Friday 22 April 2016

Breast imaging for diagnosis – what works

Paula Sivyer

difw, Brisbane, Australia

Imaging for breast cancer comprises multiple options in terms of modalities and protocols that have to be applied in the clinical context by radiologists, referring GPs and medical imaging technicians across a broad patient population. We will discuss the roles of modalities such as mammography (standard 2D and 3D/DBT), breast ultrasound as well as the suite of interventional options including ultrasound‐guided fine needle aspiration/biopsy, core biopsy, vacuum‐assisted core biopsy, stereotactic vacuum core (mammotomy), pre‐operative hookwire placement and specimen imaging. We will discuss briefly the patient/practitioner expectations of breast MR and the reality. The clinical application of imaging protocols across the screening and diagnostic patient populations, including modality combination and imaging intervals, will be mentioned. Imaging case studies will be presented.

Psychosocial aspects of patient care during treatment of breast cancer

Jane Turner

The University of Queensland, Brisbane, Australia

The diagnosis of breast cancer represents a crisis for the woman and her family. There is often a sense of urgency about making treatment decisions, and anxiety is common as the woman navigates a complex and often confusing health care system. Surgical treatments can have a profound impact on body image, and chemotherapy is can be associated with varying side‐effects including nausea, cognitive changes, hair loss and fatigue. Radiotherapy is often anticipated by women as a low‐toxicity treatment which will be negotiated without difficulty.

The clinical reality is that fatigue is often compounded during radiotherapy, and the disruption to routines can dominate daily life. For many women this is the time they increasingly reflect on the enormity of their experience and contemplate the “new normal” after completion of treatment.

This presentation will overview some of the key psychosocial issues affecting women with breast cancer, including anxiety and depression, and provide practical strategies for therapists to respond to distress.

Advanced MR spectroscopy of the breast

Thomas Lloyd

Princess Alexandra Hospital, Brisbane, Australia

Single and multi voxel MRI spectroscopy has been used to investigate abnormal metabolites in disease processes for some time. A new method of spectroscopic analysis (2D cosy spectroscopy) is being investigated within the breast to assess risk of developing breast cancer. This has already been shown to demonstrate quantifiable differences in some high risk categories. We will discuss the work and possible future directions.

From technician to patient and back again (a personal case study of metastatic breast cancer, mucinous carcinoma grade 2)

Cathy Jones

PRP Castle Hill, Sydney, Australia

Breast cancer is the most common invasive cancer among Australian and New Zealand women affecting one in eight women over fifty.^1,2 Imagine the shock; breast cancer was not supposed to happen to me. As a radiographer, my work has enabled me to develop expertise in many aspects of diagnostic imaging including mammography, ultrasound, CT and interventional biopsy procedures and also with educating staff in clinical procedures and patient care. However, as a breast cancer patient, having the opportunities to see the workings of other medical departments such as nuclear medicine and radiotherapy has had a powerful impact on me. I have used Poetry writing as an expression to help me through this physical and emotional journey. This journey has given me an understanding of the diagnostics tests, treatments and anxieties, from the perspective of the patient, in view of how such treatments impact on patients undergoing breast cancer treatments. Through personal experience of these treatments, I have not only gained more knowledge, but I have developed a deep sense of empathy and insight into the patients’ perspective and their journey's. This presentation will highlight the importance of sensitive communication and empathy shown to our patients that not only gives job satisfaction, but also assists in the journey of recovery from breast cancer for our patients.

References

1. Australian Institute of Health and Welfare, 2012. Cancer incidence projections: Australia, 2011 to 2020. Cancer series no. 66 cat. No. CAN 62. Canberra: AIHW.

2. New Zealand Ministry of Health. Breast Cancer registration and death information for 2009. Breast cancer Aotearoa Coalition 2009.

Collapsed cone algorithm versus superposition algorithm in 3D conformal planning of lung cancer: considerations for implementing a planning system change

Ashleigh Allsop

Radiation Oncology Centres, Maroochydore, Australia

Objective: Implementing a radiotherapy planning system change requires consideration of the potential impact different algorithms can have on dose distribution and organ at risk (OAR) damage. The aim was to compare the effects of collapsed cone and superposition algorithm planning systems on 3D conformal treatment plans for lung cancer patients.

Method: Twenty three lung cancer patient plans were developed using both the superposition and collapsed cone algorithms. Plans were compared for 95% planning target volume (PTV) coverage, maximum spinal cord dose and mean, V10, V20 and V30 lung doses using paired sample t‐tests.

Results: 95% PTV coverage was significantly lower using the collapsed cone algorithm (75.8 ± 24.1 [SD]% vs. 96.0 ± 7.7%; P < 0.001). There was no significant difference between planning systems for any outcomes of OAR dose to the lungs or spinal cord.

Conclusions: Collapsed cone and superposition algorithms produce slight differences in 95% PTV coverage but do not affect OAR dose. Consideration of PTV coverage is necessary when implementing a planning system change for lung cancer patients. Irrespective of the planning system type it is feasible to maintain acceptable doses to OAR and achieve coverage of lung PTVs by optimising treatment plans whilst adhering to QUANTEC guidelines.

Novel method of positively biasing knowledge‐based planning output

Kenton Thompson

Radiation Oncology Centres, Cairns North, Australia

Objectives: Knowledge‐based planning (KBP) is a transformational change to treatment planning where previous plans can be used to train a model to accurately estimate the dose volume histogram (DVH) in a new patient. As the quality of plans generated by the model (output) is determined by the quality of the plans used to train the model (input) it is important to understand the effect of removing certain patients from the training process.

The aim of this paper is to explore the possibility of positively biasing a RapidPlan^™ (Varian Medical Systems, Palo Alto, CA) model by starting with a large number of patients and reducing the number of plans used for training but improving the quality of plans selected for training.

Methods: Fifty patient planned for and treated with IMRT to the prostate +/− seminal vesicles were randomly selected to train a RapidPlan^™ model. This model was duplicated and two new models created, one model with patients where the actual DVH for the rectum was worse than estimated and one where the actual DVH for the rectum was better than estimated on the residual rectum plot.

Results: Initial results demonstrate that the output of a model can be improved through positively biasing the selection of plans. However, positively biasing one organ at risk (OAR) can have a negative effect on other OARs.

Conclusion: This paper demonstrates that RapidPlan^™ can be positively biased. However, all OARs should be considered to ensure that the balance of trade‐offs reflect departmental goals for plan quality.

Innovative method of leveraging treatment planning expertise in a large multi‐vender organisation

Liam Jukes, Kenton Thompson

Radiation Oncology Centres, Cairns, Australia

Objectives: Experience with new techniques can vary across an organisation and expertise can often be hard to transfer due to differences in software between centres. Radiation Oncology Centres (ROC) has established SBRT programs at the Gold Coast in Queensland and at Gosford and Wahroonga in New South Wales. It is advantageous to leverage as much knowledge as possible including plan quality from the experts at these centres when implementing SBRT at other ROC centres.

This paper aims to validate the ability of RapidPlan^™ (Varian Medical Systems, Palo Alto, CA) to effectively model lung SBRT cases for Cairns to that of a different vender's treatment planning system.

Methods: Twenty‐four lung SBRT patients planned and delivered on TomoTherapy^® (Accuray, Sunnyvale, CA) were imported into RapidPlan^™ and a knowledge‐based planning (KBP) model was trained.

Results: TomoTherapy^® plans were successfully imported into RapidPlan^™ and a model trained. The model was validated by a closed‐loop analysis whereby the patient datasets used in model training were also used in model validation. RapidArc^® (Varian Medical Systems, Palo Alto, CA) was used for validation as this was the closest match to TomoTherapy^® available.

Standard SBRT DVH parameters and dose indices were used to compare plans created by the model to plans created with the lung SBRT model available within RapidPlan^™.

Conclusion: ROC has successfully demonstrated that knowledge‐based tools enhance the ability of centres to collaborate and are advantageous to streamline and standardise the implementation of new techniques.

An objective analysis of class solution based Monaco^® IMRT planning for prostate patients using Quality Reports^™ software

Sarah Clarke, Stuart Greenham, Josie Goodworth, Andrea Laszczyk, Brendan Chick, Matthew Hoffman, Jacqueline Pacey, Richard Ford, Justin Westhuyzen

NCCI, Port Macquarie, Australia

Introduction: In Radiation Therapy, plan quality depends largely on the skill of the planner. Until recently the tools for plan or class solution assessment were relatively limited. This contributed to variability even when plans were considered clinically acceptable.

Objectives/Aims: We describe the implementation process and use of Sun Nuclear Quality Reports to conduct a retrospective, quantitative analysis of IMRT prostate plan quality. Expanding on earlier work this study validated a range of class solutions in order to: (a) increase confidence in the concept (b) aid understanding of the optimal Monaco IMRT planning parameters (c) inform the development of further class solutions.

Description/Methodology: Seventy six prostate cases were analysed. Three successive Monaco class solutions templates were applied to each case without any planner optimisation or intervention. Resultant plans were then compared to the clinically delivered plan and benchmarked against a set of quality metrics.

Results/Conclusions: Non‐parametric statistical tests of the 296 plans indicated a high degree of consistency across patient plans using an automated class solution approach. Achieving clinically acceptable dosimetry in 90.75% of cases confirms the validity of the automated approach. Implementing an automated class solution on current IMRT planning systems is feasible and has the capacity to reduce plan and planner variability while improving efficiency and quality.

The rationale, benefits and limitations of dynamic conformal arc therapy (DCAT) ‐ a comparison between planning techniques

Tatiana De Martin

Genesis Cancer Care, Crows Nest, Australia

Introduction: Dynamic Conformal Arc Therapy (DCAT) is a widely accepted, effective planning technique used for various targets including lung, liver and intracranial lesions¹ with studies showing that DCAT is the preferred planning technique for lesions smaller than 2 cm compared to IMRT.² Comparative studies conducted at Genesis Cancer Care's Mater department found additional advantages of DCAT over VMAT leading to the adoption of DCAT planning.

Method: Using BrainLab's iPlan and Varian's Eclipse planning systems, a variety of targets and prescriptions were planned with conical collimation, DCAT, conformal planning and VMAT. Comparisons were made between plans including PTV coverage, dose drop off, dose to healthy tissues, planning and treatment delivery time, MUs and reliability of QA between techniques.

Results: Comparing planning and delivery time as well as number of MUs, DCAT was the preferred planning technique over VMAT. Conical collimation provided superior plans for targets smaller than 1.5 cm with steeper dose drop off and reliable QA results. Conformal planning showed advantages in delivery and planning time, however resulted in higher volume of healthy tissue receiving the prescribed dose. VMAT displayed clear advantage in dose conformity for irregular lesions, however high dose modulation particularly with smaller targets results in higher MUs and a large number of QA failures.

Conclusion: DCAT has proven to be both reliable and efficient, decreasing treatment time compared to VMAT and providing preferable dose distribution compared to conformal planning. This comparative study has outlined which planning techniques are preferable for each target location and limitations of each planning technique.

References

1. Shi C, Chen Y, Fang D, Iannuzzi C. Application of modified dynamic conformal arc (MDCA) technique on liver stereotactic body radiation therapy (SBRT) planning following RTOG 0438 guideline. Medical Dosimetry 2015; 40: 26–31.

2. Wiggenraad R, Petoukhova A, Versluis L, Santvoort J. Stereotactic radiotherapy of intracranial tumours: a comparison of intensity‐modulated radiotherapy and dynamic conformal arc. International Journal of Radiation Oncology Biology Physics 2009; 74: 1018–26.

Head and neck model training and validation for knowledge‐based planning

Ashley Harwood

Radiation Oncology Centres, Toowoomba, Australia

Objectives: Large variations in treatment plan quality exist due to the intricacy of inverse planning and the need to balance trade‐offs. Knowledge‐based planning (KBP) is a proven method to improve consistency of plan quality where practice can be effectively modelled.

This paper, explores how plan selection and the number of plans used to train a KBP model effect the ability of the model to estimate plans that are comparable to clinical head and neck (H&N) plans that have been planned conventionally.

Methods: Three RapidPlan^™ (Varian Medical Systems, Palo Alto, CA) models were created using a total 60 modulated oropharyngeal plans treated at Radiation Oncology Centres (ROC) Toowoomba. Models 1 and 2 contained random samples of 30 plans. Model 3 contained all 60 plans contained in models 1 and 2. These models were then validated on 10 independent patients to evaluate the effectiveness of each model and to explore the effect of patient selection and number of patients.

Results: Variations between models were observed. This points to patient selection and patient numbers being important in the creation of the model. Further analysis of these variations will be analysed as well as factors in the selection process such as outliers and influential points.

Conclusion: Knowledge‐based planning can accurately estimate DVHs in new patients. However, the effectiveness of the model is dependent on patient selection and patient numbers that are used to train the model.

Evaluating the dosimetric effects of higher energy photons on intensity and volumetric modulated radiotherapy plans for prostate cancer patients

John Fernandez, Timothy Blacketer

The Crown Princess Mary Cancer Centre, Westmead, Australia

Objectives: The purpose of this study was to evaluate the effect of patient size and beam energy on intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) planning of prostate cancer patients.

Methods: 10 patients with intact prostates and no nodal involvement were selected and planned to 78 Gy for this study. VMAT and IMRT plans were generated for 6‐MV and 10‐MV photons using the Eclipse planning system. The anisotropic analytical algorithm was used for all dose calculations. Monitor unit, conformity indices and dose‐volumetric data generated by the planning system was recorded and averaged for each technique and energy. The collected statistics was then assessed for both the entire cohort and subsets of patients stratified by size according to their circumference measured at the level of isocentre. Circumferences less than 94 cm were classified as small, 94–100 cm as medium, and greater than 100 cm as large patient sizes.

Results: All 40 plans met departmental and ICRU protocols. 10‐MV plans displayed slightly higher PTV mean doses and modestly lower conformity indices, d99%, monitor units and rectal and bladder doses when compared to 6 MV plans. No significant differences were observed between plans when comparing patient size to the same planning criteria.

Conclusions: IMRT and VMAT, 6‐MV and 10‐MV techniques produced clinically acceptable plans and are comparable in terms of their dosimetry. No technique or energy was shown to be outright superior to its counterpart or more beneficial to any patient of a particular size.

How useful is a detailed MIT driven clinical worksheet in aiding accurate reporting of MSK MRI examinations?

Wai Niu Karen Teh,^1,2 Parm Naidoo,¹ Joanne Ickeringill¹

¹Monash Health Dandenong, Dandenong, Australia

²University of Queensland, St Lucia, Australia

Objectives: A quantitative approach to investigate the feasibility of the routine use of an MRI clinical worksheet(CW) to accompany clinical details on MRI request forms for MSK exams and whether it will alter the diagnosis, and/or confidence in report findings.

Methods: A retrospective review was conducted on all the referral forms for MSK MRI examinations performed at Monash Health Dandenong Hospital from January to December 2015 by three senior MRI Consultant Radiologist. MIT fills the MRI CW with the patient prior to examination to obtain detailed clinical information. The worksheet is scanned on to PACS. The radiologist reads the imaging request, reviews the images and makes an interim report. Radiologist then reads the MIT MRI CW and reviews the images and report. The report may be altered or approved. The radiologist then fills a quality questionnaire (RDQQ) by rating it on a 4‐point scale. This data from the RDQQ was collected, analysed and presented in graphs and percentages.

