Ethnography and medicine: the utility of positivist methods in research.

This commentary discusses the methodological utility of ethnography within the medical space. Whilst a general consensus affirms that ethnography aligns with qualitative approaches, as identified within the existing medical literature, here, we demonstrate how quantitative [positivist] methods can also be incorporated. This paper begins by contextualising ethnographic approaches within medical contexts by demonstrating its empirical value within the existing literature. Next, we discuss the interconnection between the practice of 'doctoring' and ethnographic research, whereby doctors themselves use forms of inductive and deductive reasoning to treat and manage patients in their everyday context. This philosophical discussion not only links to the everyday practice of medical practitioners, but also critically reflects on the role of the first author, as a diagnostic radiographer. Lastly, this paper identifies the virtues of ethnographic research for medical students and/or medical doctors whereby the combination of qualitative and quantitative methods (within an ethnographic methodology) can lead to new empirical and methodological insights, enabling the creation of alternate research strategies and evidence. This methodological strategy may be best considered amongst medical students and/or early career medical researchers, but we also anticipate it to resonate and open further discussion with experienced medical practitioners and researchers transnationally.

Concept analysis of 'Facilitating a transformative radiation protection environment'.

INTRODUCTION: Suboptimal radiation protection evidenced in literature necessitated the development of a theory to optimise radiation protection. To develop a theory, concept analysis of the central concept guiding the theory is required to provide explicit theoretical and operational definitions. This article presents the concept analysis of the central concept of 'facilitating a transformative radiation protection environment' used to develop a theory to optimise radiation protection. METHODS: The study used Walker and Avant's concept analysis process of selecting a concept, determining the aims and purpose of analysis, identifying all uses of the concept, and determining the defining attributes by identifying a model case, a borderline case and a contrary case. RESULTS: The central concept was dissected into the individual concepts of facilitating, transformative, radiation, protection, and environment to enhance the definition and conceptual meaning of the central concept. The essential and related attributes of the individual concepts informed the summative definition of the central concept, and a model, borderline and contrary case contributed to the conceptual meaning. CONCLUSION: The summative definition of the central concept of "facilitating a transformative radiation protection environment" was determined to be through the essential attributes of help, process, change, X-rays, keeping safe considering the benefits versus risks of ionising radiation exposure and the total internal, external context within which persons exist and the related attributes. IMPLICATIONS FOR PRACTICE: Explored extensively in nursing literature, concept analyses in radiography are limited. Therefore, this article articulates the process of concept analysis and its use in radiography. Concept analysis provides a systematic process to analyse concepts often assumed to be understood, highlighting its importance in radiography literature and to educational praxis.

Attitudes and practices of radiation protection among Jordanian dental radiography practitioners.

INTRODUCTION: Varying radiation protection practices have been documented in the literature. This study aims to evaluate the attitudes and practices of dental radiography practitioners towards radiation protection in Jordan, as no data currently explores their understanding and practices in this area. METHODS: The survey involved 192 dental radiography practitioners. A cross-sectional, self-administered questionnaire containing 43 questions covered socio-demographic data, practices towards radiation protection, and attitudes. RESULTS: The majority of participants were less than 40 years old (87.5 %), with 66.7 % working in private clinics and 53.6 % based in the capital city of Jordan. Nearly a quarter (26.5 %) of the practitioners used an X-ray tube voltage of 65-70 kVp; however, 14.6 % were unaware of the X-ray tube voltage used in their machines. Additionally, almost one quarter of the participants never or rarely used light beam positioning aids and available positioning guides in panoramic radiography practice. Only 33.3 % of practitioners consistently used lead aprons, with the main reasons for non-use being the weight of the apron or its unavailability. About 81 % of participants believed in spreading awareness about radiation protection and applying this knowledge in their daily practices. CONCLUSIONS: The study found that the practitioners' practices were satisfactory to some extent, supported by a positive attitude towards radiation protection. The participants understand the importance of increasing their awareness and knowledge of radiation protection practices. IMPLICATIONS FOR PRACTICE: The findings of this study highlight the need to improve radiation protection practices among dental radiography practitioners in Jordan by introducing standard dose protocols, supporting the transition to digital systems, establishing diagnostic reference levels, and encouraging the use of equipment over staff holding practices, and raising awareness about radiation safety.

Interprofessional education (IPE) in medical radiation science: A scoping review.

