Radiographers’ Experiences of Clinical Handover in Diagnostic Imaging: A Qualitative Study of Communication, Safety, and Organizational Influences

Abstract

Background

Handover in diagnostic medical imaging (DMI) is a critical process involving the transfer of professional responsibility, clinical information, and patient accountability between healthcare practitioners, supported by the communication practices that enable this information exchange. Although handover is widely recognized as essential to patient safety in broader healthcare, the specific experiences and perspectives of radiographers within DMI encounters remain insufficiently explored. This study examined how radiographers understand, practice, and perceive handovers, and how these processes influence continuity of care, patient safety, and quality-of-service delivery.

Methods

A qualitative exploratory design was employed, underpinned by an interpretivist paradigm. Eighteen semi-structured interviews were conducted with diagnostic radiographers working in Australian public hospitals. Participants were purposively sampled to capture varied experience levels and modality specializations. Interviews were digitally audio-recorded, transcribed verbatim, anonymized, and analysed using reflexive thematic analysis.

Results

Eight overarching themes were identified: (1) handover as a critical safety mechanism in DMI, (2) communication quality determines handover effectiveness, (3) poor or absent handover creates risk, delay, and inefficiency, (4) contextual variation in handover practices across settings, (5) interpersonal and cultural dynamics shape handover quality, (6) organizational structures and workflow pressures constrain handover, (7) cross-disciplinary handover in acute and high-acuity settings, and (8) strategies to improve handover. Participants described handover as essential for safe imaging and workflow continuity, yet inconsistently practiced, with no standardized protocols across DMI departments. Radiographers reported missing or inaccurate clinical information, exclusion from multidisciplinary briefings, and organizational barriers such as staffing pressures and lack of shift overlap.

Conclusion

Radiographers identified substantial variability and gaps in handover practices that may compromise patient safety and service quality. The findings highlight the need for standardized, profession-specific handover frameworks, interprofessional education, and organizational commitment to structured communication within DMI workflows.

Plain Language Summary

Radiographers rely on handover to receive essential patient information and ensure imaging is performed safely. In this study, radiographers working in Australian public hospitals described handover as important but often inconsistent, mostly verbal, and affected by missing details, workload pressures, and limited communication with other hospital teams. They reported that poor or absent handover can lead to delays, confusion, and safety risks. Radiographers emphasised the need for clearer expectations, better digital systems, and profession-specific training to support reliable information exchange and improve patient safety in diagnostic imaging.

Introduction

Diagnostic medical imaging (DMI) is a technologically sophisticated, multi-modality environment that delivers diagnostic, interventional, and therapeutic services across diverse healthcare settings.¹ Within this fast-paced environment, patients frequently move between departments and interact with multiple practitioners during short, episodic encounters. These transitions create numerous points at which clinical information must be transferred accurately to support safe and appropriate imaging decisions.² As DMI workflows increasingly intersect with emergency, surgical, and inpatient care, radiographers play a central role in ensuring that critical information is communicated effectively across disciplines.

In Australia, the National Safety and Quality Health Service (NSQHS) Standards define clinical handover as the transfer of relevant, timely, and accurate information to the appropriate person(s) to ensure continuity of care.³ In DMI, handover encompasses not only the formal transfer of professional responsibility and accountability for aspects of a patient’s care, but also the broader communication and information-transfer practices—verbal updates, electronic notes, and multidisciplinary exchanges—that enable safe imaging workflows.^4,5 As regulated health practitioners, radiographers are expected to demonstrate safe and effective communication within multidisciplinary teams.⁶

Radiographers engage in diverse forms of clinical information exchange that extend beyond formal shift-to-shift transitions. These interactions illustrate that information transfer in DMI is fluid, distributed, and shaped by context. In this study, the term handover is therefore used as an umbrella construct that reflects radiographers’ profession-specific conceptualisation of the communication practices required to maintain continuity of care and safe imaging workflows. This aligns with broader understandings of information transfer and situational awareness in imaging contexts.

