Remembering Baby exhibition highlights role of MRI in foetal and neonatal post-mortem

Dr Elspeth Whitby reflects on the changing shape of her clinical practice, after a research project and the curation of an exhibition which has opened up new ways to engage the public with her work and medical imaging.

RB-PR sheet8This month I am involved in the launch of a new exhibition, Remembering Baby: Life, Loss and Post-Mortem which opens in London (3-14 November 2017) and then in Sheffield (5-14 December 2017). The exhibition is a result of the “‘End of’ or ‘Start of’ Life’” research project which explores how Magnetic Resonance Imaging (or MRI) techniques are starting to be applied to post-mortem practice – including pregnancy loss and neonatal death. This is an important initiative as it is a technique which is less invasive and arguably less distressing for all involved.

This interdisciplinary collaboration has provided an insight into aspects of my work as a radiologist that I would never normally be aware of, and it has highlighted the importance of understanding parents’ needs at a time when they may be anxious, upset, stressed, concerned and affected by a whole range of emotions. I have learnt how ‘little’ things mean so much to families who experience baby loss, and that these can have a huge impact on how they live with their child’s death.

Making visible the often hidden care practices enacted by health professionals who look after babies and their families following a foetal or neonatal death, is a key aim of the Remembering Baby exhibition. Our research team has worked in collaboration with the BIR artist in residence, Hugh Turvey and sound artist Justin Wiggan, to create exhibits related to early-life loss.

remembering-baby-exhibition-workshop-imagesbanners2 (1)Remembering Baby seeks to make these encounters more visible and features a collection of visual images, physical objects and sound installations that sensitively explore what happens when a baby dies, from both parental and professional perspectives. By talking with Hugh about our study, he has been able to interpret and creatively represent some key themes and findings from the research – including MRI’s role in the developing landscape of minimally invasive post-mortem for babies. In the pieces there is also a broader focus on care practices and memorialisation.

As part of the research project we ran a Lasting Impressions workshop. We invited bereaved parents and relatives from the local area to bring along items that were precious to them and related to their baby. The individuals who came were amazing. They talked very openly to us and to each other about their babies and the memory objects they had bought. Guided by Hugh the participants made paper impressions and rubbings of their items and donated their work to us for the exhibition. Those that came to the workshop were at different stages of their bereavement – for some the loss was very recent, for others it was many years ago – and they all had very different experiences. There was not a single person in the room who did not have tears in their eyes at some point during the workshop, but they were not all sad tears.

HughTurvey_WP_20170912_09_55_03_Pro_LIIt made me realise that as professionals we have improved greatly over the years in terms of how we include families in decision-making and with regard to the support we provide, but we can still do more. During the workshop a parent shared how one item held sad memories for her because it was associated with seeing a spot of blood on her child’s Babygro as they were preparing for the memorial service. This is something I will never forget, and something that could have been avoided. I now look at things in detail beyond the medical side, and consider if there is there anything more we can do to ensure that we avoid additional sadness however small it seems.

In my blog The Role of a Radiologist when a Baby Dies I mentioned the difference between what I understood by the question “what happens to my baby?” and what the parent really wanted to know. We now have leaflets in all our patient packs explaining who looks after the baby, who dresses it, cares for it and where. The midwives have the information for parents when they ask and some of the uncertainties have been removed.

Volunteers have been linked with professionals and support groups so that the items they create meet the needs of all these groups.
Where next? We plan to run educational events for health professionals and support groups, and to continue to work in collaboration and extend our work to looking at consent.

Throughout my career I have been taught that experience is the most important learning tool. This work has highlighted that it is not just the medical experience but my journey with each individual patient, what their needs are and what they can teach me for my future interactions with other patients and relatives.

For more information: https://www.rememberingbaby.co.uk/
Details of the exhibition workshops: https://www.rememberingbaby.co.uk/workshops/

This project is funded by the Economic and Social Research Council (ESRC) and is a close collaboration with colleagues in Sociological Studies at the University of Sheffield – Kate Reed (project lead) and Julie Ellis (researcher)

Images courtesy of Hugh Turvey


ew2Dr Elspeth Whitby is a senior lecturer at the University of Sheffield and an honorary consultant at Sheffield teaching Hospitals NHS Foundation trust. Her clinical and research interests are based around MR Imaging of the foetus and neonate. She provides a national service for foetal MRI and is an integral part of the team at Sheffield Children’s hospital, which has set up the world’s first clinical service for minimally invasive autopsy for the foetal and neonatal age group. Her research provides the necessary data to assess the value of new MRI techniques and then to support the transitions from research to service. The multidisciplinary nature of her more recent work is changing her as well as influencing clinical practice.

