Understanding the humanistic interaction with medical imaging technology

"I think this could be a big success" - A mixed methods study on practitioner perspectives on the acceptance of a virtual reality tool for preparation in MRI

INTRODUCTION

A key part of a radiographer's role within MRI is providing the required emotional support to help patients succeed with a scan. Being informed is important; whilst information leaflets and videos are commonly used, these can be limited in their representation of the experience. Virtual reality tools are being shown to reasonably replicate a scan experience, having a positive impact on patient satisfaction and anxiety. The aim was to obtain the views of practitioners on the use and implementation of such a tool in practice.

METHODS

A mixed methods study was conducted looking at the use of a virtual scan experience for patients prior to MRI. Nine radiographers attended two focus group sessions to see the tool and undergo a virtual experience. Following this, a survey based on the technology acceptance model was completed along with a semi-structured discussion about its use.

RESULTS

Perceived usefulness, ease of use, attitude and intention to use were all positive towards the virtual scan tool. All practitioners saw value in such a tool and how it could be implemented within practice, highlighting areas for improvement and development.

CONCLUSION

The practitioner's perspective was that access to such a virtual scan experience could be of use to better prepare and support those patients needing extra support before a real scan. Acknowledgement of having time to discuss patient concerns was noted and this could provide a means of doing so away from busy scanning lists whilst not taking up additional time.

IMPLICATIONS FOR PRACTICE

Use of VR tools could be a conduit through which trust and rapport are built in advance away from busy scanning lists, thereby not impacting on operational throughput and hindering efficiency.

DuDoSS: Deep-learning-based dual-domain sinogram synthesis from sparsely sampled projections of cardiac SPECT

PURPOSE

Myocardial perfusion imaging (MPI) using single-photon emission-computed tomography (SPECT) is widely applied for the diagnosis of cardiovascular diseases. In clinical practice, the long scanning procedures and acquisition time might induce patient anxiety and discomfort, motion artifacts, and misalignments between SPECT and computed tomography (CT). Reducing the number of projection angles provides a solution that results in a shorter scanning time. However, fewer projection angles might cause lower reconstruction accuracy, higher noise level, and reconstruction artifacts due to reduced angular sampling. We developed a deep-learning-based approach for high-quality SPECT image reconstruction using sparsely sampled projections.

METHODS

We proposed a novel deep-learning-based dual-domain sinogram synthesis (DuDoSS) method to recover full-view projections from sparsely sampled projections of cardiac SPECT. DuDoSS utilized the SPECT images predicted in the image domain as guidance to generate synthetic full-view projections in the sinogram domain. The synthetic projections were then reconstructed into non-attenuation-corrected and attenuation-corrected (AC) SPECT images for voxel-wise and segment-wise quantitative evaluations in terms of normalized mean square error (NMSE) and absolute percent error (APE). Previous deep-learning-based approaches, including direct sinogram generation (Direct Sino2Sino) and direct image prediction (Direct Img2Img), were tested in this study for comparison. The dataset used in this study included a total of 500 anonymized clinical stress-state MPI studies acquired on a GE NM/CT 850 scanner with 60 projection angles following the injection of 99m Tc-tetrofosmin.

RESULTS

Our proposed DuDoSS generated more consistent synthetic projections and SPECT images with the ground truth than other approaches. The average voxel-wise NMSE between the synthetic projections by DuDoSS and the ground-truth full-view projections was 2.08% ± 0.81%, as compared to 2.21% ± 0.86% (p < 0.001) by Direct Sino2Sino. The averaged voxel-wise NMSE between the AC SPECT images by DuDoSS and the ground-truth AC SPECT images was 1.63% ± 0.72%, as compared to 1.84% ± 0.79% (p < 0.001) by Direct Sino2Sino and 1.90% ± 0.66% (p < 0.001) by Direct Img2Img. The averaged segment-wise APE between the AC SPECT images by DuDoSS and the ground-truth AC SPECT images was 3.87% ± 3.23%, as compared to 3.95% ± 3.21% (p = 0.023) by Direct Img2Img and 4.46% ± 3.58% (p < 0.001) by Direct Sino2Sino.

