TEACHING THE INTERPRETATION OF IMAGING EXAMS: AN ANALYSIS OF NURSING COURSES CURRICULA IN BRAZILIAN UNIVERSITIESABSTRACT
Objective: To describe the curricular components including theoretical and/or practical content focused on the interpretation of imaging exams in undergraduate Nursing courses.
Method: Documentary study based on the analysis of 53 Course Curriculum Proposals from federal higher education institutions. Data were organized using descriptive statistics, without the need for ethical review, in accordance with Resolution No. 510/2016. Nevertheless, ethical precautions were taken regarding the non-identification of the institutions, ensuring a neutral, descriptive character free from value judgments.
Results: Of the 53 Curriculum Proposals analyzed, only five included subjects related to the theme. There are three higher education institutions (HEI) in the Northeast, one in the South, and one in the Southeast. Two institutions offered mandatory components, but only one required technical prerequisites, while the others offered the content as an elective course. The average course load was 45 hours, with poorly detailed course outlines and limited clarity regarding the practical approach or the use of innovative methodologies.
Discussion: Although the interpretation of imaging exams is relevant to the nursing process, its teaching is still in its early stages. This scenario contrasts with current regulations, highlighting curricular weaknesses and the need for updates aligned with the National Curricular Guidelines and current health demands.
Conclusion: The study highlights gaps in the federal universities analyzed regarding the interpretation of imaging exams, pointing to the need for curricular revision that systematically integrates the topic, expanding skills and improving professional performance.
DESCRIPTORS:
Radiological and imaging nursing; Diagnostic imaging; Higher education policy; Nursing professionals; Nursing training
RESUMO
Objetivo: Descrever os componentes curriculares que contemplam conteúdos teóricos e/ou práticos voltados à interpretação de exames por imagem em cursos de graduação em Enfermagem.
Método: Estudo documental baseado na análise de 53 Projetos Pedagógicos de Curso de instituições federais de ensino superior. Os dados foram organizados por meio de estatística descritiva, sem necessidade de apreciação ética, conforme a Resolução nº 510/2016. Ainda assim, adotaram-se cuidados éticos quanto à não identificação das instituições, garantindo caráter neutro, descritivo e isento de juízos de valor.
Resultados: Dos 53 Projetos Pedagógicos analisados, apenas cinco contemplavam disciplinas relacionadas à temática. Sendo três IES no Nordeste, uma no Sul e uma no Sudeste. Duas instituições ofertavam componentes obrigatórios, mas somente uma exigia pré-requisitos técnicos, enquanto as demais disponibilizavam o conteúdo como disciplina eletiva. A carga horária média foi de 45 horas, com ementas pouco detalhadas e limitada clareza quanto à abordagem prática ou ao uso de metodologias inovadoras.
Discussão: Embora a interpretação de exames por imagem seja relevante para o processo de enfermagem, seu ensino ainda é incipiente. Esse cenário contrasta com as normativas vigentes, evidenciando fragilidades curriculares e a necessidade de atualização alinhada às Diretrizes Curriculares Nacionais e às demandas atuais da saúde.
Conclusão: O estudo evidencia lacunas nas universidades federais analisadas quanto à interpretação de exames por imagem, apontando para a necessidade de revisão curricular que integre o tema de forma sistemática, ampliando competências e qualificando a atuação profissional.
DESCRITORES:
Enfermagem radiológica e de imagem; Diagnóstico por imagem; Política de educação superior; Profissionais de enfermagem; Formação em enfermagem
RESUMEN
Objetivo: Describir los componentes curriculares que incluyen contenido teórico y/o práctico centrado en la interpretación de exámenes de imagen en los cursos de pregrado de Enfermería.
Método: Estudio documental basado en el análisis de 53 proyectos pedagógicos de cursos de instituciones federales de educación superior. Los datos se organizaron utilizando estadística descriptiva, sin necesidad de revisión ética, de conformidad con la Resolución N° 510/2016. No obstante, se tomaron precauciones éticas con respecto a la no identificación de las instituciones, garantizando un carácter neutral y descriptivo, libre de juicios de valor.
