Introduktion: CT-angiografi med kontrastinjektion kan ge en god visualisering av kroppens blodkärl. Även om CT har många fördelar i samband med avbildning, har det några nackdelar som bör uppmärksammas. Det finns forskning som visar hur optimering av kontrastmedelsanvändning kan minska stråldosen och samtidigt förbättra bildkvaliteten.

Syfte: Syftet med denna studie är att undersöka hur kontrastmedelsanvändningen vid CT-angiografi kan optimeras utifrån faktorerna cardiac output, arm- och kroppspositionering samt val av injektionsplats.

Material och metod: En systematisk litteraturöversikt genomfördes. Studierna som använts i litteraturstudien hämtades från tre olika databaser. Totalt valdes 16 studier ut för att besvara syftet. De inkluderade artiklarna publicerades på engelska mellan 2010–2019.

Resultat: Resultatet visade att blodflödet beror på cardiac output och påverkar kontrastförstärkningen i kärlen. Den ventrala armpositionen bidrar till minst artefakter och förbättrad kontrastförstärkning. Den optimala kroppspositioneringen är den som följer blod- och kontrastflödet för att undvika artefakter. Resultatet visade även att injektion i höger arm gav bättre attenuering, mindre artefakter samt lägre stråldos.

Slutsats: Resultatet från studien visade att de olika faktorerna hos patienten kan påverka kontrastförstärkningen i blodkärlen samtidigt som bildkvalitet förbättras och stråldosen reduceras.

Background: Covid-19 was classified as a pandemic in the beginning of 2020. This forced health care professionals within elderly care, emergency departments, intensive care units, and infection wards with focus on care of patients with covid-19 to work under high pressure, which has been highlighted by various media. Despite playing an important role within covid-healthcare, radiographers have not been acknowledged to the same extent.

Aim: To highlight radiographers’ experiences of their role in the covid-healthcare when performing computed tomography examinations of patients who are suspected or confirmed to have covid-19.

Material and method: This study has a qualitative design and is based on semi-structured interviews with five radiographers from two radiology departments in Sweden.

Results: Covid-19 has led to a change in the work situation for radiographers where a new patient group requires new routines, including more planning and time. The radiographers’ role in covid-healthcare is perceived to be unseen by other departments.

Conclusion: The participants' experiences of stress, uncertainty and time spent due to covid-routines affect their work, but have changed during the pandemic as these routines have become part of their daily work. Radiographers are providing patients with good care in connection to the examination, which has been and still is a challenge due to protective equipment feeling obstructive.

Computed tomography (CT) examinations have increased markedly in recent decades and, in parallel with this, the technology has developed considerably. Dual-energy CT is a relatively new technology that has emerged after single-energy CT technology. CT examinations involve high patient doses, and therefore the purpose of this study is to compare radiation doses between new and old technology. The study is of a quantitative approach and retrospective data collection. Participants who met the selection criteria were included in the study and divided into four groups to allow comparison of radiation doses between genders and both modalities. The number of participants included in the study was 569 and these were performed at Ryhov County Hospital in Jönköping. Data were processed in SPSS where each group in each gender was compared against each other to see if there was a radiation dose difference. The variables tested were Dose length product (DLP), Computed tomography dose index by volume (CTDIvol) and mAs. The results show that single-energy CT gave a higher DLP and CTDIvol and a lower mAs. The results of this study are supported by the results of other research studies that have come to similar conclusions.

Our aim was to develop communication support material for information sharing related to an ¹⁸F-FDG PET/CT examination.

Methods: The study had a qualitative design adapting a multiphase structure. A prototype of communication support material consisting of illustrations and text related to an ¹⁸F-FDG PET/CT examination was developed. Interviews were conducted with patients scheduled for an ¹⁸F-FDG PET/CT examination for the first time, and questionnaires were collected from health care professionals with experience in ¹⁸F-FDG PET/CT. The communication support material was revised until consensus was reached about it.

Results: The results are based on interviews with patients (n = 10) and questionnaires collected from health care professionals (n = 9). The overall theme revealed that patient information about an ¹⁸F-FDG PET/CT examination is a balancing act between text and illustrations. The analysis showed 2 categories: "illustrations as a complement" and "easy-to-understand layout."

Conclusion: The participants strengthened the development of the communication support material by bringing in valuable viewpoints from various perspectives. The results support a person-centered approach in which information about an ¹⁸F-FDG PET/CT examination can be adapted to each patient's needs as a balancing act between text and illustrations.

Magnetresonanstomografiska undersökningar av brösten (MRT-mammografi) har utförts i över två decennier. Undersökningen görs vid mammografiskt oklara fynd, planering inför kirurgi samt vid kontroll när det finns ökad risk för bröstcancer. Informationen inför en magnetresonanstomografisk undersökning är avgörande då information angående undersökningsprocedurer ökar patientmedverkandet vilket kan gynna bildkvalitén inför diagnostik. Syftet med studien var att undersöka patientupplevelser av informationsbehovet i samband med en MRT-mammografisk undersökning. Urvalet för studien bestod av 6 patienter som genomgick en MRT-mammografi under månaderna februari till april 2015. Studien har en kvalitativ ansats där enskilda telefonintervjuer gjorts. Insamlad data har analyserats med innehållsanalys som resulterat i 4 kategorier: Informationsmetod, Kunskap och tidigare erfarenheter, Röntgensjuksköterskans interaktion med patienter och önskat informationsinnehåll. Informationen i samband med undersökningen anses vara tillräcklig och bra enligt de flesta informanterna. Brister belyses dock i den nuvarande informationen och förbättringsutrymmen så som information på andra språk, vägbeskrivning samt information om undersökningsproceduren har angivits. En viktig kategori som synliggjorts under studiens gång är Röntgensjuksköterskans interaktion med patienter. Röntgensjuksköterskans information är ett komplement till informationen som givits i samband med en MRT-mammografi och har en betydande roll i mötet med patienter. 

