Evaluation of the quality and impact of online learning through the SAFE EUROPE webinars

INTRODUCTION

The SAFE EUROPE project, a European-funded project, addressed educational gaps of Therapeutic Radiographers/Radiation Therapists (TR/RTTs) by offering a series of free webinars. This study aimed to assess the quality of these webinars and their impact on professional practice.

METHODS

Data collection involved two methods: an automated feedback form administered after each webinar, supplemented by a survey disseminated through social media. The collected data encompassed attendance statistics, participants' professions and geographic locations, webinar quality assessment, the acquisition of new knowledge and skills, the application of this newfound knowledge in practice, and the likelihood of recommending these webinars. Descriptive statistics and thematic analysis were used to analyse the quantitative and qualitative data, respectively. Ethical approval for the study was obtained.

RESULTS

11,286 individuals from 107 countries participated in 18 webinars. Despite 72.7% being radiographers, a diverse array of professionals attended the webinars, including medical physicists, oncologists, radiologists, and academics. Remarkably, 98.7% of respondents rated the webinar quality as either good or excellent. The average rating for the likelihood of recommending these webinars to colleagues was 8.96/10. A substantial proportion of respondents expressed agreement or strong agreement that the webinars enhanced their knowledge (85%) and skills (73%). Furthermore, 79% of participants indicated that the webinars motivated them to change practice, with 65% having already implemented these changes. The insights from open-ended questions corroborated these findings.

CONCLUSION

The webinars effectively achieved the aim of the SAFE EUROPE project to enhance practice by increasing knowledge and skills. Participants overwhelmingly endorsed the quality of these webinars.

IMPLICATIONS FOR PRACTICE

Webinars represent a cost-efficient training tool that reaches a global audience and various radiography/radiotherapy professions. The development of additional webinars is strongly recommended.

Radiography students' viewpoints of the clinical learning environment: A cross-sectional study

INTRODUCTION

The quality of clinical learning environments (CLEs) impact learners' experience and competence development. Objective instruments have been developed to evaluate CLEs from the perspective of medical and nursing students. No such instruments have been used in Radiography.

METHODS

Radiography students' perspectives of CLEs were investigated using the validated Undergraduate Clinical Education Environment Measure (UCEEM). Undergraduate (UG) (n = 365) and graduate entry (GE) radiography students (n = 45) from an Irish university were invited to participate. CLEs consisted of 25 public and 10 private hospitals. The UCEEM contains 26 items under two overarching dimensions, experiential learning and social participation, with four subscales: opportunities to learn in and through work and quality of supervision; preparedness for student entry; workplace interaction patterns and student inclusion; and equal treatment.

RESULTS

Two hundred and ten students participated (response rate 52.4%; n = 185 UG, n = 30 GE), most of whom were based in public hospitals (87.4%). The mean UCEEM score was 107.5 ± 17.7 (optimal range: 90-125). Experiential learning and social participation were scored 74.2 ± 12.5 (optimal range: 60-85) and 33.37 ± 6.29 (optimal range: 30-40), respectively. Private hospitals ranked slightly higher than public hospitals for 'opportunities to learn in and through work and quality of supervision' (p = 0.018). Items ranked highest related to 'equal treatment' and 'opportunity to put theory into practice'. Clinical supervision-related items were scored highest by first-year students.

CONCLUSION

High UCEEM scores indicate radiography students' positive perceptions of their CLEs, particularly regarding equality and experiential learning. Findings support the expansion of radiography placement to include public and private hospitals.

IMPLICATIONS FOR PRACTICE

The UCEEM is a theoretically robust, validated tool which appears suitable for evaluating radiography CLEs. This study provides valuable baseline data for comparison of Radiography CLEs.

An investigation into academic career pathways across Radiography education centres internationally

INTRODUCTION

Robust academic pathways are critical to support of radiography faculty within third level education. As the profession of Radiography grows its' research activity, it is important that academic opportunities meet the needs of the profession. The purpose of this research was to investigate current academic career pathways across radiography education centres internationally.