Resultados: De los 53 Proyectos Pedagógicos analizados, solo cinco incluían temas relacionados con la temática. Hay tres instituciones de educación superior en el noreste, una en el sur y una en el sureste. Dos instituciones ofrecían componentes obligatorios, pero solo una requería requisitos técnicos previos, mientras que las demás ofrecían el contenido como curso optativo. La carga lectiva promedio era de 45 horas, con programas de estudio poco detallados y escasa claridad en cuanto al enfoque práctico o el uso de metodologías innovadoras.
Discusión: Si bien la interpretación de las pruebas de imagen es relevante para el proceso de enfermería, su enseñanza aún se encuentra en sus primeras etapas. Este escenario contrasta con la normativa vigente, lo que pone de manifiesto las deficiencias del plan de estudios y la necesidad de actualizarlo de acuerdo con las Directrices Curriculares Nacionales y las exigencias sanitarias actuales.
Conclusión: El estudio pone de relieve las deficiencias de las universidades federales analizadas en lo que respecta a la interpretación de exámenes de imagen, señalando la necesidad de una revisión curricular que integre sistemáticamente el tema, ampliando las competencias y mejorando el desempeño profesional.
DESCRIPTORES:
Enfermería radiológica y de imagen; Diagnóstico por Imagen; Política de educación superior; Profesionales de enfermería; Formación en enfermería
INTRODUCTION
The increasing complexity of healthcare has raised the demand for nursing professionals with a strong integration of specialized clinical knowledge1. This category is incrementaly present in more complex contexts, requiring refined technical expertise and an understanding of the risks involved2. In this context, knowledge of how to interpret imaging exams emerges as a relevant skill for care planning, clinical decision-making, and quality of care enhancement3.
It is worth highlighting that basic knowledge of imaging exams allows nurses to identify critical clinical changes early, such as pneumothorax, acute pulmonary edema, hemorrhages, device displacement, and signs of inflammation4. In this context, given the need for technical support for planning nursing care, COFEN Resolution No. 679/2021 approved the standardization of point-of-care ultrasound (POCUS) performed by nurses5. Recent evidence suggests that, when performed by qualified professionals, POCUS contributes to safer interventions, more reliable clinical decisions, and greater autonomy for the nursing team, especially in critical care units such as ICUs and emergency departments6.
Supporting this expansion of the professional scope, a recent study explored how nurses perceive the use of point-of-care ultrasound in clinical practice, especially in the assessment of vascular access and guided cannulation in hemodialysis patients. The results demonstrated that POCUS is seen as a resource capable of increasing procedure safety, reducing complications, and promoting more assertive clinical decisions. Professionals reported greater technical confidence and autonomy when incorporating this technology into care, although they also pointed out challenges such as the need for training and adequate access to equipment7.
However, weaknesses persist in the field of academic training. Although there have been some improvements, most nursing courses still omit content on the interpretation of imaging exams from their course outlines. This absence reflects training models centered on technique and on the hospital setting, which disregard the comprehensiveness of care and critical engagement within the Brazilian Public Health System (SUS)8. As pointed out by scholars in the field, it is urgent to reorient the curriculum beyond traditional competencies, incorporating new demands from the health system and strengthening the connection between theory, practice, and social reality9.
This skill promotes quick and well-informed decisions, directly impacting patient safety and clinical outcomes10. From this perspective, technical expertise in radiology resources not only improves the quality of direct care but also makes it more precise, efficient, and safe. By anticipating complications, supporting clinical management, and collaborating more effectively with the multidisciplinary team, nurses contribute to the resolution capacity of healthcare services11.
Despite the relevance of this topic, knowledge about how the Nursing Course Curriculum Proposals (CCPs) at Brazilian Federal Public Universities address teaching related to the interpretation of imaging exams is still incipient. Given this gap, the present study aims to describe the curricular components that include theoretical and/or practical content focused on the use of imaging exams by nurses in undergraduate nursing courses at federal universities in Brazil.
METHOD
This is an exploratory and descriptive study, with a qualitative approach and a documentary nature12. The investigation focused on the analysis of the CCPs of undergraduate Nursing courses from Brazilian federal institutions, considering their digital versions. The study design and reporting were guided by the Standards for Reporting Qualitative Research (SRQR) guidelines, ensuring methodological rigor and transparency in the research conduction13. It should be noted that no artificial intelligence tools were used to conduct this study.
