Assessing the predictive value of first trimester ultrasound and biochemical markers in miscarriage: A scoping review.

INTRODUCTION: Vaginal bleeding in the first trimester of pregnancy generates anxiety and uncertainty for expecting parents. The ability to determine pregnancy outcome through a first trimester ultrasound scan remains a challenge in obstetrics. Several first trimester ultrasound markers used individually or in combination, as well as ultrasound markers used in combination with biochemical markers, have been studied to determine their predictive value in pregnancy outcome. This scoping review was performed to determine which markers have already been investigated for this purpose. METHODS: An extensive and systematic database search was performed using four different categories of keywords which were combined using Boolean terms. A total of 14 variables were included on the final data charting forms. Data was synthesised collectively for each variable and then separately for the studies analysing only one marker. For the studies which analysed multiple markers, data was synthesised based on the number of markers per study. RESULTS: The search yielded 3608 studies, of which 128 were ultimately used for this review. Data extraction, based on predetermined eligibility criteria, was performed by two authors independently. Seventy-seven (62.6%) studies investigated the predictive value of a single ultrasound marker. The remaining 46 (37.4%) studies explored multiple markers, of which at least one was an ultrasound marker. CONCLUSION: This review identified several discrepancies among different studies. This highlights the need for better consensus among researchers to allow for the design of a predictive model which enables extrapolation of findings to all pregnant women. IMPLICATIONS FOR PRACTICE: Through the study of ultrasound and biochemical markers in the first trimester of pregnancy, clinicians may provide a more accurate prediction of pregnancy outcome following threatened miscarriage.

Optimisation of the CT pulmonary angiogram (CTPA) protocol using a low kV technique combined with high iterative reconstruction (IR): A phantom study.

INTRODUCTION: This study aims to optimise the current CTPA protocol at a public general hospital in Malta using lower kV combined with high Iterative Reconstruction (IR) (>50%). METHODS: The research consisted of a 2-phase anthropomorphic phantom study. Phase 1: radiation dose evaluation of 6 experimental protocols consisting of the low kV technique and high IR values and comparison with the current protocol. Phase 2: image evaluation. Objective image quality was evaluated in terms of contrast to noise ratio (CNR) and signal to noise ratio (SNR). Subjective image quality evaluation was performed by 3 radiologists undertaking Absolute Visual Grading Analysis (VGA). Resultant image quality scores were analysed using Visual Grading Characteristics (VGC). RESULTS: All experimental protocols achieved significant (p < 0.05) dose reductions. SNR and CNR improved in almost all protocols, however, differences were not significant (p > 0.05). In subjective image quality analysis, the current protocol provided significant superior image quality (AUC > 0.5; p < 0.05) when compared to the experimental protocols consisting of 80 kV with 70%, 80%, 90% and 100% IR. The only two experimental protocols yielding comparable image quality to the current protocol were 80 kV with 50% IR (AUC: 0.195; p: 0.137) and 80 kV with 60% IR (AUC: 0.554; p: 0.624). The protocol yielding the greatest decrease in radiation dose being 80 kV with 60% IR. CONCLUSIONS: The optimal IR value was 60%. When applying the optimal experimental protocol (80 kV combined with 60% IR), a significant dose reduction was achieved while maintaining diagnostic image quality. IMPLICATIONS FOR PRACTICE: The low kV technique combined with high IR parameter is easily implemented and involves no additional cost and equipment.

Low dose CTPA using a low kV technique combined with high IR: A clinical study.

INTRODUCTION: To investigate optimising a computerised tomography pulmonary angiogram (CTPA) scan protocol in terms of radiation dose and image quality using a low kV technique combined with high iterative reconstruction (IR) parameters (>50%) and apply the optimised protocol in clinical practice on patients irrespective of their body weight. METHODS: CTPA examinations were performed on 64 patients equally divided into control and experimental groups. Patients in the control group were scanned using the current protocol (100 kV with 50% IR) while patients in the experimental group were scanned using an optimised protocol (80 kV with 60%IR). The radiation dose indices volume computerised tomography dose index (CTDIvol), dose length product (DLP), size specific dose estimates (SSDE) and effective dose (ED) were recorded. Subjective image quality was evaluated by 3 radiologists through absolute visual grading analysis (VGA) using an image quality scoring tool. The resultant image quality scores were analysed using Visual Grading Characteristics (VGC). Objective image quality was recorded in terms of contrast-to-noise-ratio (CNR) and signal-to-noise-ratio (SNR). RESULTS: The application of the optimised protocol resulted in a statistically significant (p < 0.05) reduction in mean CTDIvol (-49%), DLP (-48%), SSDE (-52%) and ED (-49%). Objective image quality was significantly (p < 0.05) improved both in CNR (32%) and SNR (13%). Subjective image quality scores were higher for the current protocol but variation between the two protocols was not significant (p = 0.650). CONCLUSIONS: When applying the low kV technique combined with high IR parameters, a significant dose reduction may be achieved while still maintaining diagnostic image quality. IMPLICATIONS FOR PRACTICE: The low kV technique combined with high IR parameters is an effective optimisation technique which can be easily implemented for the CTPA protocol.

