Radiography (2009) 15, e1ee2

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GUEST EDITORIAL

Reflections of a diagnostic radiographer

It has been my great pleasure to act as the guest editor forthis special edition of Radiography. The publication of thisedition heralds the 90th anniversary of the Society ofRadiographers in 2010. This is a very important milestonefor the profession. This edition is also timely in that itspublication marks the end of the use of X-ray film in theNHS as the rollout of PACS/CR has now been completed-again a major milestone in the history of medical imaging.

As someone who has been qualified for approximatelya third of the 90-year period since the establishment of theSociety, it astonishes me to reflect on the changes I haveseen, both in clinical radiography and in education.

Clinical radiography

At the time I commenced my training in Manchester, filmprocessing still took place in darkrooms, where the greatestsin anyone could commit was to ‘fog the hopper’ by leavingthe heavy lightproof drawer (where all the unexposed filmwas kept) open when the white lights were switched on. Mostradiographers of my generation have stories about this eoften involving closing the hopper quickly in the hope that noone would notice! One of the very first articles I ever wroteconcerned the introduction of ‘daylight’ processing into thedepartment I was working in at the time.1 It is certainlya tribute to the ability of radiographers to deal with change,that the transition to PACS/CR took place so easily.

The introduction of modalities such as CT and MRI hasmeant changes in the examinations undertaken. I stillremember seeing an air encephalogram and undertooka number of lymphangiograms on patients who were going toChristie Hospital for oncology in the days before CT wasavailable. Examinations such as oral cholecystography andvenography have disappeared in recent years and intravenousurography is also fast dying out as CT urography replaces it.

One of Brian Bentley’s articles in this edition refers tothe practice of colonic washouts. I remember two nursesemployed in the department in which I trained, who spenttheir whole day doing colonic washouts on patients whowere scheduled for barium enemas later that same day.Those were the days before Picolax. Now the barium enemaitself is being replaced by CT colonography. Barium enemas

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and intravenous urograms have been staple examinations inthe work of a general X-ray department for decades ecertainly since before I trained as a radiographer. Theperformance of barium enemas has also been one of thetasks which led the way in radiographer role extension andmany radiographers throughout the country have beentrained to carry these out.

After my first post I spent time working in a women’s andchildren’s hospital. My days were spent flattening theabdomens of pregnant women with compression bands forpelvimetry and to determine gestational age of the fetusfrom the ossification centres in the knees and ankles of thebaby. This work has been taken over by ultrasound andcompression bands will probably disappear from depart-ments with the IVU, despite the improvements in imagequality that their use can bring.

Education

I was one of the first cohort of radiographers who wereawarded the Diploma of the College of Radiographers (DCR)as opposed to the Society Diploma (DSR). My training wasfor two years, not three, although they were two full yearsrather than academic years, so we were enrolled in Octoberand took our exams two years later, receiving our results inDecember. In my case that was in time to be out of workjust before Christmas; the number of radiographers quali-fying has been subject to fluctuations ever since.

In 1983 I became a lecturer at Salford College of Tech-nology. At that time Salford was the largest school ofradiography in the country with an intake of over 70students; most schools typically took an intake of around12e15 students. Now university intakes to diagnostic radi-ography courses often number at least 50.

My teacher training required me to study for the Collegeof Radiographers’ Teacher’s Diploma. This was an experi-ential qualification requiring documentation of teachingpractice and visits to a number of other radiographyschools, culminating in a formal viva voce examination heldat the Society’s headquarters which were then located inUpper Wimpole Street. Interestingly, universities haverecently adopted the practice of requiring all novice

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e2 Guest Editorial

lecturers to undertake a teaching certificate, modelling thison the longstanding requirements of the radiography andnursing professions. Previously the concept of requiringa university lecturer to undertake training in teaching hadbeen regarded as anathema.

In the 1980s there were around 55 schools of radiography inthe UK, nearly all of which were based on hospital sites in theNHS. Salford was, again, unusual at that time for being locatedin the education sector. The beginning of the 1990s saw thetransfer of radiography education into higher education withthe amalgamation or closure of around half the schools ofradiography in the UK. Many radiography educators wereforcibly retired or lost their jobs at this time. I took threeseparate groups of radiography teaching staff from the NHSinto higher education and many found it an extremely difficulttransition. This was closely followed by the move fromdiploma to degree courses, again a problematic process.