Initially, the study considered 69 Brazilian Federal Institutions of Higher Education (IFES) qualified to offer courses in the health field, according to data from the electronic information system on the regulation of higher education, the e-MEC14. The Ministry of Education provides, through this platform, data on the CCPs of higher education courses authorized in the Brazilian territory. A documentary census was then carried out, in which only the HEIs offering the undergraduate Nursing course were systematically screened. Thus, after document analysis, 53 CCPs were selected and comprised the corpus of analysis for the study.
Flowchart of the census and document screening process. Campina Grande, Paraíba, Brazil, 2025. (n=53).
Federal HEIs that actively offered Nursing courses and made their respective CCPs available publicly, freely, without restriction, and in full, as well as sufficiently detailed syllabi to allow the identification of curricular components related to the research topic, accompanied by their respective course outlines, were included. Only the course curriculum proposals in which it was not possible to identify curricular components containing content relevant to the object of investigation were excluded, as shown in Figure 1.
After selecting the eligible CCPs, institutional digital documents, publicly available on official websites, such as the official website pages of the Pro-Rectorate for Undergraduate Studies, the Departments, and the Coordinations of the Nursing courses included in the study, were also consulted. Furthermore, information available on the public e-MEC platform14 contributed to the preparation of the article.
The document search was conducted between March and July 2024. Initially, a survey was conducted through the e-MEC system to identify federal HEIs actively offering Nursing courses. Subsequently, after selecting the eligible CCPs, a manual search was conducted on institutional portals, using the following descriptors in combination: “projeto pedagógico do curso” (course curriculum proposal), “PPC Enfermagem (CCP Nursing)”, “matriz curricular” (syllabus), and “estrutura curricular” (curricular structure), associated with the institution's name, including the use of external search engines (e.g., site:ufxx.br enfermagem “projeto pedagógico” (site:ufxx.br nursing "curriculum proposal").
For each identified CCP, the following information was recorded in a dedicated spreadsheet: geographic region, institution name, state and campus, access link (URL), file format, and year of approval. The information was extracted manually through a complete reading of the CCPs, syllabi, course outlines, and course overview tables.
For the organization, analysis, and interpretation of the data, the principles of thematic content analysis were followed15, with categories defined a priori based on the research objective. The coding and categorization stages were performed manually in an Excel spreadsheet, with the courses being classified as shown in Table 1.
There was independent double coding, with review and consensus among the researchers to ensure consistency in interpretation. The methodological and interpretative decisions were documented in an electronic field diary, ensuring traceability, auditability, and analytical consistency in the process.
The agreement among experts was measured using the modified Kappa coefficient. For each item, the probability of chance agreement was calculated, considering the total number of evaluators and the number of experts who classified it as relevant. The interpretation followed a previously established cutoff point: values between 0.40 and 0.59 indicate low agreement; between 0.60 and 0.74, moderate to good agreement; and values above 0.75 represent excellent agreement16. When analyzing the CCPs, all items showed excellent agreement (Chart 1).
Coding of the subjects presented in the CCPs of Nursing courses at Brazilian Federal Universities. Campina Grande, Paraíba, Brazil, 2025. (n=53).
Considering the nature and specificities of the data analyzed, as well as the fact that the information is not identifiable, Resolution No. 510, of April 7, 2016, of the National Health Council, establishes that protocols do not have to be registered and/or evaluated by the CEP/CONEP System. Nevertheless, the research was committed to not issuing value judgments that would allow the identification of specific institutions, ensuring a neutral, ethical, and eminently descriptive character to the results.
RESULTS
Of the 53 CCPs analyzed, it was found that 5 (9.4%) of the federal HEIs describe components in their syllabus that deal with the subject, while 48 (90.6%) do not mention the teaching of the analysis and interpretation of imaging exams in their CCPs. Regarding the distribution by state, 3 (60%) were located in the Northeast region, 1 (20%) in the South region, and 1 (20%) in the Southeast, as shown in Table 1.
Although only five HEIs (9.4%) among those analyzed present content related to the topic, it should be noted that the Universidade Federal do Recôncavo Baiano (UFRB) includes two distinct curricular components whose course outline includes topics related to the interpretation of imaging exams. Considering all the identified components, four courses are mandatory, which corresponds to 66.7% of the total analyzed. These components are predominantly concentrated in the Northeast region, distributed between the CCPs of UFRB and the Universidade Federal da Bahia (UFBA).
