Virtual reality versus conventional clinical role-play for radiographic positioning training: A students' perception study.

INTRODUCTION: Simulated learning environments (SLEs) are commonly utilised by educational institutions. The aim of this study was to assess if students perceptions varied relating to the effectiveness of either a virtual reality (VR) simulation or traditional clinical role-play scenario in developing radiographic hand positioning skills. METHODS: A split-cohort study was performed with Year 1 Undergraduate Radiography students (n = 76). Students were randomly assigned to undertake training for radiographic hand positioning tasks using either the CETSOL VR Clinic software (Group 1) or traditional clinical role-play (Group 2). Following completion of their positioning training, students' perceived impact of the SLE on developing practical and technical skills were assessed using a 5-point Likert scale questionnaire and free text option. RESULTS: Quantitative student perception scores indicated no significant difference between the two simulation modalities, the mean agreement scores (combined strongly agree + agree) for Groups 1 and 2 were 74.8% and 83.8%, respectively, where χ2 (4, n = 66) = 9.5, p-value = 0.394. Key themes expressed by students following a thematic analysis were "engagement with the learning environment, positioning practice and comparability to clinical practice. CONCLUSION: The perceptions of novice students in training for radiographic hand positioning tasks, using either a VR SLE or clinical role-play scenario, did not differ. There was a strong similarity in common themes, however, a key point of difference identified was the benefit of repetition afforded by the VR simulation, in contrast to the need for more time using traditional role-play in a constrained laboratory setting. IMPLICATIONS FOR PRACTICE: The lack of difference in student perceptions between VR and clinical role-play training, could offer a different approach to clinical training which is easily accessible and allows users to correct mistakes at their own pace.

An Overview of the Cardiac Catheterization Lab.

The role of the cardiac catheterization lab technologist differs from other radiologic technologist roles. This article demystifies the cardiac catheterization lab by explaining commonly performed procedures. The anatomy and pathology that might require treatment in the catheterization lab also are discussed.

Positioning end-of-life care education within the pre-registration therapeutic radiography curriculum: A survey of current practices amongst UK higher education institutions.

AIM: It is essential that all health professionals who come into contact with patients with terminal diagnoses are equipped to effectively and competently provide end of life care. This study aims to investigate the manner in which Higher Education Institutions address this requirement with their programmes of pre-registration therapeutic radiography education. METHOD: A structured survey was administered electronically to all UK universities with responsibility for therapeutic radiography education. The scope of the survey addressed mode and duration of end of life care education, its location, curricular assessment, identifiable barriers and best practice. RESULTS: All respondents confirmed the presence of dedicated end of life care education within their curriculum. Variation in the duration and location of this education is reported as are approaches to assessment of associated skills and knowledge. Analysis of respondent commentary has identified three themes-preparedness for the clinical role, dissonance between technology and care, and holistic approaches to course design. CONCLUSION: Respondents have highlighted the importance of end of life care instruction with their programmes of study and identified aspects of the mode and duration of its delivery. Inclusion of this aspect of study may be problematic in the face of competing demands arising from the volume and complexity of the curriculum. Practical experience of end of life care predominantly occurs within the radiotherapy department, although there is scope to explore opportunities within the hospice and community care setting.

[Position-checking by imaging embarked there tomotherapy and the delegation to the radiology technician]. / Contrôle de position quotidien par imagerie embarquée en tomothérapie et de la délégation aux manipulateurs en électroradiologie médicale.

Tomotherapy is a technique of IMRT and IGRT using a linear accelerator and a helical CT-scanner. To reach this targeting of precision, the repositioning of the patient is essential. The use of a contention adapted according to the location of the disease and the morphology of the patient is necessary for the safety of this one and the treatment. Once the patient positioned on the reference table, technicians of imager's team check by the acquisition of helical imagery with the reference CT-scanner the position of the patient, the zone of the PTV and healthy organs in the protected surroundings. At first, adjustment will be made automatically on three planes of the space (axial, sagittal, frontal) and three rotations (pitch, roll and yaw) by the device of treatment, then the technicians of imagery will bring a modification of these recalls manually. After validation, the processing will then be made in complete safety for the patient and the nursing. This check by MVCT is daily before every session of processing. It is made by the technicians of imagery. The radiation oncologist confirms the images at j0, then controls once a week MVCT. Traceability in the file of the patient of the various marks (osseous and\or soft tissue) necessary for the daily gaps will be noted by this one to delegate to the technicians of imagery the validation of the MVCT before every session.

Evaluation of Stress and a Stress-Reduction Program Among Radiologic Technologists.

