Roles and Responsibilities in the Transition to Working Independently: A Qualitative Study of Recently Graduated Radiographers' Perspectives in Australia.

Background: Medical imaging features along the entire healthcare continuum and is known for its fast-paced technological evolution which enables it to keep up with the demands of the healthcare system to provide safe, quality services. The overall efficacy and efficiency of the system depends on practitioners' clinical competence, achieved through professional education and continuous professional development. Recent studies have revealed concerns regarding newly graduated healthcare professionals' preparedness and readiness to handle actual practice. Methods: We conducted qualitative face-to-face and telephonic interviews with a convenient and purposive sample of 23 participants consisting of recently graduated radiographers (n=14), radiography students (n=5) and supervising radiographers (n=4) in Australia. Verbatim transcriptions were analyzed inductively to identify themes pertaining to perspectives and experiences of the work readiness of novice radiographers. Results: The findings of our study suggest that the workplace immersion and transitioning of recently graduated radiographers into their professional roles requires a process of experiential learning and honing of knowledge and skills if they are to function efficiently and independently in a team-oriented workplace. Radiographic services are spread across various levels of care and are an integral part of the organizational structure of a healthcare system. Maladaptive transitions to the workplace may be the result of low self-confidence, a lack of support, uncertainty in inter-collegial interactions, or unrealistic performance expectations. The overarching themes of communication and interaction emerged clearly as recently graduated radiographers navigated the four roles of coordinator, collaborator, mediator, and advocate. Conclusion: The application of radiographic skills is embedded in a workplace culture of communication and safety. Transitioning to independent practice takes place in a complex, multifaceted environment and is accompanied by internal and external expectations. Because each workplace has a unique context, system and culture, no novice radiographic professional can ever be fully prepared through pre-service training and workplace induction.

Students' and Qualified Radiographers' Perspectives and Understanding on Occupational Dose Monitoring and Prevention Strategies.

ABSTRACT: Effective implementation and ongoing monitoring of occupational radiation safety and protection is key for radiographers as prolonged exposure to ionizing radiation can increase the risk of long-term ill health effects. It is important that radiographers are aware of what is required of them to remain within the permitted dose limit. Topics and training on dose monitoring and occupational practice safety and practice are embedded in both undergraduate and postgraduate courses and ongoing as part of continuous professional development. However, whether these are accurately, effectively implemented and adhered too in practice needs to be monitored. This study aimed to investigate students and radiographers' awareness, observations, and understandings of their compliance to occupational radiation safety and protection and monitoring thereof in the clinical setting. A cross sectional survey design with a questionnaire consisting of closed and open-ended items were used. The data were analysed with the use of SPSS statistical software tool. The response rates for student radiographers were 62% and qualified radiographers 23.19%. Most participants indicated that they were knowledgeable on best practice methods regarding radiation protection and safety. However, regarding the importance of personal monitoring devices, the responses varied and there were some inconsistencies. The perspectives of participants on rotating through different imaging examination types revealed that of least importance was the occupational exposure. Students were focused as part of their training on acquiring the necessary skills to conduct imaging examinations. Qualified radiographers focused on upkeeping their skills when it came to their rotation between the general and specialized imaging examinations. To overcome some of these inconsistencies it is recommended that standardized practice guidelines be reviewed by both the academic institution and the clinical training sites enforcing the importance of dose monitoring and radiation safety and best practice principles.

The emerging radiographer's transient community service professional career pathway.

BACKGROUND: Post-qualification regulatory 12-month community service (CS) was implemented in South Africa in 1998. Since the implementation, studies have been conducted in various disciplines to measure the impact on health services and on the affected professionals, but these did not include radiography professionals. AIM: This study explored the expectations and experiences of student radiographers in respect of the CS concept as an integral transitional career pathway from the student radiographer role to that of a provisional practitioner in transit to acquiring registered radiographer practitioner status. RESEARCH METHODS: The research design entailed a qualitative exploratory approach using a longitudinal data collection approach. That is, data collection from the purposefully selected student radiographers' focus group discussions, as well as from placement institutions' qualified professionals and managers, formed the triangulated data sources. In addition, individual interviews were conducted post-placement until data and thematic saturation had been reached. Tesch's (1990) method was used for the data interpretation and analysis. RESULTS: The themes that emerged reflected the preparedness of these students to fulfil the requirements, their experiences of their anticipated placement institution, preparedness for their roles and responsibilities and uncertainties about their readiness for the actual encounter. A golden thread throughout was critical self-reflection on their ability, adaptability and capability to meet the requirements of the system, namely the community placement institutions and appeasing the Department of Health. CONCLUSION: The study illustrates, by means of a framework, the student radiographers' journey in transit to acquiring eligibility as registered radiography practitioners in a regulated career pathway.

