Cumulative radiation exposure from multimodality recurrent imaging of CT, fluoroscopically guided intervention, and nuclear medicine.

OBJECTIVES: To assess cumulative effective dose (CED) over a 4-year period in patients undergoing multimodality recurrent imaging at a major hospital in the USA. METHODS: CED from CT, fluoroscopically guided intervention (FGI), and nuclear medicine was analyzed in consecutive exams in a tertiary care center in 2018-2021. Patients with CED ≥ 100 mSv were classified by age and body habitus (underweight, healthy weight, overweight, obese), as per body mass index percentiles < 5th, 5th to < 85th, 85th to < 95th, and ≥ 95th (age 2-19 years), and its ranges < 18.5, 18.5-24.9, 25-29.9, and ≥ 30 (≥ 20 years), respectively. RESULTS: Among a total of 205,425 patients, 5.7% received CED ≥ 100 mSv (mean 184 mSv, maximum 1165 mSv) and their ages were mostly 50-64 years (34.1%), followed by 65-74 years (29.8%), ≥ 75 years (19.5%), 20-49 years (16.3%), and ≤ 19 years (0.29%). Body habitus in decreasing occurrence was obese (38.6%), overweight (31.9%), healthy weight (27.5%), and underweight (2.1%). Classification by dose indicated 172 patients (≥ 500 mSv) and 3 (≥ 1000 mSv). In comparison, 5.3% of 189,030 CT patients, 1.6% of 18,963 FGI patients, and 0.19% of 41,401 nuclear-medicine patients received CED ≥ 100 mSv from a single modality. CONCLUSIONS: The study of total dose from CT, FGI, and nuclear medicine of patients with CED ≥ 100 mSv indicates major (89%) contribution of CT to CED with 70% of cohort being obese and overweight, and 64% of cohort aged 50-74 years. CLINICAL RELEVANCE STATEMENT: Multimodality recurrent exams are common and there is a lack of information on patient cumulative radiation exposure. This study attempts to address this lacuna and has the potential to motivate actions to improve the justification process for enhancing patient safety. KEY POINTS: • In total, 5.7% of patients undergoing multimodality recurrent imaging (CT, fluoroscopically guided intervention, nuclear medicine) incurred a dose of ≥ 100 mSv. • Mean dose was 184 mSv, with 15 to 18 times contribution from CT than that from fluoroscopically guided intervention or nuclear medicine. • In total, 70% of those who received ≥ 100mSv were either overweight or obese.

In vivo 3D tomography of the lumbar spine using a twin robotic X-ray system: quantitative and qualitative evaluation of the lumbar neural foramina in supine and upright position.

OBJECTIVES: Supine lumbar spine examinations underestimate body weight effects on neuroforaminal size. Therefore, our purpose was to evaluate size changes of the lumbar neuroforamina using supine and upright 3D tomography and to initially assess image quality compared with computed tomography (CT). METHODS: The lumbar spines were prospectively scanned in 48 patients in upright (3D tomographic twin robotic X-ray) and supine (30 with 3D tomography, 18 with CT) position. Cross-sectional area (CSA), cranio-caudal (CC), and ventro-dorsal (VD) diameters of foramina were measured by two readers and additionally graded in relation to the intervertebral disc height. Visibility of bone/soft tissue structures and image quality were assessed independently on a 5-point Likert scale for the 18 patients scanned with both modalities. Descriptive statistics, Wilcoxon's signed-rank test (p < 0.05), and interreader reliability were calculated. RESULTS: Neuroforaminal size significantly decreased at all levels for both readers from the supine (normal intervertebral disc height; CSA 1.25 ± 0.32 cm2; CC 1.84 ± 0.24 cm2; VD 0.88 ± 0.16 cm2) to upright position (CSA 1.12 ± 0.34 cm2; CC 1.78 ± 0.24 cm2; VD 0.83 ± 0.16 cm2; each p < 0.001). Decrease in intervertebral disc height correlated with decrease in foraminal size (supine: CSA 0.88 ± 0.34 cm2; CC 1.39 ± 0.33 cm2; VD 0.87 ± 0.26 cm2; upright: CSA 0.83 ± 0.37 cm2, p = 0.010; CC 1.32 ± 0.33 cm2, p = 0.015; VD 0.80 ± 0.21 cm2, p = 0.021). Interreader reliability for area was fair to excellent (0.51-0.89) with a wide range for cranio-caudal (0.32-0.74) and ventro-dorsal (0.03-0.70) distances. Image quality was superior for CT compared with that for 3D tomography (p < 0.001; κ, CT = 0.66-0.92/3D tomography = 0.51-1.00). CONCLUSIONS: The size of the lumbar foramina is smaller in the upright weight-bearing position compared with that in the supine position. Image quality, especially nerve root delineation, is inferior using 3D tomography compared to CT. KEY POINTS: • Weight-bearing examination demonstrates a decrease of the neuroforaminal size. • Patients with higher decrease in intervertebral disc showed a narrower foraminal size. • Image quality is superior with CT compared to 3D tomographic twin robotic X-ray at the lumbar spine.

