The Trans‐Tasman 3D printing experience
Christine Albantow,1 Savannah Brown2
1 The Crown Princess Mary Cancer Centre, Westmead, Australia
2 Townsville Cancer Centre, Townsville, Australia
Introduction: A cross‐sectional survey was conducted to collect data from Australian and New Zealand radiotherapy departments to establish a baseline for 3D printer ownership and 3D printed product use.
Methods: All Antipodean departments were contacted by phone to establish 3D printed product use and determine the most appropriate person to answer the survey. An email containing a Microsoft Forms link to a survey was sent to the knowledge expert in eligible departments. The survey contained 47 questions in relation to how 3D printed products were being utilised and specific questions regarding ownership of a 3D printer. The data was uploaded to Microsoft Excel and descriptive statistics were performed.
Results: 112 departments were initially contacted, with 22.3% reporting 3D printer ownership, and 33.3% of Australian departments choosing to outsource 3D printed product. The primary use of 3D printers was bolus production (60.9%). Public departments represent 84% of printer ownership, while private departments are the greatest users of outsourced 3D printed product (91.4%). 3D Slicer is the most common software used for digital imaging and communications in medicine file conversion (42.3%), while polylactic acid and acrylonitrile butadiene styrene are the most common filaments in use, 46% and 14%, respectively.
Conclusion: This research established a baseline for 3D printer and product use within Australian and New Zealand radiotherapy departments. The knowledge gained from this analysis can inform departments in the decision‐making process for future 3D printer acquisition and implementation.
A tale of two reviews
Edel Doyle1,2,3
1 Lumus Imaging, Melbourne, Australia
2 Monash University, Melbourne, Australia
3 ANZ Branch, International Association of Forensic Radiographers, Melbourne, Australia
Background: An empty systematised literature review was performed.1 However, it was rejected by the first journal it was submitted to because it was “not of interest” to their readers. The scope was widened to undertake a systematic review.
Objective: The aim of the literature reviews was to establish the evidence base regarding the use of low‐dose CT in the investigation of non‐accidental injury or suspected physical abuse.
Methods: Literature searches were performed in accordance with the PRISMA 2020 Statement, including the grey literature. A total of eight databases were searched. Advice and support were provided by academic librarians to translate the Medical Subject Headings (MeSH) using a polyglot. Inclusion and exclusion criteria were applied, and the articles were reviewed by two independent reviewers using Covidence.
Results/Conclusion: The research is yet to be completed; the results and conclusion of the literature reviews are yet to be confirmed.
Reference
1. Doyle E, Dimmock M, Lee K, Ng J, Bassed R. A systematised literature review: can low‐dose whole‐body computed tomography replace a radiographic skeletal survey when investigating paediatric non‐accidental injury? Forensic Imaging 2021;27:200481.
Barriers and facilitators affecting utilisation of radiation therapy
Leah Cramp1
1 The University of Newcastle, Callaghan, Australia
Objective: Optimal radiation therapy (RT) utilisation, estimated at 52%, differs significantly from actual utilisation rates of 31% seen around the world.1–3 Inter‐related barriers and influences resulting in this shortfall have been investigated.2,4 The objective of this scoping review is to identify and map the extent and scope of the current body of literature examining factors affecting utilisation of RT.
Methods: Studies were identified by conducting a search of four databases (Medline, Embase, Scopus, CINAHL) from date of inception until November 2021 with human‐only and English language limitations. Inclusion criteria for the current review included studies reporting on RT services, focussing on barriers, influences, perspectives and attitudes to utilisation. Title and abstract screening were conducted by two reviewers with discrepancies resolved by a third independent reviewer. Subsequently, a data table was utilised to determine variables for extraction and data synthesis.
Results: Following removal of duplicates, 3315 papers were included in the initial search. Full text screening resulted in data extraction and categorisation into three primary categories of barriers and facilitators affecting utilisation of RT: patient, health professional, and department level influences.
Discussion/Conclusion: On a global scale, clinical evidence has determined optimal utilisation rates of RT services are not being met.1–3 This scoping review summarises perceived barriers and perspectives influencing the utilisation of RT to identify gaps and inform areas of further research, establishing a needs assessment for intervention proposals and ultimately assisting in improving RT utilisation.
References
1. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence‐based clinical guidelines. Cancer 2005;104(6):1129–37.
2. Gillan C, Briggs K, Goytisolo Pazos A, et al. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol 2012;4(7):167.
3. Royce TJ, Qureshi MM, Truong MT. Radiotherapy utilization and fractionation patterns during the first course of cancer treatment in the United States from 2004 to 2014. J Am Coll Radiol 2018;15(11):1558–64.
4. Barton M, Jacob S, Shafiq J, et al. Review of optimal radiotherapy utilisation rates. Ingham Institute Applied Medical Research. 2013. Available at https://inghaminstitute.org.au/wp-content/uploads/2017/05/RTU-Review-Final-v3-02042013.compressed.pdf
Exposing gaps in our knowledge – osteoradionecrosis of the mandible
Xanthe Keneally1
1 The Princess Alexandra Hospital, Brisbane, Australia
Introduction: Osteoradionecrosis (ORN) of the mandible is a debilitating, long‐term complication of head and neck cancer radiation therapy, occurring in 5–15% of patients.1 While this condition requires significant imaging involvement for diagnosis, surgical planning, follow‐up and monitoring complications, it is often not well understood by radiographers. Through following the journey from radiation therapy to diagnosis and treatment, this poster aims to educate radiographers on the importance of these examinations.
