Image gently campaign back to basics initiative: ten steps to help manage radiation dose in pediatric digital radiography.

OBJECTIVE: The purpose of this review is to summarize 10 steps a practice can take to manage radiation exposure in pediatric digital radiography. CONCLUSION: The Image Gently campaign raises awareness of opportunities for lowering radiation dose while maintaining diagnostic quality of images of children. The newest initiative in the campaign, Back to Basics, addresses methods for standardizing the approach to pediatric digital radiography, highlighting challenges related to the technology in imaging of patients of widely varying body sizes.

Perceptions of Radiation Safety Culture Among Radiography, Computed Tomography, And Mammography Technologists.

PURPOSE: To investigate determinants of radiation safety culture among radiologic technologists to determine whether factors related to the primary imaging modality affect the perception of workplace radiation safety. METHODS: A secondary analysis was performed on deidentified data from 425 radiologic technologists collected with the Radiation Actions and Dimensions of Radiation Safety (RADS) questionnaire, a 35-item survey with valid and reliable psychometric properties. The data included radiologic technologists working in radiography, computed tomography (CT), and mammography. Descriptive statistics were used to report RADS determinant outcomes by imaging discipline, and 1-way analysis of variance and Games-Howell post hoc tests were conducted to analyze the hypothesis. RESULTS: Mean differences in the radiologic technologists' perceptions of teamwork across imaging stakeholders pertaining to radiation safety were found (P < .001). Mammographers had the most favorable perceptions of teamwork compared with radiographers and CT technologists. DISCUSSION: Collaboration in mammography between imaging stakeholders is dictated by professional practice standards and federal law. The resultant engagement might influence mammographers' perceptions of radiation safety. Additional research is warranted to determine if perception differences exist among technologists in other modalities and whether intentional collaboration drives improved perceptions of radiation safety culture. CONCLUSION: An analysis of the collaborative actions in the mammography department is needed, and the findings could be applied in radiography and CT to improve perceptions of radiation safety-related teamwork.

Effects of Work Shift or Shift Length on Radiation Safety Perception.

PURPOSE: This study investigated several determinants of radiation safety culture among radiologic technologists to determine whether factors related to work shifts or workday length affect the perception of workplace radiation safety. METHODS: The secondary analysis used de-identified data from 425 radiologic technologists collected with the Radiation Actions and Dimensions of Radiation Safety (RADS) questionnaire, a 35-item survey with valid and reliable psychometric properties. Respondents included radiologic technologists working in radiography, computed tomography (CT), mammography, and hospital radiology administration. Descriptive statistics were used to report RADS survey item outcomes, and analysis of variance (ANOVA) tests with Games-Howell post hoc tests were conducted to analyze the hypotheses. RESULTS: Mean differences in perception of teamwork across imaging stakeholders (P < .001) and leadership actions (P = .001) were found across shift-length groups. In addition, mean differences in perception of teamwork across imaging stakeholders (P = .007) were found across work-shift groups. DISCUSSION: Longer shifts (≥ 12 hours) and night shifts are related to a diminished perception of the importance of radiation safety among radiologic technologists. The study showed a significant effect of these shift factors on the perception of teamwork and leadership actions concerning radiation safety. CONCLUSION: These results underscore the importance of leadership actions and messaging, teamwork-building, and in-service training on radiation safety for technologists who frequently work long, after-hours shifts.

Perceptions of Radiation Safety Culture in Medical Imaging by Role.

PURPOSE: To determine whether radiologic technologists' perceptions of determinants of radiation safety culture differ significantly based on their primary role. METHODS: A secondary analysis of deidentified data from 425 radiologic technologists who participated in the Radiation Actions and Dimensions of Radiation Safety questionnaire, a 35-item survey with valid and reliable psychometric properties, was performed. Nine determinants (dependent variables) of radiation safety culture were analyzed in this study. The radiologic technologists worked primarily as staff technologists; shift, team, or modality leads; and managers or directors. Descriptive statistics were used to analyze differences in favorability for the determinants of radiation safety culture by primary role. Games-Howell post hoc tests were conducted to analyze the hypothesis for each determinant. RESULTS: Four determinants demonstrated significant differences with appropriate observed power between staff technologists, leads, and managers and directors: questioning attitude (P < .001), feedback loops (P < .001), leadership actions (P < .001), and nonpunitive response (P < .001). DISCUSSION: The findings indicate that dialogue is needed between all stakeholders to improve the radiation safety culture and that power imbalances caused by the hierarchical system should be considered when seeking to improve the safety culture. CONCLUSION: Positional hierarchies in the medical imaging profession affect the perception of radiation safety, with managers and directors having different perceptions of leadership actions, questioning attitudes, feedback loops, and nonpunitive responses than staff technologists. Therefore, radiologic technologist subgroups must be included purposefully in the process of establishing a radiation safety culture in the imaging department.

