What roles do radiographers play in justification of radiographic examinations?
Radiologist said that he has to a projection image which was low dose and high image quality.
Am looking at factors that can influence radiographers justification of radiographic examinations.
Justification principles state that not practice should be adopted or no individual should be exposed to ionising radiation unless the is sufficient benefit of the exposure to offset the radiation detriments that comes along with it.
I am not Radiologist , but I am interested . Can you describe your answer last?
X-rays have some harm associated with it use in imaging. However the benefits derived from its usage outweighs the harm. But it is important that patients are exposed only if the results of exposure will alter management of their condition. Radiographers are individuals who administer radiation to patients to produce an x-ray image. What factors do they consider to determin whether it is appropriate to x- ray a particular patient?
Thanks for re-wrote. In my opinion , First, image quality is available for Doctor in order to reduce exposure again. Second, Beam quality is suitable for patients . And then , The kinds of digital x-ray detector are also important . In perspective of engineer.
This is a term used in the ROW for Radiologic technicians. Diagnostic radiographers work in x-ray departments and therapy radiographers work in cancer departments. The courses vary and are minimum of 3-4 years study in South Africa, Australia and the UK with possibilities of doing honors and masters programs afterwards.
Hi Yvette. Can u please make your contribution to my question? Thanks
A radiographer is not in the position to decide if it's
appropriate to examine or not. This decision should be made
by the treating physician and / or a radiologist.
But do radiographers play any role in justification?
What abt conventional radiography where a radiologist is not always around?
At least in Switzerland and Germany is a prescription from the treating doctor necessary to get a radiologic examination. May it be the doc in the ER or somewhere else in a private medical practice. The radiographer is legaly accountable for the correct ("state of the art") execution of the requested examination.
The is published evidence that clinicians who request for x-rays do not consider radiation dose issues whn requesting for x-rays.
This means that the radiographer who sees the request prior to the exposure is responsible for ensuring that there is diffident data to warrant the exposure
In the light of this, I asked, what factors can influence the radiographers justification of radiographic examinations?
If there are any doubts about the medical justification the radiographer has to discuss them with his or her radiologist. The radiologist is informed about the current guidelines regarding imaging and can discuss the issue with the referring physician. Like I said, the radiographer is not in the position to decide if imaging is appropriate or not.
I totally agree with Steve. Many times, radiologists are not around and patients can´t wait. Definitely, we should always do prescriptions, but if the radiographer has enough experience then they also can "save the situation".
Digital or plain film radiography a radiographer is an integral part of any radiology department be it interventional or otherwise.
Dr v moodley radiologist
Radiographic examinations entails radiation exposure,usually administered by radiographers.There should be enough clinical information to justify irradiation. Health care delivery is all about teamwork which borders on effective communication geared towards enhancing patient safety. The training of a radiographer empowers him/her as a radiation protection specialist, to alert the clinician when the justification for an exam is unclear..
I agree with Ms. Idigo. It is clearly the role of the radiographer to advocate for the patient in situations regarding questionable need or misordered exams. The cultural climate of your medical institution will determine how the radiographer can address this issue. In some cases (as with where I worked) it was acceptable for the radiographer to contact the requesting clinician for clarification. In other instances, protocol demands that physicians speak to physicians. In that scenario, the radiographer advocate for the patient through the radiologist. Either way, radiographers are responsible for maintaining radiation doses as low as possible.
Just to add a perspective from the UK given this is where you are based, the two prior entries are correct. As radiographers we can assess a referral according to nationally produced and locally held protocols. Anything which falls outside this should bediscussed either by a radiologist or the referrer.
The Operator (radiographer) will only explicitly be able to decline an examination if this is part of the procedure (eg Abdomen XR for gall stones)
Steve is also correct though I think is answering a different question to me.
Some quality criteria - yes. SOME- unfortunately - NO!
Of cours there are big differences regarding experience during time and beacause of feedback (some have no feedback and think they are the best). But this is the problem with other (not only medical persons ) too..
Control of pathology and histology is often the time..