Results: Did the clinician's referral provide adequate clinical information? (53%) Did the clinical (MIT) CW add useful additional clinical information?(42.1%) Did your diagnosis become more specific after viewing the (MIT) CW?(24%) Was the report altered after viewing the CW?(17.8%) Did the clinical (MIT) CW alter your confidence in reporting this case (findings and/or conclusion)?(30.5%) Should the CW be included as a routine part of the examination?(90.5%).

Conclusion: MIT driven CW did aid in the accurate reporting of MSK MRI examinations. Radiologist indicated 90.5% prefers the MIT CW to be provided routinely.

Mindful MRI imaging for trigeminal neuraligia

Helen Daly

Lake Imaging, Mt. Helen, Australia

Mindful MRI imaging of the trigeminal nerve discusses the key imaging considerations when scanning for trigeminal neuralgia:

1. Patient experience of living with trigeminal neuralgia.

2. Clinical classifications of trigeminal neuralgia.

3. Functions and dermatomes of the nerve.

4. Intracranial anatomical segments of the ganglion and its divisions

5. Extracranial pathways of V1, V2 and V3.

This presentation proposes and explains how as radiographers we can keep the pathological causes of trigeminal neuralgia and the anatomy of the nerve inseparable. This ensures an expert approach to maintaining flexible and relevant protocols thus enabling the best outcomes for our patients.

Refining a department CPD program under the constraints of a current health care service

Adam Steward, Isabella Argyropoulos

Western Health, Maribyrnong, Australia

Continuing Professional Development (CPD) for radiographers is not a new requirement nor is it foreign to many radiographers, particularly those employed in medical imaging departments that have traditionally provided staff with opportunity and activities to maintain professional education. This would often include regular lunch time meetings to discuss cases and presentations.

Current times have placed a continued budgetary constraint on many departments and the typical department education meetings are often compromised or disregarded in the demand to maintain patient throughput. As a modern multi‐campus medical imaging department servicing three separate campuses with an increased workload and difficult scheduling, Western Health have had to redesign a CPD program that provides adequate opportunity for professional education among staff that is accessible to all. This presentation provides an insight and description into the advances made to our program to meet these demands and the process played out over 4 years to develop a CPD program that is flexible, covers a broad scope and successfully provides for over 100 staff.

A year in Alice springs‐ how much did I grow?

Tu Anh Dao

Medical Imaging Department‐ Alice Springs Hospital, Australia

Many would agree that participating in the delivery of health care at the Alice Springs Hospital is such a unique and fascinating experience. It is due to the hospital's role as the major acute health provider for many diverse and scattered communities in Central Australia and its strong focus on rural and remote Aboriginal health ¹. This fascinating experience comes with many challenges, mainly involving cultural, communication and location barriers as well as limited human resource. This presentation focuses on my learning experience as a graduate radiographer in working with a multi‐disciplinary team to overcome these challenges. It requires not only adaptation in radiographic and communication techniques but also cultural understanding and clinical thinking. Although 1 year is not a long time in relative of a career, my experience at Alice Springs Hospital plays a crucial role in focusing my clinical approach in the direction of patient‐centred care and clinical thinking. It is a valuable asset for my life‐long journey in radiography.

Reference

1. Department of Health 2015, Alice Springs Hospital, Northern Territory Government, viewed 1 November 2015, Available from: http://health.nt.gov.au/Hospitals/Alice_Springs_Hospital/Work_for_Us/index.aspx.

An investigation into patient experiences and perceptions of diagnostic radiographers’ communication skills

Natalie Pollard, Michelle Lincoln, Merrolee Penman, Gillian Nisbet

University of Sydney, Faculty of Health Science, Lidcombe, Australia

Objectives: Excellent communication skills are essential in establishing and maintaining the relationship between a diagnostic radiographer and their patient. Effective communication is challenging to learn with students needing multiple sources of feedback in order to develop competence. Typically student supervisors assess and provide feedback to the student. Another valuable source is the recipient of the students’ service, that is the patient, although there is little evidence to support their essential role in student's learning.^1,2 Whilst tools for assessing students’ communication are available, these have largely been devised from what the literature states is best practice; to date patients have not been involved as a stakeholder in their development.

The aim of this exploratory study is to improve understandings of what, from the patient's perspective, makes a communication encounter with a diagnostic radiographer effective.

Methods: Participants were recruited from private medical imaging practices throughout NSW. Semi‐structured interviews were completed with patients immediately after an encounter with a diagnostic radiographer. Interviews were audio‐recorded, transcribed and thematically analysed.

Results: 10 interviews were completed with patients who have experienced an encounter with a diagnostic radiographer. Thematic analysis of data is currently being undertaken and it is expected that results from this study will be available for presentation at this conference.

Conclusion: Findings obtained from this study will inform the development of a communication inventory tool, to assist in the identification and development of student diagnostic radiographers communication skills.

References

1. Bridge P, Pirihi C, Carmichael M. The role of radiotherapy patients in provision of student interpersonal skills feedback. Journal of Radiotherapy in Practice 2014; 13: 141–8.

2. Towle A, Bainbridge L, Godolphin W, et al. Active patient involvement in the education of health professionals. Medical Education 2010; 44: 64–74.

Surveying the landscape: organisational change and its effects

Tanaya Tumata, Mansoor Ahmed

Lady Cilento Children's Hospital, Brisbane, Australia

The Lady Cilento Children's Hospital was officially opened on the 29th of November, 2014. The hospital combined the Royal Children's Hospital, Herston, and the Mater Children's Hospital, representing the largest investment in children's health services in Queensland's state history.

With the merging of two hospitals, each department faced many challenges. The effects of organisational change can influence the amount of employee engagement each person experiences.

Employee engagement is the emotional attachment employees feel towards their place of work, job role, position within the company, colleagues and culture and the affect this attachment has on well being and productivity.¹

We are interested in gathering data and information from all staff members of the Medical Imaging Department. The survey will utilise quantitative and qualitative methods. After ethics approval, the survey will be emailed to all staff members, and data will be collected, analysed and discussed.

The aim of this survey is to gain a better understanding of the current state of the department, how the staff members felt about the merging of the two departments, what went right, what went wrong, and how we can improve for the future. The results will address specific areas such as communication, management, workflow processes and problems encountered when working in a multidisciplinary team.

Understanding change and its role on human dynamics is important. The results of this survey will help provide feedback to our department, and also provide advice to other hospitals looking at combining their services in the future.

Reference

1. Children's Hospital Queensland. Employee Engagement Survey (2015) CHQ.

Can less equal more? Using a simplified tool to improve the quality of undergraduate radiography student feedback

Katrina O'Keefe

Queensland Health, Chermside, Australia

Introduction/Background: Undergraduate Radiography clinical practice within The Prince Charles Hospital is facilitated by a Clinical Educator (CE) with the majority of day‐to‐day supervision provided by direct clinical supervisors. Usually, the only university requirement is an end of placement summative assessment. To validate this assessment, the CE is required to collate periodic feedback from clinical supervisors. The traditional method was based around the university assessment form, offered little space for comments, was non‐specific and didn't encourage the clinical supervisor to give face‐to‐face feedback to the student beyond correcting technical inadequacies.

The role of the CE, in addition to formal reporting to the university, is to support the student to work‐shop feedback they have received, discuss issues relating to performance and professional attributes, and promote reflective practice. These discussions rely on the clinical supervisor communicating with both CE and student. A reduction in supervisor engagement over time saw less and poorer quality information being submitted to the CE and virtually no formative shop‐floor feedback. Causes were cited as time constraints, un‐clear assessment criteria and supervision fatigue relating to number, frequency and variability of student supervision demands.

Purpose/Objectives: The presentation will focus on the process of design, implementation and evaluation of a shorter form with fewer, direct questions to promote feedback as a learning tool rather than solely for assessment. The aim is to increase the quantity and quality of clinical supervisor contributions by making the process quicker and arguably more relevant whilst encouraging supervisors to discuss their comments directly with the student.

Three ways to engage students of the digital age

Jodie Ringin

Deakin University, University Hospital Geelong, Geelong, Australia

Jumping into ‘The Third Space¹’ making the transition from radiographer to clinical instructor is something all radiographers can do as a part of our daily role at the University Hospital Geelong. With the introduction of the Bachelor of Medical Imaging degree at Deakin University in 2015, Geelong has provided many new and exciting opportunities to teach and peek behind the lead lined walls of this rising establishment. This has confirmed the necessity of keeping students of this digital age engaged.

It doesn't take much to be suddenly off in another space of like‐friend‐share. Keeping students engaged applies not only on campus, but also in the clinical setting. I'll introduce you to some of the profiles of the inaugural cohort and share some of the ‘ah‐ha’ moments from the experiments our students have conducted in the Medical Imaging Laboratory; where they have learnt and understood many of the basic concepts of radiography.

We have observed that engaged learning comes through a social process. Students working together on common projects at the university, being involved in your clinical team during placements and actively working alongside you as an encourager, all attract a digital thumbs up. What we have to share we hope will empower you and be of benefit to you and your workplace in engaging students of the digital age.

Reference

1. Fraser A. The Third Space. William Heinemann, 2012.

Reading minds – using functional magnetic resonance imaging to understand schizophrenia

Bronte Moses

Royal Brisbane and Women's Hospital, Herston, Australia

Currently, the diagnosis of neurobehavioural disorders is limited to correlating clinical symptoms to known psychological disorders. Recent studies have conceptualised schizophrenia as a neuropathological process manifesting in structural and functional disconnectivity. These biomarkers are able to be detected by Functional Magnetic Resonance Imaging (fMRI) sequences, demonstrated as quantifiable changes to neuroanatomy of the schizophrenic patients.

Schizophrenia has been described as a brain connectivity disorder. Studies have found evidence of abnormalities in the callosal structure resulting in atypical interhemispheric interaction. Furthermore, research has shown measurable changes to localised areas of white matter due to reduced axonal density and demyelination.

An fMRI sequence known as Blood Oxygen Level Dependant fMRI (BOLD) is a haemodynamic model which maps cortical blood supply using the magnetic susceptibility of blood constituents. This sequence successfully demonstrates callosal abnormalities in schizophrenic patients.

Areas of demyelination of axons can be demonstrated through the use of Diffusion Tensor Imaging (DTI). This sequence relies on the free motion of extracellular water molecules causing a rapid loss of signal. In areas of demyelination, there is an increase in extracellular water molecules, allowing for free diffusion of water, thus resulting in a decrease in signal. This technique has demonstrated a sensitivity of 85% for detecting schizophrenia patients when compared to healthy subjects.

In conclusion, in vivo pathophysiological information of schizophrenia can be readily demonstrated by fMRI techniques. Specific protocols are yet to be implemented clinically for the early diagnosis and monitoring of schizophrenia.

A tandem for learning: the value of learning partnerships in a clinical setting

Andrea Thompson

University of Auckland, Auckland, New Zealand

Objectives: Formalised support for students in the frequently busy, complex clinical settings in which they learn is likely to progress their learning and improve their learning experiences. Supportive one‐to‐one relationships provide students with valuable support for their learning^1,2 enabling quality time with an experienced professional as a student develops professional skills. The aim of the study was to develop, implement and evaluate an intervention to instigate change and to foster and improve the facilitation of quality learning experiences for medical imaging students.

Methods: An action research approach was employed. Data were generated through a series of fourteen collaborative action research focus groups with MITs and student MITs.

Results: The findings revealed that a sound relationship between a student and their MIT partner gave students an ‘anchor’ for learning. Students gained a sense of belonging which enabled them to develop confidence and competence in a clinical learning setting. An online platform supported the relationship and provided an effective means for communication between students and their MIT partners. The relationship was not one‐directional as it also supported the enhancement of MITs’ practice.

Conclusions: The recommendations from the study suggest learning partnerships between MITs and student MITs will be valuable in supporting teaching and learning respectively. MITs need to be better supported in their teaching role to enable them to make a greater investment in students’ learning.

References

1. Graham P, Tso S, Wood E. Shadowing a foundation‐year doctor: A third‐year medical student perspective. Clinical Teacher 2011; 8: 156–9. doi:10.1111%2Fj.1743‐498X.2011.00449.x

2. Newton J, Jolly B, Ockerby C, Cross W. Student centredness in clinical learning: The influence of the clinical teacher. Journal of Advanced Nursing 2012; 68: 2331–40. doi:10.1111%2Fj.1365‐2648.2012.05946.x

DIBH – breathing new life into breast treatments

Nakia‐Rae Beaton, Patricia Browne, Harish Sharma, Elizabeth Brown, Cathy Hargrave, Margot Lehman, Jennifer Harvey, Tao Mai

Princess Alexandra Hospital, Woolloongabba, Australia

Objective: With the success of adjuvant therapies for women with breast cancer, it is essential that treatment toxicities are minimised. Deep Inspiration Breath Hold (DIBH) radiotherapy aims to decrease long‐term heart toxicity for left breast or chestwall patients and right‐sided breast patients with internal mammary nodal involvement. The objective is to describe the Princess Alexandra Hospital (PAH) DIBH implementation experience using the Elekta Active Breathing Control (ABC) device, report on dosimetric comparison results and highlight preliminary results of a pilot study.

Description: The project group formed to implement DIBH encountered successes and obstacles throughout the process. Successes included; offline time for a project officer, patient coaching appointments, implementing dummy runs and staff training. Obstacles included CT intercom problems and the time required to complete a CBCT.

Dosimetric comparisons were performed between the patient's free breathing and breath hold scans. A pilot study investigating intra‐fraction motion, patient experience and the development of a predictive profile is scheduled to start in early 2016.

Results: DIBH has been successfully implemented with Elekta's ABC device at the PAH. Departmental protocols and procedures have been developed and initial staff training completed. Dosimetric comparisons to date have demonstrated an average decrease in maximum heart and left anterior descending artery (LAD) dose by 62% and 42% respectively. Preliminary results of the pilot study will also be presented.

Conclusion: The PAH DIBH experience has been successful thus far and will continue to be an ongoing journey during which we will constantly develop and learn.

Voluntary breath hold in left‐sided breast cancer radiation therapy, is it safe?

Lani Fingleton, Diana Naehrig, Reuben Patrick Estoesta, Elizabeth Claridge‐Mackonis, Melissa Pham, David Odgers, Susan Carroll, Joanne Toohey

Chris O'Brien Lifehouse, Camperdown, Australia

Objectives: Deep Inspiration Breath Hold (DIBH) is commonly practiced using commercial breath hold monitoring equipment. DIBH does not reach the majority of patients due to the cost and time associated with establishing monitoring equipment, and low patient compliance. This study evaluates voluntary DIBH (vDIBH) treatment delivery using existing resources.

Methods: The EPI device was used in Cinematographic (cine) mode to capture images during treatment. Cine images for 20 patients receiving vDIBH treatment, and 20 patients receiving Free Breathing (FB) treatment were acquired. 1087 cine images were evaluated. The distance from the beam central axis (CA) to the internal chest wall (ICW) was measured on cine image, then compared to digitally reconstructed radiograph (DRR). The proportion of patients recruited for vDIBH was assessed.

Results: Maximum intra‐beam motion was 0.30 cm (vDIBH) and 0.20 cm (FB). The mean difference from the CA to ICW on DRR and cine was 0.28 cm (SD 0.17) for vDIBH and 0.26 cm (SD 0.14) for FB. vDIBH had high patient compliance and 100% of patients were successfully able to maintain the vDIBH requirements. vDIBH was completed within the standard appointment time.