METHODS

An online survey was developed and administered to radiography academics and clinical/academic staff members internationally. The survey questions (n = 28) include demographic data; teaching and research requirements; academic promotion criteria; identification of the challenges and benefits of being an academic, including equality, diversity and inclusion (EDI) matters.

RESULTS

A total of 175 responses were obtained (6 continents and 39 countries), with a variety of experience levels amongst academics that primarily held permanent work contracts. Regarding the highest qualifications held, 31.4% (n = 55) had a Doctorate and 45.7% (n = 80) a Master's degree, and most respondents were employed as academic lecturers (40.6%; n = 71), with 17.7% (n = 31) employed at professorial level. The minimum time requirement to achieve a permanent contract was variable, ranging from no delay (5.7%; n = 10) to more than 10 years (12.6%; n = 22). Doctorate qualification is currently not necessary in order to career progression for 126 (72%) respondents, while 52% (n = 91) provided specific research requirements. 106 (60.6%) respondents indicated that their institution has EDI policy.

CONCLUSION

This study has captured details related to academic pathways across international radiography education centres. Whilst some heterogeneity exists, there are numerous differences impacting standardised academic career opportunities for Radiography academics. These may challenge academic career opportunities and discourage those interested in an academic career.

IMPLICATIONS FOR PRACTICE

The profile and educational background of these academics has been highlighted as well as the perceived barriers and advantages of a career in academic.

Radiography education in 2022 and beyond - Writing the history of the present: A narrative review

OBJECTIVES

The COVID-19 pandemic had a major effect on teaching and learning. This study aimed to describe a range of teaching, learning, and assessment strategies related to radiography education which have become more common due to the pandemic through a narrative literature review.

KEY FINDINGS

Educational change in radiography was accelerated by the disruption caused by the pandemic. Changes included the site and mode of teaching and conducting of assessment. While some of the digital transformation trends were introduced before the pandemic, others were further amplified during this period of time. Alternative solutions such as virtual reality technology, gamification, and technology-enhanced learning were especially salient and have the potential to mitigate challenges brought about by the pandemic. The use of technology in the clinical setting, in assessment, and to facilitate feedback, are important tools for improving learners' clinical skills performance. Collectively, these digital technologies can maximise learning and support mastery of knowledge, skills and attitudes.

CONCLUSION

The pandemic has cast a new light on existing methodologies and pedagogies in education. This review suggests that digital technology is shaping teaching and learning within radiography education and also that educators cannot ignore this digital shift. With the digital trajectory, it would be highly useful to transform approaches to education within radiography to support learning as radiography education moves towards the new normal era.

IMPLICATIONS FOR PRACTICE

Digital technology in education can help improve the learning experience for learners but educators need to be equipped with the technological skills and be adaptable to these changes. Continual sharing of experiences and knowledge among radiography educators is essential. Safety nets need to be in place to ensure digital inclusiveness and that no learner gets left behind due to the digital divide in education.

The risk of burnout in academic radiographers during the COVID-19 pandemic

Introduction

The COVID-19 pandemic created major challenges across society, healthcare provision and also for those delivering healthcare education programmes. Clinical placements were disrupted and, in many incidences cancelled. Higher education institutions were required to move completely to online delivery methods with little notice. This created significant additional workload, stress and the need to learn new skills at a time of great uncertainty. This study explored the risks of burnout in academic radiographers during the first 12 months of the pandemic.

Methods

A survey was circulated using SurveyMonkey™ via personal, national and international networks, including the European Federation of Radiographer Societies (EFRS), to reach as many academic radiographers as possible. Disengagement and exhaustion were measured using the Oldenburg burnout inventory. Descriptive statistics and a one-way ANOVA were used to analyse the quantitative data using STATA V16 (Statacorp, TA).

Results

533 academic radiographers responded to the survey from 43 different countries. Mean disengagement was in the medium range and exhaustion was high for the total dataset. In a subset of countries with 10 or more responses, there was significant variation between countries, with the UK having highest mean exhaustion score and the UK, Ireland and France sharing the highest mean disengagement score. In the total dataset, 86% agreed workload had increased during the pandemic and 35% had considered leaving academia in the last year.