Radiologic Technologists' Perceptions of Imaging Appropriateness in Radiography, CT, and Mammography.

PURPOSE: To determine U.S.-based radiologic technologists' perceptions of imaging appropriateness by imaging modality and to examine relationships between descriptive variables and perception of imaging appropriateness scores. METHODS: A cross-sectional survey was used to collect data and guide testing of the hypotheses. Radiologic technologists working in radiography, computed tomography, and mammography were eligible to participate in the study. The survey instrument items were evaluated for validity and reliability. Categorical and descriptive data were calculated, and 1-way analysis of variance tests were used to analyze hypotheses. RESULTS: Survey results found that the radiologic technologists perceived that 16% to 30% of completed examinations were inappropriate, with the primary reasons being fear of lawsuits and patient expectations. Technologists indicated that imaging ordering should be based on the effect that an imaging procedure can have on the patient's diagnosis or treatment. The study found 6 main effects with mean differences between groups for the perception of imaging appropriateness score, including primary employed imaging modality (P < .001), shift length (P < .001), work shift (P < .001), primary practice facility (P < .001), primary patient population (P = .009), and level of education (P = .044). Employment status, primary role, age, years of experience, number of imaging credentials, gender, and practice location were not significant at the level of P ≤ .05. DISCUSSION: Study findings demonstrate the complexity and interconnectedness of imaging appropriateness, the potential reasons driving ordering practices, and the importance of increasing radiologic technologists' familiarity with appropriate use criteria. Further, the results show the importance of using clinical decision support mechanisms and ensuring that potential risk from ionizing radiation exposure remains a core component of the decision-making process when choosing among imaging examinations of similar diagnostic value. CONCLUSION: Further research needs to be conducted to better understand perceptions of imaging appropriateness, how perceptions align or deviate from appropriate use criteria, and improvements in imaging appropriateness from enhanced radiologic technologist-provider collaboration.

Radiologic Technologists' Perceived Reasons for Inappropriate Imaging.

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

Radiologic Technologists' Knowledge of And Comfort Explaining Effective Dose.

PURPOSE: To examine U.S. radiologic technologists' perceived level of knowledge of radiation effective dose, their level of comfort communicating effective dose information for common imaging procedures to patients, and their ability to compare effective doses for different medical imaging procedures. METHODS: A national cross-sectional study was conducted using a simple randomized sample of American Society of Radiologic Technologists (ASRT) members employed in radiography, computed tomography (CT), mammography, or radiology management. Survey items were created; descriptive and categorical statistics were analyzed; and relationships among knowledge of effective dose, comfort explaining effective dose, and procedural rank-order accuracy scores were evaluated with chi-square tests. RESULTS: More than half (56.5%) of participants perceived themselves as knowledgeable about radiation effective dose and 67.5% were comfortable discussing radiation effective dose information with patients. More than three-quarters (75.1%) of participants achieved a rank-order accuracy score of 75% or higher. A significant relationship was found between perceived knowledge of effective dose and perceived level of comfort explaining effective dose. DISCUSSION: Perceived knowledge of radiation effective dose, comfort explaining effective dose, and rank-order accuracy scores were higher among U.S. radiologic technologists in this study compared with similar assessments reported in the literature. However, rank-order derived methodology might not represent an in-depth assessment of radiologic technologists' radiation effective dose knowledge. CONCLUSION: The findings demonstrate that radiologic technologists have average-to-good perceived radiation effective dose knowledge, neutral-to-good levels of comfort explaining effective dose information to patients, and, in general, can rank-order common medical imaging procedures by effective dose.

Intrapersonal and Institutional Influences On Overall Perception of Radiation Safety Among Radiologic Technologists.

