• Accident and emergency radiography: A comparison of radiographer commenting and 'red dotting'

      Hardy, Maryann L.; Culpan, Gary (2007-02)
      Purpose: The College of Radiographers has called for ‘Red Dot’ schemes to evolve and has recommended the development of radiographer commenting. The implementation of a radiographer comment scheme assumes that radiographers previously participating in ‘red dot’ schemes have been accurately recognising radiographic abnormalities and are, therefore, able to comment upon, and describe, such radiographic appearances. Research evidence to support such an assumption is sparse. This study compares the ability of radiographers attending a short course on musculoskeletal trauma to ‘red dot’ and comment on A&E radiographic appearances. Methods: This study adopted a pre-test, post-test approach. One hundred and twenty one radiographers attending a short course on musculoskeletal trauma (Bradford Red Dot Course) were invited to undertake an assessment of their ability to recognise (‘red dot’) and describe (comment upon) radiographic abnormalities at the start and end of the short course. Results: One hundred and fifteen radiographers (n = 115/121; 95.0%) completed both the pre- and post-training assessments. Post-training mean scores per case improved on average by 9.8% [p = 0.012; 95% CI: 2.4, 17.1] for ‘red dots’ and 12.7% [p = 0.007; 95% CI: 3.8, 21.5] for commenting. However, the difference between mean ‘red dot’ and commenting scores remained similar with mean radiographer comment scores being 13.7% less than mean ‘red dot’ scores pre-training and 10.8% less post-training. Conclusions: The results of this study indicate that the accuracy of radiographer comments was significantly reduced when compared to the accuracy of ‘red dots’ for the same radiographic images. The clinical significance of these findings for departments wanting to move from a ‘red dot’ system to a radiographer commenting scheme is that without appropriate training and audit, the quality of service and assistance to the A&E department could be significantly reduced.
    • Advanced Practice: Research Report

      Hardy, Maryann L.; Snaith, Beverly; Edwards, Lisa; Baxter, John; Millington, Paul; Harris, Martine A. (Health & Care Professions Council, 2021-01)
      The Health Care and Professions Council (HCPC) regulates fifteen different professions; some of these are large groups like Physiotherapists and some are much smaller such as Speech and Language Therapists (SLT). Most of the people registered by the HCPC work within their own areas of clinical expertise and defined professional scope of practice. However, an increasing number of registrants are undertaking new or additional roles beyond the traditional scope of practice for the defined profession. These roles are often shared with other medical or health professionals and persons undertaking these roles are often, but not consistently, referred to as Advanced Practitioners. Advanced Practitioners are employed within the NHS across all four countries of the UK and are also employed by private healthcare providers. The roles they undertake vary from the highly specialised (e.g. an advanced podiatrist might specialise in biomechanics) to more general roles with greater professional autonomy and decision-making (e.g. a paramedic working in a GP Practice assessing patients with undifferentiated acute problems). As a result, there is currently no consistency in role title, scope of advanced practice, necessary underpinning education or professional accreditation across the HCPC registered professions. This study was undertaken to explore these issues and seek opinion on the need for additional regulatory measures for persons working at an advanced practice level. NB: For the purposes of this study, advanced practice was considered to encompass all roles, regardless of role title, where the level of practice undertaken was considered to be advanced. Method Three approaches to data collection were undertaken to ensure the differing opinions across all HCPC registered professions, different stakeholders and the four nations of the UK were collected. Data were collected through: 1. A UK wide survey of HCPC registered healthcare professionals; 2. A UK wide survey of organisations delivering AHP & scientific advanced practice education; 3. A series of focus groups and interviews across a range of stakeholder groups. Findings The concept of advanced level practice was not consistently understood or interpreted across the different stakeholder groups. Those participants identifying as working at an advanced practice level undertook a range of activities both within and out with the traditional scope of practice of the registered profession adding a further layer of complexity. Educational support and availability for advanced level practice varied across professional groups and inequity of accessibility and appropriateness of content were raised as concerns. There is no consensus across participant groups on the need for regulation of advanced level practice. Perceived advantages to additional regulation were the consistent and equal educational and employer governance expectations, particularly where multiple professional groups are undertaking the same role, all be it with a differing professional educational foundation and lens. However, while some voices across the participant groups felt regulation was essential to assure practice standards and reduce risk of role title misuse, there was equally a lack of appetite for regulation that inhibited agility to respond to, and reflect, the rapidly changing healthcare environment and evolving scope of advanced level practice. Importantly, no evidence was presented from any participant group that advanced level practice within HCPC regulated professions presents a risk to the public. Conclusion The study data presented in this report reflect the complexity of the concept of advanced practice within the HCPC regulated professions. Much of this is a consequence of the differing speeds of professional role development across healthcare organisations and professional groups, often related to service capacity gaps and locally developed education to support local initiatives. Despite this, there is no clear evidence, based on the findings of this research, that additional regulation of advanced level practice is needed, or desired, to protect the public. However, as the HCPC is one of the few organisations with a UK wide remit, it may have a central role in achieving unification across the 4 nations in relation to the future role expectations, educational standards, and governance of advanced level practice.
    • Artificial intelligence in diagnostic imaging: impact on the radiography profession

