Accuracy of radiographers in Fiji in interpreting adult chest X-ray images

IntroductionThe idea of radiographer image interpretation has not been fully explored in Fiji despite the great shortage of radiologists in the country. This is a feasibility study of radiographer image interpretation aimed at assessing the accuracy of radiographers in interpreting adult chest X-ray images at the Colonial War Memorial Hospital (CWMH) in Fiji.MethodsForty PA chest X-ray images were interpreted in terms of correctly commenting on the presence/ absence of pathology, the name of the pathology, and the location of the pathology on the data sheets by the CWMH diagnostic radiographers (n = 14). The radiographers were grouped according to their years of work experience (≤ 5 vs > 5) and the Mann Whitney U test on a two-tailed p-value of 0.05 was used to compare this grouping.ResultsThe data analysis was conducted using the Statistical Package for Social Sciences (SPSS) v.25 and Microsoft Excel. The diagnostic performance of all radiographers in terms of triaging normal and abnormal in the images shows sensitivity ranging from 71.4 to 100%, with specificity ranging from 47.4 to 100%. The mean sensitivity, specificity, and the overall accuracy of radiographers in triaging normal and abnormal on the images were 89.5%, 72.9%, and 81.6%, respectively. The mean accuracy in naming the pathology was 33.6% and the location sensitivity was 45.7%. There was no statistically significant difference in results between the radiographers’ years of experience.ConclusionWithout any formal qualification, training, and practice, the current results suggest that the cohort of radiographers can perform normal/abnormal triage of CXRs within a test setting. With a significant reduction in the radiographers’ accuracy in terms of naming and locating the abnormality, the study results do not support image interpretation by the radiographers at this stage.Implications for practiceThis feasibility study provides baseline information about the accuracy of image interpretation by diagnostic radiographers at CWMH and provides a platform for further research in image interpretation in Fiji.     

Anatomic Site Markers: Evaluation of Their Use among Maltese Radiographers

PurposeTo evaluate the perception and 5-year application of anatomic side markers (ASMs) by radiographers in Malta.Methods and materialsPhase 1 involved a longitudinal, retrospective observation of a stratified sample of radiographs over 5 years, using a self-designed data record sheet to record features of the placement of ASMs. Phase 2 consisted of a cross-sectional, prospective self-designed questionnaire evaluating the radiographers' perception on the use of ASMs in professional practice.ResultsIn phase 1, radiographs (n = 500) were selected from 234,105 taken over the 5-year period (error: ±4.38%; 95% confidence level). Four hundred thirty radiographs (86%) had evidence of markers, of which 110 (25.6%) had a pre-exposure marker and 320 (74.4%) had a postprocessed marker. The remaining 14% had no evidence of any markers. Two hundred eighty two (56.4%) of the radiographs had ASMs placed according to recommended guidelines by Ballinger, Frank, and Merrill. In phase 2, most radiographers (84.6%) preferred using postprocessing markers, with 15.4% preferring pre-exposure markers (76.6% of radiographers found applying pre-exposure markers time consuming). Sixty percent (60.5%) of radiographers gave correct answers on use of markers as recommended in the guidelines.ConclusionsRadiographer preference in using postprocessing markers was evident, while the use of pre-exposure markers was seen to be influenced by time of examination, projection executed, and patient positioning. Radiographer awareness and continuous training are recommended.     

A Comparison of MRI Radiographers' Knowledge in Saudi Arabia and the Republic of Ireland in Relation to Image Quality Management,for Abdomen and Pelvic MRI Examinations

PurposeThe purpose of this article was to qualitatively compare current MRI radiographers’ knowledge from Saudi Arabia and the Republic of Ireland in relation to MR image quality for abdominal and pelvic MRI examinations.Methods and materialsSemistructured interviews were designed to investigate the professional role of radiographers towards image quality management, personal development in MRI, and training in relation to image quality improvement. Public, private, military, and academic hospitals in the Western region of the Kingdom of Saudi Arabia participated, as did a range of public and private Irish centres. Clinical specialist radiographers (CSRs)/supervisors, and MR radiographers working in MR completed the interviews. These were recorded, coded, and transcribed.ResultsSixty-one MR radiographers and CSRs/supervisors within 11 MRI departments in the Kingdom of Saudi Arabia and 11 MRI departments in the Republic of Ireland participated in this study. Three themes resulted by using a qualitative data analysis program called NVivo: (1) health care professional and the cultural attitudes with regards to the scope of professional roles, (2) factors affecting image quality, and (3) departmental policy. Participants' knowledge of image quality varied and challenges to achieving optimal quality levels were noted. Differences in clinical practice between countries were identified, as was the impact of clinical experience and levels of education.ConclusionDifferences in attitude and clinical practice between Saudi and Irish radiographers and CSRs/supervisors working in MRI departments were identified. There is a need for further training and subsequent assessment of professional skills, including developing postgraduate opportunities, particularly for Saudi radiographers, to support radiographers in the routine management of MR image quality.     