INTRODUCTION: Interprofessional education (IPE) in medical radiation education is designed to enhance both student and longer-term patient outcomes. This scoping review aims to provide an overview of the available evidence and examine the effectiveness of IPE strategies used to enhance the development of medical radiation science (MRS) students. METHODS: Medline, CINAHL, Cochrane Library and Emcare were searched for articles which employed an experimental study design to quantitatively assess the effectiveness of IPE for MRS students. Two reviewers screened and extracted relevant data independently. Critical appraisal was conducted using the JBI critical appraisal tool. RESULTS: Eighteen studies were included in this review. Diverse approaches to IPE were discovered, particularly in terms of the method of delivery, setting and duration of interventions. MRS students interact with many professions, particularly medical doctors and nurses. All studies which employed a control arm demonstrated statistically positive findings favoring IPE intervention(s). In pre-post studies, most IPE interventions reported significant positive differences after IPE was implemented. This entailed an enhanced perceived knowledge and understanding of other professions, and ability to undertake their role in the team. CONCLUSION: IPE was shown to be effective in enhancing students' perceptions and attitudes and to a limited extent, improve knowledge acquisition. Future research should assess long-term effects and patient-related outcomes. IMPLICATIONS FOR PRACTICE: IPE in a variety of formats demonstrates positive results for MRS students; however, interventions which are longer-term, conducted in small groups, and performed earlier in the educational pathway, may demonstrate greater effectiveness.

Australian radiographers' awareness of cardiac implantable electronic devices (CIEDs) in mammographic imaging.

INTRODUCTION: Women presenting for mammography occasionally have pacemakers or other cardiac-implantable electronic devices (CIEDs) in situ. This research investigates Australian radiographers' awareness of CIEDs in the diagnostic and screening settings. METHODS: A survey of radiographers with mammography experience in Australia was conducted using SurveyMonkey™. Respondents were asked if they could confidently identify images of devices and whether they had imaged them mammographically. A Chi-squared test of independence was used to compare the association between demographics and CIED awareness. A value of p < 0.05 was deemed statistically significant. RESULTS: There were 220 valid responses. All CIED types had been imaged. Most respondents had imaged a pacemaker (94.5%) and implantable cardioverter-defibrillator (ICD) (85.6%), compared to the three different implantable loop recorders (ILRs) (ILR-1: 63.4%; ILR-2: 14.1%; and IRL-3: 26.9% and the emerging subcutaneous ICDs (S-ICDs) (11.9%). Most respondents felt confident identifying the pacemaker (95%) and the ICD (86.1%). Only 19.4% of respondents could confidently identify the emerging S-ICD. CONCLUSION: A lack of awareness of new and emerging devices may impact approaches to imaging and present significant risk to patients. The lack of studies comprehensively describing devices and their mammographic appearance to support radiographers' knowledge and awareness highlights an urgent need to progress research in this area. IMPLICATIONS FOR PRACTICE: As a part of continuing professional development, radiographers performing mammography must ensure they remain up to date with current and emerging technology, including CIEDs. This study has identified a lack of awareness of the different types of CIEDs currently being implanted and imaged, which may translate to unsafe imaging practices. There is an urgent need for further education to bridge this knowledge gap and ensure the safety of practice in imaging women with CIEDs. FOOTLINE: Mammography: CIED Imaging.

Australian student radiographers' experiences and perspectives in general paediatric medical imaging examinations.

INTRODUCTION: Paediatric patients differ from adult patients with respect to anatomy, examination factors, behaviour, and intellectual development, requiring dedicated specialised knowledge and expertise. In the absence of a formal dedicated paediatric medical imaging subspecialty, this study undertook to understand student radiographers' experiences and perspectives on paediatric medical imaging. METHODS: The study entailed a descriptive cross-sectional survey design entailed a 51-item closed and open-ended response questionnaire using a total sampling method. Data were collected from both under- and postgraduate student radiographers who undertook clinical placement. Data interpretation and analysis involved statistical analysis of close-ended questions and thematic analysis of open-ended questions. RESULTS: The overall response rate was 70%. Most participants acknowledged the importance of dedicated paediatric content as well as the theory content covered. The shortcoming in pre-placement practical component was overcome through varied approaches like observations and attempting through supervision whilst experiencing uncertainty, anxiety and felt unfair to risk the patient. As reported in literature like their qualified counterparts expressed similar challenges in technique adaptation, styles of interactions in gaining cooperation from both the children and parents. They also felt paediatric content and the practicals should be embedded throughout the course offering to not compromise the day-to-day service delivery. CONCLUSIONS: The study findings iterate the importance paediatric imaging in the service delivery context. The importance of undertaking these examinations reliant on experiential learning is insufficient to bridge the gap of preparation prior to placement. IMPLICATIONS FOR PRACTICE: Collaborative academic and clinical radiography education will ensure that radiography students' dedicated specialised paediatric imaging knowledge and experience are enhanced.

