Individual patient radiation dose tracking: Perceptions of radiographers in South Africa.

INTRODUCTION: Medical imaging examinations that make use of ionising radiation provide valuable information towards patient management. Literature suggests that there is a significant rise in the number of patient referrals for such examinations. The concept "individual patient radiation dose tracking" (IPRDT) is introduced to optimise radiation monitoring. Many countries across the globe explored and implemented methods to enhance and promote the justification and optimisation principles essential for patient radiation safety. In South Africa (SA), however, attention to IPRDT is limited. METHODS: A qualitative research design was employed. Radiographers in the Western Cape Province of SA were purposefully sampled for participation in one-on-one, semi-structured interviews. Thematic analysis was applied to the transcribed interview data. RESULTS: This paper presents a theme developed from the radiographer cohort of ten (10) participants. The theme: the need for creating awareness and implementing legislative support structures, was developed from the data, with the following supporting subthemes: 1) stakeholder awareness and 'buy-in' 2) continuous professional development and 3) mandated practice. CONCLUSION: This study provides findings that are of value for patient radiation safety in SA by giving a voice to local stakeholders. Other countries that are conducting similar research investigations toward the integration of an IPRDT model, method, or framework, may also benefit from these findings. IMPLICATIONS FOR PRACTICE: The effective integration of IPRDT into the clinical environment requires unison amongst the relevant stakeholders and clarity on the various professionals' roles and responsibilities. The findings of this study furthermore suggest the involvement of regulatory organisations for the provision of a mandated form of practice at national and international levels.

Radiology image interpretation services in a low-resource setting: Medical doctors' experiences and the potential role of radiographers.

INTRODUCTION: Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers. METHODS: A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9). RESULTS: Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system. CONCLUSION: Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges. IMPLICATIONS FOR PRACTICE: There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers.

Knowledge of computed tomography dose optimisation and justification among CT users and referring physicians: A single hospital study.

INTRODUCTION: Radiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging. OBJECTIVE: To determine radiographers' and radiologists' awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians. METHODS: Radiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval. RESULTS: The response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited. CONCLUSION: The study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.

Radiographers' experiences of image interpretation training in a low-resource setting.

INTRODUCTION: Radiographers extend their roles through formal and on-the-job training to keep up with clinical practice changes. One area of role extension that is now incorporated into undergraduate programmes is image interpretation, although the training provided may vary between institutions. This study explored the experiences of graduates from one higher education institution in a low-resource context with regard to their image interpretation training. METHODS: A qualitative phenomenological research design was employed to investigate the experiences of ten radiography graduates who were purposively selected from one higher education institution. Individual semi-structured interviews were conducted with each participant after obtaining their informed consent. The interview recordings were transcribed and analysed using Atlas.ti Windows (Version 9.0) software, following Colaizzi's seven-steps of data analysis. RESULTS: From the ten interviews conducted, teaching approach, clinical education, and assessment strategy emerged as areas of experience within the teaching and learning theme, while practitioner role modelling, skill utilisation, and industry impact were sub-themes under the paradoxical reality theme. The participants' experiences indicated a theory-practice gap in image interpretation among radiographers. CONCLUSION: The participants' experiences reflected a misalignment in the educational process due to inadequacies in the teaching approach, clinical education, and assessment strategies. Participants encountered significant differences between their expectations and clinical realities during and after training. Image interpretation by radiographers was recognised as a relevant area for role extension in this low-resource setting. IMPLICATIONS FOR PRACTICE: While these findings are specific to the experiences of the participants, conducting similar research in comparable contexts and implementing competency-based image interpretation assessments could help identify gaps and guide interventions to address shortcomings.

Resilience from the perspective of diagnostic radiography students.

INTRODUCTION: Resilience is a concept associated with the ability to overcome, adapt, and recover from stressors. The radiography profession is known to be stressful, and one can reason that radiographers must be resilient in order to cope with the clinical environment. Research shows there are varied understandings of resilience. However, little is known about the concept of resilience specifically as it relates to the perspectives of diagnostic radiography students within the clinical workplace. This paper reports on one aspect of a comprehensive study of resilience amongst radiography students. The objective of this paper is, therefore, to present the exploration of the concept of resilience drawing from the data gathered from first-year diagnostic radiography students. METHODS: A qualitative, explorative, descriptive and contextual approach was adopted for this study. Qualitative data was collected through focus group interviews. A purposive sampling method was employed, selecting from first-year diagnostic radiography students at a University of Technology (UoT) in the Western Cape, South Africa. Interviews were audio-recorded transcribed and thematically analysed. Data was collected until saturation was reached. RESULTS: The meaning of resilience as explained from the perspective of radiography students included three subthemes namely: (1) fundamentals of resilience; (2) external protective factors and (3) internal protective factors. CONCLUSION: This study demonstrated that radiography students associated resilience with positive attributes. Furthermore, the study identified various resilience enhancement strategies to better support diagnostic radiography students in the clinical environment like supportive radiographers and talking to peers. IMPLICATIONS FOR PRACTICE: The identification of resilience enhancement strategies is important as it will assist with the introduction of curriculum renewal initiatives tailored to support first-year diagnostic radiography students as they develop their resilience to stressors in the clinical environment.