Conclusion: The intra‐beam motion and difference between planned values and measured values are comparable for vDIBH and FB patients. The use of in‐room lasers and skin tattoos as a tool to perform vDIBH is safe and effective. High patient acceptance and no increase in treatment time enables a larger number of patients to be treated with vDIBH.

A dosimetric study on hybrid volumetric arc therapy for deep inspiration breath hold treatments

Kristin Fuller

Radiation Oncology Centres, Toowoomba, Australia

Objectives: To investigate the use of Hybrid planning utilising Volumetric Arc Therapy (VMAT) and conventional photon field planning on left breast Deep Inspiration Breath Hold (DIBH) patients. Hybrid plans will be compared with our standard 3D conformal practice, evaluating dose to organs at risk (OAR) and Planning Target Volume (PTV) coverage.

Method: A retrospective dosimetric analysis of 10 patients, comparing our standard field in field breast planning, with a hybrid of tangents and a partial arc. The standard 3D conformal plan is the benchmark for the hybrid VMAT plan, aiming to achieve comparable dosimetry with the focus on reducing dose to the right breast, left and right lungs, heart and Left Anterior Descending Coronary Artery (LAD).

Results: Initial results analysing the Dose Volume Histograms (DVHs) have indicated that hybrid plans produce acceptable dosimetry, achieving a more homogenous dose distribution and a quantifiable reduction in lung dose.

Conclusion: The results of this study have shown that the use of hybrid planning utilising VMAT and 3D conformal fields can improve the dosimetry to the left breast and further reduce dose to the surrounding OARs. Further investigation into the treatment of hybrid plans is now required.

A retrospective study evaluating dosimetric benefit and setup reproducibility of deep inspiration breath hold technique for left‐sided breast cancer radiotherapy

Lucille Scott, Christine Kenny, Kenneth Wan, Jonathan Tomaszewski

Ballarat Austin Radiation Oncology Centre, Austin Health, Ballarat, Australia

Objectives: To evaluate target coverage and dose to organs at risk (OARs) in the first 32 patients planned and treated using deep inspiration breath hold (DIBH) at Ballarat Austin Radiation Oncology Centre (BAROC) and to determine any compromise of setup reproducibility with DIBH.

Methods: Left‐sided breast cancer patients eligible for DIBH were simulated during breath‐hold and free breathing. On each dataset the planning target volume (PTV), heart, left anterior descending (LAD) coronary artery and left lung were contoured. In‐field imaging was performed as part of routine treatment verification.

Organ‐at‐risk doses and target coverage were compared for DIBH and FB plans. Setup reproducibility during DIBH was analysed according to daily couch and gantry parameters, and 2D infield images, and compared with a contemporaneously treated FB cohort.

Results: 32 women were treated with DIBH between April‐November 2015. DIBH radiotherapy resulted in a >50% reduction in mean heart dose in the majority of patients, while maintaining target coverage. Setup reproducibility was comparable to FB.

Conclusion: DIBH radiotherapy, using the Varian Real‐Time Position Management (RPM) system with video goggles, is a reproducible and valuable technique for cardiac‐sparing in patients with left‐sided breast cancer.

Correction has been added on 24 May 2016, following initial online publication 8 April 2016. Two additional author names were added, Kenneth Wan and Jonathan Tomaszewski and affiliation has been changed from “BAROC, Buninyong, Australia” to “Ballarat Austin Radiation Oncology Centre, Austin Health, Ballarat, Australia”

A case study evaluating advanced radiotherapy techniques to minimise long‐term toxicity in a young patient with bulky mediastinal Hodgkin lymphoma

Kenneth Wan, Lucille Scott, Sarah Crook, Jonathan Tomaszewski

Ballarat Austin Radiation Oncology Centre, Austin Health, Ballarat, Australia

Objectives: Radiotherapy (RT) plays an important role in ensuring high cure rates for patients with early‐stage Hodgkin lymphoma (HL), but late toxicity (e.g cardiovascular, second malignancy) remains a major concern.. Our aim was to evaluate the potential role of deep inspiration breath‐hold (DIBH) and intensity modulated radiotherapy (IMRT) in minimising toxicity from mediastinal radiotherapy.

Method: A 24 year old male with early‐stage bulky mediastinal Hodgkin lymphoma was prescribed involved‐site radiotherapy as part of a combined modality program. Simulation was performed in both free‐breathing (with four‐dimensional CT), and DIBH. The target and organs‐at‐risk (OAR) were contoured on both datasets. Comparative planning was undertaken comparing FB‐3D conformal (3DCRT), DIBH‐3DCRT, FB‐IMRT and DIBH‐IMRT with respect to target coverage and doses to OARs. IMRT was delivered using a ‘butterfly’ technique to minimise the low dose bath.

Results: In our patient, both DIBH (regardless of mode of delivery) and IMRT (in both FB and DIBH) achieved reductions in mean heart dose. DIBH substantially improved all lung parameters, while IMRT reduced high dose (V20) but increased low dose (V5) to lung. DIBH‐IMRT was chosen for treatment delivery.

Conclusion: Modern radiotherapy techniques, such as DIBH and IMRT, have the potential to further optimise the therapeutic ratio in patients with mediastinal lymphoma. Benefits will vary depending on individual anatomy, and should be assessed on an individualised basis.

Reduction in heart dose with Deep Inspiration Breath Hold

Susan Hewitt

Radiation Oncology Centres, Cairns, Australia

Objectives: Radiation therapy (RT) is proven to significantly reduce the risks of local recurrence and mortality for breast cancer. However, RT for left sided breast cancer can result in late cardiac effects due to unintended irradiation of the heart. Deep Inspiration Breath Hold (DIBH) has been successfully implemented at Radiation Oncology Centres (ROC) with the aim of reducing cardiac dose.

This paper aims to evaluate the effect of DIBH radiation therapy on the dose to the heart as well as the ipsilateral lung in 20 left breast cancer patients.

Methods: Twenty patients with left‐sided breast cancer underwent both a free breathing (FB) and DIBH CT scan to determine their suitability for DIBH. All patients received whole breast irradiation with tangential fields. Treatment plans were generated on both the FB and DIBH CT datasets. Dosimetric comparisons were made between the two techniques specifically assessing the dose to the heart and ipsilateral lung.

Results: Initial results indicate that the increased lung volume associated with DIBH has successfully increased the distance or reduced the overlap of the heart with the treatment fields for more than 80% of cases. This relationship will be explored further to determine the reduction in dose to the heart and ipsilateral lung as overlap with the treatment fields decreases or the distance increases.

Conclusion: DIBH has been successfully implemented into daily clinical practice for left sided breast cancer patients at ROC with a resulting reduction in heart and lung doses for the majority of patients observed.

The evaluation of cone beam computed tomography (CBCT) for breast image guided radiotherapy (IGRT)

Melissa Burns, Molly McGuinness

Westmead CPMCC, Caringbah, Australia

Objectives: Utilising advanced IGRT in breast cancer patients is important to ensure their radiation treatment is delivered accurately. This study aims to determine if CBCTs are superior to orthogonal kV pairs for breast IGRT and evaluate whether daily CBCTs are a viable option.

Methods: Fifteen patients receiving radiotherapy to the breast or chest wall were included in this study. Adhering to department protocols, these patients were treated with daily online kV matching, and weekly post‐treatment CBCTs were acquired. This yielded 40 kV and 40 CBCT ‘events’. On the days the CBCTs were taken, both imaging types were matched retrospectively, with both translational and rotational error values. The time taken to match each ‘event’ was also recorded.

Results: 32.5% of images had a significant difference between the kV and CBCT offline match in any one plane; however the absolute average error difference in all planes were within department tolerances of 0.5 cm translational and 2° rotational errors (vrt: 0.2 cm; lng: 0.4 cm; lat: 0.4 cm; pitch: 0.9°; roll: 0.8°; Yaw: 0.8°). The average time taken to match the CBCTs and orthogonal kVs was 46 and 74 sec respectively.

Conclusion: This study found CBCTs are not significantly better in correcting for translational errors; however orthogonal kV pairs cannot accurately correct for rotation in any plane for breast IGRT. Therefore CBCTs are necessary if considering rotational errors. The time taken to match each imaging modality is not significantly different. Intra‐fraction motion between the kV and CBCT acquisitions may have affected our results.

To evaluate the role of daily kilovoltage (kV) Supraclavicular Fossa (SCF) imaging during SCF breast radiation therapy

Hayden Sheehan, Kim Faulkner, Andrea Michalski, Jane Rowe

Central Coast Cancer Centre Gosford Hospital, Gosford, Australia

Objectives: To measure inter‐fraction motion using daily SCF kilovoltage (kV) imaging and to assess if action levels and frequency of imaging can be reduced in this patient cohort.

Methods: The daily SCF kV images from 20 patients (10 left/10 right) receiving SCF treatment were audited. Images were rematched offline according to protocol and compared to online matches to determine compliance with the protocol. A simulation of applying a permanent isocentre shift and the effect if images were only taken on days 1–3 then every 5 fractions and repeated if any were >0.5 cm outside of tolerance was assessed.

Results: A total of 499 images were reviewed and the average time recorded between imaging and beam on was 2.12 min, with 98% of matches’ protocol compliant. Systematic and random error was <0.3 cm in both long and lateral directions. 105/499 (21%) images exceeded the 0.5 cm action level requiring a move prior to treatment. Simulating a permanent isocentre shift only 85 moves would have been required. However, with reduced imaging frequency, 42 images would have a move but 43 (50%) would have missed a required move.

Conclusion: Daily kV SCF imaging is time efficient and accounts for error to ensure all set‐up discrepancies >0.5 cm are corrected. This study showed that the introduction of a permanent isocentre shift would reduce the number of daily moves required but reducing the frequency of imaging would miss 50% of the errors.

Perhaps it is useful to have a small, plastic brain in our ever‐changing environment: especially if one is a bee

Mark Greco

Charles Sturt University, Wagga Wagga, Australia

Objectives: The experiment was conducted as a ‘proof of principle’ study to identify potentials for CT scanning of live bees as a non‐invasive method for teaching morphology and physiology of the brain.

Methods: A bench‐top MicroCT scanner and a synchrotron Beamline were used to scan live bees. To enhance tissue differentiation, bolus injections of radiographic contrast were delivered directly into the haemolymph (Fig. 1). Brain volume and plasticity data (Fig. 2) were measured using BeeView software.

Fig. 1. To enhance brain tissue differentiation, bolus injections of radiographic contrast media were delivered via a 30G needle (A) directly into the haemolymph, between the dorsal abdominal terga, of live bees that were previously secured for scanning (B) and (C). The 3D rendered brain (D) showed that contrast had perfused into tissue to enable improved structural differentiation.

Fig. 2. A 3D volume rendered image of a live honeybee's head capsule showing gross morphological structures such as the optic lobes (OL), antennal lobes (AL), aorta (AO), mushroom body calyces (MBc) and median ocellus (MO). The compound eyes (CE) are visualised immediately adjacent and lateral to the optic lobes. Image and brain volume (plasticity) reports were generated using BeeView volume rendering software (DISECT Ltd).

Results: Gross brain morphology was visualised in 2D and 3D projections. Scanning of live bees enabled minimally‐invasive imaging of physiological processes (for the first time) such as passage of contrast from gut to haemolymph (Fig. 3) as well as preliminary brain perfusion and plasticity studies (Fig. 4).

Fig. 3. A 3D volume rendered image of a live honeybee showing the three body segments (A) and orthogonal, 2D images (B), (C) and (D) showing the passage of radiographic contrast from the ventriculus (true stomach) to the haemolymph in the coelum. Images were rendered 1.5 h after ingestion of contrast.

Fig. 4. A 2D axial view of a live honeybee brain showing perfusion of contrast medium (C) into peripheral regions. Arrows indicate areas of higher concentration. At 30 min post bolus injection, into the haemolymph, the lateral ocelli (LO) and aorta (AO) contained more contrast than the protocerebral lobes (P).

Conclusions: Understanding the relationships between experience and brain structure is key to understanding the relationships between brain and behaviour. Simple environmental manipulations can both accelerate and delay brain growth in bees, and since brain volume and density are sensitive to behaviour throughout life, the honeybee has great potential as a model for exploring the interactions between environment, behaviour and brain structure.

The use of CT imaging for the non‐invasive study of insects (termed Diagnostic Radioentomology‐DR) is increasing (^{1, 2, 3, 4}) and (Fig. 5). Results demonstrate limitations of live bee scanning however they also show great potential for in‐vivo, non‐invasive DR imaging of the honeybee for future research and teaching of brain morphology and physiology.

Fig. 5. An axial view of the head capsule of an ancient stingless bee Proplebeia abdita trapped in amber. The brain of this 20 million year old bee was particularly well preserved as evidenced by the optic lobes including the medullae (Me) and lobulae (Lo), antennal lobes (AL), protocerebral lobes (P) and the mushroom bodies (MB). The retinal zone (RT) was also well preserved.

References

1. Greco MK, Spooner‐Hart R, Holford P. A new technique for monitoring Trigona carbonaria nest contents, brood and activity using X‐ray computerised tomography. Journal of Apicultural Research 2005; 44: 97–100.

2. Greco MK, Jones A, Spooner‐Hart R, Holford P. X‐ray computerised microtomography (MicroCT): a new technique for assessing external and internal morphology of bees. Journal of Apicultural Research and Bee World 2008; 47: 286–91.

3. Greco MK, Bell D, Robson‐Brown K, Mortimore D, Corp N. A new CT masking method for calculating organ and lesion volumes in Ants, Bees, Butterflies, Locusts “and Humans” using specialised software. European Society of Radiology Imaging Conference Vienna 2014; 6–10 March 2014.

4. Eyer M, Greco MK, Lang J, Neumann P, Dietemann V. No spatial patterns for early nectar storage in honey bee colonies. Insectes Socieux. 2015. http://dx.doi.org/10.1007/s00040‐015‐0432‐4

Rotationplasty: A treatment for lower limb osteosarcoma

Clare Gill

Princess Alexandra Hospital, Brisbane, Australia

Introduction: A patient at the Princess Alexandra Hospital was treated for a patella and proximal tibial osteosarcoma with a limb‐saving technique called Rotationplasty, as an alternative to an above the knee amputation.

Aim: To investigate in detail rotationplasty as a limb‐saving technique for malignant bone tumours and the psychological journey that these oncology patients go through.

Methods: A review of literature exploring topics such as rotationplasty, complications, advantages, psychological journey for amputee patients. Articles within the last 10 years were utilised, obtained from databases CKN and Google Scholar.

Results: Rotationplasty is a durable and biologic reconstructive option involving a 180° rotation of the distal limb to permit the ankle to function as a knee joint when fitted with a modified below‐knee prosthesis. The most important advantage is that the incorporation of the ankle joint, the natural function of the knee joint is approximated, allowing a large range of movement to be maintained. Other benefits include a lower lever arm for the prosthesis, a more tolerated anatomy (the foot) for the prosthesis and the important sensory feedback that the foot sends to the brain. The psychological effects on the patient vary significantly depending on their point in the pathway.

Conclusion: The patient continues on his road to recovery and at this time the procedure has proven to be a success. It is important for radiographers to be attuned to the many emotional stages, especially in those patients undergoing complicated and novel procedures.

The 2014 workforce innovation survey: Identifying innovation in practice in the Australian Medical Radiation Professions

Christopher Hicks

Medical Radiation Practice Board of Australia, Newtown, Australia

Objective: An objective of the Medical Radiation Practice Board of Australia (MRPBA) is to facilitate workforce innovation to contribute to public safety and access to services. In November, 2014, as part of the registration renewal process, practitioners were invited to participate in a survey about perceptions and current practice relevant to workforce innovation in the Medical Radiation Practice (MRP) workforce.