She was the ex-Vice President for Education at the BIR. Whilst in this role Elspeth helped to improve the educational scope and methods of delivery of educational events for all BIR members.

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How a radiographer is making a difference as a “Freedom to Speak up Guardian”

A remarkably different role for a radiographer

Heather Bruce

High quality and safe care is a must for our patients. But what should health professionals do if they witness a situation that puts a patient at risk? Heather Bruce, Diagnostic Radiographer, explains how her role as a “Freedom to Speak Up Guardian” enables staff to raise concerns and how it contributes to an open culture at her trust.

I have worked as a Diagnostic Radiographer for a long time in The University Hospitals of Morecambe Bay National Health Service Foundation Trust (UHMBT)–knocking along happily in plain film imaging; then about four years ago I was elected Industrial Relations Representative for the Society of Radiographers and that change increased my interest in quality and safety of patient care through supporting staff.

Robert Francis’ public inquiry into the Mid-Staffordshire scandal exposed how patient care was neglected, by focussing on performance targets and the goal of achieving Foundation Trust Status at the expense of safety, and it was apparent that those staff who had raised concerns there were treated very badly. Francis was commissioned to carry out the Freedom to Speak Up (FTSU) review, published February 2015, where he found that that victimisation of whistle-blowers has been widespread throughout the NHS. This history is well known among NHS staff and makes them very reluctant to raise concerns for fear of reprisals, and not speaking up endangers our patients.

The Government accepted all of the recommendations of the Freedom to Speak Up (FTSU) review one of which was to have a FTSU Guardian in every Trust to support staff to speak up.

UHMBT board closely followed the recommendations of the FTSU review; so they advertised for someone who was clinically professional and with a background of management (governance or staff side) ensuring that the FTSU Guardian was accessible to all. I was very interested in the potential of this post and it also enabled me to continue to practise professionally. I was appointed in July 2015 and became one of the first FTSU Guardians in the country. It is always challenging to start in a new post but especially when the job was not there before. There was no training available and the only guidance available was in the FTSU review which I found inspirational.

The job has evolved and expanded to more than three days a week and it is divided into being proactive and reactive. The promotion of a culture where speaking up is normal everyday practice is very time consuming, especially in our geographically challenged trust–Morecambe Bay sits right in the middle of UHMBT.

One of the problems in promoting FTSU is that frontline staff do not have time to access the intranet for Trust communications while they are working. More staff saw a recent article in the local press than read it in the Trust communications. Even though it is time consuming, walkabouts are still the best way to raise awareness and I continue to do them regularly. I also do all the induction sessions for new staff, students and apprentices. I attend as many networks and audit meetings as possible to get the message out there.

Heather Bruce 2

(Image: Promoting speaking up as everyday practice in Furness General Radiology Dept)

As a radiographer I am keen on using innovative technology and UHMBT was the first Trust to have the “Freedom to Speak Up App” which makes it is very easy to speak up–staff may not read Trust communications but they often have their phones on them!
FTSU doesn’t come about overnight or in isolation, and has to be part of an open and transparent culture that values its staff and patients. The best performing Trusts have the highest rate of reporting of clinical incidents and similarly you would expect concerns to be raised and welcomed for patient safety.

When someone has a concern that they think is not being addressed, or they are not sure how to raise it or who to raise it with, they then get in touch with me by a variety of means; email, text message, phone call, through the FTSU App or by direct approach. I usually meet up with them at a mutually agreed venue not necessarily on Trust premises–with 12,000 leaflets distributed across the Bay I am quite recognisable and not everyone wants to be seen meeting with me by their colleagues etc! After establishing the nature of the concern we agree how to escalate it and then it is a case of checking that it is addressed appropriately – with follow-up and feedback.

I meet with the Lead Non-Executive Director for FTSU and the Medical Director every month to discuss the concerns that are being raised, themes that may be identified and any issues in getting the concerns addressed. All concerns are treated confidentially and if staff do not wish to be named, that is usually possible except if it is required for legal purposes.

However, change can be slow to embed and the promotion of speaking up is a never-ending task. I am confident that I have the full support of the Board and any concerns that I flag up with Directors are always promptly responded to.

I am pleased to say that I have been contacted by a range of staff from volunteers, governors (non-clinical and clinical), to consultants; feedback has been good and staff seem to feel that their concerns have been listened to and addressed. One of the things I have noticed is how much staff value being kept informed so that they know that they haven’t been forgotten or ignored.

