Journal of Medical Radiation Sciences最新文献

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.

Introduction

Imaging surveillance of patients post breast surgery for breast cancer is routinely performed with mammography. In practice, a large number of patients receive a concomitant ultrasound. The latter has not been established as routine practice and varies across imaging departments and referrers. This study aims to determine if the use of digital breast tomosynthesis (DBT) has decreased the need for concomitant ultrasound and extra mammographic views compared to digital mammography (DM).

Methods

Data was retrospectively reviewed for patients undergoing surveillance mammography for two periods: 2015–2016 (DM) and 2018–2019 (DBT). Patients identified as first-year post breast-conserving surgery (BCS) were included in the study. Comparison of proportions of concomitant ultrasound use between the two periods, with subgroup analysis for breast density categories, was performed using Chi-squared tests.

Results

The study included 499 patients, of which 245 and 254 represented the DM and DBT periods, respectively, with a mean age of 60.1 years (SD 13.1) for the entire cohort.

During DBT period, the percentage of patients having concomitant ultrasounds decreased by 15 percentage points (95% CI 8.9%–21.1%) (p < 0.0001) when compared to the DM period. During DBT period, the percentage of patients having extra views decreased by 44 percentage points (95% CI 36.1%–51.1%) (p < 0.0001).

Conclusion

The introduction of DBT resulted in fewer concomitant ultrasound examinations and extra mammographic views performed in the first-year post breast cancer treatment. The role of ultrasound in cancer surveillance post-treatment is debatable and large prospective studies investigating its value are warranted.

Introduction

Antoni Cieszynski, a 19th-century Polish dentist, pioneered a rule of isometry for accurate dental radiography. His bisecting angle technique improved the precision of imaging teeth by angling the x-ray tube perpendicular to a ‘bisecting line’ between the object and the image receptor, thereby minimising geometric distortion and achieving more anatomically accurate images. This study explored the potential use of this rule for x-ray imaging of long bones when routine positioning techniques are compromised.

Methods

Using an adult phantom forearm, an experiment was conducted to quantify the effectiveness of the bisecting angle technique on a long bone. A control image using a straight tube with the bone parallel to the digital image receptor (IR) was taken. This was followed by x-rays of the phantom forearm at 15° increments with a straight tube, matching tube angle and the bisecting angle technique. The resulting images were analysed by a single scribe and reviewed by one other peer for geometric distortion using the calliper measurement tool.

Results

The control image measured 21.4 cm. When the central ray matched the angle of the phantom forearm, the maximum elongation exceeded the length of the detector (> 43 cm). When a straight tube angle was applied, the maximum foreshortening measured 13.5 cm. Meanwhile, the maximum length of the phantom forearm, when the bisecting angle was applied, was 24.1 cm. While the use of the bisecting angle technique did not eliminate geometric distortion, it greatly reduced it. The experiment identified that common radiographic practice has the potential to be improved.

Conclusions

The bisecting angle technique offers a promising method to improve long bone imaging. While it does not fully eliminate geometric distortion, it effectively minimises elongation, suggesting a potential to enhance imaging accuracy for long bones in clinical settings.

Introduction

X-rays of bone fractures immobilised with Plaster of Paris (POP) produce images of reduced diagnostic quality due to the increased density and irregular pattern of the POP overlying the anatomy of interest. Post-processing parameters in digital radiography (DR) can be applied to POP images to increase diagnostic quality without increasing radiation dose. The aim of this study was to evaluate the preferred image quality of POP immobilised distal radius fractures using optimised digital image manipulation algorithms.

Methods

A cross-sectional, quantitative survey study was conducted between November 2021 and December 2023 at a large metropolitan health network. The manufacturer standard algorithm and three new image post-processing algorithms were applied to pre-selected image sets. Orthopaedic surgeons (n = 34) and radiologists (n = 35) were surveyed to rank image quality of 10 random image sets (80 images in total). Data were described and analysed using median rankings, Mann–Whitney U tests and Friedman rank tests with post hoc Wilcoxin rank tests.

Results

A total of 13 orthopaedic surgeons and 14 radiologists participated. A highly enhanced algorithm using contrast boost (Algorithm D) was the most preferred set (n = 18/27) due to better visibility of bony detail and fracture sites. There was no difference in rankings between clinician groups.

Conclusion

In this single site survey, both orthopaedic surgeons and radiologists preferred the highly enhanced post-processing algorithm (D) indicating that image quality can be improved using optimised digital manipulation. POP post-processing parameters with contrast boosting could be implemented to potentially increase diagnostic accuracy without increasing radiation dose for x-ray imaging of the wrist with POP.

Introduction

The COVID-19 outbreak has had far-reaching impacts on cancer services worldwide. It has yet to be described how the pandemic has impacted patient selection methods for proton therapy (PT) specifically. This survey aimed to investigate the current international methods implemented for PT patient selection and to determine whether COVID-19 has impacted PT practice.

Methods

A 44-question survey was conducted from 29th January 2024 to 18th March 2024 using the Qualtrics platform. PT centres in 21 countries were invited to respond to the survey regarding patient selection methods used currently and prior to the pandemic, as well as impacts of COVID-19 on patient selection and service provision. The survey was disseminated with assistance from The Particle Therapy Co-operative Group.

Results

Nine centres completed the survey: four in Europe, three in the United States of America (USA), and two in Asia. Diagnosis or indications lists, clinical trials group assignment, dose distribution, dose metrics, and expert recommendations were the most reported patient selection approaches within the last five years. Only one centre in the USA reported changes to patient selection approaches during the height of the pandemic, mainly ceasing use of clinical trial group assignment. Six of the nine centres continued to treat patients infected with COVID-19. Five respondents indicated various suspensions or delays for certain treatment groups.

Conclusions

The findings show most respondents did not alter their patient selection approaches during the pandemic. These findings, however, cannot be generalised to all PT centres due to the small sample size of respondents.

Introduction

Preparing diagnostic radiographers for clinical roles is vital to ensure readiness for real-world scenarios. Traditional simulation methods have been central to radiography education, but virtual reality (VR) technology introduces immersive and dynamic environments that may enhance clinical preparedness. This study compares the perceptions of clinical preparedness among newly qualified radiographers trained with VR by Virtual Medical Coaching and traditional simulation methods.

Methods

A mixed-methods comparative study was conducted with 80 newly qualified radiographers from two universities. Forty were trained using VR, and forty with traditional methods. Participation in the assigned simulation methods was mandatory, but students could opt out of having their responses recorded. All invited students consented to inclusion in the study. Data were collected through semi-structured interviews, focus groups and objective performance measures, including input from heads of departments. Thematic analysis identified key themes in qualitative data, while quantitative data were analysed using mixed-effects models, two-way ANOVA and t-tests.

Results

The mixed-effects model showed that VR-trained students had significantly higher clinical preparedness scores (β = 0.905, SE = 0.106, z = 8.513, p < 0.001). T-tests revealed that VR-trained students scored higher in confidence, adaptability, technical proficiency and problem-solving skills (p < 0.0001). VR-trained radiographers also outperformed their traditionally trained counterparts in supervisor evaluations, radiograph quality and emergency performance.

Conclusion

VR training enhances confidence, adaptability and technical proficiency in newly qualified radiographers. Its immersive nature, combined with immediate feedback, contributes to improved clinical preparedness. This study highlights the potential benefits of incorporating VR into radiography education.