Conclusion

These data demonstrate the stark reality of the impact of the COVID-19 pandemic on academic radiographers’ workload, wellbeing, and intention to leave their roles.

Implications for practice

COVID-19 has had a significant impact on academic radiographers and this study highlights the urgent need for remedial measures to better support academic radiographers in order to ensure a sufficient, and sustainable workforce.

THE EFFECTS OF CONE-BEAM COMPUTED TOMOGRAPHY IMAGING GUIDANCE ON PATIENT RADIATION EXPOSURES IN TRANS-ARTERIAL CHEMOEMBOLISATION FOR HEPATOCELLULAR CARCINOMA

This study investigated the effects of cone-beam computed tomography (CBCT) guidance in trans-arterial chemoembolisation (TACE) procedures on the number of digital subtraction angiography (DSA) runs acquired and total patient radiation exposure in patients with hepatocellular carcinoma (HCC). A retrospective, analytical cross-sectional, single institution, study was conducted. Dose data were compared across the control (DSA guidance alone) and study (DSA and CBCT guidance) groups. A total of 122 procedures were included within the study. There was a significant reduction in the number of DSA runs (3 vs 5, p < 0.001) and DSA air kerma-area product (PKA) (3077.3 vs 4276.6 μGym2, p = 0.042) for the study group when compared to the control group. Total procedural PKA and total procedural reference air kerma (Ka,r) were shown to be 50 and 73% higher, respectively, for the study group when compared to the control group. CBCT imaging guidance does reduce the number of DSA runs and DSA PKA required to complete the TACE procedure for patients diagnosed with HCC; however, a substantial increase in total procedural PKA is to be expected and it is thus important that this increased dose is carefully considered and justified.

International audit of simulation use in pre-registration medical radiation science training

INTRODUCTION

Simulation-based education (SBE) can replicate the challenging aspects of real-world clinical environments, while providing a safe and less intimidating setting. Literature supports its use within medical radiation science (MRS) training for safe practice of psychomotor skills, development of problem solving, team working, interpersonal and decision-making skills and embedding awareness of patient safety. This project aimed to quantify usage of SBE resources and activities internationally and to evaluate how this changed during COVID-19 restrictions.

METHODS

An anonymous online survey tool gathered data relating to programme demographics, simulation resources, simulation activities and future plans. A link to the survey was distributed to programme leads via social media, professional bodies and national networks.

RESULTS

A total of 72 responses were received from a range of countries and representing a range of programme structures. Most respondents reported up to 100 h of SBE per student per year with low fidelity resources and image viewing software featuring most prominently. There was low reported engagement of service users within simulation activities. Respondents also indicated that COVID-19 had been a trigger for rapid uptake of simulation resources.

CONCLUSION

SBE forms an important aspect of MRS training internationally with low-fidelity resources being widely deployed. Where available, high fidelity virtual reality and specialised profession-specific resources were used heavily. There was a low level of reported engagement with service users or expert patients in simulation activities. Future research will identify whether the rapid uptake of SBE during COVID-19 continues and clarify the role of service users in SBE provision.

IMPLICATIONS FOR PRACTICE

Increased collaboration between MRS education providers may help to improve parity of SBE provision and identify additional opportunities to engage service users within SBE.

International perspectives on radiography practice education

INTRODUCTION

The radiography profession is built upon strong educational foundations which help ensure graduate radiographers have the required knowledge, skills, and competence to practise safely and effectively. Changing clinical practices, service needs, technological developments, regulatory changes, together with our growing professional evidence-base, all contribute to the need for our curricula to responsive and continually reviewed and enhanced. This study aims to explore similarities and differences in training curricula and follows a 2012 global survey on radiography education and more recent surveys undertaken by the European Federation of Radiographer Societies (EFRS).

METHODS

An online questionnaire, based on previous EFRS education and clinical education surveys, which comprised of open and closed questions and consisted of sections designed to ascertain data on: type, level and duration of education programmes leading to an initial or pre-registration qualification in radiography/medical radiation practice, pre-clinical skill development and clinical placement within programmes. The survey was distributed via social media channels and through an international network of professional societies. Descriptive statistics are reported for most analyses while open questions were analysed thematically.