Nationally I enjoy networking with my fellow FTSU Guardians, and the newly established National Guardian’s Office is supportive.

This is an unusual role for a radiographer but I understand that there are four or five of us now across the UK. Diagnostic Radiographers work in a range of departments in hospitals, so that gives us an ease of access that has been really useful.

Recently I was lucky enough to be asked to speak at the National Radiology Managers conference and that was a great opportunity to promote speaking up and the suitability of radiographers to other roles within the NHS–all linked to high quality patient care.
This can be a difficult role but it is rewarding as there have been obvious improvements in patient safety and staff are really pleased that someone will make sure that their concerns are listened to and acted on. We know the FTSU campaign is working as concerns have continued to be raised.

The aim of the FTSU campaign is to make sure everyone who works in the NHS feels able to speak up for our patients’ safety–patients are vulnerable and it is our duty to be alert for them.

We will all be patients one day-and FTSU is part of ensuring that everyone experiences the high quality safe care that we are all entitled to.

If you would like any more info on FTSU in University Hospitals of Morecambe Bay NHSFT then please don’t hesitate to contact Heather on heather.bruce@mbht.nhs.uk or on 07890 587013

The government has accepted all the recommendations of the FTSU and so there will be opportunities for posts in all Trusts

BIR award winning MRI app attracts worldwide interest

Jonathan Ashmore portraitJonathan Ashmore explains how winning a BIR award has helped to raise awareness for an app to help children who are anxious about having an MRI scan. Find out how you can access the app and how it is helping children across the world.

A free award-winning app has been developed to help children who are scared and anxious about having an MRI scan. A team from the King’s College Hospital, King’s College London and The Belfast Trust have used their experience to develop the resource which, after winning the BIR/Bayer Make it Better Award (Highly Commended), is now attracting interest from across the world.

Jonathan Ashmore, an MRI physicist in the Neuroradiology Department at King’s College Hospital said the idea came about because he had an office within easy earshot of the scanner. “I would often hear nervous paediatric patients arrive for their scan, becoming increasingly upset when they saw the scanner and then were told to lay inside,” he said.

“To help prepare children for this daunting experience it seemed a 360 camera and a google cardboard headset could be used to create a “virtual reality mock scanner” giving a child the full MRI experience before the real thing took place. As the MRI safety expert in the hospital I was the one person qualified to try it out in the scanner.”

DummyInScannerA team including physicists, radiographers, a play specialist and a learning technologist subsequently developed an app, which when used with a £5 virtual reality (VR) headset and a standard mobile phone, allowed children to feel as though they are inside an MRI scanner and experience what it will be like on the day of their scan.

To accompany the app, they also developed an MRI preparation book showing the full MRI journey with clickable links to load the 360 videos from YouTube, which can also be displayed in a virtual reality headset. The preparation books are a great way for other sites to recreate the same thing, you just need to know how to make a word document and upload videos to YouTube.

So far the app has been extremely well received. Via feedback from 22 patients (aged 4-12) and ten staff, they ascertained how effective the app is. Unanimously it appeared to have had a positive impact: children seem to find it enjoyable, informative and genuinely helpful to relieve their anxieties. One child even suggested they were now excited to have their MRI scan! Even though the app is targeted to children, an unexpected outcome was the impact on parents who said the app made them far less anxious about their child’s procedure. It has also been used to avoid the need for a patient to be anaesthetised during the procedure.

Since the app’s release and winning the BIR/Bayer Make it Better Award there have been queries from across the world from sites wanting to re-create the experience. The most common question asked is “How did you film inside the scanner?” Interestingly, besides some minor projectile effects (easily overcome by fixing Samsung Gear360 camera to a phantom) they were able to capture footage whist the scanner was on.

Apps are currently available for the King’s College Hospital and The Belfast Trust children’s MRI units and hopefully soon to be released for Raigmore Hospital in Inverness. There is continued interest from other NHS trusts for other journeys. The filming for one such journey, a patient going to theatres for surgery is also already underway. Costs for the project included the 360 camera and a number of headsets and in total would amount to under £400 which was initially funded by hospital charities and research budgets.