Prostate cancer is the most common cancer in men. The prostate belongs to the male reproductive organs and produces, among other things, prostate-specific antigen (PSA) that can be detected in the blood. Elevated levels of PSA may be due to prostate cancer. Transrectally ultrasound (TRULS)-guided systemic biopsies are used at higher frequency than magnetic cameras with directed biopsy. The X-ray nurse's meeting with these patients is before, during and after the imaging with the magnetic camera. The aim was to make an overview of the diagnostic accuracy of TRULS guided systematic biopsies and MRI with targeted biopsies on suspicion of prostate cancer. The method consisted of a literature review with systematic approach. Inclusion criteria were scientific articles written between 2015-2020. The articles would be peer-reviewed and ethically approved. The Medline database was used for the search. Quality review was done with review protocols obtained from the Department of Nursing at the School of Health. The result included 15 articles showing that there was no big difference in the diagnostic accuracy of prostate cancer in men between the methods. In contrast, MRI with targeted biopsies found a greater proportion of clinically significant cancers and a smaller proportion of insignificant cancers than TRULS guided systematic biopsies did. MRI with targeted biopsy is a good method for increasing the accuracy of finding clinically significant cancer. However, TRULS guided systematic biopsies cannot be ruled out as contraindications and missed cancers on MRI with targeted biopsies occur.

Background: In radiographic practice, radiographers play a crucial role in ensuring accurate diagnostic images. With the rapid advancement in medical technology and the introduction of artificial intelligence (AI), radiographers face new challenges and opportunities, leading to changes in their work responsibilities. 

Aim: The aim of this study was to explore radiographers’ experiences and perceptions regarding the use of artificial intelligence in radiographic practice. 

Method and Materials: This qualitative study is based on semi-structured interviews with seven radiology nurses who have experience working with artificial intelligence in radiographic practice. 

Results: The study's findings indicate that it is crucial for all personnel working with AI to feel secure and competent. Although radiographers are optimistic about the potential of AI, they emphasize the need for clear regulations, guidelines, and suitable education. They recognize that the technology may introduce new tasks but maintaining human presence is essential for patient safety and care quality. All respondents believe, it is important to protect the profession with its technical aspects. 

Conclusion: The study shows that radiographers are generally positive about AI while wanting to retain their professional identity and expertise in radiographic practice.

Titel: Röntgensjuksköterskans upplevelse av att arbeta med externa granskare under jourtid

Syfte: Att undersöka hur röntgensjuksköterskan upplever arbetet med externa granskare under jourtid.

Material och metod: Sex stycken röntgensjuksköterskor från två olika sjukhus i mellansverige intervjuades under perioden januari till mars 2017. Inklusionskriterierna för studien var minst två års erfarenhet av yrket samt minst ett års erfarenhet av att arbeta med externa granskare under jourtid. Tillstånd från verksamhetschefer och samtycke från informanterna erhölls innan studien startade. Data samlades in genom en kvalitativ metod med semistrukturerade intervjuer bestående av öppna frågor. Den insamlade datan analyserades med kvalitativ innehållsanalys enligt Graneheim & Lundman. Intervjuerna transkriberades och lästes igenom flera gånger. Därefter identifierades meningsbärande enheter och dessa kondenserades till koder. Genom koderna kunde kategorier och subkategorier identifieras.

Resultat: I resultatet framkom fyra kategorier; Teleradiologi – tekniska aspekter, externa granskare jämfört med radiolog på plats, kommunikation och röntgensjuksköterskans kompetenser och egenskaper med tillhörande subkategorier.

Konklusion: Informanterna upplever att det tar längre tid att kommunicera med externa granskare (EG) i jämförelse med att ha en radiolog på plats som kan ge svar direkt när röntgensjuksköterskan (RSS) är i behov av vägledning och snabba svar. I kommunikationen upplevs det också finnas språkbarriärer samt bristande kunskap, speciellt hos de sekreterare som tar emot samtal hos EG. Detta leder till frustration och blir ofta ett hinder i akuta situationer då RSS vill prata med en radiolog direkt. Under jourtid upplever RSS att denne får ta ett ökat ansvar samtidigt som förmågan att ta egna initiativ och beslut måste finnas. RSS upplever ingen förändring av bildkvalitén på de bilder som skickas i arbetet med EG. Informanterna upplevde i helhet att arbetet med EG fungerar bra och tillfredsställande under förutsättningarna att tekniken fungerar som den ska samtidigt som arbetsflödet inte ökar för mycket. 

Summary

 Patient’s experience av CT Colonography.

 Background: CT Colonography is used to examine the colon and detect pathological changes such as polyps and cancer. This method requires similar preparations to colonoscopy. The examination includes thorough bowl preparations and the administration of CO₂ insufflation, which can cause discomfort and pain for patients. These aspects impact both the patients physical and psychological state.

Purpose: The purpose of the study is to examine the patient’s experience of CT Colonography.

Method : A systematic literature review was conducted with data collection from the CINAHL database. Selected studies were published between 2012 and 2022 and then quality assessed to address this study's purpose.

Results: The results from fourteen scientific articles demonstrate varying patient experiences with different bowel preparations, including complete and reduced laxation, fiber diet, before CT colonography.

Conclusion: The patients, experiences during CT Colonography are complex and influenced by multiple factors. Continued research and clinical development are crucial to improve patient experience and increase diagnostic accuracy. Keywords: CT colonography, patient experience, bowel preparations and CO₂ insufflation.

This study investigates radiographers' views on implementing dose-reduction measures, with a focus on verifying patient identity and pregnancy status, practising gonad shielding in men and using compression. An electronic questionnaire was distributed to radiographers working in general radiography and/or computed tomography. The questionnaire was based on factors from a framework for analysing risk and safety in clinical medicine. Ordered logistic regressions were used to analyse associations among factors and use of dose-reduction measures. In total, 466 questionnaires were distributed and 170 radiographers (36%) completed them. Clear instructions and routines, support from colleagues, knowledge and experience, a strong safety culture, managerial support and access to proper equipment influence the likelihood of using dose-reduction measures. The strongest associations were found between support from colleagues and verifying pregnancy status (OR = 5.65, P = 0.026), safety culture and use of gonad shielding (OR = 2.36, P = 0.042), and having enough time and use of compression (OR = 2.11, P = 0.003). A strong safety culture and a supportive work environment appears to be essential for the use of dose-reduction measures, and education, training and stress management can improve utilisation of dose-reduction measures.

