Diagnostic Radiographers

• Introduction

• Development of Multidisciplinary Training and Education at Southampton

• Future Developments

 

Introduction

Education and Training for Radiographers: Excerpt from Curriculum Framework 2003, Society of Radiographers (SoR)

Diagnostic radiographers are responsible for providing safe and accurate imaging examinations in a wide range of clinical environments, using a variety of imaging modalities and techniques so that appropriate management and treatment of patients and clients can proceed. The identification, evaluation and monitoring of systemic diseases, skeletal and soft tissue abnormalities and trauma are the major focus of diagnostic radiography. Significantly, radiographers provide this service throughout the twenty-four hour day, often working alone or in interprofessional care teams. Hence, they need to be prepared to deal with medical emergencies, which may arise during examination and treatment.

Diagnostic radiographers are concerned with both non-invasive and interventional procedures, radiation treatments, health surveillance screening and research, with additional involvement in occupational medicine. They use their professional judgement to decide how to achieve a diagnostic outcome.

This includes deciding what examination is indicated and how best to execute the procedure. Increasingly, radiographers report on the images they produce and hence play a vital role in the diagnosis and management of disease and trauma.

A key aspect of the radiographers' role is the management of complex interpersonal dynamics in what is sometimes a short episode of care. During that period, diagnostic radiographers take responsibility for the physical and psychological well being of the patient. They work independently and frequently in situations where they are required to make rapid professional judgments using their scientific, technical and patient care related knowledge base.

Routinely this includes roles such as:

• plain film radiography and trauma imaging;
• ultrasound investigations;
• nuclear medicine investigations and treatments;
• computed tomography examinations;
• magnetic resonance imaging and functional studies;
• breast imaging;
• urography;
• vascular investigations and treatments;
• gastro-intestinal procedures;
• clinical education;
• research;
• practice development;
• service management.

The Strategy for Radiographer Continuing Education 2002 (SoR) is actively pursued at Southampton by:

• Promoting inter-professional academic and clinical skills development that protects the public through safe working practices;
• Advocating a system of registration and accreditation processes supported by a directorate wide database of practitioners;
• Demanding formal validation and accreditation of learning wherever it takes place and the regular monitoring and evaluation of outcomes using learning assessment proformas;
• Advocating a learning environment that supports the development of healthcare assistants, radiography assistant practitioners and radiographers;
• Confirming the Bachelor's degree or its equivalent as the minimum qualification for professional practice as a State Registered Radiographer;
• Promoting alternative pathways to state registration and professional practice such as Accelerated BSc (Hons) and Postgraduate Diploma/Masters Degrees, in-service programmes, direct entry etc;
• Ensuring that radiography practice is grounded in clinical skills and competency;
• Defining a structured preceptorship/induction period with specified goals for new registrants to professional practice;
• Affirming a clear expectation that each state registered professional carries a responsibility for practice supervision and clinical teaching and learning;
• Advocating structured life-long learning to include both formal, informal and specific post registration education and research programmes at Masters and PhD levels to support higher/advanced and (in the future) consultant level clinical practice;
• Recommending that academic and clinical skills within professional qualifications must be aligned with relevant national occupational standards and standards of proficiency;
• Promoting the maintenance of professional standards;
• Recognising the need for evaluation of new ways of working models to ensure that the consistency and quality of patient centred care is maintained and enhanced;
• Harmonising the educational strategy with the training infrastructure offered by the organisation to support career development.

Development of Multidisciplinary Training and Education at Southampton

Achievements during the last eighteen months:

• Radiographers Study Day 2005 was very successful with delegates from all over the country attending. A new study day is scheduled for late 2007.
• Admin & Clerical Study Day also occurred in 2005 with positive feedback.
• A number of key radiographer MSc degree candidates are established, namely in MRI practice, radiographer reporting and advanced professional development in healthcare sciences.
• The Wessex British Institute of Radiologists Autumn meeting is now held in Southampton and open to all staff groups.
• Role extension has been taken forward in several areas including multidisciplinary plain film reporting, chest x-ray and CT head comments, video-fluorography barium swallows, mammography core biopsy, radiographers assisting in breast surgical clinics and radiographer-led IVU lists.

Radiographer Assistant Practitioners (RAPs):

• Eight have obtained the Foundation Degree, covering the areas of chest x-ray, fluoroscopy, extremities and dentals.
• Three are currently in FD training this academic year.
• Four RAPS are now undertaking the BSc degree to become radiographers.

Radiographer Role Redesign

There have been notable successes during the last eighteen months building up from 2004-05

• Breast imaging client communication and clinical examination
• Mammography core biopsies.
• CT Head reporting
• Intra-ocular Foreign Body reporting
• Chest Comments System for Cardiac Radiographers
• The Emergency Radiographer Practice Development. Although still in the development stages, it builds upon the work of the Nurse Practitioner Scheme incorporating incorporates the red dot and image comments system. This will be a priority during 2006-08.
• Longline training for radiographers is proposed for the near future.

A & C Role Redesign

• Following the successful inpatient coordinator appointment in the main X-ray department, the Ultrasound department have also introduced a ward coordinator.
• A typing manager has been appointed to co-ordinate typing across main x-ray.
• A deputy Administration Manager has been appointed to co-ordinate typing across PAH, cross sectional imaging, paediatrics, ultrasound, main x-ray and the RSH.
• An admin manager has been appointed to co-ordinate the film library project.
• Provision of shared typing/secretarial facilities with dedicated space.
• Centralised helpline for call vetting is proposed to reduce interruptions. Voice recognition has the potential to ameliorate A&C shortages.

Nurse Role Redesign

• Pre-assessment clinics for all day cases.
• Assessment of inpatients prior to Interventions.
• PAS training to effect transfer of care, completion of Discharge Summary (Interventional Patients).
• Informed consent is by trained Nurse clinical assessor.
• Nurse sedation expert during interventional procedures.
• Cannulation / venesection service.
• Small bowel catheter intubation for barium studies.
• Mechanical treatment following arterial thrombolysis.
• Proposed longline training for nurses.
• Nurse prescriber (from June 2006).
• Administration of Entonox by qualified Nurses.
• Clinical assessment, MEWS scoring of deteriorating Patents by Nurses
• Patient transfer / handover by trained HCSWs.
• Venesection, ECG by HCSWs.

Future Developments

• Establish a secure'Red Dot' system in-house training for all new staff and retraining established staff.
• Appropriate CT rotas for the rostering of radiographer CT head reporter.
• Establish CT rotation for all main department radiographers – essential towards maintenance of registration; extend to all radiographers.
• Promote and support MINTS-trained radiographers to enhance and increase patient care and provide efficient and appropriate imaging for the Accident and Emergency Department.
• Establish a strengthened CPD secondment programme.
• Initiation of mentorship, preceptorship and clinical supervision as set out by the Department of Health. This is a two-pronged approach, firstly, to support staff in new roles, and secondly, to assist staff to critically reflect upon practice to improve and build confidence and expertise in professional development.
• Further MR training for ED radiographers' rotation into the scanner area (this is assuming the MRE scanner is still viable during 2006-07).
• Appropriate life support training as well as other mandatory training