Journal of Medical Radiation Sciences最新文献

Introduction: Urinary drainage (ureteral stenting or percutaneous nephrostomy) is commonly used for malignant ureteral obstruction (MUO), but optimal indications remain unclear. [^99mTc]Tc-mercaptoacetyltriglycine (MAG₃) renal scintigraphy assesses urinary tract obstruction and may help identify patients who can avoid drainage. The aim of this case series was to investigate the impact of urinary drainage guided by MAG₃ findings on renal function in MUO patients.

Methods: We retrospectively reviewed 44 MUO patients who underwent MAG₃ scintigraphy between April 2020 and January 2022. Based on results, 29 patients underwent urinary drainage and 15 patients were treated conservatively. Patients were classified by MAG₃ excretion pattern and followed by renal function, pyelonephritis and flank pain at 1, 2, 3 and 6 months.

Results: Among the conservative group (n = 15), MAG₃ patterns included non-function (n = 7), delayed excretion (n = 7) and obstruction (n = 1). No patients developed renal deterioration or pyelonephritis, though one patient underwent drainage for contralateral flank pain. Among the drainage group (n = 29), MAG₃ patterns included obstruction (n = 16), delayed excretion (n = 8), declined excretion (n = 3) and non-function (n = 2).

Conclusion: Fourteen of 15 patients treated conservatively after MAG₃ scintigraphy experienced no renal complications during 6 months of follow-up. MAG₃ scintigraphy may support individualised decision-making and help avoid unnecessary drainage. Conservative management may be appropriate for patients with a non-functional MAG₃ pattern.

This letter highlights the valuable contribution of the review titled 'Quantifying the Carbon Footprint of External Beam Radiation Therapy-A Narrative Review' (https://doi.org/10.1002/jmrs.70009) in understanding how radiation therapy impacts healthcare-related greenhouse gas emissions, particularly through pre-treatment imaging, treatment delivery, and patient travel. Therefore, the letter emphasizes that empowering radiation therapists with green skills is essential to foster a culture of environmental responsibility within radiation therapy departments.

Breast cancer is the most commonly diagnosed cancer among women worldwide, and concerns regarding radiation exposure from mammography screening remain a potential barrier to participation. This scoping review explores existing models estimating long-term radiation risks associated with repeated mammography screening. A structured search across five databases (Medline, Embase, Scopus, Web of Science and CINAHL) along with manual searching identified 24 studies published between 2014 and 2024. These were categorised into three themes: (1) models estimating dose-risk profiles, (2) factors affecting radiation dose and (3) the use of artificial intelligence (AI) in dose estimation and mammographic breast density (MBD) estimation. Studies showed that breast density, compressed breast thickness (CBT) and technical imaging parameters significantly influence mean glandular dose (MGD). Modelling studies highlighted the low risk of radiation-induced cancer, inconsistencies in protocols and vendor-specific limitations. AI applications are emerging as promising tools for improving individualised dose-risk assessments but require further development for compatibility across different imaging platforms.

Introduction: Health-related quality of life (HRQoL) outcomes are not routinely collected in paediatric radiation therapy (RT). This study co-designed and evaluated an electronic platform to support routine HRQoL assessment using patient-reported outcome measures (PROMs).

Methods: A digital platform was developed following a user-centred design approach. Development included planning with consumers and clinicians, identifying user needs through interviews and iterative design refinements. Alpha testing was performed with consumers. Beta testing involved directed tasks by children, parents and clinician participants to evaluate the developed platform. Thematic analysis of participant feedback was performed to identify refinements and shape clinical implementation strategies.

Results: Iterative alpha testing with end-users led to significant improvements in functionality and aesthetics. Beta testing involved 18 participants, including seven healthcare professionals, seven children and four parents. All participants successfully navigated the platform, completed tasks and interpreted PROM results. Participants described the platform as intuitive and child-friendly. Challenges included minor navigation issues on mobile devices. Suggestions for improvement included streamlined result visualisation and enhancements to the instructional material. Whilst parents and clinicians recognised the value of allowing parents to view their child's PROM results, considerations to ensure sensitivity were described.

Conclusion: The electronic PROM platform was successfully developed to support HRQoL assessment of children undergoing RT. Future research is needed to evaluate the feasibility, usability and acceptability in clinical practice.

Introduction: Neurodivergent conditions such as autism and attention deficit hyperactivity disorder (ADHD) are increasingly recognised in clinical and societal contexts. However, neurodivergent individuals continue to face barriers in accessing healthcare services, including medical imaging. Their complex sensory, communication and emotional needs often go unmet, contributing to reduced rates of completed medical imaging examinations. This systematic review aimed to identify strategies reported in the literature to improve imaging procedure completion among neurodivergent patients.