Observer Performance in Computed Tomography Head Reporting

AimTo audit the reporting results of a cohort of radiographers (n = 6) completing an accredited academic program in clinical reporting of computed tomography (CT) head examinations.MethodsAn audit of retrospective academic image case banks and prospective random clinical workload case banks. Both the academic test banks and clinical workload banks included a wide range of normal and abnormal cases of different levels of difficulty and pathology. Abnormalities included hemorrhage, fractures, lesions, infarctions, degeneration, and normal variants from a variety of referral sources. True positive and negative, as well as false positive and negative fractions were used to mark the reports, which were analyzed for accuracy against a reference standard. Furthermore, interobserver variability was assessed using Cohen’s kappa, one-way analysis of variance, and Tukey for multiple comparisons and significance testing at 95% confidence intervals (CI).ResultsThe mean accuracy score for all radiographers (n = 6) and reports (n = 3,008) was 90.7% (95% CI, 88.3%–93.0%). Mean sensitivity and specificity rates were 86.9% (95% CI, 85.8%–88.2%) and 94% (95% CI, 89.6%–98.3%), respectively. The most common errors were associated with herniation, lacunar infarctions, and subtle fractures (false negatives) and involutional changes, subtle infarctions, and ventricular dilation (false positives).ConclusionsThe results suggest appropriately trained radiographers can successfully undertake to report computed tomography head examinations to a high standard. The adoption of both academic and clinical workload image banks that reflect disease examples and the prevalence that may logically be encountered in practice offers the potential for an accurate measure of performance of radiographer's abilities.     

A Pilot Study Evaluating the Effectiveness of Dual-Registration Image-Guided Radiotherapy in Patients with Oropharyngeal Cancer

PurposeThe purpose of the article was to determine the impact of Dual Registration (DR) image-guided radiotherapy (IGRT) on clinical judgement and treatment delivery for patients with oropharyngeal cancer before implementation.MethodsNinety cone beam computed tomography images from 10 retrospective patients were matched using standard clipbox registration (SCR) and DR. Three IGRT specialist radiographers performed all registrations and evaluated by intraclass correlation to determine inter-rater agreement, Bland-Altman with 95% limits of agreement to determine differences between SCR and DR procedures, changes in clinical judgment, time taken to perform registrations, and radiographer satisfaction.ResultsInter-rater agreement between radiographers using both SCR and DR was high (0.867 and 0.917, P ≤ .0001). The 95% limits of agreement between SCR and DR procedures in the mediolateral, cranial–caudal, and ventrodorsal translational directions were −6.40 to +4.91, −7.49 to +6.05, and −7.00 to +5.44 mm, respectively. The mediolateral direction demonstrated significant proportional bias (P ≤ .001) suggesting non-agreement between SCR and DR. Eighty percent of DR matches resulted in a change in clinical judgement to ensure maximum target coverage. Mean registration times for SCR and DR were 94 and 115 seconds, respectively, and radiographers found DR feasible and satisfactory.ConclusionThe standard method using SCR in patients with oropharyngeal cancer underestimates the deviation in the lower neck. In these patients, DR is an effective IGRT tool to ensure target coverage of the inferior neck nodes and has demonstrated acceptability to radiotherapy clinical practice.     

