HLSU241 Diagnostic Radiography

Overview of the patient pathway

A neck of femur fracture (NOF) patient’s pathway begins at the initial contact with the National Health Service (NHS) either through an initial referral to a hospital specialist by a patient’s general practitioner or from an assessment in a hospital’s emergency care department.  A diagnostic radiographer carries out the medical imaging and the result given to a radiologist. The radiologists then interpret the medical imaging to diagnose and prescribe treatment. Physiotherapists then help the patient to regain mobility and may continue their services even after discharge until the patient is recovered.

 Roles of different healthcare professionals within the diagnostic imaging department

The treatment of neck of femur fracture involves the diagnostic radiographer as well as other healthcare professionals. In the acute setting, the diagnostic radiographer performs the imaging scans using either X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans, or nuclear medicine. The first line investigation for NOF fractures is normally plain radiography followed by MRI and then CT or nuclear medicine scan as the third-line.

A radiologist is a doctor whose specialization is to use medical imaging from the radiographer to diagnose and treat NOF fracture patients. The radiologist reviews and interprets the medical imaging to help in diagnosis.  After radiography and diagnosis, the main treatment options are non-operative management, internal fixation for young and fit patients, or prosthetic replacement for elderly patients whose fractures have a high risk of avascular necrosis. These are done by orthopedists.

Following fixation or prosthetic replacement, the patient is admitted to the trauma ward where physiotherapists and occupational therapists work to ensure the patient regains mobility and a level of independence. Therapy may continue into community care or home after the patient is discharged from the trauma ward.

Managing challenges to patient satisfaction within healthcare provision

NOF fracture patient satisfaction is mainly affected by the radiographer or other aspects of service quality. Radiographers interact directly with the patients before, during, and after radiography such as by reassuring the patient before imaging and monitoring them for pain or discomfort during imaging. Unprofessional conduct is therefore likely to lead to dissatisfaction. Aspects of service quality that may lead to dissatisfaction include perceived poor quality of equipment, long waiting times, billing issues, and receptionist unprofessionalism. Therefore, for healthcare professionals to achieve patient-oriented radiology care, they must foster a service-oriented culture throughout their practice.

Role conflicts between the health care professionals involved in the NOF fracture pathway are not very common due to the clear differentiation of roles.  However, role conflicts sometimes do occur due to several reasons. First, personal differences resulting from differences in individual's backgrounds, education, experience, and culture may lead to role conflicts. Second, communication breakdown is another major cause of role conflict in the patient's pathway. This results from a lack of information, misunderstanding, or misinformation. Lastly, workplace stressors such as a cramped schedule may also cause conflicts.  It is important to maintain a clear role differentiation to avoid role conflicts in the neck of femur fracture patient pathway.

Evaluation of the radiographer’s role within the diagnostic radiography department

The positive outcome of a radiographer’s role in the radiography department is the successful treatment of neck of femur fracture patients. Surgical interventions lead to the prevention of common complications such as non-union and avascular necrosis. However, some negative outcomes may arise. Patients who receive hemiarthroplasty may develop prosthesis-related complications especially with the uncemented prostheses which may lead to the death of some patients.

The main factors which influence whether radiography has positive or negative outcomes on a patient are accuracy of the radiography and accuracy of the diagnosis by the radiologist. Inaccurate radiography may result from old or low-quality imaging equipment or incompetence of the radiographer. Additionally, a radiologist may make a wrong interpretation of the medical imaging and recommend an inappropriate treatment. These lead to negative outcomes.

Diagnostic radiographers play a central role in a wider multidisciplinary team as they work and consult with colleagues within various departments. To enhance future professional development, radiographers should take courses and attend conferences and seminars to learn the best practices in the field. Radiographers should also be trained in pathology to enable them to have an expanded clinical role that includes radiological diagnosis.

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