Assessing MRI referrals' appropriateness for low back pain post a radiology-initiated intervention.

INTRODUCTION: This study evaluated a pilot intervention to reduce low-value Magnetic Resonance Imaging (MRI) referrals for Low Back Pain (LBP). METHODS: This before-after intervention study analysed MRI referrals for LBP at two private imaging centres in Norway. MRI referrals for LBP obtained before and after an intervention of information campaigns and sending a return letter to clinicians for declined referrals were evaluated on information, quality, and justification rates. Four radiologists and two radiographers assessed the referrals. A point system was used to calculate referral quality. Each referral was given a score 'good' when rated above 5.5 and 'poor' below 2.5. Justification was based on assessors categorised rating as justified, unjustified or need more information. Stata Statistical Software (Release 18) was used for analysis. A mixed model analysed variations of the referrals pre- and post-intervention. A p-value of <.05 in variations was considered statistically significant. RESULTS: A total n = 300 patients' referrals (150 referrals pre- and post-intervention) were collected and assessed. Post-intervention, 68% of referrals were justified, up from 63% pre-intervention. The assessment showed a 4% decrease in referrals with poor scores and a 2% increase in those rated as good or intermediate quality post-intervention. These changes were not statistically significant. CONCLUSION: It is important to state that it was not possible in our study to identify the subgroup of referrals that are known to be from clinicians who had received a return letter, although the information campaign targeted all referrers. Despite the limitations our findings suggest that providing reasons for declined referrals can serve as an educational tool for clinicians and contribute to the reduction of low value MRI for LBP. IMPLICATIONS FOR PRACTICE: Radiology department initiatives that raise awareness and offer referral criteria guidance to clinicians can serve as valuable educational tools, and further emphasize the importance of providing comprehensive information in MRI referrals for LBP.

Radiographers' experiences in working with patients living with dementia in Norway - A qualitative study.

INTRODUCTION: Imaging departments are seeing an increase in the number of patients living with dementia (PWD), driven by the ageing population and diagnostic benefits offered by medical imaging. This study explored radiographers' experiences during imaging examinations for PWD. METHODS: A semi-structured interview guide comprising questions about radiographers' experiences, knowledge concerning PWD, challenges faced, and departmental initiatives was developed. Eight radiographers were interviewed, four working in MRI or general imaging, including CT and four in nuclear medicine, at three hospital trusts in Norway. Data analysis was conducted using inductive content analysis as described by Elo and Kyngäs, following a three-step process of preparation, organising and reporting. The qualified radiographers coded, categorised, and defined the themes and sub-themes to report on the findings. RESULTS: Three main categories emerged: 1. Radiographers' experiences, which included overall challenges and the radiographers' attitudes. 2. Measures undertaken, outlining the actions radiographers take during procedures, and 3.Competencies, highlighting the knowledge possessed by radiographers. Organisational challenges, such as the absence of overarching protocols and insufficient training for radiographers related to PWD, posed difficulties in effectively conducting procedures. Creating a calm environment, collaborating with caregivers, scheduling adequate time for examinations, and possessing good communication skills were viewed as facilitators for conducting examinations successfully. CONCLUSION: Radiographers perceived imaging of patients living with dementia to be generally uncomplicated. However, challenges in planning for and communicating with patients, particularly for advanced examinations or acute settings, were reported. Establishing dementia-friendly departments and training radiographers in specific communication techniques could be beneficial. IMPLICATIONS FOR PRACTICE: There is a need for more dementia-friendly imaging departments and communication training for radiographers working with PWD.

The radiographers' opinion on assessing radiological referrals.

