Determinants of using (non-)fluoroscopy-guided positioning for radiographs: a case study research

This study examines the determinants of using (non-)fluoroscopy-guided positioning (FGP) for radiographs, in order to improve the use of non-FGP imaging techniques. We focused on knowledge and attitudes of radiographers and radiologists with respect to applying non-FGP in radiography and organizational factors. We analyzed data from an in-depth multiple case study that includes observations and field notes, interviews, documents and images collected from the radiology departments of four hospitals. The unified theory of acceptance and use of technology (UTAUT) was used to frame the findings. We found that inadequate skills and insufficient knowledge of positioning techniques and negative attitudes towards non-FGP were present. More precisely, staff expressed concerns with respect to the impact on the workload and workflow. Besides facilitating organizational conditions, the social influence of peers and the clinical leadership of RLs were found to be important. Adequate supervision, regular feedback and coaching were identified as important enabling factors for increasing the quality of the applied imaging techniques. In the conclusion we state that determinants of using non-FGP are quite complex. Therefore we argue that a holistic approach considering all these aspects is needed to improve imaging practices.