Pathology: ORN is where bone within an irradiated field undergoes ischaemic necrosis in the absence of primary or metastatic disease, with exposed bone failing to heal within a 3–6 month period.2,3 ORN is associated with physical and functional complications, such as dysphagia and dysarthria.4 There are several risk factors, where compromised dental hygiene increases the likelihood of development.5 Dental extractions following radiation therapy pose a significant risk.6
Imaging: As a preventive measure, orthopantomograms are recommended to check for infections before radiation therapy.7 Diagnosis requires a combination of physical examination, biopsy and imaging. Treatment varies, with a vascularised free flap being the most extreme, planning for which relies on CT, MRI and angiography.8 Fluoroscopic swallows are common following surgery.4
Conclusion: This serious complication of radiation therapy has many long‐term impacts on the patient, requiring significant imaging input from diagnosis to treatment planning and follow‐up. Radiography plays a key role in the diagnosis and treatment of this condition, thus a thorough knowledge of ORN not only adds value to our work but puts the weight of these examinations into perspective.
References
1. Chronopoulos A, Zarra T, Ehrenfeld M, Otto S. Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review. Int Dent J 2017;68(1):22–30.
2. Rice N, Polyzois I, Ekanayake K, Moer O, Stassen LFA. The management of osteoradionecrosis of the jaws – a review. Surgeon 2015;3(2):101–9.
3. Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg 2011;40(3):229–43.
4. Brady G, Leigh‐Doyle L, Riva FMG, Kerawala C, Row J. Speech and swallowing outcomes following surgical resection with immediate free tissue transfer reconstruction for advanced osteoradionecrosis of the mandible following radiation treatment for head and neck cancer. Dyspagia 2015;70(2):197–205.
5. Rayatt S, Mureau M, Hofer S. Indian J Plast Surg 2007;40(12):65.
6. Khoo CK, Nabil S, Fauzi AA, et al. Predictors of osteoradionecrosis following irradiated tooth extraction. Radiat Oncol J 2021;16(1):130.
7. Devi S, Singh N. Dental care during and after radiotherapy in head and neck cancer. Natl J Maxillofac Surg 2014;5(2):117–25.
8. Knitschke M, Sonnabend S, Backer C, et al. Partial and total flap failure after fibula free flap in head and neck reconstructive surgery: retrospective analysis of 180 flaps over 19 years. Cancers 2021;13(4):865.
Uniting accuracy and patient comfort: implementing open‐face masks with ExacTrac Dynamic
Kendall Muscat,1 Elizabeth Brown,1 Janet Ferrari‐Anderson,1 Rachel Wan1
1 The Princess Alexandra Hospital, Brisbane, Australia
Objective: ExacTrac Dynamic utilises real‐time thermal‐surface tracking with X‐ray monitoring during surface guided radiotherapy. It has facilitated the introduction of open‐face masks for patients receiving brain radiotherapy by easing claustrophobia and improving comfort for those unable to tolerate an enclosed mask.1,2 The aim of this study was to retrospectively assess open‐face mask stability.
Methods: Nine patients in CIVCO open‐face radiotherapy masks were evaluated. Five received stereotactic radiotherapy in five fractions, three received volumetric modulated arc therapy in 5–15 fractions, and one patient received whole brain radiotherapy in five fractions. X‐ray and surface monitoring were performed with ExacTrac Dynamic, where an initial reference image was taken followed by intrafraction stereoscopic images and continuous thermal‐surface tracking. Positional couch shifts were applied after online image registration. The number of instances where a positional shift was required, and the point during treatment at which they occurred, were recorded as an indicator of stability.
Results: To date, 88 actioned images have been reviewed. Most (47%) occurred at initial set‐up or after a floor turn (27%). At initial set‐up, shifts were most frequently required for pitch and roll rotations (70%). After floor turns, shifts were most frequently required in the superior/inferior direction and yaw rotation (51%).
Conclusion: Open‐face masks have been found to be a stable alternative to enclosed masks for patients receiving brain radiotherapy treatment. The implementation of ExacTrac Dynamic with open‐face masks has made it possible to deliver highly accurate stereotactic radiotherapy treatment to anxious patients.
References
1. Li G, Lovelock DM, Mechalakos J, et al. Migration from full‐head mask to “open‐face” mask for immobilisation of patients with head and neck cancer. J Appl Clin Med Phys 2013;14(5):243–54.
2. Wiant D, Squire S, Liu H, et al. A prospective evaluation of open face masks for head and neck radiotherapy. Pract Radiat Oncol 2016;6:e259‐e67.
Can intra‐fraction imaging replace the mid treatment cone beam CT for lung stereotactic ablative radiotherapy?
Maryam Hazem1
1 Nepean Cancer Care Centre, Kingswood, Australia
Objective: Image guidance to localise the target for lung stereotactic ablative radiotherapy treatment delivered via a dual arc technique can be time consuming due to pre‐, mid‐ and post‐treatment imaging.1 Intra‐fraction imaging (IFI) acquires a cone beam CT (CBCT) during dose delivery, reducing the overall treatment time.2 Currently there is a lack of literature on the suitability of replacing the mid treatment CBCT with IFI. This study compares the image match correlation between an IFI and mid‐treatment CBCT on an Elekta Synergy linac to determine if this is possible.
Methods: Data from five dual arc lung stereotactic ablative radiotherapy patients was analysed. All patients had an intra‐fraction CBCT acquired during the first treatment arc, and a separate mid treatment CBCT. The mid CBCT was used for the treatment delivery, and the intra‐fraction image was matched post‐treatment and compared for match correlation. Both the translational (TX, TY, TZ) and the rotational (RX, RY, RZ) values were recorded. A Bland–Altman plot was used to compare the agreement between the CBCT and IFI.
Results: Bland–Altman plot for the pairs of comparisons has acceptable limit of agreement. Preliminary data analysis on 21 image datasets from five (out of intended 10 patients) suggests excellent intra‐class correlation between IFI and mid CBCT for Tx (0.83), Tz (0.93), Rx (0.93) and Rz (0.92), and good intra‐class correlation for Ty (0.63) and Ry (0.62) (Table 1).
