Radiography Open

A survey of the NHS reporting radiographer workforce in England

Paul Lockwood, Christopher Burton, Theresa Shaw, Nicholas Woznitza — Mon, 05 Feb 2024 00:00:00 +0100

Introduction: At present there is no national register of the population size and scope of reporting radiographers in England. This makes operational workforce and succession planning for sustainable healthcare services in the National Health Service England (NHSE) difficult, affecting implementing NHSE policies and priorities such as 50% of X-rays reported by reporting radiographers and decreasing reporting Turnaround Times (TATs). This survey aimed to establish the workforce population employed as reporting radiographers in NHSE.

Methods: An online anonymous seven question survey was distributed on social media and at the UK Imaging and Oncology Congress. Participant criteria included NHSE radiology staff (diagnostic radiographer, reporting radiographer, radiology manager, imaging superintendent modality lead, consultant radiologist, etc.) or a student diagnostic radiographer working within an NHSE trust. The survey recorded the participant's NHSE region (North Western, North Eastern and Yorkshire, Midlands, East of England, London, South Eastern and South Western regions), Integrated Care Systems (ICS), NHSE Trust, hospital, the amount of reporting radiographers and trainees employed, the Agenda for Change (AfC) job banding and imaging modality reported (X-ray, CT, MRI, NM, PET, DEXA). The data analysis applied descriptive statistics for estimating patterns and trends in the distrubtion of data (English region, AfC banding and imaging modality).

Results: Responses were received from all seven of the NHSE regions (n=36/43 ICSs). The data demonstrated a larger workforce in the north of England than in the south, with employment at a range of AfC bandings from 5-8. The imaging modalities reported by radiographers in England demonstrated X-ray (n=34), the most reported imaging examination by region, and Nuclear Medicine (n=3) the least, with evidence of clinical reporting for CT (n=20), MRI (n=18), DEXA (n=16), Mammography (n=13) and fluoroscopy (n=12) being completed by radiographers in England.

Conclusion: The findings for England (n=704 reporters; n=142 trainees) provide an estimate based on the response rate of the current reporting radiographer workforce across the NHSE regions, and their contribution to the skills mix radiology reporting service delivery. It is hoped future surveys will provide ongoing workforce estimates for the diagnostic radiographer reporting workforce in NHSE to support workforce transformation and sustainability plans for the radiography profession and to meet government healthcare targets and priorities.

Comparison of Size specific dose estimates (SSDE) and CTDIvol values in patients undergoing CT examinations of abdomen and pelvis

Sweta Joshi, Sharma Paudel, Shanta Lall Shrestha, Surendra Maharjan — Mon, 17 Jun 2024 00:00:00 +0200

Introduction: Computed Tomography Dose Index volume (CTDI_vol) is a measure of radiation output of the CT scanner and does not represent patient dose. It often underestimates the radiation dose being given to small children and smaller adults and overestimates the dose to larger patients. The use of Size Specific Dose Index (SSDE) helps convert CTDI_vol into more patient size specific radiation dose and is a better measure of estimated patient dose than CTDI_vol.

Methods: This cross-sectional study was conducted in the Department of Radiology and Imaging of Tribhuvan University Teaching Hospital (TUTH), Maharajgunj, Nepal. CT scans were performed on the Siemens Somaton Definition AS+ 128 slice scanner. During 96 CT examinations of the abdomen and pelvis collected over a period of 4 months, effective diameters were calculated from the AP and Lateral diameters at the mid-liver region. These were used to determine the conversion factors which were then used to convert the CTDI_vol values to SSDE. Obtained SSDE values were compared with the displayed CTDI_vol values.

Results: The average CTDI_vol was found to be 9.42 ± 3.26 mGy and the average SSDE was found to be 13.48 ± 3.53 mGy. Moderate positive correlation (r=+0.52, p<0.001) was found between CTDI_vol and patient weight and low positive correlation (r=+0.17, p=0.08) was found between SSDE and patient weight. Similarly, moderate positive correlation (r=+0.5, p<0.001) was found between CTDI_vol and patient BMI and low positive correlation (r=+0.14, p=0.15) was found between SSDE and patient BMI.

Conclusion: In comparison with SSDE, CTDI_vol seemed to underestimate the patient dose estimate by 30.11%. CTDI_vol values showed dependency with patient weight and BMI, this dependency was significantly reduced when those values were converted into SSDE (i.e. r=+0.52, p<0.001 (CTDI_vol and Patient weight) vs. r=+0.17, p=0.08 (SSDE and Patient weight) and r=+0.5, p<0.001 (CTDI_vol and BMI) vs. r=+0.14, p=0.15 (SSDE and BMI). Thus, providing more concrete evidence to the fact that SSDE values are a more reliable patient dose estimate since it addresses the patient’s size.

