Can radiological technologists serve as primary screeners of low-dose computed tomography for the diagnosis of lung cancer?

BACKGROUND: The Accreditation Council for Lung Cancer CT Screening of Japan established guidelines for the certification of Radiological Technologists in 2009. OBJECTIVE: To analyze the trends in examination pass rates of the Radiological Technologists and discuss the reasons. METHODS: The cohort comprised 1593 Radiological Technologists (as examinees) based on 10-year of data (with a total of 17 examination runs). First, the examinees' written test results were analyzed. Second, an abnormal finding detection test was conducted using >100 client PCs connected to a dedicated server containing low-dose lung cancer CT screening images of 60 cases. The passing scores were correct answer rate >60% and sensitivity (TP) of >90%, respectively. RESULTS: Overall, 1243 examinees passed with an overall rate of 78%. The average pass rate for the written test was 91%, whereas that for the abnormal findings detection test was 85%. There was a moderate correlation between the test pass rate and average years of clinical experience of the examinees for the abnormal findings detection test (R = 0.558), whereas no such correlation existed for the written test (R = 0.105). CONCLUSIONS: In order for accredited Radiological Technologists to serve as primary screeners of low-dose computed tomography, it is important to revise the educational system according to current standard practices.

[Creation and Evaluation of Educational Programs for Additional Delayed Scan of FDG-PET/CT].

Generally, FDG-PET/CT image is acquired at the 60th minute after tracer administration. Depending on the clinical case, additional delayed scans may be useful. However, it is difficult to judge whether additional delayed scan is useful or not. The purposes of this study were creation and evaluation of educational programs to help radiological technologists to decide the usefulness of additional delayed scan of FDG-PET/CT. METHODS: Educational programs consisted of the instructional materials and the judgment test of clinical cases. The instructional materials provided the valuable findings for differentiation between uptake in the wall of the colon and colon content, distinction between uptake in the lymph node and urinary tract, and evaluation of malignancy. The judgment test of clinical cases consisted of 10 cases selected by a nuclear medicine physician (for 5 of that cases additional delayed scan was decided to be useful). Five experienced technologists and five inexperienced technologists scored the volubility of additional delayed scan pre- and post-training using the instructional materials (the full marks of score is 5). RESULTS: After the educational programs using the instructional materials, the score was improved with the significant difference in both experienced (pre: 3.6±1.4, post: 4.0±1.2) and inexperienced (pre: 2.8±1.5, post: 3.7±1.5) groups (p<0.05). CONCLUSION: According to the educational programs, technologist might be able to decide whether the additional delayed scan is useful or not. The successful results of this study may improve the interpretation or reduce the total exposure dose of the PET/CT scan.

Enhancing the Imaging Experience for Pediatric Patients.

The University of Maryland Medical Center's goal was to improve the safety and comfort of pediatric imaging by enhancing the experience for children. Two pediatric radiologists and two child life specialists worked together to create a training program to help guide radiology technologists on how to approach and interact with children undergoing medical imaging. The results of surveys administered to technologists and parents or caregivers helped refine the strategy for both creating training sessions for technologists and reading materials for children and their parents to optimally prepare for the procedures. Training sessions included information on language choices, developmental considerations, comfort techniques, patient- and family-centered care practices, procedural support techniques, and coping styles. Through the implementation of learning sessions and distraction resources for technologists, and the development of preparation books, the imaging experience for pediatric patients at UMMC has improved.

Study of Radiologic Technologists' Perceptions of Picture Archiving and Communication System (PACS) Competence and Educational Issues in Western Australia.

Although the implementation of picture archiving and communication system (PACS) could increase productivity of radiology departments, this depends on factors such as the PACS competence of radiologic technologists (RTs). The purpose of this study was to investigate the RTs' perceptions of PACS competence and educational issues in Western Australia (WA). A hardcopy questionnaire was distributed to WA RTs for obtaining their perceptions of PACS competence and educational issues. Descriptive (percentage of frequency, mean and standard deviation) and inferential statistics (t test and analysis of variance) were used to analyze the responses of the multiple choice and five-point scale questions from the returned questionnaires. The questionnaire response rate was 57.7% (173 out of 300). The mean values of all PACS competence questions except questions 2e-g are in the range of 3.9-4.9, i.e., around competent to very competent. Participants indicated they received adequate PACS training (mean 3.8). Statistically significant variables influencing RTs' perceptions of their PACS competence and educational issues including the age (p < 0.01), gender (p < 0.05), years of practice (p < 0.005-0.05), primary duty (p < 0.05), medical imaging qualification (p < 0.001), general computer skills (p < 0.001), and type of PACS education received (p < 0.001-0.05). The WA RTs indicated that they were competent in using the modality workstation, PACS and radiology information system, and received adequate training. However, future PACS education programs should be tailored to different RTs' groups. For example, multiple training modules might be necessary to support the PACS competence development of older RTs and those with lower general computer literacy.