PURPOSE: The purpose of the study was to examine mean differences between intrapersonal and institutional variables and the overall perception of radiation safety (OPRS) among U.S. radiologic technologists. The study also sought to demonstrate the applicability of the socioecological model for radiation safety decision-making. METHODS: A quantitative, cross-sectional design with the Radiation Actions and Dimensions of Radiation Safety survey instrument was used to collect data and guide hypotheses testing. The 425 research participants included radiologic technologists working in radiography, mammography, computed tomography, and radiology management. Categorical and descriptive data were calculated, and 1-way analysis of variance tests were used to analyze hypotheses. RESULTS: Seven main effects demonstrated mean differences between groups for the OPRS, including age (F5,419 = 2.55, P = .03), years of experience (F5,419 = 4.27, P = .001), primary employed imaging modality (F2,422 = 9.04, P < .001), primary role (F2,422 = 4.58, P = .01), shift length (F3,421 = 10.33, P < .001), primary practice facility (F4,404 = 5.00, P = .001), and work shift (F3,405 = 4.14, P = .007), with shift length having the largest effect. Level of education, employment status, number of imaging credentials, gender, patient population, and practice location were not significant at the level of P ≤ .05. DISCUSSION: Radiation safety culture is a multidimensional topic that requires consideration of several intervening influences, making the socioecological model well aligned when considering radiation safety culture and radiation safety perception in medical imaging. Previous research on radiation safety perception among radiologic technologists demonstrated that leadership actions, teamwork across imaging stakeholders, organizational learning, and questioning behavior are drivers of OPRS. However, this study's findings demonstrate that radiologic technologist scheduling practices and primary employed imaging modalities also should be considered when seeking to improve OPRS. CONCLUSION: This study presents an extensive examination of intrapersonal and institutional variables on OPRS among U.S.-based radiologic technologists and provides findings to support radiation safety culture decision-making in medical imaging, particularly for shift length considerations.

Determinants of Overall Perception of Radiation Safety Among Radiologic Technologists.

PURPOSE: To examine the determinants of radiation safety culture among radiologic technologists in the United States. The specific aims were to report descriptive statistics related to radiation safety culture determinants and examine relationships between specific determinants of radiation safety culture and overall perception of radiation safety (OPRS). METHODS: Radiologic technologists working in radiography, mammography, and computed tomography were identified using the American Society of Radiologic Technologists membership database. The researcher implemented a quantitative cross-sectional design using the Radiation Actions and Dimensions of Radiation Safety (RADS) survey instrument, which contained the study's determinants and OPRS variable, to guide hypotheses testing. Descriptive statistics were used to report RADS survey item outcomes, and Pearson correlation and multiple linear regression tests were conducted to analyze the hypothesis. RESULTS: A total of 425 radiologic technologists completed the survey. Ten variables significantly correlated with OPRS. The variables of leadership actions (ß = .402; P < .001), teamwork across imaging stakeholders (ß = .304; P = .011), organizational learning (ß = .121; P = .007), and questioning attitude (ß = .110; P = .001) predicted OPRS, with leadership actions being most important in the model. DISCUSSION: The correlation between OPRS scores and the 10 determinants suggests that each variable is a relevant determinant of radiation safety culture among radiologic technologists in the United States. The outcomes establish key priorities and provide an actionable foundation to facilitate a positive radiation safety culture in medical imaging. CONCLUSION: The study presented a unique examination of OPRS determinants among American radiologic technologists. Findings can be used to support clinically-oriented interventions in improving radiation safety culture.

Validity and Reliability of a Radiation Safety Culture Survey Instrument for Radiologic Technologists.

PURPOSE: To design and evaluate a survey instrument to quantitatively examine radiologic technologists' perception of radiation safety culture. METHODS: A survey instrument with determinants related to radiation actions and dimensions of radiation safety (RADS) was designed through a multisequential process involving content and scale validity and internal reliability. A 6-member panel evaluated content validity, and 425 radiologic technologists participated in the study to determine the reliability of the survey instrument items and determinant scales. RESULTS: The 35-items in the survey instrument were found to be valid (content validity index = 0.995) and reliable (α = .94). In addition, 10 determinant scales also were found to be reliable (α = .70-.84). The scales included teamwork in imaging, teamwork across imaging stakeholders, questioning attitude, feedback loops, organizational learning, leadership actions, nonpunitive response, error reporting, radiation policy, and overall perception of radiation safety. DISCUSSION: The survey instrument meets recommendations to have a quantitative tool to assess radiation safety culture perception and represents the first instrument of its kind for radiologic technologists. The survey instrument is intended to assess perception of radiation safety culture, but the tool should be paired with clinically relevant outcome data to assess the alignment between radiologic technologist perception and objective radiation safety-related performance indicators. CONCLUSION: The RADS survey instrument is a reliable and valid tool to examine radiologic technologists' perceptions of radiation safety culture in medical imaging. Survey use and subsequent process improvement and leadership intervention for areas of deficiency can strengthen radiation safety culture in medical imaging.