      Hardy, Maryann L.; Harvey, H. (2020-03)
      The arrival of artificially intelligent systems into the domain of medical imaging has focused attention and sparked much debate on the role and responsibilities of the radiologist. However, discussion about the impact of such technology on the radiographer role is lacking. This paper discusses the potential impact of artificial intelligence (AI) on the radiography profession by assessing current workflow and cross-mapping potential areas of AI automation such as procedure planning, image acquisition and processing. We also highlight the opportunities that AI brings including enhancing patient-facing care, increased cross-modality education and working, increased technological expertise and expansion of radiographer responsibility into AI-supported image reporting and auditing roles.
    • Assessing Sagittal Rotation on Posteroanterior Chest Radiographs: The Effect of Body Morphology on Radiographic Appearances.

      Hardy, Maryann L.; Scotland, Blake; Herron, Lisa (2015-12)
      Chest radiography is one of the most commonly performed radiographic examinations worldwide. Routinely acquired in the erect posteroanterior (PA) position, a chest radiograph displays substantial amounts of medical information when accurate patient positioning is achieved. However, a rotated PA chest radiograph has reduced diagnostic quality and appearances may mask or mimic chest pathology. Radiographic assessment of patient rotation around the sagittal plane has traditionally been undertaken by assessing the distance between the medial end of the clavicles and a line drawn through the spinous processes at the level of the clavicles. This approach continues to be advocated in radiographic technique textbooks internationally although no identified author has provided criteria to determine when a rotated PA chest radiograph should be repeated; determined the relationship between perceived clavicle to spinous process distance and actual degree of patient rotation; or considered the impact of body morphology, in particular the anteroposterior thoracic diameter, on radiographic appearances of rotation. Objectives To determine the impact of anteroposterior chest diameter on radiographic appearances of sagittal rotation on PA chest radiographs. Design Experimental study. Methods and Settings Sixty computed tomography thorax examinations, stratified for gender, were reviewed and data aggregated to determine average anteroposterior (AP) thoracic dimensions. A bespoke experimental unit was constructed specifically to enable testing of the impact of sagittal rotation on radiographic appearances. The experimental unit was situated within a calibrated circular frame enabling 360° rotation at 1° intervals around a central rotational point. The experimental unit components were varied in 1 cm intervals from 9 cm to 15 cm around the central rotation point to reflect varying AP chest diameters. At each interval, images were acquired at 0, 2, 5, 7, 10, and 15° sagittal rotation using a horizontal central ray, consistent centring point, and a source-image distance of 180 cm. Results A clear linear relationship between AP thoracic diameter and the radiographic appearances of sagittal rotation was noted. Considering significant rotation to be when the medial end of clavicle overlaps the spinous process on the radiographic image, this appearance occurred at a much smaller degree of rotation on wide AP thoracic diameters (15 cm, 5°) than narrower AP thoracic diameters (9 cm, 10°). Conclusions The routine application of the distance between the medial end of the clavicles and a line drawn through the spinous processes at the level of the clavicles as a method of assessing degree of sagittal rotation, diagnostic image quality, and need for repeat is flawed. Persistence in the application of this approach without cognisance of the impact of body morphology on radiographic appearances will result in persons with large AP thoracic diameters being more likely to have a PA chest radiograph repeated for a specified degree of rotation than persons with smaller AP thoracic diameters.
    • Can dual CT with fast kV-switching determine renal stone composition accurately?

