REVIEW ARTICLE

Obese patients and radiography literature: what do we

know about a big issue?
Nhat Tan Thanh Le, BAppSci (MRS), DR (Hons), John Robinson, BAppSci (MRS), DR, & Sarah J. Lewis,
PhD, Med, BAppSci (MRS), DR (Hons)
Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia

Keywords Abstract
Attitudes, obesity, patient care,
radiography Obesity is a global health issue with obese patients requiring specialised
diagnosis, treatment and care through the health service. The practical and
Correspondence social difficulties associated with medical imaging of obese patients are an
Sarah J. Lewis, Associate Professor in increasingly common problem and it is currently unknown how student and
Diagnostic Radiography, Discipline of Medical qualified radiographers perceive and respond to these challenges. By better
Radiation Sciences, Faculty of Health
understanding challenges presented in providing quality imaging and care of
Sciences, The University of Sydney, 75 East
imaging obese patients, education for both qualified and student radiographers
Street, Lidcombe, New South Wales 1825,
Australia. Tel: +61 2 9351 9149; Fax: + 60 2 can be enhanced. Radiographers are heavily reliant on visual and tactile senses
9351 9460; E-mail: [email protected]. to locate the position of anatomical structures for diagnostic imaging and
au determine radiation exposure through a delicate consideration of dose, image
quality and anatomical attenuation. However, obese patients require
Funding Information modifications to routine radiographic practice in terms of movement/assisted
No funding information provided.
positioning, equipment capabilities to take increased weight or coverage. These
patients may also be subject to compromised radiological diagnosis through
Received: 9 November 2014; Revised: 25
March 2015; Accepted: 27 March 2015 poor visualisation of structures. In this paper, the professional and educational
literature was narratively reviewed to assess gaps in the evidence base related to
J Med Radiat Sci 62 (2015) 132141 the skill and care knowledge for obese patients. Literature was sourced relating
to discrete radiographic considerations such as the technical factors of imaging
doi: 10.1002/jmrs.105 obese patients, exposure and the impact of obesity on imaging departments
service provisions. The recent literature (post-2000 to coincide with the sharp
increase in global obesity) on the perceptions of health professionals and
student health practitioners has also been explored because there are no specific
radiographer studies to report. By understanding the research in similar fields,
we may identify what common attitudes qualified and student radiographers
hold and what challenges, technical and care related, can be prepared for.

impact with reported direct costs in Australia estimated

Introduction
at $830 million.6,7
Over the past few decades there has been an increasing Obese patients require a tailored standard of care as
prevalence of obese patients presenting to emergency radiographers must compensate for issues arising from
departments and requiring medical imaging for acute and both technical and patient care considerations. These
chronic conditions.1,2 Obesity is a complex issue in health include patients exceeding the weight limits of imaging
care because of extensive indirect effects and associated equipment, motion artefacts due to increased exposure
medical conditions such as type 2 diabetes, coronary factors requiring elongated exposure time, insufficient
artery disease, hypertension, asthma, stroke, gout, venous coverage of the image receptor, difficulty in palpating
insufficiency, degenerative joint disease and sleep anatomical landmarks and potential patient
apnoea.25 In addition, obesity has a large economic embarrassment. The adipose tissue also complicates the

132 2015 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of
Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License,
which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and
no modifications or adaptations are made.
N. T. T. Le et al. Obese Patient and Radiography Literature

