SS 1014 - Professional issues in radiography
An investigation of mobile phone use in the radiology department and the success of an awareness campaign at reducing the associated nosocomial infection risks
Purpose: To determine whether a mobile phone infection control awareness campaign will improve radiographers’ phone and hand hygiene practices.
Methods and Materials: 36 radiographers in two tertiary hospitals (convenience sampling) volunteered to have their mobile phones swabbed and tested using an adenosine triphosphate (ATP) meter to numerically quantify surface cleanliness. A survey determined their current practices and awareness levels. Subsequently, a poster campaign took place for one month in one hospital. The ATP testing and survey were repeated in both sites and compared. Changes were measured using simple descriptive analysis and Wilcoxon signed rank testing (survey data) and Mann Whitney U testing (ATP results).
Results: 100% (n=36) of radiographers used their phone at work. However, the majority were uninformed of the associated infection risks with only 6% being informed. 33% had been performing adequate phone disinfection and 0% performed adequate hand hygiene following phone use. Following the campaign, there was a significant improvement (p=0.028) in the frequency of phone disinfection. Utilisation of the optimal phone disinfection method increased (33% vs 7% in control). The ATP meter readings showed numerical reductions (p>0.05) and there were negligible changes in hand hygiene practices. Radiographers considered the ATP testing just as effective as the campaign at improving their awareness.
Conclusion: Radiographers are unaware of mobile phone infection risks. Although significant improvements in phone cleanliness and hygiene habits were not achieved, the improvements in phone hygiene practices indicate that an awareness campaign could play an important role as an educational tool to improve awareness.
Purpose: In radiology departments, radiographers are concerned with the production of the radiograph, and radiologists report the findings. Disagreement on the clinical acceptability of radiographs may lead to unnecessary retakes or insufficient image quality to report on, with a needless exposure of patients in both cases. This study compares the agreement on image quality and clinical acceptability between these professions.
Methods and Materials: Five radiographers and five radiologists evaluated the image quality of 22 chest radiographs using, respectively, a secondary and a primary class monitor to mimic reality. Participants rated the reproduction of five anatomical structures on a scale from 1 to 5. These data were assessed using a VGC approach. They also judged the clinical acceptability of the radiograph using the RadLex categories and expressed their confidence concerning their decision. The responses for the two groups were compared using Nagelkerke Pseudo R-Square.
Results: No significant (p>0.05) difference was found in the area under the curve between the groups for none of the structures. The judgement of clinical acceptability by radiographers is significantly different (Pseudo-R2 0.076, p<0.01) from the radiologists. Radiographers rejected 21% more radiographs then the radiologists and were less confident in 29% of their decisions, especially in cases with limited quality.
Conclusion: These findings indicate that radiographers and radiologists agree on the evaluation of anatomical structures. On the contrary, they do not agree on the clinical acceptability, indicating that the decision of accepting or rejecting a radiograph is based on other information then purely the visualisation of anatomy.
Purpose: The improvement of results in healthcare through the transmission of information to the patient within a relation of empathy and trust is already a verified hypothesis. Healthcare professionals should base themselves on interpersonal competences throughout their daily work routine, to promote quality in radiotherapy, patient safety and technical excellence. The aim of this study was the exploration of patient’s perceptions regarding the performance of the radiation therapist in terms of interpersonal communication skills.
Methods and Materials: The instrument used was the questionnaire “Communication Assessment Tool” (Makoul et al. 2007) adapted to the professional reality of the radiation therapists. A total of 118 valid questionnaires (including 15 questions with a 5 point Likert scale) from patients aged between 22 to 87 years old from a private radiotherapy center. The patients have performed at least 5 radiotherapy sessions to be included in this study.
Results: The internal consistency of the questionnaire was excelent (Cronbach's alpha = 0.97). Highest ratings were for radiation therapist behavior items, such as “paying attention to the patients” (4.45), “respect for the patients” (4.43) and “using comprehensive language and terms” (4.42). Lowest ratings were “explained the treatment plan” (4.00), “encouraged to make questions” (4.07) and other items related with being involved in decision-making process.
Conclusion: Patients demonstrated high levels of confidence in their therapist and feel well treated during the sessions. Despite the overall positive results, “Radiation Therapist - Patient” relationships can be strengthened and patient outcomes improved through improved communication.
Purpose: Analyse the application of the Evidence-Based Practice (EBP) in Radiology by the radiographers’ in their daily practice in CT departments.
Methods and Materials: A self-applied questionnaire to assess EBP was addressed to 97 radiographers working in 5 public hospitals. A total of 65 valid questionnaires (including 3 main sections with a total of 103 items, and a 7 point Likert scale format) were interpreted and statistically analysed through descriptive statistics. T-student and ANOVA tests were used for groups’ comparison.