RESULTS

Responses were received from 79 individuals from 28 identified countries across four continents. This represented a total of 121 different pre-registration/entry level programmes offered across these institutions. While dedicated diagnostic radiography programmes were most common (42/121), almost one-third of programmes (40/121) offered two or more areas of specialisation within the curriculum. The average of total hours for clinical placement were 1397 h for diagnostic radiography programmes; 1300 h for radiation therapy programmes; 1025 h for nuclear medicine programmes; and 1134 h for combined specialisation programmes, respectively. Institutions provided a range of physical and virtual systems to support pre-clinical skills development.

CONCLUSION

Around the world, radiography programmes vary considerably in terms of their level, duration, programme type, pre-clinical and clinical training, use of simulation, and also in terms of class sizes, student/staff ratios, and graduate employment prospects. The ability of graduates to work independently in areas covered within their programmes varied considerably. While some changes around simulation use were evident, given the impact of COVID-19 it would be beneficial for future research to investigate if pre-clinical and clinical education hours or use of simulation resources has changed due to the pandemic.

IMPLICATIONS FOR PRACTICE

The heterogeneity that exists between radiography programmes presents a significant challenge in terms of the mutual recognition of qualifications and the international movement of the radiographer workforce.

The impact of COVID-19 upon student radiographers and clinical training

Introduction

To investigate student clinical placement concerns and opinions, during the initial COVID-19 pandemic outbreak and to inform educational institution support planning.

Methods

Between mid-June to mid-July 2020, educational institutions from 12 countries were invited to participate in an online survey designed to gain student radiographer opinion from a wide geographical spread and countries with varying levels of COVID-19 cases.

Results

1277 respondents participated, of these 592 had completed clinical placements during January to June 2020. Accommodation and cohabiting risks were identified as challenging, as was isolation from family, travel to clinical placements, and to a lesser extent childcare. Students stated they had been affected by the feeling of isolation and concerns about the virus whilst on placement. Overall 35.4% of all respondents were ‘Not at all worried’ about being a radiographer, however, 64.6% expressed varying levels of concern and individual domestic or health situations significantly impacted responses (p ≤ 0.05). Year 4 students and recent graduates were significantly more likely to be ‘Not worried at all’ compared to Year 2 and 3 students (p ≤ 0.05). The need for improved communication regarding clinical placements scheduling was identified as almost 50% of students on clinical placements between January to June 2020 identified the completion of assessments as challenging. Furthermore, only 66% of respondents with COVID-19 imaging experience stated being confident with personal protective equipment (PPE) use.

Conclusion

Student radiographers identified key challenges which require consideration to ensure appropriate measures are in place to support their ongoing needs. Importantly PPE training is required before placement regardless of prior COVID-19 imaging experience.

Implications for practice

As the next academic year commences, the study findings identify important matters to be considered by education institutions with responsibility for Radiography training and as students commence clinical placements during the on-going global COVID-19 pandemic.

Inclusion of evidence and research in European radiography curricula

PURPOSE

To provide a short reflective article discussing the extent to which evidence and research are included within radiography training curricula and whether there is a need for change and greater standardisation.

FINDINGS

Great steps have been taken to harmonise aspects of radiography training programmes across Europe, however, variations do exist, especially in the areas of clinical practice, training hours and inclusion of specific curriculum topics. Limited evidence exists regarding the inclusion of evidence and research; thus, diversity is likely. The majority of training curricula follow the Bologna cycle and both research and evidence components are likely to be included within teaching and assessment. Wider questions exist regarding maintaining and developing the research and evidence culture within the radiography profession. Education institutions will play an important role in this process.

CONCLUSION

Limited evidence exists regarding the inclusion of 'evidence' and 'research' themes within European radiography training curricula. Undoubtedly, there is a need for these themes, but this must be balanced with other demands on the curriculum and how research is likely to evolve within the profession.

