Saturday 25 March 2017

Chest x‐ray interpretation by radiographers

Nick Woznitza^1,2

¹Homerton University Hospital, London, United Kingdom²Canterbury Christ Church University, Canterbury, United Kingdom

Chest X‐rays are one of the most frequently performed diagnostic tests worldwide, providing rapid and cost effective assessment across a spectrum of patient pathways. There is a relative paucity of evidence supporting chest X‐ray reporting by radiographers, especially compared to the substantial evidence base supporting skeletal reporting by radiographers.

A study was conducted to establish the accuracy of radiographer chest X‐ray reporting and the influence of these reports on clinicians’ diagnostic decision‐making. Comparable accuracy was found between a cohort of reporting radiographers (n = 11) and consultant radiologists (n = 10) using jack‐knife alternate free‐response receiver operator characteristic curve (JAFROC) methodology. No difference in the influence of reporting radiographer and consultant radiologist chest X‐ray reports on clinicians’ diagnosis or diagnostic confidence was found.

These results suggest that with appropriate postgraduate education, reporting radiographers are able to interpret chest x‐rays at a level comparable to consultant radiologists. Opportunities to redesign patient pathways and streamline care are discussed.

Collimation on chest x‐rays: Comparing film‐screen trained vs digital trained radiographers

Sally Ball, Meg McKerrow

Princess Alexandra Hospital, Brisbane, Australia

Objectives: The quality of film‐screen radiography is more sensitive to exposure factors and collimation, whereas digital radiography (computed or direct digital radiography) has the ability for a mask to be applied in post‐processing.

The aim of this study was to assess the extent of collimation of film‐screen trained radiographers versus digital trained radiographers in posteroanterior (PA) and lateral chest x‐rays (CXR).

Methods: A retrospective review of chest x‐ray examinations was undertaken on out‐patients presenting to the general x‐ray department of the Princess Alexandra Hospital. The collimation dimensions for PA and lateral CXRs was recorded and calculated as the field of view. The collimation area was compared for film‐screen and digital trained radiographers. Current university students completing clinical placement were also included in the comparison.

Results: A small scale pilot study was conducted to calculate sample size for a larger scale study. Preliminary findings from this pilot study demonstrated an already significant increase in the area of the collimation field between radiographers trained on digital radiography when compared with those trained on film‐screen (P < 0.05). This significant increase was demonstrated in both the PA and lateral chest x‐ray views.

The results of a larger scale study will be presented at the conference including observations on the effects of the collimation areas on centring points and exposure index values.

Conclusion: Preliminary findings conclude that radiographers trained on computed or digital radiography systems collimate to a larger field of view than those trained on film‐screen radiography systems in PA and lateral chest examinations.

Finding Dory: the search for impacted fishbones

Michael Neep, Daniel Sgualdino

Metro South Health, Queensland Health, Brisbane, Australia

Objectives: In the search for an impacted fish bone in the upper aerodigestive tract, it is common practice for patients to receive a lateral x‐ray of the neck. The utility of this exam is contentious, with several studies questioning its sensitivity.^1,2 This study examined the utility of digital radiography in assessment of impacted fishbones in the upper aerodigestive tract.

Methods: Two phantoms were selected that contained soft tissue densities comparable to the soft tissues visualised on a lateral neck x‐ray of a human (perspex block phantom and an anthropomorphic phantom). Fishbones from five commonly eaten fish species in Brisbane were x‐rayed. Multiple exposures factors (kVp/ mAs) were tested including; 50/1, 60/2, 60/4, 60/8, 80/25 and 109/3.2. Two radiographers graded the radio‐density of each bone using a four point visual scale.

Results: All five species of fish (100%) were visualised when viewed within both phantoms with an exposure of 60kVp and 4mAs. All five species were not adequately visualised on the perspex phantom when x‐rayed with 50/1, 80/25 and 109/3.2 (kVp/ mAs). The two species with less radiodense bones were mullet and king snapper.

Conclusion: Fishbones from five commonly eaten fish species in Brisbane were visible when x‐rayed in a background of soft tissue density, however the exposure factor may play a significant role in the visibility. Since fishbones frequently become impacted in anatomical locations of high tissue density such as thyroid cartilage, plain radiography may have low utility to exclude impacted fishbones in the upper aerodigestive tract.

References

1. Kumar M, Joseph G, Kumar S, Clayton M. Fish bone as a foreign body. The Journal of Laryngology & Otology J Laryngol Otol 2003; 117.

2. Evans R, Ahuja A, Williams SR, Hasselt CV. The lateral neck radiograph in suspected impacted fish bones — Does it have a role? Clinical Radiology 1992; 46: 121–3.

Image quality and dose analysis for a pa chest x‐ray: comparison between AEC mode acquisition and manual mode using the 10 kvp rule

Cláudia Sá Dos Reis, João Gonçalves, Ana Rita Barbara, Ryan Hegarty, Chloe Bloor, Tania Lagrange, Noëlle Temming, Corrie Klompmaker, Henriette Røkeness, Mathilde Vinsand Sønnesyn, Amandine Yamasathien, Peter Hogg

Curtin University, Perth, Australia

Purpose: To determine whether the application of the 10 kVp rule manually or the use of AEC gives the best image quality with an optimised patient dose.

Method: 68 anthropomorphic chest phantom X‐ray images were acquired using a Wolverson Arcoma X‐ray unit, and compared against a reference image using the 2 alternative forced choice method by five radiographers. The effective dose was then estimated using PCXMC software and the exposure index was recorded.

Results: Statistical differences between several AEC modes (P = 0.002) were observed regarding effective dose. The exposure time dramatically decreases when applying the 10 kVp rule with manual mode (50–28%) compared to automatic mode (36–23%). Considering the image quality, no statistical differences (P = 0.348) were observed for images with no lesions and different AEC modes (P = 0.348). Using a higher kVp value the lgM values will also increase. The lgM values showed significant statistical differences (P = 0.000). The image quality scores did not present statistical significant differences (P = 0.043) for the images with lesions comparing manual with AEC mode.

Conclusion: In general the doses was lower using the manual mode. By using the right AEC ionising chamber the effective dose will be the lowest in comparison to other ionising chambers. The use of the 10 kVp rule did not affect the detectability of the lesions.

Cyberknife stereotactic radiosurgery for trigeminal neuralgia: experiences and outcomes

Peter Devlin

Sir Charles Gairdner Hospital, Perth, Australia

Aim: Trigeminal Neuralgia is a condition affecting the fifth cranial nerve and results in episodes of intense pain. Current treatment largely involves medical therapies, followed by minimally invasive procedures when the medication fails, with Stereotactic Radiosurgery emerging as an excellent treatment option as its offers pain relief with very minimal side effects.¹ Since 2014, we have treated a total of 7 cases of Trigeminal Neuralgia using the Cyberknife at Sir Charles Gairdner Hospital. This presentation aims to review our planning and treatment processes, as well as the patient outcomes, for this largely untraditional treatment site.

Method: All patients have a thermoplastic mask made and have a planning CT and MRI approximately 2 weeks before they are due to start treatment. The treatment is then planned according to protocol using the MultiPlan planning system, with doses of up to 62 Gy in a single fraction. Following treatment, patient data, including the treatment plan and toxicities, is recorded in the RSSearch database.

Results: We have been able to successfully deliver treatment to a total of 7 patients so far, with patients experiencing minimal side effects.

Conclusion: Through the use of the Cyberknife we have been able to accurately deliver high doses the effectively treat Trigeminal Neuralgia, a site traditionally hard to treat due to its proximity to a number of radiation sensitive organs.

References

1. Lopez BC, Hamlyn PJ, Zakrzewska JM. Stereotactic radiosurgery for primary trigeminal neuralgia: state of the evidence and recommendations for future reports. J Neurol Neurosurg Psychiatry 2004; 75: 1019–1024.

Stereotactic Ablative Body Radiotherapy (SABR) for liver tumours – the Peter MacCallum Cancer Centre experience

Roshini Thomas

Peter Maccallum Cancer Centre, Brunswick West, Australia

Introduction: Stereotactic Ablative Body Radiotherapy (SABR) techniques offer the ability to deliver significantly higher effective biological radiation therapy (RT) doses to discrete regions. SABR is ideally suited to treat disease within radiosensitive structures such as the liver. The risk of radiation induced liver disease, coupled with the high therapeutic doses required to treat cancer in this region, necessitates a highly conformal approach to RT planning and delivery. With modern technological advances in stereotactic treatment delivery and image verification, it has become possible to deliver ablative doses to liver lesions using plans characterised by rapid dose fall‐off and acceptable doses to critical structures.

Discussion: Delivering SABR techniques to the liver involves complex challenges, with treatment outcomes heavily reliant on accurate definition of target volumes and confidence in treatment verification. Targets are often delineated using several imaging modalities, requiring multiple scans and image fusion accounting for breathing motion in this readily deformable organ. Furthermore, treatment verification is confounded by difficulty in visualising the lesions on cone‐beam computed tomography (CBCT) alone. A personalised workflow developed at our centre has been a result of maximising clinical experience, to obtain a consistent and yet personalised method for each patient. This presentation will detail our approach to treatment Liver SBRT patients, data gained thus far, and demonstrate the advantages of a patient‐centred approach.

Conclusion: We have developed a process of triaging our patients at simulation to define the optimal motion management strategy, managing the complexities of motion during treatment delivery and the delivery of acceptable dose.

The role of stereotactic body radiation therapy in the management of paediatric tumours

Nina Lin

Queensland University of Technology, Brisbane, Australia

Stereotactic body radiation therapy (SBRT) has a well‐established role in the management of many adult tumours, including lung, intracranial and prostate lesions. However, there is limited data regarding the role of SBRT in the management of paediatric tumours.

Paediatric patients often require anaesthetic to withstand long treatment times. Additionally, their tissues also react differently than adult tissues to radiation. Childhood tumours often have different characteristics and are treated differently to adult tumours. Hence, many factors must be considered before the implementation of SBRT.¹

A study of a variety of paediatric tumours found high local control for bone metastases; however, there was a 15% rate of Grade 3 toxicity.² Another study found that whilst local control was good, there were concerns over the toxicity of the treatment.³ In paediatric tumours with a good prognosis, a major concern is the long‐term effects of treatment. Hence, studies with long‐term follow‐up are required to establish the safety of utilising SBRT in paediatric malignancies.

A literature review was conducted to investigate the current status of paediatric SBRT and the potential for future development. This presentation will discuss the unique characteristics of paediatric patients and tumours, clinical precedents and the future direction of SBRT in managing paediatric tumours.

