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INTRODUCTION: The Radiography Research Ethics Standards for Europe (RRESFE) project aimed to provide a cross-sectional view of the current state of radiography research ethics across Europe. This included investigating education and training in research ethics, and identifying the key challenges and potential improvements associated with using existing research ethics frameworks. METHODS: This cross-sectional online survey targeting radiography researchers in Europe was conducted between April 26 and July 12, 2021. Descriptive and analytical statistics were used to identify research ethics education and training trends. Content analysis of qualitative responses was employed to identify significant challenges and proposed improvements in research ethics frameworks of practice. RESULTS: There were 232 responses received across 33 European countries. Most (n = 132; 57%) respondents had received some research ethics training; however, fewer participants had received training on safeguarding vulnerable patients (n = 72; 38%), diversity and inclusivity (n = 62; 33%), or research with healthy volunteers (n = 60; 32%). Training was associated with a greater perceived importance of the need for research ethics review (p = 0.031) and with the establishment of EQF Level 6 training (p = 0.038). The proportion of formally trained researchers also varied by region (p = <0.001). Time-to-ethics-approval was noted as the biggest challenge for professionals making research ethics applications. CONCLUSION: Early and universal integration of research-oriented teaching within the radiography education framework which emphasises research ethics is recommended. Additionally, study findings suggest research ethics committee application and approval processes could be further simplified and streamlined. IMPLICATIONS FOR PRACTICE: The survey contributes to a growing body of knowledge surrounding the importance of education and training in research ethics for assuring a high standard of research outputs in Radiography and has identified hurdles to obtaining research ethics approval for further investigation and address.
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Currículo , Ética em Pesquisa , Estudos Transversais , Europa (Continente) , Humanos , RadiografiaRESUMO
INTRODUCTION: The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs. METHODS: A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe. RESULTS: 285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X2 (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X2 (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X2 (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X2 (1, n = 231) = 15.448, p = <0.001) within respondents' country. CONCLUSION: Respondents from countries with longer programme durations/availability of multiple programme lengths, availability of postgraduate training, and establishment of European Qualifications Framework Level 6 were generally associated with less uncertainty and more comprehensive research ethics requirements. IMPLICATIONS FOR PRACTICE: Results are informative of the current status of research ethics within evidence-based radiography.
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Ética em Pesquisa , Estudos Transversais , Europa (Continente) , Humanos , Radiografia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: The education of Therapeutic Radiographers (TRs) is regulated in some countries but is not standardised across the EU, leading to differences in competencies between and within member states. This study aimed to explore stakeholders' perceptions regarding underdeveloped competencies of TRs practising on the linear accelerator, identified in a previous study by the same research team. METHODS: Interviews with stakeholders from four countries (selected based on the characteristics of their degrees) were performed as part of this cross-case study. Stakeholders were asked to provide their perception regarding the least developed competencies identified in a previous study. RESULTS: The 27 stakeholders confirmed that Pharmacology, Quality Assurance (QA), Management and Leadership, Research (from the previous study) were underdeveloped and identified Image Verification and Critical Thinking as additional underdeveloped competencies. Suggested causes included: lack of regulation of required competencies at the national level, lack of training dedicated to radiotherapy (RT) (taught within generic modules) and lack of time within the degree programme. The ideal academic level to develop these competencies and whether they are essential varied between country and stakeholder. CONCLUSION: It is essential to regulate learning outcomes at the national level to ensure a high level of care is provided to all RT patients and, ideally, standardise it across Europe. Education institutions should review their curricula to ensure that sufficient time is dedicated to RT and that the essential competencies are developed. Due to time constraints within some programmes, some competencies must be developed after graduation. IMPLICATIONS FOR PRACTICE: Lack of regulation of learning outcomes (at European level and national level in many countries) and lack of RT-specific training lead to underdeveloped competencies that may compromise patient care.