balance between adequate radiation exposure and saw a 74% increase in prevalence of obesity between 1991
penetration and keeping the dose to as low as reasonably and 2001 and 65% of the adult American population is
achievable (ALARA).1,2,7,8 Failure to accommodate these now overweight or obese,1 although a recent USA
issues results in sub-optimal imaging, possibly impeding National Health and Nutrition Examination survey has
an accurate and timely diagnosis. This is highlighted by a suggested a plateau of rates.14 These US trends are
study by Katz in 2006, which found that radiologists reflected in the Australian population with data collected
reported greater difficulty in diagnosing cases involving between 1999 and 2000 estimating 60% of the adult
obese patients.9 population being either overweight or obese.6 There has
The purpose of this article is to review the current been a steady increase in the mean BMI of the Australian
literature regarding the impact of obesity on imaging population over the past two decades.6,15 These findings
departments, the technical difficulties of imaging obese coincide with official census data from the Australian
patients and the associated attitudes and perceptions of Bureau of Statistics (ABS) from 2011 to 2012 which
radiographers. Databases including Pubmed, Scopus, classified 62.8% of Australian adults as either overweight
Medline and Cinahl were accessed and key words were or obese.16,17 Additionally, these census statistics confirm
used to extract entries. Key words included but were not an increase in the prevalence of obesity across all age
limited to: obese, obesity, radiography, medical imaging, groups between 1995 and 2008, rising from 56.3% to
patients, perceptions, attitudes, education, physics, 61.2%. 17
radiation, challenges, experiences, impact, equipment,
students, practitioners and bias. Due to limited studies
The Impact of Obesity on Health care
found in the medical imaging discipline, the scope was
widened to include the attitudes and perceptions of allied The correlation between an increased prevalence of obesity
health care professions, nursing and medical practitioners. and a rise in the number of obese patients requiring
By better understanding these attitudes and perceptions, medical imaging has been explored in a study by Uppot
translational research of imaging of obese patients can et al. in 200618 where dictated radiology reports over a
inform radiographer education. 3-year period were assessed retrospectively for the phrase
limited due to body habitus. This was correlated with
the prevalence of obesity in the USA using a Pearsons
Statistics and Trends in Overweight
correlation coefficient. The authors concluded that there
and Obese Individuals in Society
was a positive correlation with a progressive increase in
A full in-depth review of factors and trends in the rising the number of obesity-compromised reports. Furthermore,
proportion of overweight and obese individuals in society studies explored obesity challenges across multiple
is beyond the scope of this review. However, a brief modalities and found that general radiography was the
overview will be provided for context and definition. The second most commonly affected modality for poor image
body mass index (BMI) is a common measure for quality behind ultrasound.18,19
determining the weight class of individuals and The increased prevalence of obesity places additional
populations (underweight, normal, overweight, obese or strain on imaging departments as doctors increasingly
morbidly obese). It is calculated by a formula of weight turn to medical imaging for efficient diagnosis.2,20,21
(kg) and height (cm) in a ratio of kg/m2. Obesity is Obesity is an important issue in health care due to
defined as a chronic condition of excess body fat extensive associated secondary conditions, especially
disproportionate to ones height, quantified with a BMI venous insufficiency and degenerative joint disease, which
higher than 30.2,4,10,11 However, using BMI as a definition are often the clinical context for plain radiography
of obesity has several limitations. The key limitation is referrals.25 The strain of carrying additional weight is
that it uses absolute weight and does not consider the type especially prevalent on the knee and hip joints. The
of fat, location of fat or the density of lean muscle mass. It likelihood of developing osteoarthritis is up to seven
provides a more accurate measure of body fat proportion times higher for obese individuals, compared with normal
than weight alone, but due to these limitations it may weight or underweight people.22
incorrectly under, or overestimate measurements in There are also economic impacts to population obesity
certain people.1113 This point aside, BMI is widely with pressure on health facility resources, including
accepted in the literature, including the limited literature departments requiring equipment to accommodate the
in medical imaging, as a good descriptor of obesity at a wider girths and increased weight in beds, chairs,
population level.12 operating tables, floating radiology tables, and
Obesity is a major health issue, reaching epidemic wheelchairs.21,23 The aperture size of the gantry and table
proportions in the western world.3 The U.S population weight limits in computed tomography (CT) and

2015 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of 133
Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology
Obese Patient and Radiography Literature N. T. T. Le et al.