Diagnostic radiography students' perspectives on cultural competence and safety.

INTRODUCTION: Cultural competency and safety are essential components to consider in the provision of person-centred equitable healthcare. Therefore, student radiographers' learning should include the necessary knowledge, skill sets and competence to recognise the patient's unique characteristics to enable culturally competent and safe medical imaging services. Therefore, this study explored undergraduate and postgraduate diagnostic radiography students' perspectives on cultural competency and safety. METHODS: A qualitative phenomenological design with a hermeneutic phenomenological approach was followed to explore student perspectives. Student radiographers (second and third-year undergraduate and first and second-year postgraduate) from the study site were purposively and conveniently recruited to participate in focus group interviews. Fifteen focus group interviews were conducted, recorded and transcribed verbatim before undergoing thematic analysis. RESULTS: Thematic analysis identified two themes. Theme one centred around the cultural competence and safety learnt by student radiographers at university and the second theme cultural competence and safety learnt in workplace learning. CONCLUSION: This study demonstrated the importance of cultural competence and safe practice in examining patients of different cultures. It highlights the importance of creating awareness among students of their own abilities and capabilities of cultural sensitivity and safe practice as part of their learning. Future health professionals should be empowered to address and respond to patients' unique needs in a competent, safe and professional manner to reduce health disparities. IMPLICATIONS FOR PRACTICE: Cultural competence and safety are integral to person-centred care. Including these concepts in radiography education is therefore vital to ensure optimal patient outcomes.

Radiographers' organisational commitment and occupational stress: First Covid-19 wave.

INTRODUCTION: Radiographers, like many health professionals, are in a high-risk group for succumbing to workplace demands beyond their ability to cope, particularly in the context of the COVID-19 pandemic resulting in occupational stress. Occupational stress has been linked to poor organisational commitment. Therefore, the purpose of this research was to evaluate radiographers' organisational commitment and occupational stress after the first wave of the COVID-19 pandemic. METHODS: A mixed method approach entailed data collected from purposively sampled Australian radiographers working during the first COVID-19 wave. The quantitative phase used an online commitment questionnaire, and 21 semi-structured individual virtual interviews were conducted in the qualitative phase. Data interpretation and analysis used statistical and thematic approaches. RESULTS: The quantitative data revealed a higher level of continuance than affective and normative commitment. Whereas the qualitative findings showed participants high levels of affective commitment to their occupation and, together with leadership support, working collectively towards a positive outcome. CONCLUSION: Despite the variety of occupational stressors that arose during the COVID-19 crisis, Australian radiographers enjoy a high level of occupational and organisational commitment. IMPLICATIONS FOR PRACTICE: Radiographers' organisational commitment represents their emotional and psychological attachment to their workplace, and radiographers experiencing occupational stress represent high levels of psychosomatic distress and burnout. Therefore, considering radiographers' organisational commitment and occupational stress is essential in the delivery of services, quality of patient care and radiographers well-being.

South African radiographers' radiation protection practices, a qualitative study.

INTRODUCTION: Radiation protection is multifarious, and consequently, a radiographers' application of radiation protection is multifaceted. Studies have shown varying radiation protection practices among radiographers. The first quantitative phase of this explanatory, sequential mixed-method study used the theory of planned behaviour to explore South African radiographers' radiation protection behaviour. Overall, South African radiographers' attitudes to radiation protection, subjective norm, perceived behavioural control, and radiation protection intention was high. This second phase of the study aimed to explore the reasons for South African radiographers' radiation protection practices. METHODS: This study used an exploratory and descriptive qualitative approach. Data was collected through 13 in-depth semi-structured telephone interviews. Thematic analysis was used in order to uncover original phenomena. Data saturation was achieved and the study adhered to trustworthiness and ethical measures. RESULTS: Thematic analysis identified two themes. The participants had the appropriate radiation protection knowledge, but radiation protection compliance remained a personal choice. Impediments such as feeling rushed during imaging of trauma and challenging patients, patients knowledge of radiation protection, resources, imaging referrals, inadequate training when transitioning from analogue to digital radiography and managerial support contributed to radiation protection compliance. Strategies such as further education, research and a change in mindset were suggested to further foster radiation protection compliance. CONCLUSION: Even though participants' knowledge of radiation protection aligned with the legislated guidelines, limited internalising of the knowledge resulted in compliance being a personal choice. Participants reflected on their insouciant attitude and observed a similar attitude in their radiographer colleagues. Patient and work-related impediments were identified to contribute to radiation protection compliance. Strategies to further foster compliance were suggested. IMPLICATIONS FOR PRACTICE: Understanding the reasons for radiographers' choice in radiation protection will allow the development of strategies that foster optimum application of radiation protection practises. Developing a radiation protection culture that enhances personal compliance supported by education and evidence should be considered.

