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Badawy MK, Kashish K, Payne S, Masterson M. Comparing fetal phantoms with surrogate organs in female phantoms during CT exposure of pregnant patients. Phys Eng Sci Med 2024; 47:531-538. [PMID: 38206532 PMCID: PMC11166780 DOI: 10.1007/s13246-024-01383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
With the rising use of Computed Tomography (CT) in diagnostic radiology, there are concerns regarding radiation exposure to sensitive groups, including pregnant patients. Accurately determining the radiation dose to the fetus during CT scans is essential to balance diagnostic efficacy with patient safety. This study assessed the accuracy of using the female uterus as a surrogate for fetal radiation dose during CT imaging. The study used common CT protocols to encompass various scenarios, including primary beam, scatter, and partial exposure. The computational program NCICT was used to calculate radiation doses for an adult female and a fetus phantom. The study highlighted that using the uterus for dose estimation can result in consistent underestimations of the effective dose, particularly when the fetus lies within the primary radiation beam. These discrepancies may influence clinical decisions, affecting care strategies and perceptions of associated risks. In conclusion, while the female uterus can indicate fetal radiation dose if the fetus is outside the primary beam, it is unreliable when the fetus is within the primary beam. More reliable abdomen/pelvic organs were recommended.
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Affiliation(s)
- Mohamed Khaldoun Badawy
- Monash Health Imaging, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3800, Australia.
| | - Kashish Kashish
- School of Life and Environmental Sciences, Deakin University, Burwood, VIC, 3125, Australia
| | - Shay Payne
- Monash Health Imaging, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Maeve Masterson
- Monash Health Imaging, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
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Kaim A, Singer C, Bergovoy-Yellin L, Luxenburg O, Vaknin S, Boldor N, Wilf-Miron R, Myers V. Exploring pre-MRI imaging tests: patient survey reveals potential implications for healthcare efficiency in Israel. Isr J Health Policy Res 2024; 13:7. [PMID: 38556863 PMCID: PMC10983758 DOI: 10.1186/s13584-024-00593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/27/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Medical imaging tests are vital in healthcare but can be costly, impacting national health expenditures. Magnetic resonance imaging (MRI) is a crucial diagnostic tool for assessing medical conditions. However, the rising demand for MRI scans has frequently strained available resources. This study aimed to estimate the prevalence of different imaging tests in individuals who eventually had an MRI, in the Israeli public health system. METHODS An online survey of patient experience of scheduling an MRI was conducted in January-February 2023, among 557 Israeli adults, representing all four health maintenance organizations (HMOs). All participants had undergone an MRI in the public health system within the past year. RESULTS Results showed that 60% of participants underwent other imaging tests before their MRI scan. Of those, computed tomography (CT) scans (43%), X-rays (39%), and ultrasounds (32%) were the most common additional imaging procedures. In addition, of the 60% of participants, 23% had undergone more than one prior imaging examination. CONCLUSIONS These findings highlight the high prevalence of preliminary imaging tests prior to MRI, with many patients undergoing multiple tests for the same problem. The health system may need to evaluate whether current clinical guidelines defining the use of various imaging tests are cost-effective.
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Affiliation(s)
- Arielle Kaim
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel.
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Tel Aviv University, P.O. Box 39040, 6139001, Tel Aviv, Israel.
| | - Clara Singer
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
| | - Lucia Bergovoy-Yellin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Sharona Vaknin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Noga Boldor
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
- Department of Health Promotion, Faculty of Medicine, School of Public Health, Tel Aviv University, P.O. Box 39040, 6139001, Tel Aviv, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5266202, Ramat-Gan, Israel
- Department of Health Promotion, Faculty of Medicine, School of Public Health, Tel Aviv University, P.O. Box 39040, 6139001, Tel Aviv, Israel
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Abu Awwad D, Hill S, Lewis S, Jimenez YA. Infection prevention and control in CT Part 1: An Australian study of roles, responsibilities and practices. Radiography (Lond) 2024; 30:245-251. [PMID: 38035440 DOI: 10.1016/j.radi.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The computed tomography (CT) suite presents Infection Prevention and Control (IPC) risks for staff and patients. This is the first of a two-part series on IPC in the CT setting and reports on Australian baseline data related to intravenous contrast media administration and the use of power injectors in the CT suite, including knowledge sources related to the delivery of contrast media. The second part provides insights into CT staff's perceptions of high-risk scenarios for non-adherence to standard or transmission-based precautions. METHODS The study employed an online survey design, directed at radiographers and radiology nurses working in Australia. The survey included questions relating to CT workplace staffing and equipment, contrast media use and occupational roles, and knowledge sources used for infection control and contrast injectors. RESULTS Overall, 160 study participants completed the survey (radiographers: n = 138, 86.3%; nurses: n = 22, 13.7%). Differences were identified between public and private practice. Public hospitals completed more contrast-enhanced scans, and with dual injecting systems, operated and cleaned by radiographers and nurses. Private clinics generally used single-system, power injectors. Radiographers and nurses relied heavily on their colleagues and product guidelines for IPC information. IPC teams were uncommon in private clinics, very common in public departments and 50% of respondents had undertaken IPC training in the last 12 months. CONCLUSION Insights into use and duties of professionals delivering intravenous contrast media administration using power injectors in the CT suite will help to inform decision-making processes on IPC education strategies and map risk. IMPLICATION FOR PRACTICE Future research should focus on how radiology workers in CT perceive IPC risk and/or might vary from best practice, which has direct clinical implications for safety if contamination, or incorrect information is routinely applied.