magnetic resonance imaging (MRI) must also be signal. However, these techniques come with an increased
considered otherwise alternative arrangements to another radiation dose to the patient and the literature does not
suite/imaging facility with the appropriate wide bore give comprehensive information on how changes to
equipment may be required.24,25 exposures can be optimised to reduce dose for obese
Physical strain and injury to health care workers patients. Buckley et al.12 make the point that dose
attending to the transportation requirements of obese reference levels (DRLs) are standardised to a 70 kg
patients maybe a consideration if correct procedures are person with an upper limit of 90 kg. However in 2008,
not followed.3 Extended hospital stays are also a costly the BMI of the average European was classified as
factor, and although the exact cost is not known, obese overweight and the consideration may be made that
individuals tend to have longer stays than non-obese separate DRLs for obese patients may be warranted due
patients. The reasons for this increased length of stay are to the increasing presentation of bariatric patients. A
suggested to arise from the extra complexity from method for overcoming poor photon penetration as
secondary conditions. Shorter stays in hospitals for obese itemised in Table 1 is to increase the kVp. Again,
patients may be negated by a higher probability requiring however, the trade-off is the reduction in image contrast
a transfer to another department with weight-appropriate that may mean this technique is unsuitable to answer the
equipment and specialist care incurring additional clinical question. The holistic question of whether
transportation costs.26,27 altering kVp in combination with mAs has not been
adequately explored, as previous studies have only
considered each parameter in isolation. Furthermore, in
Technical Challenges in Radiography
the same way that paediatric exposures are studied and
Due to Obesity
modified to optimise technique and reduce dose, a
Despite technical advancements in medical imaging, obese standardised approach to obesity needs to be considered
patients still present challenges in image quality and due to the increasing presentation of bariatric patients.
viable alternative imaging options are limited. The size of For student radiographers without experience, the
the patient and the anatomical region to be imaged (such problem of positioning obese patients can be exacerbated
as the abdominal and pelvic regions) have been found to by the exemplars of correct positioning technique.
be more important than weight or BMI alone in Common textbooks used throughout Australian
determining when protocols and techniques need to be diagnostic radiography/medical imaging degree programs,
adjusted.2,7 Radiographic image quality of obese patients such as Textbook of Radiographic Positioning and
is mainly compromised by an inadequate signal to noise Anatomy33 and Merrills Atlas of Radiographic Positioning
ratio due to additional radiation scatter caused by the and Procedures,34 use thin patients in their photographic
thicker layer of adipose tissue.2 illustrations of positioning. The latter includes a chapter
The common difficulties experienced by radiographers on imaging obese patients in its latest edition, but it is
when imaging obese patients has been explored by several not comprehensive and does not discuss the limits of
authors. These are provided as a summary of the physics of imaging modalities. These resources become
professional literature in Table 1. less applicable as anatomical landmarks are increasingly
The skill set used in radiography is heavily reliant on obscured by adipose fat and patient mobility becomes
visual and tactile senses to locate and palpate structures for limited. Overall the current theoretical teaching of
imaging. A thick layer of adipose tissue obscuring bony radiographic positioning based on physically fit, thin
landmarks hinders accurate positioning, making repeat patients does not reflect the increasing proportion
projections due to positioning error more likely.1 It is of obese patients presenting to medical imaging
suggested that this particular error is becoming departments.35,36 Some adjustments to positioning via
increasingly common as the proportion of obese patients surface anatomy landmarks are suggested in Table 1 for
presenting to the imaging department rises.6 Consideration areas such as the abdomen and these articles may be
of technique modification and adjusting exposure useful for educational purposes although they do not
parameters often comes with experience, however, very few have a sound evidence base. These include the use of
adaptive techniques are listed in the literature or through adjacent structures where the location of the structure
learning resources, with the bulk of the professional (e.g. the elbow crease) is unaffected but approximately
literature being commentary in nature. close to desired positioning landmark which is obscured
Common successful techniques in imaging obese (such as the iliac crest). Overall, there are limited peer-
patients, as discussed in Table 1, include increasing the reviewed publications that focus on optimising radiography
mAs, employment of grids or use of the automated for obese patients from a radiographers perspective, a
exposure control to overcome reduced image receptor medical-physics perspective or a patient perspective.

134 2015 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of
Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology
N. T. T. Le et al. Obese Patient and Radiography Literature

Table 1. Summary of the common radiographic challenges as identified in the literature.

Literature
Cause of technical recommendations Complication of
Author(s) Technical issue challenges for improved practice practice suggestions