Experiences of undergraduate African health sciences students: A hermeneutic inquiry.

While efforts have been made to understand the experiences of African students in predominantly white environments, the experiences of African students in clinical placement areas have rarely been explored. This paper is a report on a study designed to address the gap in educational research on the experiences of African health sciences students in clinical placements in predominantly white environments. Interviews adopting an open approach to conversations were conducted with nine African students from three health disciplines at one metropolitan university in Australia between 2012 and 2013. Interview transcripts were analyzed using philosophical hermeneutics, where shared meanings were arrived at by employing key Gadamerian hermeneutic components. Findings revealed a number of factors that had a direct effect on the meaning students derived from their clinical placement experiences. These, as revealed in the interlinked domains of body, space, relationships, and time included difference, acceptance, resilience, and cultural sensitivity. Insights from this study may lead to the adoption of strategies designed to improve the experiences of African students studying health sciences in predominantly white environments.

Cross-Trained Radiologic Technologists: A Survey.

Cross-training technologists would help increase department efficiency from a labor viewpoint, while also helping to increase the job stability and marketability of staff members. A survey of radiology managers was conducted to determine views on hiring preferences of radiologic technologists with a focus on multi-modality training. The current trend for hiring radiologic technologists sees an increase in demand for multi-modality and cross-trained employees. Employees who are content with their single modality training should be encouraged to cross-train and certify in an additional area. Radiology managers should also help to create opportunities and incentivize those who are currently interested in doing so.

[Usefulness of the Training of Trigger Point in Coronary CT Using Test Bolus Tracking Method].

BACKGROUND: Test bolus tracking (TBT) method has been used in coronary CT examination, because it is possible to examine the optimum contrast timing. However, the scan timing highly depends on an operators' recognition of peak in test bolus, thus there is a possibility of variation in contrast effect. PURPOSE: The aim of this study is to improve the variation of contrast effect among the operators. METHODS: The training for the operators was conducted to acknowledge them the optimal trigger points. The mean CT value and standard deviation of the ascending aorta were calculated to compare before and after the training. RESULTS: The mean CT value of the ascending aorta after the training was 485.02±73.06 HU, compared to 462.53±78.26 HU before the training. Standard deviation was significantly lower than before the training. CONCLUSION: The variation of contrast effect between the operators has been reduced by the training, and reproducibility of the examination has been improved.

[An introduction and implementation of problem-based learning for radiography positioning training].

The knowledge of radiological technologists is expected to increase with medical development. However, it is impossible to impart all knowledge in a limited time frame. Problem-based learning (PBL) is a learning methodology to solve it. In the PBL, students can gain problem-solving abilities by acquiring necessary knowledge from clinical cases and applying them during practice. We here report to implement the PBL in radiography practice. This practice opened a course at 2nd semester of third-grade students in our school. The practice flow includes presentation of clinical case and a survey of necessary knowledge, group work, radiography, reflection through practice, and deliberation of different cases. The clinical case was the radiography of an emergency patient. The evaluation items were about knowledge, skill, and attitude. By the PBL practice, students could realize a clinical scene, and discover considerable points unwritten in textbooks.

Education and career progression of imaging administrators.

The advancement into leadership positions for many administrators began as staff technologists moving up via interim management opportunities. New managers must develop supervisory skills while simultaneously assuming responsibility for the operation of the department. Mobility today is based primarily on a formal educational background. A transferable set of skills must be augmented with higher education. Those in the imaging sciences realize that an administrative position requires business and management acumen as well as technical skills. A shortage of imaging administrators is predicted due to an aging population and the rapid advancement of technology in healthcare. Institutes of higher education need to address and support the curricula and programs needed, which includes the CRA credential, for this growing field.

[Development of cloud chamber having thin-film entrance windows and proposal of practical training for beginners using X-ray equipment and unsealed radioactive material].