Multicentric study of patients receiving 50 or 100 mSv in a single day through CT imaging-frequency determination and imaging protocols involved.

OBJECTIVES: To assess the magnitude and characterization of CT imaging protocols of patients receiving 50 or 100 mSv in a single day. METHODS: In this multicentric retrospective study covering up to 279 hospitals from January 2015 to December 2019, the effective dose (E) as estimated by dose management system from dose length product of patients was filtered and grouped into per-day dose bands (≤ 20, > 20-50, > 50-70, > 70-100, > 100-200, > 200 mSv). Information on patient's age and imaging protocol was noted. The data were analyzed to determine the frequency of occurrence in each dose band. Top 20 CT imaging protocols that led to patients with a dose of ≥ 50 mSv in a single acquisition were identified and their relative frequency was estimated. RESULTS: A total of approx. 4.3 million (4,283,738) CT exams were performed in approx. 3.9 million (3,880,524) patient-days indicating 9.41% had more than one CT exam in a single day. There were 31,058 (0.8%) patient-days with ≥ 50 mSv and 1191 (0.03%) with ≥ 100 mSv. Nearly 1/3rd patient-days reaching ≥ 50 mSv were of patients aged 50 years or younger. The top 20 CT imaging protocols that led to ≥ 50 mSv in a single day belonged to the body region (chest or abdomen and pelvis) and nearly one-third were angiographic studies. CONCLUSIONS: In the first study of its kind, we report that patients with 50 mSv+ in a single day or a single exam are not rare. The information on imaging protocols leading to such doses and their frequency has been provided to help develop dose management strategies. KEY POINTS: • Our study of 4,283,738 CT exams performed in 3,880,524 patient-days indicates 0.8% with 50 mSv+ and 0.03% with 100 mSv+ in a single day. • A total of 9.41% underwent more than one CT exam in a single day; nearly 1/3rd of those with 50 mSv+ were ≤ 50 years of age. • Identified top 20 CT imaging protocols that led to 50 mSv+ doses in a single exam. All belong to chest or abdomen and pelvis and nearly 1/3rd were angiographic studies.

Radiomics in liver diseases: Current progress and future opportunities.

Liver diseases, a wide spectrum of pathologies from inflammation to neoplasm, have become an increasingly significant health problem worldwide. Noninvasive imaging plays a critical role in the clinical workflow of liver diseases, but conventional imaging assessment may provide limited information. Accurate detection, characterization and monitoring remain challenging. With progress in quantitative imaging analysis techniques, radiomics emerged as an efficient tool that shows promise to aid in personalized diagnosis and treatment decision-making. Radiomics could reflect the heterogeneity of liver lesions via extracting high-throughput and high-dimensional features from multi-modality imaging. Machine learning algorithms are then used to construct clinical target-oriented imaging biomarkers to assist disease management. Here, we review the methodological process in liver disease radiomics studies in a stepwise fashion from data acquisition and curation, region of interest segmentation, liver-specific feature extraction, to task-oriented modelling. Furthermore, the applications of radiomics in liver diseases are outlined in aspects of diagnosis and staging, evaluation of liver tumour biological behaviours, and prognosis according to different disease type. Finally, we discuss the current limitations of radiomics in liver disease studies and explore its future opportunities.

Multinational data on cumulative radiation exposure of patients from recurrent radiological procedures: call for action.