Introduction: Iodine-based contrast agents are used in hospitals equipped with a computed tomographic camera, as their purpose is to enhance both healthy and diseased tissue. As contrast agents are used frequently, it is important to use the correct dosage. According to recommendations, the dosage should be adjusted depending on the patient’s kidney function (GFR), age, weight, and height. Despite the recommendations, hospitals use different doses even though the examination concerns the same patient. Methods: A survey was out to 49 hospitals via email to collect information on the dosage of intravenous contrast agents in computed tomographic abdominal examinations. A total of 33 hospitals participated in the data collection (67%), including 3 university hospitals, 11 district hospitals, 17 county hospitals and 2 anonymous hospitals. The survey was conducted using esMaker and included two fictitious patient cases, and five questions regarding their computed tomographic camera and their calculations system. Objectives: To investigate differences in the usage of contrast agents in computed tomographic abdominal examinations. Results: Patient case 1 had a contrast agents dose ranging from 84–120 ml, while patient case 2 showed a variation between 66–96 ml. Absolute GFR were used in 53% of the hospitals for calculating the contrast agent dosage, 27% used relative GFR, and 21% used a combination of both. Conclusions: There is a variation in the dosage of contrast agents used in different hospitals across Sweden. 

INTRODUCTION: Guidelines concerning intravenous iodinated contrast media (CM) during computed tomography (CT) examinations are important to follow to minimize the risk for post-contrast acute kidney injury (PC-AKI). The purpose of this study was to investigate the radiology departmental policy compliance with Swedish guidelines concerning PC-AKI.

METHODS: In February 2020, an electronic survey was distributed to the responsible radiographer at 41 radiology departments in all university hospitals and medium-sized hospitals in Sweden. The questions focused on routines around renal functional tests, individualized contrast administration and handling of patients with diabetes mellitus taking metformin.

RESULTS: The response rate was 83%. Seventy-six percent (n = 26) of radiology departments calculated estimated glomerular filtration rate (eGFR) from serum creatinine prior to CM administration, but only 24% (n = 8) followed the recommendation to calculate eGFR from both serum creatinine and cystatin C. For acute/inpatients, 55% (n = 18) followed the recommendation that renal functional tests should be performed within 12 h before CM administration. For elective patients, 97% (n = 33) followed the recommendation to have eGFR newer than three months which is acceptable for patients with no history of disease that may have affected renal function. Approximately 80% of the radiology departments followed the recommendation that CM dose always should be individually adjusted to patient eGFR. Seventy-six percent (n = 26) followed the recommendation to continue with metformin at eGFR ≥ 45 ml/min.

CONCLUSION: Compliance with the national guidelines was high regarding routines around renal functional tests, dose adjustment of CM and metformin discontinuation. Improvements can be made in using both cystatin C and serum creatinine for eGFR calculations as well as ensuring renal function tests within 12 h for acute/inpatients with acute disease that may affect renal function.

IMPLICATIONS FOR PRACTICE: This study raises awareness of the importance of adhering to guidelines in healthcare. To have knowledge about the current level of compliance regarding PCI-AKI is important to maintain and develop effective clinical implementation of guidelines. The variation in practice seen in this study emphasizes the need of more effective implementation strategies to ensure adherence with best practice.

Introduction: Radiographers are today facing various challenges as the technical equipment is getting more advanced and the examinations encounter patients with complex medical records. Furthermore, in the Swedish context, radiology departments are struggling with shortage of both radiologists and radiographers. Following, this has led to a work-situation where radiologists are not always in place during emergency duty, and radiographers’are taking on additional responsibility. Hence, there is a need for further and deeper knowledge within areas that previously was undertaken solely by radiologists. One such area is reporting; and a 7.5 ECTS course was designed and offered to registered radiographers. The aim was to investigate radiographer’s experience of their work-performance and contribution to the clinic after attending this particular course in reporting.

Methods: The study had a qualitative design based on individual and semi-structured interviews with 34 radiographers who attended the course in reporting the fall of 2013, 2014 and 2015. The interviews were transcribed verbatim and analysed using qualitative content analysis.

Results: The analysis resulted in a comprehensive theme: Width and depth in the professional practice. This theme embraced three categories: Increased knowledge, Professional recognition, Work satisfaction.

Conclusions: Increased knowledge in reporting is necessary to meet the demands from the diagnostic departments. A course in reporting on advanced level is a tool for deeper understanding of the medical image. However, there will still be challenges and constraints during the path to be a fully specialized radiographer in reporting. There is a need for more courses in this area on the second and third level.

Introduction: Radiography is a healthcare speciality with many technical challenges. Advances in engineering and information technology applications may continue to drive and be driven by radiographers. The world of diagnostic imaging is changing rapidly and radiographers must be proactive in order to survive. To ensure sustainable development, organisations have to identify future opportunities and threats in a timely manner and incorporate them into their strategic planning. Hence, the aim of this study was to analyse and describe plausible scenarios for the radiography profession in 2025.

Method: The study has a qualitative design with an inductive approach based on focus group interviews. The interviews were inspired by the Scenario-Planning method.

Results: Of the seven trends identified in a previous study, the radiographers considered two as the most uncertain scenarios that would have the greatest impact on the profession should they occur. These trends, labelled "Access to career advancement" and "A sufficient number of radiographers", were inserted into the scenario cross. The resulting four plausible future scenarios were: The happy radiographer, the specialist radiographer, the dying profession and the assembly line.

Conclusion: It is suggested that "The dying profession" scenario could probably be turned in the opposite direction by facilitating career development opportunities for radiographers within the profession. Changing the direction would probably lead to a profession composed of "happy radiographers" who are specialists, proud of their profession and competent to carry out advanced tasks, in contrast to being solely occupied by "the assembly line".

Introduction: Anxiety is often experienced by children undergoing health care procedures, and children with autism spectrum disorders (ADS) experience more anxiety than typically developed children. A prerequisite for obtaining an optimum procedure is firstly based on the health care provider’s knowledge about children with ASD, but may also depend on the use of guidelines. Two previous national surveys showed, that none radiology or paediatric departments and a minority of anaesthesiology departments throughout Sweden use specific guidelines when seeing children with ASD. Following, the purpose was to develop guidelines to use when caring for and preparing children with ASD in those settings.