Computed tomography during the COVID-19 pandemic: A survey of changes to service delivery,working practices and decision-making role of radiographers

IntroductionDuring the COVID-19 pandemic, Computed Tomography (CT) departments have established additional acute capacity whilst maintaining essential services. The purpose of this study was to investigate the changes in service delivery, working practices and decision-making role of diagnostic radiographers during the pandemic.MethodsWe conducted an electronic cross-sectional survey of diagnostic radiographers working in CT during the COVID-19 pandemic. The survey was open for 6-weeks, with radiographers from all geographical regions encouraged to respond. The questionnaire explored social distancing, patient scheduling and departmental organisation; PPE usage; recognition and escalation of COVID-19 changes, patient management pathways and any training. Additionally, we sought the personal perspectives of radiographers through free text comments.ResultsFollowing exclusions, 180 responses were analysed. Service delivery changes included social distancing (59.4%; n= 107), restriction of referrals to those considered time-critical (63.3%; n=114) and dedicated COVID-19 scanners (66.1%; n=119). Working practices were impacted by a need to implement PPE, although variation in PPE worn for different scenarios was seen. Half of the radiographers were routinely reviewing asymptomatic outpatient images for common COVID-19 signs, despite 63.5% of respondents not receiving formal training. Ad hoc patient pathways were in place in 90.5% of cases with 35% indicating that this was radiographer-led. CT staff had experienced anxiety, fatigue, and low morale, but praised teamwork.ConclusionsRadiographers were able to reduce the risk of transmission through social distancing, designated scanners, and PPE. This study has demonstrated that despite variance in practice, radiographers play a key role in identifying and triaging high-risk patients.     

Precision and Accuracy of Measurements on CT Scout View

ObjectivesThe purposes of this study were to (1) investigate the limits of measurements on scout view in three computed tomography axes, x, y and z and (2) develop a model to provide better understanding of measurement accuracy.MethodsFor the first objective, anteroposterior and lateral scout views of a Catphan phantom 200 mm in diameter and length were acquired with a GE scanner at 21 different table heights. Phantom measurements on scout view were performed by two experienced readers. The comparison of their measures provided estimation of precision. The accuracy was assessed by determining the bias, calculated as the difference between the values measured on scout view and the real phantom size. Second, a model was developed investigating the relationship between the dimensions of the object, its image, and the table height. This relationship was tested on our data.ResultsScout view measurements were precise, with less than 0.53% difference between readers. In addition, small biases of about 1 mm were detected in the z-axis, whatever the table height. In the other axes, serious biases from −13 to +73 mm were measured. Furthermore, at isocentre, overestimations up to 7 mm were shown. The results also indicated that biases in scout view measurements are because of the geometrical projection related to the object-detector distance.ConclusionsMeasurements in the table movement axis are precise and accurate, conferring to scout views an added value for preoperative planning in orthopedic surgery.     

South African radiography leadership co-constructing radiation protection change ideas

BackgroundThis article presents the findings of phase three of a mixed-method study. Phases one and two explored South African radiographers’ radiation protection intention and practices and found that even though radiographers reported a high intention to perform radiation protection, varying practices were observed. Phase three of the study explored optimising radiation protection among radiographers in South Africa.ObjectiveThe research objective guiding phase three of the study was to explore co-constructed change ideas to facilitate optimal radiation protection.MethodsA qualitative research approach using focus group interviews collected data from eight purposively selected radiography managers. The collected data was analysed using thematic analysis.ResultsTwo themes and related categories were identified. Radiographer managers defined radiation protection correctly and concurred that they observed suboptimal radiation protection practices. They attributed suboptimal practice with diminished stature of the radiographer within the healthcare team, ionising radiation being an unseen harm and radiographers’ attitude. Radiography managers envisioned their ideal radiation protection environment and suggested ways to attain it. Among the suggestions was a strong collaboration between stakeholders, continuous education, research, national standardised policies, and radiography organisational structures.ConclusionTo rectify suboptimal radiation protection, radiography managers co-constructed ideas to optimise radiation protection practices. Fundamental to change was healthcare organisations embedding radiation protection within their safety culture; thereby, all stakeholders would be invested in upholding the organisation-wide impetus. However, ultimately compliance and accountability is an individual choice.     

