From quality assurance to scientific radiography publishing
Eli Eikefjord from Department of Radiology at HUS and from the Radiography education program at
Bergen University College (HiB) gave an internal presentation “From quality assurance to scientific
radiography publishing” on the 16th of April.
Most radiographers work within quality assurance, based on evidence based practice and systematic
documentation as method. This is partly in contrast to the more generalizing research focus based on
scientific methods. However, there exists a huge grey zone between the quality assurance and the
scientific approaches, in terms of publishable results, Eli pointed out. This is because several quality
assurance projects also might lead to results that can be published in both level 2 (Radiotherapy and
Oncology) and level 1 (Radiography ) international journals. Many good ideas and data from Bachelor
and Master theses might be published, e.g. from optimizing new equipment and technology, given
that you get support from the local management and that you have access to scientific supervision
on the way.
Impact
“Will publishing of the quality assurance aspects have any value or impact in the health care
society?” Eli asked the audience. “Yes,” she answered, “publishing of these kinds of data might
challenge the current practice, contribute to improve technical quality, diagnostic quality and
increase therapeutic impact for the patients, and also lead to more socio-economic benefits in the
health care institutions”, referring to [1, 2], (Figure 1).
Figure 1. Thornbury and Fryback’s hierarchy model of efficacy in radiology.
Eli Eikefjord highlighted the value of having a good project plan, as a good planning tool, but also
because a project plan might be the key to anchor your idea in the management team and to get
finances. She also gave an example of a successful and published pilot study [3], where they wanted
to develop a low-dose CT-protocol for patients with suspected kidney stones. In the pilot study they
used pig kidneys as phantom and added real human kidney stones, which gave a lot of valuable
technical information from CT scans. Based on results from the pilot study a validation study was
performed to compare the low dose CT-protocol with conventional urography which at that time was
current practice. In this study they included 119 patients with suspected kidney stones and compared
radiation dose, diagnostic accuracy and cost between the two imaging methods. This study resulted
in two research publications, one regarding radiation dose [4] and the other covering the costeffectiveness approach based on estimated costs and diagnostic accuracy [5]. The study gave clear
conclusions, first that low-dose CT applied to patients with kidney stone disease gave no added dose
compared to conventional urography, and secondly that CT was both less expensive and had higher
diagnostic accuracy (= more cost-effective). Results from this study contributed to change current
practice (2005) in the hospital clinic.
Given the recommendations from the presentation by Eli Eikefjord, there are reasons to believe that
more young students within radiography will be able to publish their results in the near future and
thereby give a significant contribution to improve our health care system. Such studies might benefit
from all sources of medical image data and support from MedViz.
References
[1] Thornbury JR. Eugene W. Caldwell Lecture. Clinical efficacy of diagnostic imaging: love it or leave
it. AJR American journal of roentgenology. 1994, 162(1): 1-8.
[2] Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Medical decision making : an
international journal of the Society for Medical Decision Making. 1991, 11(2): 88-94.
[3] E. Eikefjord NMU, D. Jensen, J. Rørvik Decreasing the radiation dose for renal stone CT European
Congress of Radiology Vienna, Austria, 2005.
http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=55
39&ti=29116&si=206&searchkey=&scrollpos=undefined
[4] Eikefjord EN, Thorsen F, Rorvik J. Comparison of effective radiation doses in patients undergoing
unenhanced MDCT and excretory urography for acute flank pain. AJR American journal of
roentgenology. 2007, 188(4): 934-9.
[5] Eikefjord E, Askildsen JE, Rorvik J. Cost-effectiveness analysis (CEA) of intravenous urography (IVU)
and unenhanced multidetector computed tomography (MDCT) for initial investigation of suspected
acute ureterolithiasis. Acta radiologica. 2008, 49(2): 222-9.