Results: 80% of radiographers applied the principles of EBP in their daily practice. However, the major limiting factors highlighted by the radiographers for the application of EBP were: "Knowledge to transfer the results of literature/scientific articles in their daily practice" (18,5%), “Existence of legislation/regulation about practices” (18,5%), "Knowledge of EBP concepts" (15,4%) and "Professional motivation" (15,4%). Regarding the training and updating of knowledge, the item “Specific training to be able to apply an EBP model in professional activity” had the highest mean score (5,25) and the item “Regular attendance in courses about EBP and research topics” had the lowest (3,49).
Conclusion: Despite the general application of EBP by radiographers, thanks to regular consultation of CT guidelines and decision-making processes based on literature review and scientific articles, this group of professionals would benefit from further training. Such approach would be well received and help the radiographers to enhance their knowledge and technical skills, which would ultimately result in an increase of the deparment’s quality.
Purpose: To Assess the appropriate use of infection control principles/measures by radiographers during radiological examinations and to establish whether infection control guidelines are necessary.
Methods and Materials: A self-applied questionnaire about infection prevention and control measures was applied to 48 radiographers within 3 different public hospitals. Besides, using an observational grid, 20 of them were observed during the performance of radiological examinations to check if the infection prevention measures were applied. Efficiency of alcohol based solution and hand-scrubbing technique were evaluated with ultraviolet light after procedure.
Results: 58,3% of radiographers had training in hospital infection control measures and 62,5% of them indicated the use of individual equipment protection, such as gloves and aprons when necessary. During the observation, only 1 radiographer disinfected their hands before placing gloves and 8 of them never did it after removing gloves. During the evaluation of hand scrubbing technique using ultraviolet light, it was observed that only 20% of radiographers presented a total area of disinfected hand.
Conclusion: Radiographers were aware of infection control guidelines but several of them failed to apply these procedures during the radiological examinations. Therefore, radiographers must be given periodic training in infection control procedures, written protocols and legislation must be outlined to monitor the use of infection control procedures during work and there should be a periodic monitoring of practice of infection control procedures by radiographers.
Purpose: To gather opinions of radiographers regarding the use of humour among students and professionals, and to apprehend possible positive and/or negative impacts of its use on the care relationship.
Methods and Materials: Sample. Six hundred forty-one senior radiographers and 411 first, second or third year undergraduate radiographers, for a total sample of 1052 subjects from all over France. Material.Within a quantitative phase, both professionals radiographers and radiographers-in-training were assessed on several Likert-type scales involving concepts such as the functions of humour, and a second, qualitative phase based on open survey questions further focused on investigating the most salient concepts, notably within the senior radiographer sample.
Results: Although radiographer apprentices saw the major benefits of humour in their relationships with patients (i.e. building a trust relationship, distraction technique), the senior radiographers put forward benefits especially regarding their colleagues or their own person (pleasant working environment, coping strategy during stressful events). Positive aspects of humour do prevail over the negative ones in both radiographer groups, but professionals emphasize the contextualized aspects of humour and warn that it may infringe on patients and their dignity.
Conclusion: Considering humour as a personal and a professional value among the samples studied opens new perspectives on use of humour and its training within both institutional and educational contexts, preventing any possible harmful use.
Purpose: Consultant radiographers' roles are currently unique to the UK and evidence of their impact is limited, particularly at an organisational level. This study reviews the activity of consultant practitioners across their 4 key functions (clinical practice, leadership, research and education), evidencing the impact this has on patients, staff and the organisation.
Methods and Materials: The study was a prospective exploratory study using activity diaries and comprised interval sampling by 6 consultant radiographers employed within a busy multisite English NHS Trust. All radiographers work a standard 37.5 hour week across a range of specialities/modalities. Data were collected using a coded list and recorded in fifteen-minute intervals over the period of one week to establish the relative hours of activity.
Results: The mean number of hours worked within the study week was 45.8 (range 41.3-50.8). All individuals evidenced activities in the 4 key functions; however, the proportions varied. Clinical work predominated and comprised 43.9% of the worked hours (mean=20.1). Support for other staff was a key component of all roles, undertaking one-on-one teaching or assessment, case discussion or problem solving. The individuals evidenced strategic working at an organisational and national level. Multi-tasking was common, with interruptions of work a feature of the accessibility of the role.
Conclusion: This localised study provides a snapshot of the breadth and complexity of the activities performed by consultant radiographers. The individuals appear to be routinely performing functions which have an impact on patients, colleagues, the organisation and profession.
Purpose: To assess the image quality criteria from examinations in digital radiography based on quality control charts and to demonstrate the importance of implementing an image quality control system.