However, the broader healthcare literature consistently identifies handover as a vulnerable process. Communication failures are a leading contributor to adverse events, delays, and diagnostic errors.^7–11 Within DMI specifically, Australian evidence demonstrates that handover failures are a major contributor to patient-safety incidents.^5,8 A national analysis of 3976 Australian imaging incident reports found that handover and communication errors were among the most frequent causes of DMI-related harm, including inadequate patient handover, missing clinical histories, incorrect request information, and unsafe transfers.⁵ These findings highlight that radiographers operate in a communication-intensive environment where breakdowns can have immediate clinical consequences.¹²

International research reinforces this pattern. In the United States, radiology handover has been identified as a leading source of medical error, with failures in information transfer affecting protocol decisions, imaging acquisition, reporting, and consultation.¹³ Canadian research demonstrates that structured handover tools significantly improve communication clarity and diagnostic reasoning.¹⁴ Broader international reviews also highlight that DMI communication is inherently complex and error-prone due to the multilevel, multidisciplinary nature of imaging pathways.¹⁵ Together, this global evidence shows that communication failures in imaging are not unique to Australia but represent a widespread challenge across healthcare systems.

Despite these recognised risks, research exploring radiographers’ own experiences of handover remains limited. Much of the existing evidence focuses on nursing and medical professions, leaving a gap in understanding how radiographers conceptualise and enact handover within their unique workflow. While structured communication tools such as SBAR are widely recommended, their application and effectiveness in DMI contexts remain under-examined.¹⁶ Furthermore, factors known to influence communication quality—such as workload, interruptions, scheduling pressures, and staffing models—are well documented in general healthcare literature^17–19 but have not been sufficiently explored within imaging departments, where rapid throughput and multidisciplinary interactions are routine.

A further gap identified at the time of conducting this study is that DMI-specific professional standards and competency frameworks do not explicitly address handover, despite radiographers’ central role in multidisciplinary communication and patient flow. This absence of profession-specific guidance contrasts with Australian and international evidence showing that communication failures in imaging can pose significant patient-safety risks. It underscores the need for empirical research that foregrounds radiographers’ perspectives.

Given the increasing complexity of DMI workflows and the central role of radiographers in coordinating patient movement, information flow, and imaging decisions, understanding their perspectives on handover is essential.¹⁰ This study therefore aims to explore the experiences of radiographers working in Australian public hospitals, examining how they understand and enact handover and how they perceive its impact on continuity of care, patient safety, and quality of service delivery.

Methods

This study employed a qualitative exploratory design to investigate diagnostic radiographers’ experiences of handover within everyday DMI practice. The research was grounded in an interpretivist paradigm, recognising that professional meanings are socially constructed through clinical experience and context.^20,21

Sampling and Participants

Purposive sampling was used to obtain rich, experience-based accounts of handover practices within DMI encounters.²² As shown in Table 1, 18 diagnostic radiographers participated in the study. Participants were predominantly female (66.7%), with a mean age of 36.3 years (SD 11.0; range 24–62 years). Professional experience ranged from less than one year to 35 years, and participants reported experience across a broad range of DMI practice areas, including general radiography, CT, theatre imaging, mobile radiography, fluoroscopy, mammography, MRI, angiography/interventional radiology, and ultrasound. This variation supported the inclusion of diverse practice-based perspectives on handover across imaging contexts.

Table 1.

Participant Demographic Information

Participant Characteristics	Total Participants (N = 18)
Total participants interviewed	18
Age Range
20–29 years	5 (27.8%)
30–39 years	6 (33.3%)
40–49 years	5 (27.8%)
≥ 50 years	2 (11.1%)
Gender
Female	12 (66.7%)
Male	6 (33.3%)
Years of professional experience
<1 year	4 (22.2%)
1–5 years	5 (27.8%)
6–10 years	3 (16.7%)
11–20 years	1 (5.6%)
≥21 years	5 (27.8%)
Highest qualification
Diploma	1 (5.6%)
Bachelor degree only	7 (38.9%)
Bachelor degree plus postgraduate qualification	10 (55.6%)
Interview mode
Online	5 (27.8%)
Telephone	5 (27.8%)
Face to face	8 (44.4%)
Modalities/areas of practice reported*
General radiography/X-ray	18 (100.0%)
CT	14 (77.8%)
Theatre imaging	15 (83.3%)
Mobile radiography	8 (44.4%)
Fluoroscopy	7 (38.9%)
Angiography/interventional radiology	5 (27.8%)
MRI	4 (22.2%)
Mammography	5 (27.8%)
Ultrasound	1 (5.6%)

Notes: Modalities were not mutually exclusive, as participants could report experience across multiple areas of diagnostic medical imaging.