PURPOSE: To investigate stress levels and causes of stress among radiologic technologists and determine whether an intervention could reduce stress in a selected radiologic technologist population. METHODS: Demographic characteristics and data on preintervention stress sources and levels were collected through Internet-based questionnaires. A 6-week, self-administered, mindfulness-based stress-reduction program was conducted as a pilot intervention with 42 radiologic technologists from the Veterans Administration Medical Center. Data also were collected postintervention. Identified sources of stress were compared with findings from previous studies. RESULTS: Some radiologic technologists experienced improvement in their perceptions of stress after the intervention. Sources of stress for radiologic technologists were similar to those shown in earlier research, including inconsistent management, poor management communication, conflicting demands, long work hours, excessive workloads, lack of work breaks, and time pressures. CONCLUSION: The mindfulness-based stress-reduction program is an example of an inexpensive method that could improve personal well-being, reduce work errors, improve relationships in the workplace, and increase job satisfaction. More research is needed to determine the best type of intervention for stress reduction in a larger radiologic technologist population.

Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case-Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees.

Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced maternity care providers in academic and clinical settings. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.

Social network analysis of physician interactions: the effect of institutional boundaries on breast cancer care.

Although comparative effectiveness trials and nationally recognized clinical guidelines offer substantial guidance about ideal patient treatment, we remain largely uninformed about the patterns of care seen in everyday clinical practice. To address this gap in knowledge, we looked at registry-based data on breast cancer care at two neighboring healthcare institutions with a specific focus on whether organizational boundaries determine the physicians that a patient will see. From an initial patient-oriented data set, we developed a social network of physicians, modeling their interactions over the course of the provided treatments. Applying a mixture of visual and quantitative analyses to this network, we found evidence for strong intra-institutional ties and poignantly weak connections to physicians operating out of other healthcare centers.

O perfil brasileiro de propriedade intelectual em radiologia e diagnóstico por imagem em um contexto internacional, nos anos 2000-2009 / The Brazilian profile of intellectual property in radiology and imaging diagnosis in an international context in the years 2000 to 2009

OBJETIVO: Analisar a inovação tecnológica brasileira na área de radiologia e diagnóstico por imagem, em termos de indicadores de patentes. MATERIAIS E MÉTODOS: Este é um estudo analítico-exploratório de informações recuperadas por meio de consultas cruzadas nas bases de dados dos escritórios de propriedade intelectual do Brasil (Instituto Nacional da Propriedade Industrial - INPI), dos Estados Unidos (United States Patent and Trademark Office - USPTO) e da Europa (European Patent Office - EPO). RESULTADOS: Foram encontradas 277.057 patentes. Desse total, 7.800 foram registradas no INPI (3 por cento), 65.428 (24 por cento) registradas no EPO e 203.829 (73 por cento) emitidas no USPTO. O Brasil é o país signatário em 1.732 patentes publicadas no INPI, 80 no EPO e 26 no escritório USPTO. Globalmente, 219.993 (79 por cento) patentes referiam-se a dispositivos eletrônicos ligados a informática em saúde, ultrassonografia, ressonância magnética, tomografia computadorizada e procedimentos de geração, comunicação e arquivamento de imagens, e 57.064 (21 por cento) das patentes tratavam das tecnologias relacionadas a radioproteção e dosimetria, física nuclear, eletroterapia, terapia magnética e radioterapia. CONCLUSÃO: Os resultados obtidos apontam para a fragilidade da produção nacional de inovação tecnológica registrada em patentes, no campo de radiologia e diagnóstico por Imagem.

OBJECTIVE: To analyze the Brazilian technological innovation in the field of radiology and imaging diagnosis, in terms of patent indicators. MATERIALS AND METHODS: Exploratory analytical study of information retrieved through cross queries in databases of intellectual property offices in Brazil (State Industrial Property Office [Instituto Nacional da Propriedade Industrial - INPI]), United States (United States Patent and Trademark Office - USPTO) and Europe (European Patent Office - EPO). RESULTS: There were 277,057 patents in the field of radiology and imaging diagnosis. Of this total, 7,800 were registered at INPI (3 percent), 65,428 (24 percent) registered at the EPO and 203,829 (73 percent) issued by USPTO. Brazil is a signatory to 1,732 patents published by the INPI, 80 by the EPO and 26 by the USPTO. Overall, 219,993 (79 percent) patents were related to electronic devices strongly linked to information technology in health care, ultrasonography, tomography, magnetic resonance imaging procedures as well as to images generation, communication and archiving, and 57,064 patents (21 percent) dealt with technologies related to radiation protection and dosimetry, nuclear physics, electrotherapy, magnetic therapy and radiotherapy. CONCLUSION: The results indicate the weakness of the domestic production of patented technological innovation in the field of radiology and imaging diagnosis.

Changing stress while stressing change: the role of interprofessional education in mediating stress in the introduction of a transformative technology.

