Journal of Medical Radiation Sciences最新文献

Introduction

Poor clinical decision-making in MRI can lead to significant patient injuries and, in some cases, prove fatal. With the ever-increasing range and numbers of MR-conditional implants and devices, the complexity of decision-making in this environment has increased. While historically performed by radiologists, this decision-making is becoming integrated into the MRI technologists' (radiographers') role. The aim of this paper is to document the evolving role and responsibilities of MRI technologists (MRITs) in New Zealand (NZ) and Australia when scanning patients with medical implants.

Methods

Utilising a mixed-methods case study research design, quantitative and qualitative data were collected via an online questionnaire and semistructured interviews. The questionnaire was completed by 235 MRITs, 12 of whom were also interviewed.

Results

Findings confirm that the MRIT role in NZ and Australia in 2018 had evolved over the preceding decade from one focused on technical proficiency to a role involving a higher level of cognitive function and competency relating to MRI safety. Participants identified that all MRITs must be responsible for MRI safety clinical decision-making, not just a select few. Some concerns were raised that radiologists are no longer sufficiently educated in MRI safety, supporting the need for a team effort instead.

Conclusion

Aligning with recent global calls to standardise MRIT education and regulation requirements, this study provides evidence to support a separate registerable MRI scope of practice. This will enable MRI-specific knowledge and continuing professional development (CPD) in MRI safety to be mandated and audited so that clinical decisions are informed and safe.

Introduction

Effective communication between patients and healthcare professionals has been shown to contribute to beneficial patient outcomes but requires recognition of linguistic and cultural differences. This is critical in a locality like Auckland which has been shown to be the most diverse region in New Zealand in terms of ethnicity, languages and culture. English is the most spoken language in New Zealand, followed by Te Reo Māori. The aim of this qualitative, phenomenological study was to explore and describe the experience of radiographers communicating with patients in a multi-cultural, multi-lingual healthcare setting in Auckland, New Zealand.

Methods

The research study population included radiographers registered with the Medical Radiation Technologists Board (MRTB) employed at the study location. The participant recruitment process included convenience, purposive, and snowball sampling. Data was collected through individual interviews that were audio-recorded and transcribed verbatim, with the sample size (n = 11) determined through the saturation of themes. Data was analysed by means of Tesch's framework for data analysis.

Results

Four themes emerged: (a) cross-cultural challenges in patient communication; (b) enhanced patient-centred care through culturally responsive communication; (c) tailored communication methods based on contextual patient factors; and (d) adaptive communication strategies.

Conclusion

This study underscores the importance of adaptive communication in overcoming linguistic and cultural barriers, emphasising the need for culturally safe and patient-centered care while maintaining professionals' responsibility to provide quality care to diverse patient populations.

The findings have relevance beyond Māori context, highlighting the changing role of radiographers towards equitable and culturally sensitive healthcare.

Introduction

Pelvic x-rays can be conducted on a trauma trolley or conventional table bucky. The aim of this study was to compare the positional challenges and reject rate between pelvic x-ray images taken on a trauma trolley and a table bucky during a 12-month period in an Australian public metropolitan hospital's emergency department and to determine the accuracy rate of anatomical inclusion via a qualitative assessment of pelvic x-rays using a modified Visual Grading Scale (VGS).

Methods

A retrospective clinical audit of pelvic x-ray image reject rates over a 12-month period was conducted for an emergency department at an Australian hospital. Reject rate and anatomical cut-off were compared between images taken on a trauma trolley and a table bucky using independent samples t-test.

Results

A total of 1847 patients who underwent pelvic x-ray examinations were included in the study. The mean reject rate and the first exposure accuracy of pelvis x-rays taken on a trauma trolley were 35.5% and 56.7% respectively, while the mean reject rate and the first exposure accuracy for images taken on a table bucky were 18.8% and 81.8%, respectively (p < 0.01). The superior and lateral anatomy cut-off were the major causes of image rejection for both techniques.

Conclusions

Pelvic x-rays taken on a trauma trolley had a significantly higher reject rate and lower first exposure accuracy compared with those taken on an x-ray table. Future studies could involve implementing strategies to reduce the reject rate of pelvic x-rays taken on trauma trolleys.

