Concept analysis of 'Facilitating a transformative radiation protection environment'.

INTRODUCTION: Suboptimal radiation protection evidenced in literature necessitated the development of a theory to optimise radiation protection. To develop a theory, concept analysis of the central concept guiding the theory is required to provide explicit theoretical and operational definitions. This article presents the concept analysis of the central concept of 'facilitating a transformative radiation protection environment' used to develop a theory to optimise radiation protection. METHODS: The study used Walker and Avant's concept analysis process of selecting a concept, determining the aims and purpose of analysis, identifying all uses of the concept, and determining the defining attributes by identifying a model case, a borderline case and a contrary case. RESULTS: The central concept was dissected into the individual concepts of facilitating, transformative, radiation, protection, and environment to enhance the definition and conceptual meaning of the central concept. The essential and related attributes of the individual concepts informed the summative definition of the central concept, and a model, borderline and contrary case contributed to the conceptual meaning. CONCLUSION: The summative definition of the central concept of "facilitating a transformative radiation protection environment" was determined to be through the essential attributes of help, process, change, X-rays, keeping safe considering the benefits versus risks of ionising radiation exposure and the total internal, external context within which persons exist and the related attributes. IMPLICATIONS FOR PRACTICE: Explored extensively in nursing literature, concept analyses in radiography are limited. Therefore, this article articulates the process of concept analysis and its use in radiography. Concept analysis provides a systematic process to analyse concepts often assumed to be understood, highlighting its importance in radiography literature and to educational praxis.

Radiographers' organisational commitment and occupational stress: First Covid-19 wave.

INTRODUCTION: Radiographers, like many health professionals, are in a high-risk group for succumbing to workplace demands beyond their ability to cope, particularly in the context of the COVID-19 pandemic resulting in occupational stress. Occupational stress has been linked to poor organisational commitment. Therefore, the purpose of this research was to evaluate radiographers' organisational commitment and occupational stress after the first wave of the COVID-19 pandemic. METHODS: A mixed method approach entailed data collected from purposively sampled Australian radiographers working during the first COVID-19 wave. The quantitative phase used an online commitment questionnaire, and 21 semi-structured individual virtual interviews were conducted in the qualitative phase. Data interpretation and analysis used statistical and thematic approaches. RESULTS: The quantitative data revealed a higher level of continuance than affective and normative commitment. Whereas the qualitative findings showed participants high levels of affective commitment to their occupation and, together with leadership support, working collectively towards a positive outcome. CONCLUSION: Despite the variety of occupational stressors that arose during the COVID-19 crisis, Australian radiographers enjoy a high level of occupational and organisational commitment. IMPLICATIONS FOR PRACTICE: Radiographers' organisational commitment represents their emotional and psychological attachment to their workplace, and radiographers experiencing occupational stress represent high levels of psychosomatic distress and burnout. Therefore, considering radiographers' organisational commitment and occupational stress is essential in the delivery of services, quality of patient care and radiographers well-being.

Radiographers' experiences and perspectives of forensic imaging in Australia: A qualitative study.

INTRODUCTION: Forensic imaging plays a pivotal role regarding medico-legal issues by investigating the cause(s) of injuries to living or deceased individuals. There is currently a gap in the literature on forensic imaging due to limited national and international guidelines, protocols and scope of duties and responsibilities of radiographers undertaking forensic imaging. Thus, this study aimed to investigate the gap by exploring the experiences and perspectives of radiographers on forensic imaging in Australia. METHODS: A qualitative approach collected data from fifteen purposively sampled qualified Australian radiographers through individual in-depth interviews. The verbatim transcribed data were thematically analysed. RESULTS: Two themes were identified: 1) Radiographers' experiences of forensic imaging; 2) Radiographers' perceptions of forensic imaging within the job scope of a qualified radiographer. CONCLUSIONS: Participants' experiences of forensic imaging ranged from anxiety to a positive experience, and others posed ethical and situational dilemmas heightened by the lack of dedicated forensic imaging protocols. While some radiographers expressed that every radiographer should conduct forensic imaging, others felt it was not mandatory. IMPLICATIONS FOR PRACTICE: Radiographers' shared subjective experiences, thoughts and feelings provided insight into forensic imaging and the need for more significant support from educational and governing bodies.

South African radiographers' radiation protection practices, a qualitative study.

