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BACKGROUND: Worldwide there has been a shift in the ideology within healthcare systems that focuses on 'people' rather than the 'patients'. A patient should not only be perceived by their condition but rather viewed holistically as a person. Within a South African (SA) context, the constitution has been amended to state that all South African citizens have the right to healthcare that is caring, free from harm, and effective. Hence, it can be rationalized that patient-centered care (PCC) is a necessary and vital approach in South African healthcare as well. A study conducted by Hyde and Hardy in the United Kingdom (UK) explored measures of PCC from radiography patients, radiographers, radiography managers, radiography educators, and radiography students' perspectives. This study was duplicated to define informed measures of PCC from a South African perspective. Therefore, this study aimed to gain perspectives on PCC measures in diagnostic radiography within a sample of the South African community. This paper focuses on the perspectives of the clinical radiographer and patient respondents. METHOD: This study was conducted using a quantitative approach with the use of an online survey. The Qualtrics software was utilized to design the survey. The survey consisted of three PCC themes; use of technology, comfort and emotional support, and control over the environment. Recruitment of the subgroups was via advertisement in social media, email networks, and word of mouth. RESULTS: There were 28 radiographer responses and 14 patient responses. The data were analyzed using SPSS software version 28. Patient care while explaining the use of technology in radiography, received positive responses from both respondent groups. Patient care measures that explored comfort and emotional support received varied responses from patients and radiographers. Important PCC concepts, such as asking the patient about their care needs and health problems, were lacking. Patients indicated that radiographers do not include their family members in the discussion of the care needs even though family involvement is a PCC element. CONCLUSION: The perceptions of PCC measures differed between the two groups which indicated that there are still some gaps in clinical practice. Patient involvement in their care and individualized care should be prioritized. There is a need for family involvement during radiography procedures to be better highlighted within clinical practice. It is also recommended that more importance be placed on PCC during undergraduate training. While service delivery is important, radiographers must not disregard their PCC responsibilities towards the patient.
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INTRODUCTION: Inadequate clinical information in medical imaging requests negatively affects the clinical relevance of imaging performed and the quality of resultant radiology reports. Currently, there are no published Australian guidelines on what constitutes adequate clinical information in computed tomography (CT) requests. This study aimed to determine specific items of clinical information radiologists require in CT requests for acute chest, abdomen and blunt trauma examinations, to support optimal reporting. METHODS: A panel of 24 CT-reporting consultant radiologists participated in this e-Delphi consensus study. Panellists undertook multiple online survey rounds of open-ended, dichotomous and Likert scale questions, receiving feedback following each. Round 1 responses formulated lists for each CT examination. Round 2 set a threshold of 80% agreement after dichotomous scoring. Round 3 accepted items which averaged 4 or more on a 5-point Likert scale. Round 4 required panellists to rank items within the aggregated, accepted lists, based on panellists' perceived level of usefulness. RESULTS: The large numbers of round 1 items (chest: 101, abdomen: 76, blunt trauma: 80) were rationalised and grouped into categories to facilitate efficiency during subsequent rounds. Twenty-three chest, 24 abdomen and 17 blunt trauma items met the 80% agreement threshold in round 2. Items below threshold were included in round 3; numbering 44, 19 and 23 for chest, abdomen and blunt trauma, respectively. Through the e-Delphi process, we formulated clinical information criteria standards for three CT types. CONCLUSIONS: The developed standards will guide Australian referrers in providing adequate clinical information in CT requests, to support optimal reporting, diagnosis and treatment.
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Tomografía Computarizada por Rayos X , Heridas no Penetrantes , Humanos , Técnica Delphi , Australia , Servicio de Urgencia en HospitalRESUMEN
INTRODUCTION: The aim of this study was to investigate the effects of clinical information on the accuracy, timeliness, reporting confidence and clinical relevance of the radiology report. METHODS: A systematic review of studies that investigated a link between primary communication of clinical information to the radiologist and the resultant report was conducted. Relevant studies were identified by a comprehensive search of electronic databases (PubMed, Scopus and EMBASE). Studies were screened using pre-defined criteria. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies. Synthesis of findings was narrative. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: There were 21 studies which met the inclusion criteria, of which 20 were included in our review following quality assessment. Sixteen studies investigated the effect of clinical information on reporting accuracy, three studies investigated the effect of clinical information on reporting confidence, three studies explored the impact of clinical information on clinical relevance, and two studies investigated the impact of clinical information on reporting timeliness. Some studies explored multiple outcomes. Studies concluded that clinical information improved interpretation accuracy, clinical relevance and reporting confidence; however, reporting time was not substantially affected by the addition of clinical information. CONCLUSION: The findings of this review suggest clinical information has a positive impact on the radiology report. It is in the best interests of radiologists to communicate the importance of clinical information to reporting via the creation of criteria standards to guide the requesting practices of medical imaging referrers. Further work is recommended to establish these criteria standards.