An Interdisciplinary Approach to Improving Radiation Protection in Digital Radiography.

PURPOSE: To determine improvement approaches that can be routinely incorporated in digital radiography to ensure that radiation protection practices are based on current equipment capabilities. METHODS: A literature review was conducted on digital radiography as it pertains to radiation protection, quality improvement, evidence-based practice, and interdisciplinary approaches. RESULTS: Transitioning from film-screen radiography to digital radiography has resulted in confusion in applying appropriate techniques and abiding by the as low as reasonably achievable (ALARA) concept. DISCUSSION: Clinically effective research should be continually reviewed and incorporated into practice as routine. Applying quality improvement approaches and implementing practice improvement projects will help facilities achieve radiation-based benchmarks to improve imaging practices. CONCLUSION: Developing interdisciplinary quality improvement workgroups that include a variety of imaging stakeholders will allow for improvement in applying radiation protection research.

Manipulation of projection approach in pediatric radiography.

PURPOSE: To determine whether manipulating routine projections from anteroposterior (AP) to posteroanterior (PA) during projection radiography studies will result in reduced pediatric radiation exposure. METHOD: A literature analysis was conducted on pediatric radiation exposure, radiation protection, and tissue weighting factors. Multiple quantitative datasets were used to support findings related to projection manipulation. RESULTS: Dosimetric studies confirm that the PA projection significantly decreases radiation exposure to nearly all radiosensitive tissue, with the exception of the patient's bone marrow. DISCUSSION: Pediatric patients are inherently more sensitive to ionizing radiation, making this patient population a major focus of dose-reduction issues. Radiologic technologists are charged with keeping dose as low as reasonably achievable (following the ALARA principle), and performing PA projections rather than routine AP projections might decrease radiation to the pediatric population. CONCLUSION: The PA projection results in a definitive reduction in radiation exposure to the majority of radiosensitive organs and tissues and should be considered for implementation on a routine basis.

Medical radiation dose perception and its effect on public health.

PURPOSE: To determine whether public health implications exist in regard to medical radiation exposure. METHODS: A comprehensive literature review was conducted to investigate the value of medical imaging procedures that use ionizing radiation and the need for public radiation awareness. The significance of radiation exposure on public health was sought from historic and modern perspectives. DISCUSSION: Potential issues involving medical imaging procedures that use ionizing radiation were identified. Ionizing radiation, effective dose, and radiation perception were investigated from a multimodality perspective to demonstrate the importance of radiation awareness. CONCLUSION: Medical imaging's role in health care dictates the need for quality and competence. Organizational efforts have enhanced radiation risk knowledge, but medical imaging facilities should augment employee and public knowledge regarding medical imaging procedures. To change public perception of radiation, technologists should be prepared to discuss imaging benefits and risks, understand dose associated with different modalities, and implement radiation dose protocols. The findings reveal the importance of monitoring ionizing radiation medical imaging safety to maintain the benefits of imaging procedures.

The Image Gently pediatric digital radiography safety checklist: tools for improving pediatric radiography.

Transition from film-screen to digital radiography requires changes in radiographic technique and workflow processes to ensure that the minimum radiation exposure is used while maintaining diagnostic image quality. Checklists have been demonstrated to be useful tools for decreasing errors and improving safety in several areas, including commercial aviation and surgical procedures. The Image Gently campaign, through a competitive grant from the FDA, developed a checklist for technologists to use during the performance of digital radiography in pediatric patients. The checklist outlines the critical steps in digital radiography workflow, with an emphasis on steps that affect radiation exposure and image quality. The checklist and its accompanying implementation manual and practice quality improvement project are open source and downloadable at www.imagegently.org. The authors describe the process of developing and testing the checklist and offer suggestions for using the checklist to minimize radiation exposure to children during radiography.