Radiographers: Basic Sessions

As professionals, ethical codes guide on how we should behave in our practice and as individuals in the society that we live in. The first modern code governing ethics in research was developed during the Nuremberg trials in response to the abuse performed during medical experimentation. Various published reports about abuses were the motivating factors that led to the development of legislation on ethical principles and regulations when conducting research. These regulations may be seen as the boundaries that direct us in specific situations to help us make decisions and guide our behaviour while conducting research. Policies and procedures are also generally linked to cultural values and may be explicit to a particular time and are subject to change as attitudes and values evolve in today’s society. Conflicts may arise while performing research and these have to be addressed while being respectful to the participants at all times. It is crucial for researchers to be knowledgeable of any pitfalls that may inhibit the undertaking of the study. Research ethics committees have been set up to ensure that researchers follow procedures during the collection of data so that participants willingly consent to take part and are aware, and know of the associated risks and benefits. These committees also need to ensure that legislation is being respected and adhered to. If integrity is not maintained, public confidence and belief in findings will be lost. Therefore, it is important to be transparent, competent, and follow ethical procedures when conducting research.

When planning a research project, it is vital that a good appreciation of the existing literature is gained. Performing a literature search prior to beginning your research enables you to realise trends, understand the gaps in the existing literature, and limitations in the existing knowledge base. Article critique is a core skill for evidence-based practice and it is important to have the skills and knowledge to successfully critique research articles. The different elements of a research paper will be discussed, helping you understand what information you should expect to find, and which aspects of a research paper require close inspection. Good critique is should always be positive and negative, and this session will help you understand the implications of positive and negative aspects of a research article on the overall outcomes and meaning of the research.

The abstract is the “door” to your scientific publication, and when written in the right way, will open the desire of the reader to continue reading your full work. Although the main objective for the author is that the number of persons who read the publication will be all interested by the scientific topic, he must write the abstract as the “big picture” in 250 words in order to sell his work. To achieve this goal, it is needed to choose the words that are capable of creating a desire of continue reading, but also with scientific content and respecting the format covenanted by the rigours scientific community, in other words, sell the work within the rules. In this talk, we will try to use the precise and right words to “How to write a good scientific abstract” according to a scientific structure and with the right message of your work. The measure of the success of your abstract is given by the equivalent number of readers of the full work. To conclude we hope to see you all at this talk, and at the end of that fulfil your expectations, because it is the most important!

Communication and dissemination of research in an ethical and systematised manner is as important as the research itself. One of the most common, most direct and commonly encountered ways to share data is the scientific poster. There are specific rules about the structure, the format, the presentation devised each time by the respective scientific event at which the poster is submitted and presented. However, there are also some generic rules universally applicable about structure, content and presentation of scientific posters that this talk will delve into. Once these rules adhere to the poster can fulfil its aim, which is to communicate the findings of research and stimulate discussion. Many research collaborations have started from a well-organised poster, and it is considered the predecessor of scientific presentations and research papers. It remains one of the most versatile means of disseminating evidence-based practice.

The European Commission issued its most recent radiation protection Directive (2013/59/Euratom) in December 2013 which repealed five other Directives (including 97/43/Euratom) and had a deadline for transposition by all Member States of the EU by February 2018. Therefore this presentation will review the European-wide adoption of the new Directive, which takes into account new recommendations from the ICRP in light of new scientific evidence and is hoped will strengthen the culture of radiation safety throughout Europe. While the Directive remains faithful to and maintains the already well-accepted pillars of radiation protection - justification, optimisation and dose limitation, these are further strengthened in this Directive. Further new requirements under the Directive will also be discussed, including obligations related to recording dose information and communicating benefit/risk to patients. Additional responsibilities have also been designated to a number of professionals which will impact the work of both radiographers and radiologists alike, so all imaging staff need to be aware of its implications. This will ensure the true ethos of the Directive can be effectively implemented into routine clinical practice. Finally, some potential challenges for practical adoption of the Directive will be addressed.