OBJECTIVES: To have a global picture of the recurrent use of CT imaging to a level where cumulative effective dose (CED) to individual patients may be exceeding 100 mSv at which organ doses typically are in a range at which radiation effects are of concern METHODS: The IAEA convened a meeting in 2019 with participants from 26 countries, representatives of various organizations, and experts in radiology, medical physics, radiation biology, and epidemiology. Participants were asked to collect data prior to the meeting on cumulative radiation doses to assess the magnitude of patients above a defined level of CED. RESULTS: It was observed that the number of patients with CED ≥ 100 mSv is much larger than previously known or anticipated. Studies were presented in the meeting with data from about 3.2 million patients who underwent imaging procedures over periods of between 1 and 5 years in different hospitals. It is probable that an additional 0.9 million patients reach the CED ≥ 100 mSv every year globally. CONCLUSIONS: There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients. The actions include development of appropriateness criteria/referral guidelines by professional societies for patients who require recurrent imaging studies, development of CT machines with lower radiation dose than today by manufacturers, and development of policies by risk management organizations to enhance patient radiation safety. Alert values for cumulative radiation exposures of patients should be set up and introduced in dose monitoring systems. KEY POINTS: • Recurrent radiological imaging procedures leading to high radiation dose to patients are more common than ever before. • Tracking of radiation exposure of individual patients provides useful information on cumulative radiation dose. • There is a need for urgent actions by all stakeholders to address the issue of high cumulative radiation doses to patients.

Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness.

OBJECTIVE: To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness. METHODS: From the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a widely adopted standard of 1-3 (red) as "not usually appropriate," 4-6 (yellow) "may or may not be appropriate," and 7-9 (green) "usually appropriate." Clinicians reviewed patient records to assess compliance with appropriate use criteria (AUC). RESULTS: 9.6% of patients in our series were with non-malignant conditions and 1.4% with age ≤ 40 years. CDS scores (rounded) were 2% red, 38% yellow, 27% green, and 33% unscored CTs. Clinical society guidelines for CT exams, wherever available, were followed in 87.5 to 100% of cases. AUCs were not available for several clinical indications as also referral guidelines for serial CT imaging. More than half of CT exams were unrelated to follow-up of a primary chronic disease. CONCLUSIONS: We are faced with a situation wherein patients in age ≤ 40 years require or are thought to require many CT exams over the course of a few years but the radiation risk creates concern. There is a fair number of conditions for which AUC are not available. Suggested solutions include development of CT scanners with lesser radiation dose and further development of appropriateness criteria. KEY POINTS: We are faced with a situation wherein patients in age group 0-40 years and with non-malignant diagnosis require or are thought to require many CT exams over the course of a few years. More than half of CT exams were unrelated to follow-up of a primary chronic disease. Imaging guidelines and appropriateness use criteria are not available for many conditions. Wherever available, they are for initial work-up and diagnosis and there is a lack of guidance on serial CT imaging.

Patients undergoing recurrent CT scans: assessing the magnitude.

OBJECTIVES: To assess percent of patients undergoing multiple CT exams that leads to cumulative effective dose (CED) of ≥ 100 mSv and determine their age distribution. METHODS: Data was retrieved retrospectively from established radiation dose monitoring systems by setting the threshold value of 100 mSv at four institutions covering 324 hospitals. The number of patients with CED ≥ 100 mSv only from recurrent CT exams during a feasible time period between 1 and 5 years was identified. Age and gender distribution of these patients were assessed to identify the magnitude of patients in the relatively lower age group of ≤ 50 years. RESULTS: Of the 2.5 million (2,504,585) patients who underwent 4.8 million (4,819,661) CT exams during the period of between 1 and 5 years, a total of 33,407 (1.33%) patients received a CED of ≥ 100 mSv with an overall median CED of 130.3 mSv and maximum of 1185 mSv. Although the vast majority (72-86%) of patients are > 50 years of age, nearly 20% (13.4 to 28%) are ≤ 50 years. The minimum time to accrue 100 mSv was a single day at all four institutions, an unreported finding to date. CONCLUSIONS: We are in an unprecedented era, where patients undergoing multiple CT exams and receiving CED ≥ 100 mSv are not uncommon. While underscoring the need for imaging appropriateness, the consideration of the number and percent of patients with high exposures and related clinical necessities creates an urgent need for the industry to develop CT scanners and protocols with sub-mSv radiation dose, a goal that has been lingering. KEY POINTS: • We are in an era where patients undergoing multiple CT exams during a short span of 1 to 5 years are not uncommon and a sizable fraction among them are below 50 years of age. • This leads to cumulative radiation dose to individual patients at which radiation effects are of real concern. • There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering.