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Pessoal Técnico de Saúde , Currículo , Europa (Continente) , Humanos , LiderançaAssuntos
Infecções por Coronavirus/diagnóstico por imagem , Intervenção Baseada em Internet , Unidades Móveis de Saúde/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/diagnóstico por imagem , Testes Imediatos/organização & administração , Radiologistas/educação , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Saúde Global , Recursos em Saúde , Humanos , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Radiologistas/estatística & dados numéricos , Sociedades Médicas/organização & administraçãoRESUMO
INTRODUCTION: The United Kingdom has a sonographer shortage. Health Education England are working with stakeholders to address these shortages and increase clinical capacity for sonographer education. The aims of this survey were to ascertain current sonographer staffing levels, estimate staffing requirements in five years' time and review current clinical placement capacity. METHODS: An on-line survey was used to explore the aims of the study. Questions included current and predicted sonographer staffing requirements and clinical capacity for teaching ultrasound. Free text comments were available for expanding on responses. RESULTS: Of 72 completed responses the mean sonographer vacancy rate was 2.65 and the predicted number of sonographers needed to provide the service in five years was 4.6. Departments were teaching an average of two sonographers and 2 non-sonographers. A small number of departments had further capacity for sonography student training which was not being utilised for reasons including limited capacity, inadequate staffing levels or competing demands of teaching other health care professionals. Extended working days and weekend training lists were used to increase capacity, along with rolling programmes for teaching sonographers and the use of simulation. CONCLUSION: The survey supported previous publications that have shown sonographer shortages in England and this is predicted to increase over the next five years. Departments were teaching a similar number of sonographers as other health care professionals. Many experienced competing demands, which challenged their ability to increase clinical capacity. IMPLICATIONS FOR PRACTICE: Suggestions for increasing capacity are provided to help grow the sonography workforce. With the advent of new sonography programmes the departments with spare capacity could be utilised to support clinical practice for sonography students in need of a placement on a direct entry programme.
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Educação Médica , Mão de Obra em Saúde , Admissão e Escalonamento de Pessoal , Ultrassonografia , Competência Clínica , Currículo , Inglaterra , Humanos , Capacitação em Serviço , Inquéritos e Questionários , EnsinoRESUMO
INTRODUCTION: Online Twitter journal clubs are a recent and popular innovation with the potential to increase research awareness and inform practice. The medical radiation sciences' MedRadJournalClub (MJRC) is a Twitter-based event that attracts a global group of participants at the monthly chats. An analysis of a recent MedRadJournalClub discussion evaluated the perceived benefits and limitations of medical radiation practitioners participating in an online journal club. METHODS: The February 2017 chat used for analysis was based on the Journal of Medical Imaging and Radiation Sciences article by Currie et al. "Twitter Journal Club in Medical Radiation Science" that examines the educational theory behind learning and evidencing professional development through MRJC and social media. The data consisted of chat tweets which were collated using the Twitter advanced search function using the #medradjclub. An initial reviewed was performed to exclude irrelevant content. A second review was then undertaken to categorize the main theme of the tweet. The data were then subjected to thematic analysis which yielded seven different categories. RESULTS: The main benefits included global access due to the online nature of MRJC that has facilitated networking and collaboration. Open access to recently published research was another key benefit. The character limitation of a tweet was the most common constraint, and the dynamic nature of the twitter conversation requires multi-tasking that may be difficult. CONCLUSION: Our analysis indicated that participants use MedRadJournalClub as a source of continuing professional development with some evidence that this is directly informing clinical and educational practice.