INTRODUCTION: Radiation protection is multifarious, and consequently, a radiographers' application of radiation protection is multifaceted. Studies have shown varying radiation protection practices among radiographers. The first quantitative phase of this explanatory, sequential mixed-method study used the theory of planned behaviour to explore South African radiographers' radiation protection behaviour. Overall, South African radiographers' attitudes to radiation protection, subjective norm, perceived behavioural control, and radiation protection intention was high. This second phase of the study aimed to explore the reasons for South African radiographers' radiation protection practices. METHODS: This study used an exploratory and descriptive qualitative approach. Data was collected through 13 in-depth semi-structured telephone interviews. Thematic analysis was used in order to uncover original phenomena. Data saturation was achieved and the study adhered to trustworthiness and ethical measures. RESULTS: Thematic analysis identified two themes. The participants had the appropriate radiation protection knowledge, but radiation protection compliance remained a personal choice. Impediments such as feeling rushed during imaging of trauma and challenging patients, patients knowledge of radiation protection, resources, imaging referrals, inadequate training when transitioning from analogue to digital radiography and managerial support contributed to radiation protection compliance. Strategies such as further education, research and a change in mindset were suggested to further foster radiation protection compliance. CONCLUSION: Even though participants' knowledge of radiation protection aligned with the legislated guidelines, limited internalising of the knowledge resulted in compliance being a personal choice. Participants reflected on their insouciant attitude and observed a similar attitude in their radiographer colleagues. Patient and work-related impediments were identified to contribute to radiation protection compliance. Strategies to further foster compliance were suggested. IMPLICATIONS FOR PRACTICE: Understanding the reasons for radiographers' choice in radiation protection will allow the development of strategies that foster optimum application of radiation protection practises. Developing a radiation protection culture that enhances personal compliance supported by education and evidence should be considered.

Ethnography and medicine: the utility of positivist methods in research.

This commentary discusses the methodological utility of ethnography within the medical space. Whilst a general consensus affirms that ethnography aligns with qualitative approaches, as identified within the existing medical literature, here, we demonstrate how quantitative [positivist] methods can also be incorporated. This paper begins by contextualising ethnographic approaches within medical contexts by demonstrating its empirical value within the existing literature. Next, we discuss the interconnection between the practice of 'doctoring' and ethnographic research, whereby doctors themselves use forms of inductive and deductive reasoning to treat and manage patients in their everyday context. This philosophical discussion not only links to the everyday practice of medical practitioners, but also critically reflects on the role of the first author, as a diagnostic radiographer. Lastly, this paper identifies the virtues of ethnographic research for medical students and/or medical doctors whereby the combination of qualitative and quantitative methods (within an ethnographic methodology) can lead to new empirical and methodological insights, enabling the creation of alternate research strategies and evidence. This methodological strategy may be best considered amongst medical students and/or early career medical researchers, but we also anticipate it to resonate and open further discussion with experienced medical practitioners and researchers transnationally.

Investigating perceptions of 'dose creep' amongst student radiographers: A grounded theory study.

INTRODUCTION: The dose creep phenomenon is now a widely recognized concept in diagnostic radiography in light of recent technological advancements transnationally. However, this still remains underexplored amongst radiography students preparing to enter the radiography profession. In response, this study explores the perceptions of dose creep amongst undergraduate student radiographers. METHODS: The methodological approach utilized in this research study was grounded theory. The qualitative approach aimed to uncover findings from a higher education institution in Australia. Six students were recruited and took part in semi-structured interviews. This enabled the exploration of previously uncovered data, leading to the construction of original theory within the clinical and academic environment. The data analysis employed was constant comparative analysis (CCA). RESULTS: A number of insights emerged from the qualitative data set. For instance, the radiography students understanding of the term 'dose creep' and decision making leading to dose creep in the clinical environment is captured. This is further supported with assessment of image evaluation determining appropriate exposure factor selection and future impact upon graduation as diagnostic radiographers. The findings identify some important learning needs and actions for both clinical and academic settings which may help foster good use of X-ray exposures. CONCLUSION: This paper concludes by affirming some challenges surrounding optimal exposure selection and the known phenomenon, dose creep. Further, this study identifies the importance of learning and teaching in the clinical environment whereby learned behaviour leads to suboptimum practices. IMPLICATIONS FOR PRACTICE: This study advances the existing evidence base by providing a unique lens into the knowledge and understanding of dose creep amongst radiography students in both academic and clinical contexts. It is anticipated this paper will help practitioners and educators better understand potential instances of dose creep within the clinical environment.

How effective are lead-rubber aprons in protecting radiosensitive organs from secondary ionizing radiation?

INTRODUCTION: The purpose of this experiment was to explore the direction of scattered secondary ionizing radiation to a patient. A left lateral radiographic examination of the elbow was deemed appropriate due to its close proximity to radiosensitive organs and record dose limiting opportunities upon wearing a lead-rubber apron. METHODS: An anthropomorphic phantom and lead-rubber apron (Pb 0.35 mm) was used with a 15 cc ionization chamber (model 10,100 AT TRIAD) to measure scattered radiation to radiosensitive organs. Dose readings were recorded before and after in order to quantify dose reduction. Pearson's correlation, linear regression, t-test and one way analysis of variance (ANOVA) statistics were used to affirm how likely dose limitation was attributed to chance (p < 0.05). RESULTS: The lead-rubber apron offered dose reduction to most radiosensitive organs. Notably, ionizing radiation was significantly reduced to the left breast 0.0083 µGy (98%), right breast 0.0000 µGy (99.9%) and spleen 0.0262 µGy (99.9%). No empirical benefit was recorded for testes and ovaries. Interestingly, the thyroid recorded an increase in dose (0.1733 µGy; p = 0.01). This was later mitigated using a thyroid collar but identifies increased stochastic risks if lead-aprons are worn alone. Scattered radiation was also reduced to both eyes, which were not directly covered. CONCLUSION: Lead-rubber aprons are generally utilized to limit ionizing radiation, yet this article offers insight whereby increases to ionizing radiation to the thyroid are plausible when wearing a lead-rubber apron alone. Whilst these findings cannot be generalized to other radiographic examinations it provides insight into a potential increase risk of scatter to a radiosensitive organ. IMPLICATIONS FOR PRACTICE: This paper has implications because it identifies that lead-rubber has an impact on scattered ionizing radiation to radiosensitive organs for a lateral elbow examination. Further, it identifies the potential for ionizing radiation to be increased to the thyroid upon wearing a lead-rubber apron alone.