Justification of referrals is a primary principle in radiology, with impact within and beyond radiation protection. The practice of justification influences the quality of patient care, the professionals’ working conditions and the allocation of healthcare resources. Still, reported frequencies of unjustified examinations to indicate implementation challenges, explainable by the complexity of the principle. Justification of an examination demands an overview and balancing of a number of relevant benefits and risks, based on outcome predictions. Moreover, the people involved may appraise the benefits and risks differently, and the distribution of responsibility and power in the decision-making process may not be clear. The presentation will address the potential for radiographers to contribute to justified examinations. They can contribute by vetting the amount and quality of information in the referrals, by providing supplementary information, and by authorising referrals according to guidelines. The possibilities, preconditions and scope of the radiographers’ contribution will vary according to cultural and organisation aspects, training and regulations, locally and nationally. Some lessons can be learned by the radiographers’ perceived role in justification, reported in the literature. Initiatives from the radiation protection environment to improve adherence to the principle of justification are summarised in the key concepts of Awareness, Appropriateness and Audit. The presentation will consider elements of the AAA approach, and offer reasons why increased involvement by radiologist and radiographers are called for. Finally, initiatives particularly relevant for the imaging departments will be highlighted, including guideline implementation, education, clarification of roles and collaboration in the referral process.

From a dose optimisation perspective, general descriptions of image quality that are divorced from the abnormality to be considered are likely to give less accurate and possibly unreliable results. With a range of perspectives in mind, this presentation offers a reflective critical commentary on contemporary image quality definitions in relation to the abnormality to be considered. Building on this, a definition of clinical image quality is then proposed which considers the purpose of the imaging examination; image quality definitions such as this would likely result in ‘personalised’ optimisation which should result in more valid and reliable dose optimisation outcomes. With a personalised definition in mind contemporary visual and physical approaches to image quality assessment, in pure and modified forms, will be considered in relation to optimisation and the abnormality to be considered. The presentation will then examine potential pre-emptive personalised image quality assessment optimisation approaches that might be implemented before exposure; post-acquisition personalised image quality assessment will also be examined similarly. The presentation will conclude by offering practical steps which might be taken to optimise images, with dose and personalised image quality in mind. Some consideration will be given to the role of Artificial Intelligence (AI) could play in the assessment of personalised image quality in optimisation, with or without human observers as part of the interpretation process.

By now all EU Member States should have implemented the requirements specified in the BSS Council Directive 2013/59/EURATOM into their respective national legislation, thereby ensuring that relevant practices abide by the revised basic safety standards for the protection against dangers arising from exposure to ionising radiation. In effect, apart from the specific responsibilities relating to the justification and optimisation of each medical radiation exposure, referrers and/or practitioners are now legally obliged to provide each patient or their representative with adequate information relating to the benefits and risks associated with the radiation dose to be received from a proposed medical imaging procedure that involves radiation. While referrers and practitioners may have already been satisfying this 'new' responsibility in their daily practice, the fact that this is now specifically defined within regulations should oblige more health professionals to be attentive to fulfil this responsibility as effectively as possible. This lecture will, therefore, seek to outline and emphasise the key role radiographers play in benefit-risk communication. It will highlight the importance of radiographers being knowledgeable of radiation-related concepts, as well as the associated benefits and risks of medical imaging procedures they perform. Additionally, the need for radiographers to develop and have effective communication skills will also be emphasised, since these are necessary to allow them to convey adequate information in accordance to the needs and preferences of different patient groups and their families, as well as to other health professionals that may be involved in the patient’s care.

Development of the professional role of radiographers in the Nordic region has been substantial since the profession was established in the early 70s. In parallel with the development and academising of radiography education, there has been a gradual change in the tasks previously performed by other groups, as well as the continuous supply of new tasks as a result of the significant advances in computing and technology in diagnostic imaging and radiation therapy. My presentation will focus on the current status of the scope of practice for radiographers in the Nordic region, educational possibilities and projects. Based on research done by The Nordic Institute for studies in Innovation Research and Education (NIFU) I will present recommendations on role Development, drivers and barriers for radiographers to take greater responsibilities in diagnostic imaging.

With the explosion of Artificial Intelligence (AI) a review of what AI is and is not is highly appropriate at this time. We sometimes ascribe too much value and trust to that ‘intelligence' and a reminder that computers are essentially counting machines should be first and foremost. Computer-aided detection (CAD) is not new but with advances in the use of neural networks and machine learning we can produce creative and successful advances in this area. In the newest generation AI offerings, what we are talking about is advanced pattern recognition, and we must be careful that bias in the training of the 'machine learning’ does not result in flaws in what could otherwise be pattern recognition that is equivalent to if not superior to humans. A review of the number and frequency of press releases and publications is a testament to the growth and importance of this technology. Disseminating of diagnostic imaging information is also a challenge and an area of continuing research and development. There is a tendency to use software that is traditionally intended for social media use however this brings into question ethics, regulatory compliance and governance. Software platforms are evolving to provide credible and secure repositories for the storage, control and tracking of the way we disseminate information rather and we must be cognizant of the issues, and acceptable practice of the management of this data in this new age of evolved data protection regulation as accountability has never been higher.