INTRODUCTION: Radiographers have a fundamental duty to assess radiological referrals and ensure imaging is justified. This study constitutes the third part of a broader research on radiographers' assessment of referrals. The study examines the opinions of radiographers on the matter, as articulated in their own words. METHODS: A questionnaire with closed and open-ended questions was designed, validated, and distributed to radiographers following activities organised by the International Society of Radiographers and Radiological Technologists (ISRRT). This third part covers the participants' free-text comments about radiographers' assessment of referrals. Qualitative, inductive content analysis was used to report findings involving three phases: 1) Preparation, 2) Organisation where two authors individually coded and categorised the emerged themes, and 3) Reporting, were the authors compared, reviewed, and defined the meanings of the themes and sub-themes. RESULTS: Five main themes Opportunity, Competency, Work environment, Role perception and Significance emerged, shaped as descriptive, normative, and prospective statements. In opportunities the respondents (descriptively) depicted the importance of their position and challenges faced, including lack of adequate clinical information in referrals. Competencies concerned whether they have the required knowledge and skills for the task. In work environment the respondents viewed themselves as partners and collaborators with radiologists and referrers but expressed that unclear regulations could challenge their task. In role perception, the respondents expressed (normatively) that assessing referrals is vital for professional self-esteem and radiographers' responsibility. Significance covers the importance of assessing referrals for different aspects relating to quality of services. CONCLUSION: Radiographers expressed high engagement towards tasks of assessing referrals. To support radiographers in this role, it is crucial to establish clear regulations, better organisation of departmental processes and provide adequate training. IMPLICATIONS FOR PRACTICE: Radiology departments should actively explore strategies of incorporating the radiographers' resources and core position in the process of assessing referrals, in a consistent and effective manner.

Workplace factors facilitating the radiographers' assessment of referrals for diagnostic imaging - A qualitative study.

INTRODUCTION: Radiology referrals are assessed for appropriate imaging based on the available clinical information. The task is legally the responsibility of the radiologists but could be delegated to radiographers under guidance. Knowledge of how this task is organised in radiology departments is limited. The study aim was to identify workplace factors facilitating the radiographers' assessment of referrals for medical imaging. METHODS: Five radiographers were recruited by convenience- and snowball-sampling techniques through the online social media platform LinkedIn. The participants represented different private and public hospitals and had from three to above ten years of experience with assessment of referrals for plain and cross sectional imaging. Following a qualitative approach, 60-min in-depth semi-structured interviews were conducted through online video meetings. Interviews followed a topic guide with 15 questions and 20 keywords, previously tested through a pilot interview. Systematic text condensation was performed using NVivo 12, where central themes and underlying subthemes were developed. RESULTS: Five central facilitating factors were identified, each with subthemes identified as: (1) Formal responsibilities; Documented delegation, Specific role description, (2) Training; Achieving skills, Maintaining skills, (3) Guidelines; Clinical indications, Priority, (4) Resource allocation; Time, Staff, (5) a Supporting environment; Teamwork, Mutual benefits, Feedback and knowledge sharing. CONCLUSION: The study adds new and valuable insights into workplace factors facilitating the radiographers' delegated task of assessing referrals. Workflows adapting such factors benefit radiographers by increasing knowledge and professional development, while positively re-allocating radiologist resources. IMPLICATIONS FOR PRACTICE: The study findings may support radiology workplaces in establishing or improving referral assessment by radiographers. Subsequently, improved quality of patient services may be achieved.

Radiographers' assessment of referrals for CT and MR imaging using a web-based data collection tool.

INTRODUCTION: There is limited research related to the radiographers' role in assessing of radiology referrals to justify imaging. This study investigated radiographers' compliance with guidelines in the assessment of CT and MRI referrals and factors that influenced their performance. METHODS: This research was facilitated by the EFRS Research Hub at ECR 2019. Five radiology referral scenarios for CT and/or MRI were distributed to radiographers, as determined by their scope of practice, who volunteered at the Research Hub. A web-based data collection tool was used. The radiographers were required to determine the appropriateness of each referral, highlight any concerns and recommend suitable investigations if applicable. Linear regression analysis was used to determine whether postgraduate qualification, grade/role of the radiographer and use of guidelines influenced the radiographers' performance in assessing the referrals. RESULTS: Participants originated from 24 countries (n = 51 CT, n = 40 MRI), the majority originating from the UK, Ireland, Italy, Spain, Norway and Austria. Responses consistent with guidelines were 58% and 57% for CT and MRI, respectively. Possession of an MSc qualification in CT was a significant factor of influence for a higher consistency with guidelines (p = 0.02) in CT. Employment as a radiographer in a lead professional role and/or educator was a significant factor of influence for a higher consistency with guidelines in MRI (p = 0.01). CONCLUSION: A total of 58% for CT and 57% for MRI of the radiographers' responses complied with guidelines. Factors such as postgraduate education and leading professional roles are associated with better performance. IMPLICATIONS FOR PRACTICE: Considering qualifications, experience and managerial role is vital before radiographers are delegated task of justifying CT and MR Imaging.