Methods: A modified Delphi method was used, including19 experts identified from the two afore mentioned surveys. The questions considered in the process, proceeded from previous research and the results from the surveys. The experts’ responses regarding the importance of each item, were analysed and scrutinized between each round.

Results: The Delphi process resulted in guidelines consisting of 15 items and a checklist with 16 aspects. The items cover the areas: planning and involving parents, features in the environment, use of time, communication, thehealth care professionals. The checklist covers the child’spattern of communication, anxiety, sensory stimuli, special interests and likes/dislikes.

Conclusions: To obtain an optimum caring encounter when a child with ASD is seen in the preoperative and radiology setting, a meticulous planning is important and the environment should be adjusted for the needs of the child. To accomplish this, guidelines need to be in place and be followed.

Bakgrund: Barn som kommer till den radiologiska avdelningen kan uppleva oro i den högteknologiska miljön. Barn med autismspektrumtillstånd kan uppleva mer oro i dessa miljöer då diagnosen innebär nedsatta förmågor gällande social- och språklig kommunikation, föreställningsförmåga samt flexibilitet. För en optimal undersökning ställer det krav på att röntgensjuksköterskan kan ge ett bemötande som minskar oro.

Metod/Syfte: Arbetet utformades som en litteraturöversikt med systematiskt tillvägagångssätt för att besvara syftet hur röntgensjuksköterskan kan bemöta barn med autismspektrumtillstånd för att minska oro i samband med undersökning på den radiologiska avdelningen.

Resultat: Tre huvudkategorier identifierades i resultatet: vårdmiljö, vårdpersonalens roll samt föräldrarnas roll. För att minska oro hos barnet kan röntgensjuksköterskan anpassa vårdmiljön och genom förberedelser skapa en känd miljö. Röntgensjuksköterskan kan även ha ett förhållningssätt där kommunikation anpassas till barnet och ett samarbete med föräldrarna skapas.  

Slutsats: Röntgensjuksköterskan har ansvar att anpassa sitt bemötande och kan genom att tillämpa strategier minska oro hos barnet med autismspektrumtillstånd vid radiologiska undersökningar.

Recent developments in artificial intelligence (AI) and deep learning (DL) have made diagnostic imaging a prime candidate to adopt the technology. AI in mammography screening aims at promoting health with hopes of higher diagnostic accuracy. The radiographers work is characterized by properly performed imaging and actively updating the profession regarding technical developments and renewed working methods. The aim of this systematic review was to illustrate feasible effects of AI on diagnostic imaging within mammography screening. Through manifest content analysis of results obtained from subject related scientific studies published 2019–2020 in the databases Cinahl and Medline the authors identified and described categories compiled by subcategories with similar contents. Effects within the image interpretation process and diagnostic accuracy describes several perspectives regarding the outputs of AI on diagnostic imaging. AI-systems have proven to be useful in both assisting with image interpretation and reducing the workload for radiologists by disclaiming mammograms with low probability of breast cancer. Most promising effects are seen in the classification of breast tissue and reduction of false positives, but research is challenged by ethical dilemmas and the need for a legal framework, which are areas suggested for future research.  

Bakgrund: Ett sjukhus i mellersta Sverige utför samordnade undersökningar i samband med när barnet behöver sövas inför en magnetisk resonanstomografi (MR) undersökning. Detta koordineras och bokas av en röntgensjuksköterska som därefter skickar ut en kallelse till patienten.

Syfte: Att belysa hur föräldrar upplever att flera olika undersökningar utförs på deras barn i samband med sövning vid MR-undersökning.

Metod: Studien har en kvalitativ ansats där enskilda intervjuer med föräldrarna har skett. Urvalet för studien bestod av åtta föräldrar vars barn blev sövda inför en MR-undersökning där fler andra undersökningar gjordes vid samma tillfälle.

Resultat: Informanterna var helt eniga om att de samordnade undersökningarna var något positivt. En viktig aspekt som många av informanterna nämnde var bemötandet från vårdpersonalen vilket majoriteten var nöjda med. Mindre nöjda var några informanter kring informationen angående MR.

Slutsats: Generellt är föräldrarna nöjda med samordnade undersökningar. Ett informationsbrev kring hur MR-undersökningen utförs kan skickas med i kallelsen för att förbereda båda barn och föräldrar.

Röntgensjuksköterskeprogrammet är en treårig högskoleutbildning och VFU är en central del av utbildningen. Det saknas studier kring klinisk lärandemiljö som involverar röntgensjuksköterskestudenter och tillämpar ett internationellt validerat mätinstrument. Syftet med detta arbete var att studera hur röntgensjuksköterskestudenter upplever lärandemiljön och handledning inom verksamhetsförlagd utbildning. Mixad metod med segregerad design användes i studien. Röntgensjuksköterskestudenter gåendes i termin två till sex inkluderadesfrån sex olika lärosäten i Sverige. Webbversion av CLES+T användes med en öppen fråga i slutet av enkäten. Kvantitativt resultat visade generellt hög nöjdhet med sin VFU i sin helhet.Omvårdnad och genomförande av undersökningar på avdelningen och Relationen mellan handledare och student värderades högst, men även Pedagogisk atmosfär på avdelningen, Den kliniska lärarens/ huvudhandledarens roll värderades allmänt högt. Lägsta värderingen hade kategorin Ledarstil för avdelningschef. Fem dagar per vecka på VFU platsen, placering på mellanstort sjukhus och upplevelse av strukturerade och planerade arbetsdagar resulteradenöjdare studenter. Kvalitativ analys visade att Organisatorisk och social arbetsmiljö samt Professionell handledning är viktigaste aspekterna. Mixad resultat bekräftade mesta delen av varandras fynd och bidrog med kompletterande aspekter över klinisk lärandemiljön. Slutsatsenär att röntgensjuksköterskestudenterna upplever en generellt hög nöjdhet när det gäller lärandemiljön och handledning inom VFU.

