Theses and Dissertations (Radiography)

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Radiographers’ perceptions regarding establishing a self-regulatory body for radiation control purposes in the radiography departments in Swaziland
(University of Pretoria, 2019-04) Kekana, R.M. (Mable); dlamini.lungile@gmail.com; Dlamini, Lungile N.
Introduction The use of x-rays for medical imaging has benefited the medical field tremendously. The International Atomic Energy Agency (IAEA) advises that all radiography departments have some sort of radiation protection programs available in their departments due to the possible long term and short term effects of x-ray use. The problem that led to this study is that Swaziland remains one of the countries in Southern Africa without a regulating authority for monitoring the safe use of x-rays in radiography departments. Aim of the study The aim of this study was to explore the perceptions of radiographers with regards to establishing a self-regulatory body for radiation control purposes in the radiography departments in Swaziland. Methodology A qualitative, exploratory and descriptive approach was undertaken. Radiographers were purposively selected and invited to be part of the study. This was because radiographers are trained in quality assurance procedures. They are therefore knowledgeable on how to ensure safety for themselves, the patients and the public. Individual interviews were conducted with those who agreed to participate in this study. Data collection continued until data saturation. The raw data was first transcribed verbatim and then analyzed using qualitative content analysis. Six themes emerged, namely a) awareness of the need for QC tests, b) radiation protection and safety in the radiography departments, c) radiographers’ responsibility towards radiation protection, d) education and training in radiation safety for radiographers and other stakeholders, e) support from governmental and management structures and f) the need for the self-regulatory body in the radiography departments. Conclusion Three findings were made, namely; a) there is awareness that radiation safety practices are necessary in the radiography departments, b) education and training can help improve radiation safety in the radiography departments, and c) the self- regulatory body can be established with support from government and management structures. In conclusion, while radiographers seem aware of the importance of radiation safety practices, there is a need for continuous education and training, radiation safety awareness for other stakeholders and finally the need for the self-regulatory body in Swaziland.
The development of a mobile application to enhance fetal radiation dose monitoring among pregnant Radiographers
(University of Pretoria, 2024-07-24) Kekana, Mable; Smuts, Hanlie; hafsa.essop@up.ac.za; Essop, Hafsa
Introduction: Ionising radiation has the potential to have harmful effects on cells. The risk of these effects increases in a fetus whose tissues are still developing. The effects of radiation, which depend on the amount of exposure received, can present as deterministic or stochastic effects. Based on this theory, occupational health and safety are heightened for the pregnant radiographer who is required to wear a special dosimeter to record and monitor the fetal dose exposure. This process is self-regulated by the pregnant radiographer. In the clinical department, it was observed that pregnant radiographers have inconsistent methods of recording and monitoring their fetal dose. Therefore, the study aimed to develop a mobile application to support and enhance fetal dosimetry among pregnant radiographers. Methods: The research followed a design science research (DSR) paradigm and the behaviour change, user-centred and social marketing (BUS) framework, which guided the objectives of this study. The study adopted a mixed methods research design, incorporating five major phases, aligned with the DSR paradigm, namely 1) Problem Awareness, 2) Suggestion, 3) Development, 4) Evaluation and 5) Conclusion. In Problem Awareness, the reviewed literature highlighted the problem as it exists in the literature as well as a situational analysis into the problem as it exists in the context of this study. In the Suggestion phase, recommendations are made towards addressing the problems identified in literature and the situational analysis. In the Development phase, two cycles took place. Firstly, prototype design, which adopted a design thinking methodology. Secondly, the Mobile App Development Lifecycle (MADL) to develop and test the final app. In the Evaluation phase, pregnant radiographers engaged with the app in the real-life setting. Qualitative interviews were then conducted to ascertain the usability and usefulness of the app. Results: In DSR Step 1, the study identified a lack of literature regarding pregnant radiographer compliance towards fetal dosimetry, presenting a gap in the literature. The problem awareness through the situational analysis revealed inconsistent fetal dose recording and monitoring. The study concluded that pregnant radiographers needed support regarding fetal dosimetry. This suggestion is a mobile application encompassing core functional areas such as dose tracking and education to address some of these challenges. In DSR Step 3, the prototype was designed by its actual users, who named the app PregiDose. The users further uncovered that pregnant radiographers suffer from decreased emotional well-being in the clinical setting and required support. The final app was then developed in collaboration with software engineers. In DSR Step 4, the pregnant radiographers who had been interviewed after engaging with the app revealed that it was both easy to use (usability) and useful. However, they recommended automation, whereby the doses from the dosimeter could be linked to the app automatically. Conclusion: DSR Step 5 corresponds to the conclusion of the research process. The study has highlighted that a mobile application for pregnant radiographers can enhance fetal dose monitoring. The research made the following contributions: first, to the field of research by describing the rigorous process of development and evaluation, and second, to the field of radiography and radiation protection, demonstrating that technology can be used to facilitate occupational health and safety and, in line with the pragmatic nature of the DSR paradigm, solve a real-life problem.
