Australian experiences using a COVID-19 chest radiography reporting template: An implementation study

Introduction: Chest X-rays are an important tool in COVID-19 disease management and progression.1 Several radiology societies have developed structured reporting templates to reduce interpretation variability and measure concordance.2 This study aimed to measure concordance of three international chest X-ray reporting templates in a Sydney hospital. Method(s): 12 radiologists viewed a test set of 50 COVID-19-positive patients' chest X-rays (30 classic appearance, 20 indeterminate) and 20 normal or 'other' diagnoses chest X-rays. Radiologists classified the cases according to the Royal Australian and New Zealand College of Radiology (RANZCR), British Society of Thoracic Imaging (BSTI) and modified Co-RADS (Dutch)3 templates. Intra-reader and inter-reader reliability were calculated plus measures of experiences of using templates. Result(s): Inter-reader agreement between radiologists was highest for the BSTI template (0.46), followed by RANZCR (0.36) and modified Co-RADS (0.31). The intra-reader agreement across the three templates for 'classic/characteristic' COVID-19 cases was 0.61, for 'normal' cases 0.76 and 'alternative' 0.68 with large variations that were not related to experience. Radiologists agreed the templates were easy to use and would consider using them in the future, although some cases had very low concordance (intra- and inter-reader). Conclusion(s): The BSTI template yielded highest agreement for reporting all chest X-ray types. There was a large range of intra-reader agreement for all four types of patient presentations. Further investigation of radiology lexicon is required to seek reasons for variation as well as understanding the perception of utility by referring physicians. Extension of this work should include radiographers using the templates.

Shaping radiographers of the future: A snapshot of contemporary medical imaging education

Radiographers function in a niche environment, blending advanced technical skills with patient-focussed care in a multi-disciplinary environment. The past decade has brought significant change to the profession with further change projected into the future. Education programs are dynamic, responsive to emerging technologies and improve from each iteration. The education experience of current students is significantly different to that of experienced radiographers. This presentation provides a snapshot of contemporary education approaches in a medical imaging undergraduate program, preparing radiographers for the future. A significant component of skill development in medical imaging degrees is achieved through clinical placement across a range of settings. Education providers work with clinical departments to maximise learning opportunities, scaffolding structured progression of learning. Lack of availability of suitable resources or placement opportunities, and the priority that must be given to patient service delivery can be challenging for clinical experiences. COVID-19 pandemic restrictions have exacerbated issues, particularly for already time poor clinical environments. The education program showcased draws on contemporary best imaging practice, curriculum design and learning and teaching approaches. For example, the teaching team have applied simulation as a purposeful technique to add safe and procedural steps as part of a cohesive whole-of-curriculum student learning. Simulation prior to clinical placement is widely recognised as an effective response to the challenges of assuring safe and skilled practice.1 In turn, students can reflect on this experiential learning providing robust feedback and discussion using Kolb's reflective practice - exploring the impact of their learning on their future practice.2.

Radiographers' knowledge, attitude and adherence to standard COVID-19 precautions and the policy implications: a national cross-sectional study in Nigeria.

BACKGROUND: We investigated the knowledge of COVID-19 pathogenesis and prevention, attitude, and adherence to safe clinical practices among radiographers during the pandemic and made some informed policy recommendations. MATERIALS AND METHODS: The study was an online cross-sectional survey. The questionnaire captured data on respondents' demographics, knowledge of COVID-19, attitudes, practices, and standard precaution adherence during the pandemic. Data were analysed using descriptive statistics, Pearson's correlation and one-way ANOVA tests. RESULTS: Of the 255 respondents, 17.3% were actively involved in the management of COVID-19 cases. Participants had high scores regarding their knowledge of COVID-19 pathology (82.46 ± 8.67%), prevention (93.43 ± 7.11%) and attitude (74.11 ± 11.61%), but low compliance to safety precautions (56.08 ± 18.56%). Knowledge about COVID-19 prevention strategies differed significantly across educational qualifications, F(3, 251) = 4.62, p = .004. Similarly, levels of compliance with safety precautions differed across educational qualification (F[3, 251] = 4.53, p = .004) and years-in-practice (F[4, 250] = 4.17, p = .003). CONCLUSION: Participants' adherence to standard COVID-19 precautions was low. The level of professional qualification influenced participants' knowledge and safe practices during the pandemic. Upgrading the aseptic techniques and amenities in practice settings and broadening the infectious diseases modules in the entry-level and continuous professional education may improve radiographers' response to COVID-19 and future pandemics.Key messagesRadiographers whose qualifications were lower than a bachelor's degree had significantly less knowledge of COVID-19 prevention.Generally, radiographers had a positive attitude towards safe practices during the pandemic, but inadequate education, standard operational guidelines and resources affected their level of adherence.Apart from the shortage of personal protective equipment, poor infrastructural design and inadequate hygienic facilities such as handwashing stations, running water and non-contact hand sanitizer dispensers hampered adherence to COVID-19 precautions in low-resource settings.

