Seeing, thinking, deciding: “Radiographic reasoning” in MRI — A qualitative investigation

Abstract

INTRODUCTION: Most research on radiographers' reasoning has focused on projection radiography. MRI presents a more complex decision space, with interdependent parameters, contextual pressures, and no universal checklist for adequacy. This study aimed to describe how radiographers make real-time accept-modify-repeat decisions in MRI and to analyse the reasoning processes underpinning these judgements. METHODS: Ten radiographers of varying experience participated in a qualitative study. Four anonymised neuro-MRI cases from a teaching archive were presented in a simulation-based own-point-of-view task. Participants evaluated image quality as if at the console, with a 5-min time cap. Screen recordings supported subsequent stimulus-recall, and interviews were transcribed verbatim. Data were coded in MAXQDA using a framework derived from dual-process, cognitive continuum, and script theory, supplemented by inductive codes. Two coders iteratively refined the framework until saturation was reached. RESULTS: Three dimensions of reasoning were identified: intuitive reasoning, analytical reasoning, and contextual influences shaping movement between them. Novices relied on impressions but shifted into analysis when uncertainty arose. Mid-career radiographers moved flexibly along the continuum depending on clinical relevance and time. Experts primarily relied on intuition, activating analysis only in high-stakes or unexpected cases. Patient vulnerability, time pressure, and diagnostic consequences consistently influenced decisions. CONCLUSION: Radiographers' reasoning in MRI is adaptive, integrating intuition, analysis, and context to safeguard image quality. The study highlights radiographic reasoning as a complementary concept within clinical reasoning, reflecting the profession's distinctive contribution to diagnostic reliability. IMPLICATIONS FOR PRACTICE: Training should help radiographers recognise contextual triggers that call for analytic reasoning, provide opportunities to enrich experiential scripts, and strengthen reflective practice. Recognising radiographic reasoning may support competency-based education and interprofessional collaboration.

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