The effect of different statistical approaches on image quality data obtained from radiological examinations

IntroductionSelection of optimal image acquisition protocols in medical imaging remains a grey area, the superimposed use of the Likert scale in radiological image quality evaluations creates an additional challenge for the statistical analysis of image quality data.Using a simulation study, we have trialled a novel approach to analysing radiological image quality Likert scale data.MethodsA simulation study was undertaken where simulated datasets were generated based on the distribution of Likert scale values according to varying image acquisition protocols from a real dataset. Simulated Likert scale values were pooled in four different ways; the mean, median, mode and the summation of patient Likert scale values of which the total was assigned a categorical Likert scale value. Estimates of bias, MAPE and RMSPE were then calculated for all four pooling approaches to determine which method most accurately represented an expert's opinion.ResultsWhen compared to an expert's opinion, the method of summation and categorisation of Likert scale values was most accurate 49 times out of the 114 (43.0%) tests. The mean 28 times out of 114 (24.6%), the median 23 times out of 114 (20.2%) and the mode 17 times out of 114 (14.9%).ConclusionWe conclude that our method of summation and categorisation of Likert scale values is most often the best representation of the simulated data compared to the expert's opinion.Implications for practiceThere is scope to reproduce this simulation study with multiple observers to reflect clinical reality more accurately with the dynamic nature of multiple observers. This also prompts future investigation into other anatomical areas, to see if the same methods produce similar results.     

Experiences of radiographers working alone in remote locations: A Far North Queensland non-participant observational study

IntroductionRadiographers employed in remote locations such as Far North Queensland (FNQ) can face unique sets of challenges as they often perform radiographic and sonographic diagnostic imaging without onsite radiologists' services. Additionally, the majority of patients presenting to these sites are Indigenous for whom English may be their third language. This non-participant observational study observed two FNQ radiographers' interactions with patients and interprofessional staff, and the radiographers' ability to fit into the Indigenous community during routine radiographic and sonographic examinations which to date have received little attention.MethodsNon-participant observations and semi-structured interviews with radiographers were held at two FNQ hospitals. Consecutive radiographer–patient interactions were observed and recorded on checklists. Interviews were audio recorded and transcribed for thematic analysis.ResultsAcross both remote sites, 24 patients were observed as they underwent diagnostic imaging examinations, with the majority being Aboriginal or Torres Strait Islanders (n = 17/24 (70.8%). In total, eleven general radiography and sixteen ultrasound examinations were observed. Semi-structured interviews highlighted complex issues such as the need for radiographer communication in local dialect, ongoing interprofessional collaborations, overcoming the lack of radiologists' onsite support by providing radiographic reports directly to referring doctors and midwives, and isolation with regard to professional development opportunities.ConclusionsRadiographers working in remote hospitals need to be culturally competent, navigate local indigenous languages and possess excellent interprofessional skills as well as thorough knowledge of imaging pathology to convey findings to referring doctors and allied health professionals. These findings have implications for the entry to practice curriculum.Implications for practiceThis study provides evidence that culturally competent radiographers are capable of undertaking reporting roles to facilitate patient management in the absence of timely radiologists' reports at remote sites.     

Analysis of radiation exposure data from common radiological procedures in Dutch hospitals

IntroductionIn the Netherlands, Diagnostic Reference Levels (DRLs) have not been based on a national survey as proposed by ICRP. Instead, local exposure data, expert judgment and the international scientific literature were used as sources. This study investigated whether the current DRLs are reasonable for Dutch radiological practice.MethodsA national project was set up, in which radiography students carried out dose measurements in hospitals supervised by medical physicists. The project ran from 2014 to 2017 and dose values were analysed for a trend over time. In the absence of such a trend, the joint yearly data sets were considered a single data set and were analysed together. In this way the national project mimicked a national survey.ResultsFor six out of eleven radiological procedures enough data was collected for further analysis. In the first step of the analysis no trend was found over time for any of these procedures. In the second step the joint analysis lead to suggestions for five new DRL values that are far below the current ones. The new DRLs are based on the 75 percentile values of the distributions of all dose data per procedure.ConclusionThe results show that the current DRLs are too high for five of the six procedures that have been analysed. For the other five procedures more data needs to be collected. Moreover, the mean weights of the patients are higher than expected. This introduces bias when these are not recorded and the mean weight is assumed to be 77 kg.Implications for practiceThe current checking of doses for compliance with the DRLs needs to be changed. Both the procedure (regarding weights) and the values of the DRLs should be updated.     