The app is available for free download from the android Play Store or iOS App store under the names “My MRI at King’s” or “Virtual reality MRI” for the King’s and Belfast versions. Access the preparation book for free here https://goo.gl/9NkEJe

For more enquiries please contact Jonathan Ashmore jonathan.ashmore@nhs.net

Review – The Unofficial Guide to Radiology: 100 Practice Chest X-Rays with Full Colour Annotations and Full X-Ray Reports

Tom Campion

The Unofficial Guide to Radiology won the BIR/Philips

Trainee award for Excellence in 2015.   Tom Campion, radiology trainee at Bart’s Hospital, London and Valandis Kostas, Senior Radiographer from Guy’s and St Thomas’ Hospital  reflect on the latest addition to the series which focuses on chest x-ray interpretation and is designed to support professionals and students.

Valandis KostasA follow-up to the Unofficial Guide to Radiology, and part of the Unofficial Guide to Medicine series, this new book The Unofficial Guide to Radiology: 100 Practice Chest X-rays, with full colour annotations and full X-ray reports  has at its heart the inspiring idea that the development of educational resources should be driven by those who use them. The result is a fantastic resource for reporting radiographers, medical students, junior doctors in any specialty, providing a comprehensive and practical approach to chest x-ray interpretation.

41Vnk61P4sL._SX352_BO1,204,203,200_Right from the start, the book’s cover is self-explanatory and is easily perceived to be about chest X-ray interpretations.   The 100 chest X-ray cases are presented in a test-yourself format, with the images and case history presented on one page and the interpretation and report on the next.

The cases are separated in three coloured divisions: Standard (orange), Intermediate (purple) and Advanced (blue). The first page provides the reader with a short clinical indication followed by the associated chest X-ray in high quality, all in one page. The second page then evaluates the technical features, again using a colour code scheme which is then diagrammatically presented on the same chest X-ray, but on a smaller scale. It may be coincidence that the orange, purple and blue technical features can also be perceived as standard, intermediate and advanced technical points to look out for from a radiographer’s perspective. Finally, there is a short but precise summary demonstrating a report of the chest X-ray followed by further management for the patient.

The image quality is excellent in comparison to most other available textbooks, with crisp full-page images allowing the detail of the images to be explored – crucial in the days of PACS when every possible abnormality can be magnified a hundredfold.

Each ‘answer’ page has a consistent format, embedding a sensible interpretation pathway, and a clear layout highlighting both normal and abnormal findings. The consistency, and the detailed and comprehensive annotations, allows the reader to build up an idea of ‘normal’ over the course of the cases, continuously reinforcing important structures to check on every radiograph.

The multidisciplinary approach to development also comes through strongly, with suggested first management steps in response to each radiograph placing the interpretation firmly in the pragmatic clinical world. However, the ‘reporting’ style employed also develops familiarity with the language of radiologists; if this can sometimes seems overly formal or formulaic, it serves a purpose in ensuring that clinicians and radiologists are on the same page.

The clinical cases provided are realistic and are what you expect to find whether in Accident and Emergency and/or outpatient, GP clinics. From pathologies to pneumothoraxes, fractures to line insertions, most scenarios are covered in this book.

Valandis Kostas strongly recommends this book to all grade and advanced radiographers. He observes that the book provides the patient pathway link from clinical presentation to radiology, to treatment and type of follow up imaging required i.e. CT and/or chest clinic referral. The layout enables understanding of the acquired chest x-ray, vital for best practice.

He particularly applauded the section on quality of the chest X-ray, using the similar 10 point image quality check radiographers use in their clearance of X-rays they undertake. Patient I.D, rotation, penetration and inspiration are a few examples. Furthermore, the case layout educates radiographers the importance of these checks to aid image interpretation for diagnosis whilst encouraging learning about chest pathologies. This will eliminate the repetitious perception of the chest X-ray and it will encourage radiographers to maintain high quality chest radiographs for accurate diagnosis and reduce false negatives and false positives.

The clinical details provided in the case vignettes are of a level of detail that surpasses most of those seen in clinical practice; hopefully, the detail provided here will also serve to demonstrate to clinicians who read the book how fundamental these details are, and serve as a resource on helpful requesting as well as interpretation of chest radiographs.

An important area for radiographers and radiologists that is not covered in as much detail is the inadequate chest x-ray, and perhaps the book could be improved by including a few examples of misses/near misses from poor quality radiographs in order to educate readers on when a repeat X-ray is required.

Tom Campion, trainee radiologist  would happily recommend the book to anyone whose job involves X-ray reporting as it delivers a solid foundation in interpretation skills and serves  as both a thoughtfully structured introduction to the beginner and a handy reference to the more experienced.

Both Valandis and Tom felt that the book would make a great app or online tool  in the future.