A cloud chamber is a detector that can visualize the tracks of charged particles. Hayashi, et al. suggested a visualization experiment in which X-rays generated by diagnostic X-ray equipment were directed into a cloud chamber; however, there was a problem in that the wall of the cloud chamber scattered the incoming X-rays. In this study, we developed a new cloud chamber with entrance windows. Because these windows are made of thin film, we were able to direct the X-rays through them without contamination by scattered X-rays from the cloud chamber wall. We have newly proposed an experiment in which beta-particles emitted from radioisotopes are directed into a cloud chamber. We place shielding material in the cloud chamber and visualize the various shielding effects seen with the material positioned in different ways. During the experiment, electrons scattered in the air were measured quantitatively using GM counters. We explained the physical phenomena in the cloud chamber using Monte Carlo simulation code EGS5. Because electrons follow a tortuous path in air, the shielding material must be placed appropriately to be able to effectively block their emissions. Visualization of the tracks of charged particles in this experiment proved effective for instructing not only trainee radiological technologists but also different types of healthcare professionals.

[Development of an attitude-measurement questionnaire using the semantic differential technique: defining the attitudes of radiological technology students toward X-ray examination].

BACKGROUND: In general, it is difficult to objectively evaluate the results of an educational program. The semantic differential (SeD) technique, a methodology used to measure the connotative meaning of objects, words, and concepts, can, however, be applied to the evaluation of students' attitudes. In this study, we aimed to achieve an objective evaluation of the effects of radiological technology education. We therefore investigated the attitude of radiological students using the SeD technique. We focused on X-ray examinations in the field of radiological technology science. METHODS: Bipolar adjective scales were used for the SeD questionnaire. To create the questionnaire, appropriate adjectives were selected from past reports of X-ray examination practice. The participants were 32 senior students at Hokkaido University at the Division of Radiological Technology at the School of Medicine's Department of Health Sciences. All the participants completed the questionnaire. The study was conducted in early June 2012. Attitudes toward X-ray examination were identified using a factor analysis of 11 adjectives. RESULTS: The factor analysis revealed the following three attitudes: feelings of expectation, responsibility, and resistance. Knowledge regarding the attitudes that students have toward X-ray examination will prove useful for evaluating the effects of educational intervention. In this study, a sampling bias may have occurred due to the small sample size; however, no other biases were observed.

[Clinical Validation of Chest X-ray Educational Content for Radiography Students Using Gaze Information].

PURPOSE: Radiography training for students in colleges of radiology should be based on real clinical situations. The purpose of this study was to verify the clinical validity of our originally developed scenarios for chest X-ray training and the instructional contents using gaze information of experienced radiology technologists (RTs). METHODS: We divided 8 RTs with different experiences into an evaluator group (3 RTs) and a subject group (5 RTs). The evaluator group created a validation model consisting of 31 items, a chest X-ray scenario, instructional contents, and gaze attention objects during the scenario. The subject group simulated chest X-ray wearing an eye tracker. The evaluator group evaluated fit rates of the validation model to subjects' procedures based on gaze information to verify the clinical validity of the validation model. RESULTS: The subject group procedures did not deviate from the scenario. We obtained a fit rate of 91.6±6.70%. CONCLUSION: Our validation model showed more than 90% fitting with the chest X-ray techniques of five RTs with different backgrounds. This result suggested that the scenario and instructional contents in this study had clinical validity.

Incorporating Reflective Learning Practices In Medical Imaging Curriculum.

PURPOSE: To provide an overview of the reflective learning cycle, as well as common reflective learning models, as a means of informing future implementation of reflective learning assignments in medical imaging curriculum. METHODS: Journal articles were searched for in Google Scholar, ScienceDirect, and ResearchGate, as well as the university's library databases using the keywords reflective learning, Kolb's model of learning, reflective learning practices in health care, and reflective learning in radiography. Out of 19 articles found, 12 articles were selected based on inclusion and exclusion criteria. RESULTS: The literature search yielded results in health care education, nursing, medicine, medical imaging and radiography, pharmacy, physical therapy, and occupational therapy. DISCUSSION: Studies have shown that reflection is an integral aspect of learning and has substantial implications for learners' clinical practice. Reflection is a cognitive process that facilitates learning, assists in the understanding and application of knowledge to clinical situations, and develops new clinical knowledge in student radiographers. When reflective activities, such as journaling, portfolios, and problem-based learning, are scaffolded throughout the curriculum, students develop critical reflection skills that positively affect their clinical practice. CONCLUSION: Reflective learning practices can positively affect student learning, clinical decision-making skills, and patient outcomes. When reflective learning activities are incorporated throughout the curriculum, students are more effectively able to bridge the gap between theoretical knowledge and clinical practice. In addition, the reflective learning process allows learners to examine their clinical experiences while providing context for application and future clinical practice and continued learning.

Predictive Validity of the HESI Radiography Exit Exam and Best Practices for ARRT Certification Exam Success.

