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.

The evolution of mandatory continuing professional development (CPD) for diagnostic radiographers in Ireland - A longitudinal study

INTRODUCTION

This longitudinal research study reports on aspects of CPD immediately before and in the years following the simultaneous introduction of state registration and mandatory CPD for diagnostic radiographers in Ireland.

METHODS

Surveys captured information through closed and open questions distributed nationally across various hospital types in hard copy and online formats. Opinion was gathered over 8-years at three time points, prior to the introduction of mandated changes, post-introduction at the end of the first audit cycle, and as society was emerging from a period of pandemic.

RESULTS

Responses were received across age and grade ranges with response rates in keeping with previous surveys. The overall importance with which radiographers held CPD decreased over time, and while small changes were seen, the narrow focus of what radiographers considered CPD had stayed the same, with attendance-based activities remaining the most popular. Respondents indicated that their enthusiasm for undertaking CPD and willingness to undertake CPD outside of working hours had also decreased, with the perceived primary barrier to CPD shifting from funding to time.

CONCLUSIONS

An appetite to undertake CPD amongst the majority is evident; however, addressing issues such as decreasing importance levels and willingness to use personal time for CPD is crucial. While the perceived cost of CPD has lessened as a barrier, lack of time for CPD is now a principal concern. Further research is recommended to explore the broader impacts of time pressures and optimises CPD for radiographers.

IMPLICATIONS FOR PRACTICE

Findings highlight the need for collaborative engagement and support to optimise CPD opportunities for all radiographers in the future.

Student perceptions of the use of three-dimensional (3-D) virtual reality (VR) simulation in the delivery of radiation protection training for radiography and medical students

BACKGROUND

VR simulation-based learning is increasingly used in healthcare education to prepare students for clinical practice. This study investigates healthcare students' experience of learning radiation safety in a simulated interventional radiology (IR) suite.

METHOD

Radiography students (n = 35) and medical students (n = 100) were introduced to 3D VR radiation dosimetry software designed to improve the learners' understanding of radiation safety in IR. Radiography students underwent formal VR training and assessment, which was complemented with clinical placement. Medical students practiced similar 3D VR activities informally without assessment. An online questionnaire containing Likert questions and open-ended questions was used to gather student feedback on the perceived value of VR-based radiation safety education. Descriptive statistics and Mann-Whitney U tests were used to analyse Likert-questions. Open-ended question responses were thematically analysed.

RESULTS

A survey response rate of 49% (n = 49) and 77% (n = 27) was obtained from radiography and medical students respectively. Most respondents (80%) enjoyed their 3D VR learning experience, favouring the in-person VR experience to online VR. 73% felt that VR learning enhanced their confidence across all relevant learning outcomes. Whilst confidence was enhanced across both cohorts, VR learning had a greater impact on confidence levels amongst medical students with respect to their understanding of radiation safety matters (U = 375.5, p < 0.01). 3D VR was deemed a valuable assessment tool.

CONCLUSION

Radiation dosimetry simulation-based learning in the 3D VR IR suite is perceived to be a valuable pedagogical tool by radiography and medical students and enhances curricula content.

Recruitment and retention of radiography clinical practice educators

INTRODUCTION

Clinical Practice Educators (CPEs) play a vital role in radiography education, fostering the development of students' clinical competence and creating positive learning experiences. In recent years, there has been a high turnover and difficulties recruiting radiography CPEs in Ireland. This is the first study to explore issues surrounding recruitment and retention of radiography CPEs.

METHOD

A cross-sectional, mixed-method study was conducted to gain a better understanding of the issues surrounding recruitment and retention of radiography CPEs. Current and former CPEs affiliated with undergraduate radiography training in Ireland were recruited. CPEs completed an online questionnaire detailing demographics and career background. Online semi-structured focus groups were conducted with current CPEs and interviews with former CPEs.

RESULTS

Nineteen current CPEs completed the questionnaire and participated in focus groups (95% response rate). Ten CPEs who had resigned within the last five years were interviewed. The main motivators for CPEs were an interest in teaching, inspiration from role models, personal learning goals and the appeal of part-time employment. Job satisfaction was influenced by efficacy in the role, professional growth, autonomy, and relationships with stakeholders. The main disincentives were the CPE grade not being commensurate with work involved, lack of protected time and lack of support from colleagues. A variety of reasons for resignation were provided, many of which related to grading of the CPE post and lack of career progression opportunities in the role.

CONCLUSION

The findings outline the key motivators for radiography CPEs and disincentives relative to recruitment and retention of radiography CPEs in Ireland.

IMPLICATIONS FOR PRACTICE

By understanding the disincentives relative to CPE recruitment and retention, along with the motivators, employers can devise initiatives that reduce turnover and increase CPE retention.

