A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in Diagnostic Radiology Johannesburg 2019 / Introduction: Neonates in a neonatal ICU or high care unit are a high-risk population. Besides a vulnerability to medical and surgical conditions, which often require radiological investigation, they are also at risk from the effects of radiation used in imaging. These risks increase with radiation dose. Numerous studies have assessed the dose due to primary radiation, however few have assessed the secondary radiation dose, and none have quantified the dose over time. Aim: To quantify the secondary radiation dose in our neonatal high care unit in order to determine if additional protective measures from secondary radiation are necessary. Method: A prospective analytic study was undertaken using multiple thermoluminescent devices in a cubicle of a neonatal high care unit, and control dosimeters outside the unit. Dosimeters were deployed for a 4 week period. Simultaneously, data was collected on patient numbers, and the X-rays performed in the unit. Results were compared to reference ranges for primary and secondary radiation (2-3 mSv per annum). Results: The average secondary radiation dose was 0.108mGy (p=0.6553) over 4 weeks, less than the expected background radiation dose of 0.17 – 0.25mGy. There was a large number of patients moving through the unit during the study period (89), with an average of 14 patients in the unit at a time, however this did not result a large number of X-ray exposures. Twenty one percent of patients were in the unit for less than a day, and 49 % were admitted for less than 3 days. Sixteen patients (18%) had X-ray investigations, with a total of 21 investigations and 30 exposures. Thirty percent of primary radiation dose was due to repeat exposures. Patients receiving X-rays had an average of 2 X-ray examinations (range: 1 to 4 studies) performed, with an average Entrance Skin Dose of 196.7µSv (0.197mGy) – range 77 to 554µSv (0.077mGy to 0.554mGy). There was no statistically significant difference between weeks or zones (p=0.1060 and p=0.8237 respectively), and differences in primary radiation doses was likely due to chance. Conclusion: Additional measures to protect patients in the unit from secondary radiation are unnecessary. There was a low probability of patients having a radiological investigation in the neonatal high care unit, and secondary radiation doses were not measurably higher than background radiation. / TL (2019)

Thesis (DTech (Radiology))--Cape Peninsula University of Technology, 2016. / The aim of this study was to provide evidence basedforecast for radiology demand in Zimbabwe that would support policies aimed at optimising radiology resource allocation and utilisation. This was upon the realisation that the Ministry of Health and Childcare required such forecast in order to ensure equitable, accessible and quality health services as prescribed in the 2009-2015 National Health Strategy as well as in Section 29 and 76 of the Zimbabwean constitution. On the international perspective, many researchers have reported stable high demand for radiology services giving rise to long waiting lists and backlogs. In the United Kingdom’s National Health Services (NHS), there is general consensus that these waiting lists are caused by variation mismatches between capacity and demand for radiology services. Elsewhere, it has been reported that skill mix, role changes, dynamic nature of radiography teaching and learning, technology diffusion, service transaction time, overutilisation, and unjustified exposures are key drivers of high demand for radiology services. It has long been established that demand for radiology services is stochastic in nature, and therefore planning of future investments in radiology must be guided by an understanding of how these variables interact to model the criterion variable. However, there is paucity of information pertaining to key aspects of legitimate radiology demand forecasts. Formulation of these fundamental concepts formed the impetus of this study. A document review, interviews and non-participatory observations revealed that justification of radiology examinations, dynamic nature of radiography teaching and learning, diffusion of extended roles and technology, equipment and personnel capacity, and most importantly service transaction time all had an impact on the demand for radiology services in Zimbabwe. Limited diffusion of extended roles and technology had increased over a ten year period. Observed role changes were informal additions to the procedures normally carried out by radiographers and these were not supported by formal education. Consistent with global concerns, over utilisation and unjustified requests were a national concern. In situations where capacity outweighed demand, there was evidence that internal management of radiology departments was responsible for most variation mismatches which then gave rise to long waiting times.