PURPOSE: To determine the predictive validity of Health Education Systems Incorporated (HESI) Exit Exam scores for student first-time success on the American Registry of Radiologic Technologists (ARRT) certification exam and to analyze whether schools' policies on the HESI Exit Exam are associated with end-of-program student success. METHODS: Twenty-five radiography program directors provided retrospective data on ARRT certification exam student outcomes, and 24 program directors completed the HESI Exit Exam program policy survey. Data analysis was performed to examine the correlation between students' HESI Exit Exam scores and their first-time ARRT certification exam outcomes and to investigate the relationship between program policies and performance on both exams. RESULTS: First-time ARRT certification exam outcomes were obtained for 1265 program graduates who took the HESI Exit Exam from 2018 through 2021. Students achieving acceptable (700-749) and recommended (750-799) HESI Exit Exam scores exhibited significantly higher certification exam pass rates of 79.4% and 86.4%, respectively. ARRT certification exam pass rates were higher for those scoring 800 or above (94.5-100%). Implementation of a minimum HESI Exit Exam score requirements and a required exam preparation were significantly associated with more favorable ARRT certification exam outcomes. DISCUSSION: There was a significant positive relationship between higher HESI Exit Exam scores and more successful outcomes on the ARRT certification exam. Two program policies regarding use of the HESI Exit Exam (minimum exit exam score required, required test prep) emerged as best-practice approaches for ARRT certification exam success. CONCLUSION: The HESI Exit Exam was predictive of success on the ARRT certification exam. The results presented in this study can be used to improve radiography education. Future research on how additional educational resources affect HESI Exit Exam and ARRT certification exam success is warranted.

[New Method of Paired Comparison for Improved Observer Shortage Using Deep Learning Models].

PURPOSE: The aim of this study was to validate the potential of substituting an observer in a paired comparison with a deep-learning observer. METHODS: Phantom images were obtained using computed tomography. Imaging conditions included a standard setting of 120 kVp and 200 mA, with tube current variations ranging from 160 mA, 120 mA, 80 mA, 40 mA, and 20 mA, resulting in six different imaging conditions. Fourteen radiologic technologists with >10 years of experience conducted pairwise comparisons using Ura's method. After training, VGG16 and VGG19 models were combined to form deep learning models, which were then evaluated for accuracy, recall, precision, specificity, and F1value. The validation results were used as the standard, and the results of the average degree of preference and significance tests between images were compared to the standard if the results of deep learning were incorporated. RESULTS: The average accuracy of the deep learning model was 82%, with a maximum difference of 0.13 from the standard regarding the average degree of preference, a minimum difference of 0, and an average difference of 0.05. Significant differences were observed in the test results when replacing human observers with AI counterparts for image pairs with tube currents of 160 mA vs. 120 mA and 200 mA vs. 160 mA. CONCLUSION: In paired comparisons with a limited phantom (7-point noise evaluation), the potential use of deep learning was suggested as one of the observers.

Student Observations Reveal Gaps Between Chest Imaging Theory and Practice.

PURPOSE: To assess whether first-year radiography students observed differences between what they were taught in didactic and laboratory courses and how technologists perform chest imaging procedures during clinical experiences. METHODS: This study used a mixed-methods approach with a cross-sectional survey, consisting of 11 quantitative and 11 qualitative items, during the fall 2020 semester. The survey asked participants to evaluate survey statements based on their observations of radiographers' behaviors during chest imaging procedures in relation to the 11 American Registry of Radiologic Technologist clinical competency areas. Participants rated their evaluations based on the degree to which they agreed or disagreed with statements regarding radiographers' behaviors using a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). For each statement, a follow-up, open-ended question asked participants to provide reasons why they thought technologists did or did not exhibit certain behaviors. Data were analyzed quantitatively with differential statistics and qualitatively by thematically categorizing open-ended responses. RESULTS: A total of 19 first-year radiography students (N = 19) completed the survey. Most participants somewhat agreed or strongly agreed with 8 out of the 11 competency statements based on their observations of technologists when performing chest imaging procedures: room preparation (73.7%), patient identity verification (89.5%), examination order verification (79%), patient assessment (79%), equipment operation (52.6%), patient management (100%), technique selection (73.6%), and image evaluation (94.7%). Most participants somewhat disagreed, strongly disagreed, or were neutral with 3 out of the 11 categories: patient positioning, radiation safety, and image processing. Qualitatively, participants responded that technologists only provided lead shielding for pediatric patients, were not instructing patients to take 2 inspirations before making an exposure, and were cropping their images electronically before submitting them for diagnoses. DISCUSSION: Participants reported inconsistencies between what they were taught and what they saw technologists doing during chest imaging procedures related to patient positioning, radiation safety, and imaging processing. Participants' responses stated that these inconsistencies might be because of an increase in technologist responsibilities, patient volumes, and fear of not including relative anatomy on their images. CONCLUSION: Participants reported the most disagreement with radiation safety during chest imaging procedures. Although lead shielding for abdominal and pelvic procedures is no longer recommended, shielding patients during chest imaging procedures is still recommended. Radiography programs can educate students that inconsistency between task order does not mean there is a gap between theory and practice.