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Radiología , Informe de Investigación , HumanosRESUMEN
INTRODUCTION: To assess computed tomography kidneys, ureters and bladder (CTKUB) scan extent protocol compliance and associated doses in the Emergency Department (ED) of an Australian tertiary hospital. METHODS: A retrospective clinical audit of 150 consecutive ED CTKUB cases was completed. For each patient, scan extent compliance at the superior (kidneys) and inferior (pubic symphysis) borders, in reference to the protocol was recorded. Compliance and non-compliance (over-/under-scanning) was identified, described (superior/inferior), quantified (via IMPAX measurements) and recorded via a purpose-built audit tool. In addition, a PBU40 phantom was scanned to assess the percentage of dose (DLP) increase per centimetre of over-scanning to contextualise results. RESULTS: A notable non-compliance with department protocol was noted. Eight cases (5.3%) demonstrated overall CT scan extent compliance. The remaining 142 cases (94.7%) demonstrated some form of non-compliance; superiorly, inferiorly or both. Analysing the 150 superior and 150 inferior data points independently, the most common non-compliance was over-scanning at the kidneys by 4 cm to5 cm (19 cases, ~10% extra DLP) beyond tolerance and over-scanning inferiorly at the pubic symphysis by 1 cm to 2 cm (29 cases, ~6.4% extra DLP). Estimated dose increases of up to 35% to 45% were found when clinical audit results were simulated using a PBU40. CONCLUSIONS: Over-scanning is a predominant occurrence in CTKUB scans in this department. Reasons for over-scanning weren't investigated. It's anticipated this audit will lead to greater awareness of scan extent compliance and dose ramifications of non-compliance. The usage of more easily identified anatomical landmarks and a follow-up audit is suggested.
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Auditoría Clínica , Servicio de Urgencia en Hospital , Riñón/diagnóstico por imagen , Dosis de Radiación , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The purpose of this commentary was to outline several key considerations and challenges for medical imaging departments during a global pandemic. Five public hospital medical imaging departments were identified in South-East Queensland, Australia, to provide insight into their response to the COVID-19 pandemic. Common themes were identified, with the four considered most pertinent documented in this commentary. Similar operational considerations and challenges were identified amongst all sites. This commentary intends to serve as a starting point for medical imaging departments in considering the planning and implementation of services in a pandemic scenario.
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COVID-19/epidemiología , Atención a la Salud/normas , Diagnóstico por Imagen/estadística & datos numéricos , Diagnóstico por Imagen/normas , Departamentos de Hospitales/normas , SARS-CoV-2/aislamiento & purificación , COVID-19/prevención & control , COVID-19/virología , Humanos , Queensland/epidemiologíaRESUMEN
INTRODUCTION: The purpose of this randomised controlled trial was to compare the effectiveness of intensive and non-intensive formats of delivery of image interpretation education for radiographers. METHODS: A multi-centre, stratified (by years of experience) two group parallel arm, single blind, randomised controlled trial was conducted. Participants (n = 48) were allocated to one of two groups to receive image interpretation education: (1) intensive format (13.5 h over two consecutive days) (2) non-intensive (sequential 90-min tutorials delivered 1 week apart). Participants undertook x-ray interpretation tests before education, at 1-week post-education completion and at 12-week post-education completion. RESULTS: Image interpretation performance was not significantly different between groups at baseline. A generalised linear model indicated that participants who received intensive education format improved image interpretation performance by a greater margin than the group that received non-intensive education at 1-week (P = 0.002) and 12-week (P < 0.001) follow-up assessments. CONCLUSIONS: Although both formats of education delivery may be beneficial, the findings of this study have indicated that the intensive format of delivery was more effective at improving radiographers' ability to interpret trauma radiographs in the weeks after completion of the image interpretation program.