Iodine concentration of healthy lymph nodes of neck, axilla, and groin in dual-energy computed tomography.

BACKGROUND: Lymph nodes (LN) are examined in every computed tomography (CT) scan. Until now, an evaluation is only possible based on morphological criteria. With dual-energy CT (DECT) systems, iodine concentration (IC) can be measured which could conduct in an improved diagnostic evaluation of LNs. PURPOSE: To define standard values for IC of cervical, axillary, and inguinal LNs in DECT. MATERIAL AND METHODS: Imaging data of 297 patients who received a DECT scan of the neck, thorax, abdomen-pelvis, or a combination of those in a portal-venous phase were retrospectively collected from the institutional PACS. No present history of malignancy, inflammation, or trauma in the examined region was present. For each examined region, the data of 99 patients were used. The IC of the three largest LNs, the main artery, the main vein, and a local muscle of the examined area was measured, respectively. RESULTS: Normalization of the IC of LNs to the artery, vein, muscle, or a combination of those did not lead to a decreased value-range. The smallest range and confidence interval (CI) of IC was found when using absolute values of IC for each region. Hereby, mean values (95% CI) for IC of LN were found: 2.09 mg/mL (2.00-2.18 mg/mL) for neck, 1.24 mg/mL (1.16-1.33 mg/mL) for axilla, and 1.11 mg/mL (1.04-1.17 mg/mL) for groin. CONCLUSION: The present study suggests standard values for IC of LNs in dual-layer CT could be used to differentiate between healthy and pathological lymph nodes, considering the used contrast injection protocol.

Evaluating Artificial Intelligence Competency in Education: Performance of ChatGPT-4 in the American Registry of Radiologic Technologists (ARRT) Radiography Certification Exam.

RATIONALE AND OBJECTIVES: The American Registry of Radiologic Technologists (ARRT) leads the certification process with an exam comprising 200 multiple-choice questions. This study aims to evaluate ChatGPT-4's performance in responding to practice questions similar to those found in the ARRT board examination. MATERIALS AND METHODS: We used a dataset of 200 practice multiple-choice questions for the ARRT certification exam from BoardVitals. Each question was fed to ChatGPT-4 fifteen times, resulting in 3000 observations to account for response variability. RESULTS: ChatGPT's overall performance was 80.56%, with higher accuracy on text-based questions (86.3%) compared to image-based questions (45.6%). Response times were longer for image-based questions (18.01 s) than for text-based questions (13.27 s). Performance varied by domain: 72.6% for Safety, 70.6% for Image Production, 67.3% for Patient Care, and 53.4% for Procedures. As anticipated, performance was best on on easy questions (78.5%). CONCLUSION: ChatGPT demonstrated effective performance on the BoardVitals question bank for ARRT certification. Future studies could benefit from analyzing the correlation between BoardVitals scores and actual exam outcomes. Further development in AI, particularly in image processing and interpretation, is necessary to enhance its utility in educational settings.

Evaluating the attitudes of radiologic technology students and graduates toward their study major and career prospects: A cross-sectional study.

