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Workplace Culture

The rapid technological convergence might have advanced more rapidly than technologists’ computer capabilities and faster than medical imaging workplace cultures have adapted. For example, lack of certain skills can affect self-efficacy and the focus health care workers have on continued education. Managers, particularly administrators outside of medical imaging departments, often fail to understand the critical nature of applications training and changes technology can cause in technique and patient exposure factors. Further, medical imaging departments might not use the new tools available to them for reporting and tracking dose and for process improvement.

Even when staff is given time to attend applications training, scheduling does not always afford staff time to attend the entire session uninterrupted, or attendees might not be focused on the training. This could be due to concerns regarding coverage or the self-efficacy fac-tor; learners who have high self-efficacy are more likely to visualize a successful training experience and remain more focused than those who have low self-efficacy. A technologist’s self-efficacy can be based on individual skills or knowledge, along with the context and culture in which the training and equipment installation takes place. High self- efficacy can assist in training focus and persistence, and with persistence throughout implementation of a new technology. The culture that can lead to low self-efficacy among radiologic technologists and other health care professionals when adopting new technology begins with planning by administrators and non radiology managers, and teams charged with capital purchases. When implementing converging technologies, inadequate planning can involve failing to include users in the planning process, the mistaken reliance on new or upgraded equipment to solve inefficiencies that actually result from internal departmental problems and failing to consider best practices. Poor planning and support that lacks a clear struc-ture can lead to inadequate focus or adoption and failure to adequately schedule radiologic technologists for applications training. In addition, inadequate planning for new technology and equipment installations can complicate workflow and cause inefficiencies throughout the entire process — including potentially purchasing suboptimal equipment or features, creating clerical, clinical or technical inefficiencies, extend-ing length and cost of installation, failing to achieve buy-in and training focus from users and repeated operational problems after installation. Having multiple vendors represented can complicate planning for new technology, installations and education, particularly for a new site. Important patient care aspects are introduced with medical imaging technology that some physicians and leaders outside medical imaging might not fully understand. Adequately adhering to the principles of ALARA requires the cooperation of referring physicians and a supportive and safety-minded culture. Culture change is possible at local and broader levels; pediatric radiation dose offers an excellent example. When the media and public became actively involved in concerns about childhood radiation, organizations, clinicians, government agencies and representatives of a number of resources worked together to address the issue, educate stakeholders and effect change. Eventually, a culture change occurred that modified medical imaging practice.

Thorough planning and strategizing in a safety-minded culture optimizes the use of tools available for reporting and tracking estimated doses and for process improvement. Most medical imaging equipment provides estimated dose information along with the examination, usually in the digital imaging and communications in medicine (DICOM) header.8,46 Medical and vendor societies have worked together to begin standardizing digital medical imaging exposure indicators (EIs). A standard EI value provides an estimate of incident radiation exposure to the detector for each acquired image. Regardless of standardization, medical imaging equipment offers a variety of data associated with imaging studies, such as estimated dose, dosimetric quantities, demographics and radiographic technique information that can be compiled and studied for process improvement. Vendors observe that many of these features of equipment are not used by medical imaging departments to the software’s capacity. Yet they could be used as part of carefully planned quality management and continuous improvement programs.

Desired State

challenges that can affect training in medi-cal imaging, and ultimately image quality or patient exposure, can be overcome by observing best practices regarding workplace, technological and cultural issues. The HCIAC committee discussed desired states for medical imaging departments, administrators and industry in terms of best practices.

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