Radiographic Image Interpretation

Radiographic Image Interpretation

 

            In the clinical environment it is important that people should practice their job in accordance with the needs of their patients or clients. In this regard, those who are just beginning to learn and experience things must be taught and mentored by others who have already experienced different things in relation to different health care activities. Evaluation of image quality remains a challenge in radiological studies. It has to be addressed when optimizing established techniques for various X-ray examinations. Quality assessment for imaging results is mostly based on the observers subjective scoring system because of the lack of objective and acknowledged criteria. The outcome will depend on the observers’ previous experience. Since the readers’ preferences are related to the subjective nature of the outcome, a definition of clear quality criteria is required. Comparative image quality analyses mostly refer to given anatomical details that are present in each radiograph [1–3]. These can be used for analysing changes of visibility due to varied technical procedures [4]. The Commission of the European Communities (CEC) has developed such image criteria based on anatomical details for some radiographic examinations to standardize image quality throughout Europe [5,6]. In 1996 these CEC-criteria were slightly revised and presented in the “European Guidelines on quality criteria for diagnostic radiographic images” [7]. Visual grading of the reproduction of important anatomical structures for the evaluation of image quality in radiography has become an established method [8]. The basic idea of visual grading is the assumption that the possibility to detect abnormal findings correlates to the reproducibility of anatomical structures. An alternative method for the comparative evaluation of image quality is the application of receiver operating characteristic analyses (ROC), that are well described in literature [1,9].

In the context of medical image interpretation, Nightingale (10) outlined the following four levels: detection of an abnormality, description of image appearances, interpretation of the image and independent reporting, suggesting that the trauma RDS is an example of the detection task (Level 1) and this can be distinguished from independent reporting (Level 4) provided, for example, by radiographers that have completed appropriate postgraduate education and training). Previous research (11) suggests that radiographers demonstrate different levels of ability depending on the type/extent of education and training received.

 

Ethics

Medical ethics, a branch of the philosophy of ethics, deals with moral decisions in medicine. The branch of nursing ethics could be considered under the umbrella of medical ethics. The moral foundation of the nursing profession is based on the perspectives of Florence Nightingale, who described nursing as a self-defining moral practice focused on caring. This moral foundation evolves from the nurse-patient relationship. Morality in nursing practice arises from the idea that it is morally good to promote the physical and psychological well-being of patients. Nurses, however, may find it difficult to prioritize these moral nursing values over their personal values (Killen, 2002).

In the nursing profession, acts that are ethical often reflect a commitment to standards which are beyond an individual’s personal preferences – standards on which individuals, professions, and societies agree (Potter & Perry, 2004). Ethics has become an important way of life in a post-modern society that does not acknowledge any fixed points of reference.

Nursing is essentially a work of intimacy. The tasks of nursing require the nurse to be in close contact with clients, physically and emotionally. This kind of contact is usually not acceptable in public relationships. As a result, the work of nursing involves the negotiation of values whether those values be of the client, the physician, the employer, or other concerned groups.

Maintaining their own moral integrity is central to nurses’ moral experience. Studies have documented that nurses sometimes feel they are forced to betray their own values. Their position in organizations, a lack of involvement in the decision-making process, and lack of authority seem to contribute to the experience of powerlessness in situations of moral difficulty (Mathes, 2005).

Discussion and resolution of ethical issues requires critical thinking skills. Unlike the resolution of clinical problems, however, the resolution of ethical issues involves the negotiation of closely held personal values and philosophies, not facts or measurable clinical data. Resolution of ethical issues incorporates not only the nurse’s personal values but also the interpretation of the client’s personal values, based on the unique perspective of nurses (Potter & Perry, 2004). Ethics guided by one’s own moral values is very important since an ability to make good decisions about one’s health care promotes healthy behaviors across the lifespan (Deatrick, 2000).

The commitment to save lives is the utmost goal of every healthcare practitioner. With the developing trends and current breakthroughs in the field of medicine and healthcare practice, it is always important to hold on the principles of professional ethics. However, there are situations where ethics is at stake resulting to unethical behaviour and malpractice. Medical malpractices has increasingly become the focus of attention in most empirical studies from both the medical community and the general public because of adverse economic and human consequences associated with it. The presence of numerous medical codes of conduct and the experiences of medical practitioners during their academic years are not adequate to maintain perfection in providing ethical medical practices.