Data Collection

Data was collected by all three authors between October 2025 and April 2026. Individual semi-structured interviews were conducted using a guide informed by existing literature.^23,24 Interviews lasted approximately 10–30 minutes and explored participants’ understanding of handover, experiences of communication errors and safety events, communication modalities used, organisational influences, inter-professional relationships, and opportunities for improvement. Data saturation was monitored throughout and considered achieved when no new substantive concepts emerged.^25,26

Data Analysis

Interviews were transcribed verbatim and anonymised by assigning a code and analysed using Bingham’s five-phase qualitative analysis process.²⁷ Analysis began with data management by the second author to organise transcripts and establish an audit trail. Followed by immersion by the first two authors through repeated reading to develop familiarity with participants’ accounts. Inductive coding was then undertaken manually to capture semantic and latent meanings related to DMI handover.27 Related codes were grouped into conceptual categories through iterative comparison, and these categories were synthesised into higher-order themes that reflected core patterns in radiographers’ handover experiences. 27 Reflexive memoing supported interpretive depth throughout the analytic process.27 Theme development was treated as an interpretive process through discussions with all three authors until a consensus was reached.

Trustworthiness

Credibility, transferability, dependability, and confirmability measures were used to establish trustworthiness.^28,29 Credibility was supported through repeated engagement with the transcripts, discussion of developing themes, and comparison with relevant literature.²⁸ Reflexivity was maintained through ongoing consideration of how researchers’ assumptions and professional familiarity with DMI could shape data interpretation.³⁰ Transferability was supported through detailed reporting of the study context and participant characteristics, while dependability and confirmability were supported through documentation of analytic decisions.²⁸

Results

Analysis of interviews revealed eight overarching themes that describe how handover is understood, enacted, and experienced within DMI. Consistent with the definition provided in the Introduction, participants described “handover” as encompassing not only formal transfers of responsibility but also the broader, context-dependent communication practices that support safe imaging workflows. These themes illustrate the centrality of handover to safe imaging practice, the variability of communication across settings, and the organizational and interpersonal factors that shape radiographers’ ability to exchange critical information. Each theme reflects the nuanced ways radiographers navigate handover in their daily work.

Theme 1: Conceptualization and Scope of Handover

Respondents expressed different interpretations of handover in the field of DMI. Several radiographers broadly conceptualized handover as the transfer of patient-related clinical information in a manner that ensures safety and continuity of tasks:

Handover is communication…to avoid any mistakes about the information, to keep everyone informed about what has happened and what still needs to be done. It is our job and also a duty, but also not only the formality. (P01)

P04 brought a prospective element to the definition, not just in terms of present status but, also, in terms of anticipatory identification of possible changes in a patient’s condition:

So, it should be a clinician to a clinician or clinician to healthcare worker about the handing over of a patient including the patient’s background, current medical needs, requirements and any concerns that might indicate a change in their healthcare requirements whilst under your care. (P04)

Some participants pointed out that the content of handover should include details of patient identification, allergies, and up-to-date clinical condition, already completed imaging, and modalities. Participant P03 emphasized the DMI-specificity of the information needed, as radiographers require specific information, which is important to the ability of the patient to mobilize, follow the instructions and go through the particular examination safely. P11 provided the broadest conceptualization with a multi-directional view of handover as continuing even after the DMI encounter:

Handover can happen between colleagues of the same department, between departments…it’s an opening and a closure. Care does not end at imaging; it ends when the patient is returned. (P11)

On the other hand, a single participant (P08) offered a markedly narrower interpretation. P08 questioned whether “clinical handover” occurs in routine DMI practice, arguing that radiographers do not usually assume ongoing medical responsibility for patients outside procedural contexts. As P08 stated, “I don’t believe we actually do a clinical handover in diagnostic imaging”. This participant instead positioned the referral as the principal mechanism for information transfer, explaining that “handover information is supposed to be contained within the referral”. This interpretation was reinforced later in the interview by P08 who stated:

But again, we’re not taking medical care of the patient, so it’s not actually handover occurring. So, we’re just providing a service to the medical team.