Method: Of the 13,571 practitioners who undertook General Registration renewal 11,792 practitioners responded to the survey (a response rate of 87%). Survey questions related to the following themes:

• practitioner alerts to serious and/or unexpected results;

• assessment of the appropriateness of imaging/therapy requests;

• involvement in research, advanced or extended practice roles;

• barriers and enablers to the expansion of scope of practice;

• perceptions about advantages for advanced or extended practice for practitioners, for health services and for patients.

Results: Information collected through the survey provides an excellent picture of current Medical Radiation practice in Australia. Key themes arising from the survey include:

• Advance practice is not a well understood concept within the profession;

• A component of practitioners seem unaware of the full extent of the MRPBA's Professional Capabilities Statement;

• While there is interest in broadening current scope of practice to benefit patients, many practitioners are content with their current roles;

• Perceived innovation barriers can involve multiple professions.

Conclusion: The survey results will assist the MRPBA in the development of its regulatory policy relating to workforce reform to ensure safe practice.

Career development in undergraduate medical radiations

Luke Barclay, Luella Leon, Madeleine Shanahan, Katherine Metzger, Renee Mineo, Jacqueline Wallace, Pradip Deb, Moshi Geso, Charlotte Sale

RMIT University, Melbourne, Australia

Objectives: In recent years, due to a range of influences, the number of available positions for graduates have become harder to secure.³ In order to achieve a more successful graduate assimilation into the workplace, this research project aimed to investigated the:

• requirements and standards of current Medical Radiation employers in relation to employing graduate students.

• needs and issues encountered by undergraduate students while seeking employment in the Medical Radiations profession.

Methods: Accessing all three medical radiations disciplines, a focus group of recent RMIT medical radiations graduands and, semi‐structured one‐to‐one interviews with senior managers/employees from mixed environments were undertaken. The recorded data was transcribed and assessed with NVivo for emerging themes. This research was approved by RMIT CHEAN Ethics (ASEHAPP 56‐15).

Results: Thematic data suggests that between the two groups, a number of employability domain standards including particular skill sets, knowledge of the profession and contribution/participation in professional activities are inconsistent.

Conclusion: A number of issues and needs were discovered from this research. There is a requirement for further work to be undertaken to bring the standards and expectations of these two parties together. Through the use of the DOTS framework² ‐ Decision learning – Opportunity awareness – Transition learning and Self‐awareness students will be able to understand themselves; understand and have an awareness of the world of work; decide on a career direction aligned with industry; and to know how to transition from student to professional, as outlined in Figure 1.¹

Fig. 1. The dynamics of career learning.

References

1. McIlveen P, Brooks S, Lichtenberg A, Smith M, Torjul P, Tyler J. Career development learning frameworks for work‐integrated learning Developing Learning Professionals (pp. 149–65): Springer, 2011.

2. Watts AG. Career Development Learning and Employability. York: The Higher Education Academy, 2006.

3. Wayne E. 2013. With the explosion in MRI, are we failing our radiology grads? Retrieved March, 2015, from http://blog.healthstaffsolutions.com.au/with‐the‐explosion‐in‐mri‐are‐we‐failing‐our‐radiology‐grads/.

‘Gen Z’ set to ‘rise and shine’: Implications for educators and the profession

Denise Ogilvie, Jane Shepherdson

University of South Australia, Coromandel Valley, Australia

Students across the years have changed in many ways which has resulted in universities adapting and changing the way they deliver their courses to maximise the learning opportunities for different cohorts and particularly for different ‘Generations’. ‘Gen X’ graduates are well established within the medical radiation profession and currently ‘Gen Y’ students are graduating and taking their place in the profession. The next generation, ‘Gen Z’ are now enrolling into the medical radiation science courses within the university sector but what does this next generation mean for the characteristics of the student cohort? What changes will need to be made within the university sector to accommodate this new student cohort? How will these ‘Gen Z’ students impact on the clinical environment?

This presentation will examine the characteristics of ‘Gen Z’ and how these will impact on not only the student cohort and its expectations but also on the profession as this next generation enter the profession as graduates. The medical radiation profession has embraced different generations and each generation has enriched the profession but what will ‘Gen Z’ bring to the profession? Consideration of the medical radiation profession into the future will be included in the presentation.

The Twitter journal club for Medical Radiation Professionals (#medradjclub) – Experiences from the first 12 months

Julia Watson,¹ Adam Westerink,² Charlotte Beardmore,³ Amanda Bolderston,⁴ Geoff Currie,^5,6 Lisa Di Prospero,⁷ Carly McCauig,⁸ Nick Woznitza,^9,10 Julie Nightingale¹¹

¹Foothills Medical Centre, Calgary, Canada ²Royal Brisbane & Women's Hospital, MNHHS, Herston, Australia ³Society and College of Radiographers, London, UK ⁴British Columbia Cancer Agency, Vancouver, Canada ⁵School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia ⁶Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia ⁷Odette Cancer Centre, Toronto, Canada ⁸Journal of Medical Imaging and Radiation Sciences JMIRS, Ottawa, Canada ⁹Homerton University Hospital, London, UK ¹⁰Canterbury Christ Church University, Kent, UK ¹¹University of Salford, Manchester, UK

Introduction: There is a growing trend towards the use of online journal clubs amongst healthcare professionals as a means of sharing knowledge, discussing evidence and as an accessible form of continued professional development (CPD). In March 2015, the MedRadJclub was founded as a monthly Twitter‐based chat for medical radiation professionals. The hour‐long chats are based on a selected theme relevant to all radiographers and radiation technologists, with one key study chosen from the literature and supplemented by suggested reading. The objective of this study was to examine the progression and development of this initiative over the initial 12 months.

Methods: Tweets including the journal club hashtag (#MedRadJclub) were analysed for each session through third party services, Symplur (www.symplur.com) and Keyhole (www.keyhole.co). Available information included total tweet count, total participants, total impressions and country of tweet origin. A survey of participants was conducted 12 months after the initiation of the project.

Results: This is a work in progress. Provisional analysis suggests that there is a core group of consistent participants, with others joining for topics relevant to their area of practice. The initial trend is for relatively consistent volumes of tweets and impressions across the chats.

Conclusions: Online journal clubs provide a forum for promotion of evidence based practice, academic debate and professional networking, free from traditional physical boundaries. Analysis of the first twelve months of #MedRadJclub demonstrates consistent participation and global reach, and is an accessible, interactive platform for discussion of research and practice in this field.

Text neck

Kaitlyn Joy

Princess Alexandra Hospital, Brisbane, Australia

Introduction: Widespread overuse of screened devices is resulting in a harmful and dangerous physical condition to the human body described by many as ‘Text Neck’.^1,2

Objectives: The purpose of this presentation is to educate medical radiation professionals about this issue and its potential effects and introduce strategies to prevent or alleviate any signs and symptoms.

Methodology: Peer reviewed articles and internet web pages were utilised to obtain a solid background in this new phenomenon.

Results: As smart phone use has nearly doubled between 2011 and 2014 from 98 to 195 mins per day, new research has suggested individuals will begin to lose the natural curvature in their cervical spine due to the constant poor posture attributed to their use.² Many issues result from this including early disc degeneration, disc herniation, spinal misalignment, pinched nerves and long term muscle strain.³ There are three main strategies to prevent or overcome these issues including modifying behaviours, performing strengthening exercises and even using a new phone application.¹

Conclusion: Overall as these screened devices remain new technology in generational terms, further data is required to determine if the incorrect posture attributed to their use is causing permanent damage.

References

1. Fishman D. 2015. The Text Neck Institute [Internet]. Florida, USA: iMatrix; 2015 [updated April 2015; cited 2015 October]. Available from: http://text‐neck.com/.

2. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014 Nov; 25: 277–9.

3. Hakala P, Rimpelä A, Saarni L, Salminen J. Frequent computer‐related activities increase the risk of neck–shoulder and low back pain in adolescents. Eur J Pub Health 2006; 16: 536–41.

Queensland bone bank medical imaging at the Princess Alexandra Hospital

Gary Smith

Metro South Hospital and Health Service, Woolloongabba, Australia

Queensland Bone Bank (QBB) opened a new state‐of‐the‐art facility in Brisbane in 2007. At that time it was the largest bone bank in Australia, providing allograft for transplant to over 1000 patients a year across Australia and New Zealand. Currently the Princess Alexandra Hospital (PAH) Medical Imaging Department completes around 275 x‐rays of donor bones annually for the QBB.

This educational presentation focuses on the protocol for the imaging of the donor bones and examples of allograft surgeries completed at the PAH. The criteria for bone donation, harvesting and other uses of donor bones provided by QBB will also be discussed.

101 Uses for the Fibula… well maybe not so many

Karen Lee

Princess Alexandra Hospital, Brisbane, Australia

As the title of the presentation suggests, there are multiple uses that our fibulas can provide through the means of being the perfect tissue donator site. Post‐traumatic events or invasive pathology can indicate ideal situations for vascularised fibula free‐flap transplantation surgery. This presentation showcases several sites whereby this technique can be utilised in order for the patient to regain the use of their affected limb or body part. Information gathered through several Medical Imaging modalities together form an integral part in providing the surgeons and multi‐disciplinary teams with extensive assistance with pre‐operative planning, intraoperative information as well as for the post‐operative recovery and monitoring phases.

In conclusion, the fibula is such a special part of our body and one should not underestimate the functions the fibula can provide to its host in the event of trauma or cancer situations.

Controversies in mammography

Peter Hogg^1,2

¹University of Salford, Salford, United Kingdom ²Karolinska Institute, Stockholm, Sweden

Full field digital mammography (FFDM) continues to play a key role in breast cancer screening. Despite its widespread application many aspects of FFDM practice have an inadequate evidence base which leads to difficulties during imaging and interpretation processes. Examples of areas where problems exist include: optimisation of compression; monitor specification for technical review; estimation of lifetime attributable radiation risk for screening participants; causation and impact of blurred images; image receptor position relative to infra‐mammary fold; relationship between mean glandular dose & breast thickness; and impact of inaccurate breast readout thickness on breast density estimation. This presentation will draw extensively on research performed in collaboration with the Diagnostic Imaging Research Programme (DIRP) at the University of Salford (UK) to outline how some of the problems are being investigated, what we have learned and what still needs to be done. Aside addressing research per se, this presentation will outline some of the collaborative arrangements DIRP has in place in order to conduct mammography research.

Comparing the accuracy of stereotactic vs non‐stereotactic mammographic breast localisations

Sally Ball

Princess Alexandra Hospital, Brisbane, Australia

Objectives: Mammographic hookwire localisation procedures are performed on patients with impalpable breast lesions having an open biopsy. The aim of this project is to determine which is more accurate placing these wires in the mammographic setting: stereotactic localisations or non‐stereotactic localisations.

Methods: Data has been collected retrospectively for all patients undergoing mammographic hookwire localisations from January 2008 to April 2010 (non‐stereotactic localisations) and January 2014 to December 2015 (stereotactic and non‐stereotactic localisations). The final images in the localisation procedures have been reviewed by two radiology registrars undergoing specialist training to determine if the wire is in an optimal or suboptimal position in relation to the lesion. Where there is discrepancy between the two readers, the cases have been referred to a consultant radiologist for arbitration.

Additional information collected includes the type of breast tissue, the lesion type, type of wire used, and total number of images performed as recorded from PACS and reject analysis software.

Results: Early results from a small scale pilot study indicate that stereotactic localisations are more accurate in placing hookwires. However, data collection will be ongoing until the end of 2015, and results from a larger study will be discussed at ASMMIRT 2016.

Conclusion: Stereotactic attachments have the potential advantage to increase the accuracy of placing hookwires in mammographic breast localisations. This study has sought to assess whether this is the reality in the clinical setting.

Radiographer technique: does it contribute to the question of clip migration?

Carolyn Madeley,¹ Meredith Kessell,¹ Chris Madeley,² Donna Taylor,^1,3 Elizabeth Wylie^1,3

¹Royal Perth Hospital, Perth, Australia ²SEA Propriety Limited, Perth, Australia ³University of Western Australia, Perth, Australia

Objectives: Marker clips are commonly deployed at the site of a percutaneous breast biopsy. Studies have shown that displacement of the clip from the site of deployment is not uncommon. The objective of this study was to determine how much ‘migration’ could be seen with fixed structures within the breast tissue across three consecutive annual screening examinations, and therefore attempt to quantify how much of the reported clip migration could be due to radiographer technique.

Methods: Large easily identified benign calcifications were measured by two investigators across three consecutive cycles of screening mammography. The position of the calcifications on the two standard mammographic views was measured in two planes. Other variables recorded included breast size and density, compression force used, and location of the benign calcifications within the breast.

Results: In 38% of cases benign breast calcifications showed a mimicked movement of >15 mm in at least one plane. This was greatest in large breasts, those where fibroglandular tissue occupied less than 50% of the breast volume and in the upper outer quadrant of the breast where mimicked movement >10 mm was noted up to 90% in the larger breasts.

Conclusion: Fixed immobile objects in the breast can appear to move a distance of >15 mm in up to 30% of cases. Clinically, some of what has previously been called marker ‘migration’ may be spurious and accounted for by differences in radiographic positioning techniques.

Mammography image quality: analysis of the demonstration of the inframammary fold in the digital setting

Kelly Spuur, Jodi Webb

Charles Sturt University, Wagga Wagga, Australia

In screening mammography, the PGMI (Perfect, Good, Moderate, Inadequate) image evaluation system (IES) focuses on the assessment of the degree of inclusion of all breast tissue on the mammographic image.¹ The PGMI IES reviews breast anatomy, including the inframammary fold (IMF) on the mediolateral oblique (MLO) view, and other reference points within the breast.¹ Inclusion of the IMF is said to be indicative of an accurately positioned MLO mammogram, providing assurance that lower posterior tissue has not been excluded.²

Visualisation of the IMF additionally informs radiographer quality control. Compliance rates for the PGMI IES requires 50% but preferably 75% of images to be graded P or G.¹ If all criteria are met but the IMF is not visualised only an M grade can be awarded.¹ There is no literature reporting actual rates of IMF visualisation on the MLO image to support the achievability of substantive P and G grades in the clinical setting.

This presentation aims to answer this question by reporting the evaluation of 2500 BreastScreen NSW digital mammograms, identifying the frequency of the inclusion of the IMF; including its rate of presentation as a ‘fingernail curve’ which is a new definition of inclusion for digital acquisition and display (see Fig. 1).³ Additional correlations between inclusion of the IMF, age, breast thickness and size will also be presented.

Figure 1. The “fingernail curve” (arrowed); this appearance is considered acceptable for adequate inclusion of the IMF in digital acquisition Source: Adapted from BreastScreen NSW

Although the PGMI IES is fundamentally integral to the assessment and monitoring of mammographic image quality, no previous studies have investigated the PGMI IES IMF criteria of digitally acquired mammographic images.

References

1. NQMC National Accreditation Standards BreastScreen Australia Quality Improvement Program. BreastScreen Australia. 2008; 105–7.

2. Bassett LW, Hoyt AC, Oshiro T. Digital mammography: clinical image evaluation. Radiol Clin North Am 2010; 48: 903–15.

3. Australian Institute of Radiography Medical Imaging Advisory Panel 2. PGMI Digital Reference Set Version 1 2011 [cited 20 May 2015]. Available from: http://www.air.asn.au/cms_files/08_CPD/pgmi_digital_Image_reference_set_v1.pdf.