Conversely, two courses are elective, representing 33.3% of the courses offered. The elective courses are located in the Southeast region, specifically at the Universidade Federal dos Vales do Jequitinhonha and Mucuri (UFVJM), and in the South region, at the Universidade Federal do Pampa (UNIPAMPA). Thus, it can be observed that most of the curricular components addressing the topic in the CCPs have a mandatory nature, highlighting their relevance and centrality in nursing education in the institutions analyzed, as shown in Chart 2.
As shown in Chart 3, the analysis of the course outlines revealed that the HEIs present curricular components with different scopes, but convergent in terms of the inclusion of content related to physical examination, analysis of laboratory tests, and interpretation of imaging exams. When evaluating the course loads, significant variation was identified among the curricular components.
The highest number of hours was observed at UFRB, in the component dedicated to clinical care of adults and older people, totaling 153 hours, while the lowest number of hours corresponded to the course offered by UNIPAMPA, with 30 hours. Considering all the courses analyzed, the average workload was 94.5 hours, which highlights relevant differences in the depth and scope dedicated to the development of skills related to clinical assessment, interpretation of laboratory tests, and understanding of diagnostic imaging methods.
DISCUSSION
The advancement of diagnostic technologies in healthcare has significantly transformed the dynamics of care, demanding increasingly specific and interdisciplinary skills from nursing professionals. Although nurses are not legally responsible for clinical diagnoses, the ability to analyze imaging studies is a valuable auxiliary tool in daily practice, especially for the Nursing Process (NP)3-17.
Furthermore, the expansion of legislation supporting the use of POCUS allows nurses to access information that supports clinical decisions and perform procedures more safely, such as the correct insertion of probes and catheters, assessment of urine volume, gastric residue, device placement, volume status, and cardiac, pulmonary, and abdominal functions, as well as the detection of ascites, effusions, pneumothorax, and large vessel abnormalities. These advances reinforce the need for the systematic inclusion of this competency in undergraduate education18-19.
The findings show that, among the 53 CCPs analyzed, only five HEIs, three in the Northeast, one in the South and one in the Southeast, include curricular components related to imaging exams. In two of them, these components are mandatory and distributed at different points in the course, while only one requires prerequisites aligned with the National Curriculum Guidelines (DCNs)20. In three institutions, the content is offered as elective courses, which reduces its formative centrality. Furthermore, gaps persist in the course outlines regarding the theoretical and/or practical approach, hindering pedagogical clarity and the adequate preparation of students to work in technologically advanced environments2,9-10.
To overcome these shortcomings, scholars point to the urgent need to revise and improve the curriculum structure and the teaching-learning process, ensuring clearer lesson plans aligned with the DCNs20. It is essential to strengthen the link between theoretical knowledge and practice in health services, valuing the quality of supervised internships and the active role of the teacher21-22.
In this context, Residency Programs emerge as relevant training strategies. Of particular note is the Nursing Residency Program in Diagnostic Imaging at the Nossa Senhora das Graças Nursing School and the Hospital da Restauração in Recife/PE, linked to the Government School of Public Health of Pernambuco (ESSPE). A pioneer in the Northeast, it trains nurses to work in endoscopy, hemodynamics, tomography, magnetic resonance imaging, and nuclear medicine, through a pedagogical approach that integrates theory, practice, and research, with rotations in reference hospitals. With a workload of 5,760 hours and continuous assessment, the program represents a milestone in the consolidation of the specialty and highlights the need for greater alignment between regulations, training, and professional practice23.
In contrast, it is worth noting that the low curricular representation mentioned above contrasts with the normative framework of the profession. COFEN Resolution No. 679/2021, for example, authorizes and regulates the use of ultrasound by nurses in specific clinical situations, and Resolution No. 625/2020 recognizes Nursing in Diagnostic Imaging as a specialty. Most of the projects analyzed, however, do not yet incorporate these updates, indicating a mismatch between legal advancements and the current curriculum structure5-6.
This scenario may be related to the year the CCPs were published, reinforcing the need for periodic revisions, as well as raising reflections on the profile of the teachers who develop them and whether their experience influenced the inclusion of the topic. The DCNs provide for curricular and teaching updates as a mandatory principle, making the incorporation of innovative content a normative and ethical requirement to ensure training quality15. As research indicates, these findings reinforce the urgency of rethinking curricula in light of the complexity of care settings, technological innovation, and contemporary legal and healthcare demands5,22,24-25.