Embedding new technology into clinical ultrasound practice: Is role extension for sonographers the key to improving patient pathways?

Introduction: MicroUS is a new imaging technique that may have potential to reliably monitor prostate disease and therefore release capacity in MRI departments. Firstly, however, it is essential to identify which healthcare staff may be suitable to learn to use this modality. Based on previous evidence, UK sonographers may be well placed to harness this resource. Topic: Currently, there is sparse evidence on the performance of MicroUS for monitoring prostate disease but early findings are encouraging. Although its uptake is increasing, it is believed that only two sites in the UK have MicroUS systems and only one of those uses just sonographers to undertake and interpret this new imaging technique. Discussion: UK sonographers have a history of role extension dating back several decades and have proven repeatedly that they are reliable and accurate when measured against a gold standard. We explore the background of UK sonographer role extension and postulate that sonographers are best placed to adopt and embed new imaging techniques and technology into routine clinical practice. This is of particular importance given the dearth of ultrasound focussed radiologists in the UK. To effectively introduce challenging new work streams, multi-professional collaboration in imaging, alongside sonographer role extension, will ensure precious resources are maximised thus ensuring optimum patient care. Conclusion: UK sonographers have repeatedly demonstrated reliability in many areas of role extension in various clinical settings. Early data indicate that the adoption of MicroUS for use in prostate disease surveillance may be another role suited to sonographers.

Computed Tomography Simulator (Ctlab)

University of Oulu and Oulu University of Applied Sciences have established a unique medical imaging teaching and testing laboratory in collaboration with Oulu University Hospital in a European Regional Development Fund -project. Virtually implemented medical imaging devices (CT, MRI, radiography) are unique features of the lab. Many of the virtual tools have been developed by the universities themselves. One of the virtual tools implemented during the project is the CTlab simulator, which can be widely used in computed tomography training for all professionals who use radiation in their work. The CTlab provides fast, comprehensive, and efficient solutions for numerical CT simulations with low hardware requirements. The simulator has been developed to introduce the basic operations and workflow behind the CT imaging modality and to illustrate how the polychromatic x-ray spectrum, various imaging parameters, scan geometry and CT reconstruction algorithm affect the quality of the detected images. Key user groups for the simulator include medical physics, engineering, and radiographer students. CTlab has been created with MATLAB's app designer feature. It offers its user the opportunity to select the virtual imaging target, to adjust CT imaging parameters (image volume, scan angles, detector element size and detector width, noise, algorithm/geometry specific parameters), to select specific scan geometry, to observe projection data from selected imaging target with polychromatic x-ray spectrum, and to select the specific algorithm for image reconstruction (FBP, least squares, Tikhonov regularization). The CTlab has so far been used at a postgraduate course on computed tomography technology with encouraging feedback from the students. At the course, teaching of CT modality were performed by using the simulator, giving students unlimited opportunity to practice the use of virtual imaging device and participate demonstrations remotely during the Covid-19 pandemic. Using CTlab in teaching enhances and deepens the learning experience in the physics behind computed tomography. CTlab can be used remotely (https://www.oulu.fi/fi/projektit/laaketieteellisen-kuvantamisen-opetus-ja-testilaboratorio-0), which makes teaching and training of CT scanner usage successful regardless of time and place. The simulator enables more illustrative and in-depth teaching and offers cost-effectiveness, versatility, and flexibility in education. CTlab can also be used to support teaching in special situations, such as during the Covid-19 pandemic when simulator is utilized remotely to perform teaching-related demonstrations flexibly and safely.Copyright © 2023 Southern Society for Clinical Investigation.