Positioning the breasts during mammography screening is one of the hardest tasks for the radiology nurse and is crucial for meeting all image criteria and ensuring good image quality. Even though there are guidelines for image criteria for each standard view, they can be assessed differently due to subjectivity. An AI tool can provide an objective view on whether the image criteria are met and if the image quality is correct. The purpose of this study is to evaluate if a specific AI tool can help radiology nurses assess image quality during mammography screenings. This will be done by comparing the AI tool’s assessment of image quality with that of the radiology nurses. A database of 14,700 exams was used to compare assessments of inadequate and adequate image quality. The results are divided into individual image criteria and overall image scores. Currently, the AI tool shows low agreement with the radiology nurse’s assessment in both cases. Cohen’s kappa (κ) for individual image criteria ranges from none to moderate agreement, and from none to weak for overall image scores. The positive and negative predictive values also show a low likelihood that the AI tool makes a correct assessment. The study concludes that the AI tool cannot currently be used to support radiology nurses in assessing image quality during mammography screenings.

Röntgensjuksköterskans huvudområde är radiografi som innefattar bland annat

användning av joniserande strålning. CT undersökningar av urinvägssystemen och

dess funktion ökar. CT ger en högre stråldos till patienter, jämfört med konventionell

röntgen, vilket kan medföra olika sorters skador hos den som bestrålats. ALARAprincipen

skall användas för att minska joniserande strålning så mycket som möjligt.

Studien är utförd på Höglandsjukhuset i Eksjö där de har implementerat

lågdosprotokoll på CT-urografi när det gäller att kontrollera funktionen av

urinvägarna. Syftet med studien är att jämföra stråldoser vid konventionell urografi

med lågdos CT urografi.

Studien är kvantitativ och retrospektiv. Data har insamlats från PACS och RIS.

Jämförelse av stråldoser har gjorts mellan patienter som gjort urografier med

konventionell röntgen och patienter som gjort lågdos CT. Patienterna har matchats i

avseende på kön, vikt och längd. Resultatet visar att lågdos CT-urografi gav 2,5

gånger mer stråldos till patienten än konventionell urografi. Detta var ett rimligt

resultat som stämmer med andra studier inom området.

Region Stockholm has a goal to use digitalized strategic tools to make the health care system more effective, accessible and increase patient participance. This goes hand in hand with governmental, Swedish Association of Local Authorities and Regions’s vision for eHealth 2025 that aim for Sweden to be world leader in digitalization. Results of several studies have shown positive effects on reduced no-shows with using web-based appointment system.

The purpose of this improvement work was to increase patient participance and availability through efficient use of resources in the radiology department. The goal was to reduce no-shows from 3,1 percent to <2 percent until 1 of April 2022 within conventional X-ray, computed tomography, and ultrasound atDanderyds hospital. Web-based appointment system was introduced using Nolan’s model for improvement that started with a small test and then scaled up. The results showed that most patients prefer web-based appointment system over traditional booking system. With web-based appointment system patient’s participation increased. On the other hand, the no-shows didn’t reduce.

The purpose of the study was then to describe employee’s perception when introducing a web-based appointment system. A qualitative focus group interview study with phenomenographic approach was conducted and analyzed with the same approach. Four describing categories was identified: (A) Webbased appointment system as a complementary tool for healthcare professionals (B) Web-based appointment system as a complement to higher service for specific target groups (C) Web-based appointment system as a common tool for patients and healthcare professionals (D) Web-based appointment system as part of sustainable healthcare system in the future. These categories can be seen as four steps to achieve full-scale web-based appointment system.

The conclusion is that the no-shows didn’t reduce but staff labor decreased, and patient participance increased. 

Detta arbete handlar om ett färskt område inom radiografin nämligen användandet av nanopartiklar som kontrastmedel. Det är vanligt förekommande att det används kontrastmedel inom radiografin, men de kontrastmedel som idag används är oftast inte helt riskfria. Det har gjorts många studier på senare år med nya typer av kontrastmedel som använder sig utav nanoteknologi vid framställningen. Vissa av de nya kontrastmedlen kan vara till nytta för flera olika typer av bröstundersökningar.

Radiografiska bröstundersökningar görs dels för att hitta men även för att utesluta bröstcancer. Inom radiografi kan flera modaliteter användas för bröstundersökningar, men det vanligaste och viktigaste är mammografi.

Syftet med denna studie är att undersöka vilka nanopartiklar som kan användas som kontrastmedel vid olika typer av radiografiska undersökningar av bröstvävnad och som metod valdes en systematisk litteraturstudie. Majoriteten av de sjutton artiklarna som studien baseras på är maximalt tre år gamla, vilket ger en väldigt aktuell inblick i ämnet.

Resultatet visar på att de tolv nanopartiklar som redovisas alla baseras på något metalliskt ämne och samtliga bidrar till att ge god kontrastökning i bilderna. De flesta artiklarna som ingår i denna studie har inriktat sig mot undersökning av tumörvävnad eller lymfkörtlar, men det finns även forskning som riktar sig mot screening.

Bakgrund: I magnetisk resonanstomografi (MR) är kontrastmedel baserat på gadolinium vanligast. Den senaste forskningen har visat att gadolinium kan lagras långvarigt i hjärnvävnad. Röntgensjuksköterskan administrerar vanligtvis kontrastmedlet till patienten vid undersökningen. 

Syfte: Syftet är att belysa deponering av gadolinium i hjärnvävnaderna nucleus dentatus och globus pallidus efter administrering av gadoliniumbaserade kontrastmedel samt eventuella risker till följd av deponeringen.

Metod: Litteraturstudien inkluderar 16 vetenskapliga artiklar varav den äldsta artikeln är från 2014. Sökningen av artiklarna gjordes via Jönköpings högskolebibliotek och har kvalitetsgranskats av författarna.

Resultat: Deponering i hjärnvävnad kunde påvisas bland linjära gadoliniumbaserade kontrastmedel. Liknande mätning med makrocykliska kontrastmedel gav ej samstämmiga resultat. Risker av deponeringen kunde ej påvisas.

Slutsats: En litteraturstudie som belyser deponeringsrisker kring användandet av gadoliniumbaserade kontrastmedel. Verksamma röntgensjuksköterskor bör ha kunskap om dessa deponeringsrisker vid administrering av gadoliniumbaserat kontrastmedel.

