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Wirell, Staffan
Publications (10 of 13) Show all publications
Lundvall, L.-L., Abrandt Dahlgren, M. & Wirell, S. (2015). How do technical improvements change radiographers’ practice: a practice theory perspective. Radiography, 21(3), 231-235
Open this publication in new window or tab >>How do technical improvements change radiographers’ practice: a practice theory perspective
2015 (English)In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 21, no 3, p. 231-235Article in journal (Refereed) Published
Abstract [en]

Introduction: Technical improvements in medical imaging have led to the replacement of two-plane imaging techniques by multidimensional imaging. How this affects radiographers’ professional practice has not been investigated.

Aim: To explore how technical development affects the relations between different actors and their actions in the practice of computed tomography.

Method: A qualitative design was used with data collection by open interviews (n=8) and open observations (n=10) of radiographers during their work with computed tomography. Data was first analysed inductively, resulting in seven preliminary codes. The initial analysis was followed by a phase of abduction, in which the preliminary codes were interpreted theoretically through the lens of practice theory. This resulted in four final themes.

Result: First theme: Changed materiality makes practical action easier. The actual image production has become practically easier. Second theme: New machines cause conflict between the structural arrangements of the work and the patient’s needs. The time required for the scanner to carry out image production is easy to foresee, but information about the patient’s individual status and needs is missing and this leads to difficulties in giving individual planned care. Third theme: Changing materiality prefigures learning. The different apparatus in use and the continuously changing methods of image production are coconstitutive of the practitioner’s activities and learning. Fourth theme: How the connections between different practices lead to moments of practical reasoning in the radiography process with CT. The practice of image production with computed tomography takes account of patient safety in relation to radiation doses and medical security risks. The different professions in CT practice are interconnected through common material objects such as computers and machines. However, the radiographers, who meet the patients, have to check the accuracy of the planned examination in relation to the clinical observed information about patient safety risks during the examination.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Practice, Radiographer, Radiography, Practice theory
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-111721 (URN)10.1016/j.radi.2014.12.002 (DOI)
Note

When defending the Ph.D. thesis the status of this article was Manuscript.

Available from: 2014-10-29 Created: 2014-10-29 Last updated: 2017-12-05Bibliographically approved
Norén, B., Dahlström, N., Forsgren, M., Dahlqvist Leinhard, O., Kechagias, S., Almer, S., . . . Lundberg, P. (2015). Visual assessment of biliary excretion of Gd-EOB-DTPA in patients with suspected diffuse liver disease – a biopsy-controlled prospective study. European Journal of Radiology Open, 2, 19-25
Open this publication in new window or tab >>Visual assessment of biliary excretion of Gd-EOB-DTPA in patients with suspected diffuse liver disease – a biopsy-controlled prospective study
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2015 (English)In: European Journal of Radiology Open, ISSN 2352-0477, Vol. 2, p. 19-25Article in journal (Refereed) Published
Abstract [en]

Objectives: To qualitatively evaluate late dynamic contrast phases, 10, 20 and 30 min, after administration of Gd-EOB-DTPA with regard to biliary excretion in patients presenting with elevated liver enzymes without any clinical signs of cirrhosis or hepatic decompensation and to compare the visual assessment of contrast agent excretion with histo-pathological fibrosis stage, contrast uptake parameters and blood tests.

Methods: 29 patients were prospectively examined using 1.5-T MRI. The visually assessed presence (1) or absence (0) of contrast agent for each of five anatomical regions in randomly reviewed time-series was summarised on a four grade scale. The scores, including a total visual score, were related to the histo-pathological findings, the quantitative contrast agent uptake parameters and blood tests

Results: No relationship between the fibrosis grade or contrast uptake parameters expressed as KHep or LSC_N could be established. A negative correlation between the visual assessment and ALP was found. Comparing a sub-group of cholestatic patients with fibrosis score and Gd-EOB-DTPAdynamic parameters did not add any additional significant correlation.

