Radiography and research: A United Kingdom perspective

In the past two decades radiography has experienced a wealth of changes, involving the teaching site, learning methods, curriculum, professional status, educational funding, and public expectations. Consequently this period witnessed the transition of radiography from a mainly hospital-linked to a mainly university-linked degree, from a knowledge-based discipline to an evidence-based practice. The early 1990s saw the establishment of graduate programs, the role expansion of radiographers, the technological advancements in medical imaging, the participation of the Radiography Schools in Research Assessment Exercise (RAE) schemes.Given the educational, technological and social advancements the engagement of radiographers in research is emphasized as a priority that will bring the profession forward and help to maintain high standards of patient care.Research in radiography is a requirement, as by definition professions are expected to contribute to the body of knowledge necessary for a profession to progress. Funding, ethical considerations, mentorship, proficiency in research methodology, commitment, and ability to work in a multi-disciplinary team are just a few of the requirements for high quality radiography research.There has been a definite increase in the number of radiographers who are research aware and active as well as in the number of radiographers who pursue purely academic and research careers. However intensification of personal efforts and formulation of strategic decisions are required so that research forms an integral part of the profession. Recent developments in strengthening the research base of radiography are encouraging.     

Development and challenges of a new academic discipline, radiography science

Aim

The purpose of this article is to describe and discuss the development and challenges faced by radiography science as a new academic discipline.

Background

New academic disciplines develop continually from different circumstances and for different purposes. As they develop, they are faced with the challenge of justifying their status as independent academic disciplines in various ways. Radiography science is one of the youngest disciplines among health sciences in Finland, challenged by the academic community, society and clinical practice.

Conclusions

Radiography science in Finland has already shown considerable development and achieved many substantial and structural criteria set for independent academic disciplines. However, resources are still very limited and the profile of radiography science needs to be clarified. Challenges should be considered as inspirational opportunities and takeoff for the development of radiography science nationally and internationally.     

Radiography doctorates in Arabia: Current position and opportunities to transform research practice in the Middle East

IntroductionDespite the existence of opportunities for postgraduate studies in radiography, the number of radiographers involved in postgraduate education is low and their research production is also considered low compared to other professions. The main aim of this study was to understand the profile of radiography Doctorate holders across the Arab countries, document their current role and identify barriers that may influence research and professional publication activity.MethodsThere is no formal database of doctoral radiographers in Arab countries, therefore a snowball sampling technique was used to recruit participants beyond those identified through organizational websites. An online survey was distributed to the participants with implied consent being applied through completion of the survey.ResultsFrom 53 responses, 78% were male and 98% were diagnostic radiographers. Fifty-one percent completed their PhD in non-Arab countries and 55% self-funded (paid for themselves) their PhD study. An increase in doctoral students was observed over time, where 36% (n = 19) of participants will graduate in 2020 and afterward. Barriers reported as preventing radiographers pursuing research/publication were support, employing institutions, lack of research focussed leadership and lack of collaboration.ConclusionGovernment support and direction from national professional bodies is needed. To enable research growth, there must be a foundational component within pre-registration/licensing education.Implications for practiceFocussing on government or professional body supported projects that are divided into smaller linked investigations can provide foundational work for PhD development. It is through these opportunities that practitioner research enhancement and capability is improved. Potential Arabian regional and wider international collaborations should be pursued in future as a developmental approach.     

Patient safety in medical imaging: A joint paper of the European Society of Radiology (ESR) and the European Federation of Radiographer Societies (EFRS)

The fundamental professional roles of radiographers and radiologists are focused on providing benefit to patients with our skills, while maintaining their safety at all times. There are numerous patient safety issues in radiology which must be considered. These encompass: protection from direct harm arising from the techniques and technologies we use; ensuring physical and psychological well-being of patients while under our care; maintaining the highest possible quality of service provision; and protecting the staff to ensure they can deliver safe services. This paper summarises the key categories of safety issues in the provision of radiology services, from the joint perspectives of radiographers and radiologists, and provides references for further reading in all major relevant areas. This is a joint statement of the European Society of Radiology (ESR) and the European Federation of Radiographer Societies (EFRS), published simultaneously in Insights into Imaging [DOI: https://doi.org/10.1186/s13244-019-0721-y] and Radiography [DOI: https://doi.org/10.1016/j.radi.2019.01.009].     

