bluuebunny/crossref_metadata_2025 huggingface dataset:
Are there magnetic resonance imaging‐detectable pathologies in idiopathic scoliosis patients?
Authors: Stanley Victoria GH
Published: October 2013

Scoliosis may be a spinal manifestation of underlying disease, therefore, imaging plays a very important role in determining the underlying aetiology of so‐called ‘idiopathic’ scoliosis. If underlying intraspinal defects go unrecognised and untreated, irreversible neurological deficit can develop.

Magnetic resonance imaging (MRI) is the modality of choice for imaging the spinal canal, albeit controversially. This literature review has been designed to find out whether there are associated MRI‐detectable pathologies in idiopathic scoliosis patients. If so, what is the incidence of such abnormalities? And when would MRI evaluations be warranted for idiopathic scoliosis patients?

Twenty studies relating to MRI and scoliosis met the criteria and were used to perform a meta‐analysis. The majority of the articles took the view that a non‐invasive investigation which does not use ionising radiation and which can reliably exclude such intraspinal occult disease should not be withheld.

Results showed that, in a population of 1398 idiopathic scoliosis patients, MRI detected 226 (16%) related intraspinal pathologies. The most common pathologies were 73 syringomyelias (32%) and 44 Chiari malformations (19%). In conclusion, until further investigation is conducted into the clinical significance of the intraspinal diseases with idiopathic scoliosis, whole spine MRI evaluations with a variety of imaging planes and pulse sequences are warranted in all idiopathic scoliosis patients, even if it is from a defensive risk management viewpoint.
Mammography interpretation: factors influencing the assessment of accuracy and the perception of abnormality
Authors: Reed Warren
Published: October 2013

This article examines the issues concerning the assessment of observer performance and the process by which abnormalities are perceived and reported upon in screening mammography. The assessment of observer accuracy and the perception of abnormality are discussed to gain some insight into the image interpretation process. It is surmised that, with further research into these areas, it may be possible to inform educators to adopt teaching strategies that can improve the detection of breast cancers in screening mammography.
Edge sharpness as a function of depth in plain film radiography
Authors: Auton Timothy , Bishop Romilly , Haliczenko Kylie , Hurley Matthew , Madden Shane , Rose Bethany , Hart Robin
Published: October 2013

Determination of the axial relationship between anatomical structures along the beam path in plain film radiography is often important in determining the appropriate positioning corrections to overcome initial positioning error. It has been suggested that this determination can be made on the basis of the relative sharpness of bony edges, with geometric theory predicting that the edge further from the image receptor will produce a wider penumbra (be ‘less sharp’) than an equivalent edge closer to the image receptor. In clinical practice it is doubtful if this technique is useful. Using a double‐blind trial, 33 participants including both females and males, and student and qualified medical imaging practitioners, viewed 29 images of known geometry and assessed the relative sharpness of two bony edges. Of 950 individual observations, 436 were identified correctly and 514 incorrectly. By using χ2 and binomial distribution tests, we found this result does not differ significantly from that obtained by chance, (P < 0.01). It is strongly suggested that edge sharpness alone should not be used or taught as a method to determine the relative positions of structures lying along the x‐ray beam path.
Radiographer reporting in emergency departments – a literature review
Authors: Radovanovic Hailey , Armfield Nicole
Published: October 2013

Radiographer reporting is an ongoing issue in radiology departments worldwide, and is accompanied by some complex and controversial themes. In this article, ten studies examining the accuracy of radiographer reporting are compared and considered. The ability of a radiographer to discriminate abnormal radiographs and, in addition, to identify such abnormalities, is investigated. Any biases detected in the studies are noted. Discussion leads to the conclusion that with training, radiographers are able to provide reports similar in accuracy to radiologists.

Radiographer reporting is a theme that has been noted in departments throughout the last century; however the issue has become more prevalent since the early 1980s. The term ‘radiographer reporting’ is used in many instances, but generally refers to a situation where a radiographer is required to give a professional opinion on a radiograph. This may include a radiographer being required to identify examinations where any abnormality is noted on a radiograph, such as radiographer abnormality detection systems (RADS) and specially trained radiographers writing a full report on the examination, as a radiologist would. There are considerable advantages to such a system, and to a lesser degree, disadvantages. Various studies have been conducted to investigate the efficacy of radiographer reporting systems, looking specifically at the radiographers' abilities to determine and identify any abnormality demonstrated. In addition, studies have been performed to distinguish whether special training can improve results in either of these categories.

Radiographer abnormality detection systems are used worldwide, with some countries implementing and embracing full systems and training for their radiographers in both the public and private sectors. Perhaps the most well known form of radiographer reporting is the ‘Red Dot System’ (RDS), which was created in London in 1981 and is now used in over 150 hospitals throughout the UK. The RDS was devised following the discharge of a patient with a fractured neck of femur by a casualty officer, which the radiographer had actually identified. The RDS requires radiographers to flag cases where an abnormality is noted, possibly preventing other professionals missing these abnormalities. Compared with many hospitals overseas, Australia has been slow to trial RADS and has yet to put into operation any specific system.
Online versus offline corrections: opposition or evolution? A comparison of two electronic portal imaging approaches for locally advanced prostate cancer
Authors: Middleton Mark , Rolfo Aldo , Medwell Steve , See Andrew , Wong Jacky , Joon Michael Lim , Lynton‐Moll Mary
Published: October 2013

Given the onset of dose escalation and increased planning target volume (PTV) conformity, the requirement of accurate field placement has also increased. This study compares and contrasts a combination offline/online electronic portal imaging (EPI) device correction with a complete online correction protocol and assesses their relative effectiveness in managing set‐up error. Field placement data was collected on patients receiving radical radiotherapy to the prostate. Ten patients were on an initial combination offline/online correction protocol, followed by another 10 patients on a complete online correction protocol. Analysis of 1480 portal images from 20 patients was carried out, illustrating that a combination offline/online approach can be very effective in dealing with the systematic component of set‐up error, but it is only when a complete online correction protocol is employed that both systematic and random set‐up errors can be managed. Now, EPI protocols have evolved considerably and online corrections are a highly effective tool in the quest for more accurate field placement. This study discusses the clinical workload impact issues that need to be addressed in order for an online correction protocol to be employed, and addresses many of the practical issues that need to be resolved. Management of set‐up error is paramount when seeking to dose escalate and only an online correction protocol can manage both components of set‐up error. Both systematic and random errors are important and can be effectively and efficiently managed.
Comparison of FIESTA and gadolinium‐enhanced T1‐weighted sequences in magnetic resonance of acoustic schwannoma
Authors: Rigby Paul J.
Published: October 2013

Acoustic schwannomas (AS) are a treatable cause of sensorineural hearing loss (SNHL). Currently, the gold standard magnetic resonance (MR) examination for exclusion of acoustic schwannoma is gadolinium‐enhanced T1‐weighted images of the cerebropontine angles (CPA). The FIESTA (fast imaging employing steady‐state acquisition) sequence is a true‐FISP (free induction steady‐state precession) sequence that provides high‐resolution fluid‐bright images of the CPAs and basal cisterns. The T1‐weighted sequence adds cost and time to the examination, and possibility of contrast medium reaction exists. This study of 50 patients compared the gadolinium‐enhanced T1‐weighted images and FIESTA images. The hypothesis was that the FIESTA sequence could repIACe the gadolinium‐enhanced T1‐weighted images for the diagnosis of AS. The results showed that in 98% of cases, this was possible. The conclusion was that when the FIESTA sequence does not demonstrate AS, this sequence may be employed in isolation. However, gadolinium‐enhanced images should be employed when pathology is seen and to follow‐up post‐surgical patients.
The Red‐dot system in medical imaging: ethical, legal and human rights considerations
Authors: Smith Lac
Published: October 2013

The Red‐dot system, used extensively overseas, but sporadically in Australia, allows radiographers to bring abnormal images to the attention of the referring medical practitioner, prior to the issuance of a formal radiologist's report.

There is much discussion in the public arena as to the increasing workload of medical practitioners, and the role other health professionals may play in easing this burden. In addition, hospital emergency departments across Australia are under pressure to minimise ambulance bypass and patient waiting times, while maintaining optimal diagnostic and treatment standards.

The third component to this discussion is some radiographers' general hesitance regarding the Red‐dot system because of legal issues. In addition, there is the issue of many medical practitioners not wanting to give up aspects of their practice, citing a potential decrease in the quality of the health service.

Analysis of the legal and human rights literature with respect to the provision of emergency medical services in particular, as well as detailed exploration of the various ethical issues involved with the Red‐dot system indicate to the author that such a system has a significant role to play in the provision of healthcare, particularly where a radiologist's report may be delayed. Additionally, radiographers are able to accept the challenge of contributing to healthcare without fear of legal endangerment in particular, provided they are willing to maintain a level of excellence with respect to their image interpretation skills.