Methods and Materials: A retrospective study was conducted in a public radiology department using a random sample of 1200 radiographs grouped in 60 smaller samples, each one with 20 radiographs. Using a checklist based on the “American College of Radiology Practice Guidelines for the Performance of abdominal, chest and extremities radiographs”, the conformities and non-conformities found were recorded and used to establish three types of quality control chars: (1) the proportion of conformities and non-conformities (p chart); (2) the total number of non-conformity exams (np chart) and (3) the total number of non-conformities in each sample (c chart), in order to suggest corrective actions for improvement.
Results: Considering all exams, 473 were classified as non-conform (39.42%) and 727 were classified as conform (60.58%). Considering the non-conform exams group, the quality criteria “incomplete or incorrect image post-processing” presented the highest number of non-conformities (58,92%), followed by “incorrect patient positioning” (35,32%) and “artefacts” (5,77%). Chest radiograph showed the highest number of non-conformities (174).
Conclusion: The existence of suitable quality control of the image is essential to achieve high quality standards. Strategies for improving radiographers performance must be implemented to ensure that digital radiography examinations are performed in compliance with all the quality criteria established.
Purpose: The CE-marked e-ASPECTS software (Brainomix, Oxford) assists clinicians in detecting areas of acute ischaemic stroke on CT using the validated ASPECTS score. Instant access to the processed results is crucial in stroke and depends on optimised software integration into the clinical pathway. We evaluated the main 3 integration strategies available.
Methods and Materials: Feasibility, time and user friendliness (questionnaire) of the following integration options were evaluated. 1) Images for processing sent from CT to cloud-based server, results returned to PACS. 2) Images sent from PACS to local sever, processed images returned to PACS. 3) Images automatically sent from CT to hospital-based server (accessible via ipad user interface), results returned to PACS.
Results: All 3 integration solutions were feasible. Local server compared to cloud-based processing significantly decreased time (p<0.05), the remote Internet transfer adding 2 minutes. Transferring images from PACS for post-processing incurred varying time delay, depending on PACS data load and system (max 6 min). Option 2 required most user interaction, associated with potential user errors. The fastest solution (Option 3) allowed near instant access to post-processed images (<1min) via a hospital-based server, utilising a dedicated iPad interface. This was also judged as the user-friendliest option in the acute setting. In the non-acute setting Option 2 was also judged to be important to accommodate requirements of different users (e.g. researchers, neurologists).
Conclusion: The value of computer-assisted diagnostics can be increased by optimised integration into the clinical pathway, thus increasing user friendliness, speed and potentially outcome.
The implementation of a radiology hospital inpatient turnaround team (HITT) to reduce radiology waiting times
Purpose: To estabish a radiology "Hospital Inpatient Turnaround Team" (HITT). To reduce inpatient radiology waiting times through better integration and organisation of staff and resources.
Methods and Materials: A series of radiology multidisciplinary team meetings culminated with the establishment of a radiology HITT, with representation from all relevant disciplines. Regular HITT meetings resulted in many changes being implemented in order to improve departmental efficiency. The HITT developed a clear inpatient workflow process and introduced brief daily meetings between the scheduling radiographer, clerical officer and porter. Necessary resources such as IT support were also addressed. A "turnaround time" KPI was introduced to measure the time from an x-ray order being placed to the time that order was completed on the RIS. Updates on this KPI were posted weekly around the department. A competition to name the inpatient radiography area was held to improve morale and highlight departmental focus on the area. The PACS manager carried out a retrospective audit to measure how these changes had influenced the KPI.
Results: The audit demonstrated reduction in mean inpatient waiting times of 26.2%. Median inpatient waiting times also decreased from 3 hours, 34 minutes to 2 hours, 38minutes; a reduction of 30.7%.
Conclusion: Significant improvements in efficiency are possible through closer integration of the many disciplines that make up a radiology department. The creation of a multidisciplinary team to implement a clear workflow process, with input from all disciplines, can lead to decreases in median inpatient radiology waiting times of over 30%.
Purpose: To verify if the presence of pathogens in contact areas of x-ray cassettes (Image Plates) can cause nosocomial infections and to establish whether infection control guidelines are necessary.
Methods and Materials: The methodology used consisted, initially, in observing hygiene practices performed by radiographers in the cleaning of x-ray cassettes, through an observation grid. After, the second fase involved the swabbing of contact areas to check the general levels of bacterial contamination and also to verify the presence or absence of payhogen agents.
Results: The results demonstrated that there were large levels of growth of samples taken from contact areas and developed in the Microbiology Department. The existence of colonies varies according to the method for obtaining samples from contact areas. Streptococcus, Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus and Proteus were all identified.
Conclusion: In order for cross contamination to be kept to a minimum an effective infection control policy needs to be employed and this should be to carry out regular cleaning of contact areas of x-ray cassettes (Image Plates). Therefore, radiographers must be given periodic training in infection control procedures, written protocols and legislation must be outlined to monitor the use of infection control procedures during work and there shoud be a periodic monitoring of practice of infection control procedures by radiographers.