Conclusion: Further study is required to statistically confirm if IFI can replace the mid CBCT; however, the preliminary results look promising in the clinical context.
References
1. Beasley M, Brown S, McNair H, et al. The advanced radiotherapy network (ART‐NET) UK lung stereotactic ablative radiotherapy survey: national provision and a focus on image guidance. Br J Radiol 2019;92(1098):20180988.
2. Li R, Han B, Meng B, et al. Clinical implementation of intrafraction cone beam computed tomography imaging during lung tumor stereotactic ablative radiation therapy. Int J Radiat Oncol Biol Phys 2013;87(5):917–23.
Optimisation of cerebral and neurovascular imaging requests to improve patient outcomes and reduce interdepartmental conflict
Hannah Christian,1 Nicholas Bosley,1 Jackson Monck1
1 Calvary Public Hospital, Bruce, Australia
Computed tomography (CT) of the brain including neurovascular angiography studies is often time critical. Examinations with the incorrect pathological indication or incorrect request can often lead to increased waiting times, conflict between departments and delayed clinical intervention. A three‐month clinical audit of a public emergency department found that 22% of all CT neuroimaging requests had the incorrect clinical indication. A further 22% of requests had the wrong RIS code requiring adaptation before scanning. Limited radiology gatekeeping has also placed pressure on radiographers to correct physician orders. This prompted a quality assurance project – in conjunction with a survey – to reflect the confidence levels of emergency department physicians and if further education would be beneficial.
The initial survey highlighted 60% of physicians were “not so confident/somewhat confident” in ordering the correct CT brain and neurology scan. Most of the physicians stated that more information would be helpful, and some stated they usually or sometimes feel intimidated when contacting the medical imaging department. Therefore, education in the form of a poster and an in‐service will be provided to these physicians with a follow‐up survey and clinical audit to examine the effectiveness of this education. The goals of the overall project are to improve CT efficiency and workflow, and to decrease potential conflict between departments and repeated scans due to incorrect requests.
Weightbearing valgus stress technique for the assessment of medial compartment osteoarthritis: uniting functional techniques
Adam Steward,1 Rachael Le1
1 Western Health, Melbourne, Australia
Osteoarthritis in the medial compartment of the knee is characterised by the loss of cartilage and joint space. Previously, operative management for medial compartment osteoarthritis entailed a total knee replacement, but in recent times uni‐compartmental knee replacements have gained traction due to reported lower rates of mortality, reduced recovery time and improved post‐operative function.
Valgus stress radiographs of a knee affected by medial compartment osteoarthritis can provide valuable evidence on the condition of the lateral compartment cartilage. This gives orthopaedic surgeons a better idea of the condition of the patient's knee and the opportunity to accurately plan the patient's surgery before theatre.
A successful valgus stress radiograph demonstrates a correction of the varus deformity of the knee, meaning a widening of the joint space width of the medial compartment. An assessment on the lateral compartment can therefore be made where a maintained joint space indicates an intact cartilage and a loss of joint space width indicates an unsuitable candidate for uni‐compartmental knee replacements.
Previously these stress views were performed with either referrer or radiologist donning a lead glove and gown and manually applying force to the lateral aspect of the knee. We propose a patient‐directed weightbearing valgus stress technique where gravity acts as a constant force that can potentially help overcome the lack of force applied by patients and negating the requirement for manual application of stress.
Learn & Unite – a staff‐driven in‐service program
Ken Wan1
1 GenesisCare, Victoria, Australia
The COVID‐19 pandemic affected everyone globally and at different levels, including staff education and training. Learning and sharing knowledge is key to successful development of the profession and patient service.1
Various workplace restrictions were in place during COVID‐19 lockdowns, especially in medical settings.2 Any traditional education forums using face‐to‐face formats – including seminars, lectures or in‐services – were halted.
To help alleviate this disruption to education and training, our staff were consulted via an internal survey for input into an in‐service program. A new initiative using technology to run the in‐service program for the past 18 months was established. Zoom was readily used across the Victoria practice and interstate. Various topics were suggested by the team; therefore the program was a multi‐disciplinary approach involving radiation therapists, radiation oncologists, physicists, allied health and management.
A feedback survey was conducted after the 18 months in‐service and had a huge staff satisfaction score (over 4.5 out of 5) for the content and program design. A staff‐driven directive was one of the key factors of the program's success. Staff felt there was continuation of education as well as full engagement and collaboration with the wider teams. On average, each session had 60 staff attend.
The in‐service program will continue to run in a similar way in the near future. It is critical to give staff the flexibility and opportunity to collaborate broadly.
References
1. Williams CL, Kovtun KA. The future of virtual reality in radiation oncology. Int J Radiat Oncol Biol Phys 2018;102(4):1162–4.
2. Kelly C. The New Daily, 1 Jan 2021 [updated 3 Jan 2021]. Available at https://thenewdaily.com.au/news/2021/01/01/coronavirus-timeline-australia/ [Accessed 19 November 2021].
Interpretation of the knee: everything you kneed to know
Andrew Murphy,1 Andrew Dixon2
1 The Princess Alexandra Hospital, Brisbane, Australia
2 The Alfred Hospital, Melbourne, Australia
Skeletal radiographs are still the primary imaging modality for acute musculoskeletal injuries. Radiographers are the first healthcare professionals to see and interpret a patient's medical imaging and form an important safety net in reducing error and misdiagnosis.1 Despite their frequency of use, skeletal radiographs are still prone to misinterpretation.2,3
Relying heavily on quality imaging and secondary soft tissue signs, knee radiographs are a deceptively complicated examination to interpret. Isolated, osseous injuries are rarely encountered, with even small slivers of avulsed bone signifying considerable internal derangement.
