Radiography as a profession is continuously changing as technology evolves to meet the need of modern times. Yet, at the same time the foundation still remains. The professional work and responsibilities encompass, notably two areas; technology and patient care that envelope all fields in medical imaging which include diagnostic, radiotherapy, nuclear medicine and sonography.
The study of Lundvall, Dahlgren and Wirell (2014:48) affirms that even though the professional scope varies, a general aspect of this practice is its combination of operationally high complex technology with human communication and patient care.
Equally the usage of digital image production brings transformation of the practical work and professional role as analyzed by Fridell, Aspen, Edgren, Linskold and Lundberg (2009:121) that radiographers’ practical skills in the image production process have changed from being an expert in individualizing exposure parameters to each patient to instead carrying out image processing and operating computers.
Modern Radiographers work in a highly regulated professional environment where team work provides excellence clinical care and practice which enable them to demonstrate right clinical leadership behaviors. Hence, they have been trained in a model of service delivery which requires radiographers to lead radiographic service and those who use the service but also frequently requires them to follow the medical practitioners’ direction (Lovegrove & Long, 2012:230).
The Literature (Marshall & Kasap, 2012:135; Gqweta, 2012:22; Moran & Warren-Forward, 2011:272) has shown that radiographers gain additional clinical skills and theoretical knowledge in order to take on roles that were previously the domain of the radiologist/oncologist.
Therefore, role extension in radiography has commenced in the United Kingdom four decades ago, with forty years of such practice in medical ultrasound and twenty years in other fields of medical imaging, and since that time it has evolved; the introduction of advanced and consultant practitioners has led to service improvements, reduced volume of unreported images, and a more efficient turnaround for reports to referring clinicians (The Society and College of Radiographers, 2010:6).
The role extension began in United Kingdom was as a result of shortage of radiologists and increase demand of radiological services. Government policies facilitated the development of the professional role for some radiographers who have moved on to an advanced or consulting level which include professional tasks and responsibilities belonging to the medical tradition (Ford, 2010:189; Forsyth & Maehle, 2010; The Society and College of Radiographers, 2010:8).
In order to gain a fuller understanding of this concept, Moran, Taylor and Warren-Forward (2013:131) depict role extension in radiography as additional tasks and responsibility undertake by radiographers at the requests or in need of radiologist while advanced practice implies expert and autonomous duties, independent of radiologists. Equally Gqweta (2012:22) portrays radiography role extension as a practice where by radiographers adopts duties that were previously only within the scope of practice of radiologist.
Consequently, role extension involves the acquisition and development of skills and responsibilities with resultant associated additional professional accountability.
Today, challenges confronted UK that brought role extension for radiographers’ is globally, therefore countries like Australia, Finland are in the process of extended roles for radiographers while Sweden, Canada, are already practicing it.
Notwithstanding of potential driven for role extension in other countries, this paper concentrates on the need to support for adoption of role extension in South Africa as a means by which radiographers can adapt to the demands of this dynamic profession.
Before putting the argument forward for adoption of role extension in radiography, there is need for us in this treatise to espouse the reasons underpin role extension in South African context.
Why Role Extension in South Africa?
‘ There is shortage of radiologists as report by Kawooya (ca. 2010) shows that South African radiologist per population is ratio 1:100,000 while workload per radiologist per year is 12,500 (examinations per radiologist per year) and 7,500 (examinations per year for academic record).
‘ Image interpretation is mostly done by general medical practitioners in public and remote hospitals which wrong diagnosis made by non-trained clinicians may be misleading and at times dangerous to most patients. Hence most x-ray films are not accurately reported (Hlongwane & Pitcher, 2013:638).
‘ Poor service delivery to patients and society at large due to unavailability of radiologist to give early and accurate results during emergency situation in most urban and rural government hospitals (Seggie, 2013:589).
‘ Finally but not the least, there is increasing demands of radiological services by populace which cannot be met by decreasing availability of radiologist/oncologist (Gqweta, 2012:22).
