http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:6971 Introduction: In regional, rural and remote clinical practice, radiographers work closely with medical members of the acute care team in the interpretation of radiographic images, particularly when no radiologist is available. However, the misreading of radiographs by non-radiologist physicians has been shown to be the most common type of clinical error in the emergency department. Further, in Australia few rural radiographers are specifically trained to interpret and report on images. This study aimed to evaluate the accuracy of a group of rural radiographers in interpreting musculoskeletal plain radiographs, and to assess the effectiveness of continuing education (CE) in improving their accuracy within a short time frame. Methods: Following ethics approval, 16 rural radiographers were recruited to the study. At inception a purpose-designed ‘testobject’ of 25 cases compiled by a radiologist was used to assess image interpretation accuracy. The cases were categorised into three grades of complexity. The radiographers entered their answers on a structured radiographer opinion form (ROF) that had three levels of response – ‘general opinion’, 'observations’ and ‘open comment’. Subsequent to base-line testing, the radiographers participated in a CE program aimed at improving their image interpretation skills. After a 4 month period they were re-tested using the same methodology. The ROFs were scored by the radiologist and the pooled results analysed for statistically significant changes at all ROF levels and grades of complexity. Results: While for the small number of less complex grade 1 cases there was no change in image interpretation accuracy, for the more numerous and more complex grade 2 and grade 3 cases there was a statistically significant improvement at the ‘general opinion’ and ‘observation’ levels (paired t-test, p < 0.05). Also, with the exception of the small sample of grade 1 cases, the proportion of cases correctly interpreted by the radiographers decreased as the ROF level, and therefore the amount of detail required, increased. Conclusions: This study had a number of methodological limitations but the results suggest that short-term, intensive CE programs can improve the ability of radiographers to accurately interpret plain musculoskeletal radiographic examinations. Similar, larger scale initiatives such as this could help reduce the risk of misdiagnosis in acute care settings, especially in the absence of a radiologist. However, radiographers’ ability to use radiological vocabulary needs improvement. The complementary role that exists between radiographers and other members of the acute care team should be nurtured and developed in the context of declining numbers of radiologists, particularly in non-metropolitan areas. Intensive, short-term training in image interpretation may target junior medical officers, GPs and critical care nurse practitioners, as well as radiographers. 2012-01-30T05:05:21.360Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7053 This paper is about CAD in the medical imaging domain. CAD stands for computer aided detection or computer aided diagnosis and the authors argue that both are important in assisting radiologists interpret abnormal features in medical images. The main novelty of this paper is the introduction of multiple classification ripple down rule (MCRDR). The goal of the present work is to extend the RDR approach to produce multiple conclusions for a given input, hence multiple classification ripple down rules. These theoretical advances are joined with the intelligent computer aided diagnosis (ICAD) interface that consists of three parts: image analysis, inference and reclassification. Once a medical image is loaded, the system automatically extracts image features and the system indicates the radiologic findings. The system enables only those attributes with abnormalities. The radiologist can add or modify the annotation of the image, using the attributes window, by simply selecting the value of image attributes using pop down menus to annotate any abnormalities. Results are reported for a diagnostic knowledge base with 34 cases of chest radiographs selected in the radiology department of St. Vincent’s Hospital, Sydney. Throughout this study, the authors proved that it is possible to integrate the detection system and diagnosis system by proposing a new CAD architecture, which supports multiple disease diagnosis and the learning of new adaptation knowledge. We also showed that the diagnosis system could prevent radiologists from making misdiagnoses because of the complexity of the anatomy and the subtlety of features associated with some abnormalities. 2012-01-30T05:03:05.191Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:709 In some rural and remote locations in New South Wales and elsewhere in Australia, a limited range of radiographic examinations may be performed by nurses and general practitioners if there is no radiographer available. These so called remote x-ray operators are licensed under the New South Wales Radiation Control Act 1990. This study aimed to investigate the experiences and perceptions of remote x-ray operator radiography and examine the role of remote operators in New South Wales from the perspective of a cohort of rural radiographers and nurse and GP remote x-ray operators involved in frontline delivery of rural radiographic services. Methodology Semi-structured in-depth interviews were performed with twenty rural radiographers, ten rural nurses and seven rural general practitioners from