15 research outputs found
Reply to Letter to the Editor regarding Anudjo et al. ‘Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice’
No full textThe College of Radiographers' Education and Career Framework (fourth edition): Exploring the guideline implementation gap across England using Normalisation Process Theory
No full textIn 2022, the College of Radiographers (CoR) published the fourth edition of their Education and Career Framework (ECF). This essential document provides a professional blueprint for the radiography career trajectory with the overarching aim of improving patient outcomes. However, publication does not guarantee adoption. To access the full benefits of the ECF, its implementation requires a strategic approach. To advance our understanding of the translational gap between policy and practice, this observational mixed-methods study employed Normalisation Process Theory (NPT) as a theoretical frame. Focusing on the diagnostic radiography profession in England, a national consultation survey was deployed, together with four consultation workshops. The quantitative survey data was analysed using descriptive and inferential statistics. Meanwhile, the framework approach was adapted for the qualitative analysis. The data collection took place between April-June 2023. In total, 142 survey responses were returned. Each workshop was comprised of 7-11 participants. The findings were deductively interpreted through the lens of NPT, from which five core themes emerged: making sense of complexity (coherence); bringing people together (cognitive participation); being strategic (collective action); evaluating complexity (reflexive monitoring); implementation in the 'real world' (barriers and enablers). By furthering our understanding of how the workforce has received and utilised the ECF, the gaps in its implementation were identified. This led to the development of recommendations to address the implementation gaps and enhance the ECF's adoption. The recommendations were study-derived, linked to responsible stakeholders, and grouped into four strategic priorities, aligned with the NPT domains. By enacting these evidence-based recommendations, we can enhance the ECF's translation from printed page to real-world outcomes, for the benefit of the profession, service delivery, and service users. [Abstract copyright: Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice
No full textIntroduction: Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research. Methods: A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings. Results: A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel. Conclusions: Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare. Implications for practice: Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice
The environmental sustainability implications of contrast media supply chain disruptions during the COVID-19 pandemic: A document analysis of international practice guidelines
No full textIntroduction
Travel restrictions implemented during the acute phases of the COVID-19 pandemic disrupted supply chain for critical radiology consumables including contrast media (CM) leading to shortages. Consequently, some departments had to restructure their clinical workflows in accordance to recommended guidelines to ensure safe continuity of patient care. This study aimed to summarise the temporary crisis-driven recommendations with implicit environmental sustainability essence and to analyse how these measures might inform the development of a more sustainable, long-term clinical guideline for safer and cost-effective CM usage without compromising diagnostic quality.
Methods
Documents were obtained through an electronic database search together with a relevant manual search in Google Scholar and relevant reference lists. The selected documents were subjected to a pre-defined eligibility criteria for inclusion. The READ approach was employed for document analysis and a thematic analysis of the obtained data was conducted.
Results
Of the 17 documents included, 70% (n = 12) emanate from the United States of America. The summary of the findings relate to minimising CM usage through strategic clinical approaches including optimisation of CM volumes, prioritisation of non-contrast imaging and/or alternative imaging depending on patient need without compromising diagnostic quality.
Conclusion
Critical lessons of sustainability essence are implicitly embedded in the policy guidelines issued during the periods of acute CM shortage in the COVID-19 pandemic. These lessons were themed around CM conservation based on: type and priority of medical imaging investigation, kind of imaging modality and use of smaller vials over multi-dose vials packaging.
Implications for practice: The temporary crisis-driven strategies may offer critical lessons for post-pandemic service delivery to enhance patient safety while saving cost and promoting greener practice via strategic clinical and operational monitoring of CM through policy renewal, education and training and collaboration with industry partners
Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review
No full textIntroduction: Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients.
Methods: A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis.
Results: The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI.
Discussion: Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate.
Implications for practice: MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients’ cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI
Closim, a simulation program on the closure of tidal basins
No full textThe program CLOSIM has been written to simulate the practice of the closure of tidal basins. It has not been the aim of the program to provide a new design application or to have any scientific value with respect to the results of the calculations. The simulations should rather give insight in the way closures take place, and in the problems that might be encountered when closing the connection between a tidal basin and the sea. In chapter 1, the user is introduced in the practice of the closure of tidal basins; the main phenomena of the subject are discussed. In the chapters 2 to 6, the calculations which have been done for the simulation program have been explained in detail. It should be kept in mind that most of the assumptions and calculations are based on rough estimations and do not give more than just an impression of the parameters and variables they deal with. The boundary conditions of the calculations and the way of schematizing them for the simulation program, have been considered in chapter 3. A lot of the geotechnical information presented has not been included in the program yet. Chapter 3 also covers the calculations of levels, flows and current velocities, of which the analytical derivation is presented in Appendix A. The calculation of the construction activities (decreasing the flow area) is dealt with in chapter 4. The complex geometrie calculations which translate a dumped volume of material into a dam advancement, have been described in Appendix B. The theory which has been applied to determine the loss of dam material (increasing the flow area), is explained in chapter 5 and Appendix C. Chapter 6 accounts for the scour at the end of the hottom protection, which can cause the bottom protection and eventually the structure itself to collapse. In chapter 7 general recommendations have been given for extension of the calculation procedures in future versions of the program.Civil Engineering and Geoscience
