Infection prevention and control in computed tomography: creating a national survey.

BACKGROUND: Infection prevention and control (IPC) is essential for quality healthcare, with healthcare associated infections (HAI) a known risk to patients requiring medical imaging (MI). To date, few papers have adopted a national approach to understanding or benchmarking the knowledge of, attitudes toward, and practice (KAP) of IPC in the context of MI and no validated surveys or scales are identified in the literature. The Computed Tomography (CT) suite is a unique MI environment where radiographers deliver prescription medicines to patients via intravenous (IV) means through an injector system. This paper describes the development of a survey that informs the use of IPC processes in the CT suite. METHODS: Standard Precautions via current national guidelines formed the benchmark of the survey, with a KAP survey used as the framework to explore IPC. The questions and associated responses are developed based on the National Health and Medical Research Council (NHMRC) guidelines, industry/professional protocols and adapted to the equipment and practices commonly used in the CT suite of MI departments by radiographers and nurses. RESULTS: Key survey development steps are described to include the justification of the benchmarking source, the survey framework and design. Detailed information is given to show the evolution of truth statements and sources, KAP question variations, and rationales for the methodology of question responses. National guidelines are mapped to survey questions and responses and pilot testing reflections are included. CONCLUSION: This paper reports on the construction of a standardised KAP survey for IPC specific to the CT suite in the Australian healthcare setting. The survey is ready for dissemination amongst MI departments. Documented use will aid validation and reliability as a survey tool to measure and map IPC specifically in relation to IV contrast administration.

Infection prevention and control in the medical imaging environment: a scoping review.

Infection prevention and control (IPC) practices are key to preventing and controlling the spread of pathogens in medical imaging departments (MIDs). The objective of this scoping review was to synthesise information about current research in MID regarding IPC and to use the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify the work system factors ('persons', 'organisation', 'tools and technology', 'tasks' and 'environment') influencing the practice of IPC, in order to better understand challenges and facilitators that affect IPC in MID. Predefined search terms and medical subject headings relating to IPC in the medical imaging setting were used to search 3 databases. A total of 46 publications met the inclusion criteria, which combined, encompassed all five SEIPS domains influencing IPC. The literature supports the interrelated nature of the five SEIPS domains, and influence to one another. Hand hygiene was a major focus of publications. Mechanisms of infection in contrast-enhanced computed tomography were most reported, with human error, lack of education, and issues associated with devices and processes mechanisms found to influence IPC breaches. A systems approach, such as the SEIPS model, is useful for understanding barriers and hence opportunities for improvement of IPC in the medical imaging setting. Future studies should address individuals' decision-making processes in the medical imaging setting, and a greater focus should be placed into the procedural steps, education and tools used for contrast media administration. CRITICAL RELEVANCE STATEMENT: A systems approach, such as the Systems Engineering Initiative for Patient Safety model, is useful for understanding barriers and hence opportunities for improvement of IPC in the medical imaging setting. KEY POINTS: 1. IPC in the medical imaging setting would benefit from a systems approach. 2. The role of education and monitoring of IPC compliance requires further research. 3. Geographical location is a key variable in IPC research in medical imaging.

Infection prevention and control in medical imaging surveys: The need to map to guidelines to address systemic issues?