CONCLUSIONS

Our proposed DuDoSS is feasible to generate accurate synthetic full-view projections from sparsely sampled projections for cardiac SPECT. The synthetic projections and reconstructed SPECT images generated from DuDoSS are more consistent with the ground-truth full-view projections and SPECT images than other approaches. DuDoSS can potentially enable fast data acquisition of cardiac SPECT.

A survey study investigating perceptions and acceptance of the whole-body imaging techniques used for the diagnosis of myeloma

INTRODUCTION

The purpose of this study was to investigate patient perceptions and acceptance of the three whole-body imaging (WBI) modalities used for diagnosing myeloma; radiographic skeletal survey (RSS), low-dose whole-body computed tomography (LD-WBCT) and whole-body magnetic resonance imaging (WB-MRI). The secondary aim was to explore the factors affecting the acceptance of whole-body imaging for myeloma.

METHODS

60 participants (median age = 58.5 years old) recruited from three NHS trusts and social media completed a survey in which they scored their experiences of each WBI modality on nine 5-point rating scales. Spearman's correlation coefficient, Kruskal-Wallis, Mann-Whitney and Wilcoxon signed-rank tests were used to compare scores between different WBI techniques. Participants were invited to provide additional open text responses for interpretation using thematic analysis.

RESULTS

All modalities demonstrated high levels of acceptability (median score = 4). WB-MRI was perceived as more stressful (p=<0.01) and claustrophobic (p=<0.01) than RSS and LD-WBCT. Thematic analysis showed patients understood the importance of imaging but had concerns about exacerbated pain and the results. WB-MRI was difficult to tolerate due to its duration. Respondents were averse to the physical manipulation required for RSS while remaining stationary was perceived as a benefit of LD-WBCT and WB-MRI. Staff interactions had both positive and negative effects on acceptance.

CONCLUSIONS

Despite the psychological and physical burdens of WBI, patients accepted its role in facilitating diagnosis. Staff support is vital for facilitating a positive whole-body imaging experience. Healthcare practitioners can improve WBI acceptance by understanding the burdens imposed by WBI and adopting the personalised care model.

IMPLICATIONS FOR PRACTICE

Patient experience can be improved by tailoring examinations to individual needs. RSS can be as burdensome as other WBI techniques and could be superseded by LD-WBCT or WB-MRI.

Evaluation of an equilibrium phase free-breathing dynamic contrast-enhanced MRI prototype sequence compared to traditional breath-held MRI acquisition in liver oncology patients

INTRODUCTION

Magnetic Resonance Imaging (MRI) is a commonly used for diagnosing metastatic liver disease. When patients are unable to achieve the necessary arrested respiration required during image acquisition, image artefacts occur that affect image quality and diagnostic value. The main contribution of this study is the evaluation of a novel prototype technique that allows a specific sub-group of patients to breathe freely throughout the acquisition of dynamic contrast enhanced equilibrium phase MRI of the liver.

METHODS

The study compared a traditional single phase of arrested respiration T1-weighted (T1W) fat saturated (FatSat) volumetric interpolated breath-hold sequence (VIBE) with a novel free-breathing T1W 3D Radial VIBE prototype sequence. A cohort of patients (n = 30) with known hepatic metastases who demonstrated difficulty in complying with the instructions for arrested inspiration were scanned. Both sets of data were compared for diagnostic quality using a Likert scale questionnaire by specialist Oncology Radiologists (n = 2).

RESULTS

Higher scores for all image quality criteria, including the presence of artefact (2.6 ± 0.57; p < 0.001), lesion conspicuity (2.9 ± 0.35; p < 0.001) and visibility of intra-hepatic vessels (2.8 ± 0.37; p < 0.001) were found using the free-breathing sequence (13.5 ± 1.94; p < 0.001 t = 13.31; df 29; p < 0.001) than the breath hold phase (8.1 ± 2.06), confirmed with kappa (k-0.023; p-0.050).

CONCLUSIONS

The results demonstrated a 39.5% improvement in overall image quality using the T1W 3D Radial VIBE prototype sequence, and have the potential to improve patient experience and reduce image artefacts during MRI imaging of this sub-group of patients.

Positive effect on patient experience of video information given prior to cardiovascular magnetic resonance imaging: A clinical trial

AIMS AND OBJECTIVES

To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate whether additional information has an impact on motion artefacts.