Perceptions of radiation therapists and radiation oncologists towards their interprofessional collaboration during radiation therapy in Tshwane, South Africa
(University of Pretoria, 2024-07-15) Mathurine, Germaine; Thambura, Julius; marlenecoetzee2@gmail.com; Coetzee, Marlene
Background: Collaboration in healthcare is essential as it cultivates excellence. Due to the overlap of the responsibilities of the RTT and the RO, the interdisciplinary collaboration between the two disciplines is critical to quality, holistic patient care. In the South African setting, it is unclear as to the nature of the interdisciplinary collaboration between the RTT and the RO. The Health Professional Council of South Africa (HPCSA) Scope of Practice for RTTs states that the RTT is to assist the RO during procedures in RT, while certain sectors purport close interdisciplinary collaboration between the RTT and the RO. Additionally, as far as the researcher could determine, there is a lack of literature describing the nature of the interdisciplinary collaboration between the RTT and the RO. Purpose: This study aimed to explore the nature of the interdisciplinary collaboration between the radiation therapist (RTT) and the radiation oncologist (RO) during radiation therapy (RT). Methods: An exploratory descriptive qualitative research design was adopted. The setting was the private and public RT departments situated in the Tshwane municipal area, Gauteng, South Africa. Practising RTTs and ROs were invited to take part in semi-structured, online interviews, using expert purposive sampling. Data analysis included content and thematic analysis where categories, sub- themes and themes were developed from the initial coding. Results: Seven (7) radiation oncologists and ten (10) radiation therapists were interviewed. The two main themes deducted from the data were the dual purpose of the collaborative communication, and a grappling with the collaborative communication divide. Conclusion: The study indicated that hierarchal issues, the physical divide between the two disciplines, and the status of the current communication being dominated by intermediaries are perceived by participants to hinder the collaborative communication between the two disciplines. The study offers to fill the gap in extant literature describing the specific interdisciplinary collaborative relationship between the RT and the RO during RT, and suggests possible revisions to the current HPCSA scope of practice for RO.
Customised shadow shielding solution developed to optimise entrance skin dose for chest and abdominal mobile neonatal radiographs
(University of Pretoria, 2023-11-03) Kekana, R.M. (Mable); Van der Merwe, Belinda; beakotze1983@gmail.com; Van der Linde, Beatrix
Introduction: Neonates receive frequent diagnostic imaging due to pathological conditions. Their sensitivity to radiation and frequency of imaging validate the application of the diagnostic radiation protection principle of keeping exposures to radiation as low as possible. Due to underdeveloped immune systems, neonates are susceptible to infections, which hinders radiation protection measures. This requires nursing professionals to keep the neonate in near isolation. There is a need for a customised shadow shielding solution to optimise radiation dose while simultaneously conforming to infection prevention measures. Aim and objectives: The study aimed to optimise the entrance skin dose of neonates through a customised shadow shielding solution, that also had to be aligned with infection prevention measures. The objectives identified were that the requirements of such a shielding solution needed to be determined and translated into parameters. The parameters were simulated to determine the combination with an optimised dose. After optimisation, the shielding solution was implemented and authenticated for neonatal entrance skin dose. The views for its suitability for neonatal radiography were explored. Methods: This was a prospective sequential embedded mixed method study conducted in South African tertiary/regional academic government hospitals. The study population included neonates, radiologists, paediatricians, radiographers, and nursing professionals. The study was conducted in four phases. Phase one was a survey to establish the relationship between infection prevention and radiation protection. Phase two involved an experiment to test the possible parameters of the shadow shielding solution. The shielding solution was developed with consideration of Phase one and two results. The developed shielding solution was named the Baby Cone. Phase three involved implementation and authentication of the Baby Cone during neonatal examinations. Entrance skin dose values were calculated, and logbook data collected. Phase four involved interviews to explore the suitability of the Baby Cone for neonatal radiography. Results: The Baby Cone was successfully designed and developed by considering radiation protection requirements and infection prevention measures. The entrance skin dose values for 120 neonatal radiographs were found to be significantly optimised by the Baby Cone. Logbook results showed that the Baby Cone was practical to implement with a reject rate of 8%. Conclusion: The Baby Cone allowed for a novel, unique field of view that was aligned with the anatomy of a neonate to exclude structures irrelevant to the requested radiograph. The radiographers, radiologist and paediatricians consider the Baby Cone as a form of secondary collimation that enhanced the main radiation beam collimation. A patency application (2023/09787) for the Baby Cone has been filed with the South African National Intellectual Management office. Key terms: diagnostic accuracy, dose optimisation, neonate, radiation protection, restricted field of view, secondary collimation, shadow shielding