The Australian Institute of Radiography (AIR) is correct in listing the ability of radiographers to notify referring doctors of abnormal results and offering opinions on radiographic examinations within their expertise, when requested. It is the conclusion of this paper that use of the Red‐dot system is best practice and as such should be implemented in all radiography departments associated with emergency medicine departments.
Critical analysis of the argument in favour of radiographer assistants
Authors: Smith Tony
Published: October 2013

It is apparent from current literature that Australia, like other countries, is facing an inevitable workforce crisis because of its aging population. It is predicted that, while the patient population will increase, the size of the health care workforce will decline. Health professionals are being encouraged by governments to examine new ways to practice. In the United Kingdom reform and restructuring of the radiography workforce has already taken place, apparently with some success. The introduction of assistant practitioners has aided the development of advanced and consultant practitioner roles. In Australia, health professions other than radiography have had assistant practitioners for many years. It is argued that the introduction assistant practitioners into the workforce has the potential to improve the perceived professionalism of radiographers. The radiography profession has been subject to ‘subordination’ and ‘limitation’ from the medical profession for decades but does not have capacity to formally delegate tasks to another subordinate occupation. With the prospect of health care workforce reform clearly evident, it may be timely for the radiography profession to proactively explore new, more flexible models of practice. The implementation of assistant practitioners may be a widely beneficial component of radiographic workforce reform.
Is there structured career management in the medical radiations profession?
Authors: Chan Angela
Published: October 2013

The medical radiations profession in Australia is experiencing staff recruitment and retention problems. In addition, the profession currently lacks a clear and consistent career management structure. This paper explores the published literature that relates to medical radiations career management. Upon investigation, there appears to be limited literature on the topic of career management in medical radiations. This does not mean that active career management is not taking place in the medical radiations profession; it may be that career management is not being fully explored or documented in the literature. With limited literature, a broad view needed to be taken with this paper to examine a number of issues currently impacting on the medical radiations profession.

Literature suggests that encouraging, supporting and rewarding staff through career management is required if the profession is to move forward. The profession must take control in defining itself and shaping its future. Developing career management strategies that promote and support staff in the pursuit of career development activities must occur if the profession is to overcome staff shortages and issues of low staff morale. As an emerging profession, it is time for the profession to define itself and advance in a manner that recognises career management and career structure as being central to addressing the current recruitment and retention issues.
A review of the development of electronic portfolios in education and health care disciplines: supporting students' learning and continuing professional development
Authors: Ng Curtise KC , White Peter , McKay Janice C
Published: October 2013

Using a portfolio approach is not a new idea in health care disciplines as an alternative assessment format and for Continuing Professional Development (CPD). Increasingly, the use of electronic portfolios is noted in the literature. This paper critically reviews developments, features, advantages and problems relating to different modes of operation. The review is conducted with educational and CPD usage in mind particularly for the health care professions where reflective practice, applied learning and outcomes‐based education are prominent pedagogies. The most appropriate types of electronic portfolio practice are also discussed. Although a number of problems were noted with earlier types of electronic portfolio, they have been rectified by the current existing modes of operation. It is suggested that the development of reflective abilities and professional development are well served with the currently available technology incorporating capabilities of collaborative learning, storage and management, portability and access, flexibility and multi‐media contents. Although web and web database portfolios tend to be role models for electronic portfolios, the most appropriate type depends on the values of the stakeholders. This paper concludes that web portfolios provide greater flexibility in building and are feasible in small size situations such as subject‐based portfolio practice or personal use for CPD records. Web database portfolios should be the only choice at institution or professional society level because of the capability to serve a large population. Reflective learning and professional development can be captured using electronic portfolio systems, and further advances on the current technology will evolve. What is important in establishing an electronic portfolio is to ensure that the content requirements remain the most important aspect and that development is seen to support this aspect rather than focusing on the technical process of portfolio building.
Failure to correct femoral anteversion on the AP Pelvis radiograph leads to errors in prosthesis selection in total hip arthroplasty
Authors: Meyer C , Kotecha A
Published: October 2013

The antero‐posterior pelvis radiograph is used in templating to calculate the size of components used in hip arthroplasty. This study investigates whether failure to account for femoral neck anteversion, when obtaining preoperative AP radiographs, may lead to the selection of an incorrectly sized femoral stem. Three anatomically correct saw‐bone models were labelled with radio‐opaque markers. Serial radiographs were taken as each model was rotated though successive angles, as determined with a goniometer. The resultant offset was measured from each image. The length of offset is greatest at 15° degrees of internal rotation. The length of offset is altered by rotation (Friedman Xr2 9.0, k 4, N 3, P <0.01, two‐tailed test). The results indicate that, for the Exeter hip system, this could lead to the selection of a stem two sizes too small. Lesser degrees of rotation, not readily identified by looking at the image, could still lead to the selection of an incorrectly sized stem. This finding is applicable to other modular hip replacement systems in common use. To ensure that patients receive hip prostheses of correct size, preoperative radiographs should account properly for femoral anteversion. A foot box may help to standardise the amount of femoral anteversion when preoperative radiographs are taken.
Feed‐and‐sleep: a non‐invasive and safe alternative to general anaesthesia when imaging very young children
Authors: Hansen Susanne S
Published: October 2013

