Critical Appraisal of Three Articles on Radiographic Examination and Interaction with Paediatric Patients

This report presents a critical analysis of three articles on radiographic examination and interaction with paediatric patients. The articles focus on methodology, findings, and discussion.

Critical Appraisal

Table of Contents
INTRODUCTION......................................................................................................................3
REVIEW....................................................................................................................................3
CONCLUSION..........................................................................................................................8
REFERENCES.........................................................................................................................10

INTRODUCTION
Critical appraisal may be defined as a process which lays emphasis on identifying the
positives and negative aspects of specific article or paper. Moreover, each research paper is
either appreciated or criticized by other scholars on the basis of sample size, type of
investigation, data undertaken and analysis made. Findings presented by other scholars are
the main point of critique which is undertaken by researcher at the time of doing critical
appraisal. For the present report three articles have been selected such as radiographic
examination (2), interaction between the paediatric patient and radiographer (3) and Gonad
shielding in paediatric pelvic radiography: effectiveness and practise (6). In this, report will
present critical analysis of all such three articles on the ground of several aspects such as
methodology, findings and discussion.
REVIEW
A critical literature review would be conducted on three primary articles. These would
include Immobilisation and restraint of paediatric patients during plain film radiographic
examination (article2), An observational study based on the interaction between the
paediatric patient and radiographer (article 3) and Gonad shielding in paediatric pelvic
radiography: effectiveness and practise (article 6). Among the three selected there are two
qualitative (articles 2 and 3) and one quantitative (article 6) papers (see appendix1). The
learner would be summarising evidence, critically exploring the links between methods and
findings along with identifying key themes that are similar and those which go in a different
direction. To help the learner critically review the articles Gill Marshall’s article on critiquing
research would be used.
Critical thinking is seen as a key skill for all health professionals when they are
expected to base their practise on sound evidence(Castle, 2009). A critical evaluation of an
article should be done so the reader can make a decision on the value of the article(Marshall,
2005).
The title is the first set of words which should reflect the content of the article with
accuracy and precision but be of an academic standard which would entice the reader to keep
reading.The key words present should summarize the main theme on what the article is about
allowing literature search with the help of the keywords. The abstract should be always

concise summarising what the article is about allowing readers to judge whether or not it is
relevant to their research(Marshall, 2005) .
The title of article 2 is to the point, but after reading the article some deviations were
found which did not relate. Article 3’s title was concise and also to the point whereas article 6
had a slightly misleading title because the comparison between shielding of both male and
female paediatric patients was mentioned in the discussionwhereas the title was not.
Although the keywords were relevant to the study for article 2 they were not found in the
body of the work, likewise the key word in article 3 did not represent the article either instead
words that were most commonly used within the article (anxiety, fear, x-ray and alleviate)
became key words. In orderto encapsulate the main topic for article 3 key words like
paediatric and communication could have been used for someone doing a literature research.
Article 6 keywords were related to the study the author used words such as gonads, pelvis
and radiation protection which summarises the main theme of the article.
The abstracts for all three articles were brief and to the point, concise, reflective of the article
which shows the problems and why the study needed to be conducted, which would allow the
reader to further judge the appropriateness to their research needs (Marshall, 2005).
The study in article 2 was based on two studies that dealt with child immobilization.
Within the introduction words were defined with evidence to back it up, all points made on
restraint and immobilisation were backed up with evidence to support their actions. In
addition to this the article was very long winded and obscured by other things, consent was
discussed which was linked to restraints which were not relevant to the aim. Too much
secondary sources and references from the co-writer were used which made the article seem
bias. Overall the aim in the introduction did not match the one in the abstract. The
introduction for article 3 had a deviation from the aim of the study instead of focusing in the
interaction between radiographer and child, in the introduction, it looked at the importance of
low exposure dose and why it needs to be low along with stating how children are more
radiosensitive than adults(Graham, 2004), instead of saying how can be achieved by
communicating with the child. If these points were made in the abstract the introduction
would have been stronger. Factors such as examination that would require more from a child
should have been looked at because this can have different outcome on the results. Another
factor to consider would be were any of the children posed with mental health problems or
learning difficulties. Not all variables and their possibilities were discussed for example 13