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Educação Médica Continuada/métodos , Publicações Periódicas como Assunto , Radiologia/educação , Comunicação Acadêmica , Mídias Sociais , HumanosRESUMO
INTRODUCTION: To assess whether an enhanced role for radiographers in reporting lung cancer chest radiographs is cost-effective. METHODS: Costs and outcomes of chest radiograph reporting by reporting radiographer or by a radiologist were compared using a decision tree model. The model followed patients from an initial chest radiographs for suspected lung cancer to the provision of cancer care in positive cases. Sensitivity and specificity of reporting for radiographers and radiologists were derived from a recent trial. Treatment costs and quality adjusted life expectancy were estimated over five years for those diagnosed. Deterministic and probabilistic sensitivity analyses were used to test the robustness of inference to parameter uncertainty. RESULTS: For 1000 simulated patients, radiographer reporting decreased detection costs by £8500 and detected 10.3 more cases at initial presentation. After including treatment costs and outcomes, radiographer reporting remained cheaper than radiologist reporting and resulted in 1.4 additional QALYs per 1000 screened patients. Probabilistic analysis indicated a 98% likelihood that radiographer reporting is cheaper and more effective than radiologist reporting after inclusion of treatment costs and outcomes. CONCLUSION: Radiographer reporting is a cost-effective alternative to radiologist reporting in lung cancer diagnosis. Further work is needed to support the adoption of radiographer's reporting pathway in diagnosis of lung cancer suspected patients.
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Pessoal Técnico de Saúde , Competência Clínica , Análise Custo-Benefício , Árvores de Decisões , Neoplasias Pulmonares/diagnóstico por imagem , Radiologistas , Humanos , Radiografia Torácica , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Workforce planning reports identify a staff shortfall that jeopardizes the ability of UK radiotherapy centres to meet future demands. Obtaining an understanding of the work experiences of radiotherapy professionals will support the development of strategies to increase job satisfaction, productivity and effectiveness. METHODS: A quantitative survey assessed job satisfaction, attitudes to incident reporting, stress and burnout, opportunities for professional development, workload, retention and turnover. Clinical oncologists were not included, as the Royal College of Radiologists, London, UK, had recently assessed their members' satisfaction. All questions were taken from validated instruments or adapted from the "UK National Health Service Staff Survey". RESULTS: The survey yielded 658 completed responses (approximately 16% response rate), from public and private sectors. Over a third (36%) of respondents were classified as satisfied for job satisfaction with 11% dissatisfied and the remaining 53% ambivalent. A significant proportion of clinical staff (37.5%) report high emotional exhaustion. Presenteeism was an issue with 42.4% attending work despite feeling unable to fulfil their role. CONCLUSION: Radiotherapy professionals are prone to the effects of compassion fatigue and burnout. Attention must be paid to workload and its impact on practitioners' job satisfaction. Professional development that is supported and informed by a performance development review is a simple and effective means of enhancing satisfaction. Individuals have a responsibility to themselves and their colleagues as their behaviours and attitudes influence job satisfaction. ADVANCES IN KNOWLEDGE: This work identifies areas for future research to enhance the professional resilience of practitioners, in order to provide high-quality treatments.
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Esgotamento Profissional/epidemiologia , Satisfação no Emprego , Radiologia , Auditoria Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Física , Medicina Estatal , Reino Unido , Carga de TrabalhoRESUMO
AIMS, MATERIALS AND METHOD: Data in the national radiotherapy dataset for England for 2009-2011 is based upon downloads of activity from every linear accelerator in the country through its oncology management system linked to the local patient administration system to give a full overview of each patient episode. RESULTS: An analysis of this dataset shows that there is still a considerable variation in radiotherapy activity across the country, with a two-fold variation between the most and least active networks. Lower activity is seen in London and the southeast compared with the rest of the country, but when the data are split between the north and south of the country, no such variation is seen. Activity is higher in smaller centres and non-teaching centres. About half of all treatment is palliative and this proportion does not vary with geography, although there is considerable variation between individual centres in the proportion of radical radiotherapy given. There is a trend towards less use of radiotherapy, both radical and palliative, in the more deprived population groups, although no change in the relative use of palliative and radical treatment. CONCLUSION: It is important to emphasise that these data currently reflect activity patterns only and do not reflect quality of care or treatment outcomes, which will be achieved by linkage with cancer registry data in the future.