Awareness of radiation protection and dose levels of imaging procedures among medical students,radiography students,and radiology residents at an academic hospital: Results of a comprehensive survey

PurposeTo evaluate the awareness of radiation protection issues and the knowledge of dose levels of imaging procedures among medical students, radiology residents, and radiography students at an academic hospital.Material and methodsA total of 159 young doctors and students (including 60 radiology residents, 56 medical students, and 43 radiography students) were issued a questionnaire consisting of 16 multiple choice questions divided into three separated sections (i.e., demographic data, awareness about radiation protection issues, and knowledge about radiation dose levels of common radiological examinations).ResultsMedical students claimed to have at least a good knowledge of radiation protection issues more frequently than radiology residents and radiography students (94.4% vs 55% and 35.7%, respectively; P < 0.05), with no cases of perceived excellent knowledge among radiography students. However, the actual knowledge of essential radiation protection topics such as regulations, patient and tissue susceptibility to radiation damage, professional radiation risk and dose optimisation, as well as of radiation doses delivered by common radiological procedures was significantly worse among medical students than radiology residents and radiography students (P < 0.05). Those latter significantly outperformed radiology residents as to knowledge of radiation protection issues (P < 0.01). Overall, less than 50% of survey respondents correctly answered all questions of the survey.ConclusionsRadiology residents, radiography students and medical students have a limited awareness about radiation protection, with a specific gap of knowledge concerning real radiation doses of daily radiological examinations. Both undergraduate and postgraduate teaching needs to be effectively implemented with radiation safety courses.     

Antero-posterior (AP) pelvis x-ray imaging on a trolley: Impact of trolley design,mattress design and radiographer practice on image quality and radiation dose

IntroductionPhysical and technical differences exist between imaging on an x-ray tabletop and imaging on a trolley. This study evaluates how trolley imaging impacts image quality and radiation dose for an antero-posterior (AP) pelvis projection whilst subsequently exploring means of optimising this imaging examination.MethodsAn anthropomorphic pelvis phantom was imaged on a commercially available trolley under various conditions. Variables explored included two mattresses, two image receptor holder positions, three source to image distances (SIDs) and four mAs values. Image quality was evaluated using relative visual grading analysis with the reference image acquired on the x-ray tabletop. Contrast to noise ratio (CNR) was calculated. Effective dose was established using Monte Carlo simulation. Optimisation scores were derived as a figure of merit by dividing effective dose with visual image quality scores.ResultsVisual image quality reduced significantly (p < 0.05) whilst effective dose increased significantly (p < 0.05) for images acquired on the trolley using identical acquisition parameters to the reference image. The trolley image with the highest optimisation score was acquired using 130 cm SID, 20 mAs, the standard mattress and platform not elevated. A difference of 12.8 mm was found between the image with the lowest and highest magnification factor (18%).ConclusionThe acquisition parameters used for AP pelvis on the x-ray tabletop are not transferable to trolley imaging and should be modified accordingly to compensate for the differences that exist. Exposure charts should be developed for trolley imaging to ensure optimal image quality at lowest possible dose.     