Exploring the role of communication between mammographers and patients during imaging in selected hospitals in Limpopo province
(University of Pretoria, 2022) Kekana, R.M. (Mable); Malherbe, Kathryn; katlego5306@gmail.com; Chego, C.K.
Abstract Introduction: Breast cancer is listed among the diseases that affect women around the world and have the potential to impact the quality of life. Communication is essential in management and treatment of breast cancer in the breast imaging department. Through effective communication, mammographers can help alleviate the fear and burden that breast cancer brings to the lives of women diagnosed or living with this disease. Mammographers are the essential members of the breast imaging team. The study aimed to explore and describe the role of communication between mammographers and post-mastectomy patients, before, during and after imaging in the Limpopo province, South Africa. Methodology: A qualitative exploratory and descriptive design was adopted in this study. Individual in-depth interviews were conducted with patients who had mastectomy, as well as mammographers in selected health care institutions in Limpopo. Purposive sampling was used to allow participants that were more knowledgeable about the subject to be part of the study. Summative content analysis was used to analyse the collected data. Results: Three themes emerged from the categories and codes from the analysed data. Therefore, according to the results of the interviews mammographers are accommodative, supportive, sympathetic towards patients and making every effort to maintain a good communication path and comprehension between them and their patients. The patients, on the other hand, have high admiration for the work and support of mammographers and perceive mammographers as health care providers who can be trusted and held in high regard. Conclusion: Communication in health care service delivery is key in ensuring that there is cooperation between health care professionals and their patients. In addition to that, the mode of communication should be taken into consideration. It is recommended that the Radiography and Clinical Technology Board of the Health Professions Council of South, revisits the scope of mammography practitioners in terms of the information that they can communicate with patients, especially those who have been diagnosed or are living with breast cancer.
Development of an adult chest imaging protocol for Lodox x-ray systems at trauma units in South Africa
(University of Pretoria, 2022-07-12) Jeanette, du Plessis; Cheryl, McCrindle; jmthambura@gmail.com; Thambura, Julius Muchui
The Lodox (Lodox® Systems (Pty) Ltd, South Africa) digital x-ray system was initially developed to assist in the detection of diamonds smuggled by employees in mines but was later adopted as a screening tool at hospital trauma units. Although one-third of patients are sent for additional chest x-ray imaging using a conventional x-ray machine, previous research has shown that the Lodox x-ray system can produce chest images of superior quality. The Lodox x-ray system also produces ten times less harmful radiation, although requesting additional images after a Lodox imaging has been performed increases the radiation dose to the patient. This study aimed at developing an adult chest referral pathway (imaging protocol) guidelines for the Lodox x-ray system used at trauma units in South Africa. The objectives were to assess the diagnostic similarities and quality of images acquired with a Lodox x-ray system compared to those acquired with a conventional x-ray system; then to formulate and verify the referral pathway (imaging protocol) guidelines for adult chest imaging using a Lodox x-ray system in trauma units. This research used a descriptive, correlation design, including content analysis, a structured observation, and an e-Delphi technique. When comparing the two sets of images obtained from the Lodox and conventional x-ray systems respectively, the Lodox images were superior to those from the conventional x-ray images for showing thoracic structures such as lung parenchyma, and thoracic cage, soft tissue outline, and the mediastinal structures. In contrast, conventional x-ray images were better than the Lodox x-ray images for pulmonary effusion, extra-luminal air, and pneumothorax. Both