Preliminary clinical evaluation in cross-sectional imaging: A qualitative exploration of current international radiography practice
No full textIntroductionImplementation and practice compliance of preliminary clinical evaluation (PCE) vary across national and international settings. The reason for these variations remains unclear, especially in relation to cross-sectional imaging. This study therefore explored PCE education and practice experiences of a multinational cohort of cross-sectional imaging radiographers with the aim of identifying effective training and implementation strategies, challenges, and opportunities for improvement.MethodsA phenomenological qualitative design was used, with purposive sampling to recruit a multinational cohort of cross-sectional imaging radiographers enrolled in a UK-based postgraduate medical imaging programme. Semi-structured, in-depth interviews were conducted via Microsoft Teams between December 2024 and February 2025. Data were analysed using Braun and Clarkes’ reflexive thematic analysis approach, facilitated by NVivo™ (v.20.0).ResultsTwelve radiographers from seven different countries participated in the study. The clinical experience of participants ranged (2–8 years), with most working in public or both public and private hospitals (8/12, 67 %) and (5/12, 42 %) had multinational clinical experience. All participants had PCE as a core component of their undergraduate training, but post-qualification practice expectations vary. Four overarching themes were developed: (1) education and skill refinement, (2) drivers for practice, (3) barriers to practice, and (4) opportunities for practice.ConclusionThe findings reveal inconsistencies in PCE education, including variable module content and teaching depth, which affect clinical preparedness and confidence. Additionally, systemic barriers and communication lapses hinder PCE integration, while engagement is driven by its perceived value for others, support for clinical decision-making and presence of PCE-specific practice frameworks.Implications for practiceStandardisation of PCE education and training, establishment of clear practice frameworks and addressing communication gaps can enhance the integration of PCE into routine clinical workflows
Chapter 7: When an orchestra misses its harmony (or how I learnt to work with my supervisors)
No full textThe chapter uses the metaphor of sonata form to describe the life of the author’s doctoral thesis. Her first year somewhat resembled the first movement of a sonata. Difficulties in understanding both her supervisors’ expectations and the standard of work required led to a dramatic coda in which a surprising piece of critique caused a significant drop in her confidence. Moving to her second year, she experienced a number of crashes, ranging from epistemology and research directions to working style. However, the introduction of a new voice, in the form of a third supervisor, restored some harmony to the PhD composition. Further discordance arose in the third year, but the author concludes that the journey provided some memorable counterpoints that trained her to become a skilled composer, conductor, and performer of knowledge. These counterpoints inspire her to offer a few useful lessons for current and future PhD students
The nature of the relationship between authors and publishers
No full textRelationships within and outside organizations are changing, and the publishing sector is no exception. However, the roles of author and publisher remain distinct, each dependent on the other for the successful completion of a publishing project.
Drawing upon research conducted in the English Language Teaching Division of an international publishing company, this article examines the author-publisher relationship within a service context. It considers the characteristics authors and publishers identify to be integral to the relationship, and explores the extent to which the expectations and perceptions of authors and publishers differ.
The research findings indicate that there is a mismatch between the characteristics that authors and publishers identify as integral to their relationship. Whilst publishers focus upon the role of the editor in the nurturing and maintenance of relationships with individual authors, authors consider their relationship to be with the whole publishing house, including the marketing and design functions.</p
IGF and IGFBP as an index for discrimination between Vitamin D supplementation responders and nonresponders in overweight Saudi subjects
No full textVitamin D deficiency is common in the Kingdom of Saudi Arabia (KSA). Therefore, it is significant to recognize which biochemical markers modulate serum 25 hydroxyvitamin D (25(OH)D) in response to vitamin D supplementation in such a population. Our aim was to study the correlation of insulin-like growth factor (IGF) and insulin growth factor binding protein (IGFBP) with serum 25(OH)D in response to vitamin D supplementation in a Saudi population. A total of 199 (89 males/110 females) vitamin D deficient subjects (25 (OH)D level <50 nmol/L), aged 40.4 ± 11.4 years, were given vitamin D supplements (50,000 IU/mL every week) for the first 2 months, then twice a month for 2 months, followed by daily 1000 IU in the last 2 months. Fasting blood samples were taken at baseline and 6 months after the final dose of vitamin D. Serum 25(OH)D, IGF-1 and IGF-2, and IGFBPs 2-5 were measured. Vitamin D response was computed for all subjects as the difference in levels of serum 25(OH)D concentration at the end of 6 months compared to baseline. After intervention, serum 25(OH)D concentration significantly increased from 35.6 nmol/L (26.6-43.5) to 61.8 nmol/L (54.8-73.3) in responder subjects (P < .01) and from 35.1 nmol/L (21.2-58.2) to 38.3 nmol/L (25.5-48.3) in nonresponders (P = .13). Subjects with lower baseline serum IGF-II, IGFBP-2, and IGF-1/IGFBP-3 ratio are more sensitive to acute vitamin D status changes. IGF1 and IGF-1/IGFBP-3 ratio significantly increased in all subjects after 6 months (P = .01). Changes in 25(OH)D was significantly associated with changes in IGFBP-2 and IGF-1/IGFBP-3 ratio in responders only. This study proposes that changes in circulating IGF-I and IGFBP-3 are modulated by vitamin D supplementation and can be taken into consideration in investigations involving vitamin D correction. Moreover, increase in serum 25(OH)D and IGF-I/IGFBP-3 molar ratio are more sensitive markers for the response to vitamin D supplementation in Saudi population. © 2018 the Author(s). Published by Wolters Kluwer Health, Inc