BACKGROUND: Infection prevention and control (IPC) in the medical imaging (MI) setting is recognised as an important factor in providing high-quality patient care and safe working conditions. Surveys are commonly used and have advantages for IPC research. The aim of this study was to identify the core concepts in surveys published in the literature that examined IPC in MI environments. METHODS: A literature review was conducted to identify studies that employed a survey relating to IPC in the MI setting. For each included study, descriptive study information and survey information were extracted. For IPC-specific survey items, directed content analysis was undertaken, using eleven pre-determined codes based on the 'Australian Guidelines for the Prevention and Control of Infection in Healthcare'. Content that related to 'Knowledge', 'Attitudes' and 'Practice' were also identified. RESULTS: A total of 23 studies and 21 unique surveys were included in this review. IPC-specific survey items assessed diverse dimensions of IPC, most commonly relating to 'transmission-based precautions' and 'applying standard and transmission-based precautions during procedures'. 'Practice' and 'Knowledge' related survey items were most frequent, compared to 'Attitudes'. CONCLUSION: MI research using survey methods have focused on the 'entry' points of IPC, rather than systemic IPC matters around policy, education, and stewardship. The concepts of 'Knowledge', 'Attitudes' and 'Practice' are integrated in IPC surveys in the MI context, with a greater focus evident on staff knowledge and practice. Existing topics within IPC surveys in MI are tailored to individual studies and locales, with lack of consistency to national frameworks.

Opportunities to develop leadership skills in the undergraduate diagnostic radiography program: Insights from students at an Australian university.

INTRODUCTION/BACKGROUND: Leadership is defined as the ability to influence others to work towards common visions and goals. A key principle of the Australian Health Leadership Framework is that it applies to all leaders and potential leaders, who are at any place in the system. Hence, leadership is everyone's responsibility, including health profession students. In this short communication, we discuss the concept of leadership development in the undergraduate diagnostic radiography (DR) program through experiential learning. Examples from students' and academics' perspectives are presented, with the intention of providing a broad context to the range of opportunities that support development of leadership skills in DR students. DISCUSSION: Experience and experiential learning are fundamental and natural means of learning. Experiential learning has a positive effect on leadership because of its impact on personal, attitudinal, moral, social, and cognitive outcomes. Undergraduate DR students value opportunities to develop leadership skills during their university education. Four opportunities to develop and reflect on leadership skills are discussed. Two of the opportunities, clinical placements and honours programs, form part of the curricula, whilst others, such as mentoring and profession-specific social groups, are not. Through experience-based learning, students may benefit from transformational effects in their individual skills, which may ultimately benefit the organisation or community in which the individual participates. CONCLUSION: Commitment from clinical and academic educators to enable leadership development in DR students is essential. Through implementation of obligatory and optional experiential learning opportunities, it is anticipated that leadership skills will be cultivated in DR students, enabling students to exercise effective leadership in their current student roles and establish essential skills for their future professional roles.

Teaching evidence-based practice: Case study of an integrated assessment task for diagnostic radiography students.

INTRODUCTION: A core competency for all health care professionals is evidence-based practice (EBP). An understanding of research skills are key to diagnostic radiographers adopting EBP, and should be taught and assessed in curricula leading to eligibility to register and practice. This paper focuses on the design, implementation and initial evaluation of an assessment task in the Diagnostic Radiography (DR) curriculum at an Australian university, which aimed to facilitate students' skills to identify and interpret research methods and output as a foundation for EBP by combining with EBP and DR theoretical content. METHODS: An integrated assessment task was introduced across two units of study, requiring student groups to produce a single literature review incorporating learning objectives from each distinct unit of study. This approach recognised and incorporated themes of student choice, negotiation of group membership, and scholarly writing as inherent components. RESULTS: Student feedback showed that students valued the integration of content knowledge and research principles across two units of study to better reflect their depth and breadth of learning. Students also commented on the value of team or group work in developing their communication and cooperation skills, which are essential skills in the DR workplace. DISCUSSION: A literature review assessment task integrated across two previously separate units of study provided an innovative approach to assessment of EBP in the DR curricula. CONCLUSION: It is anticipated that DR graduates, who are prepared with knowledge and skills in EBP prior to graduation, will become leaders and drive future innovation in EBP.

Designing a breast support device for phase contrast tomographic imaging: getting ready for a clinical trial.