The impact of 3D virtual reality radiography practice on student performance in clinical practice

INTRODUCTION

Simulation-based learning plays an integral role in preparing students for clinical practice. This study investigated the impact of immersive three-dimensional (3D) virtual reality (VR) simulation-based learning on first-year radiography students' performance in the clinical setting.

METHODS

A retrospective analysis of first-year radiography clinical assessments was carried out to compare performance pre-and post-introduction of VR. The stage one cohort with no VR education was considered the control group (n = 93). The VR group (n = 98) had seven hours of practice in the immersive VR suite (Virtual Medical Coaching). Experienced clinical tutors assessed first-year students performing an extremity radiographic examination in the clinical setting. Assessment criteria were ranked on a 5-point Likert scale from poor to excellent. Mann Whitney U Tests were applied to compare performance across cohorts.

RESULTS

Students trained with VR performed better across 20 of the 22 assessment criteria. VR-trained students performed significantly better (more ranked as 'very good' or 'excellent') than the control group in the following criteria; positioning patients for X-rays (19% difference) (U = 3525, z = -2.66, p < 0.05), selecting exposure factors (12% difference) (U = 3680, z = -3.13, p < 0.05), image appraisal of patient positioning (27% difference) (U = 3448, z = -2.9, p < 0.05) and image appraisal of image quality (18% difference) (U = 3514, z = -2.6, p < 0.05). Their comprehension of clinical indications, equipment set up and explanation of the procedure was also significantly better (p < 0.05).

CONCLUSION

This is the first study to investigate the translation of VR learning into radiography clinical practice. VR learning had a positive impact on the performance of first-year students in their clinical assessment, especially with respect to patient positioning, exposure parameter selection and image appraisal.

IMPLICATIONS FOR PRACTICE

VR is a valuable educational tool in preparing novice radiography students for clinical practice. It is particularly useful to enhance student knowledge in the areas of patient positioning, exposure factor selection and radiographic image appraisal.

Research ethics systems, processes, and awareness across Europe: Radiography research ethics standards for Europe (RRESFE)

INTRODUCTION

The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs.

METHODS

A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe.

RESULTS

285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X² (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X² (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X² (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X² (1, n = 231) = 15.448, p = <0.001) within respondents' country.

CONCLUSION

Respondents from countries with longer programme durations/availability of multiple programme lengths, availability of postgraduate training, and establishment of European Qualifications Framework Level 6 were generally associated with less uncertainty and more comprehensive research ethics requirements.

IMPLICATIONS FOR PRACTICE

Results are informative of the current status of research ethics within evidence-based radiography.

Research ethics training, challenges, and suggested improvements across Europe: Radiography research ethics standards for Europe (RRESFE)

INTRODUCTION

The Radiography Research Ethics Standards for Europe (RRESFE) project aimed to provide a cross-sectional view of the current state of radiography research ethics across Europe. This included investigating education and training in research ethics, and identifying the key challenges and potential improvements associated with using existing research ethics frameworks.

METHODS

This cross-sectional online survey targeting radiography researchers in Europe was conducted between April 26 and July 12, 2021. Descriptive and analytical statistics were used to identify research ethics education and training trends. Content analysis of qualitative responses was employed to identify significant challenges and proposed improvements in research ethics frameworks of practice.

RESULTS

There were 232 responses received across 33 European countries. Most (n = 132; 57%) respondents had received some research ethics training; however, fewer participants had received training on safeguarding vulnerable patients (n = 72; 38%), diversity and inclusivity (n = 62; 33%), or research with healthy volunteers (n = 60; 32%). Training was associated with a greater perceived importance of the need for research ethics review (p = 0.031) and with the establishment of EQF Level 6 training (p = 0.038). The proportion of formally trained researchers also varied by region (p = <0.001). Time-to-ethics-approval was noted as the biggest challenge for professionals making research ethics applications.

CONCLUSION

Early and universal integration of research-oriented teaching within the radiography education framework which emphasises research ethics is recommended. Additionally, study findings suggest research ethics committee application and approval processes could be further simplified and streamlined.

IMPLICATIONS FOR PRACTICE

The survey contributes to a growing body of knowledge surrounding the importance of education and training in research ethics for assuring a high standard of research outputs in Radiography and has identified hurdles to obtaining research ethics approval for further investigation and address.

Development of lumbar spine MRI referrals vetting models using machine learning and deep learning algorithms: Comparison models vs healthcare professionals

INTRODUCTION

Referrals vetting is a necessary daily task to ensure the appropriateness of radiology referrals. Vetting requires extensive clinical knowledge and may challenge those responsible. This study aims to develop AI models to automate the vetting process and to compare their performance with healthcare professionals.