This divergent account is analytically important because it exposes a lack of shared professional agreement about the scope and boundaries of handover in DMI. While most participants understood handover broadly in relation to continuity of care and safety, P08 interpreted it more narrowly as the formal transfer of medical responsibility.

Theme 2: Handover as a Critical Safety Mechanism in DMI

Participants described many cases where handover failures undermined or jeopardized patient safety. The most severe account was a scenario in which missing clinical information could be a contributing factor to a severe adverse event:

We’ve had patients where we haven’t been given an overarching clinical history, and…may have contributed to a patient’s cardiac arrest. If we had known their clinical history, signs and symptoms prior to a handover, we probably wouldn’t have done the exam in the same way. (P04)

Other deficiencies involved missing or unreliable safety-critical information, such as P01’s account of a high-risk MRI case where independent radiographer verification identified an undisclosed metallic implant despite prior verbal medical clearance. P05 recalled iodine allergies not being communicated because “people don’t put two and two together”, and P03 described discovering unhanded-over analgesia needs only after encountering distressed patients. Participants also described risks arising from poor referral information and unclear written communication. P10 described ward patients arriving with minimal information: “We get this patient, we know nothing about, apart from the request…I think that’s pretty poor”. P11 provided a reflective report on a personal handover failure whereby a vague written message during mammogram-to-ultrasound transition resulted in the wrong region of interest being scanned, which highlights that even experienced practitioners can fall victim to the effects of poor information transfer.

When handover was absent or incomplete, radiographers were forced to reconstruct the clinical picture themselves. P02 noted that missing information meant “the patient spends more time moving between departments”, and P07 highlighted that effective handover “gives the team coming in important details… to keep continuity of care good”. It supported workflow across modalities as P12 mentioned shift handover as covering “the whole department status”, enabling prioritization and preparation across modalities.

Theme 3: Communication Quality Determines Handover Effectiveness

Radiographers valued handovers that were clear, structured, and relevant to the imaging task. P06 described effective communication as “brief, precise, succinct”, while P13 emphasized sharing “the things I would want to know” if roles were reversed. Some radiographers developed their own structured approaches; P15 routinely documented cannula status, contrast, human chorionic gonadotropin (HCG), bloods, and consent in radiology information system (RIS) notes to ensure any radiographer could safely commence the examination.

However, missing or contradictory information was common. P07 recalled a case where an imaging plan had been discussed with the ward but never handed over, resulting in confusion and duplicated effort. P09 described referrals containing minimal information, including one that consisted only of a full stop. P08 noted that referrals should function as clinical handover but “the clinical information that’s provided is often insufficient”, requiring radiographers to chase details.

Verbal handover dominated practice, with written documentation used inconsistently. While RIS or picture archiving and communication system (PACS) notes provided asynchronous support, radiographers acknowledged limitations such as editable entries without traceability. P11 stressed that written notes alone were inadequate, arguing that “face to face is safest” because it allows clarification and mutual understanding.

Theme 4: Poor or Absent Handover Creates Risk, Delay, and Inefficiency

Participants described numerous examples where inadequate handover directly compromised safety. P13 recounted being physically assaulted by a patient whose aggression had not been communicated. P06 described wardsmen bringing the wrong patient due to unclear identification details. Infection control risks were also frequently missed; P14 explained that we’d only find out through the notes or someone down the line telling us about ESBL [Extended-Spectrum Beta-Lactamase], MRSA [Methicillin-Resistant Staphylococcus aureus], or TB [Tuberculosis].

P15 described a patient who had recently received morphine but was handed over without mention of mobility risk, resulting in a fall.

Workflow inefficiencies were widespread. Radiographers reported repeated imaging due to incorrect referrals, delays caused by missing preparation, and patients arriving unescorted despite requiring supervision. P07 noted that without proper handover, “you end up ringing people that have already been rung…wasting time and frustrating staff”.