OBJECTIVE: To design a device that can support the breast during phase-contrast tomography, and characterise its fit parameterisation and comfort rating. METHODS: 27 participants were recruited to trial a system for breast support during simulated phase contrast imaging, including being positioned on a prone imaging table while wearing the device. Participants underwent a photogrammetry analysis to establish the geometric parameterisations. All participants trialled a single-cup design while 14 participants also trialled a double-cup with suction holder and all completed a series of questionnaires to understand subjective comfort. RESULTS: Photogrammetry revealed significant positive correlations between bra cup volume and measured prone volume (p < 0.001), and between "best fit" single-cup holder volume and measured prone volume (p < 0.005). Both holders were suitable devices in terms of subjective comfort and immobilisation while stationary. However, some re-engineering to allow for quick, easy fitting in future trials where rotation through the radiation beam will occur is necessary. Light suction was well-tolerated when required. CONCLUSION: All participants indicated the table and breast support devices were comfortable, and they would continue in the trial. ADVANCES IN KNOWLEDGE: Phase contrast tomography is an emerging breast imaging modality and clinical trials are commencing internationally. This paper describes the biomedical engineering designs, in parallel with optimal imaging, that are necessary to measure breast volume so that adequate breast support can be achieved. Breast support devices have implications for comfort, motion correction and maximising breast tissue visualisation.

Radiation Therapy Patient Education Review and a Case Study Using the Virtual Environment for Radiotherapy Training System.

INTRODUCTION: The emergence of modern learning environments for radiation therapy (RT) education offers innovative opportunities for RT patients. This article presents a descriptive review of the current state of practice for two recently available tools, the "Virtual Environment for Radiotherapy Training" (VERT) and the "Patient Education And Radiotherapy Learning" (PEARL) systems. Subsequently, a case study summarizes the instructional design and development of an RT breast cancer patient education program, with the intention of providing a blueprint for further patient education initiatives that incorporate VERT. METHODS: A total of 278 articles were identified for the descriptive review, using academic databases and a grey literature search. After screening for descriptive accounts of patient education interventions using VERT or PEARL, five full articles were retrieved and coded using a data extraction protocol. This information was used to inform the subsequent development of a breast cancer education program using a three-step development model, encompassing (1) consultation process and literature review; (2) program content and instructional process; and (3) program evaluation plan. The VERT integration process within the second stage is the focus of the case study presented. RESULTS: The literature search found that methods for the design, delivery, and evaluation of the education programs varied across studies. Positive impacts of VERT and PEARL in patient education have been demonstrated. The development of the 1-hour education program was based on comprehensive, evidence-based learner literature and was designed with the intention of specifically engaging learners with the three-dimensional VERT system. In particular, the VERT integration process aimed to exploit VERT's range of visualization features and draw upon the multidisciplinary nature of radiation cancer care. DISCUSSION: VERT and PEARL offer innovative education opportunities and have been justly recognized as valuable tools for RT patient education. When aligned to an educational framework, rich visual displays offered by VERT and PEARL have the potential to support patient education programs and exploit the advantages of a virtual RT environment. With the increasing accessibility of these tools, the data presented in this article offer information for educators interested in development and evaluation of future patient education programs. Feasibility and economic aspects need to be addressed within local departments, and further research is required to ascertain specific capability of VERT and PEARL in supporting psychological and health-related patient outcomes.

Radiation therapy patient education using VERT: combination of technology with human care.

The Virtual Environment for Radiotherapy Training (VERT) system is a recently available tool for radiation therapy education. The majority of research regarding VERT-based education is focused on students, with a growing area of research being VERT's role in patient education. Because large differences in educational requirements exist between students and patients, focused resources and subsequent evaluations are necessary to provide solid justification for the unique benefits and challenges posed by VERT in a patient education context. This commentary article examines VERT's role in patient education, with a focus on salient visual features, VERT's ability to address some of the spatial challenges associated with RT patient education and how to combine technology with human care.

Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy.