Conclusions: In this prospective study with a limited number of patients we were not able to demonstrate a correlation between visually assessed biliary excretion of Gd-EOB-DTPA and  histo-pathological or contrast uptake parameters.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Gd-EOB-­DTPA, Dynamic contrast enhanced MRI, Liver, Bile, Excretion
National Category
Radiology, Nuclear Medicine and Medical Imaging Physical Chemistry
Identifiers
urn:nbn:se:liu:diva-90159 (URN)10.1016/j.ejro.2014.12.004 (DOI)
Projects
NILB
Available from: 2013-03-20 Created: 2013-03-20 Last updated: 2016-03-23Bibliographically approved
Lundvall, L.-L., Abrandt Dahlgren, M. & Wirell, S. (2014). Professionals' experiences of imaging in the radiography process – A phenomenological approach. Radiography, 20(1), 48-52
Open this publication in new window or tab >>Professionals' experiences of imaging in the radiography process – A phenomenological approach
2014 (English)In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 20, no 1, p. 48-52Article in journal (Refereed) Published
Abstract [en]

Introduction

Previous studies on radiographers' professional work have shown that this practice covers both technology and patient care. How these two competence areas blend together in practice needs to be investigated. The professionals' experiences of their work have not been studied in depth, and there is a need to focus on their experiences of the main features of their practice.

The aim

To explore, from the perspective of the radiographer, the general tasks and responsibilities of their work.

Method

Data were generated through a combination of open interviews with radiographers and observations of their work with Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The interviews and observations were analysed using an interpretative phenomenological method.

Result

Radiographers' professional work with diagnostic imaging, in a Swedish context, can be viewed as a problem-solving process involving judgments and responsibility for obtaining images that can be used for diagnosis. The examination process comprises three phases; planning, producing the images, and evaluation. In the first phase the radiographer makes judgments on adapting the method to the individual patient, and the second phase involves responsibilities and practical skills for image production. In the third phase, the quality of the images is judged in relation to the actual patient and the imaging process itself.

Conclusions

Radiographers consider that the main features of their professional work are patient safety aspects and their knowledge and skills regarding how to produce images of optimal quality, in the actual circumstances of each examination.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Radiography process, Radiographer, Phenomenology, Diagnostic radiography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103181 (URN)10.1016/j.radi.2013.10.002 (DOI)2-s2.0-84891740515 (Scopus ID)
Available from: 2014-01-14 Created: 2014-01-14 Last updated: 2017-12-06Bibliographically approved
Wilhelmsson, N., Dahlgren, L. O., Hult, H., Wirell, S., Ledin, T. & Josephson, A. (2013). Phenomenographic study of basic science understanding-senior medical students' conceptions of fatigue. Education for Health, 26(3), 156-163
Open this publication in new window or tab >>Phenomenographic study of basic science understanding-senior medical students' conceptions of fatigue
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2013 (English)In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 26, no 3, p. 156-163Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Helping students learn to apply their newly learned basic science knowledge to clinical situations is a long-standing challenge for medical educators. This study aims to describe how medical students' knowledge of the basic sciences is construed toward the end of their medical curriculum, focusing on how senior medical students explain the physiology of a given scenario. Methods A group of final-year medical students from two universities was investigated. Interviews were performed and phenomenographic analysis was used to interpret students' understanding of the physiology underlying the onset of fatigue in an individual on an exercise bicycle.

RESULTS: Three categories of description depict the qualitatively different ways the students conceptualized fatigue. A first category depicts well integrated physiological and bio-chemical knowledge characterized by equilibrium and causality. The second category contains conceptions of finite amount of substrate and juxtaposition of physiological concepts that are not fully integrated. The third category exhibits a fragmented understanding of disparate sections of knowledge without integration of basic science and clinical knowledge.