BACKGROUND

Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment.

DESIGN

A prospective randomised intervention study, not registered.

METHODS

The sample (n = 148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomised to receive either video information in addition to standard text-information (CMR-video/n = 49) or standard text-information alone (CMR-standard/n = 48). A third group undergoing myocardial perfusion scintigraphy (n = 51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and 1 week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait Anxiety Inventory, Hospital Anxiety and Depression scale, MRI Fear Survey Schedule and the MRI-Anxiety Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015-April 2016. The study followed the CONSORT guidelines.

RESULT

The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p = .039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p < .001). No difference was found regarding motion artefacts between CMR-video and CMR-standard.

CONCLUSION

Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts.

RELEVANCE TO CLINICAL PRACTICE

Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures.

TIME - MAKING THE BEST OF IT! A Fieldwork Study Outlining Time in Endoscopy Facilities for Short-Term Stay

Aim:

This paper focus on nursing and time in endoscopy facilities for short-term stay aiming to explore aspects of time in this setting and how expectations from the healthcare organisation, patients and nurses are expressed and met when managing nursing time.

Background:

Former research primarily focuses on the subject of time in the understanding of duration where having more time is closely associated with the ability to deliver better quality nursing care. The main concern is the nurses’ increased number of tasks and the decreased length of time at their disposal. However, few studies describe nursing when time is sparse, and the possibility of providing individualised nursing within a very short span of time.

Design:

Inspired by practical ethnographic principles, a fieldwork study was performed in high technology endoscopy clinics during 2008-2010.

Methods:

Data triangulation included participant observation, participant reports and patients and nurses semi-structured interviews.

Results/Findings:

The issue of time was an interwoven part of life in the productive endoscopy units. The understanding of time related to the main category: ‘Time - making the best of it’, and the sub categories “Responsibility of time”, “Information and preparation”, and “Time wasters”.

Conclusion:

The study underlines the possibility of combining the health care systems, patients and the nurses’ perspectives on and expectations of how to spend nursing time in endoscopy settings. In successful patient pathways nursing maximize patient outcome, support the goals of the healthcare organisations, is reliable, assure, tangible, empathic and responsive, and is individually tailored to the patient’s needs. The study contributes by underlining the importance of discussing not how to get more time in clinical practice but instead how to spend the time in the best way possible.

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.

A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol

INTRODUCTION

This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice.

METHODS AND ANALYSIS

This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments.

ETHICS AND DISSEMINATION

Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.

Action research in radiography: What it is and how it can be conducted

Action research is a form of research that investigates and describes a social or work situation with the aim of achieving a change which results in improvement. This article emphasizes the potential for action research to be a useful research method in radiography. A search was conducted to determine the extent to which action research has been utilized in radiography. Although action research has been used in a number of health-care settings, there are no published examples of action research being utilized in a clinical medical imaging department. Action research is discussed in detail, along with an example guide for an action research study. Action research has been identified as a useful way to affect change, to involve radiographers in the research process, and to introduce evidence-based practice to radiography.

The best way possible! A fieldwork study outlining expectations and needs for nursing of patients in endoscopy facilities for short-term stay

This paper is a descriptive study of nursing in facilities for short-term stay, aiming to outline the expectations and needs for nursing of patients undergoing gastroscopy in outpatient endoscopy clinics. Existing research finds it important to meet patients' expectations and needs for help to get through a procedure in the best and safest way possible. Despite recent years' focus on patient expectations, little attention has been paid to understanding the patients' distinct expectations and needs for nursing in the context of facilities for short-term stay. A fieldwork study influenced by practical ethnographic principles was performed in high-technology endoscopy outpatient clinics during 2008 - 2010. Data were collected using triangulation of participant observation for 12 weeks including participant reports and semi-structured interviews with eight patients and four nurses. The expectations and needs for nursing of patients undergoing gastroscopy were related to two main areas, summarized by the categories: 'Nervousness and anxiety' and 'Maintaining control'. The former concerned how patients managed their nervousness and anxiety and was described differently in terms of 'Getting it over with', 'The meaning of words' and 'Taking precautions'. The latter 'Maintaining control' concerned how patients in different ways managed to maintain control over their situation and was described in terms of 'Being informed', 'Others are in the same "boat"' and 'Being proactive'. The study concludes that nervousness and anxiety are expressed differently in patients undergoing gastroscopy and that patients have individual ways of claiming their right to elements of control over the situation and the course of gastroscopy. In order for nursing in endoscopy settings to be tailored to the individual patient, it must be adapted to the individual patient's ways of managing nervousness and anxiety as well as ways of claiming control.