The continuous emerge of new technologies; together with increasing age of patients and number of examinations being performed represents a big challenge within radiology. This has led to delays in the interpreting and reporting of x-rays, meaning that it takes a long time from examinations is being performed until reports with the results of the patients' x-rays are ready for the referring doctor. Congestion of unreported x-rays represents one of the biggest challenges within the delivery of radiology services today. This could result in delays in patients receiving important treatment, thus putting patients at risk. Shortage of radiologists is also contributing to delays in the delivery of radiology services. Further, with the advanced technology within radiology may lead to radiologists prioritise the more advanced examinations, meaning that the skeletal x-rays are given less priority. Educating and training radiographers to perform reporting, particularly skeletal reporting, is one way to reduce the congestion of unreported x-rays. Radiographers are experts in viewing x-rays, and with proper education and training, they could perform reporting at a comparable level to the radiologists. Reporting radiographers could thus solve the bottleneck of radiology service delivery, resulting in effective and correct reporting of x-rays and shorter response time for patients.

The provision of high quality efficient personalised services for patients is the priority for imaging and diagnostics services, with services focused around the patient; this will continue to be our goal. A team working utilising all the available proven technologies will be essential, much of the technical aspects of the role will be automated; radiographer practitioners will need to offer flexibility, creativity and continually adapt their role as robotics capability continues to advance rapidly. Research must continue to be a core part of the radiographer’s professional role in order to ensure that the rapidly changing innovations/robotics can be researched and translated into practice efficiently, where there is evidence to demonstrate a benefit for patients. The development of the radiography profession must, therefore, adapt to the changing context of this environment but ensure that research skills remain embedded within the professional education and training in order to ensure that the patients receive personalised care including the changing technological capabilities of equipment including Artificial intelligence and precision medicine. Robotics and increasing availability of vast amounts of data will enable ongoing change. The radiographers’ role will change, but the radiographer must remain the patient facing carer across the service supporting patients during their diagnosis and onto their next steps along their personalised pathway of care. Their role needs to be considered within the context of the entire imaging team to ensure that the development of their skills and competencies effectively enable delivery of excellent patient care.

Many radiographer vacancies are filled by newly qualified radiographers who are stepping away from the supportive and safe environment afforded to them as a student, where they are supervised closely and move into clinical practice as an accountable and autonomous practitioner. Confidence levels may be low as they suddenly find themselves being wholly responsible for their decisions for the first time in their radiography journey. Add to this the lack of familiarity in a new department, along with the expectations of staff, the pressure put on the newly qualified radiographer, by themselves or by others, may soon become too much. This may lead to mistakes being made, which could cause patient harm. It could also lead to increased stress levels, periods of sickness or resignation from their post. The provision of a structured support framework for newly qualified radiographers in the first few months of employment is pivotal in their transition into confident and effective practitioners who are likely to stay in post and develop further into valued, experienced and highly skilled radiographers. There are different approaches to preceptorship, but all should share the same key components, leading into the appraisal cycle. The models of preceptorship will be explained before one department approach to preceptorship is discussed.

Globalisation and collaboration in an international setting can no longer be ignored. This also applies to the profession of the radiographer. That is why it is important for us as Radiographers to deepen our knowledge and to look for opportunities in the international field. International collaboration has always been strong in research. However, this is not the only place where internationalisation is visible. An international mindset starts at the beginning of a Radiographer career. Therefore, many universities have included internationalisation in their curricula. The first steps could be internationalization@home (Crowther et al. 2001). Students often come into contact with internationalisation through internships, exchange programs or Summer schools. But in recent years, working for shorter or longer periods abroad has also become more common. A difficult challenge is recognition of the diploma, within Europe there are different forms of education and level of education. These are also important discussion points for national and European associations. Working as a radiographer around the world is still quite a challenge. Exchanging experiences is the first step.