Buckley et al.12 Poor photon Reduced photon penetration Increase kVp Reduced image contrast and
Carucci1 penetration due to larger patient Compress patient tissue increased scatter
Glanc et al.7 thickness (reduce thickness) Compression may be
Modica et al.2 uncomfortable
Reynolds 4
Yanch et al.8
Buckley et al.12 Low receptor signal More photons being Increase the current (mA) Increased mAs increases
Carucci 1 attenuated by the Use a longer exposure time patient dose
Glanc et al.7 adipose layer AEC (automated exposure Possible motion artefacts
Modica et al.2 control) if appropriate AEC must be used correctly,
Reynolds 4 may reach backup time
Uppot et al.21
Buckley et al.12 Radiation scatter Increased soft tissue Collimate primary beam Grid typically absorb 85
Carucci 1 thickness increases Use anti-scatter grid 95% of scattered photons
Glanc et al.7 likelihood of photon but also 4050% of the
Modica et al.2 interaction and scatter primary beam
Uppot et al.21 Radiation exposure is
Yanch et al.8 increased to compensate
Buckley 10 Incomplete coverage of Patient size exceeds Use several projections over Increased radiation dose
Buckley et al.12 anatomy cassette dimensions multiple cassettes
Carucci 1
Reynolds 4
Uppot et al.21
Yanch et al.8
Buckley 10 Exceeded table Patient too heavy or Reschedule where Inconvenience, delays and
Carucci 1 weight limits equipment weight limit appropriate equipment is transportation issues
Glanc et al.7 insufficient available Alternatives not always
Uppot et al.21 Awareness of equipment available
limits and alternatives
Buckley et al.12 Poor visualisation of Combination of above Digital manipulation and None listed
Carucci 1 structures factors post-processing to improve
Glanc et al.7 contrast
Uppot et al.21
Carucci 1 Difficulty positioning and Anatomical landmarks Estimate iliac crest height at None listed
centring obscured elbow level, bend hip for
interior margin of cassette
placement

health care scenarios may choose to avoid subsequent

Perceptions and Attitudes of Health
medical examinations, essentially placing their health at
Professionals Towards Obese Patients
risk.13,32
Obesity has underlying psychosocial dimensions and it is Table 2 provides a summary of the literature regarding
essential that radiographers and students are able to the attitudes and perceptions of health professionals and
customise their approach to obese patients. Health care health professional students towards obese patients. Due
professionals may hold their own attitudes and weight bias to the lack of studies within radiography/medical imaging,
and how explicitly these attitudes are perceived in practice the scope of the search was expanded to include allied
have important impact on patient satisfaction.19,2831 A health disciplines, nursing and medicine. Studies
study by Destounis found that 53% of obese published post-2000 have been included to coincide with
mammography patients believed they had experienced ABS data on the marked increase in the prevalence of
inappropriate comments directed towards them.23 Further obesity in Australia. Some meta-analyses of obesity
studies have shown that self-conscious obese or perceptions by health practitioners raise the awareness of
overweight patients who experience embarrassment in the wider issue of obesity, with these reviews noting

2015 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of 135
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Obese Patient and Radiography Literature N. T. T. Le et al.

Table 2. Literature review (post-2000) on the attitude and perception of student and qualified health professionals on obesity and their impacts.

Author(s) Aim/purpose Design Main limitations Sample Key findings

Kushner et al.37 Evaluation of 16 item questionnaire No control group. 127 medical An encounter with an overweight
students administered before Self-reporting students SP lead to a significant short-term
attitudes and and after the SP Long-term changes (first years) decrease in negative stereotyping
beliefs about encounter are unknown and a longer term increase in
obesity following empathy
a clinical Student confidence in counselling
encounter with was the most improved area
an overweight
standardised
patient (SP)
Swift et al.38 Assessment of Cross sectional, Self-reporting 1130 allied Found high levels of weight bias
factors of weight Self-reporting Desirability bias health and medical among the students
bias among UK questionnaire students Results suggest levels are higher
trainee health for the lower years
dieticians, Recommends future education
doctors, nurses interventions on the causes of
and nutritionists obesity
Forhan and Literature review: Literature review NA NA Social stigma of weight bias
Ramos39 impact of weight negatively affects patient
bias on patient treatment. This bias exists in the
treatment general population and within
health professions. Greater
understanding of obesity is linked
with lower bias levels
Miller et al.40 To investigate the Self-administered Participant weight not 310 medical students Majority of students held negative
prevalence of Weight implicit considered (third year students) weight bias. 33% showed a
weight related association test (IAT) IAT test complexity significant moderate or strong
biases among and a sematic explicit anti-fat bias. No results
medical students differential item showed an explicit anti-thin bias.
and their 39% showed a significant
self-awareness implicit anti-fat bias
and 17% of students had an
anti-thin bias. Most (67%) were
unaware of these biases
Pantenburg Investigate Cross sectional survey Vignettes not 671 medical students Weight stigma was prevalent
et al.41 attitudes of with case study randomised among its sample
medical students vignettes Data relied on Suggests raising awareness by
towards self-reported data teaching students aetiology and
overweight and factors. Weight stigma in health
obese individuals care is detrimental to patients
Budd et al.42 Review: 15 studies Literature Review NA NA Levels of negative attitudes
exploring health have improved in recent years.
provider attitudes Although these biases still exist,
towards obesity most of the research indicates
and their that there is not a large impact
methods on patient care. Professional
education is needed to change
views
Gudzune et al.43 Investigation of Questionnaires and Measurement of 39 physicians and Preliminary results found
physician respect audio recordings of respect subjective 199 patients overestimation of respect
levels from the physicianpatient Impressions from significantly increased with
perspective of interactions short encounters higher BMI. This was
obese patients unknown hypothesised due to past
experiences desensitising obese
patients to disrespectful
behaviours

(Continued)

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Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology
N. T. T. Le et al. Obese Patient and Radiography Literature

Table 2. Continued.

