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Results

Round one

Table 4 presents the number of panel members responding in each round. The response rate for round one was 85.16%.  The expert panel identified a total of 439 research priority areas in this first round that were grouped into 19 subject areas.  Thematic analysis to reduce response overlap condensed the returned priorities into 325 distinct research topics that were returned to participants in round two. 

Number of participants in panel

128

Round one

 

Number of participants responded

109

Response rate (%)

85.6

Number of topics suggested

439

Number of topics after thematic analysis

325

Number of subject areas

19

Round two

 

Number of participants responded

100

Response rate from original panel (%)

78.18

Response rate from 109 that responded to round one (%)

91.74

Number of topics reaching consensus

159

Topics from round one reaching consensus (%)

48.92

Round three

 

Number of participants responded

98

Response rate from original panel (%)

76.56

Response rate from 100 that responded to round two (%)

98

Number of topics reaching consensus

133

Topics from round one reaching consensus (%)

40.92

Table Data from expert panel:  rounds 1 to 3

On average, panel members suggested four priority areas each in round one (mode of five and range of one to five).  Of the 128 panel members, 93.75% (n=120) were radiographers (n=62 diagnostic, n=43 radiotherapy and 2 dual qualified), 3.13% (n=4) were students, 1.56% (n=2) were from other allied health professions and 1.6% (n=2) were service users. A summary of demographic information for the expert panel can be found in Table 5. 

Age range

N =

24–35

18

36–45

28

46-55

48

56–65

14

66–75

2

Prefer not to answer

2

Missing data

16

Gender

 

Male

22

Female

90

Missing data

16

Ethnic Group

 

White - English/Welsh/Scottish/Northern Irish/British

95

White – Irish

4

White – any other background

5

Mixed/multiple ethnic groups – White/Asian

1

Mixed/multiple ethnic groups – any other background

1

Asian/Asian British/Pakistani

1

Black/African/Caribbean/ Black British – African

1

Other ethnic group – any other background

1

Prefer not to answer

3

Missing data

16

Area of response

 

England

93

Wales

1

Scotland

9

Northern Ireland

4

Other

5

Missing data

16

Designation

 

Diagnostic

62

Therapeutic

43

Dual qualified

2

Other

6

Missing data

16

Years of qualification

 

1–5

4

6–10

11

11–15

15

16–20

12

21–25

14

26–30

19

31–35

12

36–40

7

41–45

2

N/A (not a radiographer)

15

Prefer not to answer

1

Missing data

16

Table Expert panel demographic data

The topics identified in round one varied from general research areas to more specific research questions.  Non-responders were followed up by email, with some participants formally withdrawing at this stage owing to workload or having moved jobs (n=4), and some were withdrawn for not responding before the round one completion deadline (n=15).

Round two

Round two responses from the panel were at an acceptable level (78.2%). Consensus was achieved on 159 of the 325 topic areas presented to the panel.  There was some attrition of participants, with those that formally withdrew (n=2) citing the length of the questionnaire or technical issues as reasons for non-completion.  Some panel members were withdrawn from the study after missing the final questionnaire deadline (n=7). The mean scores, percentage agreement and coefficient of variations (CVs) showed variable agreement from participants regarding the importance of different topics.  Following quantitative data analysis, the 166 research areas that failed to reach consensus were excluded from the round three questionnaires.

Round three

Ninety-eight participants from the original sample of 128 responded to the third round questionnaire (overall response rate of 76.6%).  The panel reached consensus on 133 of the 159 research priority areas presented in this round.  Table 6 shows the top ten research topics prioritised by the expert panel in round three. Sub-group analyses for radiotherapy, diagnostic imaging, ultrasound and mammography, and education are presented in Tables 7-10. 

 

  Rank

Priority topic

N

Mean

% agreement

CV (%)

1

Proton beam radiotherapy, including outcomes, patient experience, techniques, cost effectiveness, delivery, training and late effects

44

4.68

100.0

10

2

Audit of survivorship and late effects after radiotherapy

54

4.65

98.1

11

3

Dose optimisation, in relation to image quality and methods for reduction for all modalities using ionising radiation

87

4.64

97.7

12

4

Adaptive radiotherapy, in relation to developing guidelines, improving treatment outcomes and reducing side effects

44

4.64

97.7

11

5

How to implement individualised patient-specific radiotherapy

50

4.60

92.0

16

6

Ensuring standard procedures are evidence-based

98

4.60

88.8

14

7

Management of acute and late side effects of radiotherapy

46

4.59

97.8

12

8

Image Guided Radiotherapy (IGRT) - development of gold standard imaging regimes and image matching techniques, and consideration of dose

44

4.59

97.7

12

9

Outcome measures for radiographer-led procedures previously radiologist-led

73

4.56

91.8

14

10

Impact of 24-7, extended day and 7 day week working

88

4.53

92.0

14

Legend:

N = number of panel members that voted on topic in round 3

% agreement = % of panel members scoring ‘4’ (important) or ‘5’ (very important) on the Likert scale

CV = coefficient of variation

Consensus was considered as a mean score ≥4.0, % agreement ≥75% and coefficient of variation < 30%

Table 6 Top ten topics reaching consensus after round 3 – all subjects

 

Rank

Priority topic

N

Mean

% agreement

CV (%)

1

Proton beam radiotherapy, including outcomes, patient experience, techniques, cost effectiveness, delivery, training and late effects

44

4.68

100.0

10

2

Audit of survivorship and late effects after radiotherapy

54

4.65

98.1

11

3

Adaptive radiotherapy, in relation to developing guidelines, improving treatment outcomes and reducing side effects