Distributed decision making in action: diagnostic imaging investigations within the bigger picture.

INTRODUCTION: Decision making in the health care system - specifically with regard to diagnostic imaging investigations - occurs at multiple levels. Professional role players from various backgrounds are involved in making these decisions, from the point of referral to the outcomes of the imaging investigation. The aim of this study was to map the decision-making processes and pathways involved when patients are referred for diagnostic imaging investigations and to explore distributed decision-making events at the points of contact with patients within a health care system. METHOD: A two-phased qualitative study was conducted in an academic public health complex with the district hospital as entry point. The first phase included case studies of 24 conveniently selected patients, and the second phase involved 12 focus group interviews with health care providers. Data analysis was based on Rapley's interpretation of decision making as being distributed across time, situations and actions, and including different role players and technologies. RESULTS: Clinical decisions incorporating imaging investigations are distributed across the three vital points of contact or decision-making events, namely the initial patient consultation, the diagnostic imaging investigation and the post-investigation consultation. Each of these decision-making events is made up of a sequence of discrete decision-making moments based on the transfer of retrospective, current and prospective information and its transformation into knowledge. CONCLUSION: This paper contributes to the understanding of the microstructural processes (the 'when' and 'where') involved in the distribution of decisions related to imaging investigations. It also highlights the interdependency in decision-making events of medical and non-medical providers within a single medical encounter.

A randomized-controlled study of a modified technique to reduce extracardiac activity in myocardial perfusion imaging.

INTRODUCTION: Various techniques have been used in an attempt to reduce interfering extracardiac activity in myocardial perfusion imaging with inconsistent results. The aim of this study was to investigate the effect of a combined intervention on the frequency and intensity of interfering extracardiac activity. METHODS: Patients (n=230) routinely referred for a 2-day stress-rest myocardial perfusion examination were assigned randomly to one of two groups. Group A (n=114) received a single intervention (diluted lemon juice) before stress imaging and a combined intervention (diluted lemon juice and soda water) before rest imaging. Interventions were reversed for group B (n=116). Three interpreters, blinded to the intervention, assessed early and delayed planar images from 195 patients in terms of the frequency and the intensity of interfering extracardiac activity. RESULTS: The myocardial to extracardiac (MYO : EXC) ratio between groups for the rest studies was marginally not significant (P=0.060 and 0.059), showing an increase in ratio when the combined intervention was administered. There were significant differences (P≤0.001) in the frequency, intensity, and MYO : EXC ratio between the early and the delayed studies. CONCLUSION: Combining interventions that stimulate radiopharmaceutical hepatic excretion and utilize the volume effect is advantageous in myocardial perfusion imaging, with delayed imaging being advocated as a complementary intervention.

Comparison of rubidium-82 myocardial blood flow quantification with coronary calcium score for evaluation of coronary artery stenosis.