      Mussman, B.; Hardy, Maryann L.; Jung, H.; Ding, M.; Osther, P.J.; Graumann, O. (2020-03)
      Rationale and Objectives: To determine whether a single source computed tomography (CT) system utilizing fast kV switching and low dose settings can characterize (diameter and chemical composition) renal stones accurately when compared infrared spectroscopy. Materials and Methods: The chemical composition of 15 renal stones was determined using Fourier transform infrared spectroscopy. The stones were inserted into a porcine kidney and placed within a water tank for CT scanning using both fast kV switching dual energy and standard protocols. Effective atomic number of each stone was measured using scanner software. Stone diameter measurements were repeated twice to determine intra-rater variation and compared to actual stone diameter as measured by micro CT. Results: The chemical composition of three stones (one calcium phosphate and two carbonite apatite) could not be determined using the scanner software. The composition of 10/12 remaining stones was correctly identified using dual energy computed tomography (83% absolute agreement; k = 0.69). No statistical difference (p = 0.051) was noted in the mean stone diameter as measured by clinical CT and micro CT. Conclusion: Dual energy computed tomography using fast kV switching may potentially be developed as a low dose clinical tool for identifying and classifying renal stones in vivo supporting clinical decision-making.
    • Computer based simulation in CT and MRI radiography education: Current role and future opportunities

      Chaka, Brian; Hardy, Maryann L. (2021-05)
      Objective: The use of Computer-based simulation (CBS), a form of simulation which utilises digital and web based platforms, is widely acknowledged in healthcare education. This literature review explores the current evidence relating to CBS activities in supporting radiographer education in CT and MRI. Key findings: Journal articles published between 2010 and 2020 were reviewed (n ¼ 663). The content was evaluated and summarised with the following headings; current utility, overview of CBS types, knowledge acquisition and evaluation, and student perspective. CBS utility in CT and MRI radiography education is limited. Its current use is for pre-registration education, and the interfaces used vary in design but are predominantly used as a preclinical learning tool to support the training of geometric scan planning, image acquisition and reconstruction, and associated technical skills. CBS was positively acknowledged by student radiographers; based on its inherent flexibility, self-paced learning and the ability to practice in a safe environment. Nonetheless, the educational validation of CBS in CT and MRI education pertaining to knowledge and skill acquisition has not been fully assessed through rigorous academic assessments and metrics. Conclusion: The current use of CBS in CT and MRI education is limited. The development of software programmes with functionality and capability that correlates with current clinical practice is imperative; and to enable more research in CBS utility to be undertaken to establish the efficacy of this pedagogical approach. Implications for practice: Due to limited placement opportunities, the use of simulation is increasing and evolving; in line with the approach to design and deliver high quality Simulation Based Education (SBE) in Diagnostic Radiography education. The continued development, utility and evaluation of CBS interfaces to support student radiographers at pre and post registration level is therefore essential.
    • Define, Inform, Dictate and Deliver

      Hardy, Maryann L.; McIntosh, Bryan (2017)
      In October 2014, Simon Stevens, the chief executive of NHS England, committed the service to plugging £22 billion of the expected £30 billion gap in its finances by 2020 through productivity gains of 2–3% a year by 2020. Since that announcement, the Government promised to provide £8 billion by 2020. This may notionally have been received, but it has not alleviated the severity of these financial constraints (Barnes and Dunhill, 2015). With austerity measures biting even deeper into the budgets of NHS organisations, all staff are under pressure to make cost efficiencies and at the same time improve operational standards and patient outcomes. In this pressured change environment, there are hospitals and departments that have embraced the demand for change, creating innovative skills mix platforms from which to deliver services. But there are also those who have remained entrenched in operational protocols. In both scenarios, the overarching driver for service re-design has been operational efficiency guided by government targets.
    • Delivering informed measures of patient centred care in medical imaging: what is the international perspective?