Effectiveness of the 10-valent pneumococcal conjugate vaccine against radiographic pneumonia among children in rural Bangladesh: A case-control study

BackgroundPneumococcal conjugate vaccine (PCV) effectiveness against radiographic pneumonia in South Asia is unknown. Bangladesh introduced PCV10 in 2015 using a three dose primary series (3 + 0). We sought to measure PCV10 effectiveness for two or more vaccine doses on radiographic pneumonia among vaccine-eligible children in rural Bangladesh.MethodsWe conducted a matched case-control study over two years from 2015 to 2017 using clinic and community controls in three subdistricts of Sylhet, Bangladesh. Cases were vaccine eligible 3–35 month olds at Upazila Health Complex outpatient clinics with World Health Organization-defined radiographic primary endpoint pneumonia (radiographic pneumonia). Clinic controls were matched to cases within a one week time window by age, sex, and clinic and had an illness unlikely to be Streptococcus pneumoniae; community controls were healthy and similarly matched within a one week time window by age and sex, and distance from the clinic. We estimated adjusted vaccine effectiveness (aVE) using conditional logistic regression.ResultsWe matched 1262 cases with 2707 clinic and 2461 community controls. Overall, aVE using clinic controls was 21.4% (95% confidence interval, −0.2%, 38.4%) for ≥2 PCV10 doses and among 3–11 month olds was 47.3% (10.5%, 69.0%) for three doses. aVE increased with higher numbers of doses in clinic control sets (p = 0.007). In contrast, aVE using community controls was 7.6% (95% confidence interval, −22.2%, 30.0%) for ≥2 doses. We found vaccine introduction in the study area faster and less variable than expected with 75% coverage on average, which reduced power. Information bias may also have affected community controls.ConclusionsClinic control analyses show PCV10 prevented radiographic pneumonia in Bangladesh, especially among younger children receiving three doses. While both analyses were underpowered, community control enrollment – compared to clinic controls – was more difficult in a complex, pluralistic healthcare system. Future studies in comparable settings may consider alternative study designs.     

特发性正常压力脑积水的放射影像学研究进展

〔摘 要〕 特发性正常压力脑积水（iNPH）是一组以步态障碍、认知障碍和膀胱功能障碍为三联征表现的临床综合征。 经脑脊液分流手术后，iNPH 的临床症状可得到不同程度的改善，因而该病被认为是一种可治性痴呆。随着研究者们对该病 的进一步探索，iNPH 的放射影像学相关研究有了新的进展。本研究从脑室扩大的评估、脑网络变化和脑白质纤维变化这三 个方面对 iNPH 的放射影像学研究现状进行综述。     

X-ray operators' self-perceived competence,barriers and facilitators in general radiography practice in Western Australia

IntroductionAustralian X-ray operators (XROs) are health workers qualified with a limited radiography licence to perform basic radiography examinations in rural areas of Australia. However, no previous study explored Western Australian (WA) XROs' radiography practice. The purpose of this study was to investigate WA XROs’ self-perceived competence in the general radiography practice, and barriers and facilitators to their competence for determination of appropriate strategies to improve quality and safety of the radiographic service provided by them.MethodsInstitutional review board approval and informed consent from participants were obtained. Interviews were conducted with the WA XROs to obtain demographic information and identify their self-perceived competence in the general radiography practice, and the barriers and facilitators to their competence. A thematic analysis was used to analyse the interview data.ResultsA total of nine interviews were conducted (eight nurses and one paramedic). Participants indicated that they felt highly competent in patient care in radiography and adequately competent in the production of diagnostically acceptable images. The self-perceived barriers include overload of responsibilities, a lack of continuing professional development, and inadequacy of communication, support and XRO courses. The facilitators, post-qualification/course training, support in undertaking examinations, primary professional roles and a small population of the rural and remote areas were identified.ConclusionBased on interview data from nine WA XROs, the perception is that they have competence adequate for providing an acceptable quality radiographic service.Implications for practiceA continuous XRO course review, and provision of a video conference support channel, an online XRO networking forum and additional XROs and/or radiographers working with XROs undertaking the radiography examinations were perceived as the appropriate strategies to improve the WA XROs’ radiography practice. However, these require financial and/or managerial support from governments.