References

1. Siddiqui F, Kunos CA, Paulino AC. Stereotactic body radiation therapy in head and neck, gynecologic, and pediatric malignancies. J Radiat Oncol 2012; 1: 31–42.

2. Taunk NK, Wolden SL. Acute Toxicity and Local Control in Pediatric Cancers Treated With Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2015; 93: E508–E509.

3. Brown LC, Lester RA, Haddock MG, Sarkaria JN, Olivier KR, Arndt CAS et al. Stereotactic Body Radiation Therapy (SBRT) for Pediatric Bone Tumors. Int J Radiat Oncol Biol Phys 2013; 87: S71.

Developing a SABR dosimetry audit for Australian radiotherapy centres

Maddison Shaw^1,2, Jessica Lye^1,2, Francis Gibbons¹, Madeleine Shanahan², Moshi Geso²

¹ACDS, ARPANSA, Yallambie, Australia²RMIT University, Melbourne, Australia

Introduction: SABR/SBRT refers to radiotherapy treatment deliveries which give a high dose of radiation to an extra cranial tumour, with high geometric precision.¹ The risk to patients is increased with SABR techniques due to the increased dose per fraction, and as such specialised planning, treatment and QA practices are needed to ensure patient safety.¹ A research project to develop a SABR dosimetry audit was undertaken by the Australian Clinical Dosimetry Service.

Method: The ACDS used SABR principles from existing literature, together with common practice observed in the Australian context, to design a SABR dosimetry audit that would meet the needs of Australian Radiotherapy facilities. An end‐to‐end dosimetry audit was designed for use with various treatment delivery types (3DCRT, VMAT, FFF etc.), using various detectors in a humanoid thorax phantom. The audit planning cases replicate the most common tumour sites treated with SABR: lung, spine and soft tissue. The planning cases were designed to ensure compatibility with all TPS/Linac equipment combinations currently used for SABR across Australia. Various dosimeters were investigated for different treatment delivery modalities.

Results: Common practices of SABR in Australian facilities, results of treatment planning across multiple TPS and the optimal dosimeters for small field measurements will be discussed.

Conclusion: SABR dosimetry will be incorporated into the existing Level III audit offered by the ACDS.

References

1. Guidelines for safe practice of stereotactic body (ablative) radiation therapy. Faculty of Radiation Oncology, The Royal Australian and New Zealand College of Radiologists. (2015).

Integrating the Victorian DHHS capability framework into the intern/PCP training model at Western Health

Adam Steward

Western Health, Maribyrnong, Australia

In 2014 the Chief Allied Health Adviser for Victoria, in partnership with Monash Health, developed the Allied Health: Credentialing, Competency and Capability framework (AH:CCC). This key governance document, while developed to be generic, initially focused primarily on the allied health therapy disciplines.

In 2015 the department, in partnership with Western Health and in consultation with Monash Health, commenced work in collaboration with all Allied Health Science professions to build an expanded contextualised framework to meet the unique and varied needs of the allied health sciences disciplines. This work progressed through consultation and collaboration across all allied health science (AHS) disciplines, peak bodies, educators and various public and private health settings across Victoria.

The framework was developed so that patients and their families can have confidence in the provision of systems, which enable the provision of safe care. Available for services to use, the capability framework was utilised at a meeting at the Department of Health and Human Services on 9/12/2015 of Tutor Radiographers with a view to establish a set of expected capabilities for Intern/PCP radiographers undertaking their final year training placements.

Within Western Health, the framework has been used to amend the Position Description of the Intern/PCP radiographer and to develop an assessment tool to be used quarterly, complementing the requirements of the Medical Radiations Practice Board of Australia (MRPBA) Supervised Practice Program.

Facilitating interprofessional education

Karen Coleman, Ben Darlow, Eileen McKinlay, Louise Beckingsale, Sarah Donovan, Peter Gallagher, Ben Gray, Hazel Neser, Meredith Perry, Sue Pullon

University of Otago, Wellington, New Zealand

Objective: To explore the experiences of educators in developing and delivering a pre‐registration Interprofessional Education (IPE) programme.

Introduction: Pre‐registration IPE aims to prepare health professionals to work effectively in collaborative health teams to improve patient care by learning with, from and about each other.¹ IPE programmes require considerable commitment and engagement from educators, so it is important to understand their experience in taking part in these programmes.

Since 2011, the University of Otago, Wellington (UOW), has delivered an IPE program to pre‐registration students from the disciplines of dietetics, medicine and physiotherapy; and from 2014 radiation therapy. The IPE educators taking part have clinical backgrounds in educational psychology, dietetics, medicine, midwifery, nursing, physiotherapy and radiation therapy.

Method: An audio‐recorded, semi‐structured, one‐hour focus group was conducted with IPE educators. The focus group transcript was analysed inductively to identify themes in participant experience.

Results: Four key themes identified related to: the evolution of a growing programme, educator skill development, educator team development, and educator excitement and enthusiasm. Increased programme size, with the introduction of radiation therapy resulted in greater complexity and risk, but this was also a stimulus for finding efficiencies and improving the curriculum and its delivery. Educators found their developing collegiality positively modelled teamwork processes to students.

Conclusion: Educators reported positive and rewarding teaching experiences. Expanding the programme provided additional stimulation and excitement as well as challenges. Time must be factored in when expanding an IPE educator team, including educator‐induction and support.

References

1. Centre for the Advancement of Interprofessional Education. (2016). Retrieved 11 August, 2016, from http://caipe.org.uk/resources/defining‐ipe/

Educate the educator but what about the mentors?

Kathleene Dower, Richard Ford

Northern NSW Cancer Institute, Lismore, Australia

In this day and age of courses in abundance to educate the educator are we neglecting the mentors – the foot soldiers on the ground who work with students and new graduates day in and day out? While historically radiation therapists learnt to mentor others through osmosis, rather than through formal or informal education, this status quo is now being challenged – a reflection of changes in current teaching practices.

At the Northern NSW Cancer Institute, the educators realised the gap in our provision of education for mentors compared with the demands of students and new graduates for quality learning, interpersonal transparency and consistency from said mentors. The educators sought to bridge this gap via thirty minute in‐house workshops to upskill mentors with strategies to tailor their teaching, optimise feedback, enable conflict resolution and garner active listening and talking skills to coach students and new graduates with the aim of alleviating the burden that mentoring can occasionally bring. Even with time constraints and the burden of an ever increasing clinical load – our message is to not forget the mentor. This presentation will discuss our workshops, framework to facilitate and how big rewards can come from seemingly small investments.

‘Instagram for your aortogram’ – using Figure 1 as an educational tool for radiography students

Alexandra Schelleman

RMIT, Melbourne, Australia

Social networking applications, such as Facebook and Instagram, are already used by both students and health professionals on a daily basis. Figure 1 is a social networking application where medical professionals can share and comment on images of medical cases. The cases presented on Figure 1 range from plastic surgery to major trauma, and radiological images comprise a large number of the submissions.

This presentation will examine how Figure 1 can be used by Medical Imaging students to further their technical knowledge, improve recognition of pathologies and consider the roles of other health professionals in providing patient care. This will then be extended to a review of the literature surrounding online radiographic learning resources, and how these resources are best integrated into a university setting. Ultimately, this presentation will examine how social media can be used to help education, rather than hinder it.

Our attitudes to social media as a tool for continuing professional development

Darien Montgomerie, Gay Dungey

University of Otago, Wellington, New Zealand

Objectives: Social media is becoming increasingly prevalent in our lives. This study aimed to determine the attitudes of New Zealand Institute of Medical Radiation Technologists (NZIMRT) members towards using social media as a tool for continuing professional development (CPD).

Methods: A questionnaire was emailed to all NZIMRT members which collected data on social media use, frequency and the social media platforms utilised. Participants attitudes towards social media as a tool for CPD were determined using a 5 point likert scale. Open ended questions asked about perceived barriers and advantages towards this tool.

Results: Quantitative and qualitative data were collected from 310 out of 2034 members participated. Preliminary results suggest congruence with reported literature. A detailed analysis will be presented at conference.

Conclusion: Social media represents an innovative way to achieve CPD and is worthy of further exploration.

Abnormal results management in medical imaging – a real‐time radiographer commenting model

Ingrid Klobasa‐Hicks

Northern Sydney Local Health District, Sydney, Australia

Objectives: The Clinical Excellence Commission¹ has identified abnormal result handling as a critical safety issue for radiology. Pressures exist to improve work‐flow and reduced length of stay, hence earlier abnormality detection would assist in achieving this.

The purpose of the study was to trial formal radiographer commenting that communicates the detection of abnormality to the referrer and radiologist in real time.

Methods: A multidisciplinary Steering Group determined key barriers to timely results notification via Nominal Group Process.

The top four barriers were identified via Pareto Chart Analysis. Communication procedures were developed in the RIS as well as telephone notification for critical findings. Flagging these cases allowed radiologists to prioritise reporting.

The notification system, was trialled and audited over a 10 weeks period for general imaging (n = 17 radiographers).

The comments were correlated with radiology reports (n = 616) and false positive and true positive results determined; (PPV > 95%). False positives were investigated for adverse effects.

Satisfaction surveys were conducted for all stakeholders. Referrers were asked to report the number of cases per week that the comment had assisted in clinical management.

Results: The Positive Predictive Value (PPV) for abnormality detection was 96.8% when compared to the final radiology report. 16 critical/significant results were alerted in real‐time allowing for earlier patient intervention.

The highest ranking satisfaction survey results were from ED; 92.3% desiring continuation of the procedure.

Conclusions: The successful implementation of radiographer led notification of interim abnormal results was achieved through inter‐professional collaboration. This has enhanced patient care.

References

1. Clinical Excellence Commission Clinical Focus Report – Diagnostic Tests‐ How access and follow‐up affect patient outcome. Clinical Excellence Commission (CEC, Sydney). 2012.

How to correct an incorrectly positioned lateral knee

Michael Fuller^1,2,3,4, Christine Xiao^1,2

¹Flinders Medical Centre, Bedford Park, Australia²SA Medical Imaging, Adelaide, Australia³University of South Australia, Adelaide, Australia⁴Charles Sturt University, Port Macquarie, Australia

Consistently achieving a true lateral projection of the knee can present challenges for junior and experienced radiographers alike. What is perhaps even more challenging, is knowing how to reposition the patient's knee to achieve a true lateral position. This paper considers the traditional methods for approaching lateral knee repositioning and some techniques that are not commonly practiced by radiographers. We will consider which techniques are more reliable and provide supporting evidence and examples. The authors will be proposing that lateral knee repositioning is most successfully and consistently achieved using a method which considers all valid techniques and arrives at an on‐balance decision.