Distributed Web-supported radiology clerkship for the required clinical clerkship year of medical school: development,implementation, and evaluation

RATIONALE AND OBJECTIVES: The authors performed this study to develop, implement, and evaluate a new radiology clerkship for the required clinical clerkship year of medical school. MATERIALS AND METHODS: A mandatory radiology clerkship experience was added to the required clinical clerkships as a series of 10 independent half-day teaching sessions. These sessions were distributed as one session per existing clerkship throughout the year. To provide continuity and organization, Web-based curriculum materials were designed and implemented as a component of the radiology clerkship. The new clerkship was evaluated with observations, pretest and posttest measures with a control group, structured and unstructured student and faculty surveys, and individual and small group interviews. RESULTS: The clerkship was successfully developed and implemented. Ninety-five students have completed the clerkship. Their mean posttest score (84.8) was significantly higher than their mean pretest score (58.8, P < .001) and the mean control group score (59.7, P < .001). Students rarely used the Web site. Disadvantages of the distributed clerkship were identified. CONCLUSION: A radiology clerkship distributed among existing clerkships is feasible but has many disadvantages. Students greatly prefer live instruction, and Web-based educational materials are more valuable to faculty and administrators than to students.     

Chronic fatigue and immune deficiency syndrome (CFIDS), cellular metabolism,and ionizing radiation: a review of contemporary scientific literature and suggested directions for future research

Purpose: To investigate biochemical pathways known to be involved in radiation response and in CFIDS to determine if there might be common underlying mechanisms leading to symptoms experienced by those accidentally or deliberately exposed to radiation and those suffering from CFIDS. If such a link was established to suggest testable hypotheses to investigate the mechanisms with the aim of identifying new therapeutic targets.

Conclusions: Evidence for involvement of the alpha-synuclein, cytochrome c oxidase, αB-crystallin, RNase L, and lactate dehydrogenase/STAT1 pathways is strong and suggests a common underlying mechanism involving mitochondrial dysfunction mediated by ROS and disruption of ATP production. The downstream effect of this is compromised energy production. Testable hypotheses are suggested to investigate the involvement of these pathways further.     

Initiatives for education,training, and dissemination of morbidity assessment and reporting in a multiinstitutional international context: Insights from the EMBRACE studies on cervical cancer

In 2008, the GEC ESTRO Gyn network launched the first multiinstitutional, observational, and prospective international study on MRI-guided brachytherapy in locally advanced cervical cancer patients (EMBRACE-I). EMBRACE-I was followed by EMBRACE-II from 2016 and ongoing. Among the aims of the EMBRACE studies are to benchmark morbidity outcomes and develop dose-volume effects and predictive models for morbidity. The EMBRACE studies collect both physician (CTCAE v.3) and patient (EORTC QLQ-C30/CX24) reported outcomes, including baseline information, in a regular follow-up schedule. The EMBRACE studies feature high numbers of patients (EMBRACE-I N = 1416, EMBRACE-II N = 1500 expected) enrolled from many institutions worldwide (EMBRACE-I n = 23, EMBRACE-II n = 45). This large-scale multiinstitutional approach offers a unique opportunity to investigate and develop new strategies for improving the quality of assessment and reporting of morbidity.This report presents an overview of the challenges and pitfalls regarding the assessment and reporting of morbidity encountered during more than a decade of development and research activities within the EMBRACE consortium.This includes the recognition and evaluation of inconsistencies in the morbidity assessment, and consequently, the provision of assistance and training in the scoring procedure to reduce systematic assessment bias.In parallel, a variety of methodological approaches were tested to comprehensively summarize morbidity outcomes, and a novel approach was developed to refine dose-effect models and risk factor analyses.The purpose of this report is to present an overview of these findings, describe the learning process, and the strategies that have consequently been implemented regarding educational activities, training, and dissemination.     

