Radiography

Editorial Board

2010-02-01

A focus on history: Ninety years of age and still going strong

Richard Price — 2010-02-01

Congratulations to the Society of Radiographers in reaching its 90th year. Radiography heralded in the year with the publication of a special on-line edition on aspects of the ‘History of Radiography’. This was published in December and ably edited by Pauline Reeves, one of our review editors and Peter Hogg, who is, of course, the immediate past Editor-in-Chief of Radiography. The edition includes articles on the early days of scanning, experiences of a radiographer in Normandy in the Second World War, oral history and early journal articles. Peter Hogg also pays a worthy tribute to Brian Bentley a past editor of this journal.

Therapeutic radiography at the crossroads

Hazel Colyer — 2010-02-01

As a radiographer who is also an education manager, I inhabit two very different worlds; the professional world of radiotherapy with its attendant task of supporting the development and delivery of world class cancer services, and the Human Resource (HR)-led world of workforce planning and development, where subsidiarity and locality-based commissioning are guiding principles. Looking at the present state of therapeutic radiography from these two, quite different, perspectives provides cold comfort for those who are committed to its on-going development as a profession.

Consultant radiographers – Does the profession want them?

Peter Ford — 2010-02-01

The concept of consultancy in the non-medical professions is becoming established and within radiography around 45 posts have been appointed since 2003. In addition a number of posts have been advertised but not appointed, and subsequently lost. Factors in this may be lack of evidence of the success of the roles or limited achievements of existing appointees, but it could also be a lack of imagination in the context of post creation and understanding of the roles by candidates for posts.

A comparison of kV and MV imaging in head and neck image guided radiotherapy

B. Devereux, J. Frantzis, T. Sisson, M. Jones, J. Martin, M. Middleton — 2010-02-01

Abstract: Purpose: To compare and assess kV and MV imaging modalities and their role in image guided radiotherapy (IGRT) for head and neck cancer patients.Method: Twelve patients receiving radical radiotherapy to the head and neck were analysed in this study. Six patients undertook MV daily online intervention and a further six patients undertook kV daily online intervention. Pre-intervention field placement data were collected from three separate observers' image match analysis for each patient. The radiotherapy collective involved in the daily online image match analysis formed the fourth observer in the study. The primary end point was to establish the difference in inter- and intra-observer variance between kV and MV imaging modalities.Results: The range of the standard deviations of systematic set-up error for MV imaging calculated was 1.47–2.33mm (MV) and 1.61–1.64mm (kV) for the right–left (RL), 2.10–2.17mm (MV) and 1.53–1.84mm (kV) for the cranio–caudal (CC) and 1.43–1.63mm (MV) and 1.02–1.11mm (kV) for the anterior–posterior (AP). The mean inter-observer variance was 0.21mm (MV) and 0.41mm (kV) for the RL, 0.53mm (MV) and 0.55mm (kV) for the CC and 0.23mm (MV) and 0.16mm (kV) for the AP direction. Intra-observer mean variance was in the order of 0.60mm (MV) and 0.16mm (kV) for the RL, 1.41mm (MV) and 0.05mm (kV) for the CC and 1.41mm (MV) and 0.08mm (kV) for the AP.Discussion: The data in this study suggest both inter- and intra-observer consistency across kV and MV imaging modalities were comparable. However, it is felt that the improved clarity and quality of kV imaging allows all observers to analyse images in a consistent manner, identifying and acting on potential field placement moves.Conclusion: The introduction of kV imaging has maintained the high levels of inter- and intra-observer consistency achieved with MV imaging. This in turn further enables positive verification outcomes and supports the implementation of potential reductions in action thresholds. The increased quality, clarity and field of view offered by kV imaging have established it as the method of choice for head and neck IGRT at Radiation Oncology Queensland.