Medical imaging is becoming increasingly diverse with the continued development of multiple sub-specialities. The manner in which radiographers work within these sub-specialities and how professional work structures have developed across different countries all place a need on radiographers to continually develop and increase their knowledge and understanding of the areas of imaging they work within. Medical imaging technology and changes in practice alter rapidly. The importance of professional development planning for radiographers will be discussed in maintaining, developing and improving radiographer competencies to ensure optimal practice and service delivery, in our ever-changing and challenging clinical environment. Mandatory or voluntary CPD is becoming a common requirement across European Radiography professional societies. The importance of CPD for radiographers will be discussed, and the EFRS CPD guidelines will be outlined. Profession registration and its importance to Radiography will be discussed in the context of professional society registration and state registration of our profession by government regulators. The benefits and challenges of registration will be outlined and “real world” details will be provided to evidence points addressed in the presentation.

The potential for a patient centred approach to all diagnostic imaging begins from the moment a patient arrives within the Radiology department. The prime opportunity for attaining the required trust and rapport with the patient is during the consent process. The complexities of gaining such consent can be influenced by a wide range of varying factors including age, gender, culture and capacity all of which require a very different approach to ensure that informed consent is definitively attained. The presentation of challenges associated with consent may be overt or have the potential to be relatively subtle, and so the radiographer must be aware of both the values of the individual patient and also the requirements of the radiographic examination in order to meet the delicate balance that these potentially opposing concepts present. The increasing pace, expectations and evolution of the role of the radiographer lead to this perpetual dilemma which must be sensitively and adequately broached to avoid the potential for litigation and overall patient dissatisfaction. Student and qualified radiographers alike must ensure that informed consent is achieved by employing a systematic approach alongside appropriate problem solving and open discussion to allow for transparency and candour during every patient encounter.

Compliance with advice and instructions in the medical imaging department is important because we frequently use ionising radiation in our daily work and have long waiting lists for specialist examinations. Not adhering to instructions may result in repeating of the examination, thereby, increased waiting times for other patients and an additional radiation dose for the patient. Noncompliance can occur at any stage of the medical process - for example, failure to attend for outpatient appointments is regarded as a specific form of noncompliance. Knowledge and understanding of the various types of non-compliance would allow the formation of strategies to tackle them effectively. It is important to understand why patients do not comply with the information they are asked to follow. Compliance is generally seen to improve when patients are given more information about their state of health, investigations and treatment. Studies have shown that increasing the amount of information for the patient not only improves satisfaction but also empowers the patient and increases compliance. Affective and cognitive empathetic communication styles have a significant positive relationship with both patient satisfaction and compliance. However, providing information to certain groups of patients (people with dementia) is a challenge for healthcare professionals. Due to the projected increase in the percentage of the population suffering from dementia, who are frequently referred to imaging departments, it is suggested a CPD program (with theoretical knowledge and practical training of dementia) be provided to all radiographers.

Social media has become a useful tool for health professionals. The most frequent advantage of using social media is receiving news and updated information about research, and new technologies. However, professionals are getting more involved in other ways of using social media; for instance, for getting in touch with other colleagues and for sharing opinions about different topics related to our profession. These discussions, often motivated by some publication, are an excellent intellectual exercise that helps us stay updated and in touch. Many radiographers have taken a step forward. Social media has served to narrow the gap between professionals and patients, which is an excellent way to provide first-hand information. The close contact with individual patients and patient’s associations has another utility; make our profession visible and showing the valuable role of radiographers. In order to use social media with these objectives, it is necessary to identify ourselves adequately using a clear profile. In our opinion, it is mandatory to review the quality of the content we share and maintain a proactive and generous attitude. In our experience, the benefits far outweigh the efforts. It is also a work that can be done as a team. As a result, we identify ourselves more intensively with our profession and contribute to generating a public profile of it. Social networks should be seen as a meeting point between people. It is at this point that we understand the relevance of these tools for those of us who must be health agents.

Professionalism in Social Media implies using digital tools to innovate processes and products and keep up with the digital development. One of the keys to professionalism in Social Media is to incorporate the evidence-based radiology resource in order to evaluate the behavioural impact (qualitative and quantitative). This is done by mastering a specific metric and its research with tools provided by Digital Marketing on each of the Social Networks and Digital Platforms used. Examples of shared and connected knowledge of professional practices in various Social Networks and platforms will be presented, and the case of the creation of audio-visual content in Spanish (videos on YouTube) that, through digital narrative, the informative and formative context, and the measurement of quantitative and qualitative data, we can identify better non-clinical communicative practices in the performance of CT and MRI tests, addressing the problem of claustrophobia, and improving the professionalism of the radiographer before the patient in radiology.