IMPLICATIONS FOR PRACTICE

Greater clarity is needed on how evidence and research are to be included within radiography training curricula. A single model is unlikely to be suitable for all, curricula should focus on the requirements for the newly qualified graduate and the radiography profession as a whole.

An Investigation of Procedural Radiation Dose Level Awareness and Personal Training Experience in Communicating Ionizing Radiation Examinations Benefits and Risks to Patients in Two European Cardiac Centers

PURPOSE

Cardiac interventional practitioners need to be appropriately informed regarding radiation dose quantities and risks. Communicating benefit-risk information to patients requires attention as specified in Basic Safety Standards Directive 2013/59/Eurotom. This study investigated the awareness of procedural radiation dose levels and the impact of personal training experience in communicating ionizing radiation benefit-risks to patients.

METHODOLOGY

A questionnaire, consisting of 28 questions, was distributed directly to adult and pediatric interventional cardiology specialists at specialized cardiovascular imaging centers in Dublin, Ireland and Milan, Italy.

RESULTS

A total of 18 interventional cardiologists (senior registrar to consultant grades with between 2 y to over 21 y experience in cardiac imaging) participated. The majority of participants (n = 17) stated that parents of pediatric and adult patients should be informed of the potential benefits and risk. All participants indicated they had radiation safety training; however, 50% had not received training in radiation examination benefit-risk communication. Despite this, 77.8% (n = 14) participants indicated a high confidence level in successfully explaining risks and/or benefits of cardiac imaging procedures. When asked to estimate effective dose (ED) values for common cardiac imaging procedures less than 50% identified appropriate dose ranges. All participants underestimated procedural dose values based on recent European data. 50% (n = 9) participants answered all questions correctly for a number of true or false radiation risk statements.

CONCLUSION

Benefit-risk communication training deficits and inaccurate understanding of radiation dose levels was identified. Further research and training to support clinicians using radiation on a daily basis is required.

Clinical radiography education across Europe

PURPOSE

To establish a picture of clinical education models within radiography programmes across Europe by surveying higher education institutions registered as affiliate members of the European Federation of Radiography Societies (EFRS).

METHOD

An online survey was developed to ascertain data on: practical training, supervisory arrangements, placement logistics, quality assurance processes, and the assessment of clinical competencies. Responses were identifiable in terms of educational institution and country. All educational institutions who were affiliate members at the time of the study were invited to participate (n = 46). Descriptive and thematic analyses are reported.

RESULTS

A response rate of 82.6% (n = 38) was achieved from educational institutions representing 21 countries. Over half of responding institutions (n = 21) allocated in excess of 60 European Credit Transfer and Accumulation System (ECTS) credits to practical training. In nearly three-quarters of clinical placements there was a dedicated clinical practice supervisor in place; two-thirds of these were employed directly by the hospital. Clinical practice supervisors were typically state registered radiographers, who had a number of years of clinical experience and had received specific training for the role. Typical responsibilities included monitoring student progress, providing feedback and completing paperwork, this did however vary between respondents. In almost all institutions there were support systems in place for clinical placement supervisors within their roles.

CONCLUSIONS

Similarities exist in the provision of clinical radiography education across Europe. Clinical placements are a core component of radiography education and are supported by experienced clinical practice supervisors. Mechanisms are in place for the selection, training and support of clinical practice supervisors. Professional societies should work collaboratively to establish guidelines for effective clinical placements.

The use of neuroimaging in dementia by Irish general practitioners

BACKGROUND

More than 48,000 people in Ireland are living with dementia, and the number is likely to rise to 130,000 by 2041. Dementia frequently remains undiagnosed, depriving many of early interventions and the opportunity to plan for the future. Neuroimaging is helpful in the diagnosis of dementia, yet it is often insufficiently utilised. General practitioners (GPs) often decide which patients should be referred on for specialist assessment and as such play a crucial role in dementia diagnosis.

AIMS

To establish the accessibility of neuroimaging in dementia by GPs, current referral patterns, confidence in referral and opinions on radiology reports.

METHODS

The research design was a postal survey among GPs in single and group practices in urban, rural and semi-rural areas in the east and southeast of Ireland. GPs were identified from the Irish Medical Directory and posted individual anonymous questionnaires.