The emotional and cognitive load of compensating for poor handover was significant. P14 described feeling “alone in decision making”, and P13 expressed frustration at repeatedly filling communication gaps. P02 noted the stress of returning patients to busy wards without adequate information.

Theme 5: Contextual Variation in Handover Practices Across Settings

Handover practices varied widely across departments and hospitals. Most radiographers reported an absence of formal protocols, relying instead on ad hoc, informal communication. P01 observed that “every facility has their own way”, and P02 described handover as largely verbal. In some departments, P07 noted that “everything’s online”, with radiographers relying on digital notes rather than structured handover.

Formalized handover was typically limited to high-risk environments such as interventional radiology, sedation, MRI safety screening, and cardiac CT. In theatre, radiographers often missed the pre-procedure briefing because they were called in after anaesthesia had commenced. P11 explained that “you can’t ask if they’re pregnant…. they’re already asleep”, and P10 noted that radiographers were often told only, “what we’re there for”, without broader clinical context.

Cross-modality transitions were identified as key handover points. P11 emphasized that radiographer responsibility continues until “the patient has been handed back to where they came from”, while P09 described structured shift handover as making transitions “smooth and efficient”.

Theme 6: Interpersonal and Cultural Dynamics Shape Handover Quality

Interpersonal relationships and professional hierarchies strongly influenced handover quality. P12 described “old school medical individuals” who displayed disrespect toward radiographers, and P10 recalled doctors questioning why they should answer radiographers’ queries: “Why am I answering your questions? I’m the doctor”.

Rapport and team culture were central. P06 noted that good rapport meant issues were raised promptly, while P09 observed that staff who did not get along tended to provide poorer handovers. P13 highlighted the importance of modelling good communication, explaining that when colleagues observe thorough handover, “they think, that’s a really good way of doing that… maybe I’ll do it like that too”.

Participants also described the emotional labour of navigating conflict. P02 noted that when conflict existed, “it’s almost impossible to achieve a successful handover”, as individuals avoided communication. P04 argued that professionalism should override interpersonal issues, though this was not always achieved.

Theme 7: Organisational and Cross-Disciplinary Influences on Handover

Structural pressures like understaffing, workload, and throughput demands limited the time available for effective handover. P16 described an “internal pressure to go fast”, discouraging thorough electronic medical record (EMR) review. P11 noted that being “stretched thin” increased the likelihood of errors.

Shift patterns were a major barrier. Radiography rosters often lacked overlap, making it difficult to conduct handover during transitions. P10 explained that “there’s no overlap of staff”, and P15 described the midnight-to-midnight transition as unsafe because “there is no time to hand over”. A trialed 15-minute overlap improved safety, though P13 noted that “people didn’t like it”.

Fragmented rostering further complicated communication. P14 described inconsistent start times leading to situations where “sometimes you get five handovers for the same patient, and sometimes you get none”.

A split of opinion arose on the subject of leadership: P04 claimed that management should enforce structures and model the process of structured handover, whereas P05 insisted that a successful handover is largely a cultural one. All participants reported the lack of formal training in handover, with P10 explicitly demanding the mandatory universal handover training.

Radiographers relied heavily on nursing staff for clinical information in ED, intensive care unit, wards, and mobile imaging, but the quality of this information varied widely. P13 noted that “some nurses are very structured… others… just say ‘I don’t know’”.

Theatre was particularly challenging because radiographers often missed formal briefings. P16 noted that radiographers were “less likely to be there because they’ve already prepped and broken the skin”. Mobile and ICU imaging required situational, safety-critical handover, yet essential details were often not volunteered. P14 recalled discovering infection control risks only after reading notes or being told “down the line”. Radiographers also acted as first identifiers of clinical deterioration. P13 described detecting a pneumothorax during a mobile X-ray and alerting staff immediately: “That wasn’t there five minutes ago…. They [nurses and doctor] need to know this now”. Across acute settings, communication was essential but inconsistent.