METHODS

1020 lumbar spine MRI referrals were collected retrospectively from two Irish hospitals. Three expert MRI radiographers classified the referrals into indicated or not indicated for scanning based on iRefer guidelines. The reference label for each referral was assigned based on the majority voting. The corpus was divided into two datasets, one for the models' development with 920 referrals, and one included 100 referrals used as a held-out for the final comparison of the AI models versus national and international MRI radiographers. Three traditional models were developed: SVM, LR, RF, and two deep neural models, including CNN and Bi-LSTM. For the traditional models, four vectorisation techniques applied: BoW, bigrams, trigrams, and TF-IDF. A textual data augmentation technique was applied to investigate the influence of data augmentation on the models' performances.

RESULTS

RF with BoW achieved the highest AUC reaching 0.99. CNN model outperformed Bi-LSTM with AUC = 0.98. With the augmented dataset, the performance significantly improved with an increase in F1 scores ranging from 1% to 7%. All models outperformed the national and international radiographers when compared on the hold-out dataset.

CONCLUSION

The models assigned the referrals' appropriateness with higher accuracies than the national and international radiographers. Applying data augmentation significantly improved the models' performances.

IMPLICATIONS FOR PRACTICE

The outcomes suggest that the use of AI for checking referrals' eligibility could serve as a supporting tool to improve the referrals' management in radiology departments.

Evaluation of optimised 3D turbo spin echo and gradient echo MR pulse sequences of the knee at 3T and 1.5T

INTRODUCTION

To investigate the impact of parameter optimisation for novel three-dimensional 3D sequences at 1.5T and 3T on resultant image quality.

METHODS

Following institutional review board approval and acquisition of informed consent, MR phantom and knee joint imaging on healthy volunteers (n = 16) was performed with 1.5 and 3T MRI scanners, respectively incorporating 8- and 15-channel phased array knee radiofrequency coils. The MR phantom and healthy volunteers were prospectively scanned over a six-week period. Acquired sequences included standard two-dimensional (2D) turbo spin echo (TSE) and novel three-dimensional (3D) TSE PDW (SPACE) both with and without fat-suppression, and T2∗W gradient echo (TrueFISP) sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured for knee anatomical structures. Two musculoskeletal radiologists evaluated anatomical structure visualisation and image quality. Quantitative and qualitative findings were investigated for differences using Friedman tests. Inter- and intra-observer agreements were determined with κ statistics.

RESULTS

Phantom and healthy volunteer images revealed higher SNR for sequences acquired at 3T (p-value <0.05). Generally, the qualitative findings ranked images acquired at 3T higher than corresponding images acquired at 1.5T (p < 0.05). 3D image data sets demonstrated less sensitivity to partial volume averaging artefact (PVA) compared to 2D sequences. Inter- and intra-observer agreements for evaluation across all sequences ranged from 0.61 to 0.79 and 0.71 to 0.92, respectively.

CONCLUSION

Both 2D and 3D images demonstrated higher image quality at 3T than at 1.5T. Optimised 3D sequences performed better than the standard 2D PDW TSE sequence for contrast resolution between cartilage and joint fluid, with reduced PVA artefact.

IMPLICATIONS FOR PRACTICE

With rapid advances in MRI scanner technology, including hardware and software, the optimisation of 3D MR pulse sequences to reduce scan time while maintaining image quality, will improve diagnostic accuracy and patient management in musculoskeletal MRI.

Technique and protocols for cardiothoracic time-resolved contrast-enhanced magnetic resonance angiography sequences: a systematic review

AIM

To review contrast medium administration protocols used for cardiothoracic applications of time-resolved, contrast-enhanced magnetic resonance angiography (MRA) sequences.

MATERIALS AND METHODS

A systematic search of the literature (Medline/EMBASE) was performed to identify articles utilising time-resolved MRA sequences, focusing on type of sequence, adopted technical parameters, contrast agent (CA) issues, and acquisition workflow. Study design, year of publication, population, magnetic field strength, type, dose, and injection parameters of CA, as well as technical parameters of time-resolved MRA sequences were extracted.

RESULTS

Of 117 retrieved articles, 16 matched the inclusion criteria. The study design was prospective in 9/16 (56%) articles, and study population ranged from 5 to 185 patients, for a total of 506 patients who underwent cardiothoracic time-resolved MRA. Magnetic field strength was 1.5 T in 13/16 (81%), and 3 T in 3/16 (19%) articles. The administered CA was gadobutrol (Gadovist) in 6/16 (37%) articles, gadopentetate dimeglumine (Magnevist) in 5/16 (31%), gadobenate dimeglumine (MultiHance) in 2/16 (13%), gadodiamide (Omniscan) in 2/16 (13%), gadofosveset trisodium (Ablavar, previously Vasovist) in 1/16 (6%). CA showed highly variable doses among studies: fixed amount or based on patient body weight (0.02-0.2 mmol/kg) and was injected with a flow rate ranging 1-5 ml/s. Sequences were TWIST in 13/16 (81%), TRICKS in 2/16 (13%), and CENTRA 1/16 articles (6%).