DISCUSSION: Distinctive conceptions of fatigue based with varying completeness of students' understanding characterized the three identified categories. The students' conceptions of fatigue were based on varying understanding of how organ systems relate and of the thresholds that determine physiological processes. Medical instruction should focus on making governing steps in biological processes clear and providing opportunity for causal explanations of clinical scenarios containing bio-chemical as well as clinical knowledge. This augments earlier findings by adding descriptions in terms of the subject matter studied about how basic science is applied by students in clinical settings.

Place, publisher, year, edition, pages
The Network:Towards Unity for Health, 2013
Keywords
Phenomenography, problem-based learning, qualitative methodology, student learning, undergraduate medical education
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-110130 (URN)10.4103/1357-6283.125990 (DOI)25001348 (PubMedID)
Available from: 2014-09-03 Created: 2014-09-03 Last updated: 2017-12-05Bibliographically approved
Ragnehed, M., Dahlqvist Leinhard, O., Pihlsgård, J., Wirell, S., Sökjer, H., Fägerstam, P., . . . Lundberg, P. (2010). Visual Grading of 2D and 3D fMRI compared to image based descriptive measures. European Radiology, 20(3), 714-724
Open this publication in new window or tab >>Visual Grading of 2D and 3D fMRI compared to image based descriptive measures
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2010 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 20, no 3, p. 714-724Article in journal (Refereed) Published
Abstract [en]

A prerequisite for successful clinical use of functional Magnetic Resonance Imaging (fMRI) is the selection of an appropriate imaging sequence. In this paper, 2D and 3D fMRI sequences were compared using different image quality assessment methods. Descriptive image measures, such as activation volume and temporal signal-to-noise ratio (TSNR), were compared with results from Visual Grading Characteristics (VGC) analysis of the fMRI results. It was found that significant differences in activation volume and TSNR were not directly reflected by differences in VGC scores. The results suggest that better performance on descriptive image measures is not always an indicator of improved diagnostic quality of the fMRI results. In conclusion, in addition to descriptive image measures, it is important to include measures of diagnostic quality when comparing different fMRI data acquisition methods.

Place, publisher, year, edition, pages
Berlin / Heidelberg: Springer, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17994 (URN)10.1007/s00330-009-1578-0 (DOI)000274544800023 ()19727748 (PubMedID)
Note

The original publication is available at www.springerlink.com: Mattias Ragnehed, Olof Dahlqvist Leinhard, Johan Pihlsgård, Staffan Wirell, Hannibal Sökjer, Patrik Fägerstam, Bo Jiang, Örjan Smedby, Maria Engström and Peter Lundberg, Visual Grading of 2D and 3D fMRI compared to image based descriptive measures, 2010, European Radiology, (20), 3, 714-724. http://dx.doi.org/10.1007/s00330-009-1578-0 Copyright: Springer Science Business Media http://www.springerlink.com/

Available from: 2009-04-30 Created: 2009-04-30 Last updated: 2017-12-13Bibliographically approved
Silén, C., Wirell, S., Kvist, J., Nylander, E., Fyrénius, A. & Smedby, Ö. (2008). Advanced 3D visualization in student-centred medical education. Medical teacher, 30(5), e115-e124
Open this publication in new window or tab >>Advanced 3D visualization in student-centred medical education
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2008 (English)In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 30, no 5, p. e115-e124Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Healthcare students have difficulties achieving a conceptual understanding of 3D anatomy and misconceptions about physiological phenomena are persistent and hard to address. 3D visualization has improved the possibilities of facilitating understanding of complex phenomena. A project was carried out in which high quality 3D visualizations using high-resolution CT and MR images from clinical research were developed for educational use. Instead of standard stacks of slices (original or multiplanar reformatted) volume-rendering images in the quicktime VR format that enables students to interact intuitively were included. Based on learning theories underpinning problem based learning, 3D visualizations were implemented in the existing curricula of the medical and physiotherapy programs. The images/films were used in lectures, demonstrations and tutorial sessions. Self-study material was also developed. AIMS: To support learning efficacy by developing and using 3D datasets in regular health care curricula and enhancing the knowledge about possible educational value of 3D visualizations in learning anatomy and physiology. METHOD: Questionnaires were used to investigate the medical and physiotherapy students' opinions about the different formats of visualizations and their learning experiences. RESULTS: The 3D images/films stimulated the students will to understand more and helped them to get insights about biological variations and different organs size, space extent and relation to each other. The virtual dissections gave a clearer picture than ordinary dissections and the possibility to turn structures around was instructive. CONCLUSIONS: 3D visualizations based on authentic, viable material point out a new dimension of learning material in anatomy, physiology and probably also pathophysiology. It was successful to implement 3D images in already existing themes in the educational programs. The results show that deeper knowledge is required about students' interpretation of images/films in relation to learning outcomes. There is also a need for preparations and facilitation principles connected to the use of 3D visualizations.