To fully comprehend the complexity of the knee and its associated injuries, it is important to have a thorough understanding of the anatomy, biomechanics, soft tissue signs and common abnormalities one would expect to encounter. This poster, via a series of diagrams and cases, aims to unite these pillars of knowledge to improve the understanding of knee radiograph interpretation. On completion, the reader should have a better understanding of:
knee injury patterns
common abnormalities
the clinical significance of avulsion fractures and their associated injuries
soft tissue signs
incidental findings
appropriate imaging pathways.
Accurate image interpretation is a key component of the radiography profession and continuous, evidence‐based, education around interpretation is not only useful for everyday practice but improves the quality of care we deliver to our patients.
References
1. Murphy A, Ekpo E, Steffens T, Neep MJ. Radiographic image interpretation by Australian radiographers: a systematic review. JMRS 2019;66:269–83.
2. York T, Franklin C, Reynolds K, et al. Reporting errors in plain radiographs for lower limb trauma‐a systematic review and meta‐analysis. Skeletal Radiol 2022;51(1):171–82.
3. Gergenti L, Olympia RP. Etiology and disposition associated with radiology discrepancies on emergency department patients. Am J Emerg Med 2019;37:2015–19.
Fear no more: interpretation of the paediatric elbow
Andrew Murphy,1 Yusra Sheikh2
1 The Princess Alexandra Hospital, Brisbane, Australia
2 Children's Health Ireland, Dublin, Ireland
Elbow injuries in children are one of the most common skeletal injuries encountered in medical imaging, involving up to 10% of all paediatric fractures.1 Not only do these injuries pose a technical challenge, they are often difficult subtle abnormalities to detect.
Radiographers play an integral part in the investigation of paediatric imaging. Not only are they tasked with the often‐challenging role of obtaining diagnostic images, but they are also the first healthcare professionals to see and interpret a patient's medical imaging and form an important safety net in reducing misdiagnosis.
The elbow is a complex pivot hinge joint, complicated further in the developing years by various ossification centres and differing radiographic appearances. A systematic approach to the interpretation of the radiograph, united with a thorough understanding of developmental anatomy and alignment, is key to ensuring an accurate diagnosis.
This poster, via a series of diagrams and cases, aims to unite these pillars of knowledge to improve the understanding of paediatric elbow radiograph interpretation. On completion, the reader should have a better understanding of:
paediatric elbow anatomy
ossification centres and their typical locations
normal alignment
common abnormalities
the clinical significance of soft tissue signs
incidental findings.
The paediatric elbow can be an intimidating radiograph to interpret, and a missed diagnosis can lead to unfortunate consequences for the patient. Evidence‐based continuous review of elbow interpretation is an excellent way to both improve technical skill and overall patient care.
Reference
1. Emery KH, Zingula SN, Anton CG, Salisbury SR, Tamai J. Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol 2016;46:61–6.
Clinical implementation of hybrid volumetric arc therapy for breast cancer patients
Rebecca Bartlett,1 Melanie Rennie,1 Daniela Miller,1 Alison Gray,1,2,3 Philip Vial,1,2,3,4 George Papadatos1
1 Liverpool and Macarthur Cancer Therapy Centres, Australia
2 Ingham Institute for Applied Medical Research, Liverpool, Australia
3 The University of New South Wales, Sydney, Australia
4 The University of Sydney, Sydney, Australia
Introduction: Literature indicate that hybrid volumetric modulated arc therapy (hVMAT) technique compares favourably to other planning techniques for breast +/− simultaneous integrated boost (SIB) radiotherapy.1–3 Optimal results are achieved with 70–80% conformal fields and 20–30% VMAT. hVMAT improves coverage, while having comparable organ at risk (OAR) doses to intensity‐modulated radiation therapy (IMRT). Our aim was to clinically implement hVMAT as part of the transition to our new planning system.
Methods: 20 hVMAT breast plans were created in the new planning system using right and left‐sided cases with a prescription of 26 Gy, 42.4 Gy or 50 Gy. Seven patients were breast only, six breast + low axilla, six breast + SIB, and one breast + low axilla + SIB. Boost volumes were treated to either 48 Gy or 60 Gy. Each patient had a clinical IMRT plan using the current planning system. The plans were compared using plan evaluation metrics including dose‐volume histogram and clinical goals to evaluate if hVMAT produced clinically acceptable plans with improved coverage. A radiation oncologist reviewed the plans and physics quality assurance was performed to assess the quality and deliverability of hVMAT.
Results: hVMAT plans showed improved target dose coverage, especially in SIB patients, and comparable OAR doses. The average PTV D95 and ipsilateral lung doses are shown in Table 1. All hVMAT plans passed physics quality assurance.
Conclusion: The hVMAT technique for breast +/− SIB +/− low axilla achieved better coverage and comparable OAR doses to our current tangential IMRT technique and was clinically implemented.
References
1. Chen Y, Li A, et al. the feasibility study of a hybrid coplanar arc technique versus hybrid intensity‐modulated radiotherapy in treatment of early‐stage left‐sided breast cancer with simultaneous‐integrated boost. J Medical Physics 2017;42(5):1–8.
2. Balaji K, Yadav P, et al. Hybrid volumetric modulated arc therapy for chest wall irradiation: for a good plan, get the right mixture. Physica Medica 2018;52:86–92.
3. Doi Y, Nakao M, et al. Hybrid volumetric‐modulated arc therapy for postoperative breast cancer including regional lymph nodes: the advantage of dosimetry data and safety of toxicities. J Radiat Res 2020;61(1):747–54.
Smart stitching protocol for whole body, long bone scanogram in digital radiography
Ravindra Naik1
1 Tata Memorial Hospital, Mumbai, India
Smart stitching is used when examining an area of the body larger than the detector area.