Author(s) Aim/purpose Design Main limitations Sample Key findings

Puhl et al.44 Investigate Self-administered Patient interaction 297 dietetics Majority of students showed a
attitudes of online surveys (Fat impacts unknown. students moderate amount of fat phobia.
obesity among Phobia Scale) with Low sample diversity A statistically significant portion
dietetic students mock case study (majority Caucasian of students rated obese patients
and the impact females with less likely to comply with
on treatment low BMI). treatment
decisions and 144 (38.7%) Students also rated obese
health responses excluded patients as having poorer diets
evaluations due to inadequate despite case studies suggesting
answers no such difference
Poon and Investigate Self-administered Social desirability 352 student nurses Results found average levels of fat
Tarrant45 attitudes of questionnaire Self-reporting and 198 registered phobia and neutral attitudes
nurses (students Confined nurses towards obese patients.
and registered) convenience sample Registered nurses had
towards obesity may limit significantly higher levels of fat
and how it generalisability phobia and negative attitudes
influences the Over half of participants stated
management of obese patients should be placed
obese patients on diets whilst in hospital
Authors concluded both
registered and student nurses
have negative perceptions of
obesity and were unlikely to
attribute them with positive
characteristics
Wear et al.46 Investigation of Focus groups None listed 58 medical students The study found 5 main categories
medical students from the analysis; the patients
perception and being the object of humour,
derogatory location of humour, the humour
behaviour game, not-funny humour and
towards patients motives for humour
Brown47 Review Literature: Literature The review suggests NA Found limited research on the
attitudes of review further research with attitudes of nurses towards
nurses towards more rigorous overweight and obese patients.
adult or sampling and Study had poor measurements
overweight consistence of and sampling methods
patients and measurement. Found nurses generally had
identify patterns complex, multi-faceted negative
and methods attitudes
used
Schwartz Determine the Self-reported IAT test complexity 389 researchers and Results found significant implicit
et al.48 level of anti-fat questionnaire and 10 responses health professionals anti-fat bias and more commonly
biases of health IAT test (13.6%) excluded associated laziness, stupidity and
professionals due to incompletion worthlessness to obese people
specialising in or inadequacy (both explicitly and implicitly)
obesity and to Factors of being male, having
identify more friends who are obese,
associated weighing more personally and
factors holding a more positive emotional
outlook correlated with a lower
weight bias

(Continued)

2015 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of 137
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Obese Patient and Radiography Literature N. T. T. Le et al.

Table 2. Continued.

Author(s) Aim/purpose Design Main limitations Sample Key findings

Hebl and Xu49 Examine how Mailed survey (each Correlation of results 122 physicians Results showed patient weight
patients weight received one of six with clinical impacts was a statistically significant
affects possible case studies) unknown. factor in treatment management
physicians More negative views were
attitude and associated with heavier patients,
treatment physicians tended to prescribe
choices. those more tests and
spend less time with them
Wigton and Investigate if Case studies with Findings with 72 medical students Study found no significant
McGaghie50 decision making simulated patients simulated patients (none obese) difference in treatment of obese
process of (similar to SP) may not be patients and normal weight
medical students generalisable. patients
is influenced by Did not demonstrate Students rated obese patients as
patient weight negative impacts. being less attractive, less
compliant, more depressed and
less likely to change their lifestyles
Teachman and Investigate Self-reported Low sample diversity 84 health Study found that health
Brownell51 negative implicit questionnaire and an (mainly middle aged, professionals professionals specialising in obese
attitudes and IAT test Caucasian males) (majority physicians) patient care show a strong
beliefs of obesity implicit weight biases. These
in health levels were lower than the
professionals general population.
specialising in Personal weight was a moderate
obese patient factor in reduced weight bias