CONCLUSION

Time-resolved MRA sequences were adopted in different clinical settings with a large spectrum of technical approaches, mostly in association with different CA dose, type, and injection method. Further studies in relation to specific clinical indications are warranted to provide a common standardised acquisition protocol.

3D virtual reality simulation in radiography education: The students' experience

Introduction

Simulation forms a key element of undergraduate Radiography education as it enables students to develop their clinical skills in a safe environment. In this study, an immersive three-dimensional (3D) virtual radiography simulation tool was piloted in an undergraduate Radiography curriculum and user feedback retrieved.

Methods

The 3D virtual simulation tool by Virtual Medical Coaching Ltd was introduced to first year radiography students (n = 105). This technology guided students through a comprehensive process of learning anatomy, radiographic positioning and pathology. Students then X-rayed a virtual patient in the VR suite using HTC Vive Pro™ headsets and hand controllers. Instant feedback was provided. An online survey was later disseminated to students to gather user feedback. Thematic and descriptive statistical analyses were applied.

Results

A response rate of 79% (n = 83) was achieved. Most respondents (58%) reported enjoying VR simulation, whilst some felt indifferent towards it (27%). Ninety-four percent would recommend this tool to other students. The mean length of time it took for students to feel comfortable using the technology was 60 min (10–240 min). Most respondents (58%) desired more VR access. Students attributed enhanced confidence in the areas of beam collimation (75%), anatomical marker placement (63%), centring of the X-ray tube (64%) and exposure parameter selection (56%) to their VR practice. Many students (55%) advocated the use of VR in formative or low stakes assessments. Issues flagged included technical glitches, inability to palpate patient and lack of constructive feedback.

Conclusion

Student feedback indicates that 3D virtual radiography simulation is a valuable pedagogical tool in radiography education

Implications for practice

3D immersive VR simulation is perceived by radiography students to be a valuable learning resource. VR needs to be strategically implemented into curricula to maximise its benefits.

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.

SURVEY OF KEY RADIATION SAFETY PRACTICES IN INTERVENTIONAL RADIOLOGY: AN IRISH AND ENGLISH STUDY

Interventional radiology is a rapidly evolving speciality with potential to deliver high patient radiation doses, as a result high standards of radiation safety practice are imperative. IR radiation safety practice must be considered before during and after procedures through appropriate patient consent, dose monitoring and patient follow-up. This questionnaire-based study surveyed fixed IR departments across Ireland and England to establish clinical practice in relation to radiation safety. Pre-procedure IR patient consent includes all radiation effects in 11% of cases. The patient skin dose surrogate parameter of Kerma to air at a reference point (Kar) is under-reported. Only 39% of respondents use a substantial radiation dose level and inform patients after these have been reached. Poor compliance with unambiguous, readily available best practice guidance was observed throughout highlighting patient communication, patient dose quantification and subsequent patient dose management concerns.

Evaluation of unenhanced axial T1W and T2W liver MR images acquired from institutions within the Republic of Ireland and the Kingdom of Saudi Arabia

INTRODUCTION

This multi-site study evaluated two breath-hold sequences commonly utilised for liver MRI; non-enhanced T1W-3D-FS-GRE-TRA and T2W-2D-FSE-TRA sequences, using physical measurements of SNR and CNR, and observer perceptions' (Visual Grading Analysis: VGA).

METHODS

Liver MR image datasets (n = 168) from nine hospitals in the Kingdom of Saudi Arabia (KSA) and 11 hospitals in the Republic of Ireland were evaluated. Images were categorised into two groups per sequence, defined by slice thickness (T2W-2D-FSE, ≤5 mm vs ≥ 6 mm and T1W-3D-GRE-FS, ≤3 mm vs 4 mm). Images were evaluated using visual grading analysis VGA and physical measurements: SNR/CNR. Account was taken of varying patient sizes based on AP/transverse diameter measurements.

RESULTS

Physical image quality measurements (SNR/CNR) returned no significant findings across Irish and KSA hospitals, for both sequences, despite variations in acquisition parameters. Statistically significant differences were found for some scoring criteria based on the observers' perceptions including spleen parenchyma, and spatial resolution for the non-enhanced T1W-3D-FS-GRE-TRA images, with a preference for images acquired using thin slices (≤3 mm). In addition, statistically significant difference was found for the scoring criteria motion artefact for the axial T2W-2D-FSE-TRA images, with a preference for images acquired using thick slices (≥5 mm). Negligible correlation was noted between SNR/CNR and measured abdominal AP/transverse diameters.