Radiographers , been experts in the field of imaging(which includes routine X-rays,CT, Nuc Med, US, MRI) have roles to play in the Justification of requested procedures. These different Imaging modalities carries different degrees of radiation dose implications for the patient. Consequently any exposure performed must carry a dose as low as possible,without compromising diagnostic benefits for the patient. The radiographer is trained to appreciate pathological conditions which are been investigated with the use of radiation, and usually they are the first to see this request for this procedures. They usually start the chain of Justification , which ends with the radiologist. For an example today I got a request for a CT triphasic Pancreas from a Doctor, with clinical indication Pancreatitis. CT Triphasic protocol usually is done for cases of 'Pancreatic mass' So you see the CT protocol had to change to suit the query the team want an answer for, in this case a routine CT Abd- Pel which carried a reduced radiation implication was all the patient needed. So Radiographers are the trigger for justification of radiographic requests. Factors to aid this functions include Type of procedure requested, the age of patient, the clinical history of patient, the clinical indication for the examination, previous examinations performed on the patient among others. The question we ask as radiographers is always if the exposure alter the management of the patient?
Depends on the laws in force in the country where the radiographer operates, as well as his professional profile. In Italy, the performance of a radiographer is subject to a medical prescription, but the choice of projections to be used (or sequences, or protocols) is absolutely independent.
Radiographers safeguard patients or service users from radiation effects by ensuring that every medical exposure is justified. In the UK it is necessary to comply with The Ionising radiation (Medical Exposure) Regulations [IRMER, 2000] so if the clinical details provided by the doctor are insufficient, then the radiographer can refer the patient back to the doctor.
They should be helping decide if the test is the most appropriate to answer the clinical question being asked or to steer the clinician to a better test. If the test is not going to change medical management of the patient they should also know this. Also, most radiologists can see the number of exams a patient has already had and help decide if the benefits truely outweigh the radiation risk. Reform is happening and personally, I would rather be driving the bus than a silent passenger in the process.
Speaking as a qualified user of radioactive material, Pharmacist, and former Radiation Safety Officer and qualified expert in diagnostic and therapeutic X-ray safety for my own comany, as well as a state university nuclear medicine dept, I would have to say that the referring physicians SHOULD be weighing the benefit versus risk to their patient. Over the past 6 months, I have received 3 abdominal CTs with contrast at 2 hospitals. These procedures provide one of the highest radiation exposures as far as diagnostic studies go. The radiographer had nothing to do with deciding whether I received these studies or not. All the radiographer did was confirm the initial interpretations of the procedures by my referring surgeon or emergency dept. physician. Perhaps this process is different in other countries where there is more accountability required for expensive procedures.
@Edward Russak ,I agree that the radiographer does not decide to send you for Radiological procedures. I do not know what your laws says in the US, but in europe your physician is the prescriber who decides that he feels you need the procedure, but the radiology team ( Radiologist and Radiographer) has a duty of ensuring that the exposure from that procedure is absolutely necessary. And they would have to discuss with the physician to decide what radiological procedure or protocol would best answer his queries if they think otherwise. The three CT exposures within 6months you had may have been necessary, there is no problems with that if it deemed to be of benefit to you. We have patients who have repeated CT scan over a shorter period as you , as long as it is justified. In a nutshell in Europe, the radiology team have a duty of care, of ensuring that the exposure to a patient is justified.
Nicely stated @Robert Njoagwuani! The radiographer may have also undertaken settings and protocol changes to reduce the radiation dose for these necessary and appropriately ordered exams. Preventing exam performance is not the only way radiographers provide radiation protection to the patients (even though that is the focus of this discussion).
I agree that in developing countries like India a radiographer has no say however experienced he may be.Radiation safety is a team work.Unnecessary exposure should be avoided as and when possible.
X-ray examination means radiation exposure for the patients and the radiographer, the radiographer can justify the type and method of examination and discuss this with the clinician according to part to be examined, age of the patients, patients complain and even he can modify the exam depending on what the clinician need from the x-ray examination
The radiographer is the ^middle MAn^ so called as he or she mediates requests for imaging from a clinican to a radiologist should there be a doubt as to the indication with regard to management.The role is not to expose the patient unnecessarily if the management is not going to be affected.Therefore the radiographjer is an integral part of the radiology department and besides being imagers ., they are also the interpreters of the requests that arrive in the department and decision makers and advisers and the radiologist is solely dependent on the knowledge and assisstance of a radiographer.
