Facilitators for and barriers to radiography research in public healthcare in Nordic countries.

INTRODUCTION: It has been suggested that the future of diagnostic imaging relies on engagement in research and evidence-based practice. This implies a role transition from a clinical radiographer to a clinical radiographer-researcher. Clinical radiographers' stimuli for engaging in research in Nordic countries are unknown. This study aimed to address this gap. METHODS: Cross-sectional data collection via an online questionnaire on facilitators for and barriers to participation in radiography research was carried out among 507 clinical radiographers in public healthcare in the Nordic countries: Denmark, Finland, Norway and Sweden. RESULTS: Support from colleagues (odds ratio [OR] 2.62) and other professionals (OR 2.74), and self-esteem in research skills (OR ≥ 2.21), were facilitators for radiography research. Lack of knowledge and skills to conduct research (OR 2.48) was revealed to hinder radiographers' participation in research. The absence of a radiography research culture in the workplace explained non-participation in research (OR 1.75). CONCLUSION: This study revealed significant factors for clinical radiographers' participation in research. IMPLICATIONS FOR PRACTICE: A strategy for establishing a radiography research culture in healthcare is proposed that is novel for the context. Management support for knowledge development and activity leading to inter-professional research projects across knowledge fields, provision of a radiography research lead and acknowledgement of radiography research among colleagues signify the establishment of the culture. These prerequisites might provide a paradigm change towards not only the symbiosis of a clinical radiographer and an autonomous researcher but also a partner who adds radiography research to evidence-based practice in diagnostic imaging.

Radiographers' involvement in research activities and opinions on radiography research: A Nordic survey.

INTRODUCTION: Radiographers' engagement in research is important for the development of evidence-based practice in radiography; however, radiographers' interest in research has rarely been reported. This study sought to ascertain radiographers' opinions about radiography research and investigate their involvement in research activities in four Nordic countries. METHODS: This study was conducted in Denmark, Finland, Norway and Sweden. A study-specific questionnaire was developed in English and adapted to each language of the study sample, and the content and face validity of the adaptations were evaluated. An online tool was used to collect the study data. The questionnaire link was distributed in September 2019 to radiographers working in clinical settings in four Nordic countries (n = 4572). RESULTS: The overall response rate was 14% (n = 662/4572). Research involvement was reported by 33% of the respondents; data collection was the main type of contribution. Radiographers who contributed to research were more likely to be male, have longer work experience, hold a master's or doctoral degree, work as managers and be employed in university hospitals. Nearly all agreed that radiography research is needed to promote the radiography profession and provide the evidence base for radiographic practice. However, only 14% were aware of the current research evidence regarding their professional field of specialisation, and 19% indicated that they developed current practices based on research evidence. CONCLUSION: The findings indicate that, although radiographers had positive attitudes towards radiography research, their involvement in research and utilisation of research evidence in practice is low. IMPLICATIONS FOR PRACTICE: Strategies should be developed to improve knowledge and skills related to evidence-based practice and stimulate radiographers' engagement in research.

Patients', radiographers' and radiography students' experiences of 360° virtual counselling environment for the coronary computed tomography angiography: A qualitative study.

INTRODUCTION: The aim of this study was to describe patients', radiographers' and radiography students' experiences of the developed 360° virtual counselling environment (360°VCE) for the coronary computed tomography angiography (cCTA). METHODS: A descriptive qualitative approach was used. The participants were cCTA patients (n = 10), radiographers (n = 10) and radiography students (n = 10) who used the 360°VCE and visited or worked at a university hospital in Finland. The 360°VCE, resembling the authentic environments of a CT imaging unit, included digital counselling materials in text, image, animation and video formats. Data were gathered through thematic interviews individually to obtain an understanding of participants' perspectives and analyzed by inductive content analysis. RESULTS: Five main categories and 15 categories were identified. Identified benefits of the 360°VCE for patients included improvements in knowledge, spatial and environmental orientation, and senses of security and self-efficacy, with reductions in fear and nervousness. Patients found the counselling materials engaging, and that the 360° technology conveniently provided reassuring familiarity with the environment before their visit. Identified benefits for radiographers and radiography students included improvements in patients' mental preparedness, knowledge, spatial and environmental orientation, and reductions in patients' fear, which eased procedures and enhanced diagnostic success. The 360°VCE also provided useful information and familiarization with the cCTA unit for students during clinical practice and staff of referring units.  CONCLUSION: It seems that patients', radiographers' and radiography students' experiences of 360°VCE respond to patients' needs by improved knowledge and reduced fears. Thus, current counselling practices can be usefully complemented with spherical panoramic imaging technology and online information delivery. IMPLICATIONS FOR PRACTICE: The results may be used to improve patient counselling and care, thereby optimizing the cCTA examination procedure and reducing fear. However, further research is needed to characterize experiences of the 360° VCE more comprehensively.