Development and evaluation of a training program for therapeutic radiographers as a basis for online adaptive radiation therapy for bladder carcinoma

2010-02-01

Abstract: Aims: Online adaptive radiotherapy requires a new level of soft tissue anatomy recognition and decision making by therapeutic radiographers at the linear accelerator. We have developed a therapeutic radiographer training workshop encompassing soft tissue matching for an online adaptive protocol for muscle invasive bladder cancer. Our aim is to present the training program, and its evaluation which compares pre and post training staff soft tissue matching and bladder contouring using Cone Beam Computer Tomography (CBCT).Materials and Methods: Prior to commencement of an online adaptive bladder protocol, a staff training program for 33 therapeutic radiographers, with a separate ethics approved evaluation component was developed. A multidisciplinary training program over two days was carried out with a total of 11h of training, covering imaging technology, pelvic anatomy and protocol specific decision making in both practical and theoretical sessions. The evaluation included both pre training and post training testing of staff.Results: Pre training and post training, the standard deviations in the contoured bladder between participants in left–right direction were 0.64 vs 0.59cm, superior–inferior 0.89 vs 0.77cm and anterior–posterior direction was 0.88 vs 0.52cm respectively. Similarly the standard deviation in the volume contoured decreased from 40.7cc pre training to 24.5cc post training. Time taken in contouring was reduced by the training program (19.8 vs 17.2min) as was the discrepancy in choice of adaptive radiotherapy plans. The greatest reduction in variations in contouring was seen in staff whose pre training had the largest deviations from the reference radiation oncologist contours.Conclusion: A formalized staff training program is feasible, well received by staff and reduces variation in organ matching and contouring. The improvement was particularly noticed in staff who pre training had larger deviations from the reference standard.

Self-citation rates among medical imaging journals and a possible association with impact factor

Timothy P. Kurmis, Andrew P. Kurmis — 2010-02-01

Abstract: Purpose: Since conceptualisation in 1955, journal impact factors (IFs) have evolved as surrogate markers of perceived ‘quality’. However, no previous research has explored the relationship between IF and journal self-citation rate, which may inflate this measure. Given Radiography's ongoing push to achieve Medline and ISI database inclusion, this paper aimed to quantitatively explore the frequency of self-citation and correlate this with ISI-reported IF.Methods: A review of articles published in two peer-reviewed, Medline and ISI-listed, imaging journals (Radiology and Academic Radiology), and Radiography, within in a 12-month period, was performed. The total number of citations and self-citations per article was recorded, and the results compared. Basic statistical and correlation analyses between listed IF ratings and self-citation indices were also performed.Results & Discussion: To our knowledge, this work represents the preliminary investigation exploring the association between ISI-listed IF and self-citation frequency. From the current results it can be suggested that such a relationship does exist, as demonstrated by the strongly positive correlation statistic (Pearson's r2=0.99). Radiology was noted to have a considerably larger mean number of self-citations per article than the other two journals (p<0.01), despite near-equivalent numbers of references per article.Conclusion: Our findings suggest that there may be relationship between an ISI-listed IFs and journal self-citation rates. It is hoped that this paper will be of interest in academic and research circles, both within medical imaging and more widely, and may provide impetus for discussion relating to self-citation frequency and influence on resultant IF calculations.

A Delphi study on research priorities in radiation therapy: The Australian perspective

Jennifer Cox, Georgia Halkett, Claudia Anderson, Robert Heard — 2010-02-01

Abstract: Radiation therapists (RTs) need to engage more in research to establish an evidence base for their daily practice. However, RTs world-wide conduct little research themselves, although positive moves have been made in some countries.This project is the second stage of a Delphi process aimed at prioritising RT areas of research interest. A questionnaire was constructed using responses to a previous questionnaire which identified the research interests of Australian RTs. Fifty-three Research Areas were identified from these responses and grouped into 12 categories such as “imaging in radiation therapy”, “symptom management”, “accuracy of patient positioning” and “techniques/equipment”. The survey was sent to all Australian departments of radiation oncology, and RTs were asked to form interest groups to discuss and prioritise the Research Areas.There was a 50% response rate (18 of 36 departments surveyed). The highest ranked research Category was “imaging in radiation therapy”. Six of the top 10 ranked Research Areas were within Central RT practice (“imaging in radiation therapy”; “symptom management”; “accuracy of patient positioning” and “techniques/equipment”) and the other four were within broader RT practice (“diversification, recognition and other professional issues”; and “management and staff issues”). Patient Care was also considered to be an area requiring more research.This prioritization of Research Areas and categories provides a useful list of future research for RTs, which will enable them to decide whether their research ideas are a high priority, and spend less time deciding on a relevant research topic that needs investigation in their own workplaces.