The successful image acquisition during a Magnetic Resonance Imaging (MRI) examination requires the subject to remain motionless. For very young children this requirement presents a challenge since reduced cooperation is to be expected with young patients. A general anaesthetic is often needed to immobilise the patient and satisfactorily complete the MRI. However, utilising a general anaesthetic involves costs in terms of staffing requirements, recovery time, pharmaceuticals and specialised equipment. A non‐invasive method to ensure paediatric patient immobility during MRI may therefore be considered a better option. Evaluation of the success rate of completing paediatric MRI examinations at the Mater Private MRI Unit, Brisbane, by using food, comfort and an immobilisation device to induce sleep in infants has been undertaken. Over a period of 15 months a group of 36 infants were scanned without the aid of a general anaesthetic. The patients arrived in the department and were fed and nursed until they settled down. Once calm, the child would be taken into the scan room, accompanied by a parent or guardian and positioned in an immobilisation beanbag. The “feed‐and‐sleep” approach enabled the successful completion of scans in 89 per cent of patients in the study group. Using a feed‐and‐sleep method to complete a diagnostic imaging test offers a non‐invasive option for the young paediatric patient. The advantage of the feed‐and‐sleep method is a reduction of cost and time associated with a general anaesthetic.
Research interests identified at the coal‐face: initial Delphi analysis of Australian radiation therapists' perspectives
Authors: Cox JM , Halkett GKB , Anderson C
Published: October 2013

Radiation therapists (RTs) need to engage more in research for the benefit of their patients and their own professional development. However, radiation therapy in Australia is new to research with an undeveloped research culture, so RTs need direction when wishing to embark upon research projects. This manuscript provides the results of the first stage of a Delphi process aimed at defining RTs' areas of research interest. Questionnaires were sent to all Australian departments of radiation oncology (n = 41) asking for a group in each department to identify what problems they experienced while treating patients or working with colleagues, and what areas of radiation therapy they felt required further research by radiation therapists. The response rate was 70.7%. Of the designated RTs who collected the data, 82.8% had greater than 10 years experience and 48.1% had postgraduate qualifications. Two of the researchers categorised the responses and derived a list of themes to describe the identified questions. Of 410 research questions, 374 could be coded (91.2%). The categories defined were “Staff issues” (58.3%), “Technical issues” (28.9%) and “Patient related issues” (12.9%). The RTs were interested in many research areas, but it is of concern that the largest theme identified was “Staff issues”, which could indicate some dissatisfaction in the workplace. However, it was clear that RTs are thinking about their practice and identifying gaps in knowledge in the technical and patient related areas. The second stage of this project was to create research areas that represented the themes identified in this first stage and send them back to the radiation oncology departments for prioritising; these data are currently being analysed.
The relationship between diabetes and abdominal fat distribution, as measured by CT scanning
Authors: Stieler G , Yelland M
Published: October 2013

Background: Diabetes is rapidly becoming Australia's fastest growing disease. Efforts to prevent or detect this disease earlier have led to research into risk factors which may be relevant. The objective of this project was to examine the relationship between diabetes and abdominal fat distribution as measured by computed tomography (CT) scanning. Methods: A consecutive series of patients undergoing abdominal CT scanning, including 10 patients with type 2 diabetes and 32 patients without diabetes, who presented for CT scanning, were included in the study. Total abdominal and intra‐abdominal fat (within the peritoneum) were measured from the CT images. Results: There was no significant difference between the mean age, weight and total abdominal fat of diabetics and non‐diabetics. The diabetics had a greater amount of intra‐abdominal fat (mean: 41.3 cm3) compared to the non‐diabetic group (27.2 cm3); mean difference 14.1 cm3, 95% CI; 1.4 cm3−26.8 cm3, P = 0.028. The percentage of total abdominal fat that was intra‐abdominal was also greater among diabetic patients; diabetic 35.3%, non‐diabetic 27.6%; mean difference: 7.6%, 95% CI; 1.1%‐14.2%, P = 0.02. Conclusions: The results support the debate that location of abdominal fat within the peritoneum is more prevalent with diabetic subjects. Radiologists should consider this when reporting abdominal CT.
Ureteral calculi imaging: a literature review comparing plain film studies, contrast media studies, ultrasound and computed tomography
Authors: Meredith E , Reed W
Published: October 2013

Purpose: Through a study of the literature this paper aims to investigate the imaging pathway which should be undertaken by patients presenting to the emergency department with renal colic and flank pain. Method: The British Journal of Radiology, Journal of Endourology, Radiology, RadioGraphics, American Journal of Radiology and Adult Urology were searched to find any previous studies into this area through the use of keywords: calculi, renal, computed tomography (CT), plain imaging, abdominal, ultrasound, intravenous urogram (IVU) and x‐ray. Conclusion: This literature review determined that the use of non‐enhanced helical CT scanning of the abdomen and pelvis should be utilised as the initial imaging technique. CT is able to demonstrate all stones, can be performed rapidly and can diagnose other pathologies which may be mimicking renal colic. Plain film and contrast imaging studies including intravenous urography (IVU) are seen as being of little diagnostic value for frontline identification due to their inability to demonstrate a large number of stones due to size, location and composition. Ultrasound has been shown to be of use as a tool for pregnant or paediatric patients, however its inability to accurately demonstrate the ureters and diagnose extra‐urinary pathology limits its use for the general population. The use of low‐dose CT is also discussed, and its use advocated for patients with repeat presentation of these symptoms. As more eduction is provided into this area, the authors believe this will become the modality and technique of choice. An imaging pathway flowchart devised by this review is provided.
Systematic review — role expansion in radiation therapy: from an international perspective to an Australian context
Authors: Acharya U , Acharya V , Vatsavayi S Raja , Cox J
Published: October 2013

This systematic review aims to explore the current state of role expansion in radiation therapy internationally and gain an informed understanding of the possibilities of such practices in an Australian context. A comprehensive search from 1990 to 2008 was undertaken to extract publications from electronic databases, individual journals and professional bodies. A thorough title and abstract audit was conducted. Fifteen articles were selected for critical analysis after content examination. The results indicated that expanded roles for radiation therapists (RTs) have been implemented internationally, but few are reported in the Australian environment. The two most prominent roles identified were the patient treatment reviewer and the image reviewer. Additionally, roles such as the breast planning RT, research RT and information and support RT have also been described. The data offered a substantial amount of evidence that developed countries are progressing rapidly towards role expansion. Expanded practice has conferred greater accountability; autonomy and responsibility on RTs. Positive outcomes such as improved patient care and increased job satisfaction for RTs have been observed despite barriers such as medical dominance and legal issues. It therefore appears that role expansion in RT is viable in Australia, but further research and evaluation should be conducted before role expansion is applied.
Prior cancer‐death events: what impact does this have on radiation therapy students?
Authors: Dungey GM
Published: October 2013

Purpose: In 2004, a study was undertaken to determine whether treating cancer patients affected the identity development of radiation therapy students in New Zealand. Initial data analysis revealed many students had experienced significant cancer‐death events, such as family members or friends dying prior to entering the course. Methods: A further thematic analysis was undertaken of the transcript data to determine the effects of having a prior cancer‐death event on students' attitudes and perceptions of death. Results: Sixteen of the 21 students indicated that they had experienced a cancer‐death event before entering the course. Four main themes evolved from the analysis of the student transcripts. The themes were: impact of having a prior cancer‐death event; parent relationships; compassion; and a reported feeling that their lives are meaningful. Students reported the impact of the prior death‐event on their professional choice and other aspects of their lives. Conclusion: Previous research found that young adults tended not to want to talk to their parents about death. In this study students openly discussed with parents issues relating to previous cancer‐death events and dying patients. Both female and male students in this cohort demonstrated high levels of compassion. They expressed increased feelings of empathy with family and friends facing life‐threatening illnesses of others although not necessarily if minor illness was involved. Students also reported that their life was made more meaningful by their past experience with a cancer‐death. Further research will aim to explore whether a prior death‐related event influences a range of tertiary students with respect to their attitude to life, their relationships with other people and their career choices.
Comparison of fiducial and bony anatomy match with the introduction of implanted gold seed markers in the prostate gland
Authors: Hilder B
Published: October 2013

Purpose: The introduction of implanted gold seed fiducial markers for prostate cancer patients at the WP Holman Clinic, Hobart in November 2007 provided the opportunity to compare practice both with other centres and with the previous practice of the clinic. Methods: Images from the first 15 patients implanted with fiducial markers were analysed to ascertain the correlation between online match to fiducial markers and offline bony match. Random and systematic errors in both the matches and any changes in action level (using a clinical action level of 3 mm) between image pairs were determined. Results: The study demonstrated that the use of fiducial markers in this clinic is practicable and that the random and systematic error of both the bony anatomy and fiducial match were similar to that of other studies. The change in action level between the use of fiducial markers and bony anatomy was 46% for anterior/posterior images and 63% for lateral images. This indicates that a match to bony anatomy could result in an underdose of the treatment volume and inclusion of unintended normal tissue in the high dose irradiated region. Conclusion: This small study demonstrates that the introduction of fiducial markers for image matching should result in more accurate isocentre placement.
Development of a training package to increase the performance of radiographers in assessing screening mammograms
Authors: Moran S , Warren‐Forward H
Published: October 2013