Do you reach for lead? Development and validation of an anatomical side marker audit

Kelly Fordyce, Michael Neep

Logan Hospital, Australia

Objectives: Using anatomical lead side markers in plain radiography is essential in high quality imaging. Lack of anatomical side markers causes confusion and may lead to patient harm.¹ Developing an effective method to audit the use of anatomical side markers is crucial to maintaining quality practice.

This study aims to develop and validate a tool to effectively and efficiently audit the use of anatomical side markers as part of a quality assurance program.

Methods: A literature review was completed and audit form produced. Three radiographers with a range of experience (2–15 years) assessed n = 30 images for the placement of an anatomical side marker. Using Google forms participants recorded the presence of an anatomical side marker (lead, post processed, none), identification of correct side and satisfactory placement. The time taken to complete the audit was documented to assess the efficiency of the tool.

Results: The results demonstrated that within this sample, a post processed marker was present in 13.3% of images in comparison to 86.7% with a lead marker, with 100% identifying the correct side. The mean time for performing the audit was 35 min with an interrater reliability of 96.6%.

Conclusion: This study demonstrated that using this audit tool to assess the use of anatomical side markers for quality assurance is effective and efficient and can be performed by radiographers with varying degrees of clinical experience in a timely manner. The use of this audit tool encourages radiographers to provide a high quality service that ensures patient safety.

References

1. Titley AG, Casson P. Radiographer use of anatomical side markers and the latent conditions affecting their use in practice. Radiography 2013; 20: 42–47.

Two lefts don't make a right: how sidemarker usage has changed with increased digitalisation

Clare Gill, Tom Steffens

Queensland Metro South Health – Princess Alexandra Hospital, Brisbane, Australia

Objectives: To investigate: The relative proportion of Direct Radiography (DR) and Computed Radiography (CR) usage within a large Metropolitan Imaging Department between 2001 and 2015.

The prevalence of post‐processed sidemarkers (as opposed to lead) on radiographs over a 15 year period.

The relative rates of sidemarker error of lead and post‐processed sidemarkers.

To review potential ramifications for patients of inaccurate sidemarkers on plain radiographs.

Methods: A random sample of plain radiographs (500 per time point) from 2001, 2008 and 2015 was collected. The following information was collected for each radiograph:

Presence, type (lead or post processed) and accuracy of sidemarker,

Position of sidemarker,

Type of image receptor used (DR or CR).

Departmental equipment inventory was examined at the same time points to assess the relative contribution of DR and CR.

A review of literature and Professional Standards exploring topics including “sidemarker placement”, “error in radiography”, “digital radiography” in combination.

Results: A pilot sample of 150 images from July 2001 and July 2015 has been collected. (Refer to Table 1 for data obtained from pilot sample).

From this pilot sample, it can be seen that the use of post‐processed sidemarkers have become more prevalent, with an 11.3% increase.

The literature revealed a number of examples where post processed markers have contributed to medical error.

Conclusion: This use of post processed side markers has become more prevalent over the time period. This has raised concerns regarding increased potential for erroneous placement of markers.

Supporting documents:

The influence of digital radiography on positioning the Mortise ankle projection: a retrospective study

Seamus Power

Metro South Health – Logan Hospital, Meadowbrook, Australia

Objectives: The implementation of Digital Radiography (DR) in modern medical imaging departments has influenced radiographic technique. The ability to review images faster after acquisition compared to Computed Radiography (CR) and modify positioning accordingly are important factors in reducing exam times.¹ The purpose of this study was to analyse positional accuracy of the Mortise projection before and after the implementation of DR.

Methods: 50 projections between February/March 2007 (CR) and 50 projections between February/March 2016 (DR) were extracted from the Picture Archiving Communication System database. Images were anonymised, downloaded as JPEG files and embedded in PowerPoint.

Two radiographers of varying seniority assessed the 100 images. They were asked to score each image using four criteria developed from a review of literature.^2,3 Each radiographer's scores were compared and the mean scores calculated.

Images meeting all 4 categories were grouped ‘Optimal’, 3 categories ‘Good’ and 2 to 0 categories ‘Imperfect’.

Results: Analysis of the scores demonstrated that the positioning of the mortise was more accurate with using DR over CR:

Optimal images increased 94% (±23%) with DR.

Optimal and Good images increased 30% (±8%) with DR.

Imperfect images decreased 32% (±6%) with DR.

Conclusion: This study has demonstrated the increase in positional accuracy of the Mortise ankle projection following the implementation of DR. This study also highlighted that challenges still remain in positioning the mortise projection as only around 24% of images demonstrated ‘Optimal’ positioning.

References

1. Hartmann B, Rill L, Arreola M. Workflow Efficiency Comparison of a New CR System with Traditional CR and DR Systems in an Orthopaedic Setting. J Digit Imaging 2010; 23: 666.

2. Rageh A. Ankle Fractures [Internet]. Punjab, Pakistan: Ameen Rageh. Published Aug 12 2015, Cited Aug 3 2016. Available from: http://www.slideshare.net/ameenrageh/ankle‐fractures‐51558239

3. Murkey N. Ankle Joint Radiography [Internet]. Maharashtra, India: Nikhil Murkey. Published October 28 2012. Cited Aug 3 2016. Available from: http://www.slideshare.net/nmurkey/ankle‐joint‐radiography

Positioning critique: how close is close enough?

Michael Tarollo

Western Health, Melbourne, Australia

When critiquing a plain film X‐ray, a radiographer must consider many factors to determine whether the image is acceptable or requires repeating. One of the most fundamental of these factors is the positioning of the required anatomy. Upon critiquing an image for positioning a radiographer may ask themselves questions such as “Is it lateral enough?” or “Is this a true AP?” The answer to these questions is usually a qualitative one, with a radiographer drawing on their experience to assess for positioning adequacy. Junior radiographers and students are often confused by this assessment process and unable to understand why an image is acceptable with regards to positioning. The purpose of this presentation is to determine if a quantitative aspect can be applied to the positioning critiquing process. The study examines projections of multiple body regions and surveys radiographers, radiologists, and referrers with a vast range of experience.

Results: Given that the time for presentation would be in March 2017, results are yet to be finalised. The process of collecting images for potential surveying is currently being undertaken and will conclude in October. We then anticipate requiring another 1–2 month period to survey an adequate number of practitioners and collate results. Given this timeline, the project should be finalised and ready for presentation by December.

How to correct an incorrectly positioned lateral elbow

Michael Fuller^1,2,3,4, Mariosa Giblin^1,2

¹Flinders Medical Centre, Bedford Park, Australia²SA Medical Imaging, Adelaide, Australia³University of South Australia, Adelaide, Australia⁴Charles Sturt University, Port Macquarie, Australia

Consistently achieving a true lateral projection of the elbow is one of most difficult challenges in radiography. Furthermore, successfully repositioning an incorrectly positioned lateral elbow can challenge even the most skilled and experienced radiographers. This paper details a technique for determining the repositioning required to achieve a true lateral elbow position. The technique is focused on a detailed understanding of the bony anatomy of the elbow and employs the aid of a prop to assist the radiographer in understanding the relative positions and movements of the bony structures of the elbow as the patients elbow and wrist are raised and lowered.

The presenters will be presenting techniques which can be applied to adults rather than paediatric patients.

Hasten slowly – making time for patient care in the digital era

Ericka Beattie, Tom Steffens

Princess Alexandra Hospital, Brisbane, Australia

Just as technology has changed the rest of our lives, so to has it changed the way we image. Noticeably, Direct Radiography (DR) has created near‐instantaneous image processing which allows for greater patient throughput within medical imaging departments. In contrast to film, DR has produced a recognisable 30% decrease in time‐per‐patient and an 80% decrease in time‐to‐image availability.¹ However, besides radiography's highly technical nature, improved patient outcomes and positive patient experiences stem from empathetic and compassionate patient care by radiographers.² Striving for greater efficiency to meet the increasing imaging demands within the digital world combined with technology's influence on human connection, radiographers could be jeopardising patient care. This presentation will use data from a busy orthopedic department (where patient encounters can be as short as 3 min) as a basis to create awareness and discuss the potential for diminished patient experience as a result of imaging speed in the digital era. A renewed focus with good patient care practices will prevent the erosion of professional values and standard of care. It will allow the medical imaging community to reach above current standards to embrace the digital era while providing patient centered care.

References

1. Harvey D. Implementing Digital Radiography. Radiology Today 2009; 10: 12.

2. Bleiker J, Knapp KM, Hopkins S, Johnston G. Compassionate care in radiography recruitment, education and training: A post‐Francis Report review of the current literature and patient perspectives. Radiography 2016; 1–6.

Manual to media – 40 years of medical imaging

Stuart Nelson

Bunbury Medical Imaging, Dalyellup, Australia

The last 40 years as a radiographer I have seen rapid change in both modalities and clinical applications.

From hand developing a film to managing and producing data onto media discs and laser film, PUCK changers to rotational angiography, 20 min CT to full field dual energy in one rotation, static B‐mode ultrasound to 4D, xerography to tomosynthesis and the development of MRI and PET scanning. Radiography roles have expanded into operations managers, PACS administration and Quality Systems Officers.

In my later years, after time as a representative for imaging equipment manufacturers, I find myself in a new private practice in a rural area, setting up procedures for screening and CT, while at the same time learning the first Cone Beam CT outside of the Perth metropolitan area.

From learning to interact with a new referral base of medical practitioners and dental specialists and understanding the wide variety of changing protocols required to produce correct data sets for different pathologies on CT and cone beam, it has been a challenging change management process.

This presentation will attempt to summarize the technology advancements and how there may be cross over from “dedicated” dental systems into conventional radiology.