Competency level in radiotherapy across EU educational programmes: A cross-case study evaluating stakeholders' perceptions.

INTRODUCTION: The education of Therapeutic Radiographers (TRs) is regulated in some countries but is not standardised across the EU, leading to differences in competencies between and within member states. This study aimed to explore stakeholders' perceptions regarding underdeveloped competencies of TRs practising on the linear accelerator, identified in a previous study by the same research team. METHODS: Interviews with stakeholders from four countries (selected based on the characteristics of their degrees) were performed as part of this cross-case study. Stakeholders were asked to provide their perception regarding the least developed competencies identified in a previous study. RESULTS: The 27 stakeholders confirmed that Pharmacology, Quality Assurance (QA), Management and Leadership, Research (from the previous study) were underdeveloped and identified Image Verification and Critical Thinking as additional underdeveloped competencies. Suggested causes included: lack of regulation of required competencies at the national level, lack of training dedicated to radiotherapy (RT) (taught within generic modules) and lack of time within the degree programme. The ideal academic level to develop these competencies and whether they are essential varied between country and stakeholder. CONCLUSION: It is essential to regulate learning outcomes at the national level to ensure a high level of care is provided to all RT patients and, ideally, standardise it across Europe. Education institutions should review their curricula to ensure that sufficient time is dedicated to RT and that the essential competencies are developed. Due to time constraints within some programmes, some competencies must be developed after graduation. IMPLICATIONS FOR PRACTICE: Lack of regulation of learning outcomes (at European level and national level in many countries) and lack of RT-specific training lead to underdeveloped competencies that may compromise patient care.

Research ethics systems, processes, and awareness across Europe: Radiography research ethics standards for Europe (RRESFE).

INTRODUCTION: The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs. METHODS: A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe. RESULTS: 285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X2 (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X2 (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X2 (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X2 (1, n = 231) = 15.448, p = <0.001) within respondents' country. CONCLUSION: Respondents from countries with longer programme durations/availability of multiple programme lengths, availability of postgraduate training, and establishment of European Qualifications Framework Level 6 were generally associated with less uncertainty and more comprehensive research ethics requirements. IMPLICATIONS FOR PRACTICE: Results are informative of the current status of research ethics within evidence-based radiography.

Research ethics training, challenges, and suggested improvements across Europe: Radiography research ethics standards for Europe (RRESFE).

INTRODUCTION: The Radiography Research Ethics Standards for Europe (RRESFE) project aimed to provide a cross-sectional view of the current state of radiography research ethics across Europe. This included investigating education and training in research ethics, and identifying the key challenges and potential improvements associated with using existing research ethics frameworks. METHODS: This cross-sectional online survey targeting radiography researchers in Europe was conducted between April 26 and July 12, 2021. Descriptive and analytical statistics were used to identify research ethics education and training trends. Content analysis of qualitative responses was employed to identify significant challenges and proposed improvements in research ethics frameworks of practice. RESULTS: There were 232 responses received across 33 European countries. Most (n = 132; 57%) respondents had received some research ethics training; however, fewer participants had received training on safeguarding vulnerable patients (n = 72; 38%), diversity and inclusivity (n = 62; 33%), or research with healthy volunteers (n = 60; 32%). Training was associated with a greater perceived importance of the need for research ethics review (p = 0.031) and with the establishment of EQF Level 6 training (p = 0.038). The proportion of formally trained researchers also varied by region (p = <0.001). Time-to-ethics-approval was noted as the biggest challenge for professionals making research ethics applications. CONCLUSION: Early and universal integration of research-oriented teaching within the radiography education framework which emphasises research ethics is recommended. Additionally, study findings suggest research ethics committee application and approval processes could be further simplified and streamlined. IMPLICATIONS FOR PRACTICE: The survey contributes to a growing body of knowledge surrounding the importance of education and training in research ethics for assuring a high standard of research outputs in Radiography and has identified hurdles to obtaining research ethics approval for further investigation and address.

Evaluation of radiotherapy education across the EU and the impact on graduates' competencies working on the linear accelerator.

INTRODUCTION: Regulation and education of the professionals administering radiotherapy treatments in the linear accelerator varies across the EU. However, how different programme characteristics affect the level of competency of these professionals has never been studied before. This study also aimed to assess which are the least and most developed competencies in radiotherapy across the EU. METHODS: An online questionnaire was distributed to academic staff teaching radiotherapy across the EU. Staff were asked to identify the characteristics of the course programmes and to classify the level of competency of graduates regarding linear accelerator tasks. RESULTS: Fifty respondents from 19 EU countries answered the questionnaire. The least developed competency theme was pharmacology followed by equipment quality assurance and management and leadership. The most developed competency was positioning and immobilisation, followed by radiotherapy treatment delivery and professional and ethical practice. Some competencies are developed at the same level across EU countries, while others vary considerably between member-states. Longer programmes, with more placements, and larger proportions of radiotherapy in the programme showed significant increase in the development of some competencies. Longer placements in skills labs was correlated with a decrease in competency. CONCLUSION: There is no harmonisation of radiotherapy eduction across the EU and the differences in programme characteristics are reflected in differences in competency levels of radiotherapy radiographers. This may hinder movement of professionals and create disparities in the level of care offered across the EU. IMPLICATIONS FOR PRACTICE: Longer programmes, with longer clinical practice and adequate proportion of radiotherapy in the course are essential to ensure that these professionals are competent at similar levels across the EU and to ensure patient safety.