CONCLUSION

Whilst variations in sequences rendered no statistical differences in SNR/CNR findings, significant differences in observer image criteria scores was noted. The importance of both physical measurements and observers' perceptions evaluation methods for quality assessment of MR images was demonstrated and optimisation of liver sequence parameters is warranted.

A study to explore opinions and attitudes of Saudi Arabian MR professionals on the current status of routine MR scanner quality assurance testing in the Kingdom of Saudi Arabia

INTRODUCTION

Internationally it is recommended that quality assurance (QA) testing of MR systems is the responsibility of MR professionals to ensure efficient scanner performance. This study aims to explore the opinions and attitudes of MR professionals in the Kingdom of Saudi Arabia (KSA) regarding the current status of routine QA testing within MRI departments.

METHODS

A qualitative approach was adopted, with MR professionals working in public, semi-public and private hospitals in the KSA invited to participate in this interview-based study. A total of 52 individual semi-structured interviews were conducted with purposive sampling of MR radiographers and medical physicists based at 19 major centres across the three main geographical regions in the KSA. Data went through duration of coding following qualitative data analysis framework based on Miles and Huberman's philosophical underpinnings.

RESULTS

The findings demonstrated that 89.5% (n = 17) of the MRI departments surveyed rely on the service provided by the equipment vendor in order to ensure ongoing MR scanner performance. Overall, the level of MR radiographer participation in weekly MR scanner QA testing was low (13.3%, n = 3). Lack of legal requirement, professional organisation and knowledge were highlighted as the principal factors limiting radiographer involvement in the weekly MR QA in the KSA.

CONCLUSION

The results of this study support the establishment of a legal requirement and national policy in order to encourage radiographers in the KSA to take an active role in MRI QA testing to enable suboptimal MR scanner performance to be identified before it becomes clinically evident.

The development of patient information leaflets incorporating patient diversity considerations: Varicocele embolisation and fluoroscopy guided joint injection examinations

PURPOSE

The production of patient information leaflets (PILs) for diverse patient cohorts is challenging. This study developed varicocele and fluoroscopy guided joint injection (FLGJI) procedural PILs.

METHODOLOGY

Evidence-based PILs were developed, providing radiological procedural information - preparation, explanation of interventional procedures and aftercare. PIL readability was tested via validated readability programs: Flesch Kincaid and Flesch ease reading score methods. Radiology approval of PIL(s) content was confirmed. PILs were distributed with appointment information. Patient interviews were conducted just prior to examination and by telephone, 7 days post procedure.

RESULTS

Participants were purposely sampled (6 months): varicocele embolisation (n = 17) and FLGJI (n = 47). Overall 78.1% of all participants preferred Maltese leaflets. Varicocele embolisation patients were generally younger and a greater percentage educated to tertiary level compared to FLGJI patients. Education and age were found to be recurrent significant variables in the patient demographics and responses for both patient cohorts. Age versus education for the FLGJI cohort proved to be significant for several responses. Readability statistics identified the FLGJI leaflet as a plain English rating, the varicocele embolisation leaflet was more difficult. Patient feedback identified 'what is a varicocele?' as important to varicocele embolisation patients whereas FLGJI patients chose, 'advice about aftercare' and 'advice about pain management', highlighting differences in patients' priorities between procedures.

CONCLUSION

PILs provided tangible, accurate information pre and post examination. Patient involvement in achieving appropriate information informed the PILs development, which were adopted clinically. The development of tailored PILs to meet the diversity of other interventional radiology procedures is recommended.

Optimal abdominal CT protocol for obese patients

INTRODUCTION

This study investigated the impact of different protocols on radiation dose and image quality for obese patients undergoing abdominal CT examinations.

METHODS

Five abdominal/pelvis CT protocols employed across three scanners from a single manufacturer in a single centre used a variety of parameters (kV: 100/120, reference mAs: 150/190/218/250/300, image reconstruction: filtered back projection (FBP)/iterative (IR)). The routine protocol employed 300 reference mAs and 120 kV. Data sets resulting from obese patient examinations (n = 42) were assessed for image quality using visual grading analysis by three experienced radiologists. Objective assessment (noise, signal/contrast-noise ratios) and radiation dose was compared to determine optimal protocols for prospective testing on a further sample of patients (n = 47) for scanners using FBP and IR techniques.

