• 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.
    • 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.
    • Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

      Snaith, Beverly; Raine, S.; Fowler, L.; Osborne, C.; House, S.; Holmes, R.; Tattersall, E.; Pierce, E.; Dobson, M.; Harcus, J.W. (2020-09-01)
      In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method: This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results: Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% (n = 40/238), and this improved to 47.8% (n = 77/161) post-intervention, but declined to 32.8% (n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort (p
    • Methodological approaches to evaluating the practice of radiographers¿ interpretation of images: A review.

      Brealey, S.; Scally, Andy J. (2008)
      Recent initiatives to modernise the National Health Service describe how improving pay structures and staff working lives can be achieved in the form of advanced practitioner and consultant posts. Role development in Radiography represents a fundamental change to professional practice of radiographers and is subject to the provisions of the statutory and professional codes of conduct which govern such practice. In Diagnostic Radiography the response to Government initiatives has led to a change in practice so that radiographers in these new posts provide reports for a variety of imaging modalities. At the same time as there have been changes in the practice of Radiography, the discipline of evidence-based medicine has emerged. Changes in clinical practice should be underpinned by evidence from research. The purpose of this paper is to discuss the methodological approaches used to conduct research that evaluates one of the most salient areas of development in Radiography practice, that is the role of radiographers as advanced or consultant practitioners when interpreting plain radiographs. We begin by discussing what an evaluation is and two broad approaches for conducting health services research, and then appraise the evidence about radiographer reporting in the context of these methods of evaluation. We then suggest future considerations about the methodological approaches to evaluating radiographer reporting practice and identify where there are evidence gaps and the need for further research to inform evidence-based Radiography.
    • Patient Centred Care & Considerations

      Hyde, E.; Hardy, Maryann L. (CRC Press, 2020-07-16)
    • Radiographers as doctors: A profile of UK doctoral achievement

      Snaith, Beverly; Harris, Martine A.; Harris, R. (2016-11)
      Radiography aspires to be a research active profession, but there is limited information regarding the number of individuals with, or studying for, a doctoral award. This study aims to profile UK doctoral radiographers; including their chosen award, approach and employment status. This was a prospective cohort study utilising an electronic survey. No formal database of doctoral radiographers existed therefore a snowball sampling method was adopted. The study sample was radiographers (diagnostic and therapeutic) based in the UK who were registered with the Health and Care Professions Council (HCPC) and who held, or were studying for, a doctoral award. A total of 90 unique responses were received within the timescale. The respondents comprised 58 females (64.4%) and the majority were diagnostic radiographers (n = 71/90; 78.9%). The traditional PhD was the most common award, although increasing numbers were pursuing Education or Professional Doctorates. An overall increase in doctoral studies is observed over time, but was greatest amongst those working in academic institutions, with 63.3% of respondents (n = 57/90) working solely within a university, and a further 10% employed in a clinical–academic role (n = 9/90). This study has demonstrated that radiography is emerging as a research active profession, with increasing numbers of radiographers engaged in study at a doctoral level. This should provide a platform for the future development of academic and clinical research.
    • The concept of advanced radiographic practice: An international perspective

      Hardy, Maryann L.; Legg, J.; Smith, T.; Ween, B.; Williams, I.; Motto, J. (2008)
      Advanced radiographic practice has been the focus of much discussion and debate over the last decade, not only in the United Kingdom where advanced practitioner roles are now recognised within the national career framework, but also internationally. Yet, despite almost simultaneous professional movement towards advanced radiographic practice philosophy and ideals in many countries, international collaboration on this development has been minimal. This paper marks a growing international dialogue in this field. It discusses the theoretical concepts of advanced radiographic practice and the development of advanced practitioner roles, incorporating evidence and ideas from differing international perspectives and debates progress towards a potential unified global advanced practice identity.
    • A UK survey exploring the assistant practitioner role across diagnostic imaging: current practice, relationships and challenges to progression

      Snaith, Beverly; Harris, Martine A.; Palmer, D. (2018)
      Objective: Skill mix has been established as one method of maintaining imaging service delivery, with vertical and horizontal substitution of roles and tasks. Assistant practitioners (APs) have been undertaking limited imaging practice for almost two decades, but there remains a paucity of evidence related to the impact of their roles. Methods: This article reports on an electronic survey of individual APs within the NHS in the UK to explore utilisation, role scope and aspirations. Results: Responses were analysed from APs (n = 193) employed in 97 different organisations across the UK. The majority work in general radiography or mammography, with very few responses from other imaging modalities. Training routes varied across modalities, with most achieving Band 4 under Agenda for Change on completion of education. Limitations on practice vary between organisations and modalities, with many reporting blurring of the radiographer-AP boundary. Many aspire to continue their training to achieve registrant radiographer status, although there were clear frustrations from respondents over the lack of overt career prospects. Conclusion: Integration of the role into imaging department practice does not appear to be universal or consistent and further research is required to examine the optimal skill mix composition. Advances in knowledge: Skill mix implementation is inconsistent across modalities and geography in the UK. Opportunities for further workforce utilisation and expansion are evident.
    • Variation in pelvic radiography practice: Why can we not standardise image acquisition techniques?

      Snaith, Beverly; Field, L.; Lewis, E.F.; Flintham, K. (2019-11)
      Introduction: Pelvic radiographs remain an essential investigation in orthopaedic practice. Although it is recognised that acquisition techniques can affect image appearances and measurement accuracy, it remains unclear what variation in practice exists and what impact this could have on decision making. Method: This was a cross sectional survey of UK radiology departments utilising an electronic tool. An introductory letter and link was distributed. Responses were received from 69 unique hospital sites within the specified timeframe, a response rate of 37.9%. Results: There was no consistent technique for the positioning of patients for pelvic radiographs. The distance varied between 90 and 115 cm and 10 different centering points were described. In relation to leg position, the feet are usually internally rotated (65 of 69 [94.2%]). Only 1 teaching hospital (1 of 69 [1.4%]) uses a weight-bearing position as standard. Orthopaedic calibration devices were not in routine use, with only 21 using on pelvic x-rays (30.4%). Further, the type of device and application criteria were inconsistent. Conclusions: To our knowledge this is the first study to directly compare radiographic positioning across hospital sites. Our data demonstrated marked variation in technique for pelvis radiographs with associated implications for clinical decision making. Research is required to determine the standard technique and quality outcome measures to provide confidence in diagnostic interpretation particularly for serial radiographs.
    • What is the future of imaging in forensic practice?

      Beck, Jamie J.W. (2011)
      The last two decades has seen increased use of imaging in forensic practice. Although radiography has been used historically, the evidence base for the use of computed tomography and magnetic resonance imaging in forensic practice appears to be growing. This article reviews the evidence base for the use of radiography, CT and MRI in an attempt to ascertain the future use of these imaging techniques in forensic medicine.