Imaging of the adjacent upper limb: Outcomes and diagnostic yield.

INTRODUCTION: Injuries to extremities are a common presentation to emergency departments and may be associated with multiple abnormalities. Patients may be referred for X-ray imaging of multiple adjacent regions, but the diagnostic outcomes of these X-ray examinations have not been fully explored. The aim of this study was to assess the diagnostic efficacy of X-ray examinations of adjacent body regions in the upper limb. METHODS: Upper limb X-rays examinations performed over six months were collected from two hospitals, and all patients who had adjacent regions X-rayed were included. Using the radiology reports as a reference standard, the diagnostic yield of these additional adjacent X-ray examinations was assessed. Descriptive statistics and Pearson's Chi Square were used for data analysis. RESULTS: 591 patients had 1455 X-ray examinations, ranging from two to six X-ray requests. More than 80% of X-ray examinations were due to an injury, but less than 60% had symptoms mentioned in the clinical history. Overall, 39.1% of initial examinations reported a new finding but only 1.5% of all subsequent imaging had a new abnormality detected. Examinations with symptoms specified in the clinical history were more likely to detect new findings (p=<0.001). CONCLUSION: Imaging is an essential diagnostic tool in medical settings, but all radiographic tests should be justified, and adjacent imaging has a low diagnostic yield, hence, all limbs should be carefully assessed individually to assess the need for imaging. Every request should be justified based on presentation and symptoms, particularly when multiple areas may be impacted. IMPLICATIONS FOR PRACTICE: Radiographic imaging is easily accessible but adherence to guidelines and assessing the diagnostic yield of common examinations is important to ensure benefits to patients.

Infection prevention and control in CT Part 1: An Australian study of roles, responsibilities and practices.

INTRODUCTION: The computed tomography (CT) suite presents Infection Prevention and Control (IPC) risks for staff and patients. This is the first of a two-part series on IPC in the CT setting and reports on Australian baseline data related to intravenous contrast media administration and the use of power injectors in the CT suite, including knowledge sources related to the delivery of contrast media. The second part provides insights into CT staff's perceptions of high-risk scenarios for non-adherence to standard or transmission-based precautions. METHODS: The study employed an online survey design, directed at radiographers and radiology nurses working in Australia. The survey included questions relating to CT workplace staffing and equipment, contrast media use and occupational roles, and knowledge sources used for infection control and contrast injectors. RESULTS: Overall, 160 study participants completed the survey (radiographers: n = 138, 86.3%; nurses: n = 22, 13.7%). Differences were identified between public and private practice. Public hospitals completed more contrast-enhanced scans, and with dual injecting systems, operated and cleaned by radiographers and nurses. Private clinics generally used single-system, power injectors. Radiographers and nurses relied heavily on their colleagues and product guidelines for IPC information. IPC teams were uncommon in private clinics, very common in public departments and 50% of respondents had undertaken IPC training in the last 12 months. CONCLUSION: Insights into use and duties of professionals delivering intravenous contrast media administration using power injectors in the CT suite will help to inform decision-making processes on IPC education strategies and map risk. IMPLICATION FOR PRACTICE: Future research should focus on how radiology workers in CT perceive IPC risk and/or might vary from best practice, which has direct clinical implications for safety if contamination, or incorrect information is routinely applied.

Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols.

INTRODUCTION: Adherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. METHODS: A self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question "If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …" was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. RESULTS: Study participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). 'Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to 'Tasks' (43.7%) and 'Organisation' (30.6%) followed by issues related to 'Person' (16.9%), 'Tools and technology' (6.9%) and 'Environment' (1.9%). CONCLUSION: Multi-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. IMPLICATIONS FOR PRACTICE: Future studies that focus on evaluation of 'Tasks' and 'Organisation' domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.