The Unofficial Guide to Radiology £19.99

https://www.amazon.co.uk/Unofficial-Guide-Radiology-Practice-Annotations/dp/1910399019

Images: (Top left) Tom Campion, (top right) Valandis Kostas.

AUTHORS:

by Mohammed Rashid Akhtar MBBS BSc (Hons) FRCR (Author), Na’eem Ahmed MBBS BSc (Author), Nihad Khan MBBS BSc (Author)

EDITORS:

Mark Rodrigues MBChB(Hons) BSc(Hons) FRCR (Editor), Zeshan Qureshi BM BSc (Hons) MSc MRCPCH (Editor)

 

Hats off to Sir Peter Mansfield (1933-2017)

13-sir-peter-mansfield-2003

Sir Peter Mansfield left school with no qualifications to become one of the most eminent scientists in the world of physics. Here, Dr Adrian Thomas pays tribute to the man who lived through World War Two and with dogged determination forged his way in science to become a distinguished and recognised physicist who played a major part in the story of MRI.

 

Sir Peter Mansfield was born on 9 October 1933 in Lambeth in London, and grew up in Camberwell. His mother had worked as a waitress in a Lyons Corner House in the West End of London, and his father first worked as a labourer in the South Metropolitan Gas Company, and then as a gas fitter. Mansfield recounted being sent with other children on a holiday to Kent for disadvantaged London children by the Children’s Country Holiday Fund.

Peter Mansfield was 5 years old when the war broke out in 1939. He remembers standing with his father at the entrance of an air raid shelter watching anti-aircraft shells exploding around German bombers caught in the searchlights. As the Blitz intensified he was evacuated from the dangers of the capital, as were so many other London children. With his brother he was sent to Devon, where he was assigned to Florence and Cecil Rowland who lived in Babbacombe, Torquay. The Rowlands were called Auntie and Uncle, and Mansfield  attended the nearby junior school. Cecil Rowland was a carpenter and joiner by trade, and encouraged Peter to develop his practical skills by giving him a toolbox, and tools were slowly acquired. He obviously obtained some proficiency since with some guidance he made several wooden toys which he was able to sell at an undercover market and a toyshop in Torquay. His life was not without danger even outside London, and in early 1944,whilst out playing, he saw a German twin-engined Fokke-Wulf plane flying at rooftop level. The tail gunner was spraying bullets everywhere, and he rapidly took shelter behind a dry-stone wall.

On his return to London his secondary schooling was at Peckham Central, moving  to the William Penn School in Peckham. Shortly before he left school at 15 he had an interview with a careers adviser. Peter said that he was interested in science, and the adviser responded that since he was unqualified that he should try something less ambitious. He was interested in printing and so took up an apprentice in the Bookbinding Department of Ede and Fisher in Fenchurch Street in the City of London, and whilst there he took evening classes.   Developing an interest in rockets he was offered a position at the Rocket Propulsion Department (RPD) at Westcott, near Aylesbury.

In 1952 he was called up into the Army for his National Service, where he joined the Engineers. The Army allowed him to develop his interest in science. On demobilization he returned to Westcott and completed his A levels. This enabled him to apply for a special honors degree course in physics at Queen Mary College in London. In 1959 he obtained his BSc, and three years later he was awarded his PhD in physics. From 1962 to 1964 he was Research Associate at the Department of Physics at the University of Illinois, and in 1964 was appointed Lecturer at the Department of Physics at the University of Nottingham.

During a sabbatical in Heidelberg in 1972 Mansfield corresponded with his student, Peter Grannell in Nottingham, and became interested in what became MRI, presenting his first paper in 1973 at the First Specialized Colloque Ampère. Mansfield developed a line scanning technique, and this was used to scan the finger of one of one of his early research students, Dr Andrew Maudsley. The scan times required for these finger images varied between 15 and 23 minutes. These were the first images of a live human subject and they were presented to the Medical Research Council, which in 1976 was reviewing the work of various groups including those in Nottingham and Aberdeen.

13-terry-baines-peter-mansfield-and-andrew-maudsley-c1974

In 1977 the team at Nottingham, which included the late Brian Worthington, successfully  produced an image of a wrist. The following year Mansfield presented his first  abdominal image. In 1979 Peter Mansfield was appointed Professor of Physics at the University of Nottingham. As the Nobel Committee emphasized, the importance of the work of Peter Mansfield was that he further developed the utilization of gradients in the magnetic field. Mansfield demonstrated how the signals could be mathematically analyzed, which resulted in the development of  a practical  imaging technique. Mansfield also demonstrated how to achieve extremely fast imaging times by developing echo-planar imaging. This is all very impressive for a boy who left school at 15 with no qualifications.