Exploring patient experience of mandatory mask wearing during MRI scans

Introduction: Anxiety in patients undergoing Magnetic resonance imaging (MRI) examinations has been well documented along with causes and strategies to support patent through this. During the Covid-19 pandemic, mask wearing in clinical settings became compulsory for both staff and patients. Whilst staff may be more familiar with wearing personal protective equipment it is unknown how this could affect patient experiences. We know that patients can get claustrophobic in MR scans which affects their wellbeing, scan attendance and even scan quality. This study aims to understand if wearing a mask had any effect of their willingness to comply with the scan, and if they were adequately prepared, and how it affects their feelings about attending for future scan appointments. Method(s): A purposive sampling technique was chosen with participants being invited nationally across the UK. Inclusion criteria required that participants be aged 18 years or older, their scan had taken place in a UK organisation either NHS or private between March 2020 and December 2021 and that they had worn a face mask during their scan. Ethical approval was gained from University of Derby Research and Ethics Committee. Informed consent and participation information sheets were completed. No identifying data was collected and therefore responses were anonymous. A mixed methods online survey design was utilised, and this was shared on social media using professional accounts and charities. Result(s): Inductive thematic analysis was used with both researchers independently blind coded the qualitative data. The main themes emerged which were anxiety and discomfort, information and preparation and positivity around the experience. The quantitative data analysis in on-going and will be presented in the final presentation. Conclusion(s): We should review patient experiences taking a holistic approach to the entire examination including preparatory material as well as activity in the waiting area and scan room. We need to consider the impact of mask wearing on anxiety and discomfort and revisit what patient preparation looks like to ensure patients have a better experience. This needs to take place in the education of student radiographers as well as qualified professionals in clinical departments. People want to feel prepared and be treated as individuals. We must embrace the principles of person-centred care at every level of what we do.Copyright © 2022

Knowledge, attitudes and perceptions of radiology healthcare workers during the COVID-19 pandemic

Background: Medical imaging is vital in the diagnostic workup and evaluation of patients suspected or confirmed to have COVID-19;hence, radiology healthcare workers (HCWs) were an essential part of the early containment response to the pandemic. Radiology services are facing rising demands to introduce stricter infection control measures, and staff are expected to adhere to the new protocols while coping with a surge in patients. Objective(s): This study aims to identify the knowledge, attitudes and perceptions (KAPs) of radiology HCWs at a single site with regard to workplace preparedness during the COVID-19 pandemic. Method(s): A 26-item questionnaire was conducted with radiographers, radiology nurses, and support staff who had direct patient contact. Questions were concerned with involvement in managing suspected or positive COVID-19 patients, knowledge of infection control measures, and attitudes and perceptions in relation to working during the pandemic. Results were analysed using t-tests, chi-square tests, and Spearman's rank-order correlation, with statistical difference set at p<0.05. Result(s): Radiology HCWs self-reported significantly better knowledge of infection control measures and positive work attitudes. Those who had received the flu vaccine had significantly better perceptions of working during the pandemic. Suggested improvements included better organisational structure and more resources, better staff compliance and vigilance, better education, and a clearer focus on staff wellbeing. Conclusion(s): The findings indicate favourable KAPs among radiology HCWs in Singapore with regard to workplace preparedness during the pandemic, but efforts towards sustainability must be considered. Formulating policies to nurture motivated and resilient HCWs during a pandemic is advocated to foster a resilient workforce that is prepared for the next pandemic.Copyright © The Author(s) 2021.

'Masks and Social Distancing -You Still Want to Add That Human Element': Impact of Covid-19 Changes on Children and Families

Background Despite lower rates of illness, morbidity and mortality associated with SARS-CoV-2 infection in children during the pandemic, their health and wellbeing has been significantly impacted. Emerging evidence indicates that this includes experiences of hospital-based care for them and their families. As part of a series of multi-site research studies to undertake a rapid appraisal of healthcare workers' perceptions of working during the pandemic, our study focussed on clinical and non-clinical staff perceptions of the impact of COVID-19 on aspects of care delivery, preparedness and staffing which were specific to a specialist children's hospital. Methods This was a qualitative study. Hospital staff were invited to take part in a single telephone interview. Researchers used a qualitative rapid appraisal design. This included a semi-structured interview guide, RREAL Rapid Assessment Procedure (RAP) sheet to share data, audio recording and transcription of interviews, with a framework approach to analysis. Results Thirty-six staff participated representing a wide range of roles within the hospital: 19 (53%) nurses, seven (19%) medical staff, 10 (28%) other staff groups (including radiographers, managers, play staff, schoolteachers, domestic and portering staff, social workers). Three themes related to the impact on children and families were identified: Same Hospital but Different for Everyone, Families Paid the Price and The Digital World. Conclusion Providing care and treatment for children and families changed profoundly during the pandemic, particularly during lockdowns periods. Adaptations to deliver clinical care, play, schooling, and other therapies online were rapidly put into action, however benefits were not universal or always inclusive. The disruption to a central principle of children's hospital care-the presence and involvement of families-was of critical concern to staff. We present perceptions of staff on how changes to the organisation of care delivery within Great Ormond Street Hospital impacted upon children and families.