Results obtained present that almost all radiologists were trained on ethics pertaining to their professions or even physicians and nurses. Majority of them are exposed to medical ethics training. The knowledge on the existence of ethical committee at the institution is relatively high provided that most of the respondents agreed. On the context of unethical behaviour demonstrated by a colleague, majority agreed that they are able to recognise unethical behaviour demonstrated and the violation of professional ethics in the course of their work is seen on a daily basis. The identified factors that influence breaches of medical ethics include inadequate legislation or regulations; inadequate enforcement of legislation or regulation; lack of awareness among healthcare workers on the question of what is ethical behaviour; lack of adequate training to healthcare workers on ethics; and high workload among healthcare workers. These factors are all proven to be existent in both cases of physicians and nurses. The opinions on various aspects in medical ethics practice do not vary among respondents. Lastly, the role of ethical committee is still important as most respondents seek their intervention to check what is ethical and unethical in relation to their practice.

Discussion states that there is a crucial need for physicians and nurses to enhance ethical medical practice not only on the case of the physicians and nurses in public as well as private hospitals in the world. In order to enhance professional medical ethics, it is recommended that the government’s role in supporting existing ethical committees is needed and constant training programs among physicians and nurses are sought.

The results clearly illuminate the need for physicians and nurses to enhance ethical medical practice not only on the case of the physicians and nurses in public as well as private hospitals in the world. Training on medical ethics is said to be experienced by physicians and nurses. Also, the knowledge on the existence of ethical committee at the institution is present and briefly evaluated. On the context of unethical behaviour demonstrated by a colleague, majority agreed that they are able to recognise unethical behaviour demonstrated and the violation of professional ethics in the course of their work is seen on a daily basis. The identified factors that influence breaches of medical ethics include inadequate legislation or regulations; inadequate enforcement of legislation or regulation; lack of awareness among healthcare workers on the question of what is ethical behaviour; lack of adequate training to healthcare workers on ethics; and high workload among healthcare workers. These factors are all proven to be existent in both cases of physicians and nurses. The opinions on various aspects in medical ethics practice do not vary among respondents. Lastly, the role of ethical committee is still important as most respondents seek their intervention to check what is ethical and unethical in relation to their practice.

Specifically, ethics particularly among physicians and nurses is rooted on numerous codes of professional conduct, guidelines, and other established rules and regulations. Most medical practitioners are expected to comply on such ethical standards so as to provide the best practice. After their years of stay in the academe and prior to their actual performance of their practice, training is helpful to update their knowledge. The issue of medical ethics is always illuminated in all aspects of providing healthcare. Then, the challenge lies on how ethical each medical practitioner in pursuing his/her professional role as medical service provider. While all physicians and nurses were trained on ethics pertaining to their professions, there are still violations occurring within the medical setting. The presence of violations is said to be attributed to the inability of medical practitioners to choose the most appropriate and relevant training programs that they will undergo. Also, the changing medical practices with the emergence of modern technologies and medical breakthroughs prompt every physician and nurse to stick to their customary ethical practices that are sometimes irrelevant to the current setting. The knowledge learned over the years is not sufficient. Thus, every physician and nurse is encouraged to look for advancement of knowledge in some ways like consulting their head of departments and reading books and articles about varying ethical issues today. The findings of the study specify that no physician or nurse who seek advice from the Ministry of Health. This is quite disappointing as the Ministry of Health is the key body that should be a venue for continuous learning on professional practice and ethics as well. The knowledge on ethics is not limited on what is read and applied yet also available in the course of the experiences of other superior individuals who work on the same setting. Because training is very important, it is always imperative that all physicians and nurses should undergo consistent professional training on medical ethics and practice. This will be beneficial in the performance of their duties and responsibilities.

The knowledge on the existence of ethical committee at the institution is relatively high among the respondents. It is evident that there are many organizations, committees and professional groups that are existent to advocate ethical medical practice. However, the question is on how effective they are in communicating their visions and missions as international or national recognized bodies. In Tanzania alone, there are several ethical committees that are popularly recognized yet they are not fulfilling their roles. This is the reason why there is an apathetic or indifferent relationship among members of the medical field. To reconcile their role in the medical setting, ethical committees should not only work as vanguard of ethical practice but active participants of the quest towards the enhancement of professional ethics in the country.

In communicating the case of unethical behaviour demonstrated by a colleague, most physicians and nurses see it in every day situation. They know that a certain act is unethical and they extend the initiative to inform the involved party. Findings report that there is a strong relationship among physicians who understood the main contents of their professional code of conduct and their ability to talk to a colleague who commit a certain unethical practice. Understanding the context of code of professional conduct in any field is directly associated on the ability of a person to correct what is identified as wrong act. The physicians should play as teacher in the medical setting especially among subordinates. Similarly, the relationships of length of service or exposure to the field are important factors to consider in correcting unethical practices. Hierarchy and seniority are essential elements of the organizational culture.