Background and Objectives: Understanding students' attitudes toward their study major and career prospects in healthcare is crucial. This study evaluates radiologic technology students and graduates' attitudes toward their study major and career prospects. Methods: This cross-sectional study at Ahvaz Jundishapur University of Medical Sciences assessed 120 BSc radiologic technology students and graduates' attitudes toward their study major and career prospects using an online questionnaire. Data analysis was performed using SPSS 26, with results reported as mean ± standard deviation (SD). Significance was determined using the independent sample t-test and one-way analysis of variance (p < 0.05). Results: Participants' age, averaged 24.13 ± 3.64 years and were predominantly females (58.3%). Among radiologic technology students, the mean scores ± SD for attitudes toward their academic major and career prospects were 19.75 ± 2.27 and 15.62 ± 2.28, respectively. For graduates, these values were 19.73 ± 3.85 and 14.73 ± 2.75, respectively. Most participants exhibited a positive attitude toward their study major (90.8%) and career prospects (85.0%). No statistically significant differences were observed in attitudes across demographic specifications for students and graduates, nor between the attitudes of students and graduates toward their study major and career prospects. Conclusions: The evaluated students and graduates demonstrated a positive attitude toward their field of study and career prospects. Positive perceptions from peers and society and job opportunities for BSc graduates contribute to this. while our research highlights the prevailing positive attitudes within the radiologic technology profession, there is a clear need for ongoing evaluation and refinement to ensure continued success and satisfaction among students and graduates. Enhancing students' understanding of academic disciplines before major selection and providing effective counseling can reinforce these attitudes.

Radiologic Technology Students' Perceptions on Adoption of Artificial Intelligence Technology in Radiology.

Study Purpose: This study aims to analyze radiologic technology student's perceptions of artificial intelligence (AI) and its applications in radiology. Methods: A quantitative cross-sectional survey was conducted. A pre-validated survey questionnaire with 17 items related to students perceptions of AI and its applications was used. The sample included radiologic technology students from three universities in Saudi Arabia. The survey was conducted online for several weeks, resulting in a sample of 280 radiologic technology students. Results: Of the participants, 63.9% were aware of AI and its applications. T-tests revealed a statistically significant difference (p = 0.0471) between genders with male participants reflecting slightly higher AI awareness than female participants. Regarding the choice of radiology as specialization, 35% of the participants stated that they would not choose radiology, whereas 65% preferred it. Approximately 56% of the participants expressed concerns about the potential replacement of radiology technologists with AI, and 62.1% strongly agreed on the necessity of incorporating known ethical principles into AI. Conclusion: The findings reflect a positive evaluation of the applications of this technology, which is attributed to its essential support role. However, tailored education and training programs are necessary to prepare future healthcare professionals for the increasing role of AI in medical sciences.

3D printing and CBCT anatomical reproducibility assessment in forensic scenarios.

INTRODUCTION: The scientific community highlighted the relevance of 3D physical models since the beginning of the XXI century, complementary to three-dimensional(3D) digital volume by computer tomography, to support court discussions on medico-legal issues. The recreation of 3D evidence can be an important tool for investigators and experts, providing a better understanding of the causes and circumstances of the events involved in a crime. OBJECTIVE: The present study aims to assess the reproducibility of 3D printed and 3D tomographic volumes generated from mandibles following simulated forensic injuries, highlighting the recreation of crime tools. MATERIAL AND METHODS: Concerning the study design presented, data collection was performed in three phases. Nine simulated injuries of forensic interest were selected (phase1) and all the mandibles were scanned tomographically, individually, by Cone Beam Computed Tomography CBCT (phase 2). Then, in phase 3, the DICOM images were used for 3D printing with the Ender 3® printer by the Fused Deposition Modeling (FDM) technique. The data analysis followed two procedures: the comparison between the artificial mandible and 3D tomographic volume (AT) and the comparison between the artificial mandible and 3D printed volume, or the copy (AC). Data were analyzed using T-Student and ICC tests and presented in Bland-Altman plots. CONCLUSION: The analogic technique applied in 3D printed volume, when compared with computerized technique, using 3D digital images and measurement, showed to be accurate and reproducible. Further studies are needed in search of standardization for three-dimensional measurements in digitized and printed volumes.

The barriers, motives, perceptions, and attitudes toward research among radiology practitioners and interns in Saudi Arabia: a cross-sectional study.