Background: The purpose of percutanous transluminal angioplasty (PTA) is to treat patients with symptoms and discomfort because of stenosis and occlusions in the arteries caused by atherosclerosis. This is done by dilatation of the vessel diameter and sometimes placing a stent to maintain the patency of the artery. Working as a radiographer includes meeting patients before, during and after PTA. Purpose: The purpose of this study is to illustrate the most common late complications that can occur after PTA. Method: This is a systematic literature study. The inclusion criteria for the articles were to follow a scientific structure, they had to be published between 2007 and 2018 and they had to be peer-reviewed and ethically reviewed. The databases used in this study were CINAHL and MEDLINE. Critical Appraisal Skills Programme was used. Result: 20 scientific articles were included in this study. All of them reported restenosis. Stent fractures occurred in 5 of 20 studies and amputation occurred in 14 of 20 studies. Conclusion: Restenosis was the most common late complication of PTA both with and without stent placement. More research is needed using drug-coated balloons and drug-coated stents to see if there are any beneficial effects.

Introduction: In order for young children to be able to undergo a Magnetic Resonance Imaging (MRI) examination, general anesthesia is often required. The aim of this study was to compare the image quality, times, and costs of the examinations of infant brains performed with MRI either during sedation with dexmedetomidine administered by radiographers or anesthesia with propofol administered by anesthesia staff. Methods: This study was a quantitative retrospective study of 27 consecutive standard brain examinations performed under sedation or anesthesia, involving 15 children under sedation and 12 under anesthesia. The age of the children was from 0.5 to five years old. The image quality was evaluated by three radiologists experienced in pediatric MRI examinations. Information such as examination time and the expense of the examination was also collected. Results: There was no statistically significant difference in the general image quality, but one image series was assessed to have significantly better image quality under sedation than under anesthesia, but all images had very high quality. However, it emerged that children under anesthesia were at the hospital on average 55 min longer and the scanner room was occupied 20 min longer on average. The anesthesia examinations were three times more expensive. Conclusion: This study demonstrated equivalent image quality between sedation and anesthesia. In addition, sedation was less time-consuming and had a lower price, partly because no extra anesthetic staff were required. The use of intranasal sedation offers a possibility to expand the competence area for radiographers. Implications for practice: If radiographers learn to perform intranasal sedation, examinations can be performed in less time, at a third of the staff costs while maintaining image quality.

Background: Common examinations for the paediatric group, under 6 years, are most often of the brain when magnetic resonance imaging (MRI) is used. The problem when children get examined is the difficulty lying still and that they don’t understand why they need to be still. MRI-images are extremely sensitive to motion artifacts, which destroy the image quality. For those children who are not able to participate or cannot be stationary in these examinations, sedation or anaesthesia can be offered as an aid.

Objectives: The purpose of this study is to compare examinations of infant brains performed with MRI either during sedation with Dexdor or under anaesthesia with Propofol 

Methods: This study is a quantitative retrospective study of 27 examinations performed under anaesthesia or sedation, collected with the help from Linköpings University Hospital. The image quality was assessed with the help of three radiologists with varying experience in paediatric images. 

Results: The results showed that there was no significant difference in image quality between the two different methods. On the other hand, it was shown that anaesthesia examinations took longer time to carry out and were more expensive. Looking at the image quality assessment, it was shown that there was a correlation between professional experiences and grading of image quality, which showed that the longer the experience, the fewer problematic images. 

Conclusion: This study showed an equivalent result between sedation and anaesthesia, however, a recommendation may be to use a lager study group if the study would be redone to contribute to a more reliable result.

Computer tomography (CT) - colonography is an examination which is on the rise since coloncancer is more common and acknowledged in todays’ community. In conjunction with a CT-colonography the preparations are demanding and requires the patients' full compliance to get a successful examination. This means that the patient needs a comprehensive information leaflet to understand the extent of the preparations. This study's purpose was to examine if the patient information was sufficient enough in conjunction with the CT-colonography and determine if the experience of the patient information differ between the two hospitals. Also examine if there were and differences genders between each other as well as age. The study will also overhaul if there were any improvement proposals. This study's design followed a quantitative survey with own constructed questions. The number of participants were 51 which filled the survey anonymously during the period March to April 2018. The majority of the participants had a good impression of the information. Between the men and the women there were no differences of the information, the survey answers also showed that the ages was no differnce based on age of the subjects. Few participants had any opinions about improvements but the ones who had wanted to evolve the information in a way that decreased the amount of information. The participants were pleased with the information and there was no significant difference between the two hospitals, gender or age.

Background: Undergoing magnetic resonance imaging (MRI) examinations can be difficult to endure for patients suffering from claustrophobia and anxiety. The radiographer can give the patient stesolid and then usually all of them can perform the examination.

Purpose: The overall purpose of the study was to investigate patients experience undergoing MRI with sedation. The study would also provide the most frequent examinated part of body with stesolid and if there was any difference in the experience depending on gender and age.

Method: The study was a quantitative questionnaire study with self-designed questions about patients experience during MRI with stesolid. From February to April 2018, the questionnaire was distributed at five selected hospitals in southern Sweden to patients who underwent MRI with stesolid.

Result: The result showed that patients who underwent MRI with stesolid had a good experience of the examination and there was no significant difference between the gender and age. Head/throat was the most common examination with stesolid.

Conclusion: The patients had a good experience of MRI with stesolid. Almost all of the patients got stesolid because they thought there was a restricted space in the camera. With this result, patients who want anaesthesia because of anxiety may be able to get stesolid instead with good effect.

Abstract: Signs of interpersonal violence towards women- what radiographer can detect

Background: Domestic violence is a worldwide problem. Healthcare professionals in Sweden has no responsibility to report domestic violence against adults. It is important to raise awareness about common signs of domestic violence and give healthcare seekers adequate help.

Purpose:  The aim is to illustrate typical signs of domestic violence against women which radiographers can discover in the profession.

Method: A literature research in databases Cinahl, Medline and Psykinfo was used to find 16 scientific articles. After analysing articles, two categories, with subcategories were created.

Results: Violence-related injuries often start with mental violence and develop into different degrees of physical violence. Injuries appear in all parts of the body, studies have shown that the head, face and neck region are most usually affected. Also known is that strangulation is the cause of many violent related deaths.

Discussion: Violence against women still continues. To overcome this problem, it is necessary for all involved authorities to cooperate and take responsibility.

Conclusion: The victim is usually in shock and sensitive towards the environment. Proper care is important to reduce the negative emotions the victim may encounter.

Positron emission tomography/computed tomography (PET/CT) is a method that quantitatively visualizes physiological processes. The most common indications for PET brain are early diagnosis of various dementia types with 18F-Fludeoxyglucose (18F-FDG). The hospital in Jonkoping installed a new PET/CT and brain examinations have not yet been performed. The aim of the study was to map how hospitals in Sweden performed seven selected brain examinations with PET/CT focusing on modality structure, examination method and reconstruction method, with a comparison of radiation dose between PET/CT and single photon emission computed tomography/CT (SPECT)/CT. Out of the nine university hospitals selected, two were excluded. The method was prospective with quantitative approach and data was collected through a protocol. Compilation was made on Excel and the statistics were processed using the Wilcoxon Signed Ranks Test. The result showed similarities, for example reconstruction method and differences, for example fasting time. Effective dose was higher on SPECT than PET in examination of Parkinson's disease, however no significant difference (p = 0,059) was detected. Higher effective doses on SPECT was due to longer half-lives and greater dosages of Ioflupane (123I-Datscan) than 18F-FDG. For further studies, more hospitals and parameters in the protocol can be included. 

Sammanfattning

Tillgänglighet och väntetid till såväl undersökningar som vård är två stora utmaningar inom svensk hälso-och sjukvård. Bristande tillgänglighet och onödig väntetid är faktorer som kan innebära lidande för patienter, medföra onödiga kostnader för sjukvården och påverka medarbetarnas upplevelse av sin arbetsmiljö. I såväl diagnostik som behandling inom hälso- och sjukvården har radiologi en central roll.

Detta förbättringsarbete utgår från frågan om ett förbättrat flöde i form av en förberedelseenhet kan minska väntetider för patienter som behöver genomgå en datortomografiundersökning och hur det påverkar medarbetarnas arbetsmiljö.

Förbättringsarbetet visade att en förberedelseenhet kunde startas upp och ta emot fler patienter med samma medarbetarstyrka. Studien av förbättringsarbetet påvisade att arbetsmiljön upplevdes fortsatt positiv från medarbetarnas sida. Medarbetarna förklarade att förberedelseenheten underlättade flödet att de fick en tydligare överblick om flödet vilket gjorde planeringen lättare. Medarbetarna upplevde även att det var positivt att de fick utökade möjligheter till rotation mellan förberedelseenheten och undersökningsrum. De kände att det var tillfredsställande att kunna erbjuda lediga tider till fler patienter samtidigt som de kunde erbjuda lediga tider inom en snar framtid vid eventuella avbokningar.  

Förbättringsarbetets slutsats är att produktiviteten och effektiviteten ökade genom införandet av förberedelseenheten. Studiens slutats är att medarbetarnas arbetsmiljö påverkades positivt genom ökad variation av arbetsuppgifter och att mer tid frigörs för patientens frågor och funderingar.   

Syftet med arbetet är att studera vad forskningen säger om hur stråldosen till gravida kan minskas vid akutsituationer - arbetet är en litteraturstudie. Röntgenstrålningen kan orsaka skador och därför är det viktigt med strålskydd för att hålla stråldoserna låga. För att hitta relevanta artiklar utformade författarna sökord som användes i sökmotorerna. Författarna läste igenom alla titlar i sökningen och då titlarna verkade intressanta lästes även sammanfattningen. För de artiklar som relaterade till syftet lästes hela artikeln igenom. Sedan gjordes en kvalitetsbedömning av artiklarna, samt en översikt av artiklarnas innehåll. Resultatet säger att det är viktigt att minska stråldoserna till fostret och att det går att minska stråldoserna på flera sätt utan försämrad bildkvalitet. Det framgår också att enstaka undersökningar inte skadar fostret samt att undersökningen av den gravida kvinnan blir utförd och inte fördröjd på grund av rädsla för strålningen till fostret. Slutsatsen som författarna kom fram till är att för röntgensjuksköterskan är avskärmning det lättaste sättet att minska fosterdosen eftersom det krävs kunskap om hur de olika parametrarna kan förändras utan att bildkvaliten försämras. Röntgensjuksköterskor, strålfysiker och radiologer ska tillsammans jobba för att ta fram specialprotokoll för gravida, där dosen är mindre men radiologen ändå kan diagnostisera utifrån bilderna. 

Background: Cone beam computed tomography (CBCT) is a method commonly used in odontology and is becoming more used in orthopedic diagnostics. Fractures in upper extremities are a common occurrence in trauma. Conventional radiography is often the firsthand method but cannot always exclude scaphoid fractures, which untreated can have serious consequences.

Purpose: The purpose is to evaluate CBCT as an examination method for fractures in the upper extremities by comparing with other modalities.

Method: This study is a systematic literature review. The databases used were Medline, CINAHL and PubMed. Only articles published within the last 10 years were included. A quality audit was implemented using a protocol from Jönköping University.

Results: 15 articles were included. The factors identified were observer agreement, radiation dose, image quality, diagnostic quality, patient tolerance and image duration. CBCT had a better or equal observer agreement. In eight out of nine articles, CBCT was shown to have a lower radiation dose than its comparative modality. In general, a good image quality in CBCT was found. Differing results were found about diagnostic ability. The patient tolerance was higher for CBCT than multidetector-CT (MDCT) regarding image duration.

Conclusions: CBCT demonstrated a good image quality and diagnostic ability to a relatively low radiation dose, and a higher sensitivity and specificity than conventional radiography. Due to differences in measuring instruments used in the gathered material, no definitive conclusion could be drawn. Further studies in the subject is recommended.

Introduction: To minimise the risks associated with ionising radiation, it is necessary for all staff involved to employ specific techniques to reduce radiation exposure of the patient. These techniques include using compression during examinations of the pelvic region and lumbar spine, using a gonad shield, and asking women if they are pregnant. However, some staff do not use these techniques consistently. Increasing compliance requires determining why staff are non-compliant. Thus, this study aims to qualitatively investigate why radiographers do not use these techniques.