Social changes

I have made the case elsewhere for documentation of the oralhistoryofourprofession.2 Muchworkhasbeendone in thecaseof radiology but the work of radiographers still goes largelyundocumented. Such recollections not only record the work ofthe radiographer, but they also place the role of the radiog-rapher in the context of national social and historical changes.For example, I did my radiography training in 1975 at With-ington Hospital in South Manchester. The hospital was orig-inally founded as a workhouse in 1845 and it was accepted atthat time that elderly patients still associated the hospitalwith its workhouse origins3 (the workhouse functioncontinued until around 1915) and therefore there wasa stigma attached to coming in to hospital.

Similarly, I taught for a while at the School of Radiog-raphy in Lincoln, which was based at St George’s Hospital.The hospital had, at one time, been a sanatorium for thetreatment of tuberculosis (TB) and the school was housed inone of the old pavilions; designed to let in as much fresh airas possible for the patients and, as such, wonderful in thesummer but freezing cold in the winter.

At the time I trained at Withington it was also the largestteaching hospital in Europe. Now most of it has gone, withfunctions transferred to Wythenshawe and much of the sitesold off. The original older buildings remain, however, andnow the Internet has tales of ‘urban warriors’ who dodgesecurity men to visit the abandoned X-ray rooms.4

Whilst writing this, the town of Wigan marked the 30thanniversary of the Golborne Colliery disaster in which 3men were killed and eight more seriously injured whena fireball caused an underground explosion whilst the menwere carrying out an inspection. A local news item of thetime records that;

‘‘Arrangements were being made to transport theinjured, some of whom had burns on 90% of their bodies,from local hospitals to the burns unit at Withingtonhospital in Manchester.

Ambulance workers at Hindley and Wigan broke their striketo take the injured to hospitals.By 2 April the number ofdead had risen to 10. There was just one survivor.By 2April all but one of the injured men had died.5’’

This incident, and my involvement in the subsequent careof those men on the intensive care unit, had a profoundeffect on me at the time and the memory remains vivid tothis day. In terms of social change, 5 years later came theminers’ strike and by 1989 this pit, along with many others,was closed. The extract above also refers to strikes byambulance workers; the 1970s and 80s were a time of muchindustrial strife and hospitals were part of this.

In the early 1980s I also worked at Oldham Royal Infirmary.This hospital closed in 1989. My memory of it is of a smallhospital run by one lone Hospital Administrator whomeveryone knew; these were the days before the armies ofmanagers that now run the NHS. Later in my career, as Head ofthe Derby School of Radiography, we were based on the mainhospital corridoratDerbyshireRoyal Infirmary, inbetween thetwo X-ray departments and opposite the radiotherapydepartment. As budget holder I was responsible direct to thehospital’s Chief Executive and had regular meetings with him.This period saw the changes in the NHS leading to the estab-lishment of Trusts and we were all stunned when the newsbroke of the failure of the hospital to attain Trust status andthe Chief Executivewas forced toclear his desk that sameday.For many of us, that was the realisation that working for theNHS no longer meant a ‘job for life’.6

Conclusions

Much has been done to document the working lives ofradiologists, but this is not the case with radiography. Thepace of change in our profession is linked with technolog-ical development, meaning that the work of the radiogra-pher has changed dramatically, especially in the periodsince World War 2. The work of radiographers can also belinked with social and historical change (both directly andindirectly) and this too is important. I welcome the publi-cation of this special edition and thank all the authors fortheir contribution.

References

1. Black P. Daylight processing. Radiography January 1982;46(499).

2. Reeves P, Murphy F. Oral history as a technique for the pro-fessionalisation of student radiographers. Journal of DiagnosticRadiography & Imaging 1998;2:97e104.

3. The workhouse web site, http://www.workhouses.org.uk/index.html?Chorlton/Chorlton.shtml.

4. 28 Days later-UK urban exploration forums, http://www.28dayslater.co.uk/forums/showthread.php?sZ4d2a986e03c43ae13df1eaee86f261e6&;tZ6028.

5. BBC ’On this Day 1950e2000; 18 March, http://news.bbc.co.uk/onthisday/hi/dates/stories/march/18/newsid_4226000/4226271.stm [Accessed 25/03/09].

6. The Independent; ‘Why Clarke took a handbagging for the NHS’http://www.independent.co.uk/opinion/why-clarke-took-a-handbagging-for-the-nhs-1590764.html [Accessed 25/03/09].

Pauline J. ReevesWrexham, North Wales, UK

E-mail address: pjanec@aol.com

Available online 2 May 2009