Endoscopy versus fluoroscopy for the placement of postpyloric nasoenteric tubes in critically ill patients: A meta-analysis of randomized controlled trials

IntroductionEarly postpyloric nasoenteric nutrition is considered an accepted method of nutritional support in critically ill patients. Both endoscopy and fluoroscopy placement of postpyloric nasoenteric tubes (PNTs) have the highest percentages of placement success rate. We aimed to evaluate the differences in efficacy and safety between endoscopy and fluoroscopy methods for the placement of PNTs in critically ill patients.MethodWe searched MEDLINE, Embase, and electronic databases of Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing endoscopy and fluoroscopy placement of PNTs in critically ill patients. Two reviewers assessed the quality of each study and collected data independently. We performed the meta-analysis with Cochrane Collaboration RevMan 5.3.ResultsThree randomized controlled trials involving 243 patients were included. There were no significant differences in the placement success rate (RR, 0.99; 95% CI, 0.93, 1.06; z = 0.20, P = .84,) or procedure time (standardized mean difference, − 0.08; 95% CI, − 6.93, 6.77; z = 0.02, P = .98) between the 2 groups. No severe complications (digestive tract hemorrhage, perforation, respiratory problems, hemodynamic instability, or death) were noted in the three studies. There was a slight difference in the incidence of minor complications (RR, 8.12; 95% CI, 1.07, 61.53; z = 2.03, P = .04) between the 2 groups.ConclusionsEndoscopy and fluoroscopy placement of PNTs can be accurately and safely performed in critically ill patients. Endoscopy may be at least equally as safe as fluoroscopy for the placement of PNTs.     

A Pilot Study to Examine the Effect of an Educational Poster on the Knowledge and Practices of Lateral Elbow Radiograph Repositioning in Radiographers

AimThis pilot study aimed to evaluate the knowledge and practices of South Australian radiographers regarding lateral elbow repositioning and to determine whether an educational poster could improve repositioning knowledge.MethodThe study was undertaken in four stages. Stage one involved the development of a survey to explore radiographer knowledge and practices surrounding lateral elbow repositioning. Stage two involved the development of an educational poster. Stage three was a pilot validity study. Three participants (n = 3) were involved in testing the validity and test-retest reliability of the survey and the poster. Stage four was the interventional study which involved the distribution of surveys to two radiography departments in South Australia on two occasions, before and after the distribution of the poster. Six complete data sets were analysed.ResultsThe pilot validity study ensured the test-retest reliability of the survey was strong (P = .629). It was determined that an educational poster made no significant difference to the knowledge of lateral elbow radiograph repositioning among radiographers (P = .253). It was indicated that this result was not due to familiarity with the presurvey questions (P = .171). Thematic analysis of the open discussion questions found that most participants found the poster helpful but did not consider repositioning to be difficult. The introduction of the poster did not increase image repeat rate and the poster was used moderately over the study length.ConclusionAs this study was unable to determine whether a poster could improve the knowledge and practices of lateral elbow repositioning among radiographers, further research is needed.     

Prevalence of low back pain among Irish radiographers

BACKGROUNDAccording to the literature, low back pain (LBP) is one of the top ten diseases and injuries contributing to disability-adjusted life years worldwide. To the best of the authors’ knowledge there are no studies investigating the prevalence of LBP among radiographers working in Ireland or have compared prevalence rates with the national population or other cohorts of radiographers or healthcare professionals. This study aimed to determine the prevalence of LBP among radiographers working or who have previously worked in Ireland and to identify any causative factors.METHODSA cross-sectional study in the form of an online questionnaire was developed. Participation was advertised online via social media platforms. Inclusion criteria included qualified radiographers working in Ireland or who had recently worked in Ireland. Section A of the questionnaire focussed on acquiring demographic data. Section B comprised eight questions relating to LBP, including current and previous experiences, causative factors and consequences.Further details on any episodes of LBP in the previous year, whether work and leisure activities had been affected, whether any extracurricular activities caused LBP, and whether a participant sought professional advice. Section C (six questions) used a 5-point ordinal scale to collect information on the frequency of specific tasks performed by radiographers in their daily roles. Section D involved exploratory questions, including whether LBP has forced a career change if they knew anyone who has changed their career as a result of LBP, reaction to the amount of manual handling required for radiographers, whether they thought manual handling training was sufficient, thoughts on the availability of assistive transfer devices, reasons for not following correct patient transfer guidelines, and finally whether they were concerned about LBP affecting their future.RESULTS151 radiographers participated in this study, and the point prevalence rate of LBP was 50%, with 12 months prevalence rate of 75%. Regarding activity levels, 25% (n=37) reported reduced work activity, and a further 43%(n=65) reduced leisure activities due to LBP. 37% (n=56) have sought medical advice from a doctor, physiotherapist, or other HCP concerning their LBP in the last year. 68% (n=104) of respondents who have LBP confirmed it was not a result of any extracurricular activities.CONCLUSIONThe prevalence of LBP among radiographers in Ireland was high and 4.7 times higher than the period prevalence rate recorded in the general population. LBP rates were similar to radiographers working in other jurisdictions. Data from this study may help manage LBP and monitor any interventions' effectiveness.     