Supporting documents:

References

1. [cited 15 August 2016]. available from https://sc01.alicdn.com/kf/HTB1CqaQKFXXXXXRXXXXq6xXFXXX1/KODAK‐Industrial‐X‐Ray‐Film‐Processor.jpg

2. AuntMinnieEurope. Recalling how fetal ultrasound transformed pregnancy. Dr Adrian Thomas. May 21, 2013[cited 15 August 2016], available from http://www.auntminnieeurope.com/index.aspx?sec=ser{00AMP00}sub=def{00AMP00}pag=dis{00AMP00}ItemID=608243

3. Google Books, Equipment for Diagnostic Radiography, pg 143, E FORSTER. 1985 [cited 15 August 2016]. available from https://books.google.com.au/books?id=_1RtCQAAQBAJ{00AMP00}pg=PA143{00AMP00}lpg=PA143{00AMP00}dq=puck+film+changers{00AMP00}source=bl{00AMP00}ots=NZ7z4i3jyu{00AMP00}sig=Tc6QR1N56ChzwMIRmxk5jXVLd8{00AMP00}hl=en{00AMP00}sa=X{00AMP00}ved=0ahUKEwjikfmUxtvOAhVBRZQKHXUSBukQ6AEIHTAA#v=onepage{00AMP00}q=puck%20film%20changers{00AMP00}f=false

4. Imaginis. Brief History of CT. Courtesy of Siemens Medical Solutions. 2016. [cited 15 August 2016]. available from http://www.imaginis.com/ct‐scan/brief‐history‐of‐ct

5. [cited 15 August 2016]. available from http://img.youtube.com/vi/jIQuN7ZVB48/0.jpg

6. Wordpress.com. Lecture 7. Processing Area and Viewing Section. Page 13. 2011. KAAB mid‐uitm. [cited 15 August 2016] available from https://xraykamarul.files.wordpress.com/2011/11/lecture7.pdf

The use of digital tomosynthesis in the imaging of osteotomy and external fixation follow‐up

Adam Steward, Hayley Biding

Western Health, Maribyrnong, Australia

Over recent decades there have been considerable advancements in the field of medical imaging. This is most noticeable in Computed Tomography (CT). With such development in CT, Linear Tomography has gone uninvestigated for more than a decade. Interest in Tomosynthesis has once again regained momentum, as technological advancements have occurred which could make the clinical applications of the modality practicable. Decline in the cost of computing, development of reconstructing and post processing software and the development of the digital flat panel detectors has in modern times ushered in new possibilities for tomosynthesis.

Modern Tomosynthesis can reconstruct an arbitrary number of slice images through the patient volume via a single low‐dose acquisition of projection image data. As such, Digital Tomosynthesis may be able to offer the spatial resolution and low dose of plain film radiography with volumetric information and a decrease in superimposition provided by CT studies without the decrease in resolution due to metallic artifacts.

Orthopaedic patients that are managed by external fixation, particularly those that have undergone osteotomy procedures can prove a difficult prospect to image for any radiographer. In such cases, accurate imaging of the fracture site, important to determine bony re‐modelling and repair can often be obscured by the metallic external fixation superimposing the anatomy.

The researchers have undertaken the imaging of a home‐made phantom by direct planar radiography, digital tomosynthesis and CT in order to compare the three technologies for imaging of patients managed with external fixation.

Don't forget about the talus

Peter Elliott

Palms Xray, Palmerston North, New Zealand

Plain X‐ray imaging of the ankle is a very common radiographic procedure where valuable information can be gained about the integrity of the associated bones. Most referrers used the Ottawa Rules as guidance for justification. MRTs are generally conversant with the frequently demonstrated Jones and Weber fractures. This presentation will also feature the harder to classify anatomical and developmental variants as well as injury to the talus which is often overlooked in the image evaluation process. Cases presented have all been through our satellite emergency clinic.

Advanced radiation dosimetry in contemporary external beam radiation therapy (including particle therapy)

Anatoly Rozenfeld

Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia

An increase in the complexity of contemporary radiation oncology technologies demand sophisticated medical devices for verification of treatment delivery. The Centre for Medical Radiation Physics (CMRP) is an internationally recognised leader in the development of radiation detectors, providing real time high spatial and temporal resolution for treatment verification in radiation therapy.

Pre‐treatment and real time in‐vivo treatment delivery verification in brachytherapy was resolved with the recently developed “Magic Phantom” and “BrachyView”. These systems allow fast verification of source dwelling and radioactive seed positions with submillimeter resolution for in‐vivo real‐time verification.

Real‐time motion adaptive radiotherapy aims to reduce the impact of patient‐specific changes in anatomy during treatments through re‐optimisation of the treatment delivery. MLC tracking utilises real‐time tumour localisation to adjust the MLC configuration during delivery. Patient specific quality assurance of treatments employing MLC tracking is complex as daily variations in the patient's tumour motion create new adaptations. We have developed a family of 2D high spatial and temporal resolution pixelated detectors (“Magic Plate”) to verify real‐time motion adaptive radiotherapy delivery.

The Micro‐plus (m+) microdosimetry probe, utilising “Mushroom” 3D detector technology, allows for RBED determination on a cellular and sub‐cellular level, for all variants of particle therapy. New silicon detectors allow for fast range determination in pencil beam scanning (PBS) in proton and C‐12 therapy, including MRI guided proton therapy.

Developed and implemented in the clinic, CMRP innovations bring confidence in research and clinical trials to radiation oncology, possible only due to strong collaborations between medical physicists, radiation biologists and physicians.

References

1. Petasecca M, Newall MK, Booth JT, et al. MagicPlate‐512: a two dimensional silicon detector array for Quality Assurance of stereotactic motion adaptive radiotherapy. Med. Phys. 42, 2992–3004, 2015.

2. Safavi‐Naeini M, Han Z, Cutajar D, et al. BrachyView, A novel in‐body imaging system for HDR prostate brachytherapy: Experimental evaluation. Med. Phys. 2015.

3. Anatoly B. Rosenfeld. Novel detectors for silicon based microdosimetry, their concepts and applications. NIM A, 809, 156–170, 2016.

Implementing daily soft tissue image guidance with reduced anisotropic PTV expansions for post‐prostatectomy radiotherapy

Linda Bell, Jennifer Cox, Regina Bromley, Thomas Eade, George Hruby, Andrew Kneebone

Northern Sydney Cancer Centre, St Leonards, Australia

Objectives: To assess the training and implementation of soft tissue matched image guidance and reduced anisotropic planning target volumes (PTV) in post‐prostatectomy radiotherapy (PPRT).

Methods: Twenty‐three Radiation Therapists (RTs) were trained offline. This involved matching 6 cone beam computed tomography (CBCT) scans from 6 patients, 3 with and 3 without surgical clips. The results of the matches were analysed and compared to the intraobserver variability of 1 observer. The accuracy of online soft tissue matching for the first 8 patients treated using the new technique was assessed.

Results: See Table 1. Twenty‐three RTs completed training. Most RTs identified geographic miss. Matching improved with surgical clips. The assessment of online pre‐treatment CBCT accuracy for the first 8 patients was <0.5 cm. Online accuracy was better than offline training due to 2 RTs performing online matching. The geographic miss rate was reviewed and deemed acceptable. When repeat geographic miss or near miss occurred they were often in the same region, which could have an adverse impact on dose coverage. The new PTV expansions achieved increased coverage of the target volume and improved organ at risk constraints. Most patients required less optimisation when using the new PTV expansions. The median time for treatment was within the standard 15 min appointment. A total of 18 interventions occurred during 270 fractions, 16 with the patients being removed from the couch.

Conclusion: Implementing daily soft tissue guidance and reduced anisotropic PTV expansions for PPRT is feasible.

Supporting documents:

Synchrotron radiotherapy: towards a human clinical trial

Lloyd Smyth^1,2, Jacqueline Donoghue^2,3, Jeffrey Crosbie³, Sashendra Senthi⁴, Peter Rogers^2,5

¹Epworth Healthcare, Melbourne, Australia²University of Melbourne, Parkville, Australia³RMIT University, Melbourne, Australia⁴Alfred Hospital, Melbourne, Australia⁵Royal Women's Hospital, Parkville, Australia

Objectives: Synchrotron radiotherapy represents a radical departure from the radiobiological principles of conventional radiotherapy (CRT) and has the potential to address currently unmet clinical needs. ^1,2 The aim of this project is to address the following areas requiring development and systematic data in order to conduct the first human clinical trial at the Australian Synchrotron: (1) safety and normal tissue toxicity, (2) dose‐equivalence with CRT, and (3) treatment planning system (TPS).

Methods: For dose‐equivalence and normal tissue toxicity studies, mice were irradiated using both CRT and synchrotron radiotherapy using a dose‐escalation methodology. To validate a TPS for synchrotron radiotherapy, clinical treatment plans delivered using CRT were imported into a commercially available TPS (Eclipse™, Varian Medical Systems) and compared to plans for the same datasets generated for synchrotron radiotherapy.

Results: Dose‐response curves and the TD50 (toxic dose for 50% of mice) for CRT and synchrotron radiotherapy were calculated for total body irradiations and partial body irradiations of the head, thorax and abdomen of mice. The maximum tolerated (safe) dose was also determined for each modality. In regard to treatment planning, synchrotron radiotherapy plans were comparable to CRT plans only for small or superficial target volumes.

Conclusion: The data collected in this project is fundamental to the progression of synchrotron radiotherapy to clinical practice. The unified effort of a multidisciplinary team including radiotherapists, radiation oncologists and medical physicists, will be required to progress synchrotron radiotherapy from a pre‐clinical animal studies to a human clinical trial.

References

1. Grotzer MA, Schultke E, Brauer‐Krisch E, Laissue JA. Microbeam radiation therapy: clinical perspectives. Phys Med. 2015; 31: 564–7.

2. Smyth LM, Senthi S, Crosbie JC, Rogers PA. The normal tissue effects of microbeam radiotherapy: what do we know, and what do we need to know to plan a human clinical trial? Int J Radiat Biol. 2016; 92: 302–11.

Brass mesh bolus versus tissue‐equivalent bolus for post‐mastectomy chest wall irradiation: a clinical feasibility study

Latisha Walton, Nigel Anderson, Brent Chesson, Prabhakar Ramachandran

Peter MacCallum Cancer Centre, Melbourne, Australia

Objectives: Tissue‐equivalent bolus (TEB) is used for improved surface dose (SD) for post‐mastectomy patients undergoing radiotherapy. TEB are rigid and may cause air gaps between bolus and skin, hindering the efficacy of the build‐up effect.¹ Brass mesh bolus (BMB; Radiation Products Inc) provides excellent conformity to irregular skin surfaces and produces enhanced SD due to Compton scatter.² This study compares the effect of field size and energy on SD when TEB or BMB are applied during chest‐wall irradiation.

Methods: The BMB and chest phantom were modelled with fields of 6MV, 6MV flattening‐filter‐free (FFF), 10MV, 10MV‐FFF and 18MV energies. Measurements were carried out with one, two, and four layers of BMB, and 0.5 cm TEB. Field sizes ranged from 4x4 cm to 18x18 cm. The treatment planning system (TPS‐ Eclipse v13.6, Varian Medical Systems) was used for dose modelling. In‐vivo dosimetry was used for verification. All measurements were compared to controls (no bolus).

Results: For a typical 15x15 cm field size, with measurements taken at 1.7 mm depth under 4 mm tissue‐equivalent two‐layer BMB, an increased SD of 5.1%, 4.1%, 7.5%, and 6.9% was observed for 6MV, 6MV‐FFF, 10MV, 10MV‐FFF respectively when compared to 0.5 cm TEB. Percentage depth dose (PDD) at 25 mm depth and 18MV decreased by 1.5 and 5.0% for two‐layer BMB and TEB respectively, highlighting the dosimetric benefit of the BMB.

