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Role of Radiography in Modern Imaging Service. The Interventional Radiology; Guidance for Service Delivery (2010) aims to guide local service development of interventional radiology through summarising clinical evidence and by illustrating

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Introduction

Role of Radiography in Modern Imaging Service Introduction The Department of Health (2010) defines interventional radiology as a minimally invasive alternative to open surgery or medical interventions achieved by using radiological imaging guidance. The need to improve equity of interventional radiology is recognised by the Department of Health in their publications; 'Interventional Radiology: Guidance for Service Delivery' (2010) and 'Interventional Radiology: Improving Quality Outcomes for Patients (2009). It is also recognised within the Department of Health White Paper Equity and Excellence; Liberating the NHS (2010). The National Confidential Enquiry (2005-2009) into patient outcomes and deaths clearly illustrates inequalities in provision. It reported, over a four year period, poor and inconsistent provision, throughout the country of both diagnostic and interventional radiological services. However there are many factors, or arguably constraints, such a geographical, financial, workforce and workload that currently impede equity in service provision. The 'Interventional Radiology; Guidance for Service Delivery' (2010) aims to guide local service development of interventional radiology through summarising clinical evidence and by illustrating how successful imaging services have been set up in such a way that enables good quality, equitable care by skilled multidisciplinary teams. The document informs both organisational and practitioner requirements for service delivery improvement and is reflective of national Department of Health strategy; The Quality, Innovation, Productivity and Prevention programme which ultimately aims to improve the quality and delivery of care at the same time reduce efficiency costs that could then be reinvested in front line services. The document offers a comprehensive and varied evidence base for change, supported by key clinical data, providing details of how quality interventional radiology services can be achieved in a variety of settings. It explores different models of service from different perspectives as well as acknowledging constraints to delivery; thus implicitly acknowledging and avoiding bias. Case Study illustrations make explicit reference to the benefits of good interventional radiology services. Despite the different models of service delivery posed the potential impact on radiology departments are likely to be similar. ...read more.

Middle

Using the 'QALY' indicator, assesses the 'value for money' against quality gained. The method of ranking interventions, on grounds of their cost per 'QALY,' is controversial because it implies a quasi-utilitarian calculus to determine who will or will not receive treatment (Schlander 2010). However, since health care resources are limited, and Trusts are pressured to make budgetary savings, this method arguably enables resources to be allocated in the way that optimises patient benefits. The study attaches no value to quality indicators identified by patients and therefore suggests patient needs were not considered. It is clearly indicated in the 'IRGfSD' that Health Care Resource Groups have revised "counting and costing" activity of IR to incentivise provision; there is no mention of using the 'QALY' indicator; but stating that Health Care Resource Groups "provide a means of categorising the treatment of patients in order to monitor and evaluate the use of resources" is ambiguous. The 'Next Stage Review' stressed that improving quality must be "the basis of everything we do in the NHS"(Darzi 2007). Quality indicators obtained from patients, via questionnaire returns, focus on their needs and are used to inform practice. Patients are able to express their needs and concerns in consultation with health professionals, empowering them to make informed choice about their care and treatment. "No decision about me without me" (NHS 2010). Patients will be more aware of their rights and what to expect from a quality service; for example, to discuss their imaging examination with the radiographer or radiologist. Patients may also expect their images and reports to be accessible instantaneously, if not nationally, placing a high demand on the Information Technology Strategy. The Image Exchange Portal enables secure transfer of digital images between the NHS and other health care providers, strengthening radiology reporting. It is reported that streamlining data transfer, often carried out by radiographers, frees up their professional time to clinical tasks. ...read more.

Conclusion

Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis. Clin Radiol 2005; 60: 234-241. Krestin GP (2009)Maintaining identity in a changing environment: the professional and organizational future of radiology. Radiology 250: 612-7. http://www.rcr.ac.uk/publications.aspx?PageID=310 http://www.improvement.nhs.uk/diagnostics/ http://www.cxvascular.com/in-archives/interventional-news-1/extending-the-role-of-interventional-radiographers-and-nurses http://www.rcr.ac.uk/docs/general/pdf/NCEPOD_Response_Nov09.pdf Interventional radiologists are doctors who specialise in performing image guided minimally invasive surgery. Many of these procedures can replace traditional surgical operations. This can result in reduced complication rates and shorter stays in hospital Examples of some procedures; Femoral angiograms - dye is injected into the main artery of the body (aorta) via catheters. As the dye flows down the arteries in the legs x-rays are taken to show any abnormalities. Angioplasty - This is a way of relieving a blockage in an artery without having an operation. A fine plastic tube called a catheter is inserted through the blockage in the artery and a special balloon is then inflated, this opens up the blockage to allow more blood to flow down the artery. Stents - Metal or plastic stents can be inserted into arteries or veins to keep them patent(functioning correctly). This can relieve any blockage that's in the vessel. Stents can also be positioned in the gut to relieve any blockage and this aids the digestion of food. This procedure is done under sedation and avoids surgery along with any associated risks. Embolisation - A small bleeding artery can be embolised (blocked or sealed). Fluid, containing thousands of tiny particles, is injected through a catheter into the small arteries. This silts up small blood vessels and blocks them. Percutaneous Nephrostomy - urine from a normal kidney drains through a narrow tube called a ureter into the bladder. If this tube becomes blocked for example, by a stone, the kidney can not drain and can become infected. It is possible to relieve the blockage by inserting a catheter through the skin into the kidney allowing urine to drain from the kidney into a collecting bag outside the body. Patients may no longer need surgery. ...read more.

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An introduction outlining what would be covered would be useful to help the reader get a sense of what will be presented. It is also useful for the writer in terms of using it to check that what is in the main body matches what is written in the introduction. Nevertheless, this is a well-written piece of work examining the role of radiography in the modern imaging service. Good references to relevant documents such as policy and White Papers are made. A few minor amendments could be made, such as ensuring that diagrams are explained adequately, but other than that, this is a good piece of work.
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Marked by teacher Diane Apeah-Kubi 08/10/2013

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