Learning from experience

Before undertaking my doctoral research, I had designed the Hybrid Imaging module at my University with perhaps too much focus on the scientific parameters and not enough on the practical / fundamental aspects of hybrid imaging.  I was initially concerned that the Masters level education attached with the module required a particular specification; however there should have been greater focus around communication skills and support for patients, workflow management and the basic principles of CT and image fusion. 

Nuclear medicine departments are now being positioned at the centre of patient services, such as cardiology etc, which is beginning to further foster relationships with staff and creating new working relationships and sharing of the patient experience.   This is removing the need for a ‘hidden organisation’ as nuclear medicine / hybrid imaging roles are being recognised and there is sense of identity, professional pride etc.

There is however still a lot of work to be done, to 'shake off' the traditional traits of the nuclear medicine community and there is a need to embrace other professions into the hybrid imaging environment, encourage flat collaboration and rise to the challenge of being evidence based professionals, who use technology to aid their role development and expertise.  

Overcoming the theory / practice gap

During my research it has become apparent that a gap between theory and practice exists.  This is linked with the need to understand / define the various roles within the hybrid imaging workforce.  Creating an environment whereby a system of work exists permitting the effective use of CT during hybrid imaging examinations is paramount.  This is only one of the integral aspects of working practices within a hybrid imaging environment, however it is crucial to the overall service delivery. 

The image below depicts the range of potential autonomy associated with using CT in a hybrid imaging environment.  There is the consideration of system / software specifications, but one of the most fundamental questions that does not seem to factor during the procurement / installation and subsequent use of a hybrid imaging system is 'how will you use it?'. 

It is pointless having a 64 slice CT unit attached to a gamma camera if all you intend to do is attenuation correction +/- localisation.  Will you use contrast agent? Will you need to specialist software which looks good, but actually it is not required.  Having the appropriate underpinning knowledge and understanding of hybrid imaging practice will always be linked to the relevant theory and principles.   

 

A committed hybrid imaging workforce should be able to flex and adapt as required, exploring new potential patient pathways and establishing their position within inter-disciplinary teams.  This is easier said than done, however we need to think about our community, the 'nuclear medicine fraternity' (image below).  There needs to be an understanding that a new workforce is emerging, those practitioner that do not have a tradition in non-hybrid practice.  This has merits in the form of a greater appreciation of anatomical imaging etc, however how does the nuclear medicine fraternity balance the development needs of the traditional workforce with the emerging workforce?  This equation does not even include the new trainees who may witness / be influenced by the sub-communities within nuclear medicine. 

Becker (1961) explored the notion that our social and technical order now requires us to deliver more and more (patient) services within the environment we work.  The effective delivery of these patient services depends upon esoteric knowledge and skills and it is crucial that trust exists between all practitioners, regardless of the sub-community belonging.     

Knowledge rather than reliance on policies

Despite having an apparent abundance of policies and procedures at their fingertips and visible within the clinical imaging environment, nuclear medicine practitioners often appeared to ask their colleagues for advice or feedback.  This was most noticeable in situations where experienced nuclear medicine practitioners would be approached by staff who were not as familiar with hybrid imaging techniques or technical aspects (e.g. Quality Control checks) and were asking for help / guidance.  Although there was access to a range of policies and other useful documents, the practitioners generally preferred to ask their colleagues and learn from the experience.  This often involved citing previous experiences and / or bringing up example studies to demonstrate particular aspects of image acquisition or processing etc. 

The documents pertaining to hybrid imaging practice were being produced by a mixture of professional disciplines, including hybrid imaging practitioners and clinical scientists.  There also appeared to be a notion of health competition between the professional disciplines in terms of who could produce the most documentation / policies in some incidences.  Why was this the case? This behaviour appeared very 'tribal' in nature, almost mirroring graffiti street tags and highlighting a claim on the technology that was being used. 

Issues however may arise when protocols change or new imaging pathways are introduced.  How is this information disseminated through the hybrid imaging community? This also leads to a potential lack of evidence based knowledge development and practitioners not being able to develop enquiry based learning approaches within the workplace.

Technology Determinism

The introduction of new technology within nuclear medicine appears to have shifted the traditional positioning of the nuclear medicine practitioner.  There is a need for careful consideration around the appropriate use of new technology, in order to aid patient diagnosis and potential subsequent monitoring of treatment response.

How does a workforce, which now works with hybrid imaging technology ensure they are able to control the daily workflow within the department?  Given the automated aspects of patient worklists and seemless connectivity associated with acquiring and processing data, the professional group need to ensure their involvement in the acquisition of clinical information is central to the patient's journey.  The use of technology needs to complement the role of the healthcare practitioner, rather than replace it.