A radiographic criteria checklist to determine reasons for errors, resulting in sub-optimal routine shoulder projections

Background: Optimal shoulder images must adhere to specific radiographic criteria before they are sent to the radiologist for reporting. Repeat x-rays of the shoulder may increase radiation exposure to the patient. Aim: The aims of this study were to determine whether images adhered to the required radiographic criteria for routine shoulder imaging and to identify possible reasons for non-adherence. Setting: The study was conducted at an imaging department at a tertiary academic hospital in Bloemfontein, South Africa. Methods: A criteria checklist compiled from literature was used to evaluate 578 routine shoulder images including anteroposterior (AP) with external rotation and lateral-Y (LAT-Y) projections. The checklist determined whether the shoulder images adhered to the criteria with regard to the anatomy included, positioning and technical factors, such as inclusion of the correct anatomical lead marker. Data were analysed using SAS Version 9.2 statistical software. Results: More than 80% of the AP external rotation images included unnecessary anatomical structures owing to incorrect centring. In four out of seven criteria pertaining to positioning for AP external rotation imaging, at least 70% of images were performed incorrectly. Four-sided collimation was not present in more than 50% of both AP external rotation and LAT-Y images because of incorrect centring, while more than 30% of shoulder images presented with anatomical digital markers. Conclusion: The application of criteria required for shoulder imaging must be addressed at the participating imaging department to improve overall patient care. An in-service training session is recommended to enhance the radiographic technique with regard to routine shoulder projections

Design-based research for the development of a flexible learning environment

Background: Students enrolled for the Bachelor of Radiography degree at the Central University of Technology Free State in Bloemfontein, South Africa, spent many weeks off campus at hospitals during workplace learning. A design-based research approach was applied to analyse an educational problem, namely that students apparently fail to apply the theory of radiation safety regulations to protect themselves and patients. Aims: The purpose of the study was to develop authentic activities and assessment for radiation safety requirements, to provide flexible learning in a blended environment to students off campus. Setting: The second-year radiography students of 2016 and 2017 responded off campus to the QuestionPro survey. Method: Authentic learning and assessment opportunities were contextualised and compiled to align with learning outcomes of the safety regulations as confirmed during a Delphi process. Flexible learning opportunities were delivered via electronic mail (email) and WhatsApp. Assessment responses from the students were received via mobile phones with a Web-based software tool, QuestionPro. Results: Of the 117 students, 92.3% responded to the QuestionPro survey. From the incorrect responses, learning areas that needed revision were identified, as well as the areas in the X-ray departments of the hospitals showing non-compliance with the requirements for radiation safety. Conclusion: The three outcomes of this design-based research included the formulation of design principles, a designed product in the form of a Website and professional development of the researcher. The design-based research principles that were tested involved the use of knowledge in real life and measuring if students were effective performers with acquired knowledge