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Educación Médica/métodos , Interpretación de Imagen Asistida por Computador , Evaluación de Resultado en la Atención de Salud , Radiografía , Competencia Clínica , Humanos , Control de CalidadRESUMEN
Radiographer commenting systems have not been successfully implemented in many Australian hospitals, despite evidence of their benefit and adoption elsewhere, such as the United Kingdom. An important contributor to the lack of widespread adoption of radiographer commenting in Australia (and likely elsewhere) is the limited availability of accessible education options for radiographers. The purpose of this randomised controlled trial is to compare the effectiveness of the same image interpretation education program delivered over an intensive 2-day period (intensive format) versus a series of shorter regular workshops (non-intensive format). The study design is a multicentre, stratified (by years of experience) two group parallel-arm single-blind (assessor blinded) randomised controlled trial. Participants will be allocated to one of the two groups: (1) intensive format of education or (2) non-intensive format of education in a 1:1 ratio. Participants will undergo assessments before education, at 1 week post-intervention completion and at 12 weeks post-intervention completion. Findings from this trial will be of relevance to radiographers seeking image interpretation training as well as organisations providing image interpretation education to prepare clinical staff for participation in a radiographer commenting system. A limitation of the trial is that the sample will be inclusive of radiographers, and findings may not be able to be directly extrapolated to other clinical disciplines (e.g. junior doctors, physiotherapists or nurse practitioners).
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Educación Médica , Interpretación de Imagen Asistida por Computador , Radiografía , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , HumanosRESUMEN
INTRODUCTION: Radiographer abnormality detection systems that highlight abnormalities on trauma radiographs ('red dot' system) have been operating for more than 30 years. Recently, a number of pitfalls have been identified. These limitations initiated the evolution of a radiographer commenting system, whereby a radiographer provides a brief description of abnormalities identified in emergency healthcare settings. This study investigated radiographers' participation in abnormality detection systems, their perceptions of benefits, barriers and enablers to radiographer commenting, and perceptions of potential radiographer image interpretation services for emergency settings. METHODS: A cross-sectional survey was implemented. Participants included radiographers from four metropolitan hospitals in Queensland, Australia. Conventional descriptive statistics, histograms and thematic analysis were undertaken. RESULTS: Seventy-three surveys were completed and included in the analysis (68% response rate); 30 (41%) of respondents reported participating in abnormality detection in 20% or less of examinations, and 26(36%) reported participating in 80% or more of examinations. Five overarching perceived benefits of radiographer commenting were identified: assisting multidisciplinary teams, patient care, radiographer ability, professional benefits and quality of imaging. Frequently reported perceived barriers included 'difficulty accessing image interpretation education', 'lack of time' and 'low confidence in interpreting radiographs'. Perceived enablers included 'access to image interpretation education' and 'support from radiologist colleagues'. CONCLUSIONS: A range of factors are likely to contribute to the successful implementation of radiographer commenting in addition to abnormality detection in emergency settings. Effective image interpretation education amenable to completion by radiographers would likely prove valuable in preparing radiographers for participation in abnormality detection and commenting systems in emergency settings.
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Actitud del Personal de Salud , Documentación/estadística & datos numéricos , Servicios Médicos de Urgencia/estadística & datos numéricos , Competencia Profesional/estadística & datos numéricos , Radiología/estadística & datos numéricos , Heridas y Lesiones/diagnóstico por imagen , Encuestas de Atención de la Salud , Humanos , Queensland , Radiografía , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: The provision of a written comment on traumatic abnormalities of the musculoskeletal system detected by radiographers can assist referrers and may improve patient management, but the practice has not been widely adopted outside the United Kingdom. The purpose of this study was to investigate Australian radiographers' perceptions of their readiness for practice in a radiographer commenting system and their educational preferences in relation to two different delivery formats of image interpretation education, intensive and non-intensive. METHODS: A cross-sectional web-based questionnaire was implemented between August and September 2012. Participants included radiographers with experience working in emergency settings at four Australian metropolitan hospitals. Conventional descriptive statistics, frequency histograms, and thematic analysis were undertaken. A Wilcoxon signed-rank test examined whether a difference in preference ratings between intensive and non-intensive education delivery was evident. RESULTS: The questionnaire was completed by 73 radiographers (68% response rate). Radiographers reported higher confidence and self-perceived accuracy to detect traumatic abnormalities than to describe traumatic abnormalities of the musculoskeletal system. Radiographers frequently reported high desirability ratings for both the intensive and the non-intensive education delivery, no difference in desirability ratings for these two formats was evident (z = 1.66, P = 0.11). CONCLUSIONS: Some Australian radiographers perceive they are not ready to practise in a frontline radiographer commenting system. Overall, radiographers indicated mixed preferences for image interpretation education delivered via intensive and non-intensive formats. Further research, preferably randomised trials, investigating the effectiveness of intensive and non-intensive education formats of image interpretation education for radiographers is warranted.