The introduction of a transformative technology into practice settings can affect the functioning of interprofessional teams, placing stress on interprofessional relationships, thus slowing adoption and change. This study explored the potential of an interprofessional education (IPE) approach to mediate this stress and facilitate the adoption of a transformative technology- Image Guided Radiation Therapy (IGRT). Oncologists, physicists, and therapists in radiation medicine who attended an interprofessional IGRT Education Course were interviewed about perceived benefits and stressors to IPE and to interprofessional practice (IPP) in the IGRT context. A modified grounded theory approach was used to conduct 14 interviews, with 200 minutes of interview time recorded. In introducing IGRT, participants noted interprofessional stress in understanding and adopting new technology. IPE offered common terminology, appreciation for others' knowledge, and a holistic framework for practice. Outcomes were thought to foster collaboration, efficiency, and improved professional role definition. Time constraints and power relations were noted to be residual stressors exacerbated by IPE, but were thought to be transient. IPE can thus be of benefit in the implementation of transformative technologies such as IGRT, through mediation of interprofessional stress inherent in change. Interprofessional knowledge, collaboration, and efficiency in practice facilitate the development and adoption of a new practice model.

Educación sanitaria sobretécnicas radiológicas concontraste / Health care education on radiologic techniques using contrast

Los medios de contraste radiológicos son productos farmacológicos que,al ser administrados en la estructura anatómica en estudio y ser atravesadospor la radiación ionizante, permiten valorar la morfología y la funcionalidadde dichas estructuras, obteniéndose imágenes con una densidadradiológica que las diferencia del resto de estructuras anatómicas.El propósito de este trabajo es facilitar a la enfermera la actualización delconocimiento que es necesario para realizar las intervenciones de cuidadosenfermeros en el contexto de la realización de las técnicas de diagnósticoradiológico con contraste.El presente artículo describe las exploraciones más habituales de radiologíaconvencional contrastada (contraste de bario y yodo): TránsitoEsófago Gatroduodenal (TEG), Tránsito Intestinal (TIN), Enema Opaco,Pielografía (UIV) e HisteroSalpingoGrafía (HSG).Desde el punto de vista del cuidado del paciente es importante que la enfermeraconozca las indicaciones, la preparación del paciente, las característicasde las técnicas radiológicas con contraste y las contraindicacionesde las mismas, así como las complicaciones potenciales o losefectos indeseados derivados de los mismos (AU)

Radiologic contrast solutions are pharmacological products that, whenadministered in the anatomical structure under study and penetrated byionizing radiation, enable the assessment of the morphology and functionalityof these structures, obtaining images with a radiologic densitythat differentiates them from the other anatomic structures.The aim of this work is to provide the nurse with updated knowledgethat is necessary to carry out nursing care interventions within the contextof the performance of radiologic diagnosis techniques using contrast.This article describes the most common explorations using conventionalcontrast radiology (barium and iodine contrast): GastroduodenalEsophageal Transit, Intestinal Transit, Opaque Enema, Pyelography(IVU) and Hysterosalpingography (HSG).From the point of view of patient care, it is important that the nurse understandsits indications, patient preparation, the characteristics of radiologictechniques using contrast and their contraindications, as wellas the potential complications or undesired effects they may produce (AU)

Effects of vitamins C and E combination on element levels in blood of smoker and nonsmoker radiology X-ray technicians.

X-ray radiation is detrimental to human cells and may lead to development of life-threatening diseases. Cigarette paper and cigarette smoke contain toxic elements, whereas vitamins C and E (VCE) may have regulator effects on the elements. We investigated effects of VCE administration on X-ray-induced element changes in blood of smoker and nonsmoker X-ray technicians. Twenty technicians and 30 healthy age-matched control subjects were used in the study. Ten of the X-ray technicians and 15 of the control were smokers. Blood serum samples were taken from the control. Oral vitamins C (500 mg) and E (150 mg) were supplemented daily to the smoker and nonsmoker X-ray technicians for 5 weeks. Serum samples were taken from the X-ray technicians before and after 5 weeks. Copper, zinc, selenium, aluminum, iron, magnesium, and calcium levels were investigated in control and X-ray technicians, both smokers and nonsmokers. Copper, zinc, and selenium levels were lower in the total X-ray group and smoker X-ray group than in control and nonsmoker X-ray group, although iron, magnesium, and calcium levels were higher in X-ray group than in control. The copper, zinc, selenium, and aluminum levels were higher in the VCE treatment group than those in X-ray group, although magnesium and calcium levels were decreased by the treatment. The serum zinc, copper, selenium, and magnesium levels were lower in smoker control group when compared to nonsmoker control group. The serum zinc levels were lower in smoker X-ray group than nonsmoker X-ray group, although iron level was higher in smoker X-ray group than in nonsmoker X-ray group. VCE prevents the smoke and X-ray-induced selenium, zinc, magnesium, and copper decrease to strengthen the antioxidant trace element levels in the serum of the technicians.

Vitamin C and E combination modulates oxidative stress induced by X-ray in blood of smoker and nonsmoker radiology technicians.

X-ray radiation is detrimental to human cells and may lead to development of life-threatening diseases. Cigarette smoke contains about 500 chemicals that include organic and oxidant compounds whereas vitamin C and E (VCE) have scavenger effects on the compounds. We investigