Radiography RSS feed: Current Issue. Radiography is an international, English language, peer-reviewed journal of radiographic imaging and radiation therapy. Radiography is the official professional journal of the Society and College of Radiographers and is published quarterly by Elsevier Ltd. Radiography aims to publish the highest quality clinical scientific and educational material, on all aspects of radiographic imaging (to include diagnostic radiography, computed tomography, nuclear medicine, sonography and magnetic resonance imaging) and all aspects of radiation therapy (to include patient care, dosimetry, treatment planning, verification, treatment delivery and oncology). Radiography includes original research, novel review articles, technical analyses, evaluations and case studies. In addition it provides a forum for the exchange of information and views on all matters related to the profession of radiography. Radiography promotes excellence in the profession of radiography by its commitment to the publication of original research, encouragement and dissemination of best clinical, scientific and educational practice and support for education. http://www.radiographyonline.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Radiography1078-8174182May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.radiographyonline.com/article/PIIS1078817412000132/abstract?rss=yesEditorial Board10.1016/S1078-8174(12)00013-2Radiography 18, 2 (2012)2012-05-01Radiography2012-05-01182S1078-8174(12)X0002-6iiiihttp://www.radiographyonline.com/article/PIIS1078817412000089/abstract?rss=yesAs a peer-reviewed journal seeking to publish research findings we depend upon our reviewers to give an objective and unbiased assessment of the articles they are invited to review. Clearly then reviewers play a fundamental role and without their expert input we would have no benchmark of originality and rigour of the research submitted. In this edition Julie Nightingale and Gill Marshall in their interesting and informative article explore citation analysis as a measurement of article quality. As opposed to the role of reviewers, citation analysis can only occur once an article has been published for some time and cited by other authors. The number of times an article is cited over a given period gives an indication of its impact although the citation count is not always a reliable indicator as the two authors point out.Research assessmentRichard Price10.1016/j.radi.2012.03.001Radiography 18, 2 (2012)2012-05-01Radiography2012-05-01182S1078-8174(12)X0002-6Editorial5959http://www.radiographyonline.com/article/PIIS1078817411001374/abstract?rss=yesAbstract: The research-related performance of universities, as well as that of individual researchers, is increasingly evaluated through the use of objective measures, or metrics, which seek to support or in some cases even replace more traditional methods of peer review. In particular there is a growing awareness in research communities, government organisations and funding bodies around the concept of using evaluation metrics to analyse research citations. The tools available for ‘citation analysis’ are many and varied, enabling a quantification of scientific quality, academic impact and prestige. However there is increasing concern regarding the potential misuse of such tools, which have limitations in certain research disciplines.This article uses ‘real world’ examples from radiography research and scholarship to illustrate the range of currently available citation analysis tools. It explores the academic debate surrounding their strengths and limitations, and identifies the potential impact of citation analysis on the radiography research community.The article concludes that citation analysis is a valuable tool for researchers to use for personal reflection and research planning, yet there are inherent dangers if it is used inappropriately. Whilst citation analysis can give objective information regarding an individual, research group, journal or higher education institution, it should not be used as a total substitute for traditional qualitative review and peer assessment.Citation analysis as a measure of article quality, journal influence and individual researcher performanceJulie M. Nightingale, Gill Marshall10.1016/j.radi.2011.10.044Radiography 18, 2 (2012)2011-11-28Radiography2011-11-28182S1078-8174(12)X0002-6Original Articles6067http://www.radiographyonline.com/article/PIIS1078817411001696/abstract?rss=yesAbstract: Radiotherapy plays an important role in the treatment of Breast Cancer and thus far wedged Tangential pairs (WTP) is accepted as