A review of the results from a patient experience survey of the palliative radiotherapy bone metastases service

Introduction:A patient experience survey was undertaken as part of the role of the Macmillan Consultant Therapy Radiographer for the bone and brain metastases patients to inform future development of the service.Method:A questionnaire was developed and approved by the Trust's local Questionnaire, Interview and Survey Group to survey the experiences and satisfaction of the service including the informed consent process, radiotherapy appointments and overall experience and satisfaction. The survey used qualitative and quantitative methods, including Likert Scales and free comment boxes. The responses were analysed by counting the frequency of each response and identifying any themes in free text responses.Results:Most patients were satisfied with the consent process with 1/36 patients reporting a lack of understandable information and 4/36 wanting more side effect information. The option of plan and treat was a preference of 53% of patients due to travelling back and forth to the centre;however, only 6% stated that they wanted two separate appointments. Ninety-four percent of patients felt that they had complete confidence and trust in the professional who consented them and 86% did not feel fully involved in the decision-making process. Overall, the service was rated as 10/10 by 61% of patients (n = 36).Conclusions:The patients surveyed were satisfied with their experience of the Palliative Radiotherapy Service;however, it needs to be developed further to meet the needs and expectations of the service users.

Investigation and analysis on the infection control and radiation safety of radiodiagnostic workplace for COVID-19.

Objective: To survey and supervise the risk of infection control and radiation safety in the radiological diagnostic workplace for COVID-19, and provide data support for the safety protection of radiographers and related staff. Method(s): 4 emergency hospitals for COVID-19 including 2 makeshift hospitals, module hospital and brick pattern hospital in Hubei province were performed for testing and evaluation of imaging performance and radiological protection for the 8 new installed CT scanners and places according to the national standards of WS 519-2019 and GBZ 130-2013. The infection control safety factors such as the layout of the equipment room were monitored and investigated. Two COVID-19 designated hospitals including general hospital and infectious disease specialized hospital were selected to carry out field investigation and sampling of environmental biological samples for 4 CT rooms. Then the samples were detected for the nucleic acid of novel coronavirus. The results of radiodiagnostic workplace overall arrangement, infection prevention and the nucleic acid testing were analyzed, and the biological safety reliability and risk point were evaluated. Result(s): The indicators of imaging performance and radiation protection for 8 CT scanners in emergency hospitals could meet the requirements of national standards.Each of 2 makeshift hospitals had 3 CT rooms with the area of 38.8 m2 and 4 mm Pb equivalent thickness of protective shielding. The CT rooms in module hospital and brick pattern hospital were 20.0 m2, and 35.8 m2 in areas, with 4 mm Pb equivalent and 3 mm Pb equivalent thickness of protection shielding, respectively. The 8 radiological diagnostic workplaces of the emergency hospitals were designed and constructed based on " three zones with two passage ways". The result of the nucleic acid test indicated that the positive samples were found at the multiple sites such as scanning bed, internal of gantry and ground touched by patients in CT scanning room. The areas such as console panel and ground were risked of pollution by the virus infected hands and feet of radiographers. In addition, the similar positive samples were found in the areas in scanning room with no touch of patients, such as observation window and air outlet. Conclusion(s): 8 CT scanners and rooms in 4 emergency hospitals basically meet the requirements of imaging performance and radiation protection. The disinfection of COVID-19 radiodiagnostic workplace should be standardized.Copyright © 2020 by the Chinese Medical Association.

The use of emoji to establish student wellbeing: does the image reflect the reality?

Introduction: The impact of COVID-19 social restrictions on mental wellbeing of health professional students during placement is largely unknown. Conventional survey methods do not capture emotional fluctuations. Increasing use of smartphones suggests short message service (SMS) functionality could provide easy, rapid data. This project tested the feasibility and validity of gathering data on Therapeutic Radiography student mental wellbeing during clinical placement via emoji and SMS. Methods: Participants provided anonymous daily emoji responses via WhatsApp to a dedicated mobile phone. Additional weekly prompts sought textual responses indicating factors impacting on wellbeing. A short anonymous online survey validated responses and provided feedback on the method. Results: Participants (n = 15) provided 254 daily responses using 108 different emoji;these triangulated with weekly textual responses. Feedback concerning the method was positive. 'Happy' emoji were used most frequently;social interaction and fatigue were important wellbeing factors. Anonymity and opportunity to feedback via SMS were received positively;ease and rapidity of response engendered engagement throughout the 3-week study. Conclusions: The use of emoji for rapid assessment of cohort mental wellbeing is valid and potentially useful alongside more formal evaluation and support strategies. Capturing simple wellbeing responses from a cohort may facilitate the organisation of timely support interventions. © The Author(s), 2022. Published by Cambridge University Press.