RESULTS

A third of participants reported that they had no direct access to neuroimaging. Access differed between public and private patients. GPs primarily referred to computed tomography and magnetic resonance imaging, but only 14.6 % based these referrals on published guidelines. A total of 47.8 % of participants were not very confident in their ability to choose the most appropriate modality.

CONCLUSION

Access to neuroimaging investigations for suspected cases of dementia varies between locations and public and private systems. To improve diagnostic rates and ensure appropriate utilisation of imaging resources, GPs require access to clinical and referral guidelines to ensure appropriate use of neuroimaging and the best possible patient outcomes.

DICOM part 14: GSDF-calibrated medical grade monitor vs a DICOM part 14: GSDF-calibrated "commercial off-the-shelf" (COTS) monitor for viewing 8-bit dental images

OBJECTIVES

To investigate whether there is any difference in the presented image quality between a medical grade monitor and a "commercial off-the- shelf" (COTS) monitor when displaying an 8-bit dental image.

METHODS

The digital imaging and communications in medicine (DICOM) part 14: greyscale standard display function (GSDF) was verified for both monitors. A visual grading characteristics (VGC) curve was constructed to measure the difference in image quality between the two monitors by comparing radiological structures displayed on each monitor with a DICOM part 14: GSDF-calibrated laptop monitor as reference.

RESULTS

All of the monitors conformed to within the American Association of Physicists in Medicine Task Group 18 10% tolerance levels for the assessment of the DICOM part 14: GSDF. There was no difference in the preferred perceived visual sensation for the displayed image between the two tested monitors with the area under the VGC curve = 0.53 and 95% confidence interval = 0.47-0.59.

CONCLUSIONS

A DICOM part 14: GSDF COTS monitor is capable of displaying an image quality that is equally preferred to a DICOM part 14: GSDF medical grade monitor for an 8-bit image file.

Diagnostic Efficacy of Conventional MRI Pulse Sequences in the Detection of Lesions Causing Internuclear Ophthalmoplegia in Multiple Sclerosis Patients

PURPOSE

The purpose of this study was to investigate the diagnostic efficacy of a range of conventional magnetic resonance imaging (MRI) pulse sequences in the identification of internuclear ophthalmoplegia (INO) caused by medial longitudinal fasciculus (MLF) lesions in multiple sclerosis patients using a receiver-operating characteristic (ROC) methodology.

METHODS

A total of 15 clinically confirmed INO and 15 control subjects underwent conventional MRI at 1.5 T consisting of T2-weighted, proton density (PD)-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences, following full institutional approval. A free-response, multiple-reader multiple-case design ROC study was used to evaluate the diagnostic efficacy of each sequence. All imaging sequences were evaluated by 10 board-certified neuroradiologists. Area under the curve (AUC), sensitivity, and specificity were analysed statistically for all three pulse sequences using repeated-measures analyses of variance and post-test analysis using Bonferroni's multiple comparison test of differences.

RESULTS

No significant AUC differences were found between the three sequences (p = 0.0697), with T2 recording the highest AUC (0.8346). Sensitivity differences between PD (0.7927) and FLAIR (0.6329) were significant (p < 0.05). Non-significant differences were also evident between T2 and FLAIR (p = 0.0511). The specificity analysis revealed an overall difference (p = 0.0005), with specific inter-sequence differences shown between T2 and PD (p < 0.05) and PD and FLAIR (p < 0.001) with the PD values being lower than those provided with the other two sequences.

CONCLUSION

T2-weighted axial imaging through the MLF region resulted in the greatest overall diagnostic efficacy when viewing a combination of mean AUC, sensitivity, and specificity, in terms of the identification of INO-causing lesions.

Quality of 'commercial-off-the-shelf' (COTS) monitors displaying dental radiographs

BACKGROUND

A computer display monitor used for interpreting dental images should have a maximum luminance of 171 cd/m(2). A monitor used for clinical review should have a maximum luminance of 100 cd/m(2).