imaging systems were similar for the visualization of other thoracic structures. No significant differences were found in the factors affecting image quality for the two systems. Hence it was recommended that clinical indications should inform the referral of patients for Lodox imaging. The results confirmed that although both x-ray systems produced chest images of high quality, the Lodox x-ray system produced images of superior quality to conventional images for the viewing of some the thoracic structures such as fractures of the clavicle, nodules, effusions, retro-cardiac structures, mediastinum structures, pneumothorax, interstitial diseases, and fractures of ribs, fractures of clavicle and lung parenchyma. Additionally, following the e-Delphi process, a referral pathway (imaging protocol) for patients undergoing Lodox imaging was developed. The referral pathway (imaging protocol) suggested that after chest imaging with the Lodox x-ray system, computed tomography (CT) imaging of the chest and Ultrasound imaging should be requested. However, for certain cases, the patient could be referred directly for CT- and Ultrasound imaging of the chest, particularly in critically injured patients, where the rapid initiation of treatment could be lifesaving. The study confirmed that adult chest images obtained using the Lodox x-ray system in trauma units were of diagnostic quality. Hence, it was recommended that not all patients should automatically be referred for additional imaging with a conventional x-ray system. Instead, the Lodox images together with the clinical condition of the patient should inform the referral of the patient for additional imaging. Following these results, a referral pathway (imaging protocol) was developed for Lodox imaging at trauma units at hospitals in South Africa.
Exploring the experiences, attitudes and knowledge of radiographers and forensic pathologists regarding forensic radiography services in Lagos state, Nigeria
(University of Pretoria, 2020) Kekana, R.M. (Mable); Uche Eze, Cletus; qasimajibola82@gmail.com; Sangonuga, Kazeem Sola
Introduction Forensic radiography is both a vital tool and a subspecialty in forensic medicine. It can be used to complement autopsy findings and reveal minor injuries overlooked during autopsy. It is also an important tool used in the identification of the dead and for establishing abuse in the living. In the United States of America, one million abuse cases are resolved annually using medical imaging. The Nigerian National Bureau of Statistics has reported a high crime rate in Lagos State and forensic radiography could be used to resolve non-accidental injury and other criminal cases. Aim of the study The aim of this study was to explore and describe the experiences, attitudes and knowledge of radiographers and forensic pathologists regarding forensic radiography services rendered in Lagos state, Nigeria. The study aimed to identify the reasons that led to radiographers being reluctant to perform forensic radiographic examinations. Methodology A qualitative, exploratory, and descriptive study design was used to explore the experiences, attitudes and knowledge of radiographers and forensic pathologists regarding forensic radiography services. The population and sampling were determined by the numbers of radiographers and forensic pathologists employed in two government-owned tertiary institutions in Lagos state. The researcher used purposive sampling to gain a deeper understanding of the real-life experiences of the participants regarding forensic radiography services in Lagos. Focus group interviews were conducted with radiographers and forensic pathologists who work in the two government-owned tertiary teaching hospitals. Participation was voluntary and consent forms were signed by all participants before the commencement of the study. The interviews were audio-recorded and later transcribed verbatim. Thematic analysis was used for the identification of codes and categories. Results The following themes emerged: good and bad experiences of forensic radiographers, varying inadequate knowledge of forensic radiography, different attitudes towards forensic radiography, description of radiographers’ roles on forensic medicine teams, and recommendations for improvements of forensic radiography in Lagos state. Discussion The findings showed that in Lagos, forensic radiography was underutilized to resolve civil and criminal cases, and that there is need to improve the quality of forensic radiography services in Lagos state. Radiographers need to show more commitment in the aspect of postmortem imaging Conclusion It was concluded that the government should provide equipment and infrastructure for forensic radiography in Nigeria, specifically in Lagos state. Further research needs to be done to develop a curriculum in forensic radiography. Nigerian universities should introduce forensic radiography courses at undergraduate level and specialist training at postgraduate level.
Healthcare educators’ awareness, attitudes and practices of breast health : a mixed methods study.
