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

Most research on radiographers' reasoning has focused on projection radiography. MRI presents a more complex decision space, with interdependent parameters, contextual pressures, and no universal checklist for adequacy. This study aimed to describe how radiographers make real-time accept-modify-repeat decisions in MRI and to analyse the reasoning processes underpinning these judgements.

Ten radiographers of varying experience participated in a qualitative study. Four anonymised neuro-MRI cases from a teaching archive were presented in a simulation-based own-point-of-view task. Participants evaluated image quality as if at the console, with a 5-min time cap. Screen recordings supported subsequent stimulus-recall, and interviews were transcribed verbatim. Data were coded in MAXQDA using a framework derived from dual-process, cognitive continuum, and script theory, supplemented by inductive codes. Two coders iteratively refined the framework until saturation was reached.

Three dimensions of reasoning were identified: intuitive reasoning, analytical reasoning, and contextual influences shaping movement between them. Novices relied on impressions but shifted into analysis when uncertainty arose. Mid-career radiographers moved flexibly along the continuum depending on clinical relevance and time. Experts primarily relied on intuition, activating analysis only in high-stakes or unexpected cases. Patient vulnerability, time pressure, and diagnostic consequences consistently influenced decisions.

Radiographers' reasoning in MRI is adaptive, integrating intuition, analysis, and context to safeguard image quality. The study highlights radiographic reasoning as a complementary concept within clinical reasoning, reflecting the profession's distinctive contribution to diagnostic reliability.

Training should help radiographers recognise contextual triggers that call for analytic reasoning, provide opportunities to enrich experiential scripts, and strengthen reflective practice. Recognising radiographic reasoning may support competency-based education and interprofessional collaboration.