Conclusion: BMB is feasible for SD enhancement for post‐mastectomy patients undergoing chest‐wall irradiation with less impact on PDD than the TEB. Further investigation into contralateral breast dose is required prior to clinical implementation.

References

1. Mayadev J, Einck J, Elson S, Rugo H, Hwang S, Bold R, … & Fowble B. Practice Patterns in the Delivery of Radiation Therapy After Mastectomy Among the University of California Athena Breast Health Network. Clinical breast cancer 2015; 15: 43–47.

2. Fessenden P, Palos BB, & Karzmark CJ. (1978). Dosimetry for Tangential Chest Wall Irradiation 1. Radiology 1978; 128: 485–489.

You are not alone – Exploring a patient complaint including psychological impact, legal overview and insurance coverage

Shamus Breen¹, Lisa Newcombe², Gavin Freeman³

¹BMS Risk Solutions,²Landers & Rogers,³Business Olympian, Melbourne, Australia

It's confronting to be told you're not doing your job right, but what you might not know is just how quickly, easily and permanently such a situation can put your career and your personal wellbeing in jeopardy. Hosted by BMS group, this presentation takes a multi‐faceted look into the AHPRA complaint process and the personal impacts to a practitioner. We'll demonstrate to you that you are not alone, and that you have a professional and powerful support network at your disposal when push comes to shove.

BREAST: a multidisciplinary approach to transform the quality of breast cancer diagnoses

Patrick Brennan

University of Sydney, Sydney, Australia

Early diagnosis of breast cancer results in a 97% survival rate. However, to achieve this survival rate and even more importantly to achieve zero deaths from breast cancer by 2030, we must significantly reduce the 30–40% of breast cancers that fail to be diagnosed. Through BREAST, a world‐first infrastructure that uses the latest technological innovations, over the last 4–5 years, we, with local and international experts have identified reasons for misdiagnoses and presented exciting translational solutions. To date the work has been shown to improve radiologists’ performance by a mean value of 34%, an improvement unparalleled by any other innovation in recent years. Its unprecedented success has led to engagement by 80% of breast‐reading clinicians across all states in Australia and New Zealand, as well as adoption within Asia, Middle East and Europe. Our research data is being utilised by world‐leading scientists in six continents and has led to the generation of over $8 m. This initiative, brought about by collaboration primarily between radiography and radiology is transforming the quality of breast cancer diagnosis globally.

Assessment of grid alignment practices by radiographers

Kate Christie

Princess Alexandra Hospital, Brisbane, Australia

Objectives: The purpose of this study is to:

• determine a range of beam‐detector misalignment that causes a noticeable grid cut off effect;

• to investigate the ability of radiographers of varying levels of experience to align the x‐ray tube and grid in an AP erect chest x‐ray.

Method:

• Ethics approval was granted from the local Human Research Ethics Committee.

• AP erect chest x‐rays using a PBU‐60 whole body phantom and 6:1 focussed grid were obtained using an SID of 180 cm, with 1–15 degree variations in tube‐detector alignment, which highlight the effect misalignment has on image quality.

• 40 radiographers voluntarily participated in a simulated set up of an AP erect chest x‐ray, with the variation in alignment between the x‐ray tube and grid measured for each participant. These measurements were compared to the data collected from phantom images.

Results: Phantom images showed noticeable degradation of image contrast as a result of a 3‐degree misalignment between the x‐ray tube and grid, with 7 degrees revealing significant grid cut‐off effects. Data from radiographer simulation is yet to be finalised, with early results being within an acceptable standard of alignment (>7‐degrees).

Conclusion: Small variations in tube‐detector misalignment were found to have an effect on image quality. Early results have shown that radiographers are able to accurately align tube and grid within a tolerance that will not yield significant grid cutoff. It is hoped that this project will encourage radiographers a renewed emphasis on this part of their practice.

Improving clinical governance in medical imaging – what we can learn from the operating theatre

Christopher Hicks

West Moreton Hospital and Health Service, Ipswich, Australia

Improving Clinical Governance is a feature of many hospital Patient Safety and Quality strategies in Australia. This paper outlines the principles and processes involved in revitalising clinical governance at the Medical Imaging Department of Ipswich Hospital. Improvements included:

• Setting up a multidisciplinary Patient Quality and Safety Meeting

• Development of Key Performance Indicators and assessing and rationalising audit processes

• Developing a Patient Quality and Safety strategic plan

• Developing processes for clinical review for reported patient safety incidences

• Connecting Patient Quality and Safety with Radiation Incidence reporting

The approaches to Patient Quality and Safety taken by the Operating Theatre community will be reviewed, and they have much to teach the Medical Imaging community, including a multi‐disciplinary approach, no‐blame culture and standardised meeting formats.

Can you make a silk purse out of a sow's ear?

Deborah White¹, Jill Becker², Penny Knapp², Sylwia Zawlodzka‐Bednarz²

¹Princess Alexandra Hospital, Brisbane, Australia²Radiation Oncology – Mater Centre, Brisbane, Australia

Introduction: Need an IT solution? Funding and time poor? Can you support another system? Are you fully utilising your current software?

This is a review of a recent project to transform the current error reporting system at Radiation Oncology – Mater Centre. The existing system had reached its end of life, any modifications were time consuming and limited support was available.

MOSAIQ^® was widely utilised within the department, readily accessible, familiar to use and could be adapted to fit the requirements of the department. Mosaiq appeared the logical choice.

Methods: Having determined key drivers and stakeholders, we proceeded to define the scope of the project.

Once this was peer reviewed by a larger forum; assessments, QCLs, IQ scripts and reporting tools where built. Testing was undertaken in parallel to the existing system.

Results: While minor amendments where required to the initial set‐up, testing produced expected results.

Conclusion: Building the system in MOSAIQ^® did not require specialist knowledge (outside of IQ scripts/assessments/QCLs) and therefore is a sustainable long term solution.

It is not dependent on any software outside of MOSAIQ^®.

Entries are attached to the patient record and information is stored within the MOSAIQ^® database.

Training needs are much simpler due to staff being familiar with MOSAIQ^® and the workflows used.

Notification of events is much clearer and can be attached to work lists.

Reporting and access to recorded data is MUCH improved.

This methodology can be applied to other software packages.

Perspectives on care in medical radiation science

Clinton Heal

melanomaWA, Perth, WA, Australia

Each day, those working in the Medical Radiation Science sector have an opportunity – to make a positive impact on the people that are under their care.

Very often its not easy, a difficult diagnosis, emergency and urgent presentations which can impact on what we define as being a positive impact on patient care.

In 2005, Clinton Heal was diagnosed with melanoma at the age of 22 years. Since that time, he has experienced care as a patient in surgery, radiation therapy, radiology, chemotherapy and immunotherapy. His experiences of receiving care have coincided with his work providing care as a radiographer and CT specialist. This intersection of perspectives as both provider and receiver of patient care, coupled with Clinton's determination and resilience, has seen him emerge as a leading advocate for melanoma awareness, information and support services.

It is with this history as a Medical Radiation Science practitioner, patient and advocate of those touched by cancer that this perspective on care in Medical Radiation Science has been reached – That those working in the Medical Radiation Science sector, by understanding the case in front of them can tool themselves up with strategies to not only get the best technical results for the person as possible but also have them leaving with a positive impact of care.

This presentation will challenge us to consider our own practice from the perspective of the people in our care, as well as the opportunity to assess where we as individuals sit on the reactive – proactive health spectrum.

Dosimetry in interventional radiology: optimization of procedure for dose reduction

Anatoly Rozenfeld¹, N. Thorpe¹, D. Cutajar¹, M. Petasecca¹, M.J. Safari², J.H.D. Wong², K.A.A. Kadir², K.H. Ng², D. Robaei³, M. Pitney³

¹Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia²Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Malaysia³Eastern Heart Clinic, Randwick, Australia

Interventional procedures result in the highest radiation exposure of any clinical imaging procedure, where patients and operators are susceptible to deterministic and stochastic risks. Exposure may result in skin damage, ranging from radio‐dermatitis to erythema and ulceration in extreme cases of local overexposure. Radiation induced conditions can arise from damage to radio‐sensitive organs, including the eyes and brain. Current dose estimation methods cannot accurately predict organ doses and points of local overexposure. Direct measurement of the entrance dose is a necessity to reduce clinical exposure and ensure patient quality of life.

The MOSkin is a solid state dosimeter developed at the Centre for Medical Radiation Physics (CMRP). The dosimeter measures the dose delivered to a tissue‐equivalent measurement depth of 0.07 mm (Hp(0.07)), can perform readout in real‐time and is radio‐translucent to diagnostic beams. The MOSkin has been calibrated to clinical beam qualities and compared to commercially used dosimeters including thermoluminescent dosimeters and film. The MOSkin is a useful tool for improving machine quality assurance, assessing in vivo and real‐time patient doses, managing patient exposure and reducing the incidence of radiation induced injury in the catheterisation laboratory.

By using the MOSkin dosimetry system in conjunction with anthropomorphic and image quality phantoms, we have been able to measure patient eye lens doses during neuro‐interventional procedures, as well as perform studies comparing different machine protocols and clinical settings. This has allowed for the development of clinically relevant dose optimisation strategies, allowing the clinicians to perform low dose procedures while conserving image quality during imaging.

By using the MOSkin dosimetry system in conjunction with anthropomorphic and image quality phantoms, we have been able to measure the patient's eye lens dose during neuro‐interventional procedures, as well as perform studies comparing different machine protocols and clinical settings. This has allowed for the development of clinically relevant dose optimisation strategies, allowing the clinicians to perform low dose procedures whilst conserving image quality.

References

1. M.J. Safari, J.H.D. Wong, K.A. A. Kadir et al “Real‐time dose monitoring of patient's eye lens during cerebral angiography procedures”, European Journal of Radiology, 2016; 26: 79–86.

2. N.K. Thorpe, D. Cutajar, C. Lian, A. Rosenfeld “A comparison of entrance skin dose delivered by clinical angiographic c‐arms using the real‐time dosimeter: the MOSkin”, Australas. Phys. Eng. Sci. Med 2016; 39: 423–430.

Medical imaging dose alert – from inception to completion

Janine Hearn

Cabrini Health, Melbourne, Australia

Purpose:

• To identify patients who have received a clinically significant interventional fluoroscopic radiation dose.