13-sharing-an-amusing-tale-with-paul-lauterbur-2003

Peter Mansfield was awarded many prizes and awards including:

the Gold Medal of the Society of Magnetic Resonance in Medicine (1983); Fellow of the Royal Society (1987); the Silvanus Thompson Medal of the British Institute of Radiology (1988); the International Society of Magnetic Resonance (ISMAR) prize (jointly with Paul Lauterbur)(1992);  Knighthood (1993); Honorary Fellow of the Royal College of Radiology and Honorary Member of the British Institute of Radiology (1993);  the Gold Medal of the European Congress of Radiology and the European Association of Radiology (1995);  Honorary Fellow of the Institute of Physics (1997); the Nobel Prize for Medicine together with Paul Lauterbur (2003);   Lifetime Achievement Award presented by Prime Minister Gordon Brown (2009).

His autobiography The Long Road to Stockholm, The Story of MRI was published in 2013. This is an interesting read, particularly in relation to his early years, and is recommended reading for everyone interested in the radiological sciences. This is a revealing account of a remarkable life. Whilst we may discuss the complexities of the development of MRI and exactly who should have received the Nobel Prize, there can be no doubt about his major contributions. MRI has made, and is making major contributions to health care. He died age 83 on 8 February 2017.

The University of Nottingham has set up an online book of condolence http://www.nottingham.ac.uk/news/sir-peter-mansfield/

About Dr Adrian Thomas, Honorary Historian BIR

Dr Thomas was a medical student at University College, London. He was taught medical history by Edwin Clarke, Bill Bynum and Jonathan Miller. In the mid-1980s he was a founding member of what is now the British Society for the History of Radiology. In 1995 he organised the radiology history exhibition for the Röntgen Centenary Congress and edited his first book on radiology history.

He has published extensively on radiology history and has actively promoted radiology history throughout his career. He is currently the Chairman of the International Society for the History of Radiology.

Dr Thomas believes it is important that radiology is represented in the wider medical history community and to that end lectures on radiology history in the Diploma of the History of Medicine of the Society Apothecaries (DHMSA). He is the immediate past-president of the British Society for the History of Medicine, and the UK national representative to the International Society for the History of Medicine.

See more on the history of radiology at http://www.bshr.org.uk

 

 

Breaking the mould – how  radiographer reporting is better for the patient.

nigel-thomas

Professor Nigel Thomas from the University of Salford explains why allowing a radiographer to report X-rays  is not threat to the radiology profession.

 

 

 

I’ll nail my colours to the mast straight away, and state that I have been an active proponent of radiographer role extension in general, and radiographer reporting in particular, for over 20 years.

I first became involved in mid 1995 when the University of Salford (then University College Salford) asked for help in setting up a formal plain film reporting course for radiographers. The context for this was the unresolved tension between the large numbers of unreported films in most X-ray Departments and the realisation that radiographers as a group of professionals were often working below their full potential – a real untapped resource within our own departments. Becoming involved in the process seemed to me to be a very obvious thing to do, and I have never had any regrets about doing so. I don’t believe that I have contributed to the demise of my profession, and I certainly don’t feel like a “turkey voting for Christmas”.

Over the years since then, radiographers have increased the breadth of their involvement in reporting (to currently include some types of MR scanning and CT, as well as gastro-intestinal contrast studies amongst other things), as well as developing a career structure which encompasses working at Advanced Practitioner and Consultant Radiographer levels (the latter being a particular success in the world of breast imaging, where consultant radiographers can follow an entire patient journey by being able to perform and report mammograms, perform and report breast ultrasound and perform guided biopsies, as well as having counselling skills).

It was clear from the beginning that there would be opposition to the idea of radiographer reporting, both from the radiology establishment, and, to a much lesser extent, from within the radiography profession itself. In order to ensure that the process of creating reporting radiographers was as good as it could be, certain quality measures were put into place. No radiographer can report in the UK without a recognised qualification (at PgC or Pgd level) gained from a higher education institution. In the context of the workplace, reporting is done within an agreed scheme of work (signed off by the employing Trust Board), and regular audit is undertaken.

In 2017 between 15 and 20% of all plain film examinations in the UK are reported by radiographers, and there are now over 50 people in consultant radiographer grades around the country. Reporting radiographers have been “part of the furniture” in X-ray departments for over 20 years, and generations of junior doctors, nurses and physiotherapists have been familiar with using them as a port of call for advice on the interpretation of images.