Barriers to not informing patients about radiation in connection with radiological examinations: Radiographers' opinion.

INTRODUCTION: In some instances, little knowledge regarding radiological examinations is provided to patients. The purpose was to investigate whether radiographers inform patients about radiation, and if not, the reasons for it. METHODS: A questionnaire was sent to radiographers working in the public sector in Northern Finland. Radiographers were asked whether they had informed patients about the radiation dose and risks during the last year. If information was not provided, the reasons for it were investigated using multiple-answer type multiple-choice questions with the option for free text responses. The results were compared between a University Hospital and other departments and between different lengths of work experience. Altogether 174/272 (64%) radiographers responded to the questionnaire; 50% were from the University Hospital and 50% from other departments. RESULTS: Altogether 103/174 (59%) respondents did not inform patients about the radiation dose and 93/174 (53%) did not inform them about the associated risks. Regarding a passive approach to dose information, respondents thought that the referrer had already informed the patient (49/103, 48%), information was not needed (51/103, 50%), or it might cause unnecessary fear (47/103, 46%). Reasons for a passive approach to risk information were similar (66/93, 71%; 33/93, 36%; 47/93, 51%, respectively). Regarding the results, there were no differences between the institutions or work experience levels. According to the open question, some radiographers expected patients to ask questions before informing them. Lack of time was rarely mentioned as a reason. CONCLUSION: The main reasons for inadequate information were ignorance regarding responsibilities, assumption that information is not needed, and concern about causing unnecessary fear. IMPLICATIONS FOR PRACTICE: Education, guidelines specifying responsibilities and contents for information, and easy-access digital educational material for public and professionals are needed.

Nurses' knowledge of radiation protection: A cross-sectional study.

INTRODUCTION: Nursing roles are changing, as several countries have amended legislation so that nurses can make referrals for medical imaging examination that utilize ionising radiation. Nevertheless, nurses' radiation knowledge remains a poorly studied concept. The aim of the study was to characterize Finnish nurses' knowledge of radiation use and radiation safety. In this study, nurses were working in operating theaters, first aid clinics and cardiology laboratories. METHODS: A cross-sectional design was applied in which data were simultaneously collected from nurses working in eight hospitals. All nurses working in operating theaters, first aid clinics and cardiology laboratories (N = 1500) at the hospitals in Finland were invited to participate in the study. The response rate was 17% (n = 252). The employed Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale included three areas of knowledge: radiation physics, biology and principles of radiation use; radiation protection; and guidelines of safe ionizing radiation use. Descriptive statistics and logistic regression analyses were used to identify factors that influence these three areas. RESULTS: Nurses reported high knowledge levels in radiation protection but low knowledge levels in radiation physics, biology and principles of radiation use. Moreover, nurses who had not received radiation education reported lower knowledges across all three areas than the nurses who had completed education. CONCLUSION: This study identified one major factor that significantly affects nurses' radiation knowledge, namely, having completed medical radiation education, as this factor positively influenced all three of the included areas of radiation knowledge factors. Therefore, healthcare organizations should concentrate on providing education to all nurses working with, or exposed to, radiation.

Development and validation of a psychometric scale for assessing healthcare professionals' knowledge in radiation protection.