the gold standard. However due to greater knowledge of side effects, an interest for increased homogeneity and protection of the Heart has increased. Step and shoot IMRT (S&S) is thought to be the key to this.Purpose: To compare 3D WTP against S&S plans for Breast Radiotherapy.Method: For a feasibility study, analysis was carried out on five CT Breast data sets. The data was copied and anonymised and were retrospectively planned, firstly by WTP, and secondly by S&S. The two techniques were compared via Dose Volume Histograms (DVH).Results: When comparing V95 averages the TWP gave 97.4% coverage versus 96.2% for S&S, For V105, V110 and V115 volumes were recorded as18%, 5%, and 0.2% respectively for TWP, and 7% V105, and 0% V110 and V115 for S&S. Comparison of OAR doses revealed, on average Lung V20, V5 and Heart V13 of 4.6%, 7.6% and 1.18% respectively for TWP and. 4.2% (V20), 7.4% (V5) and 0.08% for Heart V13 for S&S.Conclusions: For V95 and hot spots the S&S planning method proved more consistent and did not yield extra dose to the lungs. In both of the planning methods the Heart received dose reduction lower than anticipated. Partially this is envisaged to be due to contouring issues and the inclusion of OARs in the defined fields. The small sample size may have also contributed to these lower than expected reductions, nevertheless any method which offers a reduction, however small, should be offered.3D tangential wedge pair radiotherapy planning versus 3D forward planned IMRT for breasts in the reduction of hot spots and cardiac doses. (A feasibility study)R. Rowse10.1016/j.radi.2011.12.002Radiography 18, 2 (2012)2012-01-13Radiography2012-01-13182S1078-8174(12)X0002-6Original Articles6873http://www.radiographyonline.com/article/PIIS1078817412000041/abstract?rss=yesAbstract: Carbon fibre has become the material of choice for many radiotherapy accessories, as it is lightweight, radio-translucent and rigid. Unfortunately specialised equipment is required to manufacture devices from it and hence these tend to be expensive. Also carbon fibre is conducting which limits its compatibility with MRI. Other composite materials have now become available that are rigid and lightweight and may be equally radio-translucent. Here we describe the use, in radiotherapy, of such a composite made of polypropylene and fibre glass (PFGC) that is MRI compatible. We measured the 6 MV x-ray transmission and build-up properties of 2.5 cm thick panels made of either carbon fibre or PFGC. They are found to have equivalent x-ray transmission properties, varying from about 0.98 at perpendicular incidence to about 0.96 at 60° oblique incidence. The build-up dose was found to be approximately 82% of the maximum dose. We also demonstrate the use of PFGC as a flat couch top for MRI scanners and as a head board for shell immobilisation devices.The use of an advanced composite material as an alternative to carbon fibre in radiotherapyK.A. Langmack10.1016/j.radi.2012.02.001Radiography 18, 2 (2012)2012-02-27Radiography2012-02-27182S1078-8174(12)X0002-6Original Articles7477http://www.radiographyonline.com/article/PIIS1078817412000028/abstract?rss=yesAbstract: Aims: This article aims to explore the ways in which diagnostic radiographers use distancing as a tool for emotional management in radiography practice.Methods: This review utilises data from oral history interviews undertaken as part of a larger study documenting the oral history of the diagnostic radiography profession in the United Kingdom as recounted by 24 participants.Results: The results are presented as illustrative of various aspects of the role of the diagnostic radiographer including the initial choice of diagnostic radiography as a profession, the endemic use of particular terminology, the nature of the encounter in diagnostic radiography (including that of sectional imaging) and whether the role is really patient-centred.Conclusions: The article concludes by suggesting that distancing from the patient is mediated by the need for physical touch in order to position the patient for radiography and also makes the suggestion that those opting for diagnostic radiography as a career may do so because they want a profession which is more distanced from the patient and that, even where this is not the case initially, individuals are socialised into adopting the ‘feeling rules’ of the profession. The article concludes by outlining potential areas for further research.Diagnostic radiography: A study in distancingPauline J. Reeves, Sola Decker10.1016/j.radi.2012.01.001Radiography 18, 2 (2012)2012-02-16Radiography2012-02-16182S1078-8174(12)X0002-6Original