Select the procedure for automatic image stitching, that is, whole body anteroposterior, whole body lateral, long bone anteroposterior, long bone lateral scanogram. By selecting ‘top’ and ‘bottom’ positions of the body part, the stitching protocol is applied.
The hand switch should not be released until all images are captured. The coverage area and image count are displayed on the screen. The captured images are automatically stitched to form a single image. If image editing is necessary, manual stitching can be performed.
Processing of plaster of Paris imaging – a new way of thinking
Paul Kelly,1 Carina Mojet,1 Haoji Sima,1 Amy Dennett1
1 Eastern Health, Box Hill, Australia
Objectives: The aim of this study was to determine specific image processing parameters to improve image quality for plaster of Paris (POP) general radiography examinations.
Methods: This mixed study comprised two phases: 1) retrospective imaging analysis to select POP images between March and April 2021 and 2) review by orthopaedic surgeons. In Phase 1, a selection of 50 wrist fracture examinations in patients more than 50 years of age and in POP were reviewed and new image processing parameters were created. In Phase 2, orthopaedic surgeons were recruited for a survey in which a random selection of 10 studies from Phase 1 was reviewed. Participants ranked the images from most (rank = 1) to least preferred (rank = 4) with reasons. Results of the survey were described using means and proportions.
Results: Four sets of image processing parameters for wrist fracture examinations with POP were created. Each set was specific to posteroanterior and lateral views. The parameter sets used were standard non‐POP (set 1), two enhanced intermediate sets (sets 2 and 3) and the current enhanced POP parameters (set 4). Thirteen participants completed the survey. Most were orthopaedic surgeons (n = 11, 85%) who had on average 14 years (SD = 10) experience. Set 4 was the preferred set (n = 9/10 sets). The main reason for preference selection was visibility of bony details. Set 3 was second most preferred (n = 6/10).
Discussion/Conclusion: Orthopaedic surgeons preferred the department's set 4 POP processing parameters. Further review of these parameters with radiologists is required before their routine implementation.
Successful implementation of a new gamma knife during a global pandemic
Christina Bianchin1
1 Peter MacCallum Cancer Centre, Melbourne, Australia
During the COVID‐19 pandemic a gamma knife was successfully commissioned, installed and went live at the Peter MacCallum Cancer Centre in Victoria (even with the substantial impact to radiation oncology services during the pandemic).
We had many challenges to overcome as very few of the clinical radiation therapy staff had the opportunity to see a gamma knife unit in person from analogous service providers. It was essential the team adapted using a range of remote services to offer timely treatment provision.
With the support from our colleagues at the Princess Alexandra Hospital in Brisbane, we were able to plan our workflows and get feedback on a new treatment planning system and help to improve our skills. After several failed attempts at organising a visit (due to border closures) we undertook virtual tours to help us better predict possible challenges we might encounter.
During the ‘go live’ week we were without the usual onsite support of a neurosurgeon, oncologist and physicist proficient in gamma knife provided by Elekta. We were instead supported remotely by Elekta and managed; facilitating time differences between Melbourne, New York and London. The use of Microsoft Teams while learning in front of patients and getting feedback in time for clinical situations was challenging but rewarding when it all came together.
This presentation aims to provide a discussion of our experience and detail the logistical and practical challenges encountered, and how we successfully launched the service and have already treated almost 200 patients.
The accuracy of self‐efficacy of clinical skills in medical imaging students
Brooke Osborne,1 Steve Milanese,1 Kerry Thoirs,1 Gisela Van Kessel,1 Sharron King1
1 The University of South Australia, Adelaide, Australia
Background: Allied health clinicians need to have an accurate awareness of their level of competence, and to work within the limits of their abilities and scope of practice to meet professional standards. However, inaccurate self‐assessment by professionals has been identified in a wide range of work settings.1,2 This discordance can have potentially serious implications. A health clinician who consistently works with an inflated sense of their ability has the potential to put patients at increased risk of mistreatment.3 Alternatively, lacking confidence in using skills in which they are competent may result in sub‐optimal and inefficient performance.
Objectives/Methods: An evaluation tool has been developed and utilised to measure how self‐efficacy of clinical skills develops as student progress through a medical imaging degree. Beginning in 2019, the longitudinal study aims to observe student self‐concept of clinical skills ability across a medical imaging program, and any relationship of this to academic success in clinical education.
Results/Discussion: The first year of student self‐efficacy data across a range of clinical experience levels throughout a medical imaging degree is presented, with correlation to clinical supervisor reports, to identify the level of accuracy of student self‐efficacy of clinical skills ability.
References
1. Dunning D, Heath C, Suls JM. Flawed self‐assessment: implications for health, education, and the workplace. Psychological Science in the Public Interest 2004;5(3):69–106.
2. Carter TJ, Dunning D. Faulty self‐assessment: why evaluating one's own competence is an intrinsically difficult task. Social and Personality Psychology Compass 2008;2(1):346–60.
3. Davis DA, Mazmanian PE, Fordis M, et al. Accuracy of physician self‐assessment compared with observed measures of competence: a systematic review. JAMA 2006;296(9):1094–1102.
High spatial resolution micro‐dosimetry in the modern radiation therapy treatment
Sree Bash Chandra Debnath,1 Carole Fauquet,1 Agnes Tallet,2 Julien Darreon,2 Didier Tonneau1
1 Aix‐Marseille University, Marseille, France
2 Institut Paoli‐Calmettes Hospital, Marseille, France
Objectives: In modern radiation therapy, optical fibre‐based scintillating dosimetry is recognised as the most advanced technique owing to its miniature size and reduced sensitive volume, but still consists of strong Cerenkov corrections.1–3 Therefore, we proposed a novel inorganic micro‐dosimetry technique to avoid the Cerenkov issue and provide quality assurance in radiation therapy.
