest pain clinic (RACPC) setting. METHODS AND RESULTS: Baseline data was collected prospectively on 768 consecutive patients, referred from the RACPC, who underwent SE between May 2014 and May 2015. Retrospective analysis was performed on follow-up data for outcomes. Among 768 patients (mean age 58 years, 57.8% males) with a mean pre-test probability of coronary artery disease (CAD) of 31%, 675 (88%) underwent SE on the same day as the RACPC consultation. Diagnostic tests were obtained in 749 (97.5%) cases with 62 (8.1%) demonstrating inducible ischemia. Coronary angiography was performed in 61 patients of whom 54 demonstrated flow-limiting CAD (positive predictive value: 88.5%). There was no occurrence of serious adverse events. During a mean follow-up period of 2.5 years, 20 first cardiac events were recorded, of which annualised events in the normal SE group were 0.64% versus 5.8% in patients with an abnormal SE (log rank p < 0.001). CONCLUSION: Sonographer-led SE interpreted by a cardiologist is feasible, safe and efficacious. It impacted on the management of patients with appropriate outcomes and may be a cost-efficient and safer alternative to other non-invasive imaging modalities in the RACPC setting.

Radiation exposure by digital radiographic imaging in very low birth weight infants.

OBJECTIVE: The aim of this study was to determine the cumulative effective doses (CED) from digital radiographic imaging in very low birth weight infants treated in a tertiary care neonatal intensive care unit (NICU). STUDY DESIGN: The CED for each infant was retrospectively calculated using a voxel-based model. The results were compared with previous studies applying conventional radiography. RESULTS: Two hundred and six preterm infants were included into this study. Neonates received a median of four radiographs (range: 1-68) and a CED of 50 µSv (4-883 µSv). Overall mean CED was lower than in previously published data applying conventional radiography. Factors contributing to a lower radiation dose per infant in our study were a lower number of radiographs and smaller field sizes per radiographic image. CONCLUSIONS: The number of conducted radiographs per patient and the employed field size had a higher impact on the CED than the applied radiographic technology.

Improving and Maintaining Radiologic Technologist Skill Using a Medical Director Partnership and Technologist Coaching Model.

OBJECTIVE: Consistent excellence in radiologic technologist performance, including ensuring high technical image quality, patient safety and comfort, and efficient workflow, largely depends on individual technologist skill. However, sustained growth in the size and complexity of health care organizations has increased the difficulty in developing and maintaining technologist expertise. In this article, we explore underlying organizational structures that contribute to this problem and propose organizational models to promote continued excellence in technologist skill. CONCLUSION: We have found that a relatively modest investment in medical directorship combined with a coaching model can bring about a significant level of improvement in skilled clinical performance. We believe that widespread implementation of similar programs could contribute to substantial improvements in quality in radiology and other health care settings.

Digital imaging and radiographic practise in diagnostic radiography: An overview of current knowledge and practice in Europe.

INTRODUCTION: Recent research has identified the issue of 'dose creep' in diagnostic radiography and claims it is due to the introduction of CR and DR technology. More recently radiographers have reported that they do not regularly manipulate exposure factors for different sized patients and rely on pre-set exposures. The aim of the study was to identify any variation in knowledge and radiographic practice across Europe when imaging the chest, abdomen and pelvis using digital imaging. METHODS: A random selection of 50% of educational institutes (n = 17) which were affiliated members of the European Federation of Radiographer Societies (EFRS) were contacted via their contact details supplied on the EFRS website. Each of these institutes identified appropriate radiographic staff in their clinical network to complete an online survey via SurveyMonkey. Data was collected on exposures used for 3 common x-ray examinations using CR/DR, range of equipment in use, staff educational training and awareness of DRL. Descriptive statistics were performed with the aid of Excel and SPSS version 21. RESULTS: A response rate of 70% was achieved from the affiliated educational members of EFRS and a rate of 55% from the individual hospitals in 12 countries across Europe. Variation was identified in practice when imaging the chest, abdomen and pelvis using both CR and DR digital systems. There is wide variation in radiographer training/education across countries. CONCLUSION: There is a need for standardisation of education and training including protocols and exposure parameters to ensure that there is continued adherence to the ALARA principle.