• To initiate post procedure skin assessment and review to enable early intervention for wound management and treatment of potential skin erythema or radiation irritation.

Background: All interventional and general fluoroscopy doses are monitored and documented in a log book noting fluoroscopy time, Dose Area Product (DAP) and accumulated dose at the end of each case.

Radiographers are trained to adhere to the As Low as Reasonably Achievable (ALARA) principle whereby the dose of a procedure should not exceed the relevant Diagnostic Reference Level (DRL).

In Interventional Fluoroscopy the radiation beam is typically directed to a relatively small area of skin for a substantial length of time. The highest doses have been reported most frequently as a result of Percutaneous Coronary Interventions (PCIs).¹

Radiation exposure to the skin may result in early transient erythema at a threshold dose of 2 Gy and temporary hair loss at 3 Gy.²

Results:

• At the Threshold dose of 2.5 Gy (2500 mGy), a verbal dose alert will be given by the MIT to the Cardiologist/Interventionist.

• At 3 Gy and every 1 Gy thereafter, a subsequent verbal dose alert will be given by the MIT to the Cardiologist/Interventionist.

• If the dose received is ≥ 5 Gy the patient will receive a copy of the ‘Medical Imaging Patient Information‐ Radiation Exposure’ document and record site of potential skin irritation (erythema).

References

1. Koenig TR et al. Skin injuries from fluoroscopically guided procedures: part 1, characteristics of radiation injury. AJR Am J Roentgenol. 2001 Jul;177(1):3–11. http://www.ajronline.org/doi/full/10.21_214/ajr.177.1.1770003.

2. Wagner LK. Radiation injury is a potentially serious complication to fluoroscopically guided complex interventions. Biomedical Imaging and Intervention Journal: http://www.biij.org/2007/2/e22.

3. Mandatory Reporting of Radiation Incidents. Management licence holder's obligations. Radiation Act 2005. Site accessed January 2015.

Predictive value of CTA for lower GI bleeding prior to angiographic embolisation

Gillian Bruce, Brendan Erskine

The Alfred, Melbourne, Australia

Objective: In patients with suspected lower GI bleeding, investigate the value of CTA for predicting angiographically bleeding prior to embolisation.

Investigate the effect of time delay between CTA and angiography and the type of CT scanner employed has on the diagnostic angiographic yield.

Methods: 9 year retrospective analysis (current data collated for 6 years, will be updated to 9 years) of all patients suspected of lower GI bleeding who progressed to angiography following CTA. *Time delay limited to 24 h between modalities.

Results: 78 patients proceeded to angiography follwing CTA. 72 of those patients were positive for lower GI bleeding on CT. Of the 6 patients that proceeded to angiography following a negative CT only one of those patients demonstrated positive angiographic bleeding (16%)

Of the 72 patients that demonstrated bleeding on CT, 65% (n47) were positive for bleeding on angiography.

There was no significant correlation between the scanner used (16 vs. 64 slice) and the predictive value of CT. (60% vs. 66%)

The angiographic yield improved significantly as the delay following CT reduced. Delays less than 2 h resulted in 92.85% angiographic yield.

91.48% (n43) of the patients who demonstrated demonstrated angiographic bleeding were successfully embolised.

Conclusion: The angiographic demonstration of lower gi bleeding shows high dependence with time delay following positive CT angiography. When performed under 2 h following positive CT, the diagnostic yield increased from 65% to above 92%.

References

1. Foley PT, Ganeshan A, Anthony S, Uberoi R. Multi‐detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?. Journal of medical imaging and radiation oncology 2010;54: 9–16.

2. Sun H, Jin Z, Li X, Qian J, Yu J, Zhu F, Zhu H. Detection and localization of active gastrointestinal bleeding with multidetector row computed tomography angiography: a 5‐year prospective study in one medical center. Journal of clinical gastroenterology 2012;46: 31–41.

3. Ramaswamy RS, Choi HW, Mouser HC, Narsinh KH, McCammack KC, Treesit T, Kinney TB. Role of interventional radiology in the management of acute gastrointestinal bleeding. World journal of radiology 2014; 6: 82.

4. Kennedy DW, Laing CJ, Tseng LH, Rosenblum DI, Tamarkin SW. Detection of active gastrointestinal hemorrhage with CT angiography: a 4½‐year retrospective review. Journal of Vascular and Interventional Radiology. 2010; 21: 848–55.

5. Annamalai G, Masson N, Robertson I. Acute gastrointestinal haemorrhage: investigation and treatment. Imaging 2014.

6. Tan KK, Shore T, Strong DH, Ahmad MR, Waugh RC, Young CJ. Factors predictive for a positive invasive mesenteric angiogram following a positive CT angiogram in patients with acute lower gastrointestinal haemorrhage. International journal of colorectal disease. 2013; 28: 1715–9.

Angiographic imaging of chronic thrombo‐embolic pulmonary hypertension

Brendan Erskine

The Alfred, Melbourne, Australia

Chronic thromboembolic pulmonary hypertension (CTEPH) is a condition resulting from the chronic accumulation of pulmonary emboli. Previously there were limited treatment options available to patients who suffered this debilitating condition. 2 years ago a surgical option, pulmonary endarterectomy, was offered at our institution. Due to a relatively high mortality rate, patients are only selected for surgical procedures given they pass strict inclusion criteria. Most literature has focused on a combination of ventilation/perfusion (VQ) and CT angiography in the workup for surgical inclusion. At our practice the choice was to include catheter pulmonary angiography in addition to ventilation perfusion (VQ) and right heart/pulmonary arterial pressures measurements. We describe 45 patients who have undergone digital subtraction pulmonary angiography in the workup of pulmonary endarterectomy. Focus of this presentation is primarily on the angiographic technique required to optimally image this condition.

References

1. Wirth G, et al. “Chronic thromboembolic pulmonary hypertension (CTEPH)–potential role of multidetector‐row CT (MD‐CT) and MR imaging in the diagnosis and differential diagnosis of the disease.” RöFo‐Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. Vol. 186. No. 08. © Georg Thieme Verlag KG, 2014.

2. Reichelt, Angela, et al. “Chronic thromboembolic pulmonary hypertension: evaluation with 64‐detector row CT versus digital substraction angiography.” European journal of radiology 71.1 (2009): 49–54.

3. Shrikanthan, Sankaran, et al. “Utility of Lung Ventilation‐Perfusion SPECT/CT scan in Chronic Thromboembolic Pulmonary Hypertension.” Journal of Nuclear Medicine 56.supplement 3 (2015): 1720–1720.

4. Fukuda, Tetsuya, et al. “Evaluation of organized thrombus in distal pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension using cone‐beam computed tomography.” Japanese journal of radiology (2016): 1–9.

Local diagnostic reference levels for fluoroscopic procedures: how does the PAH compare?

Nicole Flood

Princess Alexandra Hospital, Brisbane, Australia

Objectives: As Australia is lacking National Diagnostic Reference Levels for fluoroscopic procedures, local benchmarks need to be determined to establish a means of patient dose auditing.¹ The purpose of this project is to determine Facility Diagnostic Reference Levels (FRLs) for Fluoroscopic Barium Swallows and Peripherally Inserted Central Catheter (PICC) insertions at a large, Metropolitan Australian Hospital.

Methods: Data documented for Barium Swallows and PICC Insertions were collected from four X‐ray rooms between January 2014 and June 2016. Data collected included Dose Area Product (DAP); Fluoroscopic screening time; and Skin surface entrance dose. FRLs were set from the 75th percentile of the DAPs.²

Results: 1339 Barium Swallows were collected and were found to have a median fluoroscopic screening time of 1.8 min, a median skin surface entrance dose of 8 mGy, a median Dose Area Product of 122uGym2 yielding a FRL of 333 uGym2. Of 3168 PICC Insertions, the median screening time was 0.07 min, the median skin surface entrance dose was 2 mGy, the median Dose Area Product was 59uGm2 and the FRL was calculated as 141uGym2.

Conclusion: FRLs were calculated for Barium Swallows and PICC Insertions within the Princess Alexandra Hospital which can contribute to Queensland wide investigations in developing Local DRLs and eventually National DRLs. From this model, FRLs can be calculated for other diagnostic and interventional fluoroscopic and angiographic procedures. The establishment of Diagnostic Reference Levels will assist radiographers in identifying high dose procedures and allow them to employ dose mitigation strategies.

References

1. Crowhurst J, Whitby M, Thiele D, Halligan T, Westerink A, Crown S, Milne J. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi‐centre diagnostic reference level in Queensland public Hospitals. Journal of Medical Radiation Sciences 2014; 61:135–141.

2. Erskine B, Brady Z, Marshall E. Local diagnostic reference levels for angiographic and fluoroscopic procedures: Australian practice. Australasian College of Physical Scientists and Engineers in Medicine 2014; 37:75–82.

A retrospective dosimetric study of radiotherapy patients with left‐sided breast cancer; benefits of the deep inspiration breath hold

Eva Bezak, Eileen Giles, Amy De Smit, Mikaela Dell'Oro

University of South Australia, Adelaide, Australia

Objectives: Many studies report the cardiac dose reduction benefit of the deep inspiration breath hold (DIBH) technique for radiotherapy of the left breast. There is, however, little literature recommending selection criteria for those patients who would receive the most benefit. The objective of this retrospective study is to identify clinical characteristics that identify optimal candidates for undergoing DIBH.

Methods: A dosimetric comparison is being performed on the available retrospective data of 20 patients who underwent both free breathing and DIBH planning CT scans. A correlation between the significance of dose reduction and clinical factors will be analysed to form the basis for selection criteria. Specifically, a range of dose‐volume measurements, obtained from treatment plans, will be compared and related to the size, shape and anatomical variation of the breast tissue (e.g. cardiac contact distance), patient weight and multimodality treatment notes.

Results: A paired t‐test will be performed to compare dose distributions between plans, eliminating the variability that would be present if the samples were from different patients. The data will be tabulated and plotted using linear models to identify the dosimetric benefit and to develop selection criteria. The plan evaluation will form the preliminary results of the study to be presented.

Conclusion: It is envisaged that this study will recommend selection criteria based on predicting which patients would show the most clinical benefit from the DIBH technique. This is important in minimising the distress patients experience when undergoing breast cancer radiotherapy, as DIBH may be unnecessarily recommended with little dosimetric benefit.