The detection of wooden foreign bodies: An experimental study comparing direct digital radiography (DDR) and ultrasonography.

INTRODUCTION: This experimental study compares the appropriateness of direct digital radiography (DDR) and ultrasonography at detecting soft-tissue wooden foreign bodies (FBs) in extremities. METHODS: Varying wooden FB splinters (2 mm, 5 mm and 10 mm) were inserted into eight porcine feet to simulate a patient presenting with a soft-tissue FB injury. Each of the FBs was placed in muscle distant, behind and near bone in the porcine feet. Control groups were used to check for false-positive diagnoses and, based on the presence of FBs; images were given a score depending on the level of visibility by the researcher. RESULTS: A higher detection rate was achieved for all FBs in muscle distant from bone using ultrasound. All of the 2 mm and 5 mm wooden FBs were not detected using DDR. The sensitivity in detecting the FBs was 5.8% and 30% in DDR and ultrasound respectively. CONCLUSION: Poor sensitivities and specificities were identified in this study. However, this study shows that ultrasound remains superior to DDR at identifying small foreign body objects. This study demonstrates that ultrasound can be a clinically effective tool for detecting suspected wooden FBs >5 mm in the foot and thus should be considered as the primary imaging modality of choice for referring clinicians.

Attitudes and perceptions of radiographers applying lead (Pb) protection in general radiography: An ethnographic study.

INTRODUCTION: Since the discovery of X-rays by Rontgen in 1895, lead (Pb) has been used to limit ionising radiation for both operators and patients due to its high density and high atomic number (Z = 82). This study explores the attitudes and perceptions of diagnostic radiographers applying Pb protection during general radiographic examinations, an area underexplored within a contemporary radiographic environment(s). METHODS: This paper presents findings from a wider ethnographic study undertaken in the United Kingdom (UK). The use of participant observation and semi-structured interviews were the methods of choice. Participant observation enabled the overt researcher to uncover whether Pb remained an essential tool for radiographers. Semi-structured interviews later supported or refuted the limited use of Pb protection by radiographers. These methods enabled the construction of original phenomena within the clinical environment. RESULTS: Two themes are discussed. Firstly, radiographers, underpinned by their own values and beliefs towards radiation risk, identify a dichotomy of applying Pb protection. The cessation of Pb may be linked to cultural myths, relying on 'word of mouth' of peers and not on the existing evidence-base. Secondly, radiographers acknowledge that protecting pregnant patients may be primarily a 'personal choice' in clinical environments, which can alter if a patient requests 'are you going to cover me up?' CONCLUSION: This paper concludes by affirming the complexities surrounding Pb protection in clinical environments. It is proposed that the use of Pb protection in general radiography may become increasingly fragmented in the future if radiographers continue rely on cultural norms.

Image acquisition in general radiography: The utilisation of DDR.

OBJECTIVE: This article explores image acquisition with DDR. General radiographic technology continues to advance therefore it remains paramount to continually reflect on DDR hardware and software amongst radiographers in an imaging modality that constitutes approximately 90% of all radiological examinations. METHOD: This article reports findings from a wider ethnographic study of two general radiography environments in the United Kingdom (UK). Participant observation and semi-structured interviews were the methods used to uncover original data. RESULTS: Two key themes are discussed. Firstly, 'the extent of DDR knowledge' amongst radiographers is examined. The findings uncover that not all radiographers have an adequate knowledge base with DDR technology. Secondly, 'pitfalls and near misses with DDR' is discussed. This theme highlights the potential danger of radiographers 'over-repeating' X-ray examinations, coincided with the occurrence of radiological incidents whereby a patient is exposed to ionising radiation with no added benefit. CONCLUSION: This paper concludes by challenging the current 'skill base' to operate DDR equipment. In addition, new pitfalls and near misses are highlighted, which may help forestall radiation incidents in the future. Dose and image optimisation remain central tenets to the role of the radiographer. ADVANCES IN KNOWLEDGE: Few studies have challenged image acquisition with DDR. This study adds to existing knowledge by uncovering original phenomena that may initiate discussions within the radiography community and continually enhance healthcare delivery.