Methods: We developed a miniature infrared inorganic scintillating detector (IR‐ISD) based on (Zn.Cd)S:Ag with a sensitive volume of 1.6 x 10–6 mm3. A prototype of the detector was tested on an Elekta linac system tuned at 6 MV/15 MV and in internal dose verification by using a brachytherapy source of 320 keV‐(Ir‐192) by following international protocol TRS‐398 and TG43U1 recommendations. Cerenkov measurements were performed for different small fields and 0.25 cm distance from the brachytherapy source. Different dosimetric parameters were investigated, and a comparative study was shown using Monte Carlo simulation, visible ISD and data from recent literature.
Results: This study highlighted a complete removal of the Cerenkov effect. IR‐ISD has acceptable behaviour with dose rate variability (maximum standard deviation ~0.15%) for the dose rate of 15 cGy/s to 1200 cGy/s. An entire linear response (R2 = 1) was obtained with the dose delivered in the range of 5 cGy to 1200 cGy. Perfect repeatability (0.15%) with day‐to‐day reproducibility (0.20%) was observed. Eventually, a comparison with Monte Carlo simulations shows that considering energy dependency, measurement agrees within 0.35%.
Conclusion: The proposed detection system in this study requires no Cerenkov corrections and showed efficient performance to be applicable in external and internal beam radiation therapy.
References
1. Kertzscher G, Beddar S. Inorganic scintillation detectors for 192Ir brachytherapy. Phys Med Biol 2019;64(22):225018.
2. O'Keeffe S, Fitzpatrick C, Lewis E, Al‐Shamma'a A. A review of optical fibre radiation dosimeters. Sensor Review 2008.
3. Galavis PE, Hu L, Holmes S, Das IJ. Characterization of the plastic scintillation detector Exradin W2 for small field dosimetry. Med Physics 2019;46(5):2468–76.
Diagnostic accuracy of imaging modalities for adults with acute pulmonary embolism: systematic review and meta‐analysis
William Ransome,1,2 Janine Dizon,3 Shayne Chau,4 Katherine Guerrero2
1 Dr Jones & Partners Medical Imaging, Adelaide, Australia
2 University of South Australia, Adelaide, Australia
3 The University of Adelaide, Adelaide, Australia
4 RMIT University, Melbourne, Australia
Objectives: This systematic review aimed to evaluate the current evidence regarding diagnostic test accuracy of imaging modalities for adults with acute pulmonary embolism.
Methods: A literature search of PubMed, Embase, Trove and MedNar databases (2012–2020; English language) was performed. Eligible studies were pooled using the random or fixed‐effects model, with the remainder summarised using descriptive synthesis. Between‐study heterogeneity was assessed using the Higgins I2 test.
Results: 16 studies, involving 1934 participants, were enrolled with 10 studies (six ultrasound, four MRI) being pooled using the fixed effects model. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were calculated. Thoracic ultrasound exhibited 0.72 (95% CI, 0.66–0.79), 0.95 (95% CI, 0.92–0.97), 0.22 (95% CI, 0.11–0.46), 13.3 (95% CI, 8.31–21.3) and 54.0 (95% CI, 21.3–137.0). Focussed cardiac ultrasound showed 0.57 (95% CI, 0.50–0.65), 0.84 (95% CI, 0.80–0.88), 0.22 (95% CI, 0.03–1.60), 3.89 (95% CI, 2.10–7.20), 17.56 (95% CI, 3.59–85.9). Pulmonary MRI demonstrated 0.90 (95% CI, 0.81–0.96), 0.99 (95% CI, 0.93–1.00), 0.12 (95% CI, 0.06–0.22), 38.5 (95% CI, 7.90–187.10), 285.1 (95% CI, 45.10–1783.70). Magnetic resonance pulmonary angiography presented 0.93 (95% CI, 0.84–0.98), 0.88 (95% CI, 0.64–0.99), 0.95 (95% CI, 0.03–0.35), 6.48 (95% CI, 2.04–20.5), 65.01 (95% CI, 12.3–343.4). Planar ventilation/perfusion scanning, chest X‐ray combined with perfusion scanning and dual‐energy computed tomography pulmonary angiography (CTPA) showed sensitivity and specificity of 85.1 and 82.5, 60.0 and 86.0, and 80.8 and 96.0, respectively.
Conclusion: CTPA remains the most diagnostically accurate for acute pulmonary embolism diagnosis exhibiting 83% sensitivity and 96% specificity. However, there is evidence for the use of lower‐risk, radiation‐free alternative imaging modalities if available. Further research is required to substantiate these findings.
Developing a standardised process for projects in radiation oncology: a multi‐disciplinary team approach
Nainaben Dhana,1 Leah McDermott1
1 Austin Health, Heidelberg, Australia
The everchanging landscape in radiation oncology results in many projects undertaken across multi‐disciplinary teams. However, a busy clinical environment has significant impact on resourcing, timely completion and implementation of projects.
The aim of this project was to develop a standardised and consistent process for the initiation, reporting and completion of projects, for the radiation oncology staff. The Structure for Projects Committee (SPC) took into consideration pathways, documentation and actions to be performed at each phase of projects. All SPC members completed project management training. Objectives also included promoting the use of the current project list that enables governance committees to maintain oversight of all projects undertaken in the department and minimise data entry and duplication of reporting.
The SPC delivered a flowchart to assist project members to meet each of the stage requirements, and report to the appropriate governance committees; a project initiation and progress report form with goals, milestones and resources required; and a project completion form outlining the project outcomes achieved, communication, any new/updated protocols, training, presentations and publications.
A process for projects document describing the project structure, requirements, terminology and training videos was developed to assist new and future project leads with the newly rolled‐out process for projects within radiation oncology. The SPC also created the Project Support Manager role to monitor updates, progress, resourcing, documentation and maintenance of the project list.