Articles7883http://www.radiographyonline.com/article/PIIS1078817411000964/abstract?rss=yesAbstract: Children’s experience of radiographic examinations remains largely unexplored, although most radiographers examine children on a daily basis. In order to provide the high quality care that meets the needs of patients it was considered important to undertake research focused upon the patients’ experience of radiographic practice.The aim of the study was to investigate children’s experiences undergoing a radiographic examination for a suspected fracture.Inclusion criteria were Swedish-speaking children between 3 and 15 years of age who were submitted for a radiographic examination with an acute condition of the upper or lower extremity. Patients were informed of the study and together with the escorting parent or relative asked for consent to participate.During the examination the child was videotaped and immediately after, the child was interviewed in a nearby facility. The interview contained open-ended questions and was conducted while watching the videotape together with the child and their parent or relative and the researcher.Qualitative content analysis was used in analyzing the collected data. The analysis resulted in two categories – “feeling uncomfortable” and “feeling confident”. The subcategories contained in these categories were “pain in relation to injury and examination”, “the waiting time is strenuous”, “worries for the future and consequences of the injury”, “confidence in parental presence”, “confidence in radiographic staff and examination procedure”, and finally “recognition entails familiarity”.The results revealed that for the younger children, the experience of undergoing an acute radiographic examination was associated with pain and anxiety, but for the older children, the anxiety was more connected to whether the injury had caused a fracture and any anticipated future consequences or complications.Children’s experience of going through an acute radiographic examinationB. Björkman, L. Almqvist, B. Sigstedt, K. Enskär10.1016/j.radi.2011.10.003Radiography 18, 2 (2012)2011-11-04Radiography2011-11-04182S1078-8174(12)X0002-6Original Articles8489http://www.radiographyonline.com/article/PIIS1078817411000629/abstract?rss=yesAbstract: Rationale and Objectives: In Emergency Departments (ED) junior doctors regularly make diagnostic decisions based on radiographic images. This study investigates whether collaboration between junior doctors and radiographers impacts on diagnostic accuracy.Materials and Methods: Research was carried out in the ED of a university teaching hospital and included 10 pairs of participants. Radiographers and junior doctors were shown 42 wrist radiographs and 40 CT Brains and were asked for their level of confidence of the presence or absence of distal radius fractures or fresh intracranial bleeds respectively using ViewDEX software, first working alone and then in pairs. Receiver Operating Characteristic was used to analyze performance. Results were compared using one-way analysis of variance.Results: The results showed statistically significant improvements in the Area Under the Curve (AUC) of the junior doctors when working with the radiographers for both sets of images (wrist and CT) treated as random readers and cases (p ≤ 0.008 and p ≤ 0.0026 respectively). While the radiographers’ results saw no significant changes, their mean Az values did show an increasing trend when working in collaboration.Conclusion: Improvement in performance of junior doctors following collaboration strongly suggests changes in the potential to improve accuracy of patient diagnosis and therefore patient care. Further training for junior doctors in the interpretation of diagnostic images should also be considered. Decision making of junior doctors was positively impacted on after introducing the opinion of a radiographer. Collaboration exceeds the sum of the parts; the two professions are better together.Collaboration between radiological technologists (radiographers) and junior doctors during image interpretation improves the accuracy of diagnostic decisionsB.S. Kelly, L.A. Rainford, J. Gray, M.F. McEntee10.1016/j.radi.2011.06.002Radiography 18, 2 (2012)2011-07-15Radiography2011-07-15182S1078-8174(12)X0002-6Original Articles9095http://www.radiographyonline.com/article/PIIS1078817411001325/abstract?rss=yesAbstract: This paper outlines The College of Radiographers 39th Welbeck Memorial Eponymous Lecture presented at United Kingdom Radiological Congress in 2010. The presentation considered the future of radiography practice and how that