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Neoplasias/radioterapia , Radioterapia/instrumentação , Radioterapia/métodos , Inglaterra , Humanos , Aceleradores de Partículas , Resultado do TratamentoRESUMO
A growing body of evidence as to the benefits of intensity-modulated radiotherapy (IMRT) has led to the recommendation for its adoption as a treatment option for cancer patients within the UK. Routine clinical implementation of this technology has been slow. One of the causal factors was identified as being the need to improve confidence by improving the understanding and technical skills for IMRT of clinical oncology staff. This report determines and describes the additional knowledge and skills required for IMRT practice for clinical oncologists, clinical scientists (radiotherapy physicists) and radiographers, derived from reviewing evidence from other nations' IMRT practices and adapting them to UK needs. This knowledge and skills specification can be used to inform IMRT educational curricula. Novel educational methods to maintain the required understanding and skills are also described.
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Radiologia/educação , Radioterapia de Intensidade Modulada , Tecnologia Radiológica/educação , Competência Clínica , Humanos , Capacitação em Serviço , Neoplasias/radioterapia , Reino UnidoRESUMO
Through the DMCC and similar comprehensive training, Military and NGO personnel can prepare for deployment with a greater understanding of the issues that will confront them whilst there. Progression through the modules will provide them with a greater skill set to meet the challenges that await them and allow them to be an effective and valuable member of the team.
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Planejamento em Desastres/organização & administração , Militares , Desastres , Humanos , Medidas de Segurança/organização & administração , Reino Unido , GuerraRESUMO
Continued use of basic planning and treatment techniques, in contrast to the improved methods implemented at many other anatomical sites, has emphasized the need for improved breast dosimetry. Any future technique delivering a superior three-dimensional dose distribution will be of maximum benefit if set-up errors are minimized. To determine the influence of vacuum moulded bag (vac-fix) immobilization on routine breast radiotherapy, 17 patients received half their radiotherapy fractions using our standard breast board technique and half using a vac-fix device positioned on the breast board. Treatment accuracy and reproducibility were assessed for each technique using daily electronic portal imaging and were analysed in terms of random and systematic translational and rotational displacements of treatment fields with respect to corresponding simulation images. In addition, patients completed a short questionnaire aimed at determining which technique they preferred. Results showed that random errors for the two techniques did not differ significantly. Approximately 80% of random translations recorded were less than 3 mm and 80% of random rotations were less than 1.5 degrees. Systematic errors showed some improvement with the vac-fix system. In the anteroposterior direction, approximately 80% of systematic errors were less than 4 mm for both techniques, but in the superoinferior direction the 80% point was reduced from 5.0 mm for the standard set-up to 2.7 mm for treatment in vac-fix. For rotational systematic errors, the corresponding value dropped from 1.8 degrees for the standard set-up to 1.1 degrees in vac-fix. Therefore, for many patients, additional use of a vac-fix device improved the transfer of the planned set-up from simulator to treatment unit. Additionally, answers to the questionnaire indicated that patients generally favoured the vac-fix system over use of the breast board alone. In conclusion, however, introduction of vac-fix immobilization for all patients was not thought justified as the improvements demonstrated are not likely to be clinically significant with the present treatment technique.