RESULTS

Compared to the routine protocol, mean radiation dose was reduced by 60% when using 100 kV and SAFIRE technique strength 3 (p = 0.001). Reduction of up to 30% in radiation dose was noted for the FBP protocol: 120 kV and 190 reference mAs (p = 0.008). Subjective and objective image quality for both protocols were comparable to that of the routine protocol (p > 0.05). An overall improvement in image quality with increasing strength of SAFIRE was noted. Upon clinical implementation of the optimal dose protocols, local radiology consensus deemed image quality to be acceptable for the participating obese patient cohort.

CONCLUSION

Radiation dose for obese patients can be optimised whilst maintaining image quality. Where iterative reconstruction is available relatively low kV and quality reference mAs are also viable for imaging obese patients at 30-60% lower radiation doses.

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.

Investigation of reference levels and radiation dose associated with abdominal EVAR (endovascular aneurysm repair) procedures across several European Centres

OBJECTIVES

Endovascular aneurysm repair (EVAR) is considered the treatment of choice for abdominal aortic aneurysms with suitable anatomy. In order to improve radiation safety, European Directive (2013/59) requires member states to implement diagnostic reference levels (DRLs) in radio-diagnostic and interventional procedures. This study aimed to determine local DRLs for EVAR across five European centres and identify an interim European DRL, which currently remains unestablished.

METHODS

Retrospective data was collected for 180 standard EVARs performed between January 2014 and July 2015 from five specialist centres in Ireland (n=2) and Italy (n=3). Data capture included: air kerma-area product (P_KA), total air kerma at the reference point (K_a,r), fluoroscopic time (FT), number of acquisitions, frame rate of acquisition, type of acquisition, patient height, weight, and gender.

RESULTS

The mean values for each site A, B, C, D, and E were: P_KAs of 4343 ± 994 μGym², 18,200 ± 2141 μGym², 11,423 ± 1390 μGym², 7796 ± 704 μGym², 31,897 ± 5798 μGym²; FTs of 816 ± 92 s, 950 ± 150 s, 708 ± 70 s, 972 ± 61 s, 827 ± 118 s; and number of acquisitions of 6.72 ± 0.56, 10.38 ± 1.54, 4.74 ± 0.19, 5.64 ± 0.36, 7.28 ± 0.65, respectively. The overall pooled 75th percentile P_KA was 15,849 μGym².

CONCLUSION

Local reference levels were identified. The pooled data has been used to establish an interim European DRL for EVAR procedures.

KEY POINTS

• Abdominal endovascular aneurysm repair (EVAR) requires the use of ionising radiation. • EVAR is a minimally invasive procedure for the treatment of abdominal aortic aneurysms. • Diagnostic reference levels (DRLs) are used to monitor patient radiation exposure. • Radiation dose data was collected from five European centres for EVAR procedures. • Local DRLs have been determined and an interim European DRL is proposed.

An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors

OBJECTIVE

To investigate MR radiographers' current knowledge base and confidence level in relation to quality-related errors within MR images.

METHOD

Thirty-five MR radiographers within 16 MRI departments in the Kingdom of Saudi Arabia (KSA) independently reviewed a prepared set of 25 MR images, naming the error, specifying the error-correction strategy, scoring how confident they were in recognising this error and suggesting a correction strategy by using a scale of 1-100. The datasets were obtained from MRI departments in the KSA to represent the range of images which depicted excellent, acceptable and poor image quality.

RESULTS

The findings demonstrated a low level of radiographer knowledge in identifying the type of quality errors and when suggesting an appropriate strategy to rectify those errors. The findings show that only (n = 7) 20% of the radiographers could correctly name what the quality errors were in 70% of the dataset, and none of the radiographers correctly specified the error-correction strategy in more than 68% of the MR datasets. The confidence level of radiography participants in their ability to state the type of image quality errors was significantly different (p < 0.001) for who work in different hospital types.

CONCLUSION

The findings of this study suggest there is a need to establish a national association for MR radiographers to monitor training and the development of postgraduate MRI education in Saudi Arabia to improve the current status of the MR radiographers' knowledge and direct high quality service delivery.

Are exposure index values consistent in clinical practice? A multi-manufacturer investigation