This is an interesting discussion. The viewpoiints expressed from around the world highlight the different roles radiographers play in different countries. In the U.S., the referring clinician plays the major role in justification. This is reasonable, in my opinion, as the referring clinician knows more about the patient than the radiologist or technologist (radiographer). The radiologist plays a supporting role in justification as the expert on imaging. The technologist, medical physicist and radiologist together determine optimum protocols (this is optimization of protection, not justification). If the technologist has a concern about appropriateness, he/she brings it to the attention of the radiologist. This is a very imprtant role, as the radiologist may not see the patient, and may not be aware of the imaging request until after the examination is performed.
As per my opinion the type of radiologic examination should always be decided by physicians because they have the knowledge of medicine. But so far as radiation safety is concerned this should be decided by radiation safety officers or medical physicists or also can be by well qualified/trained radiographers.
Its always good to screen patients about the past radiologic examinations that patient has undergone and then to decide whether the next examination should be done or not. During screening it should also be seen the risk of radiation versus the benefit/ importance of the investigation.
Indication for radiological examination should be recommended by a physician clinician, or rather the doctor pneumologyst, when it is necessary. The technique of performing radiological examination belongs radiologist technician, who in the perfection of his work avoids the risk of radiation to the patient, but also for himself. It should be noted, that X-ray examination when indicated, have its value in diagnostic information.
Radiographers rely on clinical history on the request form to execute the x-ray examination. The clinical history provided enables the radiographer check to whether the clinical question to be answered matches the history for the examination and whether the clinical test will require additional projections or not. At this point the radiographer should be able to justify the appropriateness of the request to ensure the patient is not irradiated unnecessarily.
Could administrative procedures of a trust also influence Radiographers' justification?
How abt type of infrustructure, digital versus film screen with regards to paper and electronic requesting and film storage? ( record keeping)
Radiographer has main role in department of Radiology because all key activites concerning patient radiological investigation done by them as . imaging technique ,patient care , justification of examination ...optimization of radiation dose
The topic of this discussion, is 'really interesting' cause the Technologist (Radiographer) has a role in the Departments of Radiology really valuable.
However, it must always be clear that the level of professional qualification of the technologist must always be as much as' high as possible in every specialty of Radiology where he operates (CT, MRI, diagnostic traditional). 'Cause if it' s true that (at least in the department where I work) the Radiographer often performs routine X-ray examinations without the Radiologist , at his side, always remains the responsibility of the Radiologist validate the work of the technical performer for investigation. Therefore the criteria of accuracy for the execution, for the appropriateness and the decision on integration of one or more 'X-rays of detail, supplementary, additional projections, acquisitions any subsequent to the execution of protocols based on CT and MRI remains exclusive and sole responsibility Physician Radiologist.
Greetings to all.
Gaetano Rea
Radiographers can question a request for a radiographic examination especialyy if there are multiple requests for the same patient in a short interval.their position as radiographers is to justify that the radiation effects outweighs the management and therefore they can discuss the request with the radiologist.all clinical concerns must be discussed with radiologist prior to exposing the patient to radiation.
Radiographers have [limited] control over justification. X-rays without clinical data are not to be done. X-rays order for incorrect laterality are[hopefully] not x-rayed. X-ray order that doesn't match the patient complaints also need clarification. Question of pregnancy always stops exam for radiologist consult. Agree tho' that odus of burden is on radiologist and ordering provider, but the clear task of the radiographer is to be the ears and eyes of the radiologist who will ultimately interpret images..this is part and parcel to the quality of the study performed, an adequate number of views for the problem or presenting symptom.
Agreed, Francine. And with a growing number of facilities utilizing off-site radiology interpretation services, it becomes ever more critical that we as radiologic technologists stand as the protectors of our patients and advocates for the most appropriate care.
I have to underline that the european law regarding radioprotection and justification, Euratom 230/95, in Italy 187/2000, involved only radiologist and not radiographers but although nowadays radiographers works alone without the presence of radiologists. In my mind, opened to share the role in europe, radiographers have the knowledge and the competences to decide about justification.
Education, continuous professional development, departmental protocols are type of healthcare facility,length of practice etc could possibly influence radiographer's justification of radiographic examinations.
these are the themes i have deduced from the discussion
These factors will need to be investigated in a study to check for statistical significance. Thank you.
In UK it's a radiographer's responsibility to justify exposure to X-ray examinations as autonomous professional practitioners. There are strict rules for justification.