Evaluating organ motion in radiotherapy using abdominal compression

A Podreka, R van Gelder, A Le, S Wong, A Kneebone, C Haddad, G Hruby, N Hardcastle

Northern Sydney Cancer Centre, St Leonards, Australia

Objectives: The outcome of radiotherapy for cancer relies on accuracy of treatment delivery. Abdominal structures can be strongly influenced by respiratory motion. One method of minimising respiratory motion during radiotherapy is abdominal compression (AC).^1–3

Method: Fourteen patients treated for radiotherapy to upper gastrointestinal tumours were included in this ethics approved retrospective study. Each patient underwent two four‐dimensional computerised tomography (4D‐CT) scans, one with and one without AC. The liver dome and superior poles of the kidneys were used to indicate differences in organ motion on the two 4DCT scans. Measurements were taken at the peak inspiratory and expiratory phases of the breathing cycle.

Results: The mean ± standard deviation (SD) of the longitudinal motion amplitude with AC of the right kidney was 0.42 cm ± 0.11 cm and was considered beneficial in six patients. The left kidney amplitude was 0.36 cm ± 0.16 cm, and beneficial to four patients, while the liver moved 1.03 cm ± 1.12 cm in the superior/inferior plane, which benefitted four patients. No significant motion was seen in the anterior/posterior plane or the left/right plane of the liver.

Conclusion: AC was effective in reducing longitudinal motion, but was negligible or detrimental to more patients than it benefitted. These differences were possibly due to patient tolerance of the compression, location of the compression belt, patient circumference and patient body fat. The method was discontinued in our department. In spite of this, the differences in motion amplitude ranging from 0.2 cm to 2 cm in some patients require further investigation to minimise respiratory motion.

References

1. Eccles C, Dawson L, Moseley J, Brock K. Intrafraction liver shape variability and impact on GTV position during liver stereotactic radiotherapy using abdominal compression. Int J Radiation Oncology Biol Phys 2011; 80: 938–946.

2. Heinzerling J, Anderson J, Papiez L, et al. Four‐dimensional computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver. Int J Radiation Oncology Bio Phys 2008; 70: 1571–1578.

3. Wunderink W, Romero M, De Kruijf W, et al. Reduction of respiratory liver tumour motion by abdominal compression in stereotactic body frame, analyzed by tracking fiducial markers implanted in liver. Int J Radiation Oncology Biol Phys 71: 907–915.

Clinical implementation of VMAT for non‐small cell lung cancer: implications for the moving target

Rhonda Lawrence, Brent Chesson, Jenny Lydon, Catherine Lawford, Mark Burns, Shankar Siva

Peter Maccallum Cancer Centre, Melbourne, Australia

Introduction: Radiotherapy plays an integral role in the management of non‐small‐cell‐lung‐cancer (NSCLC). Whilst the benefits of highly modulated techniques such as IMRT/VMAT are well reported, their introduction for use in NSCLC has been met with caution at our institution due to the inherent risks associated with irradiating mobile targets. NSCLC radiotherapy is a complex matrix of imaging, tumour /OAR delineation, treatment planning, quality assurance. The aim of this presentation is to articulate our clinical experience in developing a NSCLC‐VMAT program, and significant risk‐mitigating steps to enable the safe implementation of this complex, multidisciplinary technique.

Discussion: Five patients were planned to confirm the anticipated dosimetric benefit of VMAT for NSCLC. Such benefits have been previously reported. However, it is the complementary steps to treatment planning that require careful consideration when initiating a lung VMAT program. Appropriate imaging, allowing functional (PET) and anatomical (CT) target delineation, is a critical first step. Tumour localisation must also incorporate motion management strategies, to ensure precision delineation complements VMAT's high conformity and modulation. Patient movement, treatment planning system MLC position/modelling, and subsequent translation to treatment delivery must also be considered. In particular, in instances of significant respiratory motion and high plan modulation commonly seen in VMAT.

Conclusion: Many believe that 3DCRT‐ whilst of inferior dosimetric quality to VMAT‐ provides superior agreement between planned and delivered dose. However, with careful consideration of key processes, the dosimetric benefits of VMAT can be exploited in suitable NSCLC cases. These considerations will form the key focus of this presentation.

Filling up on quality ‐ the implementation of a bladder VMAT program in a regional department

Kathleene Dower, Andriana Ford, Luke Kerin

Northern Nsw Cancer Institute, Lismore, Australia

Introduction: Implementation of a VMAT program for bladder cancer patients at the Northern NSW/Mid‐North Coast Cancer Institute.

Objectives/Aims: A workgroup was established to work in a consultancy role to implement a Bladder IMRT program and address associated complex issues to benefit bladder cancer patients treated within the organization.

Description/Methodology: Implementation of a contemporary program for our bladder cancer patients was undertaken via research through extensive literature reviews, analysis of comparative VMAT and IMRT dosimetric plans, current protocol and practice review and consultation with key internal stakeholders and external departments.

Results: Tangible evidence through literature reviews, in‐house analysis of the dosimetric advantages and treatment time savings showed that VMAT was the optimal radiation therapy choice for future bladder cancer patients within NNSWCI/MNCCI. The treatment time savings of VMAT is of particular importance for Bladder cancer patients, where intra‐fractional bladder filling may impact on their treatment outcomes. Other issues, such as retention, soft tissue imaging and patient education / compliance were also identified throughout the process and measures undertaken to ensure a holistic program was implemented.

Conclusion: Bladder VMAT was successfully implemented within our organisation improving quality of treatments for this patient cohort.

Future areas of research include:

• Off‐line analysis of Cone Beam CT data to formulate margin reductions to decrease small bowel dose

• The possibility of a future Adaptive Bladder VMAT program to address retention, should it occur

• Investigation into improved soft tissue imaging protocols for GTV visualisation.

Implementation of ultrasound‐guided intrafraction monitoring and correction in prostate cancer treatments at Townville Cancer Centre

Amy Brown¹, Bronwyn Shirley¹, Wilfred Angkawijaya¹, Christine Albantow¹, Alex Tan^1,2

¹Townsville Cancer Centre, Townsville, Australia²James Cook University, Townsville, Australia

Objectives: To implement intrafraction monitoring and correction using the Clarity 4D Autoscan transperineal ultrasound (TPUS) system in prostate radiotherapy at Townsville Cancer Centre (TCC), and evaluate in the first 10 clinical patients.

Methods: Clarity 4D was installed at TCC in June 2016, with 1 week of specialist training and first clinical use in August 2016. Patients treated during implementation had gold seed fiducial markers and daily cone beam computed tomography (CBCT) as per department protocol, for comparison to the TPUS acquired with Clarity 4D. Tolerances for beam interruption and isocentre correction were 10 mm isotropic except for 5 mm posteriorly, based on planning margins. Monitoring data of the first 10 clinical patients was evaluated and differences between US and CBCT assessed.

Results: Between August and October 2016, 10 patients commenced treatment with Clarity 4D. Of the 206 fractions analysed, 3 required interruption, and of those, 2 required isocentre correction. The mean vector difference across all patients between the CBCT and TPUS was 6.2 mm (0.4–17.3; SD 3.1). Intra‐patient mean vectors however varied from 3.6 mm (SD 1.1) and 7.5 mm (SD 3.4), with an improvement in vectors observed over time.

Conclusion: Clarity 4D has been successfully implemented at the TCC, thus allowing intrafraction correction in prostate radiotherapy. Intrafraction motion requiring correction at current tolerances has been minimal. Further analysis into the differences between CBCT and TPUS is warranted.

Disclosure: Elekta Ltd. has provided the Clarity 4D system to TCC in a loan agreement.

Reaching across the great divide: incorporating peer review to bridge the theory‐practice gap

Julie Burbery, Crispen Chamunyonga

Queensland University of Technology, Brisbane, Australia

Objectives: To establish how peer review can be integrated into the undergraduate teaching program at the Queensland University of Technology. Peer review programs are used to facilitate decision‐making in clinical radiation therapy planning, however, there is a paucity of evidence on its use in undergraduate radiation therapy training.

Methods: An evidenced‐based approach was used to embed systematic peer review elements into the treatment planning practical sessions to exploit its pedagogical as well as clinical benefits.

Results: Evidence highlights the feasibility of embedding peer review of treatment plans in radiation therapy training. Consistent with the current results from peer review of treatment plans in clinical practice; peer review skills have the potential to improve students’ knowledge of organ‐at‐risk contouring and treatment plan evaluation skills for undergraduate students that can be easily transferred to clinical practice. Several pedagogical benefits such as improved communication skills, provision of synchronous and asynchronous feedback can positively impact student success and future employment. However, proper implementation strategies are required to address logistical concerns as well as learning and teaching design principles.

Conclusion: It is anticipated that peer review will work synergistically with emerging teaching and learning innovations to engage the students as well as impart clinical knowledge.

Mid‐ventilation vs maximum intensity projection: retrospective comparison of 4DCT reconstructions for lung SABR treatment planning

Josephine Cannon

Royal Brisbane and Women's Hospital, Brisbane, Australia

Objectives: Mid‐Ventilation frame (MidV) of a 4DCT dataset represents the time‐weighted mean position of a tumour during the patient's respiratory cycle. Literature states that MidV based PTVs typically lead to smaller treatment volumes, by up to 50%, whilst still maintaining optimal dose coverage.¹ The aim of this study was to determine whether the use of a PTV generated from a MidV reconstruction reduces the PTV volume compared to a PTV generated from a Maximum Intensity Projection (MIP) reconstruction, current standard practice for 4DCT.

Methods: A retrospective analysis of 4DCT datasets from 8 SABR lung patients previously treated at Royal Brisbane and Women's Hospital (RBWH) was undertaken.

For each patient a MidV dataset utilising MiM Maestro software was produced. A 5 mm PTV margin was applied to the MidV and MIP GTV volumes (current RBWH MIP PTV margin for lung SABR). The physical volume of each PTV was determined using the volume tools in MiM Maetsro.

Results: The comparison demonstrated an average 28.4% reduction of the PTV volume when using the MidV dataset when compared to the MIP.

Conclusion: The results of this retrospective comparison study between MidV and MIP derived PTVs for planning of lung SABR patients has indicated that treatment volumes are reduced if derived from the MidV dataset. Further investigation is required to determine an accurate method of deriving an appropriate PTV margin to apply to MidV GTVs.

References

1. Wolthaus J, Schneider C, Sonke J. et al. Mid‐ventilation CT scan construction from four‐dimensional respiration‐correlated CT scans for radiotherapy planning of lung cancer patients. Int J Radiat Oncol Biol Phys 2006; 65: 1560–1571.

The implementation of research findings into evidence based practice within diagnostic radiography in Australia

Laura Di Michele, Warren Reed, Belinda Kenny, Mark McEntee

University of Sydney/Breast Cancer Institute, Westmead, Sydney, Australia

Practice within diagnostic radiography should be modelled upon evidence.¹ Radiographers need to reach beyond the current model of practice and strive for continual improvement; as such it is imperative that radiographers implement current research into their everyday practice in order to ensure that their patients receive the best possible outcome. Critical appraisal of studies examining change management and research translation in diagnostic radiography will be examined in order to determine whether a suitable model for research translation can be identified.