Prostate Intensity Modulated Radiotherapy (IMRT) in seven mouse clicks: Development and Evaluation of a Class Solution

Kirsty Turnbull,¹ Maree Wood,¹ Amara Fonsecca,² David Sampson,² Andrew Kovendy,^1,2 Josie Goodworth,¹ Justin Westhuyzen,¹ Thomas P Shakespeare^1,2

¹Mid North Coast Local Health District, Coffs Harbour, Australia ²Norther New South Wales Local Health District, Lismore, Australia

Objectives: To develop a prostate planning class solution that achieves target and OAR doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta‐CMS Software, MO, USA).

Method: Multiple revisions of prospective class solution templates have been developed and tested across the three geographical NCCI sites. The current template was tested on 50 consecutive patients, both single phase and simultaneous integrated boost. Each plan was assessed against the departmental protocol for target coverage and OAR constraints. Three of the Class solutions were subjected to further independent evaluation by another team of Radiation Therapists using the Quality Reports^™ software(Sun Nuclear Corporation, FL, USA).

Results: The current class solution, requiring just 7 mouse clicks, met the Departmental prostate protocol dose criteria for >90% of the 50 patients analysed. With minor adjustments to the IMRT prescription these results would be further improved. Increased efficiency has been achieved by reducing calculation time of radiation dose from 2 h to an average of 13 min. Due to the reduction in calculation times, prostate patient waiting times have been reduced, reducing waiting lists and providing cancer treatment sooner.

Conclusion: NCCI now produces high quality IMRT Prostate plans in just 7 mouse clicks for the vast majority of patients with a calculation time of approximately 13 min. The class solution developed improves consistency of plan quality, planning efficiency and more efficient treatment delivery times.

Multi criteria optimisation: a new way to plan

Megan Ryan

Radiation Oncology Centres, Wahroonga, Australia

Traditional IMRT planning is often an inefficient and repetitive process of plan re‐optimisations in an attempt for the user to meet impossible or conflicting treatment goals. This is not only frustrating for the user but inefficient for the planning process and does not allow for the objective evaluation of treatment plans.

The Multi Criteria Optimisation (MCO) Module of the Raystation treatment planning software enables the user interactive exploration of the optimal solution space of a single plan optimisation through real time manipulation of objective functions and constraints. User defined objectives and constraints are used to create multiple variants of the same optimisation. The user is then able to manipulate these objectives to directly identify and quantify necessary trade‐offs in the plan in order to meet a specific constraint while compromising on another and vice versa. This allows the user to achieve an objectively superior plan in a much shorter time frame.

I will discuss the clinical implementation of the MCO module into the planning process at Radiation Oncology Centers Wahroonga site, provide examples of clinical plans created using MCO and evaluate the MCO process specifically looking at the metrics of plan quality via DVH assessment, efficiency both in planning time and treatment delivery time and plan deliverability through physics QA measurements.

Dosimetric study on the effect of setup error to the Optic Chiasm and Optic Nerve in treatments of cranial malignancies

Jessica Cantwell, Jordan Pannowitz, Andrew Hickey

Crown Princess Mary Cancer Centre, Westmead, Australia

Immobilisation devices in radiation therapy play an integral role in ensuring brain cancer patients are positioned consistently each day and their radiation treatment is accurately delivered to the prescribed area avoiding critical structures such as the optic chiasm and optic nerves. The CPMCC introduced the Moldcare cushion in 2015 to immobilise a patient's head during brain radiation treatment. This paper will evaluate the dose received on the optic chiasm and optic nerves in patients immobilised during their treatment using a standard setup versus Moldcare cushion.

Verification plans were created from 71 cone beam CT images (CBCT) from eleven patients (n = 9 standard setup, n = 2 Moldcare) who received a curative intent treatment to the brain. Doses from optic chiasm and optic nerves were reported and compared with the original plan for each patient.

The average dose difference between the verification and original plans from all patients are 0.3 Gy (range: −3.47–1.25 Gy) for optic chiasm and 1.5 Gy (range: −8.83–10.62 Gy) for optic nerves. Using Moldcare cushions showed a slight benefit over using standard setup (standard setup = −0.37 Gy for optic chiasm, 1.57 Gy for optic nerve; Moldcare = 0.99 Gy, optic chiasm, 1.16 Gy optic nerve).

The standard setup works well with minimal differentiation in dose when comparing the planned treatment dose to the received treatment dose in brain cancer patients. The Moldcare cushions however does show a slight improvement in the optic nerve dose for the 2 patients. A larger sample size is recommended for future studies before we decide to change our practice.

Clinical implementation of a breast DIBH treatment technique using the Active Breathing Coordinator^™ system in manual gating mode

Jackie Yim

Genesis Cancer Care, Crows Nest, Australia

In the recent years, Deep Inspiration Breath Hold (DIBH) treatments have achieved a solid foothold in left sided breast cancer radiotherapy. Current literature indicates that DIBH is both feasible and of benefit to patients because of the reduction in the volume of heart in typical treatment beam portals. The Active Breathing Coordinator^™ (ABC) was purchased for the purpose of delivering DIBH treatments at the Mater Crows Nest site. As a Varian linear accelerator site, the ABC system, an Elekta product has limited connectivity and therefore unable to perform automatic gated treatments.

Manually gated treatments presents itself as a different mode of treatment delivery compared with all other Genesis Cancer Care sites in NSW as automatic gated treatments is the standard protocol. If manually gated treatments are not performed correctly, potential mistreatment could occur leading to suboptimal treatment and patient outcomes. Therefore, consistent staff training and protocol implementation was of paramount importance.

This presentation aims to report on the entire implementation process which involved research, protocol development, quality assurance tasks, specific GenesisCancerCare approval processes and staff training.

In vivo dosimetry with EPR based alanine for breast radiotherapy: An investigation using breast phantom

Sheng An Lim^1,2

¹Royal Melbourne Institute of Technology University, Bundoora, Australia ²National Cancer Centre Singapore, Singapore, Singapore

Objective: Investigate the feasibility of alanine/EPR for in vivo dosimetry in breast radiotherapy.

Methods: The four types of dosimeters, TLDs, diodes, synergy health (SH) alanine and national physics laboratory (NPL) alanine were used for dose measurement during breast radiotherapy, simulated on a customised breast phantom. In different number of fractions (1, 2 and 25), the dose at various positions (A, B and C) were measured and compared with the calculated dose from TPS. Deviations from the calculated dose, along with the uncertainty of each dosimeter was assessed to determine their accuracy.

Results: For 1 fraction, only diodes and NPL alanine measurements along with their uncertainties were within tolerance (5%). Both SH alanine and TLDs overestimated the dose by 6% and 17% respectively. For 2 fractions, measurements by SH and NPL alanine were within tolerance, but the uncertainty of SH alanine exceeded the tolerance making it inaccurate. Furthermore, TLDs overestimated the dose by 42%. For 25 fractions, both SH and NPL alanine measurements with their uncertainty were well within tolerance. The measurements made by SH and NPL alanine for dose outside the field was overestimated by 45% and 30% respectively.

Conclusion: Alanine/EPR is feasible for in vivo dosimetry as it demonstrated the required accuracy, provided that a proper EPR readout protocol was established to overcome the poor signal to noise ratio for low dose measurements. The ability for alanine/EPR to measure dose outside the field accurately makes it a potential tool for epidemiological studies.

Figure 1. Different positions of the dosimeters.

1‐position A is within the bolus, position C is 3cm right of midline.

2‐position B is 5.7cm to the right on the surface without bolus.

Use of a virtual radiography simulation enhances student learning

Madeleine Shanahan

RMIT University, Bundoora, Australia

Objective: The objective of this pilot study was to introduce and evaluate Projection VR^™, a virtual radiography simulation, as a learning tool for radiography students.

Methods: Projection VR^™ was integrated into the laboratory component of an undergraduate course as an additional student rotation. Purposefully designed worksheets were developed to support staff and student use of this new application. Following completion of the course, all enrolled students (N = 86) were invited to complete an online survey to harvest student perception on technical issues and educational value of the software. Descriptive statistics were applied. University ethics approval was granted.

Results: Responses were received from 84 students. Although few students (n = 19) had previously used simulation software, 92% were confident (49%) or moderately confident (43%) in using computer technology. The majority of students liked using this simulation (79%) and considered it was easy to use (83%). A smaller number of students (n = 17, 21%) reported technical problems made using the simulation software difficult. Perceived primary benefits of using the simulation were the ability to repeat activities until satisfied with the results (95%) and being able to quickly see images and understand if changes needed to be made (94%). Students reported using the simulation increased their confidence, ability, and that they thought more about ‐ setting up radiographic procedures (74%, 78%, 87%) and evaluating radiographic images (83%, 85%, 92%), respectively.

Conclusion: Student feedback indicates that the implemented virtual radiography simulation empowered students to develop confidence, technical and cognitive skills. Future work will extend the implementation of this software across multiple courses.

Engage in reflective feedback conversations to help your students shine

Saba Ansari,¹ Andrea Thompson^1,2

¹Deakin University, Waurn Ponds, Australia ²The University of Auckland, Grafton, New Zealand

There are many barriers to providing feedback in health professional education, particularly corrective feedback.^1–3 Nonetheless, feedback is fundamental to effective clinical teaching and supervision.⁴ Without feedback; good performance is not reinforced and poor performance can remain uncorrected, leaving the possibility for students to learn by trial and error at the expense of patient safety.⁵ Therefore, providing feedback to learners is crucial in medical imaging departments.

Many feedback models exist, including the feedback‐sandwich and the Pendleton model. However, both these models have some limitations. The feedback sandwich can create a power imbalance, allowing only one‐directional information transfer from teacher to learner. The Pendleton model allows student input but its structured approach may appear artificial and prevent getting to the core of the issue.⁵

The reflective feedback conversation model is more interactive and focuses on the essential goals of feedback – encouraging learners to reflect on their performance to motivate future learning. Engaging in reflective feedback conversations allows learners to gain insight into their performance, identify their biases and assumptions, build on existing knowledge, and integrate new understandings to improve future performance. This approach encourages independent thinking in learners and helps to develop reflective practitioners.⁵ The Bachelor of Medical Imaging degree at Deakin University encourages this model to deliver valid and constructive feedback to improve student learning and performance. This presentation will illustrate the key ingredients of reflective feedback conversations with examples.

References

1. Higgs J, Richardson B, Abrandt Dahlgren M. Developing practice knowledge for health professionals [Internet]. Butterworth & Heinemann; 2004 [cited 2015 Nov 2]. Available from: http://www.diva‐portal.org/smash/record.jsf?pid=diva2%3A243213{00AMP00}dswid=‐5214.

2. Delany C, Molloy E. Clinical Education in the Health Professions. Elsevier Australia; 2009; 213.

3. Archer JC. State of the science in health professional education: effective feedback. Med Educ 2010; 44: 101–8.

4. Hesketh EA, Laidlaw JM. Developing the teaching instinct, 1: Feedback. Med Teach 2002; 24: 245–8.

5. Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ 2008; 337: a1961.

The impact of virtual reality training on medical imaging students’ confidence and general radiographic skills

Therese Gunn,¹ Pam Rowntree,¹ Lisa Nissen,¹ Pete Bridge²

¹QUT, Brisbane, Australia ²University of Liverpool, Liverpool, UK

Objectives: Medical Imaging undergraduate students require considerable experience and training with radiographic technical skills. Traditionally this has been gained through a combination of laboratory and clinical placement time. Safe pre‐clinical practice of these skills can potentially be gained by utilising a fully immersive medical imaging virtual reality (VR) program.

The purpose of this study is to analyse the impact that VR technology has on students’ confidence and skill prior to their initial clinical placement.

Methods: Ethics was approved by the QUT ethics committee. A 3D VR software platform was developed at QUT with support from a HWA grant. The radiographical skills of 45 first year students were compared during a formative roleplay after each student had accessed traditional or VR tutorials. The same cohort was surveyed before and after their first clinical placement. Triangulation of results with focus group data enabled multi‐modal data analysis to be performed.

Results: The results demonstrated a 4.68% improved overall roleplay result when using VR to learn a specific task. The pre‐clinical survey results reveal 72% of these student (n = 59) found the VR MITIE tool useful, however post survey results indicate only 32% (n = 62) were of the same opinion after experiencing the real clinical environment.

Conclusions: Results indicate students who utilise the VR learning tool have enhanced technical radiographic skill. However, whilst on clinical placement, students realise that their capabilities exceed that of technical skill. Therefore, VR is best utilised as part of a learning suite for pre‐clinical undergraduate medical imaging students.

The synergy of peer‐to‐peer mentorship

Pamela Rowntree, Debbie Starkey, Vicki Braithwaite

Discipline of Medical Radiation Sciences, QUT, Brisbane, Australia

Introduction: Queensland University of Technology (QUT) provides a range of programs and activities designed to support student learning, engagement and success. QUT is committed to enhancing the first year experience so that all first year students will have an opportunity to engage in peer‐to‐peer interactions, which will assist the first year student's transition to university life. It was as part of this strategy that the Medical Imaging Peer Support Scheme (MIPSS) began in 2015 with the support of QUT Peer Programs and QUT Ethics Approval.

Focus: MIPSS is a program where third year medical imaging students voluntarily engage with first year students to share their experience through interactions during timetabled classes in the tutorial and medical imaging laboratory settings. Whilst providing first year students with a valuable opportunity to connect with an experienced third year student who ‘has been there and done that’, MIPSS also provides the third year students with a student leadership and development opportunity in preparation for their future professional roles.

Outcomes: Feedback from the students who participated in both year groups regarding their experiences, and the value of peer to peer interactions has been positive. The outcome shows a mutualistic relationship where the two student groups have worked together, with each drawing benefits from the interaction.

The relationship between clinical evaluation of competency and controlled OSCE examination results in a student cohort

James Bainbridge

Deakin University, Highton, Australia

The Objective Structured Clinical Examination (OSCE) is a method of assessment utilised in Medical Education for over 40 years, world‐wide. The OSCE model of examination assesses professional skills, traits, and characteristics that traditional educational examinations do not.

Clinical skills and professional attributes in Medical Imaging (MI) Education within Australia are commonly assessed by clinical radiographers. The assessment is often complicated by the differing presentations of the patients at different clinical sites, as well as examiner variation. These high‐stake professional competency examinations therefore lack conformity and are not reproducible or comparable across the student cohort.

The structured nature of the OSCE provides students with an equal and unbiased assessment experience that allows the individual to demonstrate acquired clinical skills and professional attributes, to an identical team of observers/examiners, over a series of planned stations. This reduces examiner bias and improves consistency in student evaluation, and allows for objective assessment of relevant clinical competencies.

As far as we understand Deakin University is the first MI Course in Australia to employing OSCE's in the assessment of students. Our OSCE stations has been designed using experience and expertise of the Deakin University School of Medicine, and Prof. Andrea Thompson who has implemented OSCE assessment in MI successfully in New Zealand.

We aim to compare the results of our students’ clinical placement assessments and their OSCE results to determine if there is a positive correlation between these assessment models. Our data and initial findings will be presented.

Clinical implementation of HexaPOD couch for radical brain radiotherapy

Brent Pitt

Austin Health ‐ Olivia Newton John Cancer & Wellness Centre, Epping, Australia

Introduction: Robust IGRT techniques are a valuable tool in ensuring treatment accuracy for Radical Brain radiotherapy. Positional corrections have conventionally used translations only, not accounting for rotational error in patient positioning.