radiographers took part in the study instead of one constant radiographer, they used three
different x-ray rooms and the equipment used wasn’t specified, along with the waiting time
and previous experiences of patients. A second opinion was not pursued to ensure the
information presented was accurate.
The gap of current knowledge in article 6 is evident because further research was needed to
be carried out due to the lack of evidence that supports the link between gonad irradiation and
heritable diseases in future generation(Warlow, 2014). The author mentioned that a
systematic literature review of other research was conducted on the placement of gonads
shields which was all descriptive and not critical questioning the need to repeat the study.
Furthermore, the research described in the introduction was more than 10 years old.
Marshall(2005) states, that a rational and justification for the need of thi study should be
established. Other studies were conducted before and tested numerous time and got similar
results, but Warlow et al repeated the study and did not make it clear as to why they did. The
introduction was not written in a logical order, it dose not flow or link together causing
irrelevant information to be presented for example radiation to the colon but study was
looking at gonad radiation and protection.
When the methodfor article 2 was conducted the ethical approval was met. The
method was written in a way that it could be possible for someone looking at it for the first
time can follow every step to repeat the survey (Marshall, 2005). The author stated why the
survey was used, but as a result of using the survey style questionnare, the data collected
turned out to be quantifying data, therefore questioning, if it was the best choice for the issues
raised. A positve sample approach was used by means ofselecting specific people across the
grade. 169 surveys were sent out to north east of england, but 139 radiographers responded.
One can question if the sample size was large enough to equate into national average of
different regions in the country. There was no biasnees noted in the methodology but a pilot
was performed by a 3rd year student which can cause one to question if he or she had the
experience to question the real issues.
According to Marshall (2005) “Results should be scientifically analysed to represent
representative and relevant values.”130 out of 139 radiographers responded to the survey and
had also in some form had to use restrain on a paediatric patient. However out of the 130
radiographers only 25 of them had formal training to restrain a child. 101 was not aware that
protocols were there on how to use a form of restraint on paediatric patients. Graphs were

used to represent the data collected from the questionnaire, which were easy to understand
and appeared to be nice but did not reflect the aim of the study. for example, there was a
graph made for what influences a radiographer’s decision to restrain a child, why should a
child be restrained according to age methods of restraint which could have been put into a
table form. Another factor that should be taken into consideration when critiquing results
would be the consistent generation of data when compared to the collected data (Marshall,
2005). In this case, there were some inconsistencies within the results of article 2 for example
the author stated 30 radiographers used commercially available devices, however stated in
another paragraph that it was uncertain if they represented a single trust (Hardy & Graham,
2004 p. 27). This was not further mentioned as a limitation in the rest of the article. Overall
the wrong type of survey was used to gather this type of information it did not extract any
new information.
The method used in article 3 was used in the form of an observational approach. The
author stated that this was the best method for data collection but did not give an explanation
as to why this was the case, or what other methods were available to collect the data. The
consistency of this could be put into question because the method of x-raying a hand and
chest are different and therefore could affect the child’s emotional state and the reactions will
vary depending on the age. Factors such as learning disabilities were not mentioned which
could have affected the results, the exclusion of inpatient children who were seriously ill was
decided by both the radiographer and researcherthis would have alleviate certain variables
from the data allowing a larger focus on a smaller group. If they were included results would
have been varied and harder to relate. Although the researcher wanted to minimise the
variable all were not discussed stating how they could have affected the data for example,13
staff radiographerswere used instead of one, five different x-ray rooms and equipment were
used CR and DR which could have increased or decreased the waiting time and factors
suchas if the child had x-rays before (if they knew what to expect they would be ok if they
did not then they would be more nervous). Another critique to the method would be there was
no confirmation of the data being in putted being revisited by another individual to ensure it
was reliable information being entered into the spreadsheet. In the results section, there was
no clear indication of analysis the results were categorised into three themes namely, the
child, the radiographer and emotion in which the data was going to be presented but instead
were set out as questions that had no data and was not made clear by the author if they were
questions asked during the study.