future might be influenced. The presentation was structured into 4 sections: approaches to predicting the future; use of imaging techniques and technologies; 2025 - our future; a roadmap to our future. With an emphasis on the business sector the first section considers traditional and creative ways of predicting the future; some examples of predicting the future are taken from radiography. Using specific examples from radiographic practice the second section attempts to determine whether imaging technologies and radiography techniques are optimised and whether clinical decision making is based upon research evidence. In this section consideration is also given to the temporal relationship between the introduction of new equipment, the research that supports its use and the skills required to work with it. The third section is short and it contains general predictions about what 2025 may look like. The final section proposes briefly how the radiographic profession might move forward into the future we would wish to exist.Bash bash bash – It almost fits perfectly now. College of Radiographers 39th Welbeck Memorial LecturePeter Hogg10.1016/j.radi.2011.10.039Radiography 18, 2 (2012)2011-11-18Radiography2011-11-18182S1078-8174(12)X0002-6Original Articles9699http://www.radiographyonline.com/article/PIIS1078817411000721/abstract?rss=yesAbstract: Introduction: The purpose of this study was to investigate the impact that geographic ancestry and body size have on ultrasonographic measurements of the ulnar nerve size measured at the elbow.Materials and methods: We performed anthropometric measurements of body size and ultrasonographic measurements of the ulnar nerve at the elbow on 13 Vietnamese and 24 European participants. Regression analysis was used to determine the effect of body size and geographic ancestry on ulnar nerve size.Results: BMI had the greatest impact on ulnar nerve size. The short axis diameter was least resilient, and the long axis diameter was the most resilient to the effects of body size and geographic ancestry.Discussion: The long axis diameter has an apparent immunity to the influences of overall body size, arm size, or geographic ancestry and has the most potential as a sensitive discriminator between normal nerves and nerves affected by ulnar neuropathy at the elbow.Impact of ancestry and body size on sonographic ulnar nerve dimensionsJessie T. Childs, Maureen Phillips, Kerry A. Thoirs10.1016/j.radi.2011.08.002Radiography 18, 2 (2012)2011-08-29Radiography2011-08-29182S1078-8174(12)X0002-6Original Articles100104http://www.radiographyonline.com/article/PIIS1078817411000733/abstract?rss=yesAbstract: Introduction and purpose: Despite the United Kingdom College of Radiographers aspiration that first line reporting or commenting by radiographers be normal practice, radiographers have not as yet embraced these opportunities in clinical practice and the number of radiographer commenting (initial reporting) schemes in operation is currently limited. This study explores radiographer opinion with regard to commenting with the aim of establishing the perceived opportunities and barriers to operating a commenting scheme with respect to trauma radiography.Method: A survey of 79 radiographers working within a single multi-centre Trust in the north of England was undertaken using a questionnaire. Attitudinal statements were used to elicit information on perceived opportunities and barriers to the implementation of radiographer commenting.Results: Fifty three questionnaires were returned within the specified time frame (n-53/79; 67.1%). A number of barriers to implementing a commenting scheme were identified including time, technology, anatomical confidence and training. Opportunities included improving professional profile and increased professional contribution to decision making within the patient pathway. No correlation was demonstrated between respondent demographic and responses suggesting that opinions expressed were not influenced by hospital site, radiographer grade or years experience.Conclusion: Radiographers generally had a positive attitude towards the implementation of radiographer commenting and felt that their operation was both beneficial to patient care and the professional profile of radiographers. However, a number of barriers were identified and while concerns regarding training may be increasingly addressed by the Department of Health’s e-learning image interpretation package, the impact of changes in technology and subsequent service operation have not yet been fully evaluated.An investigation into the opportunities and barriers to participation