Objectives: This review aims to identify and synthesise all published change management models within diagnostic radiography.

Methods: A systematic review was conducted of studies found in MEDLINE, CHINAL, SCOPUS, WEB OF SCIENCE and EMBASE. Search terms fell under three main groupings, cohort terms, terms relating to evidence based practice and terms relating to change management and research translation.

Results: Findings will highlight the number and nature of change management models applicable to research translation in diagnostic radiography. These findings will be used to determine the current evidence and assess any current gaps in the literature.

Conclusion: The findings of this literature review will benefit radiographers and radiography managers by assisting translation of research to evidence based practice.

References

1. Trinder L, Reynolds S. Evidence‐based practice: a critical appraisal. Malden, Mass;Oxford;: Blackwell Science; 2000.

Medical imaging in musculoskeletal and diabetes research

Kathryn Squibb

University of Tasmania, Hobart, Australia

At the Menzies Institute for Medical Research at the University of Tasmania a number of research projects are underway that use medical imaging technology and techniques. This presentation will outline how medical imaging professionals, together with researchers, are employing the imaging modalities of ultrasound, dual energy x‐ray absorptiometry and High Resolution peripheral Quantitative Computed Tomography (HRpQCT) in the investigation of diabetes and musculoskeletal diseases.

Currently, for example, a diabetes family history study is measuring brachial artery blood flow using Doppler ultrasound and forearm muscle microvasculature using contrast enhanced ultrasound. This same project is using dual energy x‐ray absorptiometry to measure body composition pre and post a 6‐week resistance training program. A study exploring plantar heel pain is using ultrasound to measure the plantar fascia and HRpQCT to examine the microarchitecture of the plantar and Achilles entheses of the calcaneum. A hand osteoarthritis study is utilising ultrasound to examine soft tissue and bony changes in hand joints and HRpQCT to examine subchondral microarchitectural bone changes in selected finger joints.

Whilst these are only a few examples, interprofessional research collaboration provides an avenue for imaging professionals to develop their own research capacity and support a research culture within the profession. Excellent opportunities exist for radiographers and sonographers to become directly involved in research, plying their imaging knowledge and skills to investigate a range of interesting research topics.

Digital radiography chest imaging: pathologies & best practice

Richard Mansfield^1,2

¹Barwon Health, Geelong, Australia²Deakin University, Geelong, Australia

With the implementation of new Radiographic technologies comes the obvious advantages of time efficiency, increased image quality and patient satisfaction. However, it is also important to update the skills of the Radiographer to accommodate these recent advances in technologies.

I will present 9 cases from The University Hospital Geelong's digital archiving system¹ which each serve two purposes: a refresher on some common and not so common pathologies & a comment on some best practices that can be employed by the Radiographer to ensure they are getting the most out of the latest technologies that are now available for use. All of the cases have accompanying correlating images (CT, PET CT Fusion, MRI, Ultrasound) to help the Radiographer identify the pathologies and use for a reference in the future.

Some of the pathologies covered are (but not limited to): tension pneumothorax, chronic obstructive pulmonary disease, pericardial effusion, hamartoma, sarcoid, mycobacterium tuberculosis & carcinogenic mass (Figure 1.1). Some of the best practice scenarios are (but not limited to): changing algorithm for clear delineation of pathologies, when to perform a lateral chest radiograph, appropriate use of AEC, grid suppression techniques, etcetera.

Live audience participation is also intended, with an audience response system implemented² that will be supplied to the audience by the presenter, for a truly interactive experience. This will provide live feedback to the audience for the identification of the correct pathology.

Supporting documents:

References

1. The University Hospital Geelong PACS, Synapse.

2. Audience response system to be supplied by Barwon Health.

Radiotherapy in Vietnam – Lessons learnt, redefining my approach

Vu Huynh

Hoc Mai Medical Foundation, The University of Sydney, Sydney, Australia

Developing countries face many different challenges to addressing healthcare. For Vietnam cancer is a leading cause of death resulting in overburdened hospitals running up to 5 times over capacity. To cope, machines and staff are overworked trying to keep up with the endless queues of patients, providing treatment all throughout the day and night. In response, Vietnam has steadily been increasing the numbers of radiotherapy machines throughout the country since the first one was installed in 2001, but this has still been nowhere near enough.

In 2010 I become involved with developing radiotherapy in Vietnam and soon came to realise that I would need to rethink my approach. Simply applying a blue print from the skills I had learnt in Australia would definitely not work. In order to have any chance of being effective, I would have to try and let go of and be willing to redefine some of my most basic perceptions and assumptions.

The relationship between clinical competency and OSCE results in a medical imaging student cohort

James Bainbridge

Deakin University, Geelong, Australia

Objectives: Since ASMMIRT 2016, the Medical Imaging Degree course at Deakin University has conducted another set of Objective Structured Clinical Examinations (OSCE's). Data collection will now examine results from the 2016 1st & 2nd Year student cohorts, in addition to existing data from 2015. There will be approximately three times the data to examine, compared to previously.

Method: By comparing anonymised OSCE results in relation to student Clinical Placement Skill Assessment (conducted at multiple sites), it will be demonstrated with a larger data set the correlation will strengthen.

Results: Whilst the assessment in the Clinical Learning environment is necessary to determine the effectiveness of learning, supervisors complain of the complexity of the task, as every university has their own assessment model. If a correlation can be found in this study, then there is the argument that our clinical partners can act in an enhanced role as educators, and less as assessors for Medical Imaging students.

Conclusion: Given the rigorous assessment students undergo via OSCEs, and the alignment of examinations to MRPBA capability framework, with an increasing data set, more positive correlation between OSCE results and Clinical Skills Assessments undertaken on placement, is becoming evident.

We wish to create valuable use of the precious time the student spends on clinical placement and create an opportunity for constructive learning, so that the educator may have a more honest and rounded perspective of the clinical abilities of the student, and not the focus on high stakes assessment tasks, as presently is the case.

Reflective practice and its role in professional identity development in undergraduate radiation therapy students

Mary‐Ann Carmichael¹, Kelly Wilson‐Stewart²

¹RMIT, Melbourne, Australia²QUT, Brisbane, Australia

Objectives: The ability to critically reflect on strengths and development needs is essential to the development of an undergraduate radiation therapy student. This does require some degree of self‐awareness. Most students start at a superficial level of reflection, and to progress beyond this students need to understand the importance of reflective practice to their professional development. Teaching of reflective practice and regular reflection with detailed personal feedback assists with the progression from superficial to critical reflection. Detailed feedback on student reflective journals was introduced to assist with this process. To determine its effectiveness, an evaluation of this process was conducted.

Methods and Materials: This mixed methods study utilised a Survey method to gather student feedback via an anonymous questionnaire comprising a combination of Likert‐type scales and open questions. The survey aimed to identify the specific value of reflective practice to student professional development. HOW MANY students from WHAT years were approached via email and invited to participate. Ethical approval for the project was provided by the University Human Research Ethics Committee. A grounded theory approach established themes from coding and collation of open question responses while Likert data were subjected to descriptive analysis and utilised for triangulation.

Results: At the time of abstract submission data analysis is still at the coding stage and this paper will present a full analysis of data collated.

Conclusions: Preliminary results indicate that students understand the value of reflective practice to their learning and development, although they do not necessarily enjoy the process.

A Wiki: an innovative approach to teaching radiation therapy and oncology in New Zealand

Gay Dungey

University of Otago, Wellington, New Zealand

Objectives: The literature suggests the use of a Wiki has great potential as an educational tool for both lecturers and students because they encourage collaborative learning and resource sharing. In 2015 the ‘Otago Wiki’ platform was introduced as a learning tool as a part of the Radiation Therapy and Oncology I course. This pilot study aimed to evaluate the student experience of using the Wikis as a learning tool in the first year of the Bachelor of Radiation Therapy.

Methods: The first year radiation therapy students were allocated into small groups. Utilising the ‘Otago Wiki’ tool each group created their own Wiki page by addressing assigned tasks that related to a hypothetical patient.

Results: At the end of the year all students were invited to participate in an online Survey Monkey questionnaire which 23/26 students completed. Three main themes emerged from the data and were identified as: the value of learning in small groups; understanding the patient experience; and the value of signposting. Students indicated the Wiki allowed discussion of ideas that group members contributed which improved their overall understanding of the patient experience and personal knowledge, by understanding other people's viewpoints.

Conclusion: Overall the Wiki was a positive learning experience for most students. Despite some students not engaging in the group work, learning in assigned groups was perceived by most students as valuable. With more signposting and some refinement the Wiki as a teaching tool will remain in the programme in the future.

Development of instructionally designed e‐learning modules that enhance reflective practice and interdisciplinary/cross‐disciplinary learning

Renee Mineo

RMIT University, Melbourne, Australia

Outline: The key objective of this project is to develop instructionally designed e‐learning modules based on patient case studies, that integrate Pathology, Anatomy and Radiology courseware to enhance the reflective practice and interdisciplinary/cross‐disciplinary learning.

By the end of their studies, the students’ professional discipline influences what is known and valued, while the relevance of the academic disciplines is unclear due to lack of engagement, reflection and application in a practice based context.

The modules will promote reflective practice by revisiting anatomy and radiology, enabling deep rather than surface learning, and transferring information to long‐term memory and into work practice. There is also strong evidence that instructionally designed e‐learning modules are more flexible in addressing the divergent range of learning styles in students and have proved to be 30% more engaging than face‐to‐face delivery.^1,2

Methods and Materials: Post‐delivery data will be collected with regards to student engagement using an anonymous questionnaire and focus group session in order to collect students’ feedback regarding the developed e‐modules. Student written questionnaires will be comprised of a mixture of Likert based responses and open ended questions that will be used to elicit the perceived benefits of this interdisciplinary/cross‐disciplinary learning and reflective practice.

Results and conclusion: At the time of abstract submission, phase 2 of the project (e‐ module delivery) is underway. Post‐delivery of the e modules data will be collected with regards to student engagement, interdisciplinary/cross‐disciplinary learning and reflective practice by means of student surveys, focus group discussions and the course experience survey.

References

1. Maley M, Harvey J, Boer W, Scott N, Arena G (2008). Addressing current problems in teaching Pathology to medical students: blended learning. Med Teach 30: e1–e9.

2. Dziuban CD, Hartman JL, Moskal PD (2004). Blended Learning. Research Bulletin – Educause Centre for Applied Research. Volume 7.