(University of Pretoria, 2020) Bresser, P.L.; krugerursula@yahoo.com; Kruger, Ursula
Background Breast cancer is a great health concern globally. According to the cancer registry of South Africa, it is the leading cause of death amongst females. The World Health Organisation (WHO) focuses on early detection of breast cancer to decrease the mortality rate and to improve the prognosis. Breast self-examination (BSE) is recommended by the WHO as one of the screening methods for early detection of breast cancer. However, it has been found that BSE is still neglected by women all over the world including those who are assumed to have adequate knowledge of BSE and breast cancer screening tests. In some cultures, women are not encouraged to do BSE while some individuals cannot access mammograms or breast ultrasound on a regular basis. In higher education institutions in South Africa the staff complement is culturally diverse due to implementation of transformation within the Higher education sector. It is therefore important to investigate the healthcare educators’ awareness, attitudes, and practises of breast health. Healthcare educators are role models to their students and therefore should set an example in their practising of breast health. Aim This research aims to describe and explain the awareness, attitude and practises of healthcare educators related to breast health at a selected University in South Africa. Methods An explanatory sequential mixed methods research design was used to describe and explain the awareness, attitudes, and practises of breast health among health care educators. For the quantitative aspect of the study participants completed an online questionnaire about breast health and after analysing the results, the qualitative aspect of the study followed with one on one semi-structured interviews that were conducted by the researcher. Results Quantitative aspect: The results obtained from the quantitative aspect of the study indicated that many participants practice BSE and gained their knowledge of BSE from medical practitioners. The most noteworthy reason for delaying issues regarding breast health was lack of time. Participants who were married or in a relationship had higher awareness scores. Family history of breast and of any other type of cancer had a significant association with participants’ attitude toward breast health. Some of the results from the quantitative aspect of the study were further elaborated on in the qualitative aspect of the study. Qualitative aspect: From the qualitative section of this study, it became evident that although participants indicated that breast health is important to them, they do not prioritise performing any of the screening tests available to them. The participants indicated that they do not have a proper or dedicated platform to speak to students about breast health, as it is usually not relevant to the subject that they are teaching. Conclusion Despite the positive attitude and awareness of breast health among healthcare educators, the practises of breast health are somewhat alarming. The main contributors to this being participants’ unwillingness to prioritise breast health, healthcare educators’ reluctance to discuss the importance of breast health with students and participants’ personal beliefs of breast health, which leads them to be shy, fearful and embarrassed to practice breast health. Keywords: Breast cancer, breast health practises, awareness, healthcare educators, attitudes
Exploring the views of teleradiology end users regarding its utilisation and impact on rural health services in Dr RSM district North-West Province
(University of Pretoria, 2018) Kekana, R.M. (Mable); u26036267@tuks.co.za; Essop, Hafsa
Introduction Teleradiology, a subcategory of eHealth, was aimed at providing specialised radiological services to such communities, by means of telephone lines and internet connectivity. The Dr Ruth Segomotsi Mompati (RSM) district of the North West province, was one of several sites across South Africa, where teleradiology was first implemented. There have been no reports of teleradiology progress that the researcher could find in the Dr RSM district to determine whether the community is benefiting from this already established infrastructure. What is known about teleradiology in this district, is through the observations of the researcher, who expressed concern that the teleradiology end users seem to be experiencing challenges with regards to CT examinations. This has appeared to the researcher as resulting in a compromised teleradiology service to the rural community. Some of the teleradiology challenges observed in this district were similar to those noted in literature, both globally and locally. Aim of the study The aim of the study was to explore and describe the views of the teleradiology end users on the utilisation of teleradiology for CT examinations and the impact it has on health care service delivery. Methodology A qualitative research approach, with an exploratory descriptive design were found to be appropriate to gain an in-depth understanding of the research problem and address the research question. Focus group interviews were conducted with three key teleradiology end users, namely the radiographer, referring clinician, and radiologists. Collected data were transcribed verbatim and analysed by means of rigorous content analysis processes to ensure trustworthiness of the research findings. From the analysed data, three major themes emerged, namely; a) factors that positively impacted teleradiology utilisation and service delivery, b) factors that negatively impacted on teleradiology utilisation and service delivery, as well as c) strategies for improving teleradiology utilisation and service delivery. Conclusion The following findings were made: namely; a) teleradiology is being utilised for CT examinations in the Dr RSM district, b) the teleradiology end users have respect for each other’s professional identity, c) onsite teleradiology end users want to be upskilled and d) there is a need to strengthen teleradiology infrastructure. The researcher therefore concludes that teleradiology is being utilised in the Dr RSM district, despite there being several aspects that need be addressed to improve its utilisation and service delivery to the community in the Dr RSM district.