Burnout and occupational stress among Hungarian radiographers working in emergency and non-emergency departments during COVID-19 pandemic.

INTRODUCTION: The increased workload caused by the coronavirus pandemic may have had a significant impact on the mental health of radiographers. The aim of our study was to investigate burnout and occupational stress in radiographers working in emergency departments (ED) and non-emergency departments (NED). METHODS: Quantitative, cross-sectional, descriptive research was carried out among radiographers working in the public health sector in Hungary. Due to the cross-sectional nature of our survey, there was no overlap between the ED and NED groups. For data collection, we used simultaneously the Maslach Burnout Inventory (MBI), the Effort-Reward Imbalance questionnaire (ERI), and our self-designed questionnaire. RESULTS: We excluded incomplete questionnaires from our survey; finally, 439 responses were evaluated. Significantly higher scores for depersonalisation (DP; 8.43 (SD = 6.69) vs. 5.63 (SD = 4.21) and emotional exhaustion (EE; 25.07 (SD = 11.41) vs. 19.72 (SD = 11.72)) were observed in radiographers working in ED (p = 0.001; p = 0.001) when compared to NED. Male radiographers working in ED aged 20-29 and 30-39 years with experience of 1-9 years were more affected by DP (p ≤ 0.05). Worrying about one's own health had a negative effect on DP and EE (p ≤ 0.05). Having close friend with a COVID-19 infection had a negative effect on EE (p ≤ 0.05); not being infected with coronavirus, not being quarantined and relocating within the workplace had a positive effect on personal accomplishment (PA); radiographers who were 50 years or older with 20-29 years of experience were more affected by depersonalisation (DP); and those who worried about their health had significantly higher stress scores (p ≤ 0.05) in both ED and NED settings. CONCLUSION: Male radiographers at the beginning of their careers were more affected by burnout. Employment in EDs had a negative impact on DP and EE. IMPLICATIONS FOR PRACTICE: Our results support the implementation of interventions to counter the effects of occupational stress and burnout among radiographers working in ED.

Burnout among oncologists, nurses, and radiographers working in oncology patient care during the COVID-19 pandemic.

INTRODUCTION: Oncology care professionals are exposed to high levels of stress that can lead to burnout. The aim of this study was to investigate the prevalence of burnout among nurses, oncologists and radiographers working in oncology patient care during the COVID -19 pandemic. METHODS: Our electronic questionnaire was sent to e-mail contacts registered in the system of the Hungarian Society of Oncologists and to all oncology staff via an internal information system in each cancer center. Burnout was measured using the Maslach Burnout Inventory, which measures depersonalization (DP), emotional exhaustion (EE), and personal accomplishment (PA). Demographic and work-related characteristics were collected in our self-designed questionnaire. Descriptive statistics, chi-square tests, two-sample t-tests, analyzes of variance, Mann-Whitney and Kruskal-Wallis tests were performed. RESULTS: A total of 205 oncology care workers' responses were analyzed. Oncologists (n = 75) were found to be significantly more committed to DP and EE (p = 0.001; p = 0.001). Working more than 50 h per week and being on-call had a negative effect on the EE dimension (p = 0.001; p = 0.003). Coming up with the idea of working abroad had a negative effect on all three dimensions of burnout (p ≤ 0.05). Respondents who did not leave their job due to their current life situation had significantly higher DE, EE, and lower PA (p ≤ 0.05). Intention to leave current profession was specific in (n = 24/78; 30.8%) of nurses (p = 0.012). CONCLUSION: Our results suggest that male gender, being an oncologist, working more than 50 h per week and taking on call duties have a negative impact on individual burnout. Future measures to prevent burnout should be integrated into the professionals' work environment, regardless of the impact of the current pandemic. IMPLICATIONS FOR PRACTICE: Prevention and oncopsychological training should be developed gradually at the organisational or personal level to avoid early burnout of professionals.

The use of emoji to establish student wellbeing: does the image reflect the reality?

