The role of conventional radiography to assess the outcome of oncologic skeletal reconstructions of lower limbs aided by vascularized fibular autograft

IntroductionVascularized fibular autografts (VFA) are used in the oncologic skeletal reconstructions of long bones, alone or combined with massive bone allografts (MBA). Data regarding the role of imaging in assessing these complex skeletal reconstructions are lacking, and have mainly focused on Computed Tomography (CT). Our aim was to evaluate if early conventional radiography (CR) findings are correlated with the outcome of these skeletal reconstructions.Materials and methodsAll consecutive patients who underwent oncologic resection of lower limbs long bones followed by VFA reconstruction were included in this single-center retrospective study. We compared the CR obtained immediately after surgery with the CR at the 6-month control, as well as the CR at 6 months with the CT at 6 months when available. The following scores were assigned to the VFA: 0 (unchanged), 1 (osteopenia-cortical bone thinning), 2 (increase in bone density-cortical thickening). We then investigated whether this score correlated with the implant outcome within 12 months (optimal integration, suboptimal integration, integration requiring further surgery or lack of integration) using Kaplan-Meier and Cox regression analyses, considering the occurrence of integration and the duration time before the surgical removal of the whole bone reconstruction.ResultsForty-five patients were included (32 men [71.1%], mean age 14.6 years), 26 affected by osteosarcoma, 14 by Ewing sarcoma, 3 by adamantinoma and 2 operated for the failure of previous reconstructions for bone sarcoma. VFA changes on 6-month CR were significantly associated with optimal integration of the implants (log-rank P = 0.0137, multivariate Hazard ratio = 7.62, 95% confidence interval = 1.13–51.25). None of the other clinical and surgical features were associated with the implant outcome. The findings on 6-month CR and CT follow-up were not significantly different. CT at 6 months was available in 36 patients (80.0%).ConclusionThe assessment of VFA morphological changes on CR performed at 6 months can predict the outcome of the skeletal implant. This data should be considered for clinical decision-making, selecting patients requiring additional images (CT), and possible subsequent revision surgical procedures.     

Writing your first paper: An informal guide for medical radiation sciences professionals*

Writing and submitting a paper can be a daunting prospect, especially the first time. One of the more challenging aspects is knowing how to begin. Countless projects in the workplace never make it past local dissemination or conference presentation. This informal guide will help you take that next step and begin the peer-reviewed publication journey.     

Evaluation of X-ray table mattresses for radiation attenuation and impact on image quality

IntroductionMattresses in the radiology department tend to be an overlooked aspect of imaging equipment. This paper evaluates the radiation attenuation characteristics of mattresses and the effect they have on image quality.MethodsThirteen mattresses (from new to 20 years of age) were evaluated. Incident air kerma (IAK) was measured in two conditions, with and without mattress over a range of exposure factors using a digital dosimeter. Image quality was assessed by calculating the inverse image quality factor (IQF_inv) using a commercially available phantom (CDRAD) for the same exposure factors. The correlation of age and attenuation and image quality was calculated.ResultsMeasured IAK and image quality was affected by the addition of a mattress with older mattresses having greater attenuation; there is a moderate/large correlation (0.38–0.51) between age and IAK. IQF_inv deteriorated with the addition of a mattress but there was no correlation with age (?0.41 to 0.16). Clinically, there is no impact of any mattress in the study as changes to the exposure factors to account for the attenuation are smaller than the increments in mAs available on X-ray equipment.ConclusionThe results indicate that while the presence of a mattress does impact on transmitted radiation and the quality of the image, the clinical impact is insignificant. Attenuation correlates with age but with no clinical significance. There is no correlation between age and image quality.Implications for practiceQuality control tests for attenuation and impact on image quality are not required in clinical practice. The method could be used by manufacturers to test new materials and mattresses and could provide users with specifications of new products.     

Nuclear medicine image interpretation by radiographers: Findings of an accredited postgraduate module

Introduction

The study aimed to analyse the results of radiographer's image interpretation of nuclear medicine (NM) examinations following a nine-month postgraduate module.

Formative feedback in the clinical practice setting: What are the perceptions of student radiographers?

The role of feedback to a learner's development has been well established. There is an absence of studies relating to student radiographers experience of gaining and applying formative feedback. This study investigated processes involved in gaining written formative feedback in the clinical practice setting as well as the impact feedback had on student radiographers learning.The data was collected from radiography students at two higher education institutions by electronic questionnaire comprising scaled and open questions. There was a response rate of 37% (n = 103/279). Scaled data was analysed using inferential statistics and the qualitative data helped explain the findings.The majority of students recognised radiographers were frequently busy; resulting in feedback that is generic and not always timely. There is strength of opinion 82.6% (n = 85/103) that student radiographers do not work with any one radiographer consistently enough to enable the provision of constructive and meaningful feedback. There appears to be difficulty in obtaining the comments but the evidence shows they are valued.The majority of students seek feedback that is specific and will clearly identify areas for development. They reflect on feedback as well as use self-criticism of their practice performance indicating the development of autonomous skills.The challenge of enabling consistent one to one working with radiographers, the need to maximise a learning culture within practice environments and ensuring full engagement by radiographers and students could be addressed by modification of the feedback system, a working group being formed from students, supervising radiographers and academic tutors.