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Neoplasias da Mama/radioterapia , Imobilização , Neoplasias da Mama/cirurgia , Fracionamento da Dose de Radiação , Feminino , Humanos , Satisfação do Paciente , Radioterapia Adjuvante/instrumentação , Reprodutibilidade dos TestesRESUMO
PURPOSE: To evaluate the impact of a customized immobilisation system on field placement accuracy, simulation and treatment delivery time, radiographer convenience and patient acceptability. PATIENTS AND METHODS: Thirty men receiving radical radiotherapy for prostate cancer were randomised using a cross over trial design to have radiotherapy planning and treatment given either in a conventional treatment position (CTP) or using an immobilisation system (IMS). The randomisation was to have either the CTP or IMS for the initial 3 weeks of radiotherapy after which patients were replanned and changed to the alternative treatment set-up. Treatment accuracy was measured using an electronic portal imaging device. Radiographers and patients completed weekly questionnaires. RESULTS: Median simulation time was 22.5 min (range 20-30 min) in the CTP and 25 min (range 15-40 min) for the IMS (P < 0.001). Median treatment time was 9 min for CTP (range 8-10 min), and 10 min (range 8.5-13.5 min) for IMS (P < 0.001). Median isocentre displacement for anterior fields was 1.7 mm from the simulated isocentre for the CTP compared to 2.0 mm for IMS (P = 0.07). For left lateral fields values were 1.8 and 1.8 mm (P = 0.98), and for right lateral fields 2.1 and 1.7 mm (P = 0.06), respectively. No clinically significant reduction in either systematic or random field placement errors was demonstrated. Radiographers reported that patients found the IMS more comfortable than CTP (P < 0.001), but when using the IMS, they noticed greater difficulty in patient positioning (P < 0.001), and alignment to skin tattoos (P < 0.001). CONCLUSIONS: Although IMS may have been more comfortable, treatment accuracy was not improved compared to the CTP in our department. In addition, treatment took longer and patient set-up was more difficult.
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Imobilização , Neoplasias da Próstata/radioterapia , Radioterapia Conformacional/instrumentação , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Satisfação do Paciente , Estudos Prospectivos , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Resultado do TratamentoRESUMO
PURPOSE: Stereotactically guided conformal radiotherapy, (SCRT) is a high precision technique of conformal radiotherapy (RT) which reduces the volume of normal tissue irradiated compared to conventional RT and may lead to a reduction in long-term toxicity We describe the technique and the preliminary results in patients with inoperable, residual or recurrent meningiomas. MATERIAL AND METHODS: From July 1993 to November 1997, 24 patients (median age: 56 years, range: 28-72) with base of skull (n = 21). falx or upper skull (n = 3) meningiomas were treated with SCRT. The technique employed immobilization in a Gill-Thomas-Cosman (GTC) frame and CT localization with a Brown-Roberts-Wells (BRW) fiducial system for stereotactic space definition. The planning target volume (PTV) was defined as gross tumour volume (GTV) and a 0.5-1 cm margin. Treatment was delivered with three (12 patients) or four non-coplanar conformal fixed fields (12 patients) Conformal blocking was achieved either with lead alloy blocks (n = 11) or with a multi-leaf collimator (MLC) (n = 13). Patients were treated on a 6 MV linear accelerator to doses of 50-55 Gy, in 30-33 daily fractions. The treatments were carried out as part of a routine work of a busy radiotherapy department. RESULTS: Median GTV for 24 meningiomas was 21.7 cm3 (range: 4.4-183 cm3). SCRT was well tolerated with minimal toxicity Three months after the end of radiotherapy, seven of 15 patients with neurological deficit had an improvement and eight remained unchanged. Two patients experienced early side effects (one VII nerve palsy, one Addisonian state). At a median follow-up of 13-months (range: 3-43) the 1 year progression free survival and overall survival are 100%. which is within the range expected for conventional fractionated radiotherapy for meningiomas. CONCLUSIONS: SCRT is a feasible technique of high precision conformal RT for patients with meningiomas. Potential advantages in tumour control, survival and toxicity over conventional RT, require evaluation in long-term prospective studies.
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Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Radioterapia Conformacional/métodos , Técnicas Estereotáxicas , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/mortalidade , Meningioma/diagnóstico por imagem , Meningioma/mortalidade , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Radiografia , Estudos Retrospectivos , Base do Crânio , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The reproducibility of patient positioning within the Gill-Thomas-Cosman relocatable stereotactic frame was re-evaluated following the substitution of a new, softer, dental impression material for the original hard acrylic compound. The average total displacement for a series of 10 patients was 1.1 mm (+/- 0.6 mm). Rotational discrepancies were small. This technique cannot deliver accurate repositioning in the absence of patient co-operation.