Graduate radiographers' expectations for role development – The potential impact of misalignment of expectation and valence on staff retention and service provision

Keren Williamson, Lynn A. Mundy — 2010-02-01

Abstract: Purpose: The purpose of this study was to investigate the role development expectations of graduate radiographers with a view to predicting the potential impact of a misalignment of these expectations and valence on service delivery and staff retention. A final year cohort of radiography students completed a questionnaire designed to explore topics associated with role development opportunities.Method: Structured questionnaires, in the Likert scale format, utilised 20 attitude questions constructed to elicit information in relation to 3 main themes of investigation; expectation, valence and knowledge.Results: All participants (n=37) stated an expectation for role development opportunities with 97.3% (n=36) indicating that these expectations would be realised within 5 years of graduation and 75.7% (n=28) within 2 years of graduation. A significant correlation between expectation for role development and job satisfaction was seen (p<0.05). 81.1% (n=30) of participants stated turnover intentions in order to meet their expectations.Conclusion: There is an expectation for role development opportunities for new graduates with a valence noted of the intrinsic reward of meeting these expectations. Expectation and valence are seen to be intrinsically linked with job satisfaction suggesting that misalignment of these would have a potentially negative impact on motivation and retention of the future radiography workforce demonstrating a positive correlation with withdrawal behaviours, including turnover intentions. In a relatively small professional group such as radiography the phenomenon of group cohesion may be strong suggesting that withdrawal behaviours may manifest as ‘resignation in post’, impacting on the quality of care and service provision for patients.

Supporting socialisation in the transition to university: A potential use for on-line discussion boards

Leslie Robinson, Pauline Reeves, Fred Murphy, Peter Hogg — 2010-02-01

Abstract: Background: Promoting socialisation for students entering Higher Education is desirable on two grounds. In the first instance it facilitates the processes of student collaboration which, according to sociocultural pedagogies, is important for effective learning. Secondly, it provides a supportive social network, enhancing the student experience which is thought to reduce the risk of attrition. These two drivers provided the rationale for our work.Method: Using the Blackboard Virtual Learning Environment, two on-line discussion boards were used during the transition and induction period for the BSc (Hons) Diagnostic Radiography programme at the University of Salford. The aim was to facilitate socialisation between students about to embark on the programme and current students and staff. The use of discussion boards was evaluated using a mixed methods approach. Statistical data regarding postings was analysed. Posts and focus group comments were subject to content analysis.Results: The discussion boards were ‘hit’ 5718 times and there were 280 posts. A small number of students did not post any messages. There was evidence of the key features of on-line socialisation which were; establishing an identity; getting to know others; discovering and contributing to communication etiquette; and developing supporting and trusting relationships.Conclusion: The discussion boards were deemed a successful method of providing socialisation during transition and induction. There were some limitations with discussion board layout and functionality and a blog, with its chronological layout and capability to display visual cues such as emoticons may be more effective.The limited participation by some students may provide a means by which to identify ‘at-risk’ students before the start of the course and this would be an interesting area for further study.

Factors influencing students' choices in considering rural radiography careers at Makerere University, Uganda

2010-02-01

Abstract: Introduction: The Faculty of Medicine, Makerere University is the oldest health professions training institution in East Africa having started in 1924. The radiography degree course started in 2001 and Makerere remains the only institution in the East African region offering this degree course. The faculty adopted a Problem based Learning/Community based education curriculum in order to stimulate students' interests to consider working in rural areas. Attracting and retaining radiographers and other health professionals in rural areas is a recognized problem in Uganda and overseas and strategic actions to enhance the rural health workforce and its ability to deliver the required services are paramount. A range of factors in different domains can be associated with recruitment and retention. By consulting students, some of these factors can be identified and addressed.Methodology: It was a descriptive exploratory study involving 31 students. Data was collected through a questionnaire and focus group discussions.Results: 58% of the students reported that they would consider rural radiography practice while 42% would not. Key motivational factors cited to work in rural areas were; attractive salaries/incentives, community based training curricular, opportunities for further training and well equipped rural health facilities.Conclusion: This study has shown that students would consider working in rural areas provided the working conditions are improved upon.

Establishing rigour in qualitative radiography research

F.J. Murphy, J. Yielder — 2010-02-01

Abstract: The vast majority of radiography research is subject to critique and evaluation from peers in order to justify the method and the outcome of the study. Within the quantitative domain, which the majority of medical imaging publications tend to fall into, there are prescribed methods for establishing scientific rigour and quality in order to critique a study.However, researchers within the qualitative paradigm, which is a developing area of radiography research, are often unclear about the most appropriate methods to measure the rigour (standards and quality) of a research study. This article considers the issues related to rigour, reliability and validity within qualitative research. The concepts of reliability and validity are briefly discussed within traditional positivism and then the attempts to use these terms as a measure of quality within qualitative research are explored.Alternative methods for research rigour in interpretive research (meanings and emotions) are suggested in order to compliment the existing radiography framework that exists for qualitative studies. The authors propose the use of an established model that is adapted to reflect the iterative process of qualitative research. Although a mechanistic approach to establishing rigour is rejected by many qualitative researchers, it is argued that a guide for novice researchers within a developing research base such as radiography is appropriate in order to establish the credibility and trustworthiness of a qualitative study.