And yet, despite all of the above, resistance to radiographer reporting persists. I find this particularly perplexing for several reasons:

  1. The reporting shortfall still persists, and patients are being put at risk by our failure to report their examinations in a timely and accurate way – would we rather leave them unreported?
  2. Radiologists have more than enough to do – there are too few of us, and our time is used to apply our unique skill set to report labour intensive complex examinations, undertake time-consuming interventional procedures, and provide a commitment to the support of MDTs.
  3. There is a substantial body of sound scientific evidence (published in the major UK peer-reviewed radiological journals) that radiographer reporting works, is safe, and is of a comparable standard to that provided by medical staff in many areas.
  4. Radiologists have been involved in this process from day 1 – advising on course content, giving lectures, acting as examiners and external examiners, and, most importantly, acting as mentors to radiographers in training at their places of work.

The final irony for me, as we progress into the 21st century is that, despite all the above, it is clear that some of my colleagues are much keener to gain help from computers than humans. Don’t get me wrong, I’m sure that Computer Aided Design (CAD) and Artificial Intelligence (AI)  will have a huge role to play in the routine provision of a radiology service in the near future, but reporting radiographers can help patients here and now.

References

Berman L, de Lacey G, Twomey E, Twomey B, Welch, T and Eban, R. ‘Reducing errors in the accident department: a simple method using radiographers’, British Medical Journal 1985; 290: 421-2

Loughran,C.F., Reporting of fracture radiographs by radiographers: the impact of a training programme. British Journal of Radiology, 67(802), 945 –950, 1994

Judith Kelly, Peter Hogg, Suzanne Henwood. The role of a consultant breast radiographer: A description and a reflection. Radiography, Volume 14, Supplement 1, e2-e10, 2008.

Brealey, S., Hewitt, C., Scally, A., Hahn, S., Godfrey, C., and Thomas, N.B. Bivariate meta-analysis of sensitivity and specificity of radiographers’ plain radiograph reporting in clinical practice. British Journal of Radiology, 82, (979), 600-604, 2009.

Piper, K., Buscall, K., Thomas, N.B., MRI reporting by radiographers: Findings of an accredited postgraduate programme. Radiography, Volume 16, Issue 2, 136-142, May 2010

  1. Piper, S. Cox, A. Paterson, A. Thomas, N.B. Thomas, N. Jeyagopal, N. Woznitza. Chest reporting by radiographers: Findings of an accredited postgraduate programme, Radiography, Volume 20, Issue 2, 94-99, February 2014
  1. Snaith, M. Hardy, E.F. Lewis Radiographer reporting in the UK: A longitudinal analysis

Radiography, Volume 21, Issue 2, 119-123, 2015

About Nigel Thomas

Born and raised in Cornwall, I qualified from St Bartholomew’s Hospital in London in 1981 having gained an intercalated B.Sc in Biochemistry in 1978.

My radiology training was undertaken on the North Western Training Scheme (based in Manchester), and I was appointed as Consultant Radiologist to North Manchester General Hospital in 1989.In 2005 I moved to a Consultant post at Trafford General Hospital and retired as a full-time NHS Consultant Radiologist in 2015.

I currently work as an independent Consultant Radiologist and, amongst other roles, am a mentor to Reporting Radiographers at two large Foundation Trusts in the Manchester conurbation.

I first became involved in the process of radiographer role development at the University of Salford in 1995, and was appointed as an Honorary Professor there in 2000. I have over 40 publications in scientific journals, and am a co-author of a standard textbook of Obstetric and Gynaecological Ultrasound scanning.

 

Image: Courtesy of Nottingham University Hospitals

 

The role of the radiologist when a baby dies

3-elspeth-whitby-100-x-150As we launch our Fetal MRI portfolio, Dr Elspeth Whitby explains how a research project on MRI in early-life autopsy made her realise what an impact a radiologist can have on bereaved parents.

She found that MRI images can help to create and manage a woman’s feelings during pregnancy and increased her own understanding of her role in the process.

 

End of or start of life

When a baby or infant dies, MRI can be used as a minimally invasive method to replace formal autopsy. Dr Elspeth Whitby explains how, not only does this provide scientific information, but with the interpretive and sensitive communication skills of the radiologist it helps to provide some answers and fill gaps for devastated and grieving parents. Here she talks through the unexpected learning which came out of an innovative and groundbreaking research project.