Submitted in fulfillment of the requirements for the degree of Master’s of Technology: Radiography, Durban University of Technology, Durban, South Africa, 2015. / Introduction Tuberculosis remains a leading cause of death, second to the Human Immunodeficiency Virus. The risk of latent tuberculosis infection and active tuberculosis disease is a known occupational hazard. In South Africa, a high tuberculosis burden country, the potential of Mycobacterium tuberculosis transmission to health care workers is high. This includes diagnostic radiographers and other radiology staff working in radiology departments. Purpose of the Study This study aimed to investigate the association of demographic and occupational factors with latent tuberculosis infection in radiology staff in public sector hospitals of the eThekwini Health District. Methodology This cross-sectional study was conducted from 26 February 2013 to 07 June 2013. Quantitative methods were used to test for associations of demographic and occupational factors with latent tuberculosis infection in participants. A sample size of 181 participants for an estimated population of 340 radiology staff was recommended at the proposal stage. The study consisted of two phases; the questionnaire survey (phase one) and the administration of a two-step tuberculin skin test (phase two). Data was obtained with regard to demographics, occupational history, social behaviours, medical history; and family and home histories. Demographic and occupational associations with latent tuberculosis infection were made in relation to the size of the first tuberculin skin test induration. Frequency distributions were developed to describe data categories. Pearson’s and Spearman rho’ correlation coefficients were used to test for correlations between the independent variables. The chi-square test was used to determine associations between the categorical independent variables and the dependent variable. Bivariate analyses were performed using these tests. The multivariate analysis was performed using logistic and linear regression on the dependent variable. Results A total of 182 questionnaires were returned from approximately 280 radiology staff. At the outset, all doctors working in the radiology department had to be excluded due to numerous failed attempts to enlist their participation. Fifty-three (29.12 percent) participants were excluded from phase one of the study and a further thirteen participants were excluded from phase two. The total sample was 116 participants. Of the 116 participants, 86.2 percent tested positive for latent tuberculosis infection at the first step of the two-step testing method used. One (0.86 percent) participant went on to convert at the second step, testing positive at this level. Demographic associations with latent tuberculosis infection included age (older) as an associated factor. A significant demographic association with latent tuberculosis infection was the use of alcohol (p-value 0.033 on the multivariate analysis). Occupational associations with latent tuberculosis infection included longer durations of employment. The annual income (higher income earners) displayed significant associations with latent tuberculosis infection (p-value 0.048 on the multivariate analysis). It is necessary in this study to note that participants include support personnel (lower income earners) making up 37.8 percent of the study, diagnostic radiographers making up 48.3 percent; and radiography managers/assistant managers (highest income earners) making up 13.8 percent of the study. Conclusion and recommendations The risk of transmission of Mycobacterium Tuberculosis to health care workers is a known occupational hazard. This study has described the prevalence of latent tuberculosis infection in radiology staff, at district and regional hospitals within the eThekwini Health District. With 23.62 percent of all participants already having active TB disease and 86.2 percent of the tested group displaying positive results for latent tuberculosis infection, using the tuberculin skin tests, the need for tuberculosis screening is essential. The findings of this study will be used as a health improvement mechanism for stakeholders, having identified potential gaps in medical screening in healthcare in Kwa-Zulu Natal. This study makes recommendations for the early detection of active tuberculosis infection and the monitoring of health care workers that are latently infected, thus assisting in reducing the rate of conversion of latent tuberculosis infection to active tuberculosis disease in radiology staff. This reduces long-term exorbitant costs related to health care associated infections, such as tuberculosis. It also reduces rates of transmission and cross infection to both co-workers and already immunocompromised patients, helping to curb the overall epidemic in South Africa.

M.Tech. (Radiography) / Satisfied patients are recognized as an important outcome measure for evaluating the quality of medical care provided in a hospital setting. A satisfied patient is more likely to comply with instructions given and cooperate with medical staff during procedures such as special radiographic examinations in the radiography department. In Malawi, studies on patient satisfaction have mostly been confined to doctor – patient interaction and other aspects of the health care service. Very little research has been conducted to explore the experiences of patients undergoing special radiographic examinations. The purpose of this study was to explore the experiences of patients undergoing special radiographic examinations at Kamuzu Central Hospital. A qualitative, contextual, explorative, descriptive approach was used to collect data from patients undergoing special radiographic examinations at Kamuzu Central Hospital in Malawi. Focus group interviews were employed to collect data from the study participants. A total number of 15 patients took part in the study. A content analysis approach was used to analyze the views of the participants. The themes that emerged from the focus group data were: Concerns about delays from reception to receiving radiography results (Radiographs and report); Patients’ experiences with regards to the quality of patient care they received and Concerns about the hospital environment and resources in the radiography department. Guidelines have been proposed to address the themes identified.