Theme 8: Strategies to Improve Handover Practice

Radiographers expressed a strong desire for clearer, more consistent, DMI -specific handover processes. P13 emphasized that any system “needs to be radiology specific, and for the situation specific”, while P15 described how her CT template prevented omissions and supported safe practice. Participants recommended cohesive digital platforms. P01 suggested: “In this digital generation, it would mostly be in an online or digital form so that everyone can access it”. P02 highlighted the need for referring ward staff to better understand imaging requirements:

One improvement that could be made is for staff on other wards to make sure that the patient is in a safe, sterile condition before coming to our department before we conduct our exams. (P02)

Protected handover time was seen as essential. P13 noted that even a short overlap “worked” by ensuring essential information was conveyed. Leadership was viewed as critical in shaping communication culture. P14 argued that “it comes from the top”, and P04 noted that without managerial reinforcement, “staff aren’t going to follow through”.

Some radiographers advocated for system-level solutions. P16 suggested a state-wide wide framework similar to ISBAR (Identify, Situation, Background, Assessment, Recommendation), and P02 argued that handover should be “clinician to clinician… with the same structure” across disciplines. P05 and P03 were skeptical of rigid checklists and warned against hollow compliance. P11 supported interprofessional education at the undergraduate level to promote mutual understanding of handover requirements across disciplines.

Figure 1 synthesizes the themes identified in the analysis and positions handover quality in DMI as the central focus. The framework illustrates how handover is a process shaped by communication quality, practice context, interpersonal dynamics, workflow pressures, cross-disciplinary interaction, and improvement strategies.

Figure 1.

Conceptual framework summarizing the eight themes influencing handover quality in diagnostic imaging.

Across participants, handover in DMI was described as essential yet inconsistently practiced. Radiographers frequently compensated for systemic gaps through personal vigilance, RIS notes, and proactive communication. However, the absence of formal structures, timeout periods and consistent expectations created variability and risk, underscoring the need for DMI-specific, context-appropriate handover processes supported by leadership and aligned with broader hospital systems.

Discussion

The results shed light on the complexity of handover in DMI and demonstrate substantial variability in how radiographers conceptualize, enact, and experience this process. This definitional divide reflects the absence of professional agreement, which may itself contribute to inconsistent practice: an issue consistent with broader healthcare literature, where unclear definitions have been linked to inconsistent application of communication strategies.^11,31 In interpreting these findings, it is important to distinguish between two forms of handover evident in the data: (1) information transfer from other health practitioners to radiographers, which provides the clinical context required for safe imaging, and (2) handover between radiographers themselves, such as shift-to-shift or cross-modality transitions, where responsibility for workflow, patient movement, and imaging tasks is transferred. These findings align with evidence that communication failures remain a major contributor to clinical risk, with breakdowns often arising from incomplete information and assumptions about shared understanding.^32,33

The safety implications reported by participants were significant. The account of a cardiac arrest potentially linked to missing clinical information aligns with Wallin et al,⁷ who found that nearly half of DMI safety events were associated with delays or misdirected care arising from communication failures. The recurring theme of radiographers acting as the final safety barrier echoes Migliorini and Portelli,¹² who emphasized efficient communication as central to DMI patient safety. These findings also parallel Hannaford et al,⁵ who identified handover and communication errors as major contributors to safety incidents in Australian imaging departments, and Sarvananthan et al,⁸ who reported that delays in care were the second most common incident type. Participants’ descriptions of compensatory safety work reflect broader evidence that patients and families perceive handover as inconsistent and vulnerable to omission.³⁴

A notable procedural gap was the routine exclusion of radiographers from theatre briefings, reflecting the marginalization described by Harvey-Lloyd and Strudwick.³⁵ While theatre staff retain full medical responsibility for the patient, the examples provided by participants do not imply a transfer of medical care to radiographers; rather, they highlight the absence of essential information transfer needed for radiographers to safely perform imaging tasks within the procedural environment. Modality-based inequities in handover quality further highlight organizational inconsistencies that may compromise safety. Differences in communication perceptions between radiographers and patients, as shown by recent evidence,³⁶ reinforces the need for targeted communication enhancement. The quality of clinical information exchanged during handover discussed by Chilanga¹ and Ching et al³⁷ also influences imaging appropriateness, underscoring the interdependence between referral quality and handover effectiveness. Evidence from structured communication research supports this need; SBAR has been shown to improve clarity and reduce omissions,³⁸ while structured perioperative handoff tools enhance continuity and reduce error.³⁹