The advent of digital radiography poses the risk of unnoticed increases in patient dose. Manufacturers have responded to this by offering an exposure index (EI) value to the clinician. Whilst the EI value is a measure of the air kerma at the detector surface, it has been recommended by international agencies as a method of monitoring radiation dose to the patient. Recent studies by the group have shown that EI values are being used in clinical practice to monitor radiation dose and assess image quality. This study aims to compare the clinical consistency of the EI value in computed radiography (CR) and direct digital radiography (DR) systems. An anthropormorphic phantom was used to simulate four common radiographic examinations: skull, pelvis, chest and hand. These examinations were chosen as they provide contrasting exposure parameters, image detail and radiation dose measurements. Four manufacturers were used for comparison: Agfa Gaevert CR, Carestream CR, Philips Digital Diagnost DR and Siemens DR. For each examination, the phantom was placed in the optimal position and exposure parameters were chosen in accordance with European guidelines and clinical practice. Multiple exposures were taken and the EI recorded. All exposure parameters and clinical conditions remained constant throughout. For both DR systems, the EI values remained consistent throughout. No significant change was noted in any examination. In both CR systems, there were noteworthy fluctuations in the EI values for all examinations. The largest for the Agfa system was a variation of 1.88-2.21 for the skull examination. This represents to the clinician a doubling of detector dose, despite all exposure parameters remaining constant. In the Kodak system, the largest fluctuation was seen for the chest examination where the EI ranged from 2560 to 2660, representing approximately an increase of 30 % in radiation dose, despite consistent parameters. The fluctuations seen with the CR systems are most likely due to image processing delay, replacing of the imaging plate and calibration factors. Fluctuations in EI values may result in confusion to the clinician and unnecessary repeat examinations. The reliability of EI values as a feedback mechanism for CR is also questionable.

The epidemiology of fungaemia at the University Hospital of the West Indies, Kingston, Jamaica

OBJECTIVES

To determine the epidemiology of fungaemia at the University Hospital of the West Indies (UHWI) as well as the incidence of fungaemia at the UHWI over a four-year period.

METHODS

A cross-sectional survey was conducted over a one-year period (2002). The RapID Yeast Plus Panel Identification kit was used to identify the yeasts found in blood while morphology and dimorphism were used to identify the single mold isolated, Histoplasma capsulatum. In addition, a retrospective review of the number of cases of fungaemia at the UHWI over a four-year period from 1998 was done using the laboratory and clinical records in order to determine the incidence over this period.

RESULTS

The study showed that Yeast not C albicans (YNCA) accounted for 47% of the isolates while Candida albicans accounted for 29%. Of the YNCA species, Candida tropicalis was the most common (75%), followed by C pseudotropicalis (12.5%) and C glabrata (12.5%). Cryptococcus sp accounted for 18% of all fungal isolates and there was one isolate (6%) of Histoplasma capsulatum. The medical wards had the most isolates (47%), followed by surgery (29%) and the Intensive Care Unit (ICU) [24%]. While the rate at which fungi were isolated from the blood remained constant over 1998, 1999 and 2001, this doubled in 2002 from 0.26% to 0.5%.

CONCLUSION

Although the incidence of fungaemia at the UHWI has remained relatively low, there was a marked increase in the last year of the study (2002) with a doubling of the number of positive fungal cultures. Candida species account for most cases of fungaemia at the UHWI. However non-albicans Candida spp were more commonly isolated than C albicans, a trend that needs to be monitored because of its implications for therapy.

Rheumatoid arthritis: a novel radiographic projection for hand assessment

Rheumatoid arthritis (RA) is the most common form of inflammatory disease, affecting 1-2% of the population. Posteroanterior (PA) and Brewerton projections are well established in radiographic practice for scoring and monitoring RA, but there is little evidence to demonstrate the diagnostic efficacy of these techniques. This work, by varying the positioning of a cadaveric hand, investigates whether an alternative radiographic projection could yield greater diagnostic information than the traditional techniques. Phase I of the study evaluated moving the hand 15 degrees from the anteroposterior position and then in 5 degrees increments in four directions: medial rotation, lateral rotation, flexion of the wrist and extension of the wrist. Phase II of the study took the optimum projections from Phase I and further manipulated these positions in a direction at right angles to the original position. Images were scored based on joint space visualisation in 29 joints. Results demonstrated that significantly higher diagnostic efficacy was evident with 15 degrees lateral rotation of the hand or 15 degrees flexion at the wrist compared to the Brewerton projection. Either projection is recommended, but on the basis of patient comfort, the latter of these novel positions, now known as the UCD projection, was chosen as the optimum procedure to replace the Brewerton projection. The value of using cadavers for the establishment of optimum radiographic procedures is highlighted.

Proposed preliminary diagnostic reference levels for three common interventional cardiology procedures in Ireland

This study has gathered data across Ireland to determine the range of radiation doses received during interventional cardiology (IC) investigations. Radiation doses for three common types of IC examinations where investigated: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). A total of 22 cardiac imaging suites participated in the study. Radiation dose was monitored for 1804 adult patients using dose area product (DAP) meters. Individual patient DAP values ranged from 136-23,101 cGy cm2, 475-41,038 cGy cm2 and 45-17,192 cGy cm2 for CA, PCI and PPI respectively, with third quartile values of 4654 cGy cm2, 10,650 cGy cm2 and 1686 cGy cm2. The importance of optimising radiation dose, while not compromising diagnostic efficacy is clear. Although setting reference levels for these complex procedures has some difficulties, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high dose procedures. The third quartile values as described by this paper may offer such guidance.