1. Benefit Vs. Detriment - the benefit of the examination must outweigh the detriment.
2. Referrer must be approved by the employer as a competent, trained referrer for X-ray examinations under IR(ME)R2000 regulations.
3. Request form must be completed correctly - 3 forms of pt. ID to be present (corresponding ID on/from patient too).
4. Request form must be signed by referrer.
5. Examination and clinical details must be completed and a relevant exam requested for the diagnostic answer required.
6. Radiographer/Operator/Practitioner is responsible for checking that the exposure has not been recently carried out as part of justification process (preventing double exposures).
7. Protocols must be in place and adhered to. Here's a link to an example freely available on the internet: http://www.ouh.nhs.uk/services/referrals/radiology/documents/justification-guidelines.pdf
8. Exposure to X-rays may only be made if other non-ionising methods of diagnosis are not appropriate - RCR Referrer guidelines must be followed.
9. Patient must be competent to give consent or parent/guardian to give consent unless life-saving procedure.
Radiographers view X-ray requests and radiographs on a daily basis. Therefore we have a vast experience of justifying requests. It is the responsibility of a referrer to understand and request only justified examinations but in reality radiographers filter out many inappropriate requests on a daily basis. It is always best to contact the referrer and ask for more information, suggest a more appropriate examination or just advise how the referrer could make justification reasons clearer, then hopefully the same errors can be avoided in future!
From your last answer it appears that the question you asked wouldn't give the answer you required! You needed to ask what factors influence a radiographer's ABILITY to justify requests. This would have given an answer of experience, education etc. The question you actually asked seemed to refer to influencing factors to the justification process.
Every day I work on X-ray examinations and meet with the issue. Important communication between doctors who prescribe rtg search and radiologists. Only in this way it is possible to choose the optimal filter, which will result in the lowest radiation for the patient and provide valuable diagnostic information, which will confirm or exclude the diagnosis.
My understanding of IRMER (UK) is that radiographers (operator) don't act as justifiers, but can accept requests on behalf of the practitioner (usually a radiologist) if the request falls within agreed guidelines set by the department. The grey area for me is who takes the role of practitioner when the examination is interpreted by a trained radiographer? Referring clinicians need to provide sufficient information when requesting the examination but play no formal role in the jsutification of the request.
For Radiographers to be able to justify an X-ray examination depends upon available rules and regulations guiding the radiographer at his/her facility (e.g referral guidelines), his or her level of training and experience. However radiographers basically do not need guidelines before going ahead to perform/justify an examination for some reasons. For example if there is no clinical history or details for the test question to be answered. Radiographers also weigh the benefit and risk of the examination requested and the referrer's identity and signature before examinations are done. Even though radiologists are mandated to justify X-ray examinations trained radiographers especially those into reporting should be able tom justify a radiological examination within the limit of their training. Radiation protection is the main concern about justification and avoiding unnecessary waste of resources and time.
Radiographers are practitioners in the UK if they justify the examination. They have a dual role as practitioner and operator for plain film imaging. CT, MRI, fluoroscopy procedures are usually justified by the radiologist although in some cases fluoroscopy procedures are justified by a specialist qualified fluoro practitioner/radiographer
I agree with both Jane & Ali.
- it is the practitioner who justifies the exposure as they must consider the risk/benefit decision but are also mandated to interpret the findings in the clinical context and provide the report. In the case if the advanced practitioner/reporting radiographer (be they plain imaging, CT or fluoro) they can assume the practitioner role and justify the request/exposure
- the radiographer, as operator, has a requirement to ensure that there is sufficient clinical information provided by the referrer and that the procedure will benefit the patient.
- radiographers can justify requests through task delegation from the practitioner if they are following local protocols and national guidance/best practice. For example, in high volume/low dose modalities such as plain imaging, the justification task can be delegated to the operator (radiographer) if the requests falls within iREFER (RCR guidance) and local imaging protocols, although if there is any dispute, the request needs to be clarified with a practitioner (radiologist/reporting radiographer) prior to imaging. Guidelines, like all aspects of evidence based practice, are never intended to replace sound clinical judgement so if in doubt these requests should be challenged and expert opinion sought.
Locally, we have senior CT radiographers justifying CT examinations, under protocols developed with consultant radiologists. As we have a team of plain film reporting radiographers we also assume this role for x-ray examinations.
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