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Affiliation(s)
- D Abu Awwad
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, USA
| | - S Hill
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, USA
| | - S Lewis
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, USA. https://twitter.com/@SarahLewisUSYD
| | - Y A Jimenez
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, USA.
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Jimenez YA, Hill S, Lewis S, Abu Awwad D. Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols. Radiography (Lond) 2024; 30:265-273. [PMID: 38035444 DOI: 10.1016/j.radi.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Adherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. METHODS A self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question "If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …" was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. RESULTS Study participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). 'Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to 'Tasks' (43.7%) and 'Organisation' (30.6%) followed by issues related to 'Person' (16.9%), 'Tools and technology' (6.9%) and 'Environment' (1.9%). CONCLUSION Multi-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. IMPLICATIONS FOR PRACTICE Future studies that focus on evaluation of 'Tasks' and 'Organisation' domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.
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Affiliation(s)
- Y A Jimenez
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia.
| | - S Hill
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| | - S Lewis
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia. https://twitter.com/@SarahLewisUSYD
| | - D Abu Awwad
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
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Ha NT, Harris M, Bulsara M, Doust J, Kamarova S, McRobbie D, O'Leary P, Parizel PM, Slavotinek J, Wright C, Youens D, Moorin R. Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia. Eur J Trauma Emerg Surg 2023; 49:2413-2427. [PMID: 37318517 PMCID: PMC10728237 DOI: 10.1007/s00068-023-02303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Whilst computed tomography (CT) imaging has been a vital component of injury management, its increasing use has raised concern regarding ionising radiation exposure. This study aims to identify latent classes (underlying patterns) of CT use over a 3-year period following the incidence of injury and factors predicting the observed patterns. METHOD A retrospective observational cohort study was conducted in 21,544 individuals aged 18 + years presenting to emergency departments (ED) of four tertiary public hospitals with new injury in Western Australia. Mixture modelling approach was used to identify latent classes of CT use over a 3-year period post injury. RESULTS Amongst injured people with at least one CT scan, three latent classes of CT use were identified including a: temporarily high CT use (46.4%); consistently high CT use (2.6%); and low CT use class (51.1%). Being 65 + years or older, having 3 + comorbidities, history with 3 + hospitalisations and history of CT use before injury were associated with consistently high use of CT. Injury to the head, neck, thorax or abdomen, being admitted to hospital after the injury and arriving to ED by ambulance were predictors for the temporarily high use class. Living in areas of higher socio-economic disadvantage was a unique factor associated with the low CT use class. CONCLUSIONS Instead of assuming a single pattern of CT use for all patients with injury, the advanced latent class modelling approach has provided more nuanced understanding of the underlying patterns of CT use that may be useful for developing targeted interventions.
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Affiliation(s)
- Ninh T Ha
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Mark Harris
- School of Accounting, Economics and Finance, Faculty of Business and Law, Curtin University, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, Brisbane, Australia
| | - Sviatlana Kamarova
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- School of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
- Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
| | - Donald McRobbie
- School of Physical Sciences, University of Adelaide, Adelaide, Australia
| | - Peter O'Leary
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, WA, Australia
| | - Paul M Parizel
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Radiology, Royal Perth Hospital, Victoria Square, Perth, WA, 6000, Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cameron Wright
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, University of Western, Perth, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - David Youens
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Crawley, Australia
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