      Hyde, E.; Hardy, Maryann L. (2021)
      Focus on patient experience and patient centred approaches within healthcare has substantially increased since the Picker Institute (a not for profit organisation) was established in the 1980′s [ [15] ]. The Picker Institute's vision for ‘the highest quality person centred care for all, always’ outlines eight principles of person-centred care which health care providers should strive for [ [15] ]: (1) Fast access to reliable healthcare advice [15]. (2) Effective treatment delivered by trusted professionals [15]. (3) Continuity of care and smooth transitions. [15] (4) Involvement and support for family and carers [15]. (5) Clear information, communication and support for self-care [15]. (6) Involvement in decisions and respect for preferences [15]. (7) Emotional support, empathy and respect [15]. (8) Attention to physical and environmental needs [15].
    • Does radiography advanced practice improve patient outcomes and health service quality? A systematic review

      Hardy, Maryann L.; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna (2016)
      Objectives To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods Using the World Health Organisation definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs and data were systematically extracted using electronic data extraction proforma. Results 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n=7) focussing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The papers were generally considered to be of low to moderate quality with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No papers reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusions Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. Powered by
    • Embedding consultant radiographer roles within radiology departments: A framework for success

      Nightingale, J.; Hardy, Maryann L.; Snaith, Beverly (2018-11)
      Objectives: Many organisations struggle to clearly differentiate the radiographer consultant role from advanced or specialist practice, with newly appointed consultant practitioners often illprepared for working at this level. This article discusses the design, implementation and validation of an outcomes framework for benchmarking competencies for trainee or new-in-post consultant radiographers. Methods: Five experienced radiographers from different clinical specialisms were seconded to a twelve month consultant trainee post, guided by a locally-devised outcomes framework. A longitudinal qualitative study explored, from the radiographers' perspective, the impact of the outcomes framework on the transition to consultant practice and beyond. Data collection included semi-structured interviews (months 1, 6 and 12), validation via a focus group (month 18) and a group interview (5 years). Results: Early interactions with framework objectives were mechanistic, but as participants better understood the role more creative approaches emerged. Despite diverse clinical expertise, the framework facilitated parity between participants, promoting transparency and credibility which was important in how the consultant role was perceived. All participants achieved all framework outcomes and were subsequently appointed to substantive consultant radiographer positions. Conclusion This outcomes framework facilitates experienced radiographers to successfully transition into consultant radiographers, enabling them to meet multiple non-clinical targets while continuing to work effectively within a changing clinical environment. It is the first validated benchmarking tool designed to support the transition to radiographer consultant practice. Adoption of the tool will provide a standardised measure of consultant radiographer outcomes that will promote inter-organisational transferability hitherto unseen in the UK.
    • Emergency department image interpretation accuracy: The influence of immediate reporting by radiology

      Snaith, Beverly; Hardy, Maryann L. (2014-04)
      The misinterpretation of radiographs is recognised as a key source of emergency department (ED) errors, regardless of clinician profession. This article compares ENP and medical staff accuracy in the interpretation of musculoskeletal trauma X-rays between immediate and delayed radiology reporting pathways. The data for this study was drawn from a larger pragmatic randomized controlled trial of immediate reporting. Patients were recruited and randomly assigned to immediate or delayed reporting arms and treated according to group assignment. Image interpretive accuracy between ED staff groups and arms was undertaken together with an assessment of the influence of immediate reporting on patient pathways and journey times. Six hundred and seventy-four radiographic examinations were performed (598 patients). There was a significant reduction in the interpretive errors in the immediate reporting arm for all ED clinicians (proportional difference = 4.2%; 95% CI [0.017,0.068]; p = 0.001), but no significant difference in proportion of interpretive errors was evident between ENPs and medical staff. Patient journey times, discharge and referral rates were not significantly different between study arms, although admission rates varied for medical staff collectively. ENP X-ray interpretation accuracy is comparable with that of medical staff, but immediate reporting was seen to reduce errors without increasing patient journey times.
    • Emergency ultrasound in the prehospital setting: the impact of environment on examination outcomes

      Snaith, Beverly; Hardy, Maryann L.; Walker, A. (2011)
      This study aimed to compare ultrasound examinations performed within a land ambulance (stationary and moving) with those completed in a simulated emergency department (ED) to determine the feasibility of undertaking ultrasound examinations within the UK prehospital care environment. The findings suggest that abdominal aortic aneurysm and extended focused assessment with sonography in trauma emergency ultrasound examinations can be performed in the stationary or moving land ambulance environment to a standard consistent with those performed in the hospital ED.
    • Estimating the Effect of Nonresponse Bias in a Survey of Hospital Organizations