The impacts of vertical off-centring, tube voltage, and phantom size on computed tomography numbers: An experimental study.

INTRODUCTION: This experimental study explored the effect of vertical off-centring on computed tomography (CT) numbers in combination with various tube voltages and phantom sizes for two CT units. METHODS: CIRS Model 062 Electron Density and system performance phantoms were imaged on Siemens Emotion 16-slice CT and GEMINI-GXL scanners, respectively. Uniformity and accuracy were evaluated as a function of vertical off-centring (20, 40, 60, and 80 mm above the gantry isocentre) using different water phantom sizes (18, 20, and 30 cm) and tube voltages (80, 90, 110, 120, 130 and 140 kVp). RESULTS: Vertical off-centring and phantom size accounted for 92% of the recorded variance and the resultant change in CT numbers. The uniformity test recorded maximum changes of 14 and 27.2 HU for peripheral ROIs across the X- and Y-axes for an 80 mm phantom shift above the gantry isocentre on the GEMINI GXL and Siemens scanners, respectively. The absolute CT number differences between the superior and inferior ROIs were 13.7 HU for the 30 cm phantom and 4.8 HU for the 20 cm phantom for 80 mm vertical off-centring. The largest differences were observed at lower tube voltages. CONCLUSIONS: It is essential to highlight the significance of CT number variation in clinical decision-making. Phantom off-centring affected the uniformity of these numbers, which were further impacted by the ROI position in this experimental study. CT number variation was more evident in peripheral phantom areas, lower tube voltages and larger phantom sizes. IMPLICATIONS FOR PRACTICE: CT number is observed to be a variable under certain common conditions. This significantly impacts several applications where clinical decisions depend on CT number accuracy for tissue lesion characterisation.

Radiographers' experiences and perspectives of forensic imaging in Australia: A qualitative study.

INTRODUCTION: Forensic imaging plays a pivotal role regarding medico-legal issues by investigating the cause(s) of injuries to living or deceased individuals. There is currently a gap in the literature on forensic imaging due to limited national and international guidelines, protocols and scope of duties and responsibilities of radiographers undertaking forensic imaging. Thus, this study aimed to investigate the gap by exploring the experiences and perspectives of radiographers on forensic imaging in Australia. METHODS: A qualitative approach collected data from fifteen purposively sampled qualified Australian radiographers through individual in-depth interviews. The verbatim transcribed data were thematically analysed. RESULTS: Two themes were identified: 1) Radiographers' experiences of forensic imaging; 2) Radiographers' perceptions of forensic imaging within the job scope of a qualified radiographer. CONCLUSIONS: Participants' experiences of forensic imaging ranged from anxiety to a positive experience, and others posed ethical and situational dilemmas heightened by the lack of dedicated forensic imaging protocols. While some radiographers expressed that every radiographer should conduct forensic imaging, others felt it was not mandatory. IMPLICATIONS FOR PRACTICE: Radiographers' shared subjective experiences, thoughts and feelings provided insight into forensic imaging and the need for more significant support from educational and governing bodies.

Investigating perceptions of 'dose creep' amongst student radiographers: A grounded theory study.