Is there dosimetric advantage in using CyberKnife for stereotactic radiosurgery? A systematic review and meta‐analysis
Lauren Gingell1
1 RMIT University, Melbourne, Australia
Background: It is a very interesting time for radiation therapy in Australia. Several sites across Australia are investing in niche technologies so that Australians can receive world class care without needing to travel overseas. Although this seems to be the direction radiation therapy is going, the considerable investment of implementing a new technology must be justified by markedly improved patient outcomes.
Objectives: The aim of this review is to compare dosimetry of CyberKnife treatments with what is achievable using a linear accelerator for stereotactic radiosurgery of multiple intracranial metastases. Ultimately, this review begins to answer the question: Is it justified to implement this technology at an additional site in Australia?
Methods: A search of PubMed was conducted and conformity index, gradient index, volume of healthy brain tissue and beam on time were all recorded. Metanalysis of conformity index and gradient index was performed.
Results: There was little differentiation between techniques for conformity index. However, CyberKnife had lower gradient index and less dose to healthy brain tissue. Linac beam on time was considerably shorter than for CyberKnife.
Conclusions: CyberKnife treatment has preferable dosimetry compared to what is possible for linac treatments. It could be beneficial for this technology to be used more widely for the treatment of patients in the future.
High BMI patients require more time during morphology scan
Edward Ek Meng Liew,1 Edwina Coghlan,1 Glyn Teale,1 Emily Olive1
1 Sunshine Hospital, Victoria, Australia
Introduction: Anecdotally, achieving adequate views of structures as stipulated by the Australian Society of Ultrasound Medicine is more technically challenging and time onerous in women with an elevated body mass index (BMI). We present a linear regression analysis of patient BMI versus the time needed to scan these patients.
Methods: This is a retrospective audit using existing medical records. All obese pregnant patients who presented to the high BMI antenatal clinic for the 12‐month period from January 2020 until January 2021 are included. We identify 126 cases who have morphology ultrasound in our department. The time needed for each scan are extracted from database such as iView or Synapse. Statistical analysis was performed using Rexcel. Prospective approval was received from the Western Health Ethics Committee.
Results: The average total scan time for each patient is 86 minutes. There is a small but significant correlation between BMI and total scan time. For every one increase in BMI, the total scanning time increase by 0.972 minute (0.0006752 day, adjusted R‐squared 0.02281, P = 0.049).
Discussion: More time should be allocated to patients with a high BMI during their morphology scan.
Measuring emotional intelligence in undergraduate medical radiation science students: a scoping review
Debra Lee,1 Tracy Burrows,1 Daphne James,1 Ross Wilkinson,1 Yolanda Surjan1
1 The University of Newcastle, Callaghan, Australia
Background: Clinically, emotional intelligence (EI) of the health practitioner plays a vital role in patient perceptions of care.1 It is expected that students in diagnostic radiography, nuclear medicine and radiation therapy degrees (medical radiation science [MRS]) will develop patient care skills cohesively alongside essential clinical skills during undergraduate training. Assessing the clinical competence of MRS students is fundamental, but the evaluation of their ability to provide patient‐focussed care in an empathetic and prudent manner is often understated.
Aim: The purpose of this scoping review of EI measurement tools used in medicine and health‐related education was to determine the most appropriate tools for deployment in the undergraduate MRS setting.
Methods: A database search of PsychInfo, Medline/PubMed, CINAHL and Embase from 1990 to 2021 was performed, with 221 papers selected for full‐text review. Articles were evaluated to determine EI evaluation tools used in undergraduate medicine, nursing and health‐related student cohorts.
Results: Initial review of the literature identified 16 different assessments for EI in medical, nursing and health education. Literature directly related to EI in MRS students was less than 1% of the papers sourced.
Conclusion: Maintaining empathy, compassion and high standards of clinical care is a skill that defines an emotionally intelligent practitioner. The need for research into the assessment and development of EI among MRS students is vital to developing life‐ready graduates.
Reference
1. Jangland E, Gunningberg L, Carlsson M. Patients' and relatives' complaints about encounters and communication in health care: evidence for quality improvement. Patient Educ Couns 2009;75(2):199–204.
Simulation for medical radiation students: a scoping review
Nathan Johnson,1 Shayne Chau,2 Elio Arruzza1
1 The University of South Australia, Adelaide, Australia
2 RMIT University, Melbourne, Australia
Introduction: Simulation‐based education is a significant aspect of teaching clinical skills in tertiary medical radiation science programs, allowing students to experience the clinical setting in a safe environment. This scoping review looks at the current literature in this field to identify the evidence surrounding simulation‐based education for medical radiation students and identify gaps.
Methods: A search of PubMed, Scopus and Medline for studies from 2010 until 2021 was performed to capture existing literature in allied health and higher education. After a thorough screening process consistent with the framework established by Arksey and O'Malley,1 data extraction was performed on 31 articles.
Results: The interventions of the studies were categorised into either role play simulation, virtual simulation, simulation videos or online learning environments. Four of the five studies using performance‐based outcomes and control groups reported significant improvement in favour of simulation‐based education. Of the 17 studies relying on self‐reported measures, 15 reported an increase in clinical competence after the simulation intervention.
Discussion/Conclusion: Simulation based education in its various forms has been proven to positively affect the education of medical radiation science students. Its versatility renders it capable of developing the communication and clinical skills of students, while assisting in their preparation for clinical placement. Student satisfaction remained high throughout the studies; however, it is the view of many that although simulation‐based education is a valid and effective tool, it is complementary to and not a replacement for clinical placement.
Reference
1. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8(1):19–32.