Introduction:The impact of COVID-19 social restrictions on mental wellbeing of health professional students during placement is largely unknown. Conventional survey methods do not capture emotional fluctuations. Increasing use of smartphones suggests short message service (SMS) functionality could provide easy, rapid data. This project tested the feasibility and validity of gathering data on Therapeutic Radiography student mental wellbeing during clinical placement via emoji and SMS.Methods:Participants provided anonymous daily emoji responses via WhatsApp to a dedicated mobile phone. Additional weekly prompts sought textual responses indicating factors impacting on wellbeing. A short anonymous online survey validated responses and provided feedback on the method.Results:Participants (n = 15) provided 254 daily responses using 108 different emoji;these triangulated with weekly textual responses. Feedback concerning the method was positive. ‘Happy’ emoji were used most frequently;social interaction and fatigue were important wellbeing factors. Anonymity and opportunity to feedback via SMS were received positively;ease and rapidity of response engendered engagement throughout the 3-week study.Conclusions:The use of emoji for rapid assessment of cohort mental wellbeing is valid and potentially useful alongside more formal evaluation and support strategies. Capturing simple wellbeing responses from a cohort may facilitate the organisation of timely support interventions.

A study on burnout among health care workers of COVID care units of some selected hospitals in Sri Lanka during the COVID 19 pandemic

Introduction: Since the declaration of COVID 19 pandemic by the WHO, the mental health toll the virus has taken on the globe, affects the health care workers in many folds which is reflected by mounting evidence on high levels of anxiety, depression, and stress among HCW.1,2,3 Psychological stresses among HCWs measured in terms of burnout provide valuable evidence to initiate support services in COVID care settings.4 The psychological distress among HCW during a pandemic of current nature, is attributed to being parents of dependent children, being junior in service, longer quarantine period, lack of practical support and stigma5 Though the health system in Sri Lanka is overwhelmingly burdened by the disease little is known about psychological issues of HCW in the country. Objectives: To Evaluate the prevalence of burnout and to identify some factors associated with burnout among health care workers attached to COVID 19 management settings in Sri Lanka Methods: A descriptive cross-sectional study was conducted in 8 selected COVID care settings in the country. Data from HCW dealing with COVID care were collected using google forms. Burnout was assessed using the Copenhagen Burnout Inventory with 0-100 scale. A score above 50 is considered as the presence of burnout. Some selected factors associated with burnout was tested with Z test and chi square test. Results: There were 473 respondents (doctors (33.4%), nurses (51.6%), physiotherapists (4.2%), radiographers (4.2%) and other staff (7.4%)). Sixty-three percent of HCW worked in intensive care facilities. There were 342 (72.5%) females and 125 (26.4%) males. Majority (61%) were between 21 to 30 years. Eighty percent of HCW had no comorbidities and 91.8% of them were vaccinated against COVID-19. The overall prevalence of burnout was 70.6 % while the prevalence of personal related, work related and client related burnout were 61.5%, 75% and 71.2% respectively. Burnout of doctors was 65.8% of nurses was 72.5% of physiotherapists was 70% of radiographers was 87.5 and the burnout of other staff was 25%. Mean burnout score was significantly higher among nurses compared to doctors (p, 0.0033) and female compared to male workers (p, 0.014). Conclusions: High prevalence of burnout is evident among all categories of HCW in COVID care settings in Sri Lanka. Establishment of necessary support services prioritizing nurses and administrative interventions are recommended.

Optimisation of the treatment pathway for stage III non-small cell cancer (NSCLC) patients receiving concurrent chemo-radiation (cCRT)

Introduction: Patients undergoing concurrent chemo-radiation (CCRT) for stage III NSCLC can be clinically and technically challenging to manage due to extensive treatment volumes including lymph nodes, oesophageal and lung radiotherapy tolerances. Patients experience toxicities including: oesophagitis, dehydration, pneumonitis and weight loss. During treatment lung changes can affect tumour position. As a result of Covid-19, our centre optimised the CCRT pathway in April 2020, to formalise a specific cCRT radiographer review clinic, to deliver an outpatient service. Former practice involved delivering inpatient chemoradiotherapy. Aim: To formalise and optimise the cCRT pathway to ensure a resilient streamlined pathway by: 1) Avoid patient admissions by early intervention and management of toxicities. 2) Problem solving of technical imaging challenges while supporting on-treatment radiographers. 3) Supporting clinical consultant oncologists by coordination post cCRT investigations and eligibility for adjuvant immunotherapy. Methods: Treatment consultation included;analysis of daily imaging, dosimetric data, blood results, electronic recording of assessment and management of patients, reviewing medications, arranging fluids, transfusions;timely intervention for chemotherapy. Patient consent for Durvalumab was instigated on the final week of review and any anatomical lung changes from the daily treatment imaging was initiated. Results: Optimisation by combining clinical and technical skills has demonstrated a positive patient and organisational impact. A formalised clinic has ensured the ability to continue to provide a cCRT service, with increasing patient numbers despite Covid-19 . Conclusion: Optimising the pathway has proven cCRT can be delivered as an outpatient service. However, future optimisation is required from the multidisciplinary team to provide prehabilitation and rehabilitation. As the service increases, capacity and resource impact needs consideration. Thus, continual audit of the service is imperative to ensure provision can be maintained. Disclosure: No significant relationships.