INTRODUCTION: The dose creep phenomenon is now a widely recognized concept in diagnostic radiography in light of recent technological advancements transnationally. However, this still remains underexplored amongst radiography students preparing to enter the radiography profession. In response, this study explores the perceptions of dose creep amongst undergraduate student radiographers. METHODS: The methodological approach utilized in this research study was grounded theory. The qualitative approach aimed to uncover findings from a higher education institution in Australia. Six students were recruited and took part in semi-structured interviews. This enabled the exploration of previously uncovered data, leading to the construction of original theory within the clinical and academic environment. The data analysis employed was constant comparative analysis (CCA). RESULTS: A number of insights emerged from the qualitative data set. For instance, the radiography students understanding of the term 'dose creep' and decision making leading to dose creep in the clinical environment is captured. This is further supported with assessment of image evaluation determining appropriate exposure factor selection and future impact upon graduation as diagnostic radiographers. The findings identify some important learning needs and actions for both clinical and academic settings which may help foster good use of X-ray exposures. CONCLUSION: This paper concludes by affirming some challenges surrounding optimal exposure selection and the known phenomenon, dose creep. Further, this study identifies the importance of learning and teaching in the clinical environment whereby learned behaviour leads to suboptimum practices. IMPLICATIONS FOR PRACTICE: This study advances the existing evidence base by providing a unique lens into the knowledge and understanding of dose creep amongst radiography students in both academic and clinical contexts. It is anticipated this paper will help practitioners and educators better understand potential instances of dose creep within the clinical environment.

How effective are lead-rubber aprons in protecting radiosensitive organs from secondary ionizing radiation?

INTRODUCTION: The purpose of this experiment was to explore the direction of scattered secondary ionizing radiation to a patient. A left lateral radiographic examination of the elbow was deemed appropriate due to its close proximity to radiosensitive organs and record dose limiting opportunities upon wearing a lead-rubber apron. METHODS: An anthropomorphic phantom and lead-rubber apron (Pb 0.35 mm) was used with a 15 cc ionization chamber (model 10,100 AT TRIAD) to measure scattered radiation to radiosensitive organs. Dose readings were recorded before and after in order to quantify dose reduction. Pearson's correlation, linear regression, t-test and one way analysis of variance (ANOVA) statistics were used to affirm how likely dose limitation was attributed to chance (p < 0.05). RESULTS: The lead-rubber apron offered dose reduction to most radiosensitive organs. Notably, ionizing radiation was significantly reduced to the left breast 0.0083 µGy (98%), right breast 0.0000 µGy (99.9%) and spleen 0.0262 µGy (99.9%). No empirical benefit was recorded for testes and ovaries. Interestingly, the thyroid recorded an increase in dose (0.1733 µGy; p = 0.01). This was later mitigated using a thyroid collar but identifies increased stochastic risks if lead-aprons are worn alone. Scattered radiation was also reduced to both eyes, which were not directly covered. CONCLUSION: Lead-rubber aprons are generally utilized to limit ionizing radiation, yet this article offers insight whereby increases to ionizing radiation to the thyroid are plausible when wearing a lead-rubber apron alone. Whilst these findings cannot be generalized to other radiographic examinations it provides insight into a potential increase risk of scatter to a radiosensitive organ. IMPLICATIONS FOR PRACTICE: This paper has implications because it identifies that lead-rubber has an impact on scattered ionizing radiation to radiosensitive organs for a lateral elbow examination. Further, it identifies the potential for ionizing radiation to be increased to the thyroid upon wearing a lead-rubber apron alone.

The detection of wooden foreign bodies: An experimental study comparing direct digital radiography (DDR) and ultrasonography.

INTRODUCTION: This experimental study compares the appropriateness of direct digital radiography (DDR) and ultrasonography at detecting soft-tissue wooden foreign bodies (FBs) in extremities. METHODS: Varying wooden FB splinters (2 mm, 5 mm and 10 mm) were inserted into eight porcine feet to simulate a patient presenting with a soft-tissue FB injury. Each of the FBs was placed in muscle distant, behind and near bone in the porcine feet. Control groups were used to check for false-positive diagnoses and, based on the presence of FBs; images were given a score depending on the level of visibility by the researcher. RESULTS: A higher detection rate was achieved for all FBs in muscle distant from bone using ultrasound. All of the 2 mm and 5 mm wooden FBs were not detected using DDR. The sensitivity in detecting the FBs was 5.8% and 30% in DDR and ultrasound respectively. CONCLUSION: Poor sensitivities and specificities were identified in this study. However, this study shows that ultrasound remains superior to DDR at identifying small foreign body objects. This study demonstrates that ultrasound can be a clinically effective tool for detecting suspected wooden FBs >5 mm in the foot and thus should be considered as the primary imaging modality of choice for referring clinicians.

Attitudes and perceptions of radiographers applying lead (Pb) protection in general radiography: An ethnographic study.