M.Tech. (Radiography) / Systematic implementation of a quality control (QC) programme is crucial for any diagnostic radiology department if consistent optimal equipment performance, quality images, accurate diagnosis and quality services at optimum radiation dose and costs are to be assured. This highlighted the necessity for the Tanzania Atomic Energy Commission (TAEC) to establish a training programme to enable radiographers to implement a QC programme and associated QC measures in their departments. Most radiographers have been trained on the QC programme, however, the level of QC implementation by the radiographers is not established. The aim of this study was to investigate the extent to which the QC programme and associated QC measures are being implemented by radiographers in conventional diagnostic radiography units, in Tanzania. A quantitative cross-sectional study design, using a questionnaire, was conducted on a sample of radiographers who have been trained on the QC programme, and who were practicing in hospitals within Tanzania. The study found that implementation of the QC programme and associated QC measures was poor. Most QC measures were not being performed and that only a few tests were being performed but not consistently. Furthermore, there were no records and procedures available for the QC programme. The challenges identified were negligence by the radiographers, lack of standardized test tools, lack of hospital managerial support, lack of enforcement and lack of motivation and coordination. Multifactor interventions by the TAEC, Ministry of Health and Social Welfare, radiographers and the hospital management teams are needed to improve the implementation of the QC programme.

M.Tech. / The recent increase in demand for radiotherapy services has led to significant delays in commencement of radical radiation treatment in most centres. Radiobiological principles suggest that a delay in starting radiotherapy may have a negative impact on tumour local control. To cope with the growing demand for radiotherapy, modern improvement models need to be accepted and adapted in radiotherapy departments. The PLAN DO STUDY ACT (PDSA) model is an example of such an improvement model which explores new possibilities of improvement through experimentation. This study aimed to determine the causes of radiotherapy delays, and to develop and implement improvements for reducing radiotherapy delays from patients’ referral to a radiotherapy department to the start of radiotherapy at Gaborone Oncology in Botswana. The objectives were to determine the causes of radiotherapy delays, develop and implement improvements of reducing radiotherapy delays using the PDSA model for improvement, and evaluate the effectiveness of the model. Patients who had received radical radiotherapy for head and neck, breast and cervix tumours were analysed as they are the commonly treated cancers at Gaborone Oncology. A retrospective survey was conducted for one year to establish the causes of radiotherapy delays from patient referral to the department to the start of radiation treatment. The PDSA model for improvement was then implemented and monitored for evidence of improvement from May to December 2008. The PDSA model showed significant reduction in radiotherapy delays at Gaborone Oncology. The results showed a decrease in radiotherapy delays in head and neck, breast and cervix cancers from an average delay time of 18.5 days in May 2008 to 8.6 days by December 2008.

Thesis (MPH. ) --University of Limpopo, 2014 / This dissertation reports on findings from a qualitative research that sought to investigate adherence and compliance to radiation safety protocols by radiographers and dental professionals in the Waterberg District. The study also sought to determine the knowledge the participants had on the chronic ill-effects of occupational exposure to radiation, safety protocols and their professional experience in dealing with occupational exposure to radiation. Altogether 60 participants from 8 health institutions in the Waterberg district took part in the study. They were compromised of males and females with ages ranging from 22-60 years. The response rate was 75% (n=45/60). The empirical data of the study shows a consistent yet disconcerting pattern among practitioners about safety compliance, safety protocols and their understanding of long term effect of occupational exposure to radiation. Despite their impressive knowledge of X-rays being a source of ionizing radiation, the level of their understanding of ill-effects thereof was of great concern. The general failure by both professionals in complying with the most basic safety protocols is worrisome. In a nutshell, yet some of the practitioners were found to be greatly exposed to radiation, their daily practices were found not consistent with procedures dictated by the guidelines on the use of medical X-ray equipment. Overall, only 59% of radiographers always wore their dosimeters, a basic monitoring and protective tool to measure their radiation exposure. In the study, only 38% of the dentists were found to be compliant and overwhelmingly alluded this to their employers being unable to supply them with crucial protective clothing, a finding that the researcher cannot dispute as indicated in the responses by the two groups. The failure of the employer in enforcing monitoring and assuring safety to the employees, patients and the general public emerged from this study. Various non-compliance patterns could be attributed to the participants and others to the employer. Protocols as clearly stipulated in R1332 of Hazardous Substance Act 15 of 1973 and other guidelines are not adhered to.