      Lewis, Emily F.; Hardy, Maryann L.; Snaith, Beverly (2013)
      Nonresponse bias in survey research can result in misleading or inaccurate findings and assessment of nonresponse bias is advocated to determine response sample representativeness. Four methods of assessing nonresponse bias (analysis of known characteristics of a population, subsampling of nonresponders, wave analysis, and linear extrapolation) were applied to the results of a postal survey of U.K. hospital organizations. The purpose was to establish whether validated methods for assessing nonresponse bias at the individual level can be successfully applied to an organizational level survey. The aim of the initial survey was to investigate trends in the implementation of radiographer abnormality detection schemes, and a response rate of 63.7% (325/510) was achieved. This study identified conflicting trends in the outcomes of analysis of nonresponse bias between the different methods applied and we were unable to validate the continuum of resistance theory as applied to organizational survey data. Further work is required to ensure established nonresponse bias analysis approaches can be successfully applied to organizational survey data. Until then, it is suggested that a combination of methods should be used to enhance the rigor of survey analysis.
    • The evaluation of compliance with iRefer guidelines for abdominal imaging and the impact of the normal abdominal radiograph on the clinical confidence and decision making of emergency clinicians

      Mowlem, P.J.; Gouveia, A.; Pinn, J.; Hardy, Maryann L. (2019-02)
      Introduction: Attendance of adult patients to the Emergency Department (ED) with acute abdominal pain is a frequent event. Abdominal X-ray imaging (AXR) is commonly the first line of investigation but previous studies have suggested that the AXR has no place in assessing acute abdominal pain because of its low diagnostic yield and limited contribution to direct clinical decision making. However, no evaluation of the impact of a negative AXR on the clinical confidence and decision making of emergency clinicians has been undertaken. This study aims to fill this gap. Method: A self-designed paper questionnaire was distributed to medical clinicians on ED placement at a single NHS trust in the South of England. The survey sought to explore the impact of the negative AXR on clinical confidence and decision making and compliance with iRefer guidelines for referring to alter-native imaging modalities (ultrasound and computed tomography) should the option to refer for AXR be restricted. Results: A total of 28 (n¼28/41; 68.3%) completed questionnaires were returned. Most clinicians(n¼18/28; 64.3%) indicated that negative AXR had little impact on their clinical decision making although a small majority (n¼10/18; 55.6%) acknowledged it provided greater clinical confidence in their decision making. Variable compliance with iRefer guidelines for referral to ultrasound and computed tomography was noted. Conclusion: Whilst the negative AXR did not impact on the clinical decision making of most ED clinicians,it did increase clinical confidence. Consequently, the AXR should remain a referral option in the workup for adult patients presenting with acute abdominal pain to the emergency department.
    • An Evaluation of Image Acquisition Techniques, Radiographic Practice, and Technical Quality in Neonatal Chest Radiography

      Pedersen, C.C.E.; Hardy, Maryann L.; Blankholm, A.D. (2018-09)
      Background Neonatal chest radiography is a frequently performed diagnostic examination, particularly in preterm infants where anatomical and/or biochemical immaturity impacts on respiratory function. However, the quality of neonatal radiographic images has been criticized internationally and a prevailing concern has been that radiographers (radiologic technologists) fail to appreciate the unique nature of neonatal and infant anatomical proportions. The aim of this study was to undertake a retrospective evaluation of neonatal chest radiography image acquisition techniques against key technical criteria. Methods Hundred neonatal chest radiographs, randomly selected from all those acquired in 2014, were retrospectively evaluated. Inclusion criteria for radiographs acquisition were as follows: anterior-posterior supine; within 30 days of birth; and with all preprocessed collimation boundaries visible. Image evaluation was systematically undertaken using an image assessment tool. To test for statistical significance, Student's t-test, χ2 test, and logistic regression were undertaken. Results Only 47% of the radiographs were considered straight in both upper and lower thoraces. The cranial collimation border extended beyond the upper border of the third cervical vertebra in 30% of cases, and the caudal border extended below the lower border of the first lumbar vertebra in 20% of cases, suggesting high possibility of neonatal overirradiation. Upper thorax rotation was significantly associated with head position (χ2 = 10.907; P < .001) as has been stated in many published textbooks internationally, but arm position had no apparent influence on rotation of the upper thorax (χ2 = 5.1260; P = .275). Birth weight was associated with accurate midline centering of central ray (logistic regression; OR = 1.0005; P = .009; CI, 1.00139–1.000957) with greater accuracy observed in images of neonates with higher birth weight. Conclusion This study has highlighted areas for neonatal chest radiography improvement. Importantly, the findings bring into question commonly advocated radiographic techniques relating to arm positioning and assessment of rotation while confirming the importance of other technical factors. These findings begin the work toward developing the evidence base to underpin neonatal chest radiograph acquisition, but further prospective work and multicenter/multinational data comparison are required to confirm the findings.
    • How to achieve advanced practitioner status: A discussion paper

