Student Perception of Optimisation compared with the Evidence of Optimisation in Paediatric Radiography Case Studies

Transcription

1 Student Perception of Optimisation compared with the Evidence of Optimisation in Paediatric Radiography Case Studies Jennifer Doyle, Allison McGee, Kate Matthews Diagnostic Imaging School of Medicine and Medical Science UCD Dublin, Ireland Many thanks for the enthusiasm and input of the second year undergraduates in the Bachelor of Science (Radiography) programme in University College Dublin, and the considerable contributions of the clinical sites involved. University College Dublin School of Medicine and Medical Science Scoil an Leighis agus Eolaíocht an Leighis

2 What was this about? UCD Radiography students gathered 37 clinical case studies focussing on paediatric optimisation My research analysed these case studies Is paediatric radiography actually optimised? Do students really understand when an examination is optimised? Jennifer Doyle Elements of Optimisation in Paediatric Radiography

3 What is Optimisation? Optimisation is about the methods used by a radiographer to get the best possible image using the lowest amount of radiation Lead Shielding Exposure Positioning Collimation Jennifer Doyle Elements of Optimisation in Paediatric Radiography

4 Justification Is practice optimised? The reasons given for each examination were compared to relevant literature, predominantly the RCR irefer Guidelines 1. Examinations are generally performed with good reason 1. Royal College of Radiologists (2012) irefer: Making the best use of clinical radiology. Do students agree? Students are accurate in judging whether this is the case Reference opinion Examination Justified Unjustified Considered Justified Student Opinion Considered Unjustified Not Discussed Chest Pelvis Spine Upper Limb Lower Limb Total Jennifer Doyle Elements of Optimisation in Paediatric Radiography

5 Use of lead rubber shielding Is practice optimised? Do students agree? On the pelvis images, the use of lead rubber gonad protection was categorised as: Present and correctly positioned (n=1) Not present in line with protocol (n=4) Present and incorrectly positioned (n=2) Used according to protocol Positioning could be more accurate Student analysis was correct in all cases Jennifer Doyle Elements of Optimisation in Paediatric Radiography

6 Torso Extremities Positioning Is practice optimised? Two experts categorised the images: Optimal 38% images Not diagnostic 5% images Diagnostic but not optimal 57% images Positioning generally highly accurate Do students agree? Positioning % n Agreement 76.2 n=16 Student Harsh 9.5 n=2 Student Lenient 14.3 n=3 % n Agreement 72.2 n=12 Student Harsh 11.1 n=2 Student Lenient 22.2 n=4 The corollaries Students may be repeating some images that could pass unnecessary radiation Students may be passing some images that need repeat compromised diagnosis

7 Torso Extremities Exposure Is practice optimised? Two experts categorised the images Optimal 60% images Diagnostic but not optimal 40% images No images were judged not diagnostic on exposure Do students agree? Exposure % n Agreement 80.0 n=16 Student Harsh 0.0 n=0 Student Lenient 20.0 n=4 % n Agreement 64.7 n=11 Student Harsh 11.8 n=2 Student Lenient 23.5 n=4 The corollaries Students may be repeating some images that could pass unnecessary radiation Students may be passing some images that need repeat compromised diagnosis

8 Collimation: is practice optimised? Poor collimation is prevalent in clinical practice Only 6 of the 37 examinations fell within a 10% tolerance level Field size discrepancies ranged % 31% 7% 47% 15% 37% 27%

9 Collimation % Considered Sub-Optimal by Students % Considered Optimal by Students 67% 33% Images with sub-optimal collimation 33% 67% Images with optimal collimation One third of students were unable to appraise collimation accurately

10 Why is this important? Children are particularly sensitive to the affects of radiation, so we need to make sure their examinations are optimised 2 Radiographers are very aware of the concept of optimisation The current study demonstrates a diligent approach to justification, positioning, exposure and use of lead rubber, and solid student understanding of these elements In line with other research, attention to more accurate collimation is required Poor collimation is associated with digital technology The best technology in the world is only as good as the operator, and radiographers have a huge role in keeping radiation doses low Collimation is a simple operator dependent tool that can help minimise radiation dose, helping to ensure patients undergo the most optimised examinations possible If students saw this in practice they would be better equipped to improve their own approaches Our responsibility as researchers is to get the message out there 2. Willis, C.E. (2009) Optimizing digital radiography in children. European Journal of Radiology. 72: pp Jennifer Doyle Elements of Optimisation in Paediatric Radiography

11 Thanks for listening! Any questions? University College Dublin School of Medicine and Medical Science Scoil an Leighis agus Eolaíocht an Leighis