Radiography lecturers' understanding of a socially responsive curriculum.

INTRODUCTION: In health professions education (HPE), focus is placed on developing clinically competent practitioners who can function within their professional scope in a broad range of health care contexts. In this study, the authors investigated diagnostic radiography lecturers' understanding of how students become socially responsive. The concept of 'critical consciousness' was explored as an intervention of being a transformer in the local environment. This places focus on learning and teaching that aims to develop radiography graduates who are critically conscious, such that they can take up the challenges of healthcare in their environment, in addition to being clinically competent in their field. The study under discussion therefore sought to find out how radiography lecturers understand a socially responsive curriculum at a University of Technology in the South African context. METHOD: A qualitative, exploratory design was used where curriculum documents were reviewed and from which stimulus points were identified for a semi-structured focus group interview with radiography lecturers followed by five individual interviews. All interviews were audio-recorded, transcribed, coded and analysed through a process of thematic analysis. RESULTS: Four dominant themes emerged from the analysis, namely i) diverse understandings of critical consciousness, ii) becoming a reflective practitioner, iii) a need for curriculum transformation and iv) emerging pedagogies. CONCLUSION: Critical reflection by both the radiography students and lecturers is key to developing social awareness and critical consciousness which could drive critical motivation and critical action to effect social change. It is recommended that the current curriculum should be reviewed and transformed to include constructive reflective practice. IMPLICATIONS FOR PRACTICE: Dedicated time should be scheduled, in the curriculum, to allow students and lecturers to engage in meaningful constructive reflection to enhance socially responsive practice.

Computed tomography dose index for head CT in northern Nigeria.

Computed tomography dose index w and dose length product were recorded for the purpose of developing diagnostic reference levels (DRLs) for radiation dose optimisation. The study was conducted in three radiology departments with CT centres in Northern Nigeria. Data were collected from 54 consenting adult participants (weighing 70 kg ± 3) that had head CT scans. Analysis was done using SPSS version statistical software. A combined dose for the three centres was calculated and compared with the reported data from the international communities where there are established DRLs. Third quartile values of CTDIw and DLP were determined as 77 mGy and 985 mGy cm, respectively. Local DRLs that are significantly higher than most of the reported data in the literature have been established.

Presentation patterns of invasive cancer of the cervix: results from Parirenyatwa Oncology and Radiotherapy Centre, Harare, Zimbabwe 1998-2010.

MAIN OBJECTIVE: The study sought to identify the presentation patterns of invasive uterine cancer of the cervix (CaCx) in Zimbabwe in terms of histology, stage of the disease, ages of patients and socio-economic status. DESIGN: Retrospective study from 1998 to 2010. SUBJECTS: All patients who registered for the first time with invasive CaCx over a systematically selected sample period of four years (1998, 2002, 2006 & 2010). SETTING: The main referral Radiotherapy and Oncology centre in Harare the capital city of Zimbabwe. RESULTS: Majority of patients (91.75%) presented with squamous cell carcinoma, 5.5% presented with adenocarcinomas and 2.75% presented with other types of histology. Late presentation was noted with the majority of the patients (89%) presenting with stage IIB and above. The common ages of patients at presentation were between 40 to 60 years. The majority of the patients (59.5%) were of low socio-economic status. CONCLUSION: In the developed countries CaCx is reducing in frequency, presentation tends to be early, treatment effective and there is decreasing mortality rate from this disease. However in developing countries the situation is not as positive and the disease remains a major concern. This is shown by the presentation pattern of patients with invasive CaCx in Zimbabwe. The patients are shown to present with late stage disease of the squamous cell type, primarily in the age ranges of 40 to 60 years and with the majority of the patients belonging to the low socio-economic status group.

Dose-area product measurements during barium enema radiograph examinations--a Western Cape study.

The aim of this study was to obtain a direct measurement of the typical dose delivered to an average adult patient during a barium enema examination. Measurement was done on a a sample of 50 patients at three departments, using a dose-area product (DAP) meter. The comparison of the results with UK median levels indicates that the doses measured in South Africa are higher (41 Gy cm2 (dose x area) v. 48 Gy cm2). Patient protection can be improved by comparing local practice with national reference levels. The values obtained in this study (first quartile 35 Gy cm2, median 48 Gy cm2, third quartile 84 Gy cm2) are recommended as initial reference dose levels for barium enemas in South Africa.