INTRODUCTION: Healthcare professionals must sufficiently understand ionising radiation and the associated protection measures to avoid unnecessarily exposing patients and staff to ionising radiation. Hence, a proper safety culture is important to lowering health risks. The development and establishment of an instrument that can indicate healthcare professionals' understanding/knowledge of radiation protection concepts can greatly contribute to a good safety culture. The purpose of the present study was to develop and psychometrically test the Healthcare Professional Knowledge of Radiation Protection (HPKRP) self-evaluation scale, which was designed to measure the knowledge level of radiation protection by healthcare professionals working with ionising radiation in a clinical environment. METHODS: The presented research employed a cross-sectional study design. Data were collected from eight Finnish hospitals in 2017. A total of 252 eligible nurses responded to the newly developed HPKRP scale. The face and content validity were tested with the Content Validity Index (CVI). Explorative factor analysis was used to test construct validity, whereas reliability was tested with Cronbach's alpha. RESULTS: Overall S-CVI for the HPKRP scale was 0.83. Exploratory factor analysis revealed a three-factor model for the HcPCRP scale containing 33 items. The first factor was defined by Radiation physics and principles of radiation usage, the second factor by Radiation protection, and the third factor by Guidelines of safe ionising radiation usage. These three factors explained 72% of the total variance. Cronbach's alpha coefficient for the scale ranged from 0.93 to 0.96. CONCLUSION: The results provide strong evidence for the validity and reliability of the HPKRP scale. Additionally, educators can use the scale to evaluate healthcare students' understanding in radiation safety before and after education.

Characterization of breast imaging education and insights from students, radiographers and teaching staff about its strengths, difficulties and needs.

INTRODUCTION: The study aimed to characterize breast imaging education and identify its strengths, difficulties and needs across five European countries according to student, radiographer and teaching staff perspectives. METHODS: An observation grid was used to collect data regarding breast imaging education and three questionnaires targeted to key-participants were developed/applied to collect data on strengths, difficulties and needs. Descriptive statistics and thematic analysis were performed according to the nature of the questions. RESULTS: Breast imaging curricula varied within and between countries. Response rate for questionnaires also varied (13-100%). More than one-third of the teaching staff (37.5%) was involved in breast research projects. This was identified as the main strength in breast imaging education followed by collaborations between hospitals and academia. Difficulties with their education program identified by the 97 students surveyed included teaching issues (45), breast positioning (18), variety of image evaluation strategies (10) and human interaction (6). The need to provide an explanation to the patient about the role of the student in the mammography setting, and performing exams and teaching at the same time (22.6%) was identified as difficult by radiographers. The need for education and training in communication, practice and technological developments was identified. CONCLUSIONS: A bridge between academia and clinical practice is extremely important in order to overcome recognized gaps between theory and practice. The development of a European education program covering the needs identified by the participants could be a possible solution to improve knowledge and access, and also to harmonize education and training across Europe.

Challenges in mammography education and training today: The perspectives of radiography teachers/mentors and students in five European countries.

INTRODUCTION: This study aims to explore current challenges in mammography education from the perspectives of radiography teachers, mentors and students. METHODS: A qualitative study including two focus groups interviews, with radiography teachers/mentors (n = 5) and student radiographers (n = 5) exploring their perspectives on challenges in mammography education today. The content analysis methodology proposed by Graneheim and Lundman was applied to the interviews. RESULTS: Three main categories were identified, each with subcategories identified as: (1) Building Bridges; Applying Theoretical knowledge in Practice, Performing Mammograms, Communication and Quality Assessment (2) State of the Art in Mammography; Personal Attitudes and Skills, Quality Awareness and Patient Care (3) Exploring the Curriculum; Time Constraints, Capacity in Clinical Placement, Multidisciplinary Field and Elective Course. CONCLUSION: The short study period allocated to this discipline and lack of material resources were considered the main limitations in mammography education, both impacting on the development of students' skills. Breast positioning, patient communication and quality control were considered key factors affecting mammography performance, patient experience and diagnostic outcome and should therefore be the core focus in mammography education.

Patient information regarding medical radiation exposure is inadequate: Patients' experience in a university hospital.