Purpose: Due to a lack of any formal training in mammographic image interpretation for radiographers in Australia, a training package was developed specifically for radiographers who were to undertake a trial of screening mammogram assessment. Methods: A PowerPoint presentation was developed and included topics such as: how best to prepare to screen read, methods of checking all areas of the breast tissue, and examples of benign and malignant lesions. The training package was made available after completion of a pilot study, and pre‐post testing was conducted on the same mammograms to determine the effectiveness of training. Results: There was an overall increase in sensitivity (73–78%) with five of seven radiographers improving. The average specificity was relatively constant (71–70%), with three radiographers showing improvement. Again, overall accuracy remained constant (72%) with four radiographers improving, one remaining constant and two decreasing in accuracy. Conclusion: Guidelines for preparing and systematically checking mammogram images were helpful to most of the radiographers, with the training package helping to improve sensitivity and accuracy for the majority of participants.
An introduction to nuclear medicine
Authors: Wheat JM , Currie GM , Davidson R , Kiat H
Published: October 2013

Nuclear medicine is the injection, ingestion or inhalation of a radiopharmaceutical for the purpose of diagnosis or therapy. It shares imaging synergies with both planar/general x‐ray and to computed tomography (CT) in its acquisition methods. Nonetheless, the prime difference is that the focus of planar x‐ray and CT is on morphology or anatomy while nuclear medicine has a focus on the evaluation of function or physiology. The history of nuclear medicine follows similar timelines to that of x‐ray. Nuclear medicine, however, had a slower recognition and clinical permeation of its imaging/treatment methods and strengths as well as a delayed recognition of the dangers of these forms of ionising radiation. Both planar x‐ray and planar nuclear medicine, and x‐ray CT and single photon emission computed tomography (SPECT) have emerged with greater integration in order provide improved diagnostic utility of each modality; the whole is greater than the sum of its parts. The strengths of x‐ray imaging modalities and the treatment approaches used in radiation therapy are well understood by diagnostic radiographers and radiation therapists. An understanding of the technical and clinical aspects of nuclear medicine and its imaging and treatments strengths can provide improved service provision and patient care.
Development and implementation of the Australian universities radiation therapy student clinical assessment form
Authors: Dempsey S , Giles E , Chiswell M , Wright C , Charlton N , Rowntree P , Forrest W , Churcher K , Jimenez Y , Hargrave C
Published: October 2013

Purpose: Prior to 2009, one of the problems faced by radiation therapists who supervised and assessed students on placement in Australian clinical centres, was that each of the six Australian universities where Radiation Therapy (RT) programmes were conducted used different clinical assessment and reporting criteria. This paper describes the development of a unified national clinical assessment and reporting form that was implemented nationally by all six universities in 2009. Methods: A four phase methodology was used to develop the new assessment form and user guide. Phase 1 included university consensus around domains of student practice and assessment, and alignment with national competency standards; Phase 2 was a national consensus workshop attended by radiation therapists involved in student supervision and assessment; Phase 3 was an action research re‐iterative Delphi technique involving two rounds of a mail‐out to gain further expert consensus; and stage 4 was national piloting of the developed assessment form. Results: The new assessment form includes five main domains of practice and 19 sub‐domain criteria which students are assessed against during placement. Feedback from the pilot centre participants was positive, with the new form being assessed to be comprehensive and complemented by the accompanying user guide. Conclusion: The new assessment form has improved both the formative and summative assessment of students on placement, as well as enhancing the quality of feedback to students and the universities. The new national form has high acceptance from the Australian universities and has been subject to wide review by the profession.
Attitudes of medical imaging technologists on use of gonad shielding in general radiography
Authors: MacKay M , Hancy C , Crowe A , D'Rozario R , Ng CKC
Published: October 2013

Purpose: Gonad shielding is an important way to address the ‘as low as reasonably achievable’ (ALARA) requirement in radiography. However, its use relies on the attitudes of medical imaging technologists (MITs) to consistently adhere to professional conduct requirements relating to the application of gonad shielding. The purpose of this study was to investigate the attitudes of Western Australian (WA) MITs to the use of gonad shielding in general radiography and also to explore the variables influencing these attitudes. Methods: A questionnaire regarding MITs' attitudes towards gonad shielding was developed based on relevant literature and distributed to MITs working in general radiography employed by public and private clinical centres in WA metropolitan and rural regions. Descriptive (percentage of frequency, mean and standard deviation) and inferential statistics (chi‐square, t‐test and analysis of variance) were used to analyse the responses of the multiple choice (MC) and 5‐point scale questions from the returned questionnaires. Results: The questionnaire response rate was 44.6% (127/285). It was found that WA MITs perceived gonad shielding as important (mean: 3.8) and that adequate education had been provided (mean: 3.1). However, statistically significant attitude variations existed among MITs from different employment sectors (P < 0.01), equipment awareness (P < 0.05), genders (P < 0.005) and educational qualifications (P < 0.05). Conclusion: Overall, WA MITs have positive and appropriate attitudes to the use of gonad shielding in general radiography. However, statistically significant attitude variations existed among MITs. Possible directions for improvement include the provision of gonad shielding protocol in each x‐ray room in clinical departments and the enhancement of education and training of shielding application. This potentially will lead to improved consistency in the appropriate application of gonad protective shielding.
Quality parameters and assessment methods of digital radiography images
Authors: Alsleem H , Davidson R
Published: October 2013