Optimizing Real-Time Advanced Ultrasound Supervision in a University Setting

Nina Hanger, Lydia Johnsen, Ruth Stoklund Thomsen, Ragna Stalsberg — Tue, 03 Sep 2024 00:00:00 +0200

Introduction: Ultrasound-based diagnosis requires great expertise for reliability and accuracy, thus practical training is vital. Digital training can offer students the possibility of practical training in their local setups. However, there are critical issues that remote educators must address, particularly in advanced ultrasound training. The present study was therefore aiming at developing a suitable technical setup for supervision and education in tele-ultrasound that can be applied to a variety of advanced diagnostic and therapeutic areas.

Methods: Using an action research approach including four cycles of action, we tested four technical setups with different software and hardware components across four ultrasound courses. Based on evaluation forms, written reflections, and two focus group interviews from the four cycles of action, respectively, we modified the setups to improve the technical solution for the next cycle.

Results: The initial set-up was using commercial video call apps via mobile phones. Although no additional equipment or expertise was required, it was precluded by the poor image quality and motion blur resulting from capturing the ultrasound image on the smartphone. Nevertheless, this solution is viable when quick clarifications are needed. Additional stabilization support in the second set-up did not provide satisfactory image quality. The best technical solution was found in the third set-up, using a frame grabber and Reacts, which allows simultaneous live streaming of the ultrasound screen image and two web cameras. However, the cumbersome software interface, the need for an expensive user license, and problems with the internet connection reduced the acceptability of this setup. The optimal setup in cycle four, was a reasonable frame grabber, and Zoom, which is free, has a simple user interface and can stream live audio-visual ultrasound data from the probe and user simultaneously. Its annotation function is also beneficial in supervision.

Conclusion: Through an action research approach including four cycles of action and thorough, subsequent evaluations, we found that a videoconferencing platform, such as Zoom, a computer, and a frame grabber connected to the ultrasound scanner was the optimal solution as this set-up is simple and affordable and is facilitating a good video-transmitted learning situation for students and supervisors. This technical set-up could therefore be suitable for a wide range of remote ultrasound courses.

A quality improvement project addressing motion artefact on CTPAs in a district general hospital setting: A complete cycle resulting in changed practice.

Jin Kai Soh, Natalia Roszkowski — Tue, 17 Sep 2024 00:00:00 +0200

Introduction: A still breath hold from the patient is one of the key requirements for a diagnostic computed tomography pulmonary angiogram (CTPA). It is important for the timely identification and treatment of patients with life threatening pulmonary emboli (PEs). Motion artefact on CTPA can cause blurring, double borders, shading and streaking in the lungs, which can either obscure PEs or create artefact that mimics PEs. This risks patient harm from delayed diagnoses, missed PEs, false positives and extra radiation and contrast exposure due to repeat studies.

Methods: We devised local standards and methodology for assessing the presence and degree of motion artefact on CTs. The study consisted of initial data collection, implementation of changes to clinical practice, and subsequent repeat data collection 3 months after implementation of interventions. For each data collection round, 100 consecutive inpatient and emergency CTPAs performed in a UK District General Hospital were retrospectively identified and images reviewed to categorise each as having either: ‘no significant’, ‘minor’ or ‘major’ motion artefact. There were no exclusions. Interventions after initial data collection included a multidisciplinary meeting with radiographers, department assistants, and radiologists to devise changes to workflow and practices to build in 'rehearsal' of a breath-hold and explanation of breathing instructions with patients before scanning. A prompting phrase for this was added to our CTPA scanning protocol.

Results: Initial results demonstrated that 50% of CTPA showed either minor or major motion artefact, while 50% showed no significant motion artefact. For 2% with minor motion, a clinical reason for why this was unavoidable was provided. Therefore 52% of studies met the proposed local standards. In total, 45% of CTPA were assessed to have minor motion and 5% had major motion artefact (non-diagnostic). 18% of CTPA were positive for PE. Following implementation of changes to practice, repeat data collection demonstrated that 67% of CTPA showed no significant motion artefact. 3% with minor motion provided a clinical reason why this was unavoidable. Therefore 70% of studies met the proposed standard. The increase in compliance with local standards was statistically significant (p=0.00906).

Conclusion: Our interventions improved compliance with local standards from 52% to 70%. We recommend rehearsal of breath-holding with patients before CTPA scans as a quick and easy way to improve the diagnostic quality of scans. A prompting phrase within the CTPA scanning protocol has proven effective.