Place, publisher, year, edition, pages
UK: Informa Healthcare, 2008
National Category
Pedagogy
Identifiers
urn:nbn:se:liu:diva-21445 (URN)10.1080/01421590801932228 (DOI)000257114000014 ()18576181 (PubMedID)
Available from: 2009-10-02 Created: 2009-10-02 Last updated: 2017-12-13Bibliographically approved
Norén, B., Dahlqvist Leinhard, O., Lundberg, P., Almer, S., Kechagias, S., Ekstedt, M., . . . Smedby, Ö. (2008). Separation of advanced from mild fibrosis in diffuse liver disease using 31P magnetic resonance spectroscopy. European Journal of Radiology, 66(2), 313-320
Open this publication in new window or tab >>Separation of advanced from mild fibrosis in diffuse liver disease using 31P magnetic resonance spectroscopy
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2008 (English)In: European Journal of Radiology, ISSN 0720-048X, E-ISSN 1872-7727, Vol. 66, no 2, p. 313-320Article in journal (Refereed) Published
Abstract [en]

31P-MRS using DRESS was used to compare absolute liver metabolite concentrations (PME, Pi, PDE, γATP, αATP, βATP) in two distinct groups of patients with chronic diffuse liver disorders, one group with steatosis (NAFLD) and none to moderate inflammation (n = 13), and one group with severe fibrosis or cirrhosis (n = 16). All patients underwent liver biopsy and extensive biochemical evaluation. A control group (n = 13) was also included. Absolute concentrations and the anabolic charge, AC = {PME}/({PME} + {PDE}), were calculated.

Comparing the control and cirrhosis groups, lower concentrations of PDE (p = 0.025) and a higher AC (p < 0.001) were found in the cirrhosis group. Also compared to the NAFLD group, the cirrhosis group had lower concentrations of PDE (p = 0.01) and a higher AC (p = 0.009). No significant differences were found between the control and NAFLD group. When the MRS findings were related to the fibrosis stage obtained at biopsy, there were significant differences in PDE between stage F0–1 and stage F4 and in AC between stage F0–1 and stage F2–3.

Using a PDE concentration of 10.5 mM as a cut-off value to discriminate between mild, F0–2, and advanced, F3–4, fibrosis the sensitivity and specificity were 81% and 69%, respectively. An AC cut-off value of 0.27 showed a sensitivity of 93% and a specificity of 54%.

In conclusion, the results suggest that PDE is a marker of liver fibrosis, and that AC is a potentially clinically useful parameter in discriminating mild fibrosis from advanced.