The changing pattern of Tinea capitis in Jamaica

The species of dermatophyte fungi causing tinea capitis vary from country to country and may also change with time. This study was done to identify the predominant organisms causing tinea capitis in the Jamaican population. It was a retrospective study looking at all fungal culture requests to the Microbiology Department at the University Hospital of the West Indies during the period January 1, 1998 to December 31, 2002. The results showed a gradual switch from the dominance of Microsporum audouinii (61.5%) in 1998 to the dominance of Trichophyton tonsurans (85%) in 2002. The mean age was 8.6. Females constituted 55.7% of positive cases and males, 44.3%.

The epidemiology of mycotic vulvovaginitis and the use of antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice

Data in the Caribbean documenting the speciation of yeast associated with vulvovaginitis are lacking. The widespread use of antibiotics and increased availability of antimycotic agents, both prescribed and over-the-counter, predisposes both to a change in the epidemiologic patterns and the possible development of secondary resistance among previously susceptible yeast. This study was conducted to evaluate the aetiologic agents associated with mycotic vulvovaginitis and to review the appropriateness of prescribed antifungal therapy. Of 134 positive isolates, the most frequent yeast isolate was C. albicans accounting for 78%, C. tropicalis 10%, Prototheca wickerhamii (P. wickerhamii) 5%, C. glabrata 4%, Cryptococcus albidus (C. albidus) 2% and C. lusitaniae (1%) were also isolated. Of the positive cases, 75% were treated with antifungals, 17% with antibiotics and 8% were not treated. The azole group was the most frequently prescribed antifungal (71%). Of cases with negative yeast cultures, 83% were treated with antifungals. The presence of non-albicans Candida species and other opportunistic fungi is an important finding and combined with the pattern of therapy, represents a major challenge for future empirical therapeutic and prophylactic strategies in the treatment of mycotic vulvovaginitis.

Disseminated histoplasmosis and AIDS at the University Hospital of the West Indies. A case report

Disseminated histoplasmosis is rare in Jamaica. However, with the increase in the number of immunocompromised patients in the population, the prevalence of this infection is likely to increase. We present a case of disseminated histoplasmosis in a 16-year-old girl with the acquired immune deficiency syndrome who presented to the Paediatric Infectious Diseases Service of the University Hospital of the West Indies, with cervical lymphadenitis progressing to ulcers and abscesses showing granulomatous inflammation likely to be of fungal aetiology. She later presented to the Emergency Room, with respiratory and gastrointestinal symptoms and was admitted to hospital, disoriented and with a persistent fever. She developed nuchal rigidity while in hospital and was anaemic, leukopaenic and thrombocytopaenic. She died of gastrointestinal bleed ten days post admission. She was the oldest known survivor of mother-to-child-transmission of human immunodeficiency virus in Jamaica. The slow growing fungus, Histoplasma capsulatum, was isolated from the patient's blood three weeks after the specimen was sent to the laboratory.

Dose-reducing strategies in combination offers substantial potential benefits to females requiring X-ray examination

This work, using an adult anthropomorphic phantom, aimed to establish an optimised technique for ladies of child-bearing age undergoing antero-posterior (AP) pelvis and AP and lateral lumbar spine examinations. Phase one of the work involved introducing the following dose-reducing measures individually: increased kVp, increased focus-film distances, a carbon fibre cassette, a faster film/screen combination. The second phase established an optimised technique based on a combination of the parameters listed above. Radiation dose was measured using thermoluminescent dosimeters and image quality was evaluated using anatomical criteria. All dose-reducing methods were compared with a standard technique, currently being used in a Dublin hospital. The results demonstrated that the optimised procedure reduced effective dose by 77, 62 and 66% for AP pelvis and AP and lateral lumbar spine respectively (p < 0.05) compared with the standard technique, with no significant changes in image quality. Dose-reducing measures used in combination offer substantial potential for optimisation of radiological procedures.

Systemic phaeohyphomycosis in pregnancy and the puerperium

Systemic fungal infections are rare. In pregnancy, treatment is problematic because of the risk of possible teratogenic effects of the antifungal drugs. We present the case of a 32 year-old woman who presented during pregnancy with a two-month history of painless subcutaneous nodules. Excision biopsy of one lesion showed dematiaceous fungal elements. Anti-fungal treatment was deferred and the pregnancy proceeded uneventfully. The remaining nodules were excised at the time of caesarean section delivery. Three weeks into the puerperium, she developed generalised seizures and investigations indicated systemic fungal infection with positive cultures for Aureobasidium spp which responded to appropriate antifungal therapy of flucytosine and itraconazole.