Objectives/Aims: To clinically implement HexaPOD couch and iGuide system and assess the accuracy and viability of positional corrections in six degrees of freedom.

Description/Methodology: 10 radical brain patients were treated using the HexaPOD couch and iGuide system for positional error corrections. CBCT image verification was performed following corrections in six degrees of freedom to verify the isocentre position.

Results: For 151 patient positionings, the mean and SD of residual translations and rotations along the major axes were: X‐axis (Right‐Left): 0.01 ± 0.02 cm and −0.04 ± 0.22°; Y‐axis (Inf‐Sup): −0.01 ± 0.03 cm and −0.04 ± 0.15°; Z‐axis (Post‐Ant): 0 ± 0.03 cm and −0.02 ± 0.21°. The mean residual 3D vector was 0.04 cm (SD: 0.03 cm, Max 0.13 cm, 90 percentile 0.1 cm).

Conclusions: Corrections in six degrees of freedom using the HexaPOD couch, delivered clinically acceptable rotational and translational positioning accuracy for brain intensity modulated radiotherapy.

Shining the light on professional development: a site visit to the princess margaret cancer centre in Toronto

Belinda Evans

Radiation Oncology Centres, Adelaide, Australia

Professional development is an important requirement for all practitioners to maintain current skills, knowledge and support in their roles. These opportunities can also open the doors to many more experiences, such as seeing how another Radiation Therapy department functions and what ideas and challenges they encounter, locally as well as in other parts of the world. As a recipient of an Australian Institute of Radiography (AIR) International Travel Scholarship I had the opportunity to undertake a site visit to the Princess Margaret Cancer Centre in Toronto in May 2015. My objectives focussed on operational aspects including workforce structure, approaches to quality and safety and establishing a research culture, as well as observing clinical practices such as new technologies, techniques and protocols. This invaluable experience highlighted the benefits of ‘rising’ in different environments and exploring professional development opportunities, along with the importance of ‘shining’ the light on these experiences upon returning home by sharing what has been learnt within the radiation therapy community.

The evaluation of a paediatric radiation oncology model of care to decrease anaesthesia rates

Brianna McCoola

RBWH, Queensland Health, Mount Gravatt, Australia

Background: The delivery of Radiation Therapy (XRT) in an adult hospital presents challenges to paediatric patients. Compliance is essential to guarantee accurate treatment. When necessary, general anaesthetic (GA) is used. The negative side‐effects of sedation are well documented. The Paediatric Radiation Therapy Group applies behavioural therapy practices to prepare paedatrics for radiation treatment.

Method: A retrospective review of behavioural therapy practices and use of GA within the paediatric treatment population at the RBWH from January 2010 to July 2014.

Results: 274 paediatrics were treated during the study period. 25% of the paediatric workload received anaesthesia. Results showed that behavioural therapy practices were best targeted at 3–8 year olds. 21.7% of 3–8 year olds required GA for their full treatment, whilst 9.4% of 3–8 year olds discontinued their GA at some point during their course of treatment. Sex, stabilisation and technique time (P = 0.22, 0.21, and 0.97 respectively) were not significantly associated with the use anaesthesia but the intention to use GA prior to simulation was (P < 0.001). Encouragingly, 50% of patients who were booked for GA prior to their simulation did not go on to require GA for their full course of treatment.

Conclusions: Behavioural therapy practices are an important component of treatment with paediatric patients. Resources are best targeted at 3–8 year olds. Sex, stabilisation or technique time were not predictors in the requirement of GA and a paedatrics anaesthetic outcome was better predicted by the patients perceived compliance prior to simulation.

The use of high dose rate brachytherapy for a paediatric perianal rhabdomyosarcoma

Chloe Hoffman

Royal Brisbane and Women's Hospital, Brisbane, Australia

Objective: Evaluate the dosimetric advantage of HDR brachytherapy compared to Intensity Modulated Arc Therapy (IMAT) and Tomotherapy for a perianal Rhabdomyosarcoma paediatric patient.

Background: Rhabdomyosarcomas (RMSs) are the most common soft tissue sarcoma in children, adolescents and young adults. Common sites include the head and neck, genitourinary and extremities, however, tumours located in the perianal region are rare.¹ This case is of a 3 year old male who was diagnosed with an embryonal rhabdomyosarcoma located in the perianal region. Surgery was not a viable treatment choice due to the tumour location. As a result, High‐Dose‐Rate brachytherapy (HDR BRT) using interstitial catheters delivered a prescribed dose of 25 Gy in 5 fractions, bi daily. This was particularly beneficial due to the number of critical structures close to the target volume, including the rectum, genitals and growing pelvic and femoral bones. To ensure adequate immobilisation of the child, a modified hip spica cast was used.

Method: To gauge the efficacy of the HDR BRT plan, additional plans were created for Intensity Modulated Arc Therapy (IMAT) and Tomotherapy (TOMO). To provide dose equivalent plans, a radiobiologically effective dose was prescribed for the external beam radiotherapy plans.

Conclusion: The superior dosimetry, reduced fractionation and positive patient experience provided evidence to support the role of brachytherapy for this paediatric patient.

Reference

1. Goldblum JR, Weiss SW, Folpe AL. Enzinger and Weiss's Soft Tissue Tumours, 6th edn. Saunders/Elseiver, Philadelphia, 2014.

Exploring psychoeducational interventions in paediatric patients

Filip Rajapakse

Queensland University of Technology, Brisbane, Australia

Paediatric radiotherapy involves complex techniques that can affect the psychosocial wellbeing of patients and may present certain challenges to radiation therapists. The main concern for paediatric patients is their ability to undergo the process of an entire course of radiation treatment which generally includes CT simulation, daily immobilisation and can include prolonged courses of general anaesthetics. With this comes the additional fear of unfamiliar environments, equipment and health care staff. This presentation documents the experiences of a 2 year radiation therapy student during a clinical placement undertaken as part of part of the Bachelor of Radiation Therapy Course, and the insight gained when involved in the treatment of the first paediatric patient at the Mater Hospital Cancer Centre in Brisbane. This paper will outline the various psychoeducational interventions, such as play therapy, that are available which enable patients and their families to cope with psychosocial distress. The results of the use of these interventions will also be presented. These interventions are designed to ensure that the treatment experience is not a negative one for patients and help to ensure that the patient experiences optimal treatment outcomes.

Challenges in obtaining optimal paediatric chest radiographs in developing countries

Stephen Lacey

Royal Children's Hospital, Melbourne, Parkville, Australia

The Murdoch Children's Research Institute (MCRI) has collaborated with the World Health Organisation (WHO) in a study to determine the effectiveness of a pneumococcal vaccine in Mongolia. One measure of vaccine efficacy is the incidence of pneumonia as demonstrated by lung consolidation on chest radiographs among children who have received the vaccine, compared with those who have not. This is highly dependent on both the imaging quality and adequacy of archiving. Inherent challenges exist in achieving good quality paediatric chest radiographs, despite a country's geographical location or economic status. In the developing world, inadequate qualifications, staff training and limitations in the standard of available equipment further complicate this.

As a result of these challenges, MCRI and WHO sought the expertise of a paediatric radiographer to evaluate the current practice and provide specialist recommendations. The project involved observation of the current practice, training of staff to improve image quality and evaluation of the changes implemented.

Observation revealed large differences in the radiological practice standards between Mongolia and developed nations, such as Australia. Radiation safety was of primary concern, relating to the available equipment and radiographic methodology. One week of intensive training was provided to participating hospitals and monitoring of subsequent changes occurred remotely through image evaluation. A return visit demonstrated a substantial improvement in image acquisition and quality.

This project's success has paved the way for the development of a Global Advisory Group for Radiologic Standardisation in Childhood Pneumonia Studies in an attempt to introduce a standard international protocol.

The role of imaging modalities in the diagnosis and treatment of osteosarcomas

Annie Chen

Queensland Health, Brisbane, Australia

The role of imaging has an important place in the diagnosis and treatment of many cancers in our society. Osteosarcomas are primary cancers that are characterised by the abnormal production of malignant mesenchymal cells within bone. The incidence of osteosarcoma is higher in adolescents (predominately 15–19 year olds) and most commonly appears in the metaphyseal region of long bones in the extremities.¹

This presentation will be exploring the pathophysiology of conventional osteosarcomas, the epidemiology as well as the range of treatment options available. Particularly, there will be a focus on the role of imaging within the multidisciplinary care pathway of a patient with osteosarcoma. From a patient's initial presentation to staging and follow up, a variety of imaging modalities are used spanning across plain film, CT, MRI and bone scintigraphy.² I will be outlining the radiographic appearances seen on each modality, when each modality is used in the workup of osteosarcoma and its advantages and disadvantages.

The histology and radiographic findings combined are imperative in determining the treatment received by the patient and ultimately their long term prognosis and survival rate.³

References

1. Hogendoorn PC. Bone Sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and followup. Annals of Oncology 2010; 21: 204–13.

2. Fadul D, Fayad LM. Advanced Modalities for the Imaging of Sarcoma. Surgical Clinics of North America 2008; 88: 521–37.

3. Wittig JC, Bickels J, Priebrat D, Jelinke J, Kellar‐Graney K, Shmookler B, Malawer MM. Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment. American Family Physician 2002; 6: 1123–33.

SBRT safety and quality

Laura Dawson

Princess Margaret Cancer Centre, University of Toronto, Canada

Stereotactic body radiation therapy (SBRT) refers to the use of short course, out‐patient, highly precise and accurate radiation therapy, generally delivered in 1 to 6 fractions. This shorter treatment time for SBRT is convenient for patients, with little ‘downtime’, and need for only short breaks between courses of systemic therapies. However, SBRT is more sensitive to uncertainties, and safety and prevention of errors are priorities. SBRT target delineation is a bottle neck in the development of an SBRT plan, and special efforts for peer review of contours are needed, to ensure the highest quality of contouring for SBRT. Breathing related motion needs to be assessed by respiratory correlated (or 4D) CT, cine‐MR imaging or 2D kV fluoroscopy to determine appropriate planning target volume (PTV) margins, and motion management strategies are desirable. Image guided RT (IGRT) based on volumetric imaging such as kV cone beam CT, is required at every fraction in order to reduce PTV margins and the volume of normal tissues irradiated. The quality and safety aspects of all steps in the SBRT process will be reviewed, with a particular emphasize on physician peer review and contour review.

As the risks of surgery to treat liver metastases increase, and as the potential for long term survival decrease, the rationale for SBRT substantially increases. Ensuring that SBRT is delivered with high quality and low risk of toxicities is crucial, especially in the absence of level I evidence for its use. Quality and safety checks are needed from the decision to treat to completion of radiation treatment. A quality program with many levels of interdisciplinary quality and safety checks is needed. In addition to developing a quality and safety program for radiation therapy equipment and the technical aspects of radiation therapy, appropriate infrastructure, resources, education, continuous improvement, and outcome assessment is required. Development of benchmarks for quality, an incident reporting system and quality monitoring are all important aspect of any quality program, and more important for SBRT.

A simple method for predicting the prescription isodose value for lung stereotactic ablative radiation therapy

Rhys Fitzgerald,^1,2 Rebecca Owen,² David Pryor,³ Cathy Hargrave,⁴ Tao Mai,³ Margot Lehman,³ Anne Bernard,⁵ Andrew Fielding²

¹Radiation Oncology Centres, Springfield, Australia ²Queensland University of Technology, Brisbane, Australia ³Department of Radiation Oncology ‐ Princess Alexandra Hospital, Woolloongabba, Australia ⁴Radiation Oncology Mater Centre, South Brisbane, Australia ⁵QFAB Bioinformatics ‐ University of Queensland, St Lucia, Australia

Objectives: The prescription isodose value chosen for lung SABR plays an important part in plan quality. Finding the optimal prescription isodose for individual patients can be arduous. Therefore this study was designed to investigate a new method for prospectively predicting the prescription isodose value used in lung stereotactic ablative radiation therapy (SABR).

Methods: Twenty SABR plans of patients that were previously enrolled into a dosimetric planning study were analysed. Characteristics which were examined included the size of the GTV, ITV and PTV along with the ITV, PTV and ipsilateral lung mean densities. The mean densities of a 0.5, 1 and 2 cm ring around the PTV were collected as well as the density of the PTV plus a 2 cm expansion. Correlation analyses and linear regressions were performed to analyse the relationship between these characteristics and prescription isodose. The linear model obtained was used to prospectively predict prescription isodoses for another ten patients.

Results: The highest correlation with the prescription isodose was observed for the density of the PTV plus 2 cm expansion with an R ² value of 0.88 and a significant linear relationship was demonstrated (P < 0.005). All of the ten plans that had their prescription isodose prospectively generated using the linear model, which produced clinically acceptable plans that adhered to all planning constraints.

Conclusions: The prescription isodose can be prospectively generated using the density of the PTV and surrounding normal tissues within 2 cm. Using the linear regression model, the manual task of finding the optimal prescription isodose is now simplified.

Simple and standardised versus complex and customised: a comparison of stereotactic lung treatments

Katrina Beecham

Radiation Oncology Centres, Gold Coast, Australia

Objectives: The implementation of Stereotactic Body Radiation Therapy (SBRT) for lung tumours at Radiation Oncology Centres (ROC) Gold Coast has been a successful but intricate process. It has presented many challenges for the department, presenting us with opportunities for growth and improvement. This study aims to compare our current individualised technique to a more standardised approach to determine if we can streamline our stereotactic planning and treatment delivery.

Method: Currently our guidelines for SBRT involve the treatment of solitary lung metastasis using a customised conformal static field arrangement consisting of 5 coplanar and 6 non‐coplanar beams. This approach has managed to achieve a high level of conformity, whilst minimising dose to surrounding healthy tissues. In the absence of a standard beam arrangement template however, each plan is customised to the individual patient, an intensive process that relies crucially on appropriate beam placement. The complexity of each plan has also resulted in long treatment delivery times.

Results: Six patients treated with lung SBRT were retrospectively planned using a simpler, standardised beam arrangement. This arrangement compromises of 6–8 fields with a single floor rotation. Each plan will be evaluated and compared using quantitative measures such as Conformity Index (CI), Region receiving 50% of prescription (R50), Planning Target Volume (PTV) coverage and Organ at Risk (OAR) doses.

Conclusions: Evaluation of these plans will determine if there is validity in implementing a more standardised approach to stereotactic lung planning and treatment.

A comparison of three non‐coplanar delivery techniques for stereotactic ablative radiation therapy (SABR) to peripheral early stage lung cancer

Rhys Fitzgerald,^1,2 Rebecca Owen,² David Pryor,³ Catriona Hargrave,⁴ Tamara Barry,³ Tao Mai,³ Margot Lehman,³ Anne Bernard,⁵ Andrew Fielding²

¹Radiation Oncology Centres, Springfield, Australia ²Queensland University of Technology, Brisbane, Australia ³Department of Radiation Oncology ‐ Princess Alexandra Hospital, Wolloongabba, Australia ⁴Radiation Oncology Mater Centre, South Brisbane, Australia ⁵QFAB Bioinformatics ‐ University of Queensland, St Lucia, Australia

Objectives: To compare three non‐coplanar delivery techniques (3‐dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT)) for the delivery of lung stereotactic ablative radiation therapy (SABR) to peripheral lung tumours.