An insight into the current perceptions of UK radiographers on the future impact of AI on the profession: A cross-sectional survey

IntroductionAs a profession, radiographers have always been keen on adapting and integrating new technologies. The increasing integration of artificial intelligence (AI) into clinical practice in the last five years has been met with scepticism by some, who predict the demise of the profession, whilst others suggest a bright future with AI, full of opportunities and synergies. Post COVID-19 pandemic need for economic recovery and a backlog of medical imaging and reporting may accelerate the adoption of AI. It is therefore timely to appreciate practitioners’ perceptions of AI used in clinical practice and their perception of the short-term impact on the profession.AimThis study aims to explore the perceptions of AI in the UK radiography workforce and to investigate its current AI applications and future technological expectations of radiographers.MethodsAn online survey (Qualtrics^?) was created by a team of radiography AI experts. The survey was disseminated via social media and professional networks in the UK. Demographic information and perceptions of the impact of AI on several aspects of the radiography profession were gathered, including the current use of AI in practice, future expectations and the perceived impact of AI on the profession.Results411 responses were collected (80% diagnostic radiographers (DR); 20% therapeutic radiographers (TR)). Awareness of AI used in clinical practice is low, with DR respondents suggesting AI will have the most value/potential in cross sectional imaging and image reporting. TR responses linked AI as having most value in treatment planning, contouring, and image acquisition/matching. Respondents felt that AI will impact radiographers’ daily work (DR, 79.6%; TR, 88.9%) by standardising some aspects of patient care and technical factors of radiography practice. A mixed response about impact on careers was reported.ConclusionsRespondents were unsure about the ways in which AI is currently used in practice and how AI will impact on careers in the future. It was felt that AI integration will lead to increased job opportunities to contribute to decision making as an end user. Job security was not identified as a cause for concern.     

Effectiveness of a treadmill-based aerobic exercise intervention on pain,daily functioning,and quality of life in women with primary dysmenorrhea: A randomized controlled trial

ObjectiveTo evaluate the effectiveness of a treadmill-based aerobic exercise intervention on pain and associated symptoms of primary dysmenorrhea.MethodsSeventy women with primary dysmenorrhea were included in the study. The experimental group underwent supervised aerobic training for 4 weeks followed by unsupervised home exercise for the next 6 months. The control group continued usual care. The primary outcome was pain. Secondary outcomes included quality of life (QoL), daily functioning, and sleep.ResultsAfter the 4-week training, compared to the control group exercise significantly improved primary outcomes pain quality (mean difference (MD) -1.9, 95% CI 3.8 to −0.04, p < .05), and intensity (MD -4.7, 95% CI -9.3 to −0.09, p < .05), but not present pain. Significant effects were also reported for pain interference (MD -1.7, 95% CI -3.4 to −0.02, p < .05) at 4 weeks; the other outcomes did not significantly differ between groups at this time. During the follow-up period of 7-months, the effect on pain improved to 22 mm (95% CI 18 to 25). Significant benefits of exercise were maintained up to 7-months for present pain, QoL and daily functioning.ConclusionExercise has significant effects on primary dysmenorrhea-related pain, QoL and function.Trial registrationACTRN12613001195741.     

Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial

ObjectiveTo assess the effects of high-intensity interval training (HIIT) on physical, mental, and cognitive functioning after stroke.DesignThe HIIT Stroke Study was a single-blind, multicenter, parallel-group randomized controlled trial.SettingSpecialized rehabilitation units at 3 Norwegian hospitals.ParticipantsAdult stroke survivors (N=70) 3 months to 5 years after a first-ever stroke. Mean age was 57.6±9.2 years and 58.7±9.2 years in the intervention and control groups, respectively.InterventionsParticipants were randomized to standard care in combination with 4×4 minutes of treadmill HIIT at 85%-95% of peak heart rate or standard care only.OutcomesOutcomes were measured using physical, mental, and cognitive tests and the FIM and Stroke Impact Scale. Linear mixed models were used to analyze differences between groups at posttest and 12-month follow-up.ResultsThe intervention group showed a significant treatment effect (95% confidence interval [CI]) from baseline to posttest on a 6-minute walk test of 28.3 (CI, 2.80-53.77) meters (P=.030); Berg Balance Scale 1.27 (CI, 0.17-2.28) points (P=.025); and Trail Making Test Part B (TMT-B; −24.16 [CI, −46.35 to −1.98] s, P=.033). The intervention group showed significantly greater improvement on TMT-B at the 12-month follow-up (25.44 [CI, −49.01 to −1.87] s, P=.035). The control group showed significantly greater improvement in total Functional Independence Measure score with a treatment effect of −2.37 (CI, −4.30 to −0.44) points (P=.016) at 12-month follow-up. No significant differences were identified between groups on other outcomes at any time point.ConclusionsHIIT combined with standard care improved walking distance, balance, and executive function immediately after the intervention compared with standard care only. However, only TMT-B remained significant at the 12-month follow-up.     

Body Weight Support Gait Training for Patients With Parkinson Disease: A Systematic Review and Meta-analyses

ObjectiveTo determine the effectiveness of body weight support (BWS) gait training to improve the clinical severity, gait, and balance in patients with Parkinson disease (PD).Data SourcesA literature search was conducted until July 2020 in MEDLINE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature.Study SelectionRandomized controlled trials that aimed at determining the effectiveness of physical activity interventions with BWS during gait training in patients with PD.Data ExtractionThe methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool (RoB 2.0). Effect size (ES) and 95% confidence intervals [CIs] were calculated for the Unified Parkinson Disease Rating Scale (UPDRS), the UPDRS section III, the 6-minute walk test (6MWT), gait parameters (ie, velocity, cadence, stride length), and the Berg Balance Scale (BBS).Data SynthesisTwelve studies were included in the systematic review. The pooled ES for the effect of BWS on total UPDRS was −0.35 (95% CI, -0.57 to −0.12; I²=1.9%, P=.418), whereas for UPDRS III it was −0.35 (95% CI, -0.68 to −0.01; I²=66.4 %, P<.001). Furthermore, the pooled ES for 6MWT was 0.56 (95% CI, −0.07 to 1.18; I²=77.1%, P=.002), for gait velocity was 0.37 (95% CI, −0.10 to 0.84); I²=78.9%, P<.001), for cadence was 0.03 (95% CI, −0.25 to 0.30; I²=0.0%, P=.930), for stride length was 1.00 (95% CI, 0.23 to 1.78; I²=79.5%, P=.001), and for BBS was 0.65 (95% CI, 0.30, 0.99; I²=51.8%, P=.042).ConclusionsInterventions with BWS could improve the general and motor clinical severity of patients with PD, as well as other parameters such as stride length and balance. However, the effect does not appear to be statistically significant in improving gait parameters such as velocity, cadence, and distance.     

Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: A systematic review and metaanalysis

ObjectivesThis systematic review and metaanalysis compared the effects of biofeedback-assisted pelvic floor muscle training with those of pelvic floor muscle training alone in patients with urinary incontinence after radical prostetactomy.DesignA review and metaanalysis study design.Data sourcesThe metaanalysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A systematic search of PubMed/Medline OVID, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, BioMed Central, Web of Science, Chinese Electronic Periodical Services, Chinese Journal and Thesis Database, and China National Knowledge Infrastructure was performed for retrieving records.Review methodsFor determining the effects of training type on urinary incontinence, randomized controlled trials on biofeedback-assisted pelvic floor muscle training with or without electrical stimulation were compared with those on pelvic floor muscle training with or without electrical stimulation, respectively, in the metaanalysis. The Cochrane Collaboration tool in the Cochrane Handbook for Systematic Review of Interventions 5.1.0 was used to assess the methodological quality of the included trials. Subjective and objective measurement of urinary incontinence improvement and the quality of life were the primary and secondary outcome measures, respectively. Data were analyzed using Comprehensive Meta-Analysis software 2.0. In addition, subgroup analyses and metaregression were performed to explore the possible sources of heterogeneity.ResultsThirteen randomized controlled trials involving 1108 patients with prostatectomy incontinence were included. The immediate-, intermediate-, and long-term effects of objectively measured biofeedback-assisted pelvic floor muscle training on urinary incontinence were significant (mean effect size = −0.316, −0.335, and −0.294; 95% CI: −0.589 to −0.043, −0.552 to −0.118 and −0.535 to −0.053; p = 0.023, 0.002, and 0.017, respectively) when compared with those of pelvic floor muscle training alone. However, when urinary incontinence was measured subjectively, only the intermediate and long-term effects of biofeedback were found (p = 0.034 and 0.005, respectively). Small-to-moderate immediate- and intermediate-term effects on the quality of life were observed when biofeedback-assisted pelvic floor muscle training was compared with pelvic floor muscle training alone. No publication bias was observed among studies.ConclusionsBiofeedback can be an adjunct treatment to pelvic floor muscle training for reducing urinary incontinence in patients who have undergone radical prostatectomy.     