As part of my work as a consultant radiologist I am involved in a minimally invasive autopsy service where magnetic resonance imaging (MRI) is used along with a number of other investigations that can replace the formal autopsy. Over the last 12 months I have embarked on a 30-month interdisciplinary project which aims to explore the use of visual technologies in post-mortem, bringing together researchers, medical practitioners and technology manufacturers to examine how clinical applications of these technologies (such as MRI) are impacting upon professional practice and parental experiences of loss.

1a-memory-box-black-and-whiteThis project, entitled ‘End of or Start of Life?’, developed from my previous work with a medical sociologist (Dr Kate Reed) looking at the value of the fetal MRI image to patients and professionals. A published paper from this original study argues that MRI can both create and manage women’s feelings of uncertainty during pregnancy. While it may not always provide women with unequivocal answers, the detailed information provided by the MRI images combined with the interpretative and communication skills of the radiologist enables women to navigate what can be difficult and emotional issues.

We think this current research on MRI in early-life autopsy will build on the original study about pregnancy and is important for a number of reasons:

  • It will benefit bereaved parents by providing information about potential choices they may have over fetal and infant autopsy;
  • It will raise general public awareness around prenatal and neonatal loss and contribute to reducing the silence and taboo which many parents who experience early life loss experience;
  • It will contribute to the ongoing professional development of pathologists and related professionals through informing professional guidelines and educational materials on visual technology use in autopsy;
  • It will provide information about how parents and other professionals feel about the use of this technology and therefore help to ensure that UK policy on autopsy is developed and applied in a way that is sensitive to practitioners and parents.

Personally my involvement in the work has allowed me to understand the needs of my patients and their families. I have had time to explore areas neglected by medical staff due to time pressures and the lack of insight into the importance of small details. When their baby is going to have a post-mortem, families need to know about what happens, who has contact with their most precious bundle and when. They don’t always need the detail I had assumed they’d want in terms of medical information about the post-mortem process, but rather more seemingly ‘mundane’ details for example: who holds their baby, how they hold them and place them on the scanner table.

Telling a bereaved mother that I was the person who held her baby boy, carried him, dressed and wrapped in a blanket, to the scanner and talked to him as I placed him on the scan table in the required position – as I would any baby in my clinical practice – resulted in tears from his mother and father.  These were followed by a very emotional hug and a comment from mum that she could finally ‘let go’ as I had put her mind at rest that he had been well looked after when she couldn’t be with him during the post-mortem. To them this part of his ‘life’ was a blank space that they could not fill and this left them feeling helpless. Being able to tell them about the process allowed them to fill this space and to understand what had happened. They knew that he had been cared for, and that they had done all they could as his parents.

1a-pm-mriThe most frequent request for information is ‘who will look after my baby when I can’t be there?’ No parent wants to be separated from their baby. I have underestimated the importance of such detail before, assuming that medical information is more important as this is what I have been trained to provide. I am beginning to understand more about parents’ complex needs, and hopefully I now provide an opportunity for all patients and parents I am involved with to obtain this information. The conversations I have with patients have changed from a medically-centred approach to a wider, more social approach. For example I have been able to book longer appointments and build in flexibility so no one feels rushed.

And so, I hope my continued involvement with the social research work can widen my understanding further and hopefully improve the services we provide. For instance, being part of this research has helped to inform my involvement in the production of a video that talks parents through the MRI post-mortem process which they can watch whenever, if ever, it suits them.

If you are interested in this topic, you may be interested in learning more. Take a look at the new BIR Fetal MRI Portfolio

References

Visualising uncertainty: Examining women’s views on the role of Magnetic Resonance Imaging (MRI) in late pregnancy


Dr Elspeth Whitby

Dr Elspeth Whitby is a senior lecturer at the University of Sheffield and an honorary consultant at Sheffield teaching Hospitals NHS Foundation trust.

Her clinical and research interests are based around MR Imaging of the fetus and neonate. She provides a national service for Fetal MRI and is an integral part of the team at Sheffield Children’s hospital, which has set up the world’s first clinical service for minimally invasive autopsy for the fetal and neonatal age group. Her research provides the necessary data to assess the value of new MRI techniques and then to support the transitions from research to service. The multidisciplinary nature of her more recent work is changing her as well as influencing clinical practice.

She is currently Vice President for Education at the BIR, helping to improve the educational scope and methods of delivery of educational events for all BIR members.

Dr Whitby was the recipient of the first BIR/Bayer Make it Better Award for her work in minimal fetal and neonatal invasive autopsy.