in a radiographer comment scheme, in a multi-centre NHS trustAnne Lancaster, Maryann Hardy10.1016/j.radi.2011.08.003Radiography 18, 2 (2012)2011-09-07Radiography2011-09-07182S1078-8174(12)X0002-6Original Articles105108http://www.radiographyonline.com/article/PIIS1078817411001726/abstract?rss=yesAbstract: Aims: To investigate if a lateral hip radiograph is always needed in the management of intra-capsular proximal femoral fractures. Furthermore, we sought to evaluate if a radiographer could accurately identify cases in which the lateral radiograph is not required.Methods: All patients who underwent surgical management of an intra-capsular proximal femoral fracture over a 3 month period at our unit were identified. Radiographs were reviewed by 6 observers: 2 consultant orthopaedic surgeons, 2 registrars, and 2 radiographers. Initially the observers viewed the AP radiographs alone and classified the fractures into displaced, undisplaced, or unclear categories. They were then shown the lateral view and asked for a diagnosis and management plan. Comparison of diagnosis and management based on AP views alone, and AP in-combination with a lateral view was made.Results: 90 patients were included; the mean age was 80.8 years with a range of 42–100 years. 73 underwent arthroplasty and 17 had internal fixation. All observers, including the radiographer were able to make a surgical decision in 90% of the cases based on AP views alone. Lateral radiographs improved the diagnostic accuracy by 6%. The availability of the lateral view did not alter the management in patients where the AP clearly demonstrated a displaced fracture.Conclusion: Elderly patients with a displaced intra-capsular fracture identifiable on the AP do not require a lateral radiograph. Such patients can be accurately identified by the radiographer. Patient discomfort experienced during positioning for the lateral view would be avoided, and a financial saving made.Is the lateral radiograph necessary for the management of intra-capsular proximal femoral fractures?Muhammad Tawfiq Korim, Venthurla Ram Mohan Reddy, David Gibbs, Clare Wildin10.1016/j.radi.2011.12.003Radiography 18, 2 (2012)2012-02-10Radiography2012-02-10182S1078-8174(12)X0002-6Original Articles109111http://www.radiographyonline.com/article/PIIS1078817411001416/abstract?rss=yesAbstract: Purpose: Having access to a library of radiological images in the university setting is important for teaching and learning in diagnostic radiography. Modern modalities such as PETCT create data volumes rather than single static 2D images. A PACS repository of images alone does not constitute a teaching library without some text based searchable index. A review of several options for acquiring a digital teaching library (DTL) of such indexed DICOM data is presented.Discussion: The data protection principles, current guidance and potential methods for migrating and cleansing large quantities of DICOM data from a clinical PACS prior to transfer to a university setting is discussed. The chosen method is described and the important enabling technology identified. Various methods of index construction are outlined and a method of migrating and cleansing HL7 data from a clinical RIS described.Results: Three terabytes of de-normalised DICOM image files were cleansed of patient, staff and geographic identifiers, within the header tags and pixel data. These files were then migrated to an educational PACS hosted at a university. A searchable index database was created based on 90,200 reports and associated data, and 886,263 DICOM headers to enable meaningful results to be found from the 51,304 unique patient specific cases.Conclusion: A large DTL in the university setting using PACS technology is becoming a valuable resource for teaching, learning and assessment.Digital teaching library (DTL) development for radiography educationPhilip Cosson, Neil Willis10.1016/j.radi.2011.11.004Radiography 18, 2 (2012)2011-12-12Radiography2011-12-12182S1078-8174(12)X0002-6Original Articles112116http://www.radiographyonline.com/article/PIIS1078817411000976/abstract?rss=yesAbstract: Aim: To report the student demographics of the inaugural intake into the Bachelor of Medical Imaging and Bachelor of Medical Sonography/Graduate Diploma of Medical Sonography at CQUniversity, Mackay, Australia.Method: Surveys were distributed to students enrolled in the course MEDI11001 Fundamentals of the Imaging Professions; this course is common to both cohorts in Term 1 of the programs. All students enrolled at the time of the survey were present to participate in the survey. Participation was voluntary. Descriptive