weaknesses in the reported literature methodology and Despite weight biases being prevalent, it is unclear
failure to utilise robust testing and standardised, consistent exactly how these attitudes affect patient treatment.
measures when considering attitudes and perceptions.4752 Forhan39 describes how weight biases reduce the quality of
For example, the review by Vitolins et al.52 found only five care by providers spending less time with obese patients,
studies that included interventional and evaluation reduced patient engagement and recommending fewer
methodologies, hence the ability to translate evidence into interventional procedures than non-obese patients.
practice and care for obese patients is lacking However, Budd42 stated that despite the existence of these
In Australia and many similar Western counties, there biases most of the studies exploring the impacts of obesity
is an association between attractiveness and slimness in practice did not demonstrate a lower level of care
which is reinforced through mass media.29,44 Being outcome. Most of the studies in Table 2 confined their
overweight or obese can be seen as a liability28 and research to a single geographic location and it is unknown
obese patients are more commonly stereotyped and to what extent these findings could be applied to different
associated with negative traits such as laziness and having groups or can be generalised across health professions.
low motivation and will power.39,53,48 Some studies have The visual and tactile skill set employed by radiographers
found that even overweight or obese individuals share is unique, includes more emphasis on diagnosis and has a
these views of themselves.54 The majority of the articles in shorter care time than other allied health professions. Thus,
Table 2 found health care professionals held negative while cross reference to other health practice is often useful
weight biases, including those professionals who specialise for comparisons and enlightenment, the issue of weight
in obese patient care.39,42,47,51 Interestingly, research has bias is difficult to generalise. Radiographic learning is more
shown that many health care practitioners may not even practical in nature, for example, accredited radiography
be aware of these implicit attitudes.40 It is important that degrees in Australia have many more weeks of clinical
health providers can empathetically address weight issues placement (approximately 4860) than other similar health
with patients as they can have a significant impact on degrees such as physiotherapy (approximately 2025
overweight and obese patients instigating healthier weeks) (http://www.medicalradiationpracticeboard.gov.
lifestyles and seeking health care.55,56 Again, if these biases au/Accreditation.aspx, http://www.physiotherapyboard.gov.
lead to an insensitive experience, patients may decide to au/Accreditation.aspx). A recent Australian pilot study has
seek an alternative physician or delay treatment.5760 suggested that student radiographers are influenced by

138 2015 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of
Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology
N. T. T. Le et al. Obese Patient and Radiography Literature

negative weight biases from qualified radiographers and 10. Buckley O. Challenges of imaging the obese patient. Irish
often observe degrading behaviour and dialogue towards Medical Times 2008; 42: 36.
obese patients.61 This study, giving preliminary qualitative 11. World Health Organisation. BMI Classification 2014.
data, demonstrates the need for an in-depth investigation [updated 8th April 2014; cited 2014 8th April]. Available
of how radiographers perceive and act towards obese from: http://apps.who.int/bmi/index.jsp?
patients in order to highlight any poor practices and introPage=intro_3.html.
enhance good practices. 12. Buckley O, Ward E, Ryan A, Colin W, Snow A,
Torreggiani WC. European obesity and the radiology
department. What can we do to help? Euro Radiol
Conclusion and Future Research 2009;19:298309.
Further research is required in identify the degree of 13. Merrill EL. Womens stories of their experiences as
weight bias in the radiographic community, how overweight patients [Ph.D.]. Texas Womans University,
practitioner attitudes/skills influence care and imaging Ann Arbor, 2007.
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15. Walls HL, Magliano DJ, Stevenson CE, et al. Projected
attitudes of qualified and student radiographers, no
progression of the prevalence of obesity in Australia.
articles were found. The literature is more established in
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other health disciplines although these studies were also
16. Australian Bureua of Statistics. Gender Indicator:
noted to be insufficient. Although a number of specific
Overweight/Obesity 2013. [updated 26th August 2013;
radiology/radiographic articles were found that
cited 2014 8th April]. Available from: http://
highlighted the difficulties of imaging obese patients,
www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/
these were generally commentary in nature and lack
4125.0~Jan%202013~Main%20Features~Overweight%
explicit and robust evidence.
20and%20obesity~3330.
17. Australian Bureua of Statistics. Profiles of Health,
Conflict of Interest Australia: Overweight and Obesity 2013. [updated 7th June
2013; cited 2014 8th April]. Available from: http://
The authors declare no conflict of interest. www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/
4338.0~2011-13~Main%20Features~Overweight%20and%
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