EVALUATIION OF THE CHALLENGES OF PAEDIATRIC RADIOGRAPHY IN THE TERIARY INSTITUTIONS IN ENUGU METROPOLIS AND THEIR SOLUTIONS

ABSTRACT The main purpose of any patient that comes to the hospital is to get healed or health condition improved. On the other hand, it is the obligation of the Radiographer to ensure that image of diagnostic value is obtained. Radiographic examination of the padediatric comes with its peculiar challenges, which the radiographer must overcome in the quest to get image of diagnostic quality. The research method used is a non-experimental survey method. The population of study is 52 Radiographers in the tertiary institutions in Enugu metropolis, comprising of UNTH, NOHE and ESUTH. 49 was the sample size. These challenges include uncooperativeness of the child (37.5%), incorrect positioning and immobilization of the child (31.26%), control of involuntary movement (25%), radiation protection and so on. 63.3% of the respondents endorsed parental or caregiver assistance as the method of immobilization most efficient for them. Overcoming these challenges boils down to the radiographer’s ingenuity in approaching the child, technical preparation in the diagnostic room, availability of all the necessary facilities to keep the child successfully immobilized and presence of child-friendly environment.   TABLE OF CONTENT
Title page-----------i Approval page---------ii Dedication-----------iii Acknowledgement---------iv Abstract-----------v Table of content----------vi List of tables---------vii
CHAPTER ONE 1.0 INTRODUCTION 1.1 Background of the study--------1 1.2 Statement of problems---------3 1.3 Objectives of study---------3 1.4 Significance of study---------4 1.5 Scope of the study---------4 1.6  Literature review---------5
CHAPTER TWO 2.0 THEORETICAL BACKGROUND 2.1.1 Psychological stages of development of children----11 2.1.2 Child development and psychology------12 2.1.3 Psychological consideration in paediatric examinations--14 2.1.4 Radiographer’s attitude to the paediatric patient----15 2.2 Ethical responsibility of the radiographer to the paediatric patient-16 2.2.1 High quality examinations-------16 2.2.2 Communication--------16 2.2.3 Compassion and respect--------17 2.2.4 Physical safety---------17 2.3 Dedicated environment for the paediatrics----18 2.3.1 The reception---------18 2.3.2 The diagnostic room--------18 2.4 Patient care and preparation-------19 2.4.1 Mode of appointment--------20 2.4.2 Pre-investigation introduction and child/parent evaluation--20 2.4.3 Pre-investigation preparation and care for common routine procedures------20 2.4.4 Preparation and care for special (contrast) procedure---23 2.4.5 Immobilization---------24 2.4.6 Radiation protection--------25 2.5.0 Practical radiographic techniques------26 2.5.1 Equipment and accessories-------26 2.5.2 The Skull----------28 2.5.3 The Chest----------29 2.5.4 The Abdomen---------30 2.6.0 Alternative medical imaging modalities-----31 2.6.1 Computed Tomography (CT)-------32 2.6.2 Ultrasound----------32 2.6.3 Magnetic Resonance Imaging (MRI)------32 2.6.4 Nuclear medicine---------33
CHAPTER THREE RESEARCH METHODOLOGY 3.0 Resaerch design---------34 3.1 Population of study--------34 3.2 Pample size---------34 3.3 Instrument of data collection-------34 3.4 Method of data collection---------35 3.5 Analytical procedure---------35
CHAPTER FOUR 4.1 Data presentation and analysis-------36 4.2 Discussion----------47
CHAPTER FIVE 5.1 Summary of findings---------52 5.2 Recommendations----------54 5.3 Area of further study---------54 5.4 Conclusion----------55 5.5 Limitations----------55 References Appendix 
LIST OF TABLES Table 1: Frequency of Paediatric Patients Encounter Table 2: Uncooperativeness prior to Radiographic Examination. Table 3: Method(s) used to gain the child’s Cooperation Table 4: Immobilization Devices available in the Radiology Department Table 5: Most efficient of the Immobilization methods Table 6: Frequency of Repeat Cases in restive paediatrics Table 8: Quality of image obtained from effective communication between the Radiographer and other members of the Medical Team.
LIST OF  FIGURES
Fig 1 :Most difficult age group Fig 2: Most frequent cause of poor quality images Fig 3:Educational level for incorporating special training programme on Paediatrics
INTRODUCTION Paediatrics is the branch of medicine concerned with the development, care and diseases of babies and children1. The paediatric patient includes neonates, infants and children up to the age of 12. On the other hand, Paediatric Radiography refers to the radiographic investigation which involves the imaging of babies and children. Special dedicated equipment and accessories are used to acquire high-quality images. The images produced are of a valuable adjunct for effective diagnosis and treatment of clinical conditions. Thus, Paediatricians and Surgeons are able to ascertain the necessity of surgery and evade the complications therein. Dr. Caffey J.P while working at Babies Hospital in New York as the hospital’s first in-house radiologist realized that the field of radiology was wide open for a physician of scholarly bent and paediatric background. He rapidly taught himself the range of normal appearances and the plain film manifestations of children’s diseases. However, some of the radiographs he viewed were of poor quality, resulting in wrong diagnosis. His meticulous, disciplined approach led, in 1945, to the first edition of Paediatric X-ray Diagnosis, a major step towards establishing paediatric radiography as a discipline in radiology2. However, few dedicated paediatric radiographers exist outside specialist children’s units of most hospitals in United States. It is inappropriate for inexperienced radiographers to undertake unsupervised paediatric radiography, for example on call or out of routine department hours. Thus, all Radiographers providing Children’s imaging should have specialist training to provide the expertise and judgment required in this demanding specialist area of radiography3.  Imaging children comes with distinct challenges. Unlike adults, children cannot always understand or comprehend a change of environment. When children are ill, they follow their instincts, which is usually to cry and stay close to their parents. This presents a huge challenge for the radiographer, who must try to gain the child's trust and co-operation.  Once this has been achieved there is another big challenge of keeping the child still or immobilized for the radiographic examination to be carried out. This can be very difficult for children in a lot of pain.   The need to prevent avoidable exposure to ionizing radiation is another facet of the challenges relevant in radiographic examination of paediatrics. However, paediatric radiography, despite being acknowledged as an imaging specialism, does not have a strong presence in either undergraduate or postgraduate radiography education programmes, and the availability of current published literature aimed at general radiographers is extremely limited. Thus, paediatric radiography is not recognised as an extended role for state registered radiographers and has no recognition within Agenda for Change3 in the United States of America. Paediatric radiography has no formal career structure and thus there is little incentive for radiographers to specialise in this area.  The research intends evaluating these challenges as encountered by radiographers, in the stride to obtain a good image of diagnostic value, in these tertiary institutions, as well as their possible solutions.