      Snaith, Beverly; Hardy, Maryann L. (2007-05)
      Accepted definitions and descriptions of advanced practice offer generic ideals for the development of advanced radiographer practitioner roles. However, they fail to specify a development pathway necessary for a clinical practitioner to attain advanced practitioner status and lack of clarity persists around the definition of advanced practice within the context of radiography [Price R. Critical factors influencing the changing scope of practice: the defining periods. Imaging & Oncology 2005;June:6–11.]. This paper will consider the expectations of practitioner and advanced practitioner competencies within the context of radiography practice in the United Kingdom and suggest criteria for an advanced practice development pathway that may be adopted by individual radiographers, or their managers, to assist professional development within any imaging speciality.
    • How to achieve consultant practitioner status: A discussion paper

      Hardy, Maryann L.; Snaith, Beverly (2007-11)
      Non-medical consultant posts are a relatively new addition to the National Health Service (NHS) workforce, the role first being announced for nurses in 1998 followed by the Allied Health Professions in 2000. They have been described as multidimensional positions that encompass the four core functions of consultant practice: expert clinical practice; professional leadership and consultancy; practice and service development, research and evaluation; education and professional development. Consequently, the purpose of non-medical consultants is to promote and develop practice at the clinical, strategic and policy level. Despite the professional drive to develop consultant radiographer roles, by the end of 2005 only 15 were in post. One of the reasons for this poor appointment rate is the deficiency in suitably qualified and experienced candidates, a finding acknowledged to be an issue across all the non-medical professions. Further, the development of potential consultant practitioners has been hampered by the lack of clearly defined clinical and educational pathways. This paper acknowledges the limited published material available to radiographers wishing to advance to consultant positions. Yet while recognising the need to establish a true consultant career pathway underpinned by an appropriate education and research strategy, it explores the requirements of consultant practice, identifying some opportunities available to radiographers to develop appropriate consultant level skills.
    • The immobilisation and restraint of paediatric patients during plain film radiographic examinations

      Graham, P.; Hardy, Maryann L. (2004-02)
      Purpose: The immobilisation and restraint of children to facilitate radiographic examination is a controversial issue that has been relatively ignored by radiography research. The aim of this study was to begin to fill this gap by providing a description of restraint used in a limited number of clinical sites in order to highlight any perceived need for training, policies or guidelines in the use of child immobilisation and restraint. Methods: A cross-sectional survey design using a postal questionnaire was adopted. One hundred and sixty-seven questionnaires were distributed to radiographers employed within six hospital Trusts. Results: A response rate of 83.2% (n=139/167) was achieved. Ninety-three percent (93.5%, n=130/139) of respondents indicated that restraining techniques were used although only 19.2% (n=25/130) had received specific training in safe restraining techniques and 7.9% (n=11/139) in distraction techniques as an alternative to restraint. A need for further guidance and support for clinical staff was evident with 73.3% (n=74/101) of respondents identifying a need for specific guidelines and 84.6% (n=110/130) indicating that further training opportunities were required. Conclusions: The use of restraint in paediatric plain film radiography is an apparently widespread practice and support for clinical radiographers through the development of training opportunities and practice guidelines are seen as essential in order to promote high quality paediatric radiography practices.