Among the identified factors that affect unethical behaviours in medical practice include inadequate legislation or regulations; inadequate enforcement of legislation or regulation; lack of awareness among healthcare workers on the question of what is ethical behaviour; lack of adequate training to healthcare workers on ethics; and high workload among healthcare workers. These factors are all proven to be existent in both cases of physicians and nurses. Inadequate legislations and regulations as well as inadequate enforcement reflect the role of the government and ethical committees. More often than not, inadequacy of legislations and regulations and the poor application are the common excuses of medical personnel who commit unethical behaviour. On this case, all parties involved particularly the government of Tanzania should come up with practical and relevant legislations and regulations and to be supported by the ethical committees and other groups. Such are to be extended to all members of the field. On the case of lack of awareness among healthcare workers on the question of what is ethical behaviour, the role of education and information dissemination is under question. Most medical practitioners are affiliated in certain organizations and professional bodies. The advocacies of these organizations and professional bodies should include education and further training to enhance work competencies and professional values. The lack of adequate training to healthcare workers on ethics is always a problem. Thus, the challenge is pass to all concerned organizations and professional bodies particularly in coming up with the given relevant training programs and development mechanisms. Lastly, the high workload among healthcare workers is associated with the increasing complexity of the providing medical services among the growing population. All public hospitals in developing countries are said to have lacking funds for a decent healthcare. Thus, the role of the government and related institutions are needed particularly in financial support such as national budget allocation. The factors that affect unethical behaviours in the medical field are not limited to the mentioned ones. The list goes on. But then again, the pursuit towards ethical medical practice will also continue.

Meanwhile, the opinions on various aspects in medical ethics practice do not vary among respondents. Opinions regarding various aspect of practicing ethics are dependent on special cases. For example, physicians and nurses were equally opinionated in the issues such as medical ethics is only important to avoid legal action. Conditions like patient wishes must always be adhered to, patient should be always informed of wrongdoing once happen in the course of treatment, confidentiality is outdated in the modern practice should be abandoned, doctors should decide what to do irrespective of patient opinions, patient should only consent for operation not for test and medications and close relatives should always be told about patient’s condition are contributory to the ethical practice.

Lastly, the role of ethical committee is still important as most respondents seek their intervention to check what is ethical and unethical in relation to their practice. As most physicians and nurses are aware of the presence of ethical committees, they seek advices and support from them. Ethical committees should then be credible and competent in providing support and education among the members of the field particularly those who sought for their involvement.

            When people want to discover some things, they usually aim to figure out and investigate the nature of occurrence, characteristics and other related facts about this certain matter. In this similar manner, they consider affecting factors in the discussion and facing of consequences brought about by their discoveries. The field of medicine, especially to microbiology and pathology is a practical instance. Before a medical specialist can provide information of a new prevailing illness, they must initially investigate and consider some factors affecting the whole nature of such.

Same as true in this condition where people consider factors rather than the presence of physical illness because factors serve as significant keys in probing the nature, medication and prevention of a specific physical illness. Some people disregard the presence of physical illness as the focus of action in other situations. Instead, they focus on the factors affecting the nature of the physical illness varying from plain physical to detailed anatomical and physiological bases. Evidences gathered both from physical and scientific examinations supply primary ingredients in determining and coming up with actions and solutions necessary to solve problems.

Factors, as imply, are essential information ranging from basic and existing knowledge, learned and acquired facts from studies and observations, or beliefs – real or imaginary that serve as prerequisites in every study conducted. They are things that will support or contradict, validate or negate, solve or worsen, and answer or disapprove claims. These are the dynamic contributors to an accomplishment, outcome, or course of action. They may provide facts that are vital in a definite field of study.

Some factors apparent in discussing the presence and diagnosis of physical illnesses are distal and proximal factors like genetics; causal, maintaining, and precipitating factors as physical signs and symptoms; and internal and environmental factors like socioeconomic and cultural (Herson and Porzelius, 2002).

Distal and proximal factors are relative to the nature of the illness as well as to the patient. Genetic factors are important contributing factors to most physical as well as psychological disorders. Genetics has something to do with genes and hereditary origin of a person’s illness. It deals with heredity of the individual, particularly the method of hereditary transmission and the variation of inherited characteristics between equivalent or related organisms. Although, genetic factors are not usually understood, it is still an important factor in tracing the nature of the illness. According to Herson and Porzelius (2002), the susceptibility of a person to a disease is “believed to be inherited, but is also modified by life experiences” (8). For example, a couple of cases of diabetes and some types of cancer are deemed to be hereditary. But today, some causes of diabetes and cancer could be accounted to the changes in lifestyle of people from food to personality. If there are related or same cases occurred from early years of the generation, genetics is the answer. Doctors and other medical experts will trace back the history of the illness from the lineage of the family.

Causal, maintaining, and precipitating factors are important considerations in studying physical illness. The signs and symptoms of an illness are very significant and must have satisfactory amount of attention. Sufficient knowledge on the characteristic of the illness can make a person aware that he or she is experiencing such ailment. Technical terms are best expressed by licensed and legitimate people knowledgeable of the disease. The physical manifestation of an illness is an important signal that will lead to the immediate findings and deliberate medication. Maintaining factors are those of medication while precipitating factors are those of prevention.  Through the use of information accumulated from the inquiry, this will be an aid in creating medicines and other related treatments or operation for the illness. It is also a helpful foundation for making precautionary guidelines. 

Internal and environmental factors have something to do with the culture and lifestyle of the patient. Ethnicity, culture, race, gender, religion, and lifestyle, are major considerations in discussing health. Internal factors like these mentioned above are within the bounds of the patient’s ways of living. Through their impact on health, relevant findings are essential in coming up with proper prescription and immediate avoidance of a disease. For example, menopausal women who are pregnant have greater chances of risky delivery or death. Tracing the nature of menopausal women, internal factors like the age and lifestyle is vital in giving birth. Another example would be the cross-breeding of different races. The evidence of heredity is manifest from physical characteristics varying from skin, hair, eyes, and other aesthetic characteristics aside from detailed scientific proofs. Socioeconomic factors include class and economic group. The main problem of poverty in the world contributes to inadequate health care and consciousness of people. Environmental factors comprise the elements present in the surrounding where the patient is living. Today, the world is experiencing different illnesses claimed to originate from declining consciousness and abuse of people in the environment. Chemical – related diseases like food poisoning and cancer are few examples of such. 

In studying physical illnesses, people frequently oversee the importance of physical characteristics visible to sample cases. This is not much relevant to some cases of study. Still, these physical illnesses possess characteristics essential in determining factors.   Most of the time, people concentrate in the factors affecting the presence of physical illness rather that dealing directly to the ailment. For some instances, diagnosis of a disease is not complete without reiterating the factors affecting its occurrence – like if it is hereditary, acquired or suddenly on the spot. Physical characteristics also influence people physically and psychologically. For example on the aspect of psychology, mildly overweight females in their adolescence years are more likely to undergo strict diet and more likely to develop a serious eating disorder (French, Perry, Leon, & Fulkerson, 1995). For example on the aspect of physical illness, a young man injures his back in a mistake on his construction job. It leads to a year of unemployment while he receives medical treatments and incapable to work or provide adequate needs for his family, he feels increasingly more helpless and depressed (Herson and Porzelius, 2002). The tendency of lingering to his physical defect is superior thus, creating a feeling of incompleteness and futility of his physical body.

A physical illness certainly has cause. This is the reason why some doctors try to trace back the factors affecting it. The probing of a nature of an illness is a standard procedure by all medical practitioners. Aside from existing knowledge and facts about the nature of the disease, they also consider factors in analyzing them. By looking to the illness physically, there is a higher tendency of inaccurate description to the nature and cause of the disease. Whereas if an existing factor is present, chances are high for an accurate and relevant analysis. If a factor was present in the diagnosis, there is a basis for coming up with the idea of prevention and medication. Formulation of new medicines and treatment is faster and reliable.

Factors are important in medication of physical illnesses. The fact that there are theories or principles behind some physical illnesses; these will aid doctors to define new methods and procedures to cure the illness. Their truthful findings are the basis in making new drugs to combat the cause of the disease. Aside from medicinal remedies, precautionary measures are observed and disseminated to people for their safety as by-product of research. The formulation of ideas will always be based to the fundamentals of the discovery or the nature of the illness.

Today, focusing on factors affecting health problems is a major point in coming up with useful and relevant solutions to existing well-being harms of the world. Since using these factors could not heal people literally, the fact that people has a grasp on the information about these will be a great help in prevention. However, it is still basic to consider the presence of physical illness in discussing health. Data obtained from written reports and records of physical illnesses are major leap for its cure and prevention. The value of visibility cannot be disregarded. When people distinguish physical manifestations of illnesses in themselves, they will immediately act on it. So, early in the conception or the first degree of an ailment, it is advisable to see the factors affecting its occurrence. That will serve as an important instrument for a fast and immediate response.

            The findings lead to the recommendation of the need to enhance professional medical ethics. In order to enhance professional medical ethics, it is recommended that the government’s role in supporting existing ethical committees is needed and constant training programs among physicians and nurses are sought. The role of the government in supporting existing ethical committee is important because legislations and regulations should be coordinated to national framework. Without government’s support, ethical committees will become mere organizations that are limited to written codes of conducts that are never implemented. Also, constant training programs among physicians and nurses are sought because continuous learning will add up to their existing professional competencies. All in all, medical ethics is grounded on the principle of doing what is right, fair, and beneficial – at all times.

 

 

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