An Exploration of Education, Experience and Social Factors on CT Dose Optimisation

Abstract

Background: The number of Computed Tomography (CT) scans in England is likely to increase by 100% in next five years. In a medical emergency or in the presence of complicated pathology such as oncology indications, CT scanning is essential, and the benefit outweighs the risk. In CT scanning, patients should receive the optimal level of radiation to achieve a clinically diagnostic image. Vulnerable groups are particularly sensitive to the ionising radiation dose from CT scanning, which could cause cancers in the future. The amount of radiation from a CT scan is disproportionately high when compared to projectional X-ray imaging technology. Radiographers are required to adjust exposure parameters and scanning technique to achieve a clinically diagnostic image with the optimal level of radiation. Collaborative working with radiographers, radiologists, clinical scientists, and application specialists is required to effectively optimise CT parameters giving maximum image quality for minimum radiation exposure. There is a national and world-wide shortage of radiographers, radiologists, clinical scientists.

Emotional Intelligence (EI) has a part to play in learning in the clinical environment, since it is important that radiographers are aware of theirs and others’ emotions, including patients and supervisors, this is believed to increase after qualification.

In a study of European Union (EU) CT radiographers it was found that there was a need for ongoing education to ensure that CT exposure parameters are adapted to optimise patient dose and that the effect of changing some of the parameters was not well understood. This study set out to explore if this held true in United Kingdom (UK) CT radiographers and explore social factors’ influence in the clinical environment.

Aim: The Aim is to identify training requirements for UK CT radiographers regarding specifically social and educational factors, and whether these have an influence on the longitudinal approach toward CT dose optimisation.

Research question: Through evaluation of radiographers’ views, experiences and perspectives using mixed methodology, what are the factors that will contribute to holistic dose optimisation within the clinical environment?

Methods: This Mixed Method study consisted of three linked convergent parallel methods, integrating, and connecting quantitative and qualitative data proceeded by three linked literature reviews. Cross-sectional, longitudinal, qualitative, and systematic review methodology was used.

Results and findings: Only 9% of radiographers in the cross-sectional study reported that multidisciplinary team working was occurring in their department. Over a third (36%) of radiographers in the cross-sectional study were concerned about the CT doses in their departments. Most UK radiographers (98%) felt that they required further training in optimisation of CT parameters.

Ongoing education is a key requirement. Knowledge of exposure parameters significantly increased (p=0.0085) from pre- to post-registration radiographers. Wellbeing and emotionality increased significantly (p=0.039 and 0.047 respectively) from pre- to post-registration radiographers, although their global emotional intelligence score was not significantly different. Pre-and post-registration radiographers appreciated the need to adjust exposures for children although they may not have seen the adjustments in practice at this stage of their careers.

The longitudinal study qualitative data identified three themes which were: Education, Culture, and Dose optimisation. The longitudinal study showed that post-registration radiographers had expanded their knowledge about the use of automatic tube current modulation (ATCM) when a patient had a metallic implant.

The experienced radiographers felt that most CT education was delivered in-house, which was the preferred method in the longitudinal study. In the UK cross-sectional study radiographers had reservations about in-house CT education since they felt that radiographers who did not have complete knowledge of CT were educating other radiographers.

Radiographers’ training is unable to keep up with the rapidly advancing technology of modern CT scans. Current knowledge of dose optimisation techniques are essential knowledge for radiographers. Radiographers taught their CT skills at undergraduate level can only keep up-to-date by participating in regular CT professional education, requiring a multi-disciplinary team approach. Advanced CT radiographers still feel that they require more knowledge and applications training before they can manipulate exposure parameters, this feeling being cascaded through the workforce to pre-registration radiographers. Compounded by ever increasing scan numbers and lack of staff, radiographers feel that they needed to protect their ‘free time’ for relaxing and leaving less time for education outside their ‘work time’. Some pre-registration and newly qualified radiographers felt poorly supported because trained professionals were too busy to pass on knowledge. Where knowledge was being actively taught, the experts in their field were unlikely to have formal clinical supervision or education training and the training would occur on an ad hoc basis. Currently most CT skills are being taught in the clinical environment, but this training is not producing newly qualified radiographers who are competent in cross-sectional imaging. There seems to be a lack of clinical reasoning and critical thinking regarding CT dose optimisation. Radiographers must be empowered to operate the technically complex equipment whilst undergoing the challenge of the balance between emotions of self, patients, and teacher/learner with all their complications. The COVID-19 pandemic has added another layer of barriers to learning, along with influencing the emotions of staff and patients.

Conclusion : This study has shown that learning in the clinical environment is complex and there is an urgent requirement for professional education to keep pace with technological advances in CT scanning. There should be an acknowledgment that good teaching and training in the clinical environment is an essential investment in the future workforce. Advanced radiographers should be offered continuous bespoke CT training, with a multi-disciplinary team approach, to keep abreast of current advancements. These radiographers should be given the time and expertise in clinical supervision and education to set out effective training programmes for pre- and post-registration radiographers in the clinical environment.