Introduction

Tissue equivalent bolus is used to increase dose to skin and superficial tissue in adjuvant breast or chest wall radiation therapy. Three-dimensional (3D) printed bolus offers a customised conformal device and potential for improved anatomic conformity and dose distribution.

Methods

A literature search was defined as per PRISMA guidelines for scoping review. Inclusion criteria were determined using PICO guidelines. The parameters of interest, including year, journal, study type, intervention details, clinical sample size and pre-clinical case numbers, were extracted from each article. The reported outcomes, such as dosimetry, anatomic conformity, dose to organs at risk and toxicity data were recorded.

Results

Thirteen publications were reviewed, six studies were pre-clinical and seven were clinical. Ten were performed in the post-mastectomy setting and utilised polylactic acid (PLA) bolus. Overall, most studies reported marginal improvement in dosimetry, anatomic conformity, organ at risk dosimetry and toxicity with 3D printed bolus. However, sample sizes utilised were small and study design was variable with unusual choices of comparator arm and introduction of other variables.

Conclusion

Three-dimensional printed bolus is an emerging technology in radiation oncology. Most available data in the setting of breast radiation therapy is positive, though interpretation of results is difficult given the small sample sizes and variable study design. Further investigations in larger cohorts in a clinical setting is warranted.

Introduction

Diagnostic Reference Levels (DRLs) are a guideline to indicate whether the radiation administered during medical procedures performed under routine conditions is unusually low or high. Currently, there are no national DRLs in Australia for Digital Breast Tomosynthesis Mammography (DBT). Given the radiosensitivity of breast tissue, establishing DRLs for DBT is of great importance. This research aims to develop Local Diagnostic Reference Levels (LDRLs) for DBT that can be used as a guide for monitoring radiation delivery levels, and a Quality Assurance tool to assist in monitoring the performance of the mammography unit.

Methods

Average Glandular Dose (AGD) was collected from patient data through OpenREM software. Other data collected included breast density, compression force, compressed breast thickness (CBT), operative and treatment status. LDRLs were set using the 75th percentile (third quartile AGD values), categorised into four CBT ranges and compared against the median AGD values.

Results

LDRLs were similar for both craniocaudal and mediolateral oblique views. LDRLs for CBT ranges of 13–49 mm, 50–74 mm, 75–99 mm and 100–118 mm were calculated to be 1.5, 2.70, 3.90 and 4.70 mGy, respectively. There was no statistically significant correlation between breast density and AGD.

Conclusion

It was found that CBT had a larger impact on dose than density. Significant differences were found between the LDRLs for each of the CBTs; therefore, setting a single LDRL for all CBTs may result in missing unacceptably high or low breast doses. LDRLs should be reviewed frequently to ensure the radiation dose patients receive is within optimal levels.

Introduction

Radiographers and physicians working in interventional radiology (IR) departments are responsible for monitoring and optimising radiation dose exposure to both patients and staff. The dose-area product (DAP) is a common measurement of radiation output but does not directly correlate with stochastic risks. Pre-determined conversion factors allow estimation of effective dose (ED) for IR procedures to better assess radiation exposure risks. This study evaluates the clinical utility of DAP-to-ED conversion factors to improve knowledge of radiation risk assessment.

Methods

Retrospective data on DAP (Gray per centimetre-squared/Gy.cm²) from uterine artery embolisation (UAE) procedures were analysed. Conversion factors were obtained from the ‘United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Global Survey on Medical Exposure: A User Manual’. Group A (n = 50), which followed standard protocols, was compared with Group B (n = 50) which implemented dose optimisation techniques.

Results

Multivariable linear regression (MVLR) analysis demonstrated that DAP correlated with the converted ED values for both groups (p < 0.01). The mean ED was 9.5 milliSieverts (mSv) for Group A and 8.7 mSv for Group B.

Conclusion

MVLR analysis confirmed a strong correlation between DAP and the ED conversions, demonstrating that the ‘UNSCEAR User Manual’ has potential to serve as a DAP-to-ED estimation tool for common interventional procedures. The mean ED found was equivalent to the radiation dose of approximately one abdominal computed tomography (CT) scan. Implementing DAP-to-ED conversion can be valuable in improving both clinicians and patients' awareness of radiation exposure.