INTRODUCTION: It is suspected that little or no information is provided to patients regarding radiological examinations. The purpose was to evaluate the coverage, content and source of this information in a university hospital. METHODS: Altogether 147 patients (18-85 years) were interviewed after different examinations using a questionnaire. The patients had undergone 35 low (<1 mSv), 66 medium (1-10), and 46 high (>10) dose examinations. They were asked if they were informed about radiation use, the course or indication of the examination, the consequences of not having the examination, other options, the dose and risks of radiation, the source for the information and if any consent was enquired. RESULTS: 52 (35%) patients did not receive any information while 95 (65%) obtained some information. Fifty-six (38%) patients received an information letter, and 75 (51%) obtained oral information, mainly from the referrer or the radiographer. The information was mostly about indication, course or radiation use, very seldom about radiation risks and the other areas. Those with a nuclear medicine examination received information more often than those with other medium- or high-dose examinations (p = 0.004). The patients scored the received information as 2.2 (mean, SD 1.3) on a Likert scale from 1 (poor) to 5 (good). CONCLUSION: Patients obtained inadequate information regarding radiological examinations in a university hospital. The information was provided non-systematically from various sources. The results help to set up practical guidelines for systematic information and to follow up their efficiency. The mode of operation might be helpful elsewhere in the future.

Clinical radiography education across Europe.

PURPOSE: To establish a picture of clinical education models within radiography programmes across Europe by surveying higher education institutions registered as affiliate members of the European Federation of Radiography Societies (EFRS). METHOD: An online survey was developed to ascertain data on: practical training, supervisory arrangements, placement logistics, quality assurance processes, and the assessment of clinical competencies. Responses were identifiable in terms of educational institution and country. All educational institutions who were affiliate members at the time of the study were invited to participate (n = 46). Descriptive and thematic analyses are reported. RESULTS: A response rate of 82.6% (n = 38) was achieved from educational institutions representing 21 countries. Over half of responding institutions (n = 21) allocated in excess of 60 European Credit Transfer and Accumulation System (ECTS) credits to practical training. In nearly three-quarters of clinical placements there was a dedicated clinical practice supervisor in place; two-thirds of these were employed directly by the hospital. Clinical practice supervisors were typically state registered radiographers, who had a number of years of clinical experience and had received specific training for the role. Typical responsibilities included monitoring student progress, providing feedback and completing paperwork, this did however vary between respondents. In almost all institutions there were support systems in place for clinical placement supervisors within their roles. CONCLUSIONS: Similarities exist in the provision of clinical radiography education across Europe. Clinical placements are a core component of radiography education and are supported by experienced clinical practice supervisors. Mechanisms are in place for the selection, training and support of clinical practice supervisors. Professional societies should work collaboratively to establish guidelines for effective clinical placements.

THE ESTABLISHMENT OF LOCAL DIAGNOSTIC REFERENCE LEVELS IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A PRACTICAL TOOL FOR THE OPTIMISATION AND FOR QUALITY ASSURANCE MANAGEMENT.

Fluoroscopic procedures are an area of special concern in relation to radiation protection. The aim of this study was to describe the current level of patient radiation doses in endoscopic retrograde cholangiopancreatography (ERCP) collected from a single centre, as well as to establish and review local diagnostic reference levels (DRLs) in ERCP. A total of 100 patients' radiation doses in ERCP were recorded, and the third-quartile method was adopted to establish local DRLs for ERCP. The mean dose area product (DAP) was 2.05 Gy cm2, fluoroscopy time (FT) 1.7 min and the number of images was 3. The proposed local DRLs for ERCP were 3.00 Gy cm2 and 3.0 min. Local DRLs were reviewed in a sample of 25 patients 5 y after they had been established. In reviewing data, the averages of DAP and FT were below the local DRLs. Local DRLs help in the optimisation process of fluoroscopic procedures and guides to a good clinical practice.

Unrecognized dural puncture during epidural analgesia in obstetrics later confirmed by brain imaging.

Accidental dural puncture is a well-recognized complication of obstetric epidurals that can potentially incapacitate the patient. Unrecognized dural puncture during epidural administration can lead to a delay in therapeutic intervention resulting in potentially serious complications. We report a case of a parturient who developed disabling intracranial hypotension and diplopia following accidental dural puncture during apparently uneventful epidural catheter insertion. Magnetic resonance neuroimaging was performed to confirm the diagnosis, and direct clinical management. We also discuss the role of neuroimaging in the investigation of postpartum headache.