Competencies of therapeutic radiographers working in the linear accelerator across Europe: A systematic search of the literature and thematic analysis.

INTRODUCTION: The literature identifies various competences required for therapy radiographers (TR), however, these are varied and scattered among different publications. The aim of this study was to identify the competences required by therapy radiographers practising on the linear accelerator in the European setting, according to published literature. METHODS: A systematic approach was performed to find relevant literature. The literature was then scrutinised for competences practised by linac TRs. Thematic analysis was performed to organise the competences according to themes. RESULTS: A list of 170 competences were generated based on the assessment of 28 publications. The competences were organised in themes, including "delivery of treatment", "verification of patient setup", "patient care" and "teamwork and multidisciplinarity". The competences of the therapeutic radiographers encompass multiple themes, evidence of the complexity of the role of these professionals. CONCLUSION: Radiographers across Europe must be trained to the highest standards to ensure the best care possible is given to patients, irrespective of the country the radiographer trained in. This will also promote for free movement of professionals across countries. The competences identified can be used as reference for the design of academic curriculum for TRs practising across Europe.

Benefit-risk communication in paediatric imaging: What do referring physicians, radiographers and radiologists think, say and do?

INTRODUCTION: To assess how referrers and practitioners disclose benefit-risk information about medical imaging examinations to paediatric patients and their parents/guardians; to gauge their confidence in doing so; and to seek their opinion about who is responsible for disclosing such information. METHODS: This study followed on from a previously published study, with a questionnaire distributed in staggered phases to 146 radiographers, 22 radiology practitioners, 55 emergency physicians and 43 paediatricians at a primary paediatric referral centre in Malta. The questionnaire sought details about referrers' and practitioners' practice of disclosing benefit-risk information, as well as their opinion about their confidence and responsibility to do so. RESULTS: An overall response rate of 63.2% (168/266) was achieved. Most referrers and practitioners would generally explain the purpose of the imaging examination, with fewer providing benefit-risk information. The content and the approach adopted to communicate benefit-risk information varied, at times considerably. While 75% (123/164) felt that the responsibility to provide benefit-risk information was a shared one between referrers and practitioners, only 32.1% (53/165) reported a high level of confidence in their own ability to do so. CONCLUSIONS: Our findings highlight potential knowledge and skills gaps amongst local referrers and practitioners. This needs addressing so as to ensure that paediatric patients and their parents/guardians are provided with adequate, reassuring and consistent information. Additionally, we recommend that local referrers and practitioners come together and develop a consensus document that can offer guidance on how to go about discussing the benefits and risks of paediatric imaging examinations.

An evaluation of the educational requirements to practise radiography in the European Union.

INTRODUCTION: Radiography is practised world wide, however, the definition of the profession varies across countries. As there is no regulation of the profession or education at EU level, different national regulations might result in educational differences that can compromise the movement of professionals or the safety of patients. The aim of this study was to identify the commonalities and discrepancies in national regulation of radiography. METHODS: National competent authorities from all EU countries where the profession is regulated (n = 27) were invited to identify the legal requirements to practise radiography and the data was analysed using thematic analysis. RESULTS: One country does not regulate the profession in the EU. Although, a single profession is regulated in 83% of the cases, 21% regulate separate professions for different specialisms (diagnostic radiography, radiotherapy and nuclear medicine). All countries (n = 27) define education as requirement to practise, however, the academic level varies from secondary school to Master's degree with required programmes varying from 2 to 4 years and from 120 to 240 ECTS. In addition, the subjects covered in the education programme showed great heterogeneity. These subjects were not identified by 35% of the respondents (n = 23) and only 26% define the subjects in terms of competencies. CONCLUSION: Education is a requisite to practise all over the EU, however, the lack of EU-wide regulation leads to a variation of national regulations. These differences may lead to inhomogeneity of competencies being developed, compromising the movement of professionals across Europe and patient safety.

Teaching primary health care: an interdisciplinary approach.

The growing importance of the development of primary health care services necessitates role development for the allied health professions, including nursing and radiography. In order to prepare the future professionals to take on the challenges brought about by these role developments, educational institutions had to include lectures on the principles involved in primary health care delivery in the undergraduate curricula of these educational programmes. This was done at the University of Malta as an educational experiment, and the students were asked to complete a questionnaire about their experiences of pursuing this module on an interdisciplinary basis. The most important finding was the fact that the majority of respondents indicated that they found the theoretical material applicable to professional practice. It also enabled them to work towards developing their own roles within a primary health care clinical setting. The researchers can therefore suggest that primary health care should be included in the curricula of the other health care professions.