statistics were developed from responses and thematic analysis applied to open-ended questions.Results: A total of 44 students were enrolled in the programs. The most common place of residence on enrolment was within 40km of the Mackay campus (16/36.4%); mature age students (30/68.2%); live on campus in the purpose built residences (18/40.9%) and were influenced by the location of the programs in Mackay to enrol (27/61.2%), with the primary justification for this being that the programs were offered close to home. The university website was identified as the primary source of information regarding the programs (15/34.1%) followed by family and friends (11/25%). The programs were first preference for 31 students (70.5%). The majority (23/52.3%) undertakes some type of paid work.Conclusion: Both programs have attracted a diverse student cohort. The majority of students were mature age students from outside of the area local to the Mackay campus of CQUniversity.Demographics of new Undergraduate Medical Imaging and Medical Sonography degree students at CQUniversity, AustraliaKelly M. Spuur, Caroline L. Falconi, Cynthia M. Cowling, Anita L. Bowman, Maria A. Maroney10.1016/j.radi.2011.10.004Radiography 18, 2 (2012)2011-11-17Radiography2011-11-17182S1078-8174(12)X0002-6Original Articles117122http://www.radiographyonline.com/article/PIIS1078817411000927/abstract?rss=yesAbstract: This paper provides an initial debate on the use of eponyms used in trauma imaging. This is followed by a review of common and interesting eponyms associated with upper limb trauma. The origin of these eponyms, which are still used in clinical practice, is often unclear or not actually attributed to the originator of the fracture type. Trauma eponyms are considered within this paper from the distal to the proximal aspect of the upper limb. A brief biography of famous eponymous surgeons gives insight and background to their work and professional achievements. Each fracture is then described briefly, supported by the relevant image and a concise summary of a radiological report. Since accuracy and conciseness are essential elements of any medical communication, the use of terms that are well understood further facilitate clarity. For this reason some knowledge of the originator and a full description of the eponymic fracture, plus its etymology, is still an essential part of clinical and radiographic teaching. This paper also argues that the radiographic report should always describe soft tissue and bony injuries with the concise use of standard anatomic radiographic terminology.Eponyms in imaging of the upper limb: A historical reviewFrederick Murphy, Heather Gunn10.1016/j.radi.2011.09.001Radiography 18, 2 (2012)2011-10-19Radiography2011-10-19182S1078-8174(12)X0002-6Review Articles123131http://www.radiographyonline.com/article/PIIS1078817410001136/abstract?rss=yesAbstract: This article provides a comprehensive literature review regarding side effects both minor and major associated with contrast agent injection. This includes a discussion of nephrogenic systemic fibrosis (NSF), which remains highly topical. Radiographers now commonly are responsible for injection of contrast agent in patients, in keeping with their extended role. Therefore it is incumbent on them to understand the agents they inject, the contra-indications for injection and any potential associated risks, so that they can act and react accordingly in a timely manner. The need for this knowledge was made very evident after the recent death of a patient from anaphylactic shock when there was a delay in mounting the appropriate procedure. This paper represents a synthesis of relevant articles and reflects on the results, before drawing appropriate conclusions particularly those of special relevance to radiographers.Adverse events caused by MRI contrast agents: Implications for radiographers who injectGill Marshall, Chris Kasap10.1016/j.radi.2010.09.007Radiography 18, 2 (2012)2010-11-08Radiography2010-11-08182S1078-8174(12)X0002-6Review Articles132136http://www.radiographyonline.com/article/PIIS1078817411000903/abstract?rss=yesAbstract: We describe that case of a 54 year old lady with achondroplasia who presented with ongoing left sided abdominal pain. Ultrasound and abdominal computerized tomography images demonstrated an enlarged left ovary and Fallopian tube trapped between the rectus abdominus and the lateral semilunar line under cover of the external oblique aponeurosis. A left sided salpingoophrectomy with mesh herniorrhaphy was performed and histological analysis confirmed the hernia contents were a hydrosalpinx and normal