IT tools – Course structure – Pedagogical approach
All teaching material is provided on the Canvas platform (Instructure,
Salt Lake City,
US).
The curriculum is presented in three Modules that contains a set of Pages,
each focusing on a central topic related to justification.
Each topic is introduced by a digital text,
a lecture or video,
and guidance to relevant literature,
followed by Quizzes and tasks to promote knowledge and reflection.
Videos are either downloaded from the internet,
or produced by USN using the tool Screencast-O-Matic (https://screencast-o-matic.com/)
The students are offered three obligatory webinars during the semester and weekly online meetings to discuss specific tasks.
USN use Zoom (https://zoom.us) as cloud platform for video and audio conferencing,
which also allows the students to chat and have webinars on their own.
The students may go online via PC or mobile,
and easily share documents for discussion.
Throughout the semester,
they work with an obligatory written Assignment,
compose a supplementary list of literature individually,
and finally there is an Oral exam (30 min per student).
The whole course structure is shown in Figure 1.
The pedagogic approach of the course in a digital setting facilitates admission of students internationally.
Module 1: The empirical and normative background for justification
The trends in use of radiology since the 1970’s in all developed countries reflects the comprehensive development in imaging technology.
The students are introduced to:
- Trends in radiology,
methods of counting examination frequency,
and how to explain variations between countries and within countries
- Drivers and consequences of excessive imaging,
the mechanisms surrounding overutilization
- Ethical foundation, values and theories underpinning radiation protection and justification
- Strategies to improve justification,
the IAEA "triple A" initiative: Awareness – Appropriateness - Audit
Module 2: Assessing referral quality using tools and guidelines
The quality of the referral depends on two (closely linked) aspects,
first the quality of the information provided,
and secondly the appropriateness of the requested examination.
In this core element in the course the students are introduced to:
- High quality referral,
focusing on types,
amount and quality of information needed in the referrals.
The quality and appropriateness of the referral may be apparent before the radiographer interact with the patient,
as illustrated in Figure 2.
- Introduction to current referral guidelines - the ACR Appropriateness criteria (1),
the Western Australia Diagnostic Imaging Pathways (2) and the ESR iGuide (3).
The students are also asked to search up and familiarize themselves with any national or local guidelines.
- Developing skills in assessing referrals - we have developed a training package of test referrals with certain pitfalls concerning missing information and appropriateness,
see example Figure 3.
The students are asked to assess them in a response sheet.
In addition,
the students are asked to compose two referral cases themselves using a template.
All the referrals were discussed on Webinar 2 addressing several clinical questions and modalities (planar X-ray,
CT,
MRI,
US)
- Research on justification,
focusing on the variety of research methods used to for determining rates of inappropriate radiological examination.
Module 3: Co-operation towards appropriate imaging
- Knowledge base of radiation risks, basic radiation biology,
tissue reactions,
late effects of radiation and uncertainties in risk estimates.
The scientific basis for the age- sex and organ-specific risk factors,
the concept of effective dose.
- Risk perception and communication,
addressing information strategies and patient preferences,
the holistic perspective of including and balancing of benefits and risks,
and the responsibilities in the benefit-risk communication.
- Roles and responsibilities in the justification process, addressing responsibility and cooperation in the decision making process,
interpretation of terms like “referrer”,
“practitioner” and “operator”,
how inter-professional boundaries and barriers for radiographers contribution in the process can be overcome.
- Clinical audit, introduced as measure to improve quality in clinical practice using evidence based guidelines,
as opposed to regulatory audits or inspections that are based on regulations and enforcements.
The Written assignment
The topic of the assignment is practicing justification,
co-operational and organization issues.
This topic is mainly situated in Module 3,
but the students are advised to regard the assignment as an ongoing task during the whole course period.
The Oral exam
The students are presented for the questions two hours in advance to the oral exam.
This include general questions from the whole curriculum,
and one referral case,
so the students can demonstrate both theoretical understanding and skills in assessing clinical information and appropriateness,
applying guidelines.