Expanding training capacity for radiographer reporting using simulation: Evaluation of a pilot academy project

YesIntroduction: Whilst there is increasing demand on radiology services in the UK, pressures are restricting the expansion of the multi-professional workforce. A pilot academy for radiography reporting was established to augment the traditional university and clinical education in a simulated environment using focussed teaching and real image worklists in a dedicated environment away from departments. Methods: Located at a facility to replicate the clinical reporting environment, the emphasis of the nine-month pilot was to provide extensive ‘hands-on’ training to eight trainees. Evaluation of the academy was undertaken through focus groups, telephone interviews, and online surveys to consider the experiences of the trainees and their managers and mentors. Results: There was overwhelming support for the academy from trainees, mentors, and managers. Key benefits included relieving pressures on department and mentors; providing an intense, structured, and safe environment to learn; and, perhaps most importantly, an extensive and cohesive peer-support network. Issues identified included conflict within departments due to differences in reporting style and the need for greater collaboration between the university, academy, and departments. Conclusion: The use of simulation in education is widely researched, however, there are a number of key factors that need to be considered when implementing it into practise. Peer-support and reflection is seen as essential for its success. Extensive dedicated time to focus on reporting alongside peers can support the development of these skills away from the clinical environment and as such can reduce pressure on service delivery and positively influence learner outcomes.The pilot academy received funding from the NHS Vanguard scheme (Working Together NHS Vanguard) for purchase of equipment and the salaries of the clinical educator (pro-rata). The university fees and backfill payments were funded by Health Education England

Letter re: Comparison of acetabular and femoral morphologies on hip, pelvic, and lumbar radiographs (Yun et al.)

YesWe read with interest the recent article by Yun et al. [1] comparing acetabular and hip measurements across pelvis, hip and lumbar spine radiographs. The authors assert that lumbar radiographs can be utilised in place of routine pelvis radiographs for these measurements. The example lumbar spine radiograph (figure 2) appears to be an abdominal image, with a contrast urogram. Indeed, standard texts [2,3] confirm that the anteroposterior lumbar spine radiograph should not include any coverage of the hips as appropriate collimation should limit the anatomy to T12 superiorly, lower sacrum inferiorly and the sacroiliac joints laterally, which would exclude the hip joints. Thus assessing any hip measurements on an appropriately collimated lumbar spine radiograph should not be possible. This is further compounded by the description of the centring point within their study (iliac crest), which varies from the internationally recognised standard of lower costal margin/L3 [2,3]

Development of the radiography evidence base: An examination of advancing practice.

Radiography has seen most development over the last 30 years with the evolution of new technologies, but perhaps more significantly changes in education models and radiographer roles. The development of advanced and consultant posts has facilitated the growth of the profession, although the evidence base is still evolving. Through a number of research projects this thesis will explore the growth in the radiography evidence base with specific reference to the extending role of the radiographer in image interpretation. Parallel clinical and academic developments have provided evidence of a scholarly profession which is slowly establishing its place through publication and a growing research base.Please Note: The full text of each of the published articles, which are listed on page vii, has been removed from the PhD online copy due to publisher copyright restrictions. Links to the publisher¿s websites are given. To see the final full text version of the articles listed on page vii, please visit the publisher¿s website. Available access to the published online version may require a subscription

Doctoral profile of the medical radiation sciences: a baseline for Australia and New Zealand

YesResearch is critical to evidence‐based practice, and the rapid developments in technology provide opportunities to innovate and improve practice. Little is known about the research profile of the medical radiation science (MRS) profession in Australia and New Zealand (NZ). This study provides a baseline of their doctoral activity. A cross‐sectional survey of MRS professionals in Australia and NZ holding a doctorate or undertaking doctoral studies, was performed using an online tool (Bristol Online Survey®, Bristol, UK). A chain‐referral sampling technique was adopted for data collection. An email invitation with a link to the survey was generated and distributed through email and social media. The survey contained questions related to participant demographics, doctoral status, qualification route, funding and employment. There were 63 responses to the survey comprising 50.8% diagnostic radiographers (DRs; n = 32), 23.8% radiation therapists (RTs; n = 15), with the remaining 25.4% (n = 16) equally split between sonographers and nuclear medicine technologists (NMTs). A total of 40 (63.5%) of respondents had completed their doctoral qualification. In NZ, only DRs held a doctoral award constituting 0.3% of DRs and 0.2% of the total registered MRS population. In Australia, there was a greater proportion of doctoral NMTs (n = 8/1098; 0.7%) than RTs (n = 15/2394; 0.6%) and DRs (n = 27/12,001; 0.2%). Similar to other countries, findings show a very small percentage of doctoral MRS professionals in Australia and NZ. Strategies to engage and support individuals in research, up to and beyond doctoral study, need to be embedded in practice

Impact of body part thickness on AP pelvis radiographic image quality and effective dose