Background: Research and the use of evidence-based practices are imperative to the advancement of diagnostic imaging modalities. The aim of this study was to assess the perceptions and attitudes of radiology practitioners (i.e., Technicians, Technologists or Specialists, and Senior Specialists) and interns in King Abdulaziz Medical Cities (KAMCs), Kingdom of Saudi Arabia, toward research, and to explore the various barriers and obstacles that hinder their research efforts. Methods: A cross-sectional descriptive investigation was carried out from December 2022 to March 2023 among 112-KAMCs' radiology practitioners and interns, using previously developed and validated questionnaire comprised of five distinct sections, each serving a specific purpose, and with a non-probability convenient sampling technique. Descriptive statistics were generated for participants' demographics, and chi-square and fisher's exact tests were used to examine the association between participants' demographics and their involvement in research. Results: Among the 137 KAMCs' radiology practitioners and interns who were invited to participate, 112 responded and completed the questionnaire, resulting in an overall response rate of 81.75%. Radiology practitioners and interns from various medical imaging subspecialties were found to be involved in research to the extent of 83%, with nearly half (40.9%) of them have had publications, and 53.3% of these publications being either cross-sectional studies or retrospective clinical studies. A lack of time (66.1%), a lack of a professional supervisor support program (50.9%), and deficiency in research skills (45.5%) were common obstacles that may impede the participants' ability to conduct research. The most common motives for participants to conduct research were the desire to improve their resumes (69.6%), get accepted into postgraduate radiology programs (58%), and improve their research skills (52.7%). Conclusion: KAMCs' radiology practitioners and interns have a positive attitude toward performing research. Despite the high percentage (83%) of those involved in research, the number of publications remains low. A crucial step to advancing the profession's evidence base is engaging radiology practitioners and interns in research and encouraging radiology practitioner-led research. The study findings can serve as a valuable basis for designing developmental programs aimed at overcoming research obstacles among healthcare professionals in Saudi Arabia.

Virtual Technology in Radiologic Technology Classrooms: Educational Effect of the COVID-19 Pandemic.

PURPOSE: To investigate the educational effect of the COVID-19 pandemic on virtual technology use in the radiologic technology classroom by comparing virtual technology use and perceived barriers for use from before the COVID-19 pandemic through the spring 2021 semester. METHODS: An explanatory mixed-method, cross-sectional survey design was used to evaluate radiologic technology educators' integration of virtual technology and continuance intention to use (CITU) virtual technology in the radiologic technology classroom. A pseudoqualitative component also was used to add meaning to the quantitative data. RESULTS: A total of 255 educators completed the survey. Educators with associate degrees scored significantly lower in CITU compared with participants with master's degrees (P = .04) and doctoral or professional degrees (P = .01). Virtual technology use significantly increased from before COVID-19 to spring 2021 (P < .001). Educators' perceptions of barriers to technology integration significantly decreased from before COVID-19 to spring 2021 (P < .001). In this report, radiologic technology educators indicated intentions for increased virtual technology use in the future compared with their use during the spring 2021 semester (P = .001). DISCUSSION: Virtual technology use was low before COVID-19, and although it increased during the spring 2021 semester, it remained relatively low. Future intentions for virtual technology use indicate an increase from spring 2021, suggesting a change in future delivery of radiologic science education. Instructors' levels of education had a significant effect on CITU scores. Cost and funding was consistently the highest reported barrier to virtual technology use, whereas student resistance to technology was consistently the lowest reported barrier. Narratives of participants' challenges, current and future use, and rewards related to virtual technology also added pseudoqualitative meaning to the quantitative findings. CONCLUSION: The educators in this study demonstrated low virtual technology use before the COVID-19 pandemic, increased virtual technology use because of the pandemic, and significantly positive CITU scores. Radiologic science educators' responses regarding their challenges, current and future use, and rewards might be helpful in facilitating more effective technology integration.

How Can We Sustain the Training Quality of Radiologic Technology Students During COVID-19 Outbreaks: A Lesson from Vietnam.

Radiologic technology training required a substantial amount of practice. The traditional teaching approach includes in-hospital placement along with theory classes. During the COVID-19 outbreaks, clinical rotations become impossible. Direct contact with patients raises safety concerns for staff and students. The COVID-19 pandemic created unprecedented challenges for medical universities worldwide. We developed in-house simulation software that can be used for training in radiologic technology. Our preliminary results yielded good efficacy of this novel teaching approach in training radiologic technology students.

Students' Perception of Learning Through Targeted Practice and Effective Feedback.