(68)Ga-labeled DOTA-peptides and (68)Ga-labeled radiopharmaceuticals for positron emission tomography: current status of research, clinical applications, and future perspectives

In this review we give an overview of current knowledge of (68)Ga-labeled pharmaceuticals, with focus on imaging receptor-mediated processes. A major advantage of a (68)Ge/(68)Ga generator is its continuous source of (68)Ga, independently from an on-site cyclotron. The increase in knowledge of purification and concentration of the eluate and the complex ligand chemistry has led to (68)Ga-labeled pharmaceuticals with major clinical impact. (68)Ga-labeled pharmaceuticals have the potential to cover all today's clinical options with (99m)Tc, with the concordant higher resolution of positron emission tomography (PET) in comparison with single photon emission computed tomography. (68)Ga-labeled analogs of octreotide, such as DOTATOC, DOTANOC, and DOTA-TATE, are in clinical application in nuclear medicine, and these analogs are now the most frequently applied of all (68)Ga-labeled pharmaceuticals. All the above-mentioned items in favor of successful application of (68)Ga-labeled radiopharmaceuticals for imaging in patients are strong arguments for the development of a (68)Ge/(68)Ga generator with Marketing Authorization and thus to provide pharmaceutical grade eluate. Moreover, now not one United States Food and Drug Administration-approved or European Medicines Agency-approved (68)Ga-radiopharmaceutical is available. As soon as these are achieved, a whole new radiopharmacy providing PET radiopharmaceuticals might develop.     

Detection of masses and microcalcifications of breast cancer on digital mammograms: comparison among hard-copy film, 3-megapixel liquid crystal display (LCD) monitors and 5-megapixel LCD monitors: an observer performance study

The purpose of the study was to compare observer performance in the detection of masses and microcalcifications of breast cancer among hard-copy reading and soft-copy readings using 3-megapixel (3M) and 5-megapixel (5M) liquid crystal display (LCD) monitors. For the microcalcification detection test, we prepared 100 mammograms: 40 surgically verified cancer cases and 60 normal cases. For the mass detection test, we prepared 100 mammograms: 50 cancer cases and 50 normal cases. After six readers assessed both microcalcifications and masses set for each modality, receiver operating characteristic (ROC) analysis was performed. The average A_zs for mass detection using a hard copy and 3M and 5M LCD monitors were 0.923, 0.927 and 0.920, respectively; there were no significant differences. The average A_z for microcalcification detection using hard copy, 3M and 5M LCD monitors was 0.977, 0.954 and 0.972, respectively. There were no significant differences, but the P-values between the hard copy and 3M LCD monitor and that between the 3M and 5M LCD monitor were 0.08 and 0.09, respectively. In conclusion, the observer performances for detecting masses of breast cancers were comparable among the hard copy and two LCD monitors; however, soft-copy reading with a 3M LCD monitor showed slightly lower observer performance for detecting microcalcifications of breast cancers than hard-copy or 5M LCD monitor reading.     

A pilot primary school active break program (ACTI-BREAK): Effects on academic and physical activity outcomes for students in Years 3 and 4

Objectives

To assess the feasibility and efficacy of a 6-week pilot active break program (ACTI-BREAK) on academic achievement, classroom behaviour and physical activity.

PET radiopharmaceuticals in Europe: Current use and data relevant for the formulation of summaries of product characteristics (SPCs)

The increasing use of radiopharmaceuticals for positron emission tomography (PET) has come to the attention of regulatory bodies. In order to help authorities in all aspects, the EANM has formed a task group for licensing PET radiopharmaceuticals; this group has surveyed the use of these compounds in Europe by a questionnaire. The number of PET centres that responded to the questionnaire was 26, which included more than 90% of the larger European PET centres. The survey showed that 2-[¹⁸F]fluoro-2-deoxyglucose is by far the most important PET radiopharmaceutical with more than 200 applications per week, followed by [¹⁵O]water, [¹⁵O]carbonmonoxide, [¹³N]ammonia, [¹¹C]-l-methionine, andl-6-[¹⁸F]fluoro-DOPA. More than 25 other PET radiopharmaceuticals are in regular use, however, at rather low application frequencies. The data were used by the European Pharmacopoeia Commission for its priority rating for requesting the formulation of monographs. Since it is likely that group registrations will be issued by authorities for the PET radiopharmaceuticals, relevant data on toxicity and dosimetry for the formulation of summaries of product characteristics have been collected by the task group as well.