INTRODUCTION: Since the discovery of X-rays by Rontgen in 1895, lead (Pb) has been used to limit ionising radiation for both operators and patients due to its high density and high atomic number (Z = 82). This study explores the attitudes and perceptions of diagnostic radiographers applying Pb protection during general radiographic examinations, an area underexplored within a contemporary radiographic environment(s). METHODS: This paper presents findings from a wider ethnographic study undertaken in the United Kingdom (UK). The use of participant observation and semi-structured interviews were the methods of choice. Participant observation enabled the overt researcher to uncover whether Pb remained an essential tool for radiographers. Semi-structured interviews later supported or refuted the limited use of Pb protection by radiographers. These methods enabled the construction of original phenomena within the clinical environment. RESULTS: Two themes are discussed. Firstly, radiographers, underpinned by their own values and beliefs towards radiation risk, identify a dichotomy of applying Pb protection. The cessation of Pb may be linked to cultural myths, relying on 'word of mouth' of peers and not on the existing evidence-base. Secondly, radiographers acknowledge that protecting pregnant patients may be primarily a 'personal choice' in clinical environments, which can alter if a patient requests 'are you going to cover me up?' CONCLUSION: This paper concludes by affirming the complexities surrounding Pb protection in clinical environments. It is proposed that the use of Pb protection in general radiography may become increasingly fragmented in the future if radiographers continue rely on cultural norms.

Can placing lead-rubber inferolateral to the light beam diaphragm limit ionising radiation to multiple radiosensitive organs?

INTRODUCTION: This article investigates a practical method of reducing the impact of scattered radiation during a lateral radiographic projection of the elbow. The light beam diaphragm (LBD) is generally accepted to limit ionising radiation using horizontal and longitudinal lead shutters, yet this article evidences further dose limitation by placing lead-rubber inferolateral to the LBD device. METHODS: Using an anthropomorphic phantom and arm construction scattered radiation was recorded at multiple radiosensitive organs. A 15 cc ionisation chamber (model 10100 AT TRIAD) was placed on each radiosensitive organ (eye, thyroid, breast, testes, spleen and ovaries) measuring exposure rate (µGy/s). Dose readings were recorded before and after the placement of lead-rubber inferolateral to the LBD. A paired two sample t-test was undertaken affirming how likely dose limitation was attributable to chance (p < 0.05). RESULTS: Descriptive and inferential statistics demonstrate dose reduction to radiosensitive organs (right eye 53%, right breast 53%, left eye 39%, thyroid 13%, left ovary 9%, testes 6%, left breast 3% and spleen 2%) upon placement of the lead-rubber inferolateral to the LBD. The paired two sample t-test demonstrated statistically significant dose limitation (t = 2.04, df = 7, p = 0.04) thus significant for radiographic practice. CONCLUSION: Placement of lead-rubber inferolateral to the LBD limits dose to multiple radiosensitive organs. Right (53%) and left (39%) eye lens, right breast (53%), thyroid (13%), left ovary (9%), testes (6%), left breast (3%) and spleen (2%) statistically demonstrate dose limiting opportunities to patients.

Image acquisition in general radiography: The utilisation of DDR.

OBJECTIVE: This article explores image acquisition with DDR. General radiographic technology continues to advance therefore it remains paramount to continually reflect on DDR hardware and software amongst radiographers in an imaging modality that constitutes approximately 90% of all radiological examinations. METHOD: This article reports findings from a wider ethnographic study of two general radiography environments in the United Kingdom (UK). Participant observation and semi-structured interviews were the methods used to uncover original data. RESULTS: Two key themes are discussed. Firstly, 'the extent of DDR knowledge' amongst radiographers is examined. The findings uncover that not all radiographers have an adequate knowledge base with DDR technology. Secondly, 'pitfalls and near misses with DDR' is discussed. This theme highlights the potential danger of radiographers 'over-repeating' X-ray examinations, coincided with the occurrence of radiological incidents whereby a patient is exposed to ionising radiation with no added benefit. CONCLUSION: This paper concludes by challenging the current 'skill base' to operate DDR equipment. In addition, new pitfalls and near misses are highlighted, which may help forestall radiation incidents in the future. Dose and image optimisation remain central tenets to the role of the radiographer. ADVANCES IN KNOWLEDGE: Few studies have challenged image acquisition with DDR. This study adds to existing knowledge by uncovering original phenomena that may initiate discussions within the radiography community and continually enhance healthcare delivery.