INTRODUCTION: PET myocardial perfusion imaging (MPI) is the standard technique for assessing myocardial function, but provides limited information on the anatomy of cardiac structures whereas the coronary artery calcium (CAC) score provides information on calcified plaque burden and the anatomical structure of the coronary arteries. The aim of this study was to determine the relationship between quantitative myocardial blood flow (MBF), CAC, and coronary artery disease (CAD). This work also aims to determine whether MBF quantification and/or CAC add value to relative MPI, and aid in the reclassification of patients with CAD. This way, a 'gatekeeper' study could be identified to predict coronary artery stenosis and improve our clinical service. MATERIALS AND METHODS: Rubidium-82 PET/CT MPI, calcium score, and computed tomographic coronary angiography imaging were performed in 128 patients with known or suspected CAD. The presence of ischemia was assessed from qualitative reporting of rubidium-82 MPI, and using the same data, quantitative values of MBF and coronary flow reserve (CFR) were derived. Calcium score images were quantitatively analyzed and categorized into three groups defined by CAC values of 0, 1-400, and >400. Significant stenosis was classified as stenosis of 50% or more on computed tomographic angiography. RESULTS: A total of 120 patients were included in the final analysis (77 men, 43 women). Our results showed an inverse correlation between stress MBF, CFR, and the percentage stenosis as well as an inverse correlation compared with CAC. A direct correlation between CAC and the percentage stenosis was observed, indicating that an increase in coronary calcification in individual coronary arteries is related to the severity of the coronary stenosis. These results proved that the addition of stress MBF to relative MPI (32%) resulted in a significantly higher sensitivity (48%, P=0.002), which increased significantly more with the addition of CFR (58%, P≤0.001). The further addition of CAC resulted in a significantly higher sensitivity (80%, P=0.001), with an even higher sensitivity with the addition of both CFR and CAC (95%, P≤0.001) to relative MPI. CONCLUSION: The addition of quantitative MBF conferred a substantial added diagnostic value to relative MPI for the diagnosis of CAD by highlighting compromised flow with the addition of CAC, increasing this added value even more. We recommend that this approach should be used to predict the presence of coronary artery stenosis at its earliest stage and guide physicians when making decisions on the management pathway of CAD without exposing patients to a high radiation dose during cardiac angiography.

Healthcare provider and patient perspectives on diagnostic imaging investigations.

BACKGROUND: Much has been written about the patient-centred approach in doctor-patient consultations. Little is known about interactions and communication processes regarding healthcare providers' and patients' perspectives on expectations and experiences of diagnostic imaging investigations within the medical encounter. Patients journey through the health system from the point of referral to the imaging investigation itself and then to the post-imaging consultation. AIM AND SETTING: To explore healthcare provider and patient perspectives on interaction and communication processes during diagnostic imaging investigations as part of their clinical journey through a healthcare complex. METHODS: A qualitative study was conducted, with two phases of data collection. Twenty-four patients were conveniently selected at a public district hospital complex and were followed throughout their journey in the hospital system, from admission to discharge. The second phase entailed focus group interviews conducted with providers in the district hospital and adjacent academic hospital (medical officers and family physicians, nurses, radiographers, radiology consultants and registrars). RESULTS: Two main themes guided our analysis: (1) provider perspectives; and (2) patient dispositions and reactions. Golden threads that cut across these themes are interactions and communication processes in the context of expectations, experiences of the imaging investigations and the outcomes thereof. CONCLUSION: Insights from this study provide a better understanding of the complexity of the processes and interactions between providers and patients during the imaging investigations conducted as part of their clinical pathway. The interactions and communication processes are provider-patient centred when a referral for a diagnostic imaging investigation is included.

Multiprovider and Patient Perspectives on Conveying Diagnostic Imaging Investigation Results in a South African Public Health Care System.

INTRODUCTION: This study explored interaction processes in conveying messages about the results of diagnostic imaging investigations in a public hospital complex in South Africa from the perspective of health care providers and patients. METHODS: The study was part of a qualitative inquiry into the interaction and communication processes relating to diagnostic imaging investigations in the public health care system. Data collection included individual interviews with 24 patients and 62 health care providers (ie, medical practitioners, specialists, radiologists, registrars, radiographers, and nurses). In addition, 12 focus group interviews were conducted with health care providers. The transcribed data were coded and analysed to identify categories and themes. RESULTS: Three main themes emerged from the study. The first theme deals with the medical territory, specifically who should interpret and convey the diagnostic results to the patient. The second theme highlights the role of radiographers and nurses in communicating parts of the diagnostic results. The last theme focuses on patient experience, interpretation, and comprehension in the provider-patient communication process. CONCLUSIONS: The findings provide a multidimensional view about the disclosure of imaging results to patients by medical and nonmedical health care providers. Further research is needed on the role of nonmedical providers in the context of ethical and moral obligation toward patients and the professional restrictions inherent in their scope of practice.