Introduction: Within medical imaging variations in patient size can generate challenges, especially when selecting appropriate acquisition parameters. This experiment sought to evaluate the impact of increasing body part thickness on image quality (IQ) and effective dose (E) and identify optimum exposure parameters. Methods: An anthropomorphic pelvis phantom was imaged with additional layers (1 to 15 cm) of animal fat as a proxy for increasing body thickness. Acquisitions used the automatic exposure control (AEC), 100 cm source to image distance (SID) and a range of tube potentials (70 to 110 kVp). IQ was evaluated physically and perceptually. E was estimated using PCXMC software. Results: For all tube potentials, signal to noise ratio (SNR) and contrast to noise ratio (CNR) deceased as body part thickness increased. 70 kVp produced the highest SNR (46.6 to 22.6); CNR (42.8 to 17.6). Visual grading showed that the highest IQ scores were achieved using 70 and 75 kVp. As thickness increases, E increased exponentially (r=0.96; p<0.001). Correlations were found between visual and physical IQ (SNR r= 0.97, p<0.001; CNR r=0.98, p<0.001). Conclusion: To achieve an optimal IQ across the range of thicknesses, lower kVp settings were most effective. This is at variance with professional practice as there is a tendency for radiographers to increase kVp as thickness increases. Dose reductions were experienced at higher kVp settings and are a valid method for optimisation when imaging larger patients

Assistant radiographer practitioners: Creating capacity or challenging professional boundaries?

YesIntroduction Over the last 2 decades the assistant radiographer practitioner (ARP) role has been introduced into NHS diagnostic imaging departments as a strategy to expand the workforce and create capacity. This skill mix initiative has not been implemented in a standardised way and there is limited knowledge of the current role scope within general radiography (X-Ray). Method An electronic survey of ARPs working within UK diagnostic imaging departments was conducted. Both open and closed questions sought information regarding basic demographic data (age category; gender; geographic region), scope of practice (patient groups; anatomical regions; imaging outside of the diagnostic imaging department), limitations placed on practice, supervision and additional roles. Results A total of 108 responses, including 13 trainees, were received. Most sites employ three or less ARPs in general radiography (n = 43/66; 65.2%), although 11 sites have five (range 1–15). The majority undertake imaging of both adults and children (n = 85/108; 78.7%), although limitations on age were described. Their scope of practice covers a broad anatomical range and included some non-ambulant patients. The level of supervision varied with some sites empowering ARPs to check the referral prior to examination (n = 25) or images post acquisition (n = 32) (both n = 20/66; χ2 = 16.003; 1df; p = 0.000). Conclusion ARPs are helping to maintain capacity in imaging departments but we suggest there is further scope for expansion. The practice described by the post holders suggests that many are working beyond the scope envisaged by the radiography professional body

A UK survey exploring the assistant practitioner role across diagnostic imaging: current practice, relationships and challenges to progression

YesObjective: Skill mix has been established as one method of maintaining imaging service delivery, with vertical and horizontal substitution of roles and tasks. Assistant practitioners (APs) have been undertaking limited imaging practice for almost two decades, but there remains a paucity of evidence related to the impact of their roles. Methods: This article reports on an electronic survey of individual APs within the NHS in the UK to explore utilisation, role scope and aspirations. Results: Responses were analysed from APs (n = 193) employed in 97 different organisations across the UK. The majority work in general radiography or mammography, with very few responses from other imaging modalities. Training routes varied across modalities, with most achieving Band 4 under Agenda for Change on completion of education. Limitations on practice vary between organisations and modalities, with many reporting blurring of the radiographer-AP boundary. Many aspire to continue their training to achieve registrant radiographer status, although there were clear frustrations from respondents over the lack of overt career prospects. Conclusion: Integration of the role into imaging department practice does not appear to be universal or consistent and further research is required to examine the optimal skill mix composition. Advances in knowledge: Skill mix implementation is inconsistent across modalities and geography in the UK. Opportunities for further workforce utilisation and expansion are evident

Diagnostic radiographer advanced clinical practice in the United Kingdom - A national cross-sectional survey

YesTo survey the diagnostic radiography workforce in the United Kingdom (UK) at an organisational level to ascertain the scope of advanced practice and compliance with Health Education England standards for multiprofessional advanced clinical practice (ACP). 174 diagnostic imaging departments were invited to participate in a cross-sectional electronic survey focused upon advanced level practice and their educational and accreditation expectations (October-December 2019). Breast imaging, computed tomography, fluoroscopy, interventional radiology, lithotripsy, magnetic resonance imaging and projectional radiography were included. A total of 97 responses were received, of which 79 were eligible for inclusion (45%). Respondents reported advanced-level practice roles across all imaging modalities, which included clinical reporting, procedural-based and combined roles. Radiograph and mammogram reporting were most prevalent (95 and 67% of Trusts), with fluoroscopy the most frequent procedure-only role (25%). Only 39% of trusts required adherence to the four pillars of ACP within job descriptions, and only 12% requiring a full Masters qualification. Diagnostic radiographer reporting and procedure-based roles in the NHS are varied and widespread. However, inconsistencies in fulfilment against the expected standards for advanced practice exist. Realignment of advanced-level roles to delineate enhanced and advanced clinical practice may ensure consistency between roles and professions. A requirement for accreditation as an advanced (clinical) practitioner with adherence to advanced practice requirements could therefore provide value to accreditation for both individual practitioners and Trusts. Within the UK, diagnostic radiographer roles previously self-identified as advanced-level practice may be termed enhanced practice when not adhering to expected ACP standards