The influence of patient positioning on radiation dose in CT imaging: A narrative review

Background and purposeAlthough it is fundamental for optimal scanner operation, it is generally accepted that accurate patient centring cannot always be achieved. This review aimed to examine the reported knowledge of the negative impact of patient positioning on radiation dose and image quality during CT imaging. Furthermore, the study evaluated the current optimisation tools and techniques used to improve patient positioning relative to the gantry iso-center.MethodologyA comprehensive search through the databases PubMed, Ovid, and Google Scholar was performed. Keywords included patient off-centring, patient positioning, localiser radiograph orientation, radiation dose, and automatic patient positioning (including synonyms). The search was limited to full-text articles that were written in English. After initial title and abstract screening, a total of 52 articles were identified to address the aim of the review. No limitations were imposed on the year of publication.ResultsVertical off-centring was reported in up to 95% of patients undergoing chest and abdominal CT examinations, showing a significant influence on radiation dose. Depending on the scanner model and vendor, localiser orientation, bowtie filter used, and patient size, radiation dose varied from a decrease of 36% to an increase of 91%. A significant dose reduction was demonstrated when utilising an AP localiser, aligning with the trend for radiographers to off-center patients below the gantry iso-centre. Utilizing a 3D camera for body contour detection allowed for more accurate patient positioning and promoted further dose reduction.ConclusionPatient positioning has shown significant effects on radiation dose and image quality in CT. Developing a good understanding of the key factors influencing patient dose (off-centring direction, localiser orientation, patient size and bowtie filter selection) is critical in optimising CT scanning practices. Utilising a 3D camera for body contour detection is strongly recommended to improve patient positioning accuracy, image quality and to minimise patient dose.     

The effect of green coffee extract supplementation on anthropometric measures in adults: A comprehensive systematic review and dose-response meta-analysis of randomized clinical trials

Background and aimTwo meta-analyses summarized data on the effects of green coffee extract (GCE) supplementation on anthropometric measures. However, the accuracy of those meta-analyses is uncertain due to several methodological limitations. Therefore, we aimed to conduct a comprehensive systematic review and dose-response meta-analysis to summarize all available evidence on the effects of GCE supplementation on anthropometric measures by considering the main limitations in the previous meta-analyses.MethodsWe searched available online databases for relevant publications up to January 2020, using relevant keywords. All randomized clinical trials (RCTs) investigating the effects of GCE supplementation, compared with a control group, on anthropometric measures [including body weight, body mass index (BMI), body fat percentage, waist circumference (WC) and waist-to-hip ratio (WHR)] were included.ResultsAfter identifying 1871 studies from our initial search, 15 RCTs with a total sample size of 897 participants were included in the systematic review and meta-analysis. We found a significant reducing effect of GCE supplementation on body weight (weighted mean difference (WMD): −1.23, 95 % CI: −1.64, −0.82 kg,P < 0.001), BMI (WMD: −0.48, 95 % CI: −0.78, −0.18 kg/m², P = 0.001), and WC (WMD: −1.00, 95 % CI: −1.70, −0.29 cm, P = 0.006). No significant effect of GCE supplementation on body fat percentage and WHR was seen. In the dose-response analyses, there was no significant association between chlorogenic acid (CGA) dosage, as the main polyphenol in green coffee, and changes in anthropometric measures.ConclusionWe found that GCE supplementation had a beneficial effect on body weight, BMI and WC. It provides a cost-effective and safe alternative for the treatment of obesity. Additional well-designed studies are required to further confirm our findings.