Methods: This qualitative study is based on a cross-sectional electronic survey with open-ended questions. The data were analysed using an inductive qualitative content analysis with quantification of the findings. In total, 111 radiographers from 20 hospitals in Sweden participated.

Results: Three categories appear related to barriers that could obstruct the radiographer from using compression, gonad shields and asking about pregnancy: patient characteristics, interaction between the patient and the radiographer and issues related to the situation and examination.

Conclusions: The barriers to not using radiation protection measures varied depending on the specific measure. However, the barriers were mainly related to the patient experiencing pain, communication difficulties and cultural reasons. In addition, the lack of adequate and user-friendly equipment was seen as a barrier to applying compression and using gonad shielding.

Introduction: The Convention on the Rights of the Child will be absorbed into Swedish law by 2020, which highlights the need to promote equality in communication between health care professionals and communicatively vulnerable children. In this regard, participation and person-centredness is important in the interaction with each child to provide adequate information on the peri-radiographic process in a way that the child can understand. Hence, the aim was to develop communication support for interaction with children during acute radiographic procedures.

Method: The study has a qualitative design adapting a multiphase structure. A participatory design was used which included four phases conducted in succession to each other. Interviews were conducted with children from Elementary School and Special School. Questionnaires were collected from their parents and from radiographers in four different Radiology Departments.

Results: The analysis of the data highlighted the need for information in the peri-radiographic process. Parents and children wanted material that is easy to use and could be adapted in a person-centred way.

Conclusion: A prototype of the ICIR (interactive communication support in radiology settings), with illustrations and accompanying text was developed that can be useful as information sharing in interaction between children, parents and health care professionals in the radiographic context.

Implications for practice: The ICIR can be a usable tool for information sharing in the interaction between children, parents and health care professionals during radiographic procedures. 

Introduction: The radiography profession is challenged by greater responsibilities and shortage of educated radiographers. Implementation of task shifting is one strategy to deal with the current situation in health care. The aim of this studiy was to evaluate radiographers’ perception of assistant nurses and nurses carrying out tasks that traditionally were undertaken within the radiography profession in a Swedish context.

Methods: An electronic questionnaire was distributed to radiographers at eleven hospitals in Sweden. The questionnaire included background questions and questions about radiographers’ perception about task shifting to nurses and assistant nurses. The respondents rated their agreement level regarding task shifting on a five-point Likert scale. Data was statistically evaluated in SPSS using Mann Whitney U test.

Results: Sixty-five radiographers participated in the study. Most radiographers responded negatively to task shifting to nurses (72%) or assistant nurses (65%). Most radiographers disagree that nurses should perform mammography screening or work within interventional radiography, while the attitude towards nurses calculating glomerular filtration rate was more positive. A majority disagree regarding assistant nurses performing conventional radiographs, informing the patient about contrast media administration or inserting peripheral intravenous catheters, while there was a positive attitude towards assistant nurses preparing patients for examinations. The attitude towards task shifting was not influenced by age, however radiographers with less working experience were more positive to task shifting in general.

Conclusion: A majority of the radiographers had a negative attitude towards task shifting to nurses and assistant nurses. The radiographers were more positive to hand over tasks related to patient care and administrative tasks than technical related tasks within the profession.

Implications for practice: Knowledge about radiographers’ perception on task shifting within the profession is essential when planning and implementing strategies for task shifting in the clinical settings.

This thesis project has been conducted at the School of Engineering at Jönköping University and in cooperation with the case company Solutions for Tomorrow AB. The project was modeled around a purpose; to develop a product concept where alternative materials and manufacturing techniques will lead to cost savings. The purpose was broken down into four questions around which the project is focused. Two of the questions are about the produced concepts and two of them are about the economic aspect of the new concepts. To answer the questions the thesis project is designed as a conceptual study where the whole development process has been carried out. The study is mostly based on a qualitative method where focus has been on collecting data from interviews and related literature. A deductive approach was used since known theories and models has been applied when assuming the conclusions. The study has resulted in two product concepts that according to the calculations will lower the production related costs. A more cost efficient manufacturing method implicates that new suppliers might be needed and new production drawings needs to be fabricated. A more extensive constructional analysis should be conducted in the future since new materials and manufacturing methods offers new possibilities to further cost potentiation. The cost calculations that are performed in this report are in many cases based on the manufacturing methods used today and the time it takes to perform the steps in the production. Parts of the present production are located in Germany and no opportunity was given to witness the process. The costs related to the manufacturing time are therefore estimates. Hence the cost calculations are expected to have a certain error margin and should not be used in decision making.

The transition between university and work can be a difficult period for some people. A good introduction to the new graduated radiographer is important for a quick and easy access to the workplace. The aim of the introduction is to feel safe and independent in the workassignments. Few studies highlight the subject of "introduction on a new workplace” and even fewer studies highlight ”new graduated radiographers’ views on the introduction”. A request from a number of radiology departments has led the authors to write this thesis. The purpose of this study is to examine factors new graduated radiographer considered important for a good introduction on a new workplace. A qualitative study was conducted with seven female informants in southern and central Sweden. The collected data was analyzed with a content analysis and three main categories were formed: Experiences of the introduction; Communication and social relations; Suggestions for improvement. Something that was appreciated by our participants was constructive feedback and continuity of supervisors to increase self-confidence. The content in this study has an improvement potential for managers and future colleagues.

A good introduction program is essential for a long successful career and makes it easier for new graduates to learn. As the transition from studies to beginning working as a licensed radiographer can be a stressful period.

The purpose of this study was to investigate the new graduate radiographers experience of the introduction at a new workplace. Data was collected for this study by interviewing nine new graduate radiographers who graduated in the summer of 2014. These radiographers are working on radiology departments in central and southern Sweden.

All collected data was analyzed using content analysis and it resulted in three categories: Introduction program, The preceptors knowledge and qualities and Social relationships importance and impact.

The new graduate radiographers felt that the introduction was sufficient and good. There were some parts that were less good, for example, they were counted as one of the regular staff while they still had the introduction. All the informants believed that it will be best if they have a specific preceptor in the beginning of the introduction, as it can easily become confusing with several preceptors.