PSYCHOLOGICAL WELLBEING IN PROFESSIONALS WORKING IN THE CANCER SETTING: THE IMPACT OF THE COVID-19 PANDEMIC

Introduction The impact of the COVID-19 pandemic on the psychological wellbeing of oncology healthcare professionals (HCPs) is an emerging field of inquiry, with new research focusing on the experiences and needs of staff. Occupational health and workforce literature places emphasis on preventive initiatives in the workplace, and the promotion of positive psychological health amongst HCPs (Boorman 2009). There is an overwhelming literature on stress, anxiety and burnout amongst HCPs using self-report questionnaires, in contrast to how individuals develop and sustain positive wellbeing under difficult circumstances through the self-management of stress and mobilisation of coping strategies (Cai et al. 2020). The effects of high stress working environments, particularly in health crises may lead to poorer psychological wellbeing outcomes amongst HCPs because of reduced peer support, low autonomy and social belonging, increased staff turnover rates and high workloads (Morgantini et al. 2020). This study explores the evolving experiences of oncology HCPs in the workplace during the COVID pandemic, and its impact on their psychological health. We captured the experiences of a wide range of staff to provide a broad understanding of their needs and where support might be required. Qualitative methods were used to explore how HCPs coped and managed their wellbeing during the pandemic. Methods The study aims were to: i) explore how oncology HCPs managed their psychological wellbeing during the pandemic, together with the support systems, coping strategies and knowledge and skills they used to maintain positive mental health, ii) identify the barriers and opportunities for psychological wellbeing, iii) inform the development of interventions and resources to promote and sustain the self-management of psychological wellbeing amongst oncology HCPs. Data was collected using diaries and semi-structured interviews over a period of 4 months from December 2020 to April 2021. A total of 102 HCPs were recruited comprising medical staff, nursing staff, radiographers, allied health professionals (non-Radiographers) and support staff (Cancer Support Workers, Healthcare Assistants). Fifty participants submitted diaries and 35 interviews were undertaken. The response rate was 64%. Thirty-five participants consented but did not submit data and two nurses requested to withdraw (37% non-response rate). Demographic data revealed the majority of participants were female (83%) and worked full-time (73%). The age range was evenly distributed between the 21-50 year groups (16% in the 51-60 age group). Most participants (62%) had been employed at the cancer centre for < 5 years, reflecting the recruitment of new staff associated with the expansion of the organisation. Transcribed diaries and interviews were analysed using Interpretative phenomenological analysis (Smith & Osborn 2015). IPA recognises individuals make sense of situations through an interpretation of events, and offers insights into how a person, within a specific context, understands and experiences a phenomenon. Results Participants experienced a myriad of emotions associated with coping during the COVID pandemic. Emotions fluctuated between positive and negative feelings, marked by the passage of time, life events and organisational changes. Regardless of professional group, individuals were dealing with similar challenges, as all were experiencing the pandemic in the context of the same organisational environment. Four main themes emerged: 1) Self-management, 2) Delivery of patient care, 3) Managing professional roles, 4) Managing the employer/ employee relationships. Self-management Participants used different strategies to manage wellbeing such as concealing emotions and speaking out. The concealment of emotions was used to maintain the appearance of coping, which was important in managing professional relationships, such as not letting colleagues down. Various strategies were used to regulate emotions, including slowing down, appreciating life more and being positive. Thought rocessing enabled the long-term consequences of the pandemic to be managed, helping to minimise the impact of fatigue and loss of concentration, however, this was not without its consequences. Sustaining the ups and downs of positive outlooks over long periods was described as an emotional 'roller-coaster'. The 'emotional roller-coaster' metaphor was used in conjunction with 'Ground Hog' day, denoting the monotony and drawn out nature of the pandemic. Seeing the bigger picture and comparing self with others aided adjustment and self-regulation, supported by the belief that others were experiencing worse situations such a job losses. Participants expressed guilt and gratitude that they had not been redeployed to the COVID front line. Delivery of patient care The provision of high quality patient care was a dominant theme in the narratives of staff. Job satisfaction was contingent on being able to meet the needs of patients and feeling that a good job had been done. The transition to remote working, loss of face-to-face contact with patients and absence of patients' families required adjustment to new ways of working. Participants described how the loss of physical contact with patients impacted negatively on patient-professional communication, in particular, not being able to interpret the person's body language as a result of mask-wearing and social distancing. The pandemic dramatically altered the cancer care landscape from reductions and cancellations in elective care and cancer treatment to protect immunosuppressed patients, to delays in diagnoses and treatment, cessation of clinical trials, and more advanced stage disease in patients with poorer health outcomes. Service pressures linked to the reinstatement and escalation of cancer services required resilience and adjustment on the part of participants. Managing professional roles The management of professional roles during the pandemic disrupted usual ways of working linked to changes in patient care, multidisciplinary teamwork and workforce organisation. Although a proportion of staff continued to work in their clinical areas during the pandemic, other teams adopted a hybrid approach, working between clinical and home environments. Working from home, dealing with technology-related issues, finding a suitable location to work in, managing home schooling and care of elderly relatives alongside the job required additional psychological resources. Participants faced redeployment from their usual places of work to help other clinical areas in greater need. As staff transitioned to working from home, corridor conversations and informal networking opportunities were lost. That said, the normality of working life and support of colleagues was a constant in the lives of participants and provided a platform on which to build positive wellbeing. Participants described the 'Dunkirk spirit' and being 'in the same boat' as others, with team solidarity and camaraderie being a core component of the wellbeing experience. Managing the employer/employee relationships A number of staff expressed frustration that management did not appear to listen to concerns and were unaware of what staff were going through, however, others felt positively supported. Although several spoke of hiding their emotions and anxieties, openly displaying feelings resulted in support being offered. Staff believed more attention should be paid to the day-to-day pressures of providing patient care. It was acknowledged that managers may have their own mental health needs, but it was less clear how these were being met. Support was believed to differ between management grades, with those closer to the workforce and more visible being valued. Communication between staff and the organisation was seen as key to understanding wellbeing needs. Email appeared to be the preferred method for conveying information during the pandemic, however, access to email was variable across staff groups, potentially leading to inequalities in staff experiences. The majority of staff in this study had not accessed wellbeing resources, mainly due to lack of time and being unfamiliar with how to use them. Conclusions This study has identified the dynamic and evolving nature of mental health and wellbeing amongst HCPs. Participants displayed enormous resilience throughout the pandemic, rising to the challenges posed by COVID, however, the study has highlighted the importance of identifying mental health issues and how these may change over time.