Daily MRI in brain radiotherapy treatments: the benefits of the Elekta Unity MR‐linac
Felicity Height,1 Drew Smith,1 Brayden Geary1
1 Olivia Newton‐John Cancer Wellness & Research Centre, Heidelberg, Australia
The Elekta Unity MR‐linac is an emerging technology in radiotherapy treatment. It has the ability to take high quality MR images before, during and after treatment to assess tumour displacement, growth or motion, while also offering the ability to deliver daily adaptive treatments.
So how does this apply in fast growing brain tumours, particularly glioblastoma? And how does it compare to conventional linac‐based treatment and imaging? Glioblastoma is of particular interest due to its ability to grow rapidly between diagnosis, radiotherapy simulation and treatment. The MR‐linac offers the ability to deliver treatment tailored to the current tumour size, shape and position. Monitoring, and adjusting to daily positional variation and response to treatment, ensures patients receive a tailored radiotherapy treatment. MRI images can accurately demonstrate changes from simulation throughout treatment and after completion. The Elekta Unity platform offers the ability to adjust and compensate for these variations. While also requiring an advanced and collaborative approach to daily treatment from the extended multidisciplinary team. Our experience demonstrates the value of MRI in this cohort of patients and what adaptive radiation therapy can look like in the future for these patients.
What the Fankle
Magdalena Dolic 1
1 Western Health, Taylors Lakes, Australia
The role of the radiographer in the justification and modification of examinations is often poorly understood. It goes beyond patient positioning and involves accurate interpretation of referrals and tailoring of protocols to each individual's needs.
This poster introduces the ‘Fankle’, a term that often appears on radiological request forms. A hybrid mixture of the words ‘foot’ and ‘ankle’, it calls for imaging that demonstrates the patient's foot and ankle in a weightbearing, lateral projection with the inclusion of distal lower leg and foot. The misinterpretation of the word Fankle has previously resulted in incorrect, unnecessary radiation exposure as well as repeat journeys to the medical imaging department. Likewise, there is a lack of literature and research describing the projection and its benefits over routine foot and ankle imaging.
Under the Medical Radiation Practice Board of Australia Professional Capabilities, medical radiation practitioners are required to collaborate with other healthcare practitioners to provide care that is patient centred. The role of the Fankle within the scope of radiographic practise emphasises the importance of communication between referrers and radiographers when clarifying requested examinations. Further, collaboration between practitioners is essential when ensuring that images are justified and beneficial to a patient's diagnostic journey. This poster discusses both how the projection is correctly acquired as well as how challenges are overcome with complex patient presentations.
Effective doses and communicating the associated risks for common paediatric X‐ray examinations
Victoria Earl,1 Amanda Potter,1 Amanda Perdomo1
1 The Royal Children's Hospital Melbourne, Melbourne, Australia
Objective: The aim of this study is to contribute to the knowledge base regarding paediatric diagnostic general radiography examinations and provide a standardised approach for the communication of radiation dose and associated risk.1,2
Methods: Based on our current paediatric protocols and weight‐based exposure technique charts, dosimetry estimates for typical effective doses for females and males aged up to 18 years were calculated using Monte Carlo simulation software, PCXMC, for 20 commonly performed X‐ray examinations. The typical effective doses were used to estimate the lifetime risk of cancer incidence, level of risk, comparison with the Australian natural background equivalent radiation time of 1.5 mSv per annum and comparison with international flight time.
Results: Typical effective doses, corresponding lifetime risk of cancer incidence and level of risk category for 20 commonly performed paediatric X‐ray examinations were calculated and presented for ease of communication.
Discussion/Conclusion: The resultant table has been optimised for presentation, for each examination it displays the typical effective dose and a simple standardised approach for the communication of risk as applied across imaging modalities at our institution. This can be used to convey risks to health professionals, patients and carers in ways that are easy to understand and compare with other everyday risks. This table serves as a reference for clinicians when weighing up the radiation risks of procedures for their patients and as a useful tool for medical imaging staff when gaining informed consent for imaging.
References
1. Peck DJ, Samei E. How to understand and communicate radiation risk. Available at https://www.imagewisely.org/Imaging-Modalities/Computed-Tomography/How-to-Understand-and-Communicate-Radiation-Risk [Accessed 15 April 2021].
2. World Health Organization. Communicating radiation risks in paediatric imaging. Information to support healthcare discussions about benefit and risk. Geneva: WHO, 2016.
Imaging of silicone breast implant rupture with MRI, ultrasound, mammography and CT
Daniella Mraovic,1 Mahnoor Malik,1 Tina Tran,1 Kate Walker,1 Kristin Sun,1 Sally Luu1
1 The University of Sydney, Sydney, Australia
Objectives: This review aims to fill the gap in current literature and investigate the detection of silicone breast implant rupture using magnetic resonance imaging (MRI), ultrasound, mammography and computed tomography (CT). It seeks to determine best practice for future management of these patients and to highlight the distinct imaging features required to assess implant rupture.
Methods: Systematic searches were conducted via Medline, Embase and Web of Science. Studies included were published between 2011 and 2021 in English and based on human, in‐vivo silicone breast implants. Manual reference list searches were also performed.
Results: 225 abstracts were screened with 116 selected for full‐text screening. 95 studies were excluded for being case studies, abstract‐only, narrative reviews or irrelevant. Due to time constraints, 21 of the most relevant and recent articles were selected with whole‐team consensus.
Conclusion: While MRI has traditionally been the gold‐standard modality, this review found that a dual‐verification pathway of ultrasound followed by MRI is the ideal pathway when rupture is suspected. Meanwhile, CT and mammography were limited in their efficacy but could be used if ultrasound and MRI are unable to be used together. Typical imaging appearances of rupture in each modality were also characterised. Future studies are needed to further examine the clinical effectiveness of ultrasound as an alternative to MRI with larger sample sizes, inclusion of both symptomatic and asymptomatic patients and utilising surgery as the reference standard.