PURPOSE: To examine how second-year radiologic technology students perceived their ability to learn based on targeted practice and effective feedback provided by clinical instructors and staff radiographers. METHODS: This study used qualitative methods with a descriptive design. Data were collected from second-year radiologic technology students in New Jersey and New York through a questionnaire and a follow-up, semistructured interview about their perceptions of the clinical learning environment. RESULTS: Two themes were identified from this study: students perceive targeted practice and effective feedback as very effectual to the clinical education process and students' desire additional opportunities for targeted practice that can be performed independently with no interference from the clinical instructor or staff radiographer, followed by effective feedback. Unexpected findings included that some clinical instructors did not provide targeted practice or effective feedback and some clinical instructors and technologists did not allow or permit enough independent practice for students to complete a self-assessment of their clinical skills. DISCUSSION: This study demonstrated that positive learning for students occurs when the clinical instructors and staff radiographers allow students to work closely with them by providing opportunities for assisted and independent practice opportunities and through a willingness to provide feedback. CONCLUSION: Additional professional development opportunities are needed for clinical instructors and staff radiographers. For clinical instructors, more education is needed to understand students' need for feedback. For staff radiographers, professional development is needed to incorporate teaching skills and to help them realize the valuable effects they have on the students' clinical education.

Clinical placement challenges associated with radiography education in a low-resource setting: A qualitative exploration of the Ethiopian landscape.

INTRODUCTION: Clinical placements (CP) are of paramount importance in the learning and the acquisition of key competencies in terms of knowledge, skill and professional attributes required for clinical radiography practice. This study explored the challenges faced by radiography students and educators in relation to clinical placement and training in Ethiopia. METHODS: A qualitative approach using focus group discussion and interviews were used to explore the experiences of students and educators, respectively, pertaining to challenges encountered in relation to the clinical placement of students across four university affiliated hospitals. Data obtained was analysed using a structured three step framework and the coding approach employed in a thematic analysis. RESULTS: Participants comprise of third- and fourth-year undergraduate radiography students (n = 14) and educators [academic faculty (n = 7) and clinical practice educators (n = 8)]. Four main themes were identified, which relate to deficiencies of an existing training curriculum and its implementation strategies, inadequate resource and infrastructure within the CP environments and absence of advanced training opportunities. CONCLUSION: This research showed that there are many and varied challenges encountered by both students and educators in relation to CP and training of radiography students in Ethiopia. These challenges could potentially affect the future performance of students/practitioners and/or the appropriate application of the core clinical radiography skills and competencies in the world of work. IMPLICATIONS FOR PRACTICE: Clinical radiography training in resource-limited settings will require urgent attention and support with modern infrastructure including simulation to augment their clinical development to acceptable standards.

Validation of a standardized CT protocol for the evaluation of varices and porto-systemic shunts in cirrhotic patients.

PURPOSE: The aim of the present study was to propose and validate a standardized CT protocol for evaluating all the types of portosystemic collaterals (P-SC), including gastroesophageal varices and spontaneous portosystemic shunts (SPSS), and to evaluate the prognostic role of portal hypertension CT features for the prediction of the hepatic decompensation risk in cirrhotic patients. METHODS: A retrospective cohort study of 184 advanced chronic liver disease who underwent CT scan between January 2014 and December 2017. Patients with an interval > 6 months between the imaging, elastometric, endoscopic and biochemical evaluation were excluded, as well as patients with previous transjugular intrahepatic portosystemic shunt (TIPS), liver transplantation (LT) or terminal medical conditions. Data on liver disease history, co-morbidities, endoscopic and radiologic findings were collected. The incidence of hepatic decompensation and other events, such as portal vein thrombosis, HCC, TIPS placement, LT, death, and its cause, were also recorded. The procedure was performed at baseline and after the administration of contrast agent using a multiphasic technique and bolus tracking. Two senior radiologists working in different centres and a non-expert radiologist reviewed all CT examinations, to evaluate both intra-observer and inter-observer variability of the CT protocol and to obtain an external validation. The radiological variables were evaluated using both univariate and adjusted multivariate competing risk regression models. RESULTS: Both intra-observer and inter-observer agreement were excellent in detection and measurement of almost all types of P-SC. The presence of SPSS, a spleen diameter > 16 cm, a portal vein diameter > 17 mm and the presence of ascites resulted independent predictors of decompensation-free survival for cirrhotic patients and were incorporated in an easy-to-use score (AUROC = 0.799, p-value = 0.732) which can the risk of decompensation at 5 years, ranking it as low (11.3%), moderate (35.6%) or high (70.8%). CONCLUSIONS: The CT protocol commonly performed during the HCC surveillance program for cirrhotic patients is valid for detecting all types of P-SC. The radiological score identified to predict the decompensation-free survival for cirrhotic patients could be an easy-to-use clinical tool.