OBJECTIVE

To compare luminance and ambient lighting measurements for a selection of computer display monitors in different locations of a dental teaching hospital to available guidelines. To assess six commercial off-the-shelf (COTS) monitors from the radiology department of the dental teaching hospital after calibration to the Digital Imaging and Communications in Medicine Part 14: Greyscale Standard Display Function (DICOM part 14: GSDF).

DESIGN

Data collection.

METHOD

Luminance and illuminance measurements were taken for a selection of monitors used for clinical applications throughout a dental teaching hospital. Conformance data were recorded for six COTS monitors from the radiology department following calibration to the DICOM part 14: GSDF. RESULTS None of the tested monitors had a maximum luminance value that was appropriate for image interpretation and the ambient lighting in the vicinity of the monitors was also set to inappropriate levels for image interpretation. The quality of conformance to the DICOM part 14: GSDF varied among the calibrated COTS monitors in the radiology department.

CONCLUSIONS

: It is important that display devices used for dental radiology are quality assured. Consideration should be given to ensure that monitors used for dental radiological interpretation have a maximum luminance that meets available guidelines. These monitors should be standardised to the DICOM part 14: GSDF and the illumination of the reporting environment should be controlled.

Could standardizing "commercial off-the-shelf" (COTS) monitors to the DICOM part 14: GSDF improve the presentation of dental images? A visual grading characteristics analysis

OBJECTIVES

To investigate whether standardizing commercial off-the-shelf (COTS) display devices to the digital imaging and communications in medicine part 14: greyscale standard display function (DICOM part 14: GSDF) would affect the presentation of dental images.

METHODS

Two COTS display devices from the radiology department of a dental teaching hospital and a laptop computer monitor for reference were calibrated to conform to DICOM part 14: GSDF. Four dental surgeons and two final-year students undertook a relative visual grading analysis of the two devices before and after calibration, under control of the viewing environment.

RESULTS

Calibrating COTS display devices to conform to the DICOM part 14: GSDF and viewing under reduced ambient light result in a consistent, perceived visual sensation for the presented radiological image. The area under the visual grading characteristics curve (AUCVGC) before calibration is 0.62 CI (0.56, 0.68) and AUCVGC after calibration is 0.51 CI (0.45, 0.57).

CONCLUSIONS

Standardizing COTS display devices to the DICOM part 14: GSDF can improve image presentation.

Investigation into scatter radiation dose levels received by a restrainer in small animal radiography

OBJECTIVES

To measure the intensity and distribution of scatter radiation received by a restrainer in veterinary radiography including the intensity of scatter radiation passing through lead protective devices at pre-defined positions.

METHODS

Anthropomorphic phantoms and a Labrador dog cadaver were used to simulate a restrainer and patient. Scatter dose measurements were recorded at the position of the restraining hands, thyroid, breast and gonads with and without appropriate lead protection. This was repeated for the eight most common projections as identified in an initial retrospective survey.

RESULTS

Manual restraint of an animal for a radiographic procedure will result in a scatter radiation dose to the restrainer. The level of radiation dose varies between body regions and between projections. The use of appropriate lead protection resulted in statistically significant dose reductions to all body regions with maximum scatter dose reductions between 93 and 100%.

CLINICAL SIGNIFICANCE

While the doses recorded were small (μGy) in terms of associated risk, they are nonetheless cumulative which can result in a more significant dose. Therefore manual restraint should be avoided and forms of immobilisation should be used such as mechanical means, sedation or general anaesthesia. However, if completely necessary both principles of distance and adequate lead protection should be employed.

Impact of bipolar disorder on a U.S. community sample

BACKGROUND

Bipolar disorder is a chronic psychiatric illness characterized by depression and at least 1 manic or hypomanic episode during the lifetime of the illness. Bipolar symptoms have been associated with significant functional impairment. We conducted a study to determine the psychosocial impact of bipolar disorder in a U.S. community sample.

METHOD

3059 subjects were selected from a large epidemiologic study of bipolar prevalence that used the Mood Disorder Questionnaire (MDQ) to screen for bipolar I and II disorder. Subjects were surveyed from April 24, 2001, to August 6, 2001, using the Sheehan Disability Scale and the Social Adjustment Scale-Self Report. Comorbid disease data were also collected.