PURPOSE: To determine the management performance indicators most frequently utilized in academic radiology departments in the United States. MATERIALS AND METHODS: This investigation met the criteria for an exemption from institutional review board approval. A cross-sectional study in which a validated national survey was sent to members of the Society of Chairmen of Academic Radiology Departments (SCARD) was conducted. The survey was designed to examine the following six categories of 28 performance indicators: (a) general organization, (b) volume and productivity, (c) radiology reporting, (d) access to examinations, (e) customer satisfaction, and (f) finance. A total of 158 variables were included in the analysis. Summary statistics, the 2 test, rank correlation, multiple regression analysis, and analysis of variance were used. RESULTS: A response rate of 42% (55 of 132 SCARD members) was achieved. The mean number of performance indicators used by radiology departments was 16 ± 6.35 (standard deviation). The most frequently utilized performance indicators were as follows: (a) productivity, in terms of examination volume (78% [43 departments]) and examination volume per modality (78% [43 departments]); (b) reporting, in terms of report turnaround (82% [45 departments]) and transcription time (71% [39 departments]); (c) access, in terms of appointment access to magnetic resonance imaging (80% [44 departments]); (d) satisfaction, in terms of number of patient complaints (84% [46 departments]); and (e) finance, in terms of expenses (67% [37 departments]). Regression analysis revealed that the numbers of performance indicators in each category were statistically significant in predicting the total number of performance indicators used (P < .001 for all). Numbers of productivity and financial indicators were moderately correlated (r = 0.51). However, there were no statistically significant correlations between the numbers of performance indicators used and hospital location, hospital size, or department size (P > .4 for all). CONCLUSION: Assessing departmental performance with a wide range of management indicators is not yet an established and standardized practice in academic radiology departments in the United States. Among all indicators, productivity indicators are the most frequently used.

Text in English / The contribution of general diagnostic imaging in the diagnosis and clinical management of patients in rural hospitals of South Africa is enormous. To provide high quality diagnostic imaging services for specific contexts requires radiographers who have up-to-date skills and expertise. Thus, rural radiographers require, over and above traditional radiographic expertise, additional competencies which are unique to rural practice. To date, however, little is known about additional core competencies and skills needed by radiographers working in rural areas. Previous studies have focused more attention primarily on other rural health professionals such as doctors and nurses. The aim of this mixed methods study was to investigate and identify additional core competencies required by radiographers working in rural district hospitals of KZN in order to propose a CPD strategy aimed at rural radiographers. An exploratory sequential design was utilised. There were seven participants in the qualitative phase of the study. In the quantitative phase a convenient sample of 109 respondents was surveyed using a structured questionnaire. Three major themes and seven categories emerged from Phase I of the study. These themes and categories were then used to develop a data collection instrument for Phase II of the study. Collectively, the findings of this mixed methods research revealed that there were a number of additional core competencies such as, but not limited to, teamwork, ability to do basic obstetric ultrasound scans, leadership, management, attitude and behaviours, and reporting on plain x-ray films, all of which are required by rural radiographers. Supporting evidence from the study indicated that the majority of these competencies were either partially or not at all covered in the audited curriculum. The study further revealed that the audited curriculum and the scope of radiography in its current form appear to focus attention on minimum competencies that do not promote the expansion and extension of the role of radiographers in rural areas. The study results also revealed a number of challenges faced by rural radiographers. / Health Studies / D. Litt. et Phil. (Health Studies)