Factors affecting chiropractor requests for full-length spinal radiography: A scoping review.

Chiropractors often refer their patients for full-length (three- to four-region) radiographs of the spine as part of their clinical assessment, which are frequently completed by radiographers in medical imaging practices. Overuse of spinal radiography by chiropractors has previously been reported and remains a contentious issue. The purpose of this scoping review was to explore the issues surrounding the utilisation of full-length spinal radiography by chiropractors and examine the alignment of this practice with current evidence. A search of four databases (AMED, EMBASE, MedLine and Scopus) and a hand search of Google was conducted using keywords. Articles were screened against an inclusion/exclusion criterion for relevance. Themes and findings were extracted from eligible articles, and evidence was synthesised using a narrative approach. In total, 25 articles were identified, five major themes were extracted, and subsequent conclusions drawn by authors were charted to identify confluent findings. This review identified a paucity of literature addressing this issue and an underrepresentation of relevant perspectives from radiographers. Several issues surrounding the use of full-length spinal radiography by chiropractors were identified and examined, including barriers to the adherence of published guidelines for spinal imaging, an absence of a reporting mechanism for the utilisation of spinal radiography in chiropractic and the existence of a spectrum of beliefs amongst chiropractors about the clinical utility and limitations of full-length spinal radiography. Further investigation is required to further understand the scope of this issue and its impacts for radiation protection and patient safety.

The cognitive and perceptual processes that affect observer performance in lung cancer detection: a scoping review.

INTRODUCTION: Early detection of malignant pulmonary nodules through screening has been shown to reduce lung cancer-related mortality by 20%. However, perceptual and cognitive factors that affect nodule detection are poorly understood. This review examines the cognitive and visual processes of various observers, with a particular focus on radiologists, during lung nodule detection. METHODS: Four databases (Medline, Embase, Scopus and PubMed) were searched to extract studies on eye-tracking in pulmonary nodule detection. Studies were included if they used eye-tracking to assess the search and detection of lung nodules in computed tomography or 2D radiographic imaging. Data were charted according to identified themes and synthesised using a thematic narrative approach. RESULTS: The literature search yielded 25 articles and five themes were discovered: 1 - functional visual field and satisfaction of search, 2 - expert search patterns, 3 - error classification through dwell time, 4 - the impact of the viewing environment and 5 - the effect of prevalence expectation on search. Functional visual field reduced to 2.7° in 3D imaging compared to 5° in 2D radiographs. Although greater visual coverage improved nodule detection, incomplete search was not responsible for missed nodules. Most radiological errors during lung nodule detection were decision-making errors (30%-45%). Dwell times associated with false-positive (FP) decisions informed feedback systems to improve diagnosis. Interruptions did not influence diagnostic performance; however, it increased viewing time by 8% and produced a 23.1% search continuation accuracy. Comparative scanning was found to increase the detection of low contrast nodules. Prevalence expectation did not directly affect diagnostic accuracy; however, decision-making time increased by 2.32 seconds with high prevalence expectations. CONCLUSION: Visual and cognitive factors influence pulmonary nodule detection. Insights gained from eye-tracking can inform advancements in lung screening. Further exploration of eye-tracking in lung screening, particularly with low-dose computed tomography (LDCT), will benefit the future of lung cancer screening.

The provision of enteral nutritional support during definitive chemoradiotherapy in head and neck cancer patients.

Combination chemoradiation is the gold standard of management for locally advanced squamous cell carcinomas of the head and neck. One of the most significant advantages of this approach to treatment is organ preservation which may not be possible with radical surgery. Unfortunately, few treatments are without side-effects and the toxicity associated with combined modality treatment causes meaningful morbidity. Patients with head and neck cancer (HNC) may have difficulties meeting their nutritional requirements as a consequence of tumour location or size or because of the acute toxicity associated with treatment. In particular, severe mucositis, xerostomia, dysgeusia and nausea and vomiting limit intake. In addition to this, dysphagia is often present at diagnosis, with many patients experiencing silent aspiration. As such, many patients will require enteral nutrition in order to complete chemoradiotherapy (CRT). Feeding occurs via catheters placed transnasally (nasogastric tubes) or directly into the stomach through the anterior abdominal wall (percutaneous gastrostomy tubes). In the absence of clear evidence concerning the superiority of one method over another, the choice of feeding tube tends to be dependent on clinician and patient preference. This review examines key issues associated with the provision of enteral nutritional support during definitive CRT in HNC patients, including feeding methods, patient outcomes and timing of tube insertion and use.

E-tutorial improves students' ability to detect lesions.

PURPOSE: This Australian study explores the effects of an educational intervention on first-year medical radiation sciences (MRS) students by examining eye-tracking metrics while they attempted to detect breast lesions on radiologic images before and after an e-learning tutorial. The study also analyzes performance using receiver operating characteristic methodology. METHODS: Fourteen first-year MRS students were equally and randomly assigned to a control or experiment group to participate in 2 image-detection sessions. The experiment group completed an online e-learning tutorial between sessions. Eighty mammographic breast images from 20 cases were obtained from a validated online image bank. Of those 20 cases, 30% were normal and 70% demonstrated a single-lesion abnormality. RESULTS: The experiment group demonstrated a 45% increase in the mean number of fixations per case (P = .047), with a 30% increase in sensitivity (P = .022) following the tutorial. The experiment group also demonstrated improved lesion detection overall and a 49% decrease in mean time to first fixation on the lesion (P = .016). DISCUSSION: This study demonstrates that increased lesion detection is possible after a brief e-learning tutorial. Early changes in the viewing patterns of less-experienced technologists are intriguing, and explanation may be gained from our current understanding of radiologic perception and cognitive neuroscience. The task for the first-year MRS students in this study was only to positively detect a lesion, and we recognize that a higher level of visual processing would be required to critique image quality. Exposure to the brief tutorial, however, might have triggered some learning-related neural changes at an early level of visual processing, representing stimuli relating to task performance. CONCLUSION: Participants in the experiment group improved their ability to identify breast lesions, which coincided with changes in eye position metrics and error type analysis. The data presented here suggest that the intervention resulted in a significant improvement in detection by the experiment group.