The clear facts and findings presented above generate reasons for potential adoption of radiographers’ role extension to meet increasing requests of radiological services and shortage of radiologist for overall better health care delivery systems in our dear country.
Our contention for role extension in radiography lies paramount of moving the imaging profession forward as technology evolves which the overall gains are for the patients and general populace of this country. Therefore base on this, our arguments for supporting radiographers in the adoption of role extension are:
Providing better service for patients
Role extension can improve early access to critical care interventions in emergency situations such as trauma where by radiology is the key to the early diagnosis and management of severely ill and injured persons (Seggie, 2013:589).
A research by Hlongwane and Pitcher (2013:638) highlights the deficiency of radiologists in South Africa, and globally, and confirms the utility of South African radiographers applying ‘red dot’ system, used in the United Kingdom since the mid-1980s, for trauma triage. Experienced radiographers evaluating appendicular fractures in adults did as well as consultant radiologists. Radiographers, if they can be facilitated to accurately identify trauma pathology, can potentially ease service pressures at regional and district public sector hospitals, where there is limited radiologist cover, particularly after hours. A compelling argument is made for formal extension of the scope of practice of South Africa radiographers.
International experience (The society and College of Radiographers, 2010: 8) has shown that radiographer reporting can reduce patient waiting times, release radiologists for other duties and improve the retention rates of radiographic staff and potentially improve patient care.
A study in South Africa by Lawrence, Poggenpoel and Myburgh (2011:p.4) shows that therapy radiographers’ experiences professional stagnation; have little opportunity for professional growth and skill development.
Role extension can assist in this regard by involving radiographers in further training which definitely lead to more diversity in their careers. A new career path with the potential for advanced roles may well provide incentives for young radiographers to take a new interest in radiographic instead of changing careers (Moran and Warren-Forward, 2011:274).
Therefore with professional training and educational post qualification, there may be a design of new career pathways for South African radiographers similar to UK such as Assistant Practitioner to Advanced Practitioner to the Consulting level.
Job satisfaction of radiographers can be enhanced by role extension. Equally it aids recruitment into the medical imaging profession. Role extension is like a motivation that can increase job fulfillment. Moran et al. (2013:135) enumerated that the most identified potential advantage of role extension was job variety, with specific reference to alleviating repetition of procedures. Role extension may aid retention of staff by facilitating avenues to reduce monotony and potential injury.
More so, role extension for radiographers can reduce lack of recognition of what radiography entails and its responsibilities among populace and even health workers.
Support to society and entire populace
The overall benefit of radiographers’ role extension is to keep society fit and stable in terms of rapid and quick response of medical imaging professionals’ to health delivery system in South Africa; no waiting times for proper diagnosis or prevention of disease as well as treatment of disease.
Equally evidence-based practices (EBP) in medical imaging will assist the society for real and right diagnosis as role extension can create research radiographers in our hospitals (Reid & Edwards, 2011:207-208) though it is not within the scope of this paper to analyze areas of role extension.
The use of advanced practitioners and consultant radiographers similar to UK will greatly improve services and reporting turnaround times, to the benefit of both patients, and referring doctors and thereby support society at large (The Society and College of Radiographers, 2010:6&8).
Gains on the part of Radiologists
Notwithstanding of all potential benefits for radiographers and society at large in role extension, there are benefits as well for radiologists such as reduction in workloads, improved reporting efficiency and more time for radiologists to work up the more subtle, complex cases, that require their more advanced skills (Moran & Warren-Forward, 2013:271; Thompson & Pollard, 2007).
Role extension for radiographers is indispensable in South Africa to support patients and society at large for better health care and services. If proper plans and careful considerations is entrust on role extension, cooperation and support of radiologists’ is vital. Educational providers need to structure their programmes for postgraduate qualifications to underpin role extension.
Professional bodies and higher authorities need to support adoption for role extension with appropriate training, and scope of practice and guidelines develop for medical imaging practitioner to work within legal boundaries.
We confidently believe, with proper adoption of role extension, is the only means by which South African radiographers can adapt to the demands of this dynamic profession.
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