Interpretations of chest x-rays by radiographers and general practitioners at district hospitals in the city of Tshwane
(University of Pretoria, 2018) Rudman, Elsje Magdalena Petronella; Hazell, L.J.; u04352718@tuks.co.za; Sethole, Khethiwe Margaret
The public health care system is at the core of transforming health services in South Africa. The effectiveness of patient service delivery in hospitals is highly dependent upon the ability to provide timeous, adequate diagnostic radiography and an immediate radiology service, to support and influence patient management. A shortage of radiologists restricts continuity in radiology services and causes a delay in diagnosis, compromising the overall quality of service to patients. The first point of entry to health services is at primary level through local clinics or primary health care hospitals. After clinical examination by general practitioners (GPs), many patients are referred for imaging to the X-ray department in district hospitals. A chest X-ray is one of the first-line diagnostic tools for GPs to diagnose, monitor treatment and predict the outcomes of many diseases. GPs are mandated to give reports on all chest X-ray images taken at district hospitals and they sometimes request image interpretation assistance from radiographers. The aim of this study was to explore methods used by radiographers and GPs to perform image interpretation on chest X-ray images at district hospitals in the City of Tshwane. A qualitative descriptive collective case study method with purposive sampling was used. Results showed that radiographers searched with a specific pattern of inspection and the GPs used a free global search by scanning X-ray images without a preconceived orderly pattern. It was concluded that the methods used by both radiographers and GPs for chest image interpretations were not systematic in approach and that inter-professional communication was limited. No protocols were in place to promote communication.
Decision making in diagnostic imaging investigations : a case study of processes and interactions between patients and health care professionals
(University of Pretoria, 2013) Bergh, Anne-Marie; Makanjee, Chandra Rekha
The aim of this study was to get an understanding of the various decision-making processes involved in referral for and the choice of the most appropriate diagnostic imaging investigation and how they had a bearing on the interactions between patients and health care professionals. A social constructivist conceptual framework informed the inductive, emerging qualitative research design adopted for this study. An instrumental case study of one district hospital and its referral links was selected as methodological point of departure. The study consisted of two main phases, the one following on the other. In the first phase, real-life, individual mini-case studies were conducted by “shadowing” 24 patients, from the point of reporting to the hospital up to their discharge from hospital or admission for in-hospital treatment. Data collection methods in this phase not only included entry and exit interviews with patients but also observations at various points of care, and interviews with different health care providers involved with the care of each patient (medical practitioners and specialists, radiologists and radiographers, and nurses). In the second phase, focus group interviews were conducted with the same and other health professionals to triangulate the findings emerging from the shadowing process. The data was analysed inductively around three main units of analysis: the district hospital; patients; and health professionals. The findings are presented in six chapters, starting with an overview of the health-facility complex in which the district hospital was situated and the various referral pathways for diagnostic imaging investigation that could be followed. This exposition is followed by an exploration of structural and organisational interactions between health care providers from referral for diagnostic imaging, to investigation, interpretation and integration. Interprofessional interactions with regard to diagnostic imaging investigation are discussed, with a special focus on the role of the radiographer as trainer, mediator, gate keeper and gap filler and the differences in interactions inside a radiology department and outside of it. Hierarii chies, boundaries and task-shifting are also highlighted. Radiographers were found to occupy a tenuous space in decision-making processes and interactions, with their services needed but their profession not appreciated by all cadres of health professionals. Providerpatient interactions are explored in terms of patterns of interaction during the consultation and the diagnostic imaging investigation, as well as in terms of issues of communication, continuity and fragmentation. Patient expectations and experiences are explored from the viewpoint of health providers and of the patients themselves. The thesis ends with a higher-level reconstruction of the “bigger” picture in which interactions and decision-making processes with regard to diagnostic imaging investigations take place, drawing eclectically on a number of theoretical models and themes from the literature. In order to accommodate the complexities of and all role players involved in diagnostic imaging investigations, it is proposed that the notions of patient-centre care and shared decision making be replaced with a patient-provider-centred approach to care and collective decision making. Collective decision making includes a sequence of discreet decision-making moments and events in which elements of distributed, shared, negotiated and collaborative decision making are found.
