Seeing, thinking, deciding: "Radiographic reasoning" in MRI - A qualitative investigation

Area of Science:

• Radiological Sciences
• Cognitive Science
• Medical Imaging

Background:

• Limited research exists on radiographer reasoning in Magnetic Resonance Imaging (MRI), unlike projection radiography.
• MRI presents complex decision-making challenges due to interdependent parameters and time pressures.
• Existing research lacks a universal checklist for assessing MRI image adequacy.

Purpose of the Study:

• To describe how radiographers make real-time decisions (accept-modify-repeat) during MRI examinations.
• To analyze the underlying reasoning processes influencing these MRI image quality judgments.
• To explore the adaptive nature of radiographic reasoning in the context of MRI.

Main Methods:

• Qualitative study involving ten radiographers with varied experience levels.
• Simulation-based task using anonymized neuro-MRI cases with a 5-minute time constraint.
• Data collection through screen recordings and verbatim interviews, analyzed using a framework derived from dual-process, cognitive continuum, and script theory.

Main Results:

• Three dimensions of reasoning identified: intuitive, analytical, and contextual influences.
• Novice radiographers used analysis when uncertain; mid-career used flexibility; experts relied on intuition.
• Patient vulnerability, time pressure, and diagnostic implications consistently impacted decisions.

Conclusions:

• Radiographers' MRI reasoning is adaptive, integrating intuition, analysis, and context to maintain image quality.
• Radiographic reasoning is a distinct yet complementary aspect of clinical reasoning, crucial for diagnostic reliability.
• Training should focus on recognizing contextual triggers for analytical reasoning and enhancing reflective practice.