The value of referral information and assessment - a cross sectional study of radiographers' perceptions

Clinical information on imaging referrals for suspected or known axial spondyloarthritis: recommendations from the Assessment of Spondyloarthritis International Society (ASAS)

OBJECTIVES

This study aims to establish expert consensus recommendations for clinical information on imaging requests in suspected/known axial spondyloarthritis (axSpA), focusing on enhancing diagnostic clarity and patient care through guidelines.

MATERIALS AND METHODS

A specialised task force was formed, comprising 7 radiologists, 11 rheumatologists from the Assessment of Spondyloarthritis International Society (ASAS) and a patient representative. Using the Delphi method, two rounds of surveys were conducted among ASAS members. These surveys aimed to identify critical elements for imaging referrals and to refine these elements for practical application. The task force deliberated on the survey outcomes and proposed a set of recommendations, which were then presented to the ASAS community for a decisive vote.

RESULTS

The collaborative effort resulted in a set of six detailed recommendations for clinicians involved in requesting imaging for patients with suspected or known axSpA. These recommendations cover crucial areas, including clinical features indicative of axSpA, clinical features, mechanical factors, past imaging data, potential contraindications for specific imaging modalities or contrast media and detailed reasons for the examination, including differential diagnoses. Garnering support from 73% of voting ASAS members, these recommendations represent a consensus on optimising imaging request protocols in axSpA.

CONCLUSION

The ASAS recommendations offer comprehensive guidance for rheumatologists in requesting imaging for axSpA, aiming to standardise requesting practices. By improving the precision and relevance of imaging requests, these guidelines should enhance the clinical impact of radiology reports, facilitate accurate diagnosis and consequently improve the management of patients with axSpA.

Discrepancy Rates in Acute Abdominal CT: An Audit of In-House and Remote Reporting Compared to Intraoperative Laparoscopic and Laparotomy Findings

INTRODUCTION

Non-traumatic abdominal pain is a common emergency presentation frequently managed by general surgeons. Abdominopelvic computed tomography (CT) scans are the most popular imaging modality in this context. In many hospitals, the rising demand for urgent and emergent scans out-of-hours has necessitated the outsourcing of this service to teleradiology companies, whereby reports are generated at sites remote from the image acquisition. The primary aim of this study was to determine the discrepancy rates of preoperative CT imaging by source (teleradiology compared to in-house).

METHODS

This was a retrospective monocentric study conducted at a busy district general hospital over a seven-month period. Patient demographic data, operative notes, and radiology reports (by source) were collated for all patients aged ≥16 years presenting with atraumatic abdominal pain who underwent abdominopelvic CT with subsequent surgical intervention (laparoscopy and/or laparotomy).

RESULTS

Seventy-one patients were identified by initial screening, and 10 patients (11 scans) met the criteria for a "major" discrepancy. Overall discrepancy rates were calculated at 5.6% for scans reported off-site compared to 9.9% for reports generated by in-house radiologists.

CONCLUSION

This study demonstrated lower discrepancy rates in scans reported remotely and can be used as the catalyst for improving aspects of in-house CT reporting.

Radiographers' perceptions of the experiences of patients with dementia attending the radiology department

BACKGROUND

Patients with dementia frequently present to the Radiology Department. However, stigmas have been recorded amongst radiographers surrounding imaging persons with dementia (PwD). This study aimed to investigate the impact of PwD attending the Radiology Department for imaging and the resultant effects to all patients, radiographers, and the Department from the perspectives of the examining radiographer.

METHODS

A paper-based questionnaire of radiographers' perceptions and experiences of individual examinations 'termed an interaction form' was created and made available in a public hospital in Ireland for a period of eight weeks. Radiographers completed the interaction form collecting data regarding individual imaging examinations of PwD. The form comprised sixteen closed and one open-ended question on the radiographers' individual perspectives of PwDs' abilities and distress levels, carers and comforters and their role in the examination, what the radiographer found helpful in the interaction, and any adverse events. Data were analysed using a combination of descriptive analysis and thematic content analysis.

RESULTS

Thirty-three interaction forms were completed by the participating radiographers. The modality most commonly represented in the survey was general X-ray (58%). Radiographers reported 84% of examinations for PwD required extra time, with 27% of examinations required repeat imaging and 69% of patients appeared distressed. A carer helped facilitate the completion of 77% of examinations. Qualitative data indicated that distractive and communicative techniques were used by radiographers to make the patient feel more comfortable and help with examination success.

CONCLUSION

PwD often require more time for radiological examinations, they often need repeat imaging and re-scheduling of an examination at a more appropriate time. These factors need to be considered when scheduling and performing radiological examinations. Patient distress was frequently encountered, this area may benefit from further research and dedicated practitioner training which could help drive improvements in patient experience.

The radiographers' opinion on assessing radiological referrals

INTRODUCTION

Radiographers have a fundamental duty to assess radiological referrals and ensure imaging is justified. This study constitutes the third part of a broader research on radiographers' assessment of referrals. The study examines the opinions of radiographers on the matter, as articulated in their own words.

METHODS

A questionnaire with closed and open-ended questions was designed, validated, and distributed to radiographers following activities organised by the International Society of Radiographers and Radiological Technologists (ISRRT). This third part covers the participants' free-text comments about radiographers' assessment of referrals. Qualitative, inductive content analysis was used to report findings involving three phases: 1) Preparation, 2) Organisation where two authors individually coded and categorised the emerged themes, and 3) Reporting, were the authors compared, reviewed, and defined the meanings of the themes and sub-themes.

RESULTS

Five main themes Opportunity, Competency, Work environment, Role perception and Significance emerged, shaped as descriptive, normative, and prospective statements. In opportunities the respondents (descriptively) depicted the importance of their position and challenges faced, including lack of adequate clinical information in referrals. Competencies concerned whether they have the required knowledge and skills for the task. In work environment the respondents viewed themselves as partners and collaborators with radiologists and referrers but expressed that unclear regulations could challenge their task. In role perception, the respondents expressed (normatively) that assessing referrals is vital for professional self-esteem and radiographers' responsibility. Significance covers the importance of assessing referrals for different aspects relating to quality of services.

CONCLUSION

Radiographers expressed high engagement towards tasks of assessing referrals. To support radiographers in this role, it is crucial to establish clear regulations, better organisation of departmental processes and provide adequate training.

IMPLICATIONS FOR PRACTICE

Radiology departments should actively explore strategies of incorporating the radiographers' resources and core position in the process of assessing referrals, in a consistent and effective manner.