PURPOSE: Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients' RT knowledge and anxiety. METHOD: Breast cancer patients were recruited into a control group (CG) (n = 18) who underwent the standard pre-RT education package at a targeted cancer therapy centre, followed by a VERT group (VG) (n = 19). VG patients attended a VERT-based education session detailing RT immobilisation, planning and treatment. All patients completed questionnaires at four time points throughout their treatment, with survey sub-sections on RT knowledge, experience and anxiety. RESULTS: For both groups, anxiety levels were highest at time point 1(T1 after initial radiation oncologist consultation) (CG, 41.2; VG, 43.1), with a gradual decrease observed thereafter at time points before simulation, at the beginning of treatment and at the end of treatment (p > 0.05). The VG's RT knowledge scores were statistically significantly higher than those of the CG scores at all time points following VERT education (p < 0.05). CONCLUSION: This study reports the high value of VERT breast cancer-targeted education programs in improving RT knowledge and perhaps decreasing patient anxiety. Continued efforts are required to improve patients' accessibility to VERT in Australia, and to better understand the effect of VERT's unique educational features on patients' emotional and physical needs throughout their RT.

Interprofessional education: evaluation of a radiation therapy and medical physics student simulation workshop.

INTRODUCTION: Interprofessional education (IPE) involves two or more professions engaged in learning with, from and about each other. An initiative was undertaken to explore IPE for radiation therapy (RT) and medical physics (MP) students through a newly developed workshop based around simulated learning. The aims of this study were to explore RT and MP students' perceptions of working as part of a collaborative team and of their own and the other group's professional roles. Student perceptions of the simulation education tool, the virtual environment for radiotherapy training (VERT) system, were also investigated. METHODS: RT and MP students were invited to participate in a 4-hour interprofessional workshop. Pre- and post-workshop surveys were employed to collect demographic data, students' perceptions of interdisciplinary education (interdisciplinary education perception scale (IEPS)) and workshop evaluation (bespoke questionnaire). RESULTS: Fifteen students attended the workshop (RT, n = 8; MP, n = 7). Thirteen pre- and post-questionnaires were returned (Pre-questionnaire: RT, n = 6, response rate, 75%; MP, n = 7, response rate, 100%; post-questionnaire: RT, n = 7, response rate, 87.5%; MP, n = 6, response rate 85.7%). For both student groups combined, IEPS scores ranged from 64 to 108 and 71 to 108 in the pre- and post-questionnaires, respectively, with insignificant differences in the mean scores post-intervention (Z = -1.305, P = 0.192). Satisfaction with VERT as a simulation tool was high for both student groups. CONCLUSIONS: The interprofessional student workshop served to promote interprofessional collaboration for RT and MP students. VERT was reported as an appropriate education tool for this purpose, enabling access to virtual clinical equipment common to both student groups. It is suggested that IPE continues to be offered and investigated in RT and MP students, in order to improve effective interprofessional strategies which may enrich future professional collaboration.

Successful implementation of Virtual Environment for Radiotherapy Training (VERT) in Medical Physics education: The University of Sydney's initial experience and recommendations.

This report outlines the University of Sydney's initial experience with the Virtual Environment for Radiotherapy Training (VERT) system in the Master of Medical Physics program. VERT is a commercially available system, simulating linear accelerators, patient computed tomography (CT) sets, plans and treatment delivery. It was purpose built for radiation therapy (RT) education and offers learners the opportunity to gain knowledge and skills within an interactive, risk-free environment. The integration of VERT into the RT physics module of the Master of Medical Physics program was intended to enhance student knowledge and skills relevant to the curriculum's learning objectives, and to alleviate some of the burden associated with student access to clinical equipment. Three VERT practical sessions were implemented: "RT treatment planning systems", "(CT) Anatomy for physicists" and "Linear accelerator measurements". Our experience and student evaluations were positive and demonstrated the viability of VERT for medical physics (MP) student education. We anticipate that integration of VERT into MP teaching is a valuable addition to traditional methods and can aid MP students' understanding and readiness for practice. Additional evaluations should be conducted to ascertain VERT's role in delivering efficient quantity and quality of MP education, and its potential in alleviating burdens placed on clinical departments.