Journal of Medical Radiation Sciences最新文献

Introduction: To evaluate insertion feasibility of a stabilised hyaluronic acid (sHA) gel rectal spacer in gynaecological cancer high dose rate brachytherapy (GynBT).

Methods: This single institution prospective study included patients with gynaecological cancers receiving magnetic resonance imaging (MRI)-guided GynBT. Feasibility was assessed by technical success, clinician user experience, spacer visibility on MRI and spacer stability over the GynBT course.

Results: Twelve patients were included in this study. Insertion of sHA gel into the rectovaginal space was achieved in all 12 patients without spacer-related complications. Clinicians reported sHA gel as easy to use, with high visibility on TRUS (rated 4-5) and excellent visibility on MRI. Target-to-rectum distance increased with sHA spacer insertion (mean 7.82 mm, 95% CI: 5.27-10.36, p < 0.001). During GynBT, there was a reduction in sHA gel spacer volume (mean 1.75 cc, 95% CI: 0.57-2.93, p = 0.007) and craniocaudal distance (mean -3.87 mm, 95% CI: -7.37 to -0.36, p = 0.034). However, there were no significant changes in target-to-rectum distance (p = 0.490) and spacer level measurements (p > 0.2).

Conclusion: Insertion of sHA gel rectal spacer is technically feasible and safe in GynBT, increasing the separation between the target and rectum. The sHA gel spacer is easy to use, highly visible on both TRUS and MRI, and stable during the entire GynBT course. Further studies are required to ascertain patient suitability, dosimetric comparison, patient-reported outcomes, toxicities, and optimal technique.

Trial registration: The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12625000167460).

Introduction: Preliminary image evaluation (PIE) is an abnormality detection system that enables radiographers to assist emergency department (ED) clinicians in their treatment decisions by minimising radiographic interpretation errors. For a PIE to be successful, radiographers need to provide accurate comments on images. Given the limited number of studies that evaluate radiographers' false PIE comments, the aim of this study was to determine common false negative (FN) and false positive (FP) comments in one district in New Zealand (NZ).

Methods: Six months of PIE comments performed in the Taranaki district in NZ were collected and scored into four categories: true positive, true negative, FP or FN. The FN and FP comments were then evaluated to determine common errors and compared with international research.

Results: A total of 844 PIE comments were collected, with 21 (2.5%) scored as FN, and 27 (3.2%) scored as FP. The common FN themes included subtle or avulsion fractures, predominantly in fingers, hands, and wrists. The common FP themes were normal variants in the foot and ankle that were mistaken for fractures.

Conclusion: Several recommendations are made from this study to help improve radiographer PIE accuracy. These include the addition of an unsure or equivocal category when scoring PIE comments to account for PIE comments with ambiguous language. Other recommendations include ongoing targeted training of common errors and a higher resolution monitor (generally used for image reporting by radiologists) for radiographers when performing PIE.

Introduction: Patient contact shielding has been used in paediatric radiography as standard practice for decades. Contemporary evidence no longer supports its use in routine clinical practice. The Medical Imaging Department of an Australian quaternary paediatric hospital implemented the discontinuation of all patient contact shielding using the capability, opportunity, motivation and behaviour (COM-B) model and the theoretical domains framework (TDF). This study evaluated the implementation process with particular focus on patient, family and staff responses.

Methods: An implementation study was conducted using a mixed-methods approach, comprising retrospective analysis of imaging records (7 months pre/post implementation) and prospective collection of survey data. Implementation strategies were developed using theory-guided frameworks to address potential barriers to change.

Results: Retrospectively, there were 1614 examinations assessed pre-implementation and 1845 post-implementation. Pre-implementation shielding rates were 45% and 39% for male and female patients respectively. The post-implementation prospective survey component included 7581 patients, 0.4% (n = 31) of whom raised queries about the policy change. Only 11 shielding requests occurred within 5 months post-implementation, declining to zero thereafter.

Conclusion: Theory-guided implementation was remarkably effective in translating contemporary evidence into practice. The process of removing patient shielding was achieved with minimal concern from patients and their families, contrary to expectations that this change would generate significant resistance.

Introduction: Facilitated Group Supervision (FGS) involves a group of professionals meeting under the guidance of a supervisor to discuss workplace challenges and promote reflective practice. Previous supervision styles have been trialled for radiation therapists (RTs) in New Zealand with mostly successful results. This pilot study aimed to explore how RTs perceived FGS and compare this with their experiences of previous supervision models.

Methods: This mixed-methods pilot study was conducted at the Wellington Blood and Cancer Centre with seven RTs. Participants met in two groups every four weeks for six months with an independent allied health-trained facilitator. Afterwards, they completed a QUALTRICS questionnaire, including the Clinical Supervision Evaluation Questionnaire, which is 14 Likert scale statements, assessing group process, purpose, and impact. Open-ended questions gathered qualitative data.