Burnout Among Saudi Radiological Sciences Undergraduate Students During COVID-19 Pandemic: A Cross-Sectional Study.

Background: The novel Coronavirus Disease 2019 (COVID-19) pandemic has posed unprecedented new stressors and challenges to the applied health sciences' education. This study explored the prevalence of burnout among Saudi radiological sciences students at King Saud bin Abdulaziz University for Health Sciences during the COVID-19 pandemic. Methods: A cross-sectional study was conducted between November and December 2020 among 176-Saudi radiological sciences students, using the 16-item questionnaire of Maslach Burnout Inventory-General Survey for Students and through non-probability convenient sampling technique. The 16 items of the questionnaire were scored on a 7-point frequency rating scale ranging from 0 (never) to 6 (every day) and consisted of three distinct burnout dimensions/subscales: a) emotional exhaustion (5-items), cynicism (5-items), and professional efficacy (6-items). The means of individual items that make up each scale of burnout were calculated, and statistical analysis was performed using the Mann-Whitney U-test. Results/Observations/Findings: From the 176-radiological sciences students approached, 96 (54.5%) completed the questionnaire. The percentage of students who were at moderate to high risk of burnout was 70.8% for emotional exhaustion, 75% for cynicism, and 74% for professional efficacy subscales. Emotional exhaustion was significantly higher among fourth-year students (P = 0.042), than third-year students. Cynicism was significantly higher among fourth-year female students (P = 0.035), than third-year female students. The professional efficacy was significantly lower among fourth-year female students (P = 0.007) than males. Conclusion: Our study shows 73.3% moderate to high burnout rates among Saudi radiological sciences students during the COVID-19 pandemic. Burnout increases as students advance to the fourth year. A block/modular curriculum structure for fourth-year courses may be necessary to reduce burnout among fourth-year students. Academic counseling can ease students' emotional stress and reduce burnout risk.

Clinical implementation of deep learning contour autosegmentation for prostate radiotherapy.

BACKGROUND AND PURPOSE: Artificial intelligence advances have stimulated a new generation of autosegmentation, however clinical evaluations of these algorithms are lacking. This study assesses the clinical utility of deep learning-based autosegmentation for MR-based prostate radiotherapy planning. MATERIALS AND METHODS: Data was collected prospectively for patients undergoing prostate-only radiation at our institution from June to December 2019. Geometric indices (volumetric Dice-Sørensen Coefficient, VDSC; surface Dice-Sørensen Coefficient, SDSC; added path length, APL) compared automated to final contours. Physicians reported contouring time and rated autocontours on 3-point protocol deviation scales. Descriptive statistics and univariable analyses evaluated relationships between the aforementioned metrics. RESULTS: Among 173 patients, 85% received SBRT. The CTV was available for 167 (97%) with median VDSC, SDSC, and APL for CTV (prostate and SV) 0.89 (IQR 0.83-0.95), 0.91 (IQR 0.75-0.96), and 1801 mm (IQR 1140-2703), respectively. Physicians completed surveys for 43/55 patients (RR 78%). 33% of autocontours (14/43) required major "clinically significant" edits. Physicians spent a median of 28 min contouring (IQR 20-30), representing a 12-minute (30%) time savings compared to historic controls (median 40, IQR 25-68, n = 21, p < 0.01). Geometric indices correlated weakly with contouring time, and had no relationship with quality scores. CONCLUSION: Deep learning-based autosegmentation was implemented successfully and improved efficiency. Major "clinically significant" edits are uncommon and do not correlate with geometric indices. APL was supported as a clinically meaningful quantitative metric. Efforts are needed to educate and generate consensus among physicians, and develop mechanisms to flag cases for quality assurance.