This article reviews the parameters that characterise the image quality of digital radiography and the available evaluation methods that are used to measure these parameters. The article also discusses the factors that affect each parameter of image quality. Digital imaging systems are the most commonly utilised technology in the field of radiology. Screen‐film radiography systems are almost replaced by digital radiography. The data acquisition and image processing principles of digital radiography differ from that of conventional radiography. The required exposure factors for each digital radiography system are not the same. Therefore, the image quality should be optimised while lower radiation dose is maintained according to the properties of the specific imaging system. Distinguishing image quality parameters and understanding the factors that control each image quality parameter are essential to optimise and maintain image quality and to reduce radiation dose to the patient. The degree of factors effects on the images of different digital radiography types and systems are not exactly same. There are different methods and approaches that are used to evaluate the quality of medical images and to assess the performance of imaging systems and each has its own rewards and limits. Therefore, these methods should be utilised and employed according to their aptitudes to improve imaging process.
A guide to foetal dose minimisation in computed tomography pulmonary angiography of the pregnant patient
Authors: Hancock J , Reed W
Published: October 2013

Purpose: For pregnant patients the imaging choice between computed tomography pulmonary angiography (CTPA) and ventilation‐perfusion scintigraphy (VQ) in the investigation of pulmonary emboli (PE) is clouded by perceptions of radiation dose levels reaching the foetus. There is also uncertainty amongst medical professionals regarding the subsequent need to implement measures directed at reducing this dose. The aim of this article is to clarify the various theories surrounding CTPA of the pregnant patient and provide radiographers and medical professionals with a clear, concise understanding of how to reduce the radiation dose to the foetus during CTPA scanning. Methods: In a review of the current data surrounding foetal doses in relation to CTPA this paper is able to compare CTPA and VQ foetal doses. By collating information from the limited number of studies performed on foetal dose reduction techniques for CTPA a number of conclusions were drawn in order to formulate a scanning guide for radiographers. Results: Current opinion suggests that the benefits of CTPA outweigh those of VQ with respect to foetal radiation dose. Survey evidence suggests that often no foetal dose reduction strategies are implemented when scanning a pregnant woman for CTPA. Recently published studies have shown that simply by altering the CTPA scanning parameters, such as kVp, mAs, and scan length, using lead protection on the abdomen, and even ingesting barium sulphate solution the dose received by the foetus can be reduced by at least half. Conclusion: Since the stochastic effects of radiation are relatively unknown it is prudent to use any practical techniques aimed at reducing the foetal dose during a CTPA study. Since most of the measures investigated are practical and cause little patient discomfort the authors suggest that consideration should be given to integrating these modifications into current routine scanning protocols.
Revolution or evolution? Hybrid imaging continues to push boundaries
Authors: Bailey DL
Published: October 2013

One of the major advances in imaging in the last decade has been the combination of existing functional imaging techniques such as SPECT (single photon emission computed tomography) or positron emission tomography (PET) with x‐ray computed tomography (CT), giving an anatomical framework to the functional image. PET/CT and SPECT/CT have changed the practice of nuclear medicine considerably since their introduction. This article examines how this hybrid technology evolved, its revolutionary impact, and that it is now seen as the first of potentially many multimodality hybrid imaging devices.
Radiological procedure induced heat loss in neonatal patients' transfer to the radiology department: implications for hypothermia
Authors: Chingarande GR , Matiki F
Published: October 2013