ovary. This case report presents the unusual radiographic images and intraoperative photographs of an ovarian Speglian hernia.Ovarian Spigelian hernia: A radiological diagnosisCiaran Scott Hill, Balvinder Chahil, Benjamin Marlow10.1016/j.radi.2011.08.004Radiography 18, 2 (2012)2011-09-14Radiography2011-09-14182S1078-8174(12)X0002-6Case Reports137139http://www.radiographyonline.com/article/PIIS1078817411000939/abstract?rss=yesAbstract: Castleman disease (CD) is a benign angiofollicular lymph node hyperplasia usually found in the mediastinum, but the pelvis is rarely affected. Descriptions of the pelvic CD mainly involve computed tomography (CT) features and focal well-defined masses, while descriptions based on magnetic resonance imaging (MRI) patterns and infiltrating masses are rare.Through a case of a pelvic CD, unusual in its radiological appearance, the authors analyse imaging features as suggested by CT and MRI in order to improve the recognition of this rare disease.Diagnosis of an unusual case of castelman diseaseM. Limeme, H. Amara, H. Zaghouani, D. Bakir, C.H. Kraiem10.1016/j.radi.2011.09.002Radiography 18, 2 (2012)2011-10-17Radiography2011-10-17182S1078-8174(12)X0002-6Case Reports140142http://www.radiographyonline.com/article/PIIS1078817411001313/abstract?rss=yesAbstract: Aims: To compare different supplementary MRI sequences of the ACL to arthroscopy and determine the diagnostic performance of each sequence. To ascertain whether radiographers could identify patients requiring supplementary MRI sequences of anterior cruciate ligament (ACL) tears, without a supervising radiologist.Methods: The study had ethical approval and two hundred and thirty one consecutive prospective MRI patients with mechanical knee symptoms (77 females, 154 males, of mean age 43.5, range 18–82 years) gave written informed consent. They then had a knee arthroscopy within seven days of the MRI. This was a pragmatic study to see if the six general MRI radiographers, each with over four years experience, could evaluate the ACL on routine orthogonal sequences (sagittal T1, Gradient Echo T2, Coronal STIR and axial fat suppressed dual echo). If they identified no ACL, then two 3D volume sequences (Dual Echo Steady State and Fast Low Angle Shot) and 2D limited sagittal oblique T1 sequences were also performed. Patients requiring extra sequences, missed by the radiographers, were recalled. The MRI sequences were independently evaluated in a blinded fashion by two consultant radiologists and a specialist radiology registrar and compared to the subsequent knee arthroscopy, as the gold standard, to determine the diagnostic performance statistics.Results: The cohort was on the knee arthroscopy weighting list and comprised 205 patients with chronic, 20 acute and 6 acute on chronic mechanical knee symptoms. There were no posterior cruciate, medial, or lateral collateral ligament tears at arthroscopy, used as the gold standard. The arthroscopy was normal and the radiographers correctly did not scan the extra sequence in 140 patients (72%) who then had normal arthroscopies. The radiographers did perform additional ACL sequences in 63 patients (27%). Of these, 10 patients had a partial and 12 complete ACL tears. Only two patients (0.9%) were recalled for additional sequences by the radiologist, and one ACL was normal and one had a full thickness tear at arthroscopy. The ACL evaluation for complete tears and a normal ACL on the volume sequences had a sensitivity of 100%, specificity of 97% and accuracy of 97%, excluding partial tears. Volume sequences including partial tears, had specificities and accuracies over 94%, with substantial interobserver agreement (Kappa 0.86, 95% CI 0.71–1.0). The limited oblique T1 sequence had sensitivities and negative predictive value of over 90%, but low specificity and positive predictive values and slight interobserver reliability (Kappa 0.42, 95% CI 0.2–0.6).Conclusions: Firstly, we have shown pragmatically that experienced radiographers identified almost all cases requiring supplementary MRI ACL sequences, without over scanning or needing supervision. Secondly, either volume sequence (DESS or FLASH) could be used as the supplementary sequence, to evaluate the ACL, but a limited oblique T1 sequence of the intercondylar notch cannot be recommended.Radiographer led supplementary anterior cruciate ligament MRI sequences: Technical reportPaula J. Richards, Iain McCall, Alexandra Kraus, Mary Jones, Gayle Walley, Kathryn Gibson, Nicola Maffulli10.1016/j.radi.2011.10.038Radiography 18, 2 (2012)2011-11-07Radiography2011-11-07182S1078-8174(12)X0002-6Case Reports143148