Organizational determinants identified by participants align with established literature on handover quality. Richter et al¹⁷ and Bam et al⁴⁰ demonstrated that organizational structures, staffing, and service delivery models directly affect safety at the point of handoff. Elliott et al.¹⁸ found that mixed shift rotations are linked to sleep disturbance, burnout, and reduced well-being in professions comparable to DMI, potentially degrading handover quality. Bell et al.¹⁹ similarly reported that information transfer is shaped by interruptions and environmental conditions within DMI workplaces. These findings are consistent with research showing that radiographers’ decision-making is shaped by workplace culture, workload, and professional norms.⁴¹ The tension between mandate-based and culture-based approaches to improvement reflects broader findings that sustainable change requires integration of both the structural support and the workplace culture.¹⁶

The universal absence of formal handover training among participants is a striking finding, distinguishing radiography from nursing, where structured handover education is now embedded in undergraduate curricula and workplace induction. Although communication is identified as a core domain in the Medical Radiation Practice Board of Australia’s professional capabilities framework,⁶ specific handover training seems to be lacking in existing educational and employment pathways.

Conclusion

This study provides a comprehensive, empirically grounded model of handover in DMI encounters, illustrating how handover quality is shaped by the interplay of conceptual, informational, organizational, interpersonal, and systemic factors. Radiographers identified handover as a vital patient safety practice, but described it as largely verbal, inconsistently organized and often undermined by organizational demands. Across the findings, two distinct forms of handover were evident: the clinical information transferred to radiographers from other practitioners, and the workflow-focused handover occurring between radiographers during shift changes and modality transitions. The findings highlight radiographers’ role as a final safety checkpoint, particularly when they identify missing information, verify clinical details, and compensate for communication gaps. In procedural environments, participants described gaps in essential information transfer rather than a formal handover of responsibility. They also show that radiographers may be excluded from key interprofessional communication points, especially in high-acuity or procedural settings, creating avoidable risks for patient safety and continuity of care.

Strengthening handover in DMI encounters therefore, requires more than procedural tools; it demands cultural, educational, and organizational changes that supports radiographers’ communicative role, enhances situational awareness, and reduces structural vulnerabilities. Implementing structured yet flexible handover processes, investing in digital documentation systems, and fostering interprofessional understanding are key strategies for improving patient safety and continuity of care. As DMI services continue to expand in scope and complexity, ensuring robust, reliable handover processes will remain central to high-quality, patient-centered DMI practice.

Limitations and Future Research

This study has several limitations. First, the sample was limited to radiographers within a single national context, which may restrict the transferability of findings to other health systems with different staffing models, digital infrastructures, or regulatory frameworks. Second, the study relied on self-reported experiences, which may be influenced by recall bias or social desirability. Observational studies of real-time handover interactions could provide deeper insight into communication behaviours and contextual influences. Third, the perspectives of other stakeholders including nurses, medical practitioners, and theatre staff, were not included, limiting the ability to triangulate findings across disciplines.

Future research should explore multidisciplinary perspectives on DMI handovers, evaluate the effectiveness of DMI-specific handover tools, and examine the impact of digital solutions such as structured RIS/EMR templates. Longitudinal studies assessing the effects of shift overlap, staffing models, and communication training on handover quality would also be valuable. Given the emerging evidence of radiographers’ role in identifying clinical deterioration, further investigation into their contribution to early warning systems and escalation pathways is warranted.

Funding Statement

No funding was received for this research.

Data Sharing Statement

Research data are not shared to maintain participant confidentiality.

Ethics Approval

The project has been approved by the Human Research Ethics Committee of the University of Canberra (HREC50411). The study was performed in regard to the National Statement on Ethical Conduct in Human Research.²⁸ All participants provided informed consent prior to the interviews. The consent process included permission for the publication of anonymized responses, including direct quotations.

Consent for Publication

Informed consent was obtained from all participants for the publication of anonymised data.

Author Contributions

All authors made a significant contribution to the work reported, whether in conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.