Purpose: The objectives of this survey were to determine temperature differences within the neonatal unit thermal environment and the radiographic room thermal environment; to measure how much time in minutes the infant spends outside the neonatal unit thermal environment during a radiographic examination carried out in the radiology department and to measure the amount of heat lost by the infant in the process. Methods: A cross sectional survey was conducted over a period of two months. Twenty two neonates, aged between one and 30 days, were included in the study. The neonate's body temperature before and after the radiological procedure, the total time the neonate spent outside the neonatal intensive care unit (NICU) and the temperature difference between the NICU and the radiological procedure room were measured for each neonate. Results: The mean time spent outside the neonatal unit was 27.82 minutes (standard deviation −1.68). The temperature difference ranged from −4°C to 3.5°C, with a mean temperature difference of −1.7°C. For 50% of the infants there was a temperature difference of 2 or more degrees. Eighteen percent of the neonates developed hypothermia during the course of the radiological procedure. The WHO classification of hypothermia, which defines a core body temperature between 36°C and 36.4°C as mild hypothermia, 32 to 35.9°C as moderate hypothermia and below 32°C as severe hypothermia, was adopted for this study. Conclusion: The study concludes that in settings where the NICU is not equipped for radiological procedures, where there is no functional mobile radiology equipment and where the neonate must be transported to the radiology department for radiographic procedures, greater care should be taken to minimise heat loss from the neonate. Greater coordination between the departments and warm linen for swaddling the neonates is recommended.
The role of breast imaging during pregnancy and lactation in the diagnosis of breast malignancy
Authors: Saunders C , Taylor D , Ives A
Published: October 2013

Purpose: Imaging the pregnant or lactating breast can prove a challenge with malignancy either obscured or masquerading as a benign mass. Pregnancy related, or gestational breast cancer occurs in 24 of every 100,000 pregnancies. It is vital to exclude malignancy in women at any age, whether pregnant or not, who present with breast symptoms and imaging is an important part of this work up. Methods: This paper reviews the current world knowledge of how best to image the breast in women who are pregnant or lactating. It includes the authors' own case series of 22 women identified from the Western Australian Gestational Breast Cancer Project and cases diagnosed at Royal Perth Hospital up to the end of March 2007 for whom breast imaging studies were available for review. Results/discussion: We discuss the imaging characteristics of gestational breast cancer as described in the world literature. Results demonstrate that most, but not all, pregnant and lactating breasts have high density but there is up to 100% negative predictive value for mammography and ultrasound. Despite the increased density mammography and/or ultrasound reveal positive findings when cancer is present in up to 90% of cases. Image guided biopsy is important to confirm a diagnosis. Conclusion: Imaging the breasts during pregnancy or lactation adds valuable information in the work up of a breast symptom. We provide an algorithm for the investigation of pregnant and/or lactating women with a palpable breast mass.
Classification of lesions identified on mammography with sonographic correlation
Authors: Peters G , Lee W
Published: October 2013

Standardised reporting for breast imaging is desirable to ensure consistency of reports. There is a minimum amount of data that should be included in a report. Classification of mammographic lesions correlated with ultrasound findings are reviewed in the pictorial review.
Identification and Estimation of Engel Curves with Endogenous and Unobserved Expenditures
Authors: Battistin Erich , Nadai Michele De
Published: October 2013

When dealing with the estimation of Engel curves, measurement errors in expenditure data and simultaneity are likely sources of endogeneity. In this paper we study identification of the parameters that characterize an Engel curve in the presence of both. We consider specifications where budget shares are polynomials in the logarithm of total expenditure, which is the case frequently encountered in empirical applications. We propose an estimation procedure which is an extension of that in Lewbel () and exploits a control function assumption to correct for the endogeneity of the true unobserved total expenditure. Copyright © 2013 John Wiley & Sons, Ltd.
Prenatal exposure to bisphenol A at the reference dose impairs mitochondria in the heart of neonatal rats
Authors: Jiang Ying , Liu Juan , Li Yuanyuan , Chang Huailong , Li Gengqi , Xu Bing , Chen Xi , Li Weiyong , Xia Wei , Xu Shunqing
Published: October 2013

Bisphenol A (BPA) exposure has been reported to be epidemiologically associated with heart disease. As mitochondria play an important role in the early development of the heart and in the pathogenesis of heart disease, the current study investigated the possibility of cardiac mitochondrial injury in neonatal rat heart prenatally exposed to BPA. Pregnant Wistar rats were exposed to BPA 50 µg kg–1 day–1 or corn oil 1 ml kg–1 by oral gavage throughout gestation. Heart samples from pups on postnatal day 1 were isolated for analysis. Ultrastructure results showed mild swelling with dissociation of cristae in myocardial mitochondria of BPA‐treated rats. Additionally, mitochondrial membrane potential and the activity of respiratory chain complex II were significantly decreased. However, the activities of other three complexes (CI, CIII, CIV) and cardiac histology stayed normal. The expression levels of some key regulators involved in mitochondria energy metabolism and ATP‐generating pathways were downregulated. The study demonstrated for the first time that prenatal exposure to BPA at the reference dose could impair mitochondria in the hearts of neonatal rats. Copyright © 2013 John Wiley & Sons, Ltd.