Methods: Institutional ethical clearance was granted to conduct a retrospective study involving twenty medically inoperable lung cancer patients, who were eligible for SABR. Treatment plans for 3DCRT, IMRT and VMAT were generated for each of the twenty patients. The plans were compared by assessing the planning target volume (PTV) coverage, doses to organs at risk, high and intermediate dose constraints (D2 cm and R50%) and delivery times using Anova for repeated measurements or Friedman's test when appropriate.

Results: Mean PTV54 Gy coverage was found to be 95.6%, 95.7% and 95.6% for the 3DCRT, IMRT and VMAT techniques respectively. PTV48.6 Gy coverage was increased for IMRT (99.99%) (P ≤ 0.001) and VMAT (99.99%) (P ≤ 0.001) when compared to 3DCRT (99.56%). No deviations to the intermediate dose constraints were found in 65%, 65% and 85% of the patients for the 3DCRT, IMRT and VMAT plans respectively. Mean treatment times were 20.0 min (16.4–21.5 min), 25.2 min (22.1–27.9 min) and 11.7 (8.0–15.2 min) minutes respectively for 3DCRT, IMRT and VMAT.

Conclusions: A non‐coplanar VMAT technique was found to provide superior intermediate dose sparing with comparable prescription dose coverage when compared to non‐coplanar 3DCRT or IMRT. Additionally, VMAT was found to reduce the treatment times of SABR delivery for peripheral lung tumours.

Why a radiation therapist led clinical trial did not rise and shine‐ let's shed some light

Rachael Beldham‐Collins

Radiation Oncology Network‐ CPMCC and NCCC, Westmead & Nepean, Australia

Objectives: The Large Breast Immobilisation Study (LBIS) was a multicentre single arm prospective study. This study intended to evaluate treatment set‐up reproducibility, skin toxicity, patient comfort and staff satisfaction of using a 2.4 mm thick thermoplastic breast mask attached and indexed to a Medtec jig for 60 large breasted (D cup and above) patients. Aims of this paper are to (a) to highlight the challenges in developing, implementing and managing a radiation therapy (RT) led clinical trial, (b) to discuss the factors that led to its abandonment.

Method: Screening logs of 24 patients were analysed from the trial duration (2010–2013). Reasons for non‐recruitment were themed into the categories: patient decision, investigator decision, non‐pendulous breast and ‘other’. Additionally a review of the barriers surrounding the trial was completed categorising them into patient, physician, protocol and process related barriers.

Results: 5/24 patients were recruited to the trial. 19/24 patients were not recruited due to: patient decision (10.5%), investigator decision (21%), non‐pendulous breast (52.5%) and other reasons (16%). The review of this trial found all‐encompassing patient related factors were minimal when contributing to non‐participation, with physician, protocol and process barriers the primary contributors to the abandonment of the trial.

Conclusion: Technology used in radiation therapy is changing rapidly, and evaluating a device in a small group of patients in a timely manner can be problematic. Increasing the awareness of the barriers that surround RT led trials, may enable RT investigators to accommodate for these barriers in the future.

A retrospective study of clinical outcomes for the radiotherapy treatment of brain and nasal cancer

Michelle Oppelaar, Julia Cathie

Brisbane Veterinary Specialist Centre, Arana Hills, Australia

Introduction: Radiation therapy is the treatment of choice for many canine and feline, brain and nasal cancers. A comprehensive retrospective clinical and technical study of these cases is possible due to the shorter lifespan of dogs and cats.

Objectives: To evaluate our radiotherapy techniques using clinical outcome data.

Methods: Over one hundred brain and one hundred nasal cancer cases have been given radiotherapy treatment between January 2008 and December 2015. Pinnacle versus 9.10 was used for 3D treatment planning. Clinical data was obtained internally, from referral centres and from phone consultations with animal owners.

Results/Conclusions: Our results up until September 2014 are as follows; brain masses received 2.37 or 2.67 Gy Reference Dose (100%) per weekday in 18 fractions. Median survival time is demonstrated in the attached graph, Figure 1. It is interesting to note that the cases in which a 3D Pinnacle plan and a 6 MV multi‐field treatment delivery technique were used, improved survival (Average: 97 days longer) was demonstrated in all three groups.

Nasal cases had prescription doses ranging from a palliative dose of 6 Gy by 5 fractions to a radical regime of 2.8 Gy in 18 fractions. Median survival time is 308 days for the 68 nasal tumour patients that have passed away.

A more thorough and complete statistical analysis including cases up until 2015 will enable reporting of more comprehensive and detailed survival data at this conference.

Figure 1. Median Survival Time

Dosimetric comparison and cost analysis of three‐dimensional conformal radiation therapy (3DCRT) and electronic compensation (E‐COMP) for patients with breast cancer

Rob Nigro

Peter MacCallum Cancer Centre, Doncaster East, Australia

Objectives: The purpose of this study was to optimise the clinical service offered to whole breast patients undergoing radiation therapy by comparing the 3DCRT (Three‐Dimensional Conformal Radiation Therapy) and E‐COMP (Electronic Tissue Compensation) techniques at the Peter MacCallum Cancer Centre (PMCC).

Methods: A simple cost and dosimetric analysis was performed on 20 retrospectively treated patients at PMCC. Two Australian Government revenue sources through the MBS (Medicare Benefits Schedule) and WAU (Weighted Activity Units) was also performed for analysis of revenue reimbursement based on two dose fractionations: 42.56 Gy in 16Fx @ 5/Wk and 50 Gy in 25Fx @ 5/Wk.

Results: Overall radiation therapy and radiation oncology resource implications did not suggest significant cost or time differences. The greatest impact for costing was found from the physics quality assurance resource. Dosimetry was equivalent with respect to target coverage and critical organs however a statistical significant reduction in absolute volume of the 103% isodose (P = 0.03) was found for E‐COMP compared to 3DCRT. Total reimbursement for the MBS and WAU for the 42.56 Gy in 16 Gy fractionation was $17,145.37 for 3DCRT and $23,053.94 for E‐COMP. Proportional results for the 25 fractionation was found.

Conclusion: The E‐COMP technique was associated with an increased amount of costs due to physics quality assurance. A statistical significant reduction in absolute volume of the 103% isodose was shown with E‐COMP compared to 3DCRT. In addition, an increase in revenue reimbursement with E‐COMP can be achieved primarily due to the WAU.

Beyond the dose: a case control study on the effect of radiation therapy (RT) on pacemakers (PM) and implantable cardioverter defibrillators (ICDs)

Felicity Hudson,^1,2 Elaine Ryan¹

¹University of Sydney, Cumberland, Australia ²Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia

Objectives: The accumulated dose received by PMs and ICDs was once regarded as the only constraint for the treatment of cardiac devices. In recent years, investigation has shown the energy may be more significant in determining the risk of failure; these studies were conducted with non‐clinical doses and techniques. This study is the first to compare patients with PMs and ICDs undergoing RT to a control group.

Method: This study was conducted retrospectively at a large Sydney Hospital during 2005–2012 inclusive. RT patients were required to have two cardiac device checks during the course of treatment. Two control patients were randomly selected for each RT patient. Cardiovascular device checks were compared between groups using RT criteria, including treatment energy, dose to the device, leads and heart, treatment intent, technique and previous RT exposure.

Results: ICDs and PMs exposed to 18MV showed a greater chance of reset than at 6MV. Maximum heart doses >20 Gy were associated with significant decrease in PM capture threshold. No significant difference was seen in RT treatment intent, technique or previous exposure. Failures were not shown to be a dose driven effect.

Conclusion: The effect of RT on PMs and ICDs has proven to be minimal in a controlled environment. Dose to the PM or ICD should not be a major limiting factor in access to treatment, with a variety of techniques available to decrease risk. Whilst the likelihood of an incident is rare, regular monitoring of these patients is necessary to identify and respond to any adverse reaction during RT.

Dosimetric and clinical effects of hydrogel insertion in patients receiving dose‐escalated prostate radiotherapy: interim analysis of a phase II trial

Bing Wei, Andrew See, Leo El‐Hage, Andrew Do, Daniel Hamilton, Jason Wasiak

Epworth Radiation Oncology, East Melbourne, Australia

Purpose: For patients receiving radiotherapy treatment to the prostate, higher dose levels have been shown to be associated with improved tumour‐control outcomes ¹. Conversely, the volume of rectum receiving ≥60 Gy is consistently associated with the risk of Grade ≥2 rectal toxicity ². The phase II trial involves the insertion of a hydrogel into the retro prostatic space to introduce a physical gap between the prostate and rectum. This study reports the early results of the application of hydrogel on rectal dose reduction in men undergoing dose‐escalated prostate radiotherapy.

Methods: 42 men with histologically confirmed adenocarcinoma of the prostate have been enrolled into this prospective phase II trial. Patients were simulated prior to, and 7–10 days post hydrogel insertion. Intensity Modulated Radiation Therapy (IMRT) plans of 78 Gy and dose escalated 82 Gy were developed for the both pre‐ and post‐hydrogel injection planning CT. Dosimetric differences in rectal dose, space established between the rectal wall and prostate and patient‐related toxicities were evaluated.

Results: IMRT plans devised on pre and post‐hydrogel scans were prospectively compared. Increased perirectal space in post hydrogel scans resulted in improvement in rectal dosimetry in all patients. Our early results demonstrated that dose escalation and rectal sparing can be achieved with the application of hydrogel.

Conclusion: Early results demonstrate the efficacy of hydrogel application in men suffering from localised prostate cancer. The spacer appears to be an effective tool in dose escalation for prostate radiotherapy. Further patient recruitment and evaluation of toxicities will continue, enabling exploration of further dose escalation.

References

1. Zelefsky MJ, Pei X, Chou JF, Schechter M, Kollmeier M, et al. Dose Escalation for Prostate Cancer Radiotherapy: Predictors of Long‐Term Biochemical Tumor Control and Distant Metastases–Free Survival Outcomes. European Urology 2011; 60: 1133–9.

2. Peeters ST, Heemsbergen WD, van Putten WL, et al. Acute and late complications after radiotherapy for prostate cancer: Results of a multicenter randomised trial comparing 68 Gy to 78 Gy. Int J Radiat Oncol Biol Phys 2005; 61: 1019–34.

Weight versus protection in protective apparel design: a critical issue

John Laban

Photon Physics Limited, Christchurch, New Zealand

Objectives: The two fundamental design considerations for protective garments are weight and protective capability. Unfortunately these characteristics are correlated to each other, and with only weight being immediately apparent to the wearer, in some instances it is a fact that the actual protective abilities of garments fall short of the claims in the interests of producing an attractively light product. The purpose of this work is to highlight these issues to the wearers of such garments

Methods: The protective ability of radiation protection garments is widely expressed in terms of ‘lead equivalence’, which is the thickness of pure lead needed to provide the same radiation attenuation (ie protection) as the garment for a given radiation beam. A range of materials and aprons (including low‐lead, and lead‐free) have been submitted to an independent laboratory for testing according to the IEC 61331 standard¹ to determine lead equivalence across a range of x‐ray energies.

Results: Results for a range of samples will be presented, and interpreted in terms of the underlying radiation physics, with analysis translating this back to the all important question of how well the wearer of the garment is being protected.

Conclusion: It is clear that commercial pressures have driven some manufacturers to cut corners of the protective aspects of their products, and if radiation protection is to remain the primary concern, then diligence is required on the part of decision makers involved in the purchase of protective apparel.

Reference

1. IEC 61331.Parts 1–3 (2014): Protective devices against diagnostic medical X‐radiation.

Review of paediatric chest X‐rays: the austin health experience

Kristal Lee, Geertje Noë, Michael Galea, Bo Arys, Fiona Song, Lee Pheng Yap

Austin Health, Heidelberg, Australia

Objectives: To review the imaging technique for paediatric chest x‐rays (pCXR) at Austin Health, a tertiary adult hospital with a small paediatric service.

Methods: A retrospective audit was performed over a three month period of 0–3 year old pCXR (n = 79) performed on a Shimadzu RADspeed Direct Digital Radiography system. Two Radiologists (including a paediatric radiologist) evaluated image quality by rating inspiratory effort, positioning, collimation, sharpness and visual exposure assessment (noise and burnout). Tube voltage, milliamperage and exposure indices (EI) for each image were analysed. Radiographers were surveyed (n = 21) regarding their confidence in performing pCXR.

Results: A wide variety of radiographic techniques were found with a broad range of resultant EI. The average tube voltage, milliamperage and EI were 64kVp (range 55–90), 1.17mAs (range 0.4–2.2) and 142 (range 31–367) respectively. Average image quality scores (maximum score of 5) were Inspiratory effort 4.8, Positioning 4.5, Collimation 4.5, Sharpness 4.9 and Visual exposure assessment 4.8. Average total score for images was 23.8/25 (range 21–25). Fifty percent of Radiographers surveyed reported a lack of confidence in pCXR imaging techniques.

Conclusion: The current standard of pCXR for 0–3 year old patients demonstrates that image quality was of a high standard, but there was a strong inconsistency in radiographic techniques used.

Following these results, a new protocol was implemented with a minimum kVp of 70 for pCXR, clearer EI ranges were established and dedicated educational workshops for Radiographers will be provided. The pCXR imaging techniques will now be reviewed quarterly as part of ongoing quality assurance

Low dose CT vs general radiography: comparison of image quality and dosage

Lesley Halmos, Peter Barnes

East Melbourne Radiology MIA, East Melbourne, Australia

Background: With the growing use of medical imaging, radiation dose must be kept to a minimum, adhering to the principle of As Low As Reasonably Achievable (ALARA). Modern imaging machines produce images with a higher resolution at lower radiation doses, making it important to be familiar with the capabilities and comparison of radiation dosage between imaging modalities.

Objective: To compare patient dose and image quality of general radiographs and low‐dose Computed Tomography (CT) images of extremities to determine which imaging modality provides the most diagnostic information whilst adhering to ALARA.

Methods: A prospective study was conducted measuring the dose to adult and paediatric phantoms in the imaging of the extremities, including the hand, wrist, elbow, foot, ankle and knee. The equipment used for this study was from MIA East Melbourne Radiology and included a Fuji Digital Radiography (DR) system and a Toshiba Aquilon One 320 slice CT. Doses were measured directly using Optically Stimulated Luminescence (OSL) technology and was calculated from the exposure technique parameters. The uncertainty in the dose measurements is estimated to ±2%. The image quality was assessed using specific anatomical markers.

Results: Preliminary results indicate superior image quality and up to 25% reduction in dose when comparing low‐dose CT scans with general radiographs.

Conclusion: Results will provide useful information about dosage and image quality of extremity imaging when using low‐dose CT and general radiography. This allows our medical practitioners to make an informed decision to justify the most appropriate diagnostic imaging for each client.

The effect of collimation on breast tissue dose in lateral chest x‐ray examinations

Megan McKerrow, Belinda Godwin

Princess Alexandra Hospital, Woolloongabba, Australia

Objectives: There is divided opinion in the workplace pertaining to the extent of collimation on lateral chest x‐ray examinations. Some feel that increasing the field of view decreases the risk of repeats, however this is potentially associated with an increased dose to the radiosensitive breast tissue.

The aim of this study was to assess the effect of collimation on breast tissue dose in lateral chest x‐ray examinations. Further research is underway regarding the effect of collimation on effective and skin dose.