various rural communities in New South Wales. Interview questions explored the informants’ knowledge, opinions and values, experience and behaviour, and attitudes and feelings in relation to remote x-ray operator radiography. Interviews were tape-recorded and transcribed. Data analysis was subsequently performed using an iterative process based on a modified grounded theory methodology. Data labelling and comparative analysis were carried out in parallel with data collection, allowing progressive modification of the interview theme list to ensure that theoretical saturation was achieved. Results Data analysis led to the emergence of three key concepts, together with their relevant themes and sub-themes. The primary key concept, ‘Dimensions of Practice’, was inclusive of the central precepts of remote x-ray operator radiography. It includes themes titled ‘Licence Conditions and Limitations’, ‘Competency Requirements’ and ‘Image Quality and Practice Standards’. The key concept of ‘Service Provision and Equity of Access’, represents the realities of clinical practice in the rural and remote health care setting. It includes themes of ‘Clinical Management and Decision Making’, ‘Access and Availability’, ‘Patient Expectations’ and ‘Commitment to Service’. The third key concept is ‘Professional Roles and Relationships’, which deals with the interactions that take place between individual practitioners and the factors that influence them. It encompasses the xii themes of ‘Boundary Delineation’, ‘Professional Status and Esteem’ and ‘Interprofessional Conflict and Collaboration’. Relationships between the key concepts, via their themes and sub-themes were also explored. Conclusions Analysis of the data led to the development of a conceptual model and a single story line that represent the perspectives of the study informants. Remote x-ray operator radiography takes place at the intersection of the occupational worlds of rural radiographers, nurses and general practitioners. Remote operators provide a valuable service that prevents rural residents having to travel to access minor radiographic examinations. However, the quality of the radiography they perform is below the standard expected of radiographers. Improvements in collaborative teamwork could improve the quality of service, although interprofessional communication is stifled by status and hierarchical relationships. The remote x-ray operator experience may inform the development of future models of health care. 2011-12-20T22:30:14.544Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:7225 At the time of Röentgen's discovery of X-rays, Australia was in a period of social transition. Federation under a centralised Australian government was at hand, while regional population centres were growing rapidly under various influences, such as the gold rush of the 1850s, the opening up of new pastoral land and the Great Drought of the 1890s. Reports of Röentgen's discovery first appeared in Australian newspapers towards the end of January 1896. The first limited description of his experimental techniques appeared on the 15th February, arousing excitement in the antipodean scientific community. Independent attempts were made to produce X-ray images at several locations in Australia, the necessary apparatus being widely available. Three men have been separately credited with having been the first to produce a radiographic image using the techniques described by Röentgen. Thomas Rankin Lyle, a Professor at Melbourne University performed a demonstration on the 3rd March 1896, X-raying a colleague's foot. The image was reproduced in the newspaper the following day. Lyle also performed a pre-surgical foreign body localisation on 12th June. Meanwhile, electrician and amateur scientist, Walter Filmer, produced a radiograph at Newcastle, also to localise a needle prior to surgical removal. Although the date of this examination is uncertain, it reportedly took place within days of the 15th February newspaper story, making it both the first successful attempt at radiography and the first medical use of X-rays in Australia. Filmer was later appointed to Newcastle Hospital as honorary ‘X-ray operator’. The third was a catholic priest and Science Master at St Stanislaus' College at Bathurst in western New South Wales, Father Joseph Slattery. On 25th July 1896 he X-rayed the hand of a former student to locate gunshot pellets, saving the hand from amputation. All three men were remarkable for their scientific knowledge and ability and all are deserving of the title of early Australian X-ray pioneer. This paper tells each of their stories. 2011-02-17T00:10:13.783Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:4514 Some United Kingdom (UK) radiographers share the task of radiological reporting with radiologists. This paper aims to describe the current status of radiographer reporting of trauma images in the countries of the UK and reflect on its relevance to the development of similar advanced practice roles internationally. In February 2007, a cross-sectional survey with respect to radiographer reporting was conducted of 456 UK hospitals with an Emergency Department (ED) or Minor Injuries Unit (MIU). The main outcome measures were the number of reporting radiographers; number of half-day radiographer reporting sessions per week; availability of, and radiographer involvement in 'hot' reporting. A total of 306 (67.1%) responses were received. Reporting radiographers were employed at 56.9% (174/306) of the respondent hospitals. Of hospitals with an ED, 70% (142/203) employed reporting radiographers compared to 31.1% (32/103) of those with a MIU. At 146 of the 174 hospitals that employed reporting radiographers (83.9%) there were between one and six radiographers involved. At 155 hospitals (155/174; 89.1%) radiographers performed between 0 and 10 reporting sessions each week. Most reported for one or two sessions. 