Comparing “triangular”, “V” and conventional patterns of dose delivery in optimizing cell kill when applied to tumour types with low α/ß ratios
(University of Pretoria, 2013-04-22) Slabbert, J.P. (Kobus); Mostert-Wentzel, Karien; Mathurine, Germaine; neo.seane@up.ac.za; Seane, Elsie Neo
The aim: To compare mean inactivation doses between the triangular and the V-shaped; the triangular and conventional; and V-shaped and conventional patterns of dose delivery on prostate tumour cells, with α/ß ratios of 1 Gy, 1.5 Gy and 3 Gy. Design and method: A total of 45 treatment plans created for prostate tumours, using conformal radiotherapy techniques, six treatment fields, and dose per fraction of 2 Gy were sequentially collected. The beam weightings and treatment field positions used in the creation of these treatment plans, as well as prostate tumour cell kinetic parameters from literature, were then used to perform computational simulations, using the Virtual Cell Radiobiology programme Version 2 to calculate tumour cell survival. The mean inactivation doses for each α/ß ratio and for each dose delivery pattern were calculated. Results: For the comparison between: (i) the triangular and conventional dose delivery patterns across the three α/ß ratios, the results showed a non- significant difference, with p=0.5436; (ii) for the triangular and V-shaped patterns of dose delivery across the three α/ß ratios, the results indicate that the triangular pattern is not statistically different from the V-shaped pattern, with p=0.5436; and (iii) for the V-shaped and conventional patterns of dose delivery, a non-significant difference with p=0.5436 was observed. Discussion: The observed non-significant differences in mean inactivation dose from the different dose delivery patterns is attributed to 1) treatment times that are shorter than the sub-lethal damage repair half times; (2) high dose rates used in conformal radiotherapy techniques; and (3) the small size of individual dose fields. Conclusions: The study demonstrated that the suggested triangular and V-shaped patterns of dose delivery do not result in different biological effect when implemented to 3-D conformal treatment techniques.
The effect of occupational stress and organizational commitment on diagnostic imaging radiographers in rendering quality service
(University of Pretoria, 2005-11-30) Uys, I.C.; Hartzer, Yolanda F.; cmakanj@op.up.ac.za; Makanjee, Chandra Rekha
The aim: The main aim of this study is to determine the effect of occupational stress and organizational commitment on diagnostic imaging radiographers in rendering quality service. Background: In the past two years radiography staff turnover at the public and private health organizations has increased by 45% and 50%. Increased occupational stress and burnout are some of the main reasons for staff leaving the organization. Limited studies were found on occupational stress amongst diagnostic imaging radiographers and no studies could be found on organizational commitment amongst diagnostic imaging radiographers at the time of conducting the study. The link between organization health services and patient outcomes is rarely tested empirically. Materials and method: It was a descriptive correlational study. The sample comprised 123 radiographers who completed a self-administered questionnaire. Results: There was a 97% response rate. Organization commitment was moderate towards a tendency of low. Sources of occupational stress, namely workload and role conflict were high, whilst social support and role ambiguity were low. Radiographers relied on problem-solving mechanisms to cope with stress. Therefore the level of occupational stress experienced was generally moderate, but with a slight tendency towards high. Discussion: There was a relationship between level and sources of occupational stress. No relationship was found between a low level of organizational commitment and a high level of occupational stress. A relationship was found between sources, levels of occupational stress and organizational commitment. Thus, the level of service delivery is affected by organizational commitment and occupational stress experienced by radiographers. Conclusion and recommendations: The overall context within which an organization functions has an effect on radiographers’ quality of working life and this directly impacts on the behaviour of the radiographer during a service encounter. Therefore, from an organizational perspective it is important to create a positive working environment for radiographers and to improve their quality of working life. The overall function of the organization would benefit were management to shift from an authorative to a participative style. Workload and role conflict could be reduced by having protocols in place to minimize the variation in standard of the quality of work done.

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