The effectiveness of interventions to reduce anxiety, claustrophobia, sedation and non-completion rates of patients undergoing high technology medical imaging

BACKGROUND

Advanced, high technology medical imaging, such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT), have seen significant increases in their use. A number of interventions have been developed with the aim of reducing anxiety, fear and claustrophobia prior to and during imaging.

OBJECTIVE

To determine the effectiveness of interventions aiming to improve the patient experience of high technology medical imaging.

INCLUSION CRITERIA

Any patients who have undergone high technology (MRI, CT, PET, Nuclear medicine and SPECT) imaging in a medical imaging department. Interventional scans were not considered for inclusion.Considered interventions were: MRI scanner designs, quieter machines, information, psychological support, anxiety reduction protocols, mock MRI, team training, prone scanning, audiovisual (AV) systems, cognitive behavioural therapies, fragrance administration, guided imagery, patient positioning devices and paediatric preparation booklets.Experimental and observational studies were included in the review.Primary patient outcomes:Secondary patient outcome measures included: SEARCH STRATEGY: A comprehensive, three-step search strategy conducted during August to October 2011 aimed to find both published and unpublished English language studies across 14 major databases. No time restrictions.

METHODOLOGICAL QUALITY

Retrieved papers were assessed by two independent reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

DATA COLLECTION

Data was extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI.

DATA SYNTHESIS

Quantitative data was, where possible pooled in statistical meta-analysis using JBI-MAStARI. All results were subject to double data entry.

RESULTS

Thirty-eight studies met the inclusion criteria and were considered to be of suitable methodological quality. The quality of the studies varied; however, all the studies included had at a minimum a comparison group. Of the final 38 studies, 29 assessed interventions for MRI, 8 Nuclear Medicine procedures, and one in CT. Meta-analysis was performed for two interventions; additional information and an AV system.Significantly fewer children (10-18 years) required sedation prior to a MRI scan when given an audiovisual intervention (n=1785) OR 0.42% (CI 0.25 - 0.70), compared with the control group. Open MRI, newer MRI scanners, quieter machines, information in combination with psychological support or an anxiety reduction protocol, mock MRI, team training, prone scanning, AV systems, cognitive behavioural therapies, fragrance administration, guided imagery, patient positioning devices and paediatric preparation booklets were all found to have some positive effect on at least one outcome, whilst the findings for additional information were mixed.

CONCLUSIONS

This review identified 38 studies that assessed interventions to reduce anxiety, claustrophobia, sedation and non-completions and improve satisfaction for patients undergoing medical imaging. The majority of the interventions studied had some positive effect on at least one outcome.Healthcare professionals need to be aware of the potential for patients undergoing medical imaging to experience anxiety, fear and claustrophobia during scanning. A number of interventions can be selected and tailored to the patient group.There is still a significant amount of research required to establish the effectiveness for a number of interventions aimed to reduce anxiety, fear and claustrophobia in medical imaging, particularly in CT.

What to know and how to get to know? A fieldwork study outlining the understanding of knowing the patient in facilities for short-term stay

AIM

To report a descriptive study of nursing in facilities for short-term stay aiming to outline what 'knowing the patient' means in an endoscopic outpatient clinic.

BACKGROUND

'Knowing the patient' is indispensable to the effort of tailoring nursing to the individual patient's needs. Structural changes in the practice environments, however, reduce the amount of time a nurse spends getting to know the patient. Despite recent years' focus on the subject, no uniform description of 'knowing the patient' in facilities for short-term stay exists.

DESIGN

A fieldwork study influenced by practical ethnographic principles was performed in a high-technology endoscopic outpatient clinic during 2008-2010.

METHODS

Data were collected using participant observation for 12 weeks and semi-structured interviews with eight patients and four nurses.