'Hot' reporting operated at only 11.1% (34/306) of the respondent hospitals, with radiographers leading this service at 64.7% (22/34) of those sites. The rate of radiographer reporting uptake in UK hospitals appears to have slowed. Also, few radiographers are engaged in 'hot' reporting of trauma images. The prevalent UK model of 'cold' radiographer reporting may not be transferable to other countries where there is a need is for immediate and accurate reporting of trauma images. 2010-09-23T22:40:01.583Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5383 This paper describes the evolution and current status of advanced practice in medical imaging and radiation therapy in the Oceania region. To date development has been slow, largely ad hoc and based on local needs. Most advanced practice is informal or is regarded as part of the core skills of some individual practitioners. However, recently, there have been signs of change taking place, with a more coordinated and collaborative approach to role development becoming evident. In Australia, although a number of reports and papers have discussed extended clinical roles, especially for diagnostic Radiographers, no concrete action has yet taken place in either discipline. Stakeholders apparently agree that existing extended roles should be formalised, however, and that continuing education must underpin future role extension initiatives. A three-level professional structure, including an advanced practitioner level, has been accepted by the New Zealand Institute of Medical Radiation Technology (NZIMRT), with the support of the District Health Boards of New Zealand (DHBNZ). Implementation is expected to begin before the end of 2008. Meanwhile, recognition of the serious lack of Radiologists in Western Pacific Island Nations led to the training of some Radiographers in radiological interpretation of images between 2004 and 2006. The aim was to up-skill the Radiographers so that they could more reliably flag abnormalities to doctors, a model that may be applicable elsewhere. It is argued that future practice models must include advanced practice roles in order to safely meet the growing demand for medical radiation services. Local factors, such as the structure of the health care system and the depth of engagement of the key stakeholders in planning and implementation, however, are expected to influence the evolution of new clinical practice models in the region. 2010-04-27T04:37:30.132Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5293 Advanced radiographic practice has been the focus of much discussion and debate over the last decade, not only in the United Kingdom where advanced practitioner roles are now recognised within the national career framework, but also internationally. Yet, despite almost simultaneous professional movement towards advanced radiographic practice philosophy and ideals in many countries, international collaboration on this development has been minimal. This paper marks a growing international dialogue in this field. It discusses the theoretical concepts of advanced radiographic practice and the development of advanced practitioner roles, incorporating evidence and ideas from differing international perspectives and debates progress towards a potential unified global advanced practice identity. 2010-04-27T04:33:20.099Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5264 This paper describes the evolution and current status of advanced practice in medical imaging and radiation therapy in the Oceania region. To date development has been slow, largely ad hoc and based on local needs. Most advanced practice is informal or is regarded as part of the core skills of some individual practitioners. However, recently, there have been signs of change taking place, with a more coordinated and collaborative approach to role development becoming evident. In Australia, although a number of reports and papers have discussed extended clinical roles, especially for diagnostic Radiographers, no concrete action has yet taken place in either discipline. Stakeholders apparently agree that existing extended roles should be formalised, however, and that continuing education must underpin future role extension initiatives. A three-level professional structure, including an advanced practitioner level, has been accepted by the New Zealand Institute of Medical Radiation Technology (NZIMRT), with the support of the District Health Boards of New Zealand (DHBNZ). Implementation is expected to begin before the end of 2008. Meanwhile, recognition of the serious lack of Radiologists in Western Pacific Island Nations led to the training of some Radiographers in radiological interpretation of images between 2004 and 2006. The aim was to up-skill the Radiographers so that they could more reliably flag abnormalities to doctors, a model that may be applicable elsewhere. It is argued that future practice models must include advanced practice roles in order to safely meet the growing demand for medical radiation services. Local factors, such as the structure of the health care system and the depth of engagement of the key stakeholders in planning and implementation, however, are expected to influence the evolution of new clinical practice models in the region. 2010-04-27T04:32:51.869Z ]]>