Methods: A systematic search of medical databases was conducted using relevant keywords related to neurodivergence and medical imaging. After screening titles and abstracts and reviewing full texts, studies that investigated interventions or strategies to support neurodivergent individuals during imaging procedures were included and analysed.

Results: The search yielded 1789 peer-reviewed articles. After applying inclusion and exclusion criteria, 40 articles underwent full-text review, with 11 meeting eligibility for inclusion. Thematic analysis identified that both pre-examination and examination strategies are necessary to improve procedure completion. These included preparatory interventions, such as mock imaging sessions, environmental adaptations, involvement of carers and flexibility in imaging techniques and scheduling.

Conclusion: Improving access to imaging for neurodivergent individuals requires adjustments across all phases of the examination. Despite the existence of supportive strategies, no formal guidelines currently exist to assist medical imaging professionals (radiographers, sonographers and nuclear medicine technologists) in delivering accessible, neurodivergent-inclusive imaging care. Further research and guideline development are needed to ensure equitable access for this patient population.

Introduction: Abdominopelvic radiography is commonly performed in both supine and erect positions, raising concerns about radiation dose exposure. In Ghana, there is limited data on organ dose evaluation in these examinations, particularly regarding patient positioning for dose optimisation. Additionally, the risk of dose creep in Digital Radiography (DR) due to its wide dynamic range further complicates dose management. This study aimed to estimate organ doses for patients undergoing abdominopelvic radiography in both positions and to develop an optimisation strategy that minimises radiation exposure while maintaining image quality.

Methods: Organ doses were estimated using CalDose X 5.0 for 112 patients across two facilities in both erect and supine positions. Image quality was assessed using signal-to-noise ratio (SNR) values for five specific organs, with the kidney, the liver, and the prostate selected for dose and image quality optimisation. Additionally, 34 exposures were performed on an anthropomorphic phantom using varying exposure parameters and focus-to-detector distances (FDD), with thermoluminescence dosimeters (TLDs) employed for dose optimisation measurement.

Results: An average of 39.9% and 52.9% of radiographs had optimal and high SNR values respectively. After the optimisation procedure, the recommended exposure parameters were 70 kVp, 10 mAs, and 110 cm FDD for both positions. In the supine position, organ doses reduced with a percentage difference of 50.0, 65.22 and 19.21, and 23.03, 28.97 and 30.98 for SNR for the kidney, the liver and the prostate respectively. In the erect position, organ doses reduced with a percentage difference of 72.34, 72 and 4.55, and SNR percentage difference of 10.69, 9.39 and 32.83 for the kidney, the liver and the prostate respectively.

Conclusion: Abdominopelvic organ doses vary based on patient demographics and exposure settings. The optimisation strategy significantly reduced radiation doses while preserving image quality. These findings emphasise the importance of standardised imaging protocols to enhance patient safety and radiation protection in clinical practice.

Clinical workplaces such as hospitals are often keen to arrange interprofessional learning activities for students on clinical placements, but radiation therapy (RT) students are often overlooked because of a lack of awareness and understanding of their role in patient care. Furthermore, there are challenges in setting up hospital-based interprofessional education (IPE) because of the logistics of liaising with a large number of staff, as students are from different disciplines. Hospitals that offer RT are ideal sites to offer IPE, as invariably staff in these settings work interprofessionally to support patients with cancer and can immediately see its value. This How I do it guide lays out the practical steps needed to initiate and implement workplace-based IPE involving RT students modelled on a long-standing Cancer Care IPE learning activity in New Zealand.

Value-based health care (VBHC) is an evolving paradigm in healthcare that prioritises patient outcomes relative to the costs incurred. VBHC emphasises efficiency, quality, and patient satisfaction as metrics and determinants of healthcare. A VBHC approach is becoming increasingly significant as healthcare systems worldwide grapple with rising costs, staff shortages, and the ongoing need for improved patient care. Online adaptive radiotherapy (oART) is a promising innovation in radiation oncology, allowing for the adaptation of radiation treatment plans to account for daily anatomical changes. This innovation has the potential to improve patient outcomes; however, it requires investment in the technology, manpower, and training to deliver an adaptive radiotherapy service. This commentary aims to explore the role of radiation therapists (RTs) in oART, using RT-led workflows within the context of the broader models of care that involve radiation oncologists and multidisciplinary teams. This commentary also aims to highlight the potential benefits and challenges of adopting an RT-led approach within VBHC principles, focusing on key themes such as treatment accuracy, patient satisfaction, training, and cost implications.