Scan With Me: A Train-the-Trainer Program to Upskill MRI Personnel in Low- and Middle-Income Countries.

PURPOSE: Access to MRI in low- and middle-income countries (LMICs) remains among the poorest in the world. The lack of skilled MRI personnel exacerbates access gaps, reinforcing long-standing health disparities. The Scan With Me (SWiM) program aims to sustainably create a network of highly skilled MRI technologists in LMICs who will facilitate the transfer of MRI knowledge and skills to their peers and contribute to the implementation of highly valuable imaging protocols for effective clinical and research use. METHODS: The program introduces a case-based curriculum designed using a novel train-the-trainer approach, integrated with peer-collaborative learning to upskill practicing MRI technologists in LMICs. The 6-week curriculum uses the teach-try-use approach, which combines self-paced didactic lectures covering the basics of MR image acquisition (teach) with hands-on expert-guided scanning experience (try) and the implementation of protocols tailored to provide the best possible images on their infrastructures (use). Each program includes research translation skills training using an established advanced MRI technique relevant to LMICs. A pilot program focused on cardiac MRI (CMR) was conducted to assess the program's curriculum, delivery, and evaluation methods. RESULTS: Forty-three MRI technologists from 16 LMICs participated in the pilot CMR program and, over the course of the training, implemented optimized CMR protocols that reduced acquisition times while improving image quality. The training resources and scanner-specific standardized protocols are published openly for public use in an online repository. In general, at the end of the program, learners reported considerable improvements in CMR knowledge and skills. All respondents to the program evaluation survey agreed to recommend the program to their colleagues, while 87% indicated interest in returning to help train others. CONCLUSIONS: The SWiM program is the first master class in MRI acquisition for practicing imaging technologists in LMICs. The program holds the potential to help reduce disparities in MRI expertise and access. The support of the MRI community, imaging societies, and funding agencies will increase its reach and further its impact in democratizing MRI.

Radiography students' perceptions of artificial intelligence in medical imaging.

INTRODUCTION: Education relating to Artificial Intelligence (AI) is becoming critical to developing contemporary radiographers. This study sought to investigate the perceptions of a sample of Australian radiography students regarding AI within the context of medical imaging. METHODS: Radiography students completed a cross-sectional online questionnaire which obtained quantitative and qualitative data relating to their perceptions and attitudes of AI within the radiographic context. Descriptive and inferential statistics were utilised, and thematic analysis was undertaken for open-text responses. RESULTS: Responses were gathered from twenty-five participants, in their second, third and fourth year of study. Most participants demonstrated a positive attitude towards AI. Most students view AI to be an assistive tool, though the cohort was less convinced AI would increase future employment in the industry. Females were more likely to disagree that AI will increase work opportunities for the radiographer (p = 0.021), as well as those in their final year of study (p = 0.011). Perceived benefits of AI related to improved work efficiency and image quality. Negative perceptions of AI involved reduced job security, and potential impact on patient care and safety. DISCUSSION: Students presented a multitude of positive and negative perceptions towards the role that AI may play in their future careers. Education pertaining to AI is central to transforming future clinical practice, and it is encouraging that undergraduate students are intrigued and willing to learn about AI in the radiographic context. CONCLUSION: This study offers insight into the current perspectives of Australian radiography students on AI within medical imaging, to assist in implementation of future AI-related education in the undergraduate setting.

From skeletons to screens: Transforming pedagogy in the age of remote learning.

This Educational Perspective explores the challenges and opportunities in Radiologic Technology education, focusing on the impact of active learning strategies and technological tools in enhancing asynchronous learning experiences. Radiologic Technology, a field reliant on hands-on experience and practical application, faced significant disruptions during the COVID-19 pandemic, necessitating a shift towards remote learning modalities. The Educational Perspective synthesizes the literature on the self-relevance effect, scaffolding, active learning, and metacognitive strategies to elucidate their role in promoting student engagement and success. The article offers recommendations to address the observed challenges, including creating scenario-based eLearning modules, providing immediate feedback and reflection opportunities, and incorporating gamification elements. These strategies aim to enrich asynchronous learning experiences, empowering radiology students to effectively adapt to changing educational landscapes and achieve optimal learning outcomes.