The method used for article 6 was a non-experimental one, therefore the researcher
was not able to control, manipulate or alter the variables or subjects. But, relies on
interpretation or observation while also conducting the study as a retrospective survey,
although it was mentioned that 886000 images were obtained from DICOM digital teaching
library, but how many were actually plain film x-ray? This question poses a problem because
image would be coming from different area, which may have different protocols and each
radiographer would have a different technique in doing the examination. The researcher
mentioned in the method how the study was conducted by collecting quantitative nominal
data by using chi2 test to determine statistical differences, from these87 images needed to be
analysed. The age of the patients was not recorded making the sample population not to be
defined, however, the DTC study stated that the year of birth was present on the images, but
was not mentioned in the study. Also, how the samples were selected was not included which
would cause you to question reliability. All images were reviewed using pro-forma which
came from other existing literature but the author failed to mention exactly what was used
form the literature.
The author did mention that theatre images were excluded, and used subjective
estimates to determine the adequate coverage of shielding the pelvic basin but what one may
find as adequate coverage may not be the same for another, also how much is 90% from what
perspective. Overall the method could not be replicated because there is no insight as to how
images were evaluated in order to be considered valid. Graphs and tables should show clarity
a mentioned before these were displayed satisfactorily. They supported both hypothesis and it
was clear as to what types of errors occurred due to these been placed in table format.
However, there were some unnecessary pie charts some texts could have been clearer and a
comparison Venn diagram could have been included
A conclusion in an article should be given a clear oversite of the article and would be
valid only if the instruments in the study was used for the purpose it was intended for along
with consistently carrying out the study with the use of mentioned instruments(Marshall,
2005). In article 2 the conclusion describes the use of restraints of children within the
radiography department in West Yorkshire and stated that this is needed because children
may get distressed but at the same time does not justify this point by saying how it is true.
The support given to the radiographers was said to be inadequate but this point was not
mentioned anywhere,there was limited opportunity for training to be readily available with in
this area which they made mention of but did not suggest how this could have been done

from the data collected, but does acknowledge that this cannot be generalised to all
radiography departments in the UK. The author also mentioned that the professional body
needed to put protocols in place so that they can be followed but this was already known and
according to Marshall (2005)a way in which the sample size represents the population can be
one way to assess the validity of the study which the author recognised and made known.
Article 3 displayed three findings one of which only brought arguments based on 2
out of 79 cases. They stated that is the techniques are altered it would help to alleviate fear or
stress,this statement did not present substantial evidence to make the point valid. If a larger
quantity of patients had the same altered examination the point would have been considered
valid. The other two findings were that more time should be allocated to each examination so
radiographers can feel less pressure which would in turn employ successful strategiesto
reduce the child’s fear and anxiety this can be achieved by using child friendly equipment
offer rewards and give the child the opportunity to view x-rays. A statement was made in the
conclusion which suggested that only with the cooperation of other personnel within the
hospital can cause it to function more effectively here the author is over claiming and does
not have supporting evidence for this point and according to Gill Marshall (2005) there
should be no form of over claiming a pointshould be based on the results.
The summary of method and findings of previous researchers had been discussed in
the conclusion of article 6, but the author failed to answer their first hypothesis (how
frequently should a gonad shield be used on a paediatric patient?). however, the second
hypothesis was answered (about the accurate placement of the gonad shield), they found that
because of the various positions of the ovaries in a female the shielding would not be
effective(Warlow, 2014), but does not give enough evidence to support this statement. 257
images were presented in the study but the researcher only chose to use 130 images and did
not give an explanation as to why only this amount was chosen. Within the conclusion, the
author also brought in new evidence from authors such as Slouis and Strauss who gives
advice on better techniques to place gonad shields.
CONCLUSION
From the above analysis, it has been identified that in article 2, scholar has followed
all the ethical aspects to a great extent. Further, it has been assessed that data collection
method which has been selected by the scholar for article 2 is highly effectual. Thus, it can be

stated that methodology which has used by the researcher is highly sound. Besides this, it can
be inferred that, article 2 is criticized on the basis of 30 radiographers who have been selected
as sample. Further, it can be summarized that in article 3 observational approach had used by
the researcher. Along with this, article 3 is also criticized on the basis of technique used for
data entering and analysis. It can be revealed from the report that article 6 has been
appreciated on the basis of non-experimental study undertaken. Moreover, such investigation
and its outcome are highly free from biasness or alteration. However, such article is criticized
on the basis of sample. Moreover, age of the sample had not been mentioned by researcher
which is turn creates confusion and negatively affects the outcome of study.

REFERENCES
Books and Journals