A clinical audit of anatomical side marker use in a pediatric medical imaging department: A quantitative and qualitative investigation

• Published in: PloS one Vol. 15; no. 11; p. e0242594
• Main Authors: Chung, Lilian, Kumar, Saravana, Oldfield, Joanne, Phillips, Maureen, Stratfold, Megan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.11.2020; Public Library of Science (PLoS)
• Subjects: Audits; Best practice; Child; Clinical Audit; Clinical medicine; Computer and Information Sciences; Contrast Media; Diagnostic imaging; Diagnostic systems; Fiducial Markers; Health care; Health risks; Human performance; Humans; Information systems; Interviews as Topic; Management; Markers; Medical communication; Medical imaging; Medical research; Medicine and Health Sciences; Methods; Pediatric research; Pediatrics; People and Places; Post-production processing; Qualitative Research; Radiographs; Radiography; Radiology Department, Hospital; Research and Analysis Methods; Research design; Retrospective Studies; Sample size; X-Ray Film; Australia; South Australia Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0242594

The presence of a radiopaque or digital anatomical side marker (ASM) is an important diagnostic feature on radiographs and should be a routine feature on every radiographic image. Despite its importance, research has indicated numerous instances where ASMs were absent which have the potential to lead to adverse events. To date, few studies have systematically examined the use of ASMs in clinical practice and explored medical imaging professionals' perspectives on ASM use. This research aimed to address this knowledge gap. This investigation was conducted in two stages. Stage 1 involved a retrospective clinical audit of 421 randomly selected radiographs within 12-months at a pediatric medical imaging department. The data were analyzed for overall presence and type of marker use. Stage 2 comprised of semi-structured interviews with 11 radiographers to garner their perspectives on ASM use, and barriers and enablers to their use in clinical practice. The interviews were transcribed verbatim and thematically analyzed. The overall presence of ASMs (radiopaque and digital) was observed on 99 per cent of radiographs. There was a noticeable shift towards the use of digital (78.8 per cent) compared to radiopaque ASMs (20.2 per cent), highlighting the growing trend towards using ASM in post-processing. A handful of images (N = 4) did not include any ASMs. Semi-structured interviews revealed multifaceted barriers (time, infection precautions, and patient factors) and few enablers (professionalism, legal requirement) for ASM use. This investigation, informed by quantitative and qualitative research paradigms, has shed new light on an important area of radiography practice. While missing ASMs were a small feature, there continue to remain opportunities where best practice standards can be improved. The increasing use of digital ASMs potentially highlights a shift in clinical practice standards.