44

4.64

97.7

11

4

How to implement individualised patient-specific radiotherapy

50

4.60

92.0

14

5

Management of acute and late side effects of radiotherapy

46

4.59

97.8

12

6

IGRT - development of gold standard imaging regimes and image matching techniques, and consideration of dose

44

4.59

97.7

12

7

Data collection of patient outcomes for as wide an amount of treatment fractionation, doses and treatment sites as possible

48

4.48

89.6

15

8

Identification of patients’ priorities from a radiotherapy service - what is important for them

63

4.46

92.1

14

9

Impact of NHS spending restrictions on radiotherapy service delivery

57

4.46

89.4

15

10

Targeted radiotherapy based on functional imaging

43

4.44

95.3

13

Table 7 Top ten topics reaching consensus after round 3 – Therapy sub-group

 

Rank

Priority topic

N

Mean

% agreement

CV (%)

1

Dose optimisation, in relation to image quality and methods for reduction for all modalities using ionising radiation

87

4.64

97.7

12

2

Outcome measures for radiographer-led procedures previously radiologist-led

73

4.56

91.8

14

3

How can we reduce the number of imaging errors?

77

4.34

89.6

15

4

What will the imaging service demands be by 2020 and how will we meet them?

73

4.32

87.7

18

5

Efficacy of diagnostic pathways

68

4.28

86.8

17

6

Radiographer-led assessment and discharge for minor injuries - evaluation of its effectiveness

65

4.28

84.6

17

7

Is tomosynthesis a viable alternative to Computed Tomography (CT) - could we replace 4 or 5 projection scaphoid series with this, and so negate the need to treat patients who have negative imaging?

26

4.27

84.6

17

8

Cost and clinical effectiveness of radiographer- led musculoskeletal services

64

4.25

87.5

16

9

Establishing the accuracy of radiographer reporting in clinical practice

65

4.23

87.7

19

10

Diagnostic reference levels need to be established for the full range of examinations for both paediatrics and adults

54

4.22

92.6

18

Table Top ten topics reaching consensus after round 3 – Diagnostic sub-group

 

Rank

Priority topic

N

Mean

        % agreement

CV (%)

1

Can the routine screening of vasa praevia at the anomaly ultrasound scan improve pregnancy outcomes?

21

4.52

100.0

11

2

Why are we still failing our babies? Persistent poor antenatal US detection rates of serious congenital heart anomalies

26

4.46

92.3

14

3

Addressing poor recruitment and retention of sonographers

61

4.36

90.1

16

4

Exploiting the potential of tomosynthesis

28

4.32

85.7

17

5

Breast tomosynthesis: use in the evaluation of difficult to visualise breast lesions in the symptomatic breast clinic

25

4.32

92.0

15

6

Should there be a more standardised approach to both performing and reporting foetal Doppler ultrasound?

25

4.24

84.0

17

7

Comparison of breast MR and contrast enhanced tomosynthesis in the diagnosis of lobular carcinoma

25

4.24

84.0

17

8

Breast tomosynthesis for screening moderate and high risk family history patients

25

4.20

88.0

15

9

The career of sonography - is a change in training required to address staff shortfall?

54

4.11

83.3

20

10

Radiographer performed mammography image interpretation

47

4.04

80.0

21

Table 9  Top ten topics reaching consensus after round 3 – Ultrasound and Mammography sub-group

 

Rank

Priority topic

N

Mean

       % agreement

CV (%)

1

Evaluating the education and workforce requirements to meet future service needs

93

4.39

87.1

18

2

Addressing poor recruitment and retention of sonographers

61

4.36

90.2

16

3

The recruitment and retention of radiographers

93

4.27

88.2

17

4

Work force/recruitment/attrition rates for radiotherapy students. How can we ensure more students are attracted to radiography (particularly therapy) and retained?

77

4.25

88.3

16

5

Identifying future skills set needs for radiographers, creating methods to obtain these and assessing effectiveness of education strategies

95

4.18

81.1

18

6

Training and educational needs for advanced radiotherapy and imaging

66

4.18

86.4

16

7

With the introduction of PET-CT, MR linacs and 4-dimensional computerised tomography do we need more diagnostic training in radiotherapy?

60

4.15

86.7

16

8

The career of sonography - is a change in training required to address staff shortfall?

54

4.11

83.3

20

9

MR linacs - what is the training requirement for therapeutic radiographers?

54

4.11

77.8

19

10

Education at all levels - how is it evolving to meet challenges of new technologies and techniques?

92

4.08

80.4

19

Table 10  Top ten topics reaching consensus after round 3 – Education sub-group

A summary of topic consensus and number of priority areas reaching consensus per topic heading can be found in Table 11.

Topic heading

Number of priority areas reaching consensus

1. Service improvement

8

2. Workforce

8

3. Education and training

5

4. Inter-professional collaboration

1

5. Research capacity, capability and attitudes to research

6

6. Role extension

8

7. Recruitment and retention

3

8. Patient experience

8

9. Patient safety

3

10. Radiotherapy

38

11. Survivorship

3

12. Imaging

15

13. Radiographer reporting

6

14. Radiographer commenting

2

15. Tomosynthesis

6

16. Ultrasound

3

17. General topics

10

Table 11: Final research topic headings and number of priority areas reaching consensus after round 3

Overarching research themes

The system used to assess if the research priority areas could be matched to one of the five identified research themes was a light touch process used to check alignment of priorities to the overarching themes.

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