RESULTS

Of the 3059 subjects surveyed, 2450 (80%) returned completed surveys: 1167 (48%) subjects screened positive for bipolar disorder based on MDQ scores; 1283 (52%) screened negative. MDQ-positive subjects reported significantly (p <.0001) more difficulties with work-related performance, social/leisure activities, and social/family interactions compared with MDQ-negative subjects. Younger subjects, aged 18 to 34 years, reported significantly (p =.003) more symptom days than did older MDQ-positive subjects. MDQ-positive women reported more disruption in social and family life, while MDQ-positive men reported being jailed, arrested, and convicted for crimes. Anxiety (30% vs. 6%), panic attacks (18% vs. 4%), migraine (24% vs. 11%), asthma (17% vs. 10%), and allergies (42% vs. 29%) were significantly (p <.05) more common in MDQ-positive versus MDQ-negative subjects.

CONCLUSION

Bipolar disorder, as identified in a community sample using the Mood Disorder Questionnaire, was significantly associated with negative impact on the performance of work-related, leisure, and interpersonal activities.

Screening for bipolar disorder in the community

BACKGROUND

Our goal was to estimate the rate of positive screens for bipolar I and bipolar II disorders in the general population of the United States.

METHOD

The Mood Disorder Questionnaire (MDQ), a validated screening instrument for bipolar I and II disorders, was sent to a sample of 127,800 people selected to represent the U.S. adult population by demographic variables. 85,358 subjects (66.8% response rate) that were 18 years of age or above returned the survey and had usable data. Of the nonrespondents, 3404 subjects matched demographically to the 2000 U.S. Census data completed a telephone interview to estimate nonresponse bias.

RESULTS

The overall positive screen rate for bipolar I and II disorders, weighted to match the 2000 U.S. Census demographics, was 3.4%. When adjusted for the nonresponse bias, the rate rose to 3.7%. Only 19.8% of the individuals with positive screens for bipolar I or II disorders reported that they had previously received a diagnosis of bipolar disorder from a physician, whereas 31.2% reported receiving a diagnosis of unipolar depression. An additional 49.0% reported receiving no diagnosis of either bipolar disorder or unipolar depression. Positive screens were more frequent in young adults and low income households. The rates of migraine, allergies, asthma, and alcohol and drug abuse were substantially higher among those with positive screens.

CONCLUSION

The positive MDQ screen rate of 3.7% suggests that nearly 4% of American adults may suffer from bipolar I and II disorders. Young adults and individuals with lower income are at greater risk for this largely underdiagnosed disorder.

Skating to where the puck is going to be: a plan for clinical trials and translation research in mood disorders

As part of the National Institute of Mental Health Strategic Plan for Mood Disorders Research effort, the Clinical Trials and Translation Workgroup was asked to define priorities for clinical trials in mood disorders and for research on how best to translate the results of such research to clinical practice settings. Through two face-to-face meetings and a series of conference calls, we established priorities based on the literature to date and what was known about research currently in progress in this area. We defined five areas of priority that cut across developmental stages, while noting that research on adult mood disorders was at a more advanced stage in each of these areas than research on child or geriatric disorders. The five areas of priority are: 1) maximizing the effectiveness and cost-effectiveness of initial (acute) treatments for mood disorders already known to be efficacious in selected populations and settings when they are applied across all populations and care settings; 2) learning what further treatments or services are most likely to reduce symptoms and improve functioning when the first treatment is delivered well, but the mood disorder does not remit or show adequate improvement; 3) learning what treatments or services are most cost-effective in preventing recurrence or relapse and maintaining optimal functioning after a patient's mood disorder has remitted or responded maximally to treatment; 4) developing and validating clinical, psychosocial, biological, or other markers that predict: a) which treatments are most effective, b) course of illness, c) risk of adverse events/tolerability and acceptability for individual patients or well-defined subgroups of patients; 5) developing clinical trial designs and methods that result in lower research costs and greater generalizability earlier in the treatment development and testing process. A rationale for the importance of each of these priorities is provided.