When analyzing the geographical distribution of institutions offering content related to imaging exams, a greater concentration was observed in the Southeast and South regions. Historically, the first nursing schools in Brazil emerged in these regions and house more established institutions with a longer history, which may have influenced the earlier incorporation of disciplines focused on specialized clinical practices26-27.
However, a linear relationship cannot be established between institutional longevity and the presence of the subject matter, since some newer universities also present innovative curricular proposals, reflecting updates in response to the new technological demands of professional practice. Despite this, the predominance of elective approaches or those integrated into broader courses indicates that skills in interpreting exams still do not occupy a central and systematic space in the generalist training of nurses.
There is also a concentration of content related to imaging exams in courses that do not have an exclusive focus on the topic, which hinders the acquisition of specific skills. This diluted approach can create insecurity among graduates when faced with the need to work in units that perform exams such as CT scans, MRIs, or ultrasounds4-10.
Furthermore, the presence of elective, rather than mandatory, curricular components that address the topic, as identified in some of the institutions analyzed, indicates that the area is not yet considered central to the generalist training of nurses. In this context, the update to the National Curriculum Guidelines, proposed by the Ministry of Education and discussed by COFEN in 2024, reinforces the need for nursing education to be aligned with contemporary care demands, including the safe and critical use of diagnostic technologies9.
These guidelines also emphasize competency-based learning, integrating theory and practice, with a focus on real and simulated experiences, an aspect that is especially relevant to teaching11.21. In this regard, references indicate that the gap between theory and practice remains a challenge in nursing education4. From this perspective, studies demonstrate that technological tools in the teaching of diagnostic imaging can enhance learning and promote students' familiarization with clinical activities. However, the scarcity of initiatives in this regard reflects the challenge of innovation in the academic environment, especially in institutions with structural and pedagogical constraints25.
Therefore, this analysis reinforces the urgency of rethinking the curricular structure of undergraduate nursing courses, systematically incorporating knowledge related to imaging exams, with legal, pedagogical, and ethical support. The structured inclusion of this content promotes the consolidation of essential skills for contemporary care and helps to reduce training gaps that are still present in a large part of Brazilian HEI. Thus, the training of professionals who are better prepared to work safely, competently, and proactively in increasingly technological and interdisciplinary healthcare services is expected.
This study has limitations inherent to its documentary design, as it is based exclusively on the analysis of Course Curriculum Proposals, and is therefore subject to the degree of completeness, updating, and transparency of these records. Additionally, there is a scarcity of primary studies, systematic reviews, and meta-analyses published in high-impact journals that specifically address the teaching of image exams interpretation in undergraduate nursing programs. This gap restricts the possibilities for comparing the findings and limits the scope of the discussion.
CONCLUSIONS
The analysis shows that Nursing courses at federal universities still present a limited, fragmented, and heterogeneous inclusion of content focused on the interpretation of imaging exams. Even when present, these themes emerge sporadically in preparatory, semiological, or elective courses, not forming a structuring axis of the training, which contrasts with the SUS growing technological demands and the recognition of the specialty by COFEN.
Given this scenario, a curricular update that continuously and transversally integrates theoretical and practical foundations of nursing practice in relation to imaging exams becomes essential, associated with the use of active methodologies, educational technologies, and simulated or real environments. This reformulation strengthens the development of clinical and analytical skills, consolidating the training of nurses capable of acting safely, critically, and proactively in increasingly technological and interdisciplinary health services, as evidenced by the research analyzed.
ACKNOWLEDGMENT
Universidade Estadual da Paraíba Graduate Program in Public Health (PPGSP).
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NOTES
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FUNDING INFORMATION
This work was carried out with the support of the Universidade Estadual da Paraíba, PRPGP Notice 01/2026.
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APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Given the nature of the sources (documentary), review by the Ethics Committee is not required, in accordance with Ethics Resolution No. 510/2016.
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TRANSLATED BY
Denise Costa Rodrigues.
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DATA AVAILABILITY
All the data supporting the results of this study were published in the article itself.
All the data supporting the results of this study were published in the article itself.