Imaging suspected cervical spine injury: Plain radiography or computed tomography? Systematic review

Gavin Cain, Jane Shepherdson, Vicki Elliott, Jon Svensson, Patrick Brennan — 2010-02-01

Abstract: Aim: (1) to establish which modality offers the greatest accuracy in the detection of cervical spine injury (CSI) Following trauma: plain radiography or computed tomography (CT), and (2) make an evidence-based recommendation for the initial imaging modality of choice.Method: A systematic literature review was performed to identify primary research studies which compare the diagnostic accuracy of plain radiography and CT with the results of a reference standard in the detection of CSI. A search of MEDLINE, EMBASE, CINAHL, Science Direct and Pubmed Central databases was conducted.Results: Ten studies were identified. Critical appraisal identified limitations among all studies. There was heterogeneity in the sensitivity estimates for plain radiography, whereas estimates for CT were consistently high. Examination of the reported sensitivities shows that CT outperforms plain radiography in the detection of CSI.Conclusion: CT is superior to plain radiography in the detection of CSI. However, the optimal imaging strategy depends on the patients' relative risk of injury. If at high-risk cervical CT is indicated. If at low-risk the increased cost and radiation exposure mean that screening CT may not be warranted, good-quality plain radiographs are sufficient.

A review of the issues surrounding three-dimensional computed tomography for medical modelling using rapid prototyping techniques

Richard Bibb, John Winder — 2010-02-01

Abstract: This technical note aims to raise awareness amongst radiographers of the application of Computed Tomography data in the production of models using Rapid Prototyping technologies. It also aims to provide radiographers with recommendations that will assist them in providing three-dimensional Computed Tomography data that can fulfil the requirements of medical modelling. Potential problem areas in data acquisition and transfer are discussed and suggestions are given for methods that aim to avoid these.

Potts disease: Diagnosis with magnetic resonance imaging

Jacqueline Pursey, Sharon Stewart — 2010-02-01

Abstract: The eponymously named Potts disease is a relatively rare form of Tuberculosis (TB) which affects the spine. TB of the spine is one of the earliest diseases known to man and in the 20th century was thought to be a disease which had been defeated by the advent of antitubercular drugs. Over the last two decades there have been several reports which indicate a revival of TB in both the developing and developed world. Factors which may be contributing to this are the spread of the HIV virus, increased immigration and the emergence of drug resistant strains of the TB bacteria. Potts disease has an insidious onset and often the radiographic findings are far advanced when a diagnosis is finally reached. MRI is able to detect changes to the vertebrae in Potts disease earlier than radiographs. This case report outlines the clinical presentation of a young male with Potts disease who was HIV negative, and the important role that MRI plays in diagnosis and therefore in appropriate and timely intervention. The typical magnetic resonance (MR) imaging features and the radiographic hallmarks of the disease will also be discussed.

Fetal Echocardiography

Gill Harrison — 2010-02-01

This specialist fetal echocardiography book, written by a Sonographer, would be useful for anyone undertaking fetal echocardiography examinations. It begins with a chapter on embryology and an overview of the fetal circulatory system. There is a chapter on technique, followed by chapters on a wide range of cardiac defects from AVSD to hypoplastic heart and cardiac masses. Most chapters cover the embryology of the defect, occurrence, ultrasound appearances, treatment, prognosis and associated abnormalities. Additional chapters on first trimester echocardiography, interventional techniques and a short introduction to 3D echocardiography are included at the end of the book. The text is supported by excellent colour diagrams and B-mode, spectral and colour Doppler ultrasound images.

Research issues in health and social care

Martin J. Benwell — 2010-02-01

David Cowan's book has an entirely appropriate title as this is a book that discusses research issues in health and social care. It is not an instruction manual, nor is it a ‘cookbook’ telling readers how to ‘do research’. Instead this is a book that highlights, often in great detail and with many examples, the current debates within research.