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Sharing the benefits of radiology research: My work as a Bevan Fellow

Research Radiographer at Betsi Cadwaladr University Health Board.

Jenna Tugwell-Allsup

Sharing the benefits of radiology research: My work as a Bevan Fellow

As a research radiographer working within the NHS, I’d heard many positive experiences of collaborating with the Bevan Commission from staff who had been involved as Bevan Exemplars, as well as from Dr Chris Subbe, a successful clinician in the research and innovation field – a Bevan Fellow. I applied for the Bevan Fellows programme for several reasons; collaboration, networking and to build a platform to disseminate and showcase my work.

As a researcher, I conduct my work independently; however, one of my areas for development is the dissemination of my completed work once published. I identified the Bevan Fellows programme as an excellent opportunity to network with experts within the field of research, offering my projects support and attention whilst increasing their effectiveness and credibility. Research can be a very lonely, isolated experience and I saw the opportunity for the Bevan Commission to introduce me to new links and resources to help make research a more open and sociable experience, in particular to facilitate collaboration between researchers in Wales.

I’m a qualified diagnostic radiographer, having moved into a clinical research role in 2012. My current role involves teaching, facilitating, supporting and conducting research within and beyond radiology. The transition from my clinical role into the research role was exciting and yet challenging. In order to help develop my skills and knowledge, I decided to enrol onto an MPhil Program with Salford University which really developed my confidence and competency in clinical research. I completed my MPhil in 2017 and I am now pursuing a PhD by published works with Salford University. My area of research expertise is optimisation of image quality and radiation dose in radiology, with additional publications outside of this area e.g. MRI anxiety.

My main research interests are:

  • methods by which image quality can be evaluated e.g. objective/mathematically and the Psychology behind the subjective nature of visual evaluation of image quality
  • inter and intra observer variation, decision making and threshold.

My interest in image quality evaluation ties in with another of my roles conducting RECIST measurements for oncology based clinical trials.

I have set myself a number of goals as a Bevan Fellow:

Goal One

To develop successful bids for grant funding. I have secured several small grants over the last few years 2 x (£5K), which were used for my MRI anxiety trial and the neonatal optimisation study. I am however keen to take my work further and apply for larger grants with my focus still being on optimisation but also transition of findings into practice especially surrounding new DR technology.

Goal Two

To support, facilitate and supervise individuals in undertaking research qualifications. I will encourage clinical NHS staff, radiology-based and those from other disciplines, to pursue a research project or even a research career. Using this approach, I hope to encourage more staff to undertake MRes, MPhil and PhD. I plan to do this by demonstrating the benefits of pursuing a clinical academic career using audit/QI meetings, conferences and showcasing events to highlight the work that myself and others do within the Health Board. In addition, I do some research teaching sessions at Bangor University with the hope to develop interest and nurture a research interest in the early career stages.

Goal Three

To focus on translating my findings into practice. This would be achieved by striving to standardise and promote a change in clinical practice whilst using the Prudent Healthcare principles to aid and support this transition. Once a change in practice is authorised, then an evaluation of practice through regular audit would need to be in place and this would be reflected when disseminating findings in order to encourage other to act upon findings.

How Covid-19 has impacted my work

I completed my neonatal project in March 2020 and have four publications as a result. The final study was funded by the College and Society of Radiographers. The neonatal project commenced with a systematic review to explore the gaps in knowledge and what was already known about the subject followed by a survey. The neonatal imaging survey was sent to all Health Boards in Wales and the North West of England (if they had a neonatal unit) to gain information on existing working practice for neonatal imaging. Both the systematic review and the survey demonstrated a significant gap in the literature and a significant variation in current clinical practice when imaging neonates. This ultimately led to the experimental optimisation project which aimed to optimised and standardise neonatal chest imaging within incubators. This is the first optimisation study to consider both visual and objective image quality for incubator imaging but also the first to derive effective dose (risk of radiation to neonate) to compare against image quality.

The experiment was also informed by two rigorous preliminary studies as described above. The findings included (without being overly technical): using the incubator tray, image quality decreased and effective dose increased making direct exposure more desirable from an imaging perspective. However, there are situations where the tray is compulsory to avoid disrupting the neonate for various safety reasons. The study therefore recommends two sets of acquisition parameters; one for direct exposure and the other for tray exposure whereby mAs and SID is modified accordingly.

The next phase is to disseminate the findings of these studies and to implement them locally and showcase them internationally with the support of the Bevan Commission.

The findings are even more significant during this pandemic as it reinforces the use of the incubator tray as described above for imaging to avoid cross contamination as many still place the image receptors directly behind the neonates. It also raises questions regarding the design of incubators which might be another area whereby future work could be done, especially linking in with manufacturers. Too often we see practices being implemented clinically without robust empirical evidence and therefore it is refreshing to do some research and seeing it influence how we work. Some of my previous work on trolley imaging has influenced clinical practice and ultimately radiology have been heavily involved in the procurement and even some re-design of trolley features used in ED; the aim is to do the same for neonatal incubators.

I’ve been a Bevan Fellow for over 12 months, the past 6 months have, for obvious reasons, been redundant in terms of networking events, and I am yet to have a face-to-face event as a Bevan Fellow! I have kept in contact with various individuals and in the near future I am hoping to attend (virtually or, in time, in person) for Bevan Commission events.

Looking towards the future

My aspirations include getting involved and contributing in more showcasing events whether they are Bevan Commission event, radiology specific or just research driven events in order to network; networking is essential for signposting and creating links with other professionals such as allied health workers, clinical academics or anyone who could be interested in collaborating in future projects.

I hope to use my position as a Bevan Fellow to develop links with experts who have experience in areas where I am looking to develop such as data capturing i.e. software and IT development, large grant captures or business case write ups etc. I look to the Bevan Commission to help find appropriate resources, as well as being a fountain of knowledge when I come across hurdles in the research pathway.

I am also already involved in a range of other projects currently including a clinical trial on MRI in Ovarian Cancer, Covid-19 National Imaging Database and other optimisation studies, including a neonatal project exploring copper filtration as a dose reducing technique to be implemented on DR equipment.

In the future, I am also looking to get involved or push for more All Wales projects facilitated by the Bevan Commission. It is often we do great projects locally but they never get disseminated. Data from more Health Boards in Wales would validate such findings and see implementation across Wales. These projects could be research, but could also be Quality Improvement projects, so if ever you are involved in any projects that could be done across Wales, I’m always willing to help or signpost you to the appropriate individuals. I’m based in radiology with numerous links across the Health Boards in terms of R&I.

Collaborative opportunities always welcomed:

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  1. Tugwell-Allsup J, England A. Imaging neonates within an incubator – A survey to determine existing working practice. Radiography 2020; 26(1): 18-23
  2. Tugwell-Allsup J, England A. A systematic review of incubator-based neonatal radiography – What does the evidence say? Radiography 2019, In Press
  3. Tugwell-Allsup J, Morris RW, Hibbs R, England A. Optimising image quality and radiation dose for neonatal incubator imaging. 2020. In press
  4. Tugwell- Allsup J, Kenworth D, England A. Mobile chest imaging of neonates in incubators: Optimising DR and CR acquisitions. Radiography 2020