Place, publisher, year, edition, pages
Elsevier, 2008
Keywords
Absolute quantification; Phosphorus; MRS; Steatosis; In vivo
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43125 (URN)10.1016/j.ejrad.2007.06.004 (DOI)000256140900026 ()17646074 (PubMedID)71944 (Local ID)71944 (Archive number)71944 (OAI)
Projects
NILB
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Smedby, Ö., Wirell, S., Kvist, J., Silén, C., Göran, P., Fyrenius, A. & Nylander, E. (2007). Interactive volume rendering 3D images for anatomy learning on low-end computers. In: ECR - European Congress of Radiology,2007.
Open this publication in new window or tab >>Interactive volume rendering 3D images for anatomy learning on low-end computers
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2007 (English)In: ECR - European Congress of Radiology,2007, 2007Conference paper, Published paper (Other academic)
Abstract [en]

  

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-38273 (URN)43385 (Local ID)43385 (Archive number)43385 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2015-03-24
Fyrenius, A., Wirell, S. & Silén, C. (2007). Student approaches to achieving understanding ― Approaches to learning revisited. Studies in Higher Education, 32(2), 149-165
Open this publication in new window or tab >>Student approaches to achieving understanding ― Approaches to learning revisited
2007 (English)In: Studies in Higher Education, ISSN 0307-5079, Vol. 32, no 2, p. 149-165Article in journal (Refereed) Published
Abstract [en]

This article presents a phenomenographic study that investigates students' approaches to achieving understanding. The results are based on interviews, addressing physiological phenomena, with 16 medical students in a problem-based curriculum. Four approaches—sifting, building, holding and moving—are outlined. The holding and moving approaches describe variations in deep-level processing. The moving approach is characterised by an intention to continuously refine understanding in an open-ended process. The student strives for a change in perspective and deliberately creates actions that are rich in variation and challenge. The holding approach is characterised by an intention to reach a final goal. This is achieved by high degrees of structure and control in the learning act. Understanding is sometimes sealed, 'held on to' and can be threatened by new input and other students' viewpoints. The study also shows how students deal with details when constructing understanding of wholes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14556 (URN)10.1080/03075070701267194 (DOI)
Available from: 2007-06-04 Created: 2007-06-04 Last updated: 2018-02-06
Fyrenius, A., Silén, C. & Wirell, S. (2007). Students' conceptions of underlying principles in medical physiology: An interview study of medical students understanding in a PBL curriculum. Advances in Physiology Education, 31, 364-369
Open this publication in new window or tab >>Students' conceptions of underlying principles in medical physiology: An interview study of medical students understanding in a PBL curriculum
2007 (English)In: Advances in Physiology Education, ISSN 1043-4046, E-ISSN 1522-1229, Vol. 31, p. 364-369Article in journal (Refereed) Published
Abstract [en]

Medical physiology is known to be a complex area where students develop significant errors in conceptual understanding. Students’ knowledge is often bound to situational descriptions rather than underlying principles. This study explores how medical students discern and process underlying principles in physiology. Indepth interviews, where students elaborated on principles related to blood pressure and blood pressure regulation, were carried out with 16 medical students in a problem-based learning curriculum. A qualitative, phenomenographic approach was used, and interviews were audiotaped, transcribed, qualitatively analyzed, and categorized. Four categories were outlined. The underlying principles were conceived as follows: 1) general conditions for body function at a specified time point, 2) transferable phenomena between organ systems and time points, 3) conditionally transferable phenomena between organ systems and time points, and 4) cognitive constructions of limited value in medical physiology. The results offers insights into students’ thinking about underlying principles in physiology and suggest how understanding can be challenged to stimulate deep-level processing of underlying principles rather than situational descriptions of physiology. A complex conception of underlying principles includes an ability to problemize phenomena beyond long causal reasoning chains, which is often rewarded in traditional examinations and tests. Keywords for problemized processing are as follows: comparisons, differences, similarities, conditions, context, relevance, multiple sampling, connections, and dependencies.

Keywords
general models, phenomenography, problem-based learning
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14557 (URN)10.1152/advan.00108.2006 (DOI)
Available from: 2007-06-04 Created: 2007-06-04 Last updated: 2017-12-13
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