Results: All seven radiation therapists completed the questionnaire, with both qualitative and quantitative results indicating highly positive feedback regarding FGS. Thematic analysis of the qualitative data revealed that participants developed valuable insights and coping strategies, felt the FGS environment enhanced safety and reflection, and found that discussing shared experiences reduced stress. The RTs also preferred FGS to their previous experiences of supervision.

Conclusion: The findings showed a positive perception of FGS among all participating RTs, especially experienced RTs who benefitted from the structure and process. Participants reported gaining valuable insights from both the facilitator and peers, which enhanced their skills and helped address clinical challenges. All participants expressed interest in continuing with FGS, agreed that FGS could benefit all RT professionals, and identified it as their preferred method of supervision.

Introduction: Radiation protection for operators performing coronary angiography (CA) and percutaneous coronary intervention (PCI) is important, with the occupational risks being increasingly recognised. The ceiling-suspended lead acrylic shield is the most commonly used piece of radiation shielding equipment, with different models available. This study sought to measure the impact of shield size on operator dose (OD) in the clinical environment, with two readily available models.

Methods: Two identical cardiac catheterisation laboratories (cath labs) were used in this single centre study. Fluoroscopy time (FT) and kerma area product (KAP) measured procedural radiation exposure. Identical lower body shields were used in both rooms. The ceiling-suspended lead acrylic shield was different in each room, with one being 35% larger and also having lead rubber pleats along the lower edge. OD was measured with a real-time dosimeter (Raysafe i3) at the end of each procedure.

Results: FT and KAP were not significantly different between the two cath labs for 1021 CA and 441 PCI procedures respectively. OD for CA procedures was 9 μSv in cath lab 1 (large shield) and 12 μSv in cath lab 2 (standard shield) (p < 0.001). For PCI procedures, the operator dose was 21 μSv in cath lab 1 (large shield) and 29 μSv in cath lab 2 (standard shield) (p < 0.001).

Conclusion: In this study, with identical cath labs, and similar procedural dose and fluoroscopy times, OD was up to 43% lower with a larger lead acrylic shield when compared to a standard lead acrylic shield.

Introduction: Skeletal surveys are a series of X-ray images used to identify bone injuries in suspected cases of non-accidental injury (NAI). This study evaluates effective radiation doses and associated risks of radiation exposure from skeletal surveys that were performed on children under 5 years of age at a tertiary paediatric hospital in Australia.

Methods: Radiographic exposure records were retrospectively analysed for 362 initial and follow-up skeletal surveys conducted between 2018 and 2023 for suspected physical abuse. Effective doses and organ absorbed doses were calculated using PCXMC software against background equivalent radiation times (BERT) in Australia. Nominal risks of radiation-induced cancer induction and fatality were estimated using Biologic Effects of Ionising Radiation (BEIR) VII risk coefficients.

Results: The mean effective dose was 0.24 mSv for initial examinations and 0.18 mSv for follow-up examinations, equivalent to 52 and 38 days of background radiation exposure, respectively. The averaged nominal risks associated with an initial skeletal survey are 9.3 in 10,000 for cancer induction, and 3.1 in 10,000 for fatal cancer. Variability of radiation effective dose is demonstrated, with an interquartile range of 0.17-0.30 mSv and an overall range of 0.04-0.76 mSv for initial skeletal surveys.

Conclusion: Radiation doses for initial and follow-up skeletal surveys performed for suspected NAI were determined from a large set of examinations. Several radiation risk metrics have been presented to assist healthcare professionals and caregivers in understanding the associated risks of radiation exposure.

Introduction: Spinal dysraphism describes a spectrum of congenital anomalies pertaining to the spine and spinal cord. Ultrasound is the preferred imaging modality for diagnosing dysraphism in low-risk neonates due to its cost-effectiveness and availability. Recent research demonstrates a low incidence of dysraphism in infants with an isolated sacral dimple and associated cutaneous stigmata (e.g., hairy tuft, haemangioma). We sought to determine the number of neonates referred for investigation of a simple sacral dimple, and the proportion found to have dysraphism.

Methods: A retrospective analysis of the radiology information system was performed in a quaternary Australian children's hospital. Children undergoing spinal ultrasound from January 2016 to November 2024 were included. Patients over 90 days of age, and with indications other than simple sacral dimple were excluded.

Results: There were 448 spinal ultrasound examinations reviewed; of these, 195 (43.5%) were for a simple sacral dimple. Mean age at scan was 33 days (range 2-90 days, sd = 24 days), 88 (45.1%) were female. Only two (1.0%) were diagnosed with dysraphism; both were found to have tethered cords. Both patients were subsequently diagnosed with concomitant anomalies (cardiac, and a Dandy Walker Malformation).

Conclusion: Our findings support literature suggesting ultrasound screening for neonates with a simple sacral dimple has a very low diagnostic yield.

Maximise your continuing professional development (CPD) by reading the following selected article and answering the five questions. Please remember to self-claim your CPD and retain your supporting evidence. Answers will be available via the QR code and published in JMRS—Volume 73, Issue 4, December 2026.

Maximise your continuing professional development (CPD) by reading the selected article and answering the five questions. Please remember to self-claim your CPD and retain your supporting evidence.