The impact of COVID-19 on the mental health of radiography staff and managers in Northern Ireland, UK: The radiography managers' perspective.

INTRODUCTION: Increasing evidence suggests that the COVID-19 pandemic has influenced the mental health of health professionals, including radiographers. Less is known about the effect of the pandemic on the mental health of radiography managers. Radiography managers have led their teams through the pandemic, making unpopular decisions to safeguard staff and patients. This study explores radiography managers' perceptions regarding the impact of the COVID-19 pandemic on the mental health of themselves and their staff. METHODS: Ethical approval was obtained from the NHS Research Ethics Committee (ID 287032). Eleven interviews were conducted with therapeutic and diagnostic radiography managers between March-April 2021. Written information was also included from a paediatric diagnostic radiography manager. Data was analysed independently by 2 researchers using thematic analysis. RESULTS: Three central themes emerged: 1) Factors perceived to have negatively influenced mental health, which included changing PPE guidance, restructuring of work conditions, social isolation, challenges to patient care and lack of quality vacation leave. 2) Factors perceived to have positively influenced mental health, which included witnessing staff resilience and team camaraderie. 3) Support provided for mental health. CONCLUSION: Managers felt that they had implemented appropriate strategies to support their staff throughout the first year of the pandemic and expressed feeling responsible for the wellbeing of their staff. Strong empathy was evident towards staff and their experiences. Despite the availability of mental health support services, managers felt that resources were underutilised by radiography teams. IMPLICATIONS FOR PRACTICE: Managers should be proactive in communicating their appreciation for their staff in an era where remote working can add to disconnect between staff and management. Mental health support services should be promoted and continually reviewed, to ensure that appropriate support services are maintained.