Methods: A retrospective review of lateral chest radiographs was undertaken on patients with recorded height and weight values, by utilising the PACS. Data for each lateral chest x‐ray stored within the hospital's imaging software was collected, including exposure factors, SID and field of view. This data was used to calculate average patient sizes and exposures, which were entered into a simulation program to mimic clinical results. The simulation program was used to evaluate breast tissue and effective dose for various patient sizes.

Further analysis of the skin dose associated with lateral chest x‐ray examinations was assessed using x‐ray phantoms.

Results: A small scale pilot study has been carried out with preliminary findings indicating less DAP per BMI in the well collimated examples.

The results of a larger scale study will be presented in detail at the conference, including specific data such as effective and skin doses for breast tissue.

Conclusion: Preliminary findings conclude that there may be a correlation between optimal collimation and reduction in DAP values.

Evaluation of anti‐scatter grid replacement software

Stephen Knight

Children's Health Queensland, Brisbane, Australia

Objective: Anti‐scatter grids have been used in radiography for a century. Whilst improving image quality by reducing scattered radiation from reaching the detector, anti‐scatter grids also increase the radiation dose to the patient. In the last few years, software algorithms has been developed by multiple vendors that have been claimed to reduce or eliminate the requirement for anti‐scatter grids in digital radiography (DR). The objective of this study was to evaluate the effectiveness of this grid‐less technology.

Method: This scientific study evaluated one of these systems, investigating radiation dose and image quality by comparing anti‐scatter grid use vs grid‐less technology vs no anti‐scatter grid and no grid‐less technology. 5 and 15 year old phantoms were used for testing. Entrance skin dose derived from dose area product was used as the radiation dose parameter.

Results: Grid‐less technology allowed for significant reductions in radiation dose whilst maintaining image quality by reducing the requirement for anti‐scatter grids. Grid‐less technology also allowed for improvements to image quality, whilst maintaining radiation dose for projections where anti‐scatter grid use is not required.

Conclusion: Grid‐less technology has great potential in digital radiography to significantly reduce radiation dose to patients, or improve image quality.

Imaging device to aid in taylor spatial frame imaging

Amber Cavanagh

Queensland Health, Redcliffe, Australia

Introduction: Taylor Spatial Frames (TSF) are external devices used for limb correction, lengthening and/or straightening. To monitor progress of the limb correction surgeons rely on medical imaging. The xrays that they require need to have the reference ring of the frame superimposed, along with both the knee and ankle joint all on the same film.

Objectives: To use a device that was been created to complete imaging for TSF with shorter examination times and with less repeat xrays required.

Methods: The device is attached to the reference ring of the TSF with plastic screws that are provided in the set.

AP projection: Patients leg is lifted/lowered until the spirit level on the imaging device is level (see Figure 1). The central beam is positioned over the reference ring which is now completely vertical. Next, the tube is tilted so that both the knee and ankle joint are included.

Horizontal beam lateral: The two ‘arms’ of the imaging device will project a shadow over the IR. The patient's leg is moved accordingly until both shadows from the two arms are completely superimposed, and hence, the two ends of reference ring.

Results: Results showed that the imaging device for TSF imaging was easy to use for several radiographers who trial the device and aided in producing accurate xrays.

Additionally, the device dramatically reduced examination time and the number of repeat xrays required.

Conclusions: Images produced with using the device were accurate and reproducible.

Figure 1. AP projection and horizontal beam lateral

The paediatric elbow

Lana Kennedy

The Royal Children's Hospital, Parkville, Australia

The elbow is the most commonly fractured area in paediatric patients, accounting for 10% of childhood fractures. It can be challenging to identify trauma from normal paediatric bones when imaging a child's elbow due to the developing ossification centres. There are six of these centres within the elbow joint and the timing of their development can be recalled using the acronym ‘CRITOL’. Research has identified that ‘CRITOL’ ossification is accurate in 95% of cases. This method is also useful in determining the bone age of paediatric patients, as each growth centre occurs within a specific age group. With a sound understanding of ‘CRITOL’, ossification centres can be distinguished from elbow fractures or may indicate that further imaging is required. A description of the development of the elbow using the CRITOL acronym will be discussed in detail. As well as common paediatric elbow fractures and their signs and symptoms.

To alert or not to alert: the rise of the frontline radiographer

Michael Neep,^1,2 Effie Pozzias¹

¹Logan Hospital Medical Imaging, Logan, Australia ²Queensland University of Technology, Brisbane, Australia

Objectives: Radiographer abnormality detection systems in emergency departments are used to highlight acute abnormalities for the referring emergency clinician ^1–3.

The aim of this study was to determine radiographer's accuracy in detecting both normal and abnormal traumatic pathologies on radiographs following the implementation of an abnormality detection system.

Methods: A total of 2942 radiological examinations were reviewed over a 6‐month period. The range of examinations incorporated in the review included the appendicular and axial skeleton along with the chest. Each examination was compared to the radiologist's reports so that true negative/positive and false negative/positive values could be allocated. This allowed sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy to be analysed. Mean scores were calculated.

Results: The radiographers reported an overall average of 95% accuracy in determining normal/abnormal radiographs. The mean values calculated for sensitivity, specificity, positive predictive value, and negative predictive value were: 73, 99, 95 and 95%, respectively.

Conclusions: This high level of accuracy by radiographers indicates that an abnormality detection system should be implemented into all emergency departments to contribute to minimising diagnostic errors made by emergency clinicians.

References

1. Hargreaves J, Mackay S. The accuracy of the red dot system: Can it improve with training? Radiography 2003; 9: 283–89.

2. McConnell JR, Webster AJ. Improving radiographer highlighting of trauma films in the accident and emergency department with a short course of study‐an evaluation. The British journal of radiology 2000; 73: 608–12.

3. Hardy M, Culpan G. Accident and emergency radiography: A comparison of radiographer commenting and “red dotting”. Radiography 2007; 13: 65–71.

The effectiveness of the addition of the apical oblique projection in the detection of acute shoulder abnormalities in adults

Kimberley J. Ross,^1,2 Grant R. Tomkinson,^3,4 Bonnie F. McGregor,² Oliver C. Ayres,² Diana Piscitelli^3,5

¹School of Health Sciences, University of South Australia, Adelaide, Australia ²Department of Medical Imaging, Flinders Medical Centre, Bedford Park, Australia ³Alliance for Research in Exercise, Nutrition and Activity ARENA, School of Health Sciences & Sansom Institute for Health Research, University of South Australia, Adelaide, Australia ⁴Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota, United States of America ⁵Discipline of Medicine, The University of Adelaide, Adelaide, Australia.

Objectives: The aim of this study was to determine if the addition of the apical oblique (AO) projection to the routinely performed anteroposterior (AP) and lateral scapular projections increases the number and/or alters the types of acute shoulder abnormalities detected in adults.

Methods: A retrospective, non‐experimental, quantitative research design was used on a sample of 56 adults who had undergone a 3‐projection (i.e. AP, lateral scapular and AO projections) plain radiographic examination of the shoulder for the assessment of acute pain or trauma at Flinders Medical Centre. Patient examinations that satisfied the criteria were duplicated, with the apical oblique projection removed in the second instance. A radiologist randomly reviewed half the 2‐ and 3‐projection cases and recorded the number and types of abnormalities detected. Three months later the same radiologist reviewed the remaining half of cases and recorded the same information. The differences in number and types of acute abnormalities between the 2‐ and 3‐ projection cases were quantified using a 1‐tailed t‐test and a 2 × 2 chi‐square test, respectively.

Results: There was a small, statistically significant increase in the number of acute shoulder abnormalities detected with 3‐projection cases compared to 2‐projection cases (difference in means ±95% CI: 0.20 ± 0.19), but no statistically significant difference in the types of acute shoulder abnormalities detected (χ ² = 135, P < 0.0001).

Conclusion: The results encourage a review of current clinical practice in plain radiography for acute shoulder pain and trauma and warrants further examination into differences in the types of acute shoulder abnormalities detected between 2‐ and 3‐projection cases.

The MAT method: improving malpositioning in horizontal beam lateral knees

Kelly Fordyce

Logan Hospital, Logan, Australia

Introduction: This study aimed to improve the ability of radiographers to correct malpositioning in horizontal beam lateral (HBL) knee examinations. There are currently many inaccurate methods of correcting malpositioning in lateral knee examinations, due to variation in anatomy and difficulty in locating identifying markers. The medial adductor tubercle (MAT) method is a system for improving malpositioning efficiently.

Methods: Eight radiographers with a range of experience (1–10 years) were tested on n = 10 malpositioned lateral knees. The participants were asked to provide their opinion of the correction required for rotation (internal, external or no change) and tube angulation (up, down and no change). Participants completed an online education package on the use of the MAT method and then retested to evaluate the effectiveness of the MAT method in correcting malpositioning.

Results: The mean participant results, out of 10, for the correction of rotation and tube angulation was 3.75 and 4 respectively. For overall positioning (combined rotation and tube angulation) the result was 1.88. Post education the result for rotation was 5.28 and 5 for tube angulation. The overall positioning was 3.13, an improvement of 66.6%. A paired t‐test had a result of P = 0.005.

Conclusions: Using the MAT method showed a significant improvement in the ability of radiographers to correct malpositioning. Using the MAT method in practice would require further education of radiographers particularly in gaining confidence in visualising the medial adductor tubercle. Further research should be conducted in using the MAT method and correcting malpositioning in lateral knee examinations.

An educational intervention to improve radiographers’ ability to reposition lateral elbows

Daniel Sgualdino,¹ Michael Neep,¹ Gianni Ribeiro²

¹Queensland Health Metro South Health ‐ Logan Hospital, Meadowbrook, Australia ²School of Psychology, University of Queensland, Saint Lucia, Australia

Objective: True lateral position of the elbow is important for accurate radiological interpretation. However, correcting a malpositioned elbow radiograph is challenging for many radiographers. This is mainly due to the complexity of the joint's appearance when radiographed.¹ An educational intervention using the appearance of the capitulum as a positioning aid was created to assist radiographers in correcting malpositioned lateral elbow radiographs. This study was designed to test whether this educational intervention was effective.

Method: 15 student and qualified radiographers participated in a within‐groups pre‐post design to assess the effectiveness of the educational intervention. 48 de‐identified malpositioned lateral elbow radiographs were collected and assessed by two senior radiographers to determine how to correct the radiographs. 20 of these radiographs for which a consensus was reached were selected as a test bank for the study – 10 each for the pre‐test and post‐test. Participants completed the pre‐test trial and were then given written educational information on how to re‐position a lateral elbow using the capitulum as the main reference point. Participants then completed the post‐test.

Results: The pre‐test mean was 3.20 (SD = 2.65) and post‐test mean was 4.0 (SD = 1.73). A within‐subjects t‐test revealed that the difference between pre‐ and post‐test scores was not significant (P = 0.271).

Conclusion: The low test means suggest that participants found correcting the positioning of a lateral elbow radiograph challenging. Scores on the post‐test improved slightly from the pre‐test, however this difference was not statistically significant. Further research will involve improving the educational intervention.

References

1. Greenspan, A. Orthopedic imaging: A practical approach, 5th edn. Wolters Kluwer Health, Philadelphia, 2012.

eviQ Radiation Oncology‐ the past, present and into the future

Jill Graham,¹ Lydia Loke,¹ Aisling Kelly,¹ Andrew Last,² Michael Ng,³ Carmen Hansen,² Shelley Rushton¹

¹Cancer Institute NSW, Eveleigh, Australia ²Mid North Coast Cancer Institute, Port Macquarie, Australia ³Radiation Oncology Victoria, Melbourne, Australia

eviQ has played a role in standardising and providing evidence‐based point of care information to facilitate well informed clinical decisions in any location; 24 h a day, 7 days a week. Since its inception in 2009, the audience has increased rapidly resulting in over 57,000 users from 160 countries with approximately 700 new registrations each month.

Currently, radiation oncology practitioners account for 12% of all users. Since 2009, there has been a steady increase in registrations of radiation therapists who represent the largest proportion of this group (43%), followed by Radiation Oncologists (26%), Nursing (21%) and other allied health (10%).

The present eviQ Radiation Oncology content stream contains 64 treatment protocols across 11 tumour sites, such as breast, urogenital, head and neck, haematology and gynaecological, in addition to online education modules for those new to the field and relevant cancer treatment information for patients.

Engagement within the national radiation oncology community, both public and private, has enabled eviQ to grow from strength to strength with the number of page views in the last 12 months (to October 2015) being greater than 12,000. Each protocol provides evidence based information on patient indications, simulation, planning, treatment and side effects.

The future of eviQ Radiation oncology is bright; with the unveiling of a brand new website in 2016, protocol development in specialised areas such as SRS and SBRT and building partnerships nationally and internationally, there are many opportunities for radiation oncology practitioners from all disciplines to contribute and benefit from this valuable resource.

An overview of culturally competent care for lesbian, gay, bisexual or transgendered patients

Amanda Bolderston

British Columbia Cancer Agency, Canada

Despite changing societal attitudes and progressive policy changes in economically developed countries like Australia, lesbian, gay, bisexual or transgendered (LGBT) people still encounter systematised discrimination, marginalisation and stigmatisation. Sexual and gender minorities are at higher risk of many physical, mental and sexual health problems and are less likely to seek access to health care and preventative screening. Chronic stress associated with stigmatised status, legal barriers to health insurance, health care providers with little or no training in working with LGBT patients and past experiences of homophobia and heterosexism within the health care system can all affect the health of LGBT people. LGBT patients may not come out to health care professionals (HCPs) such as radiographers, despite the fact that a complete picture is needed to provide patients with the most appropriate medical and culturally sensitive treatment. However, there are ways that radiographers can help to provide a more welcoming experience for LGBT patients, whether they are attending for a single routine imaging appointment or an extended course of radiation therapy. A more inclusive environment, from intake forms to waiting rooms, can make a big difference in signalling that the organisation is ‘LGBT friendly’. Culturally competent care also calls for HCP knowledge about and sensitivity to LGBT patients to improve communication and comfort.

This talk will provide an overview of the meaning of words and concepts used in describing gender identity and sexual orientation; discuss common LGBT health disparities and identify strategies to provide a welcoming environment for imaging and treatment.

Targeting cancer campaign – raising awareness of radiation therapy as an effective, safe cancer treatment

Alison Brown, Sarah Lewis

The Crown Princess Mary Cancer Centre, Westmead, Australia

One in 2 patients with cancer could benefit from radiation therapy (RT), however only 1 in 3 patients actually receive it. One reason for this is the low profile and poor understanding of RT by patients, the community and many health professionals (including GPs). In 2013, the Royal Australian College of Radiologists (RANZCR) launched the Targeting Cancer Campaign to increase awareness of RT as a safe, effective and cost effective treatment option to cure and palliate cancer. The Campaign has now joined forces with the AIR/NZIMRT and ACPSEM to collaboratively promote RT. Central to the Campaign is a website for patients, their carers and GPs providing up to date information about RT. Social and traditional media is highly effective in driving traffic to the website. The site includes patient stories and useful videos with recently updated functionality and content. The site has several hundred new visitors a month globally. In the last 12 months, Twitter & Facebook mention/share/likes have exceeded 70,000. The campaign community service announcement, ‘Targets’ has reached millions of viewers on SBS and channels 7 & 10. The Campaign has engaged 2 high‐profile Ambassadors and is getting screen messages about RT onto 450+ GP waiting room TV screens nationally. RT education sessions have reached over 150 GPs in 15 RT centres with more on the way. The Campaign needs continued support from all radiation science professionals to ensure more patients that could benefit from modern sophisticated RT, actually know about it and to have access to this treatment.