FINDINGS

Findings were summarized into two categories 'What to know?' and 'How to get to know?' The former concerned practical issues in relation to gastroscopy and was described in terms of the patient's level of anxiety, wish for medication and previous experiences. The latter 'How to get to know?' concerned instruments employed in getting to know the patient and was described in terms of the use of communication and sensing.

CONCLUSIONS

'Knowing the patient' in the endoscopic outpatient clinic was understood in a very practical sense. Conversation and the use of the eyes and physical touch enabled a situational awareness. It helped tailor nursing to the patient's needs and allowed the nurse to treat every patient as a unique individual.

The patient experience of high technology medical imaging: a systematic review of the qualitative evidence

BACKGROUND

When presenting to an imaging department, the person who is to be imaged is often in a vulnerable state, and out of their comfort zone. It is the role of the medical imaging technician to produce a high quality image and facilitate patient care throughout the imaging process. Qualitative research is necessary to better inform the medical imaging technician and to help them to understand the experience of the person being imaged. Some issues that have been identified in the literature include fear, claustrophobia, dehumanisation, and an uncomfortable or unusual experience. There is now a small but worthwhile qualitative literature base focusing on the patient experience in high technology imaging. There is no current qualitative synthesis of the literature on the patient experience in high technology imaging. It is therefore timely and worthwhile to produce a systematic review to identify and summarise the existent literature exploring the patient experience of high technology imaging.

OBJECTIVES

To identify the patient experience of high technology medical imaging.

INCLUSION CRITERIA

Studies that were of a qualitative design that explored the phenomenon of interest, the patient experience of high technology medical imaging. Participants included anyone who had undergone one of these procedures.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies, and was conducted over a period from June - September 2010. No time limits were imposed on this search strategy. A three-step search strategy was utilised in this review.

METHODOLOGICAL QUALITY

All studies that met the criteria were selected for retrieval. They were then assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

DATA EXTRACTION

Data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

DATA SYNTHESIS

Research findings were pooled using the Qualitative Assessment and Review Instrument.

RESULTS

Following the search and critical appraisal processes, 15 studies were identified that were deemed of suitable quality to be included in the review. From these 15 studies, 127 findings were extracted, forming 33 categories and 11 synthesised findings. These synthesised findings related to the patient experience, the emotions they felt (whether negative or positive), the need for support and information, and highlighted the importance of imaging to the patient.

CONCLUSION

The synthesised findings in this review highlight the diverse, unique and challenging ways in which people experience imaging with MRI and CT scanners. All health professionals involved in imaging need to be aware of the different ways each patient may experience imaging, and provide them with ongoing support and information.

IMPLICATIONS FOR PRACTICE

The implications for practice are derived directly from the results of the meta-synthesis, and each of the 11 synthesised findings.

IMPLICATIONS FOR RESEARCH

There is still scope for further high methodological qualitative studies to be conducted in this field, particularly in the field of nuclear medicine imaging and Positron Emission Tomography. Further studies may be conducted in certain patient groups, and in certain age ranges. No studies were found assessing the experience of children undergoing high technology imaging.

The information needs of people attending for computed tomography (CT): what are they and how can they be met?

OBJECTIVE

To establish patients' knowledge of CT, their views of information provided and explore the role of information in imaging.

METHODS

A sample of 150 first-time outpatients attending for CT scanning at a Scottish hospital. The study had three phases: a questionnaire survey; structured interviews pre-scan and face-to-face interviews post-scan.

RESULTS

One hundred and twelve questionnaires were returned with 82 deemed usable. Sixty and 53 respondents participated in the pre-scan and post-scan interviews, respectively. Thirty percent of questionnaire respondents and 57.4% of pre-scan interviewees identified accurately the type of scan to be received. Scores on the knowledge test improved by the time of the pre-scan interview. During all stages of the study family members were described as a source of information. Patients reported clinicians as providing few details about the scan, and there was confusion about how results were communicated. Most interviewees thought the leaflet had prepared them for the procedure.

CONCLUSION

The study revealed a lack of familiarity with CT scanning, diverse informational needs, and the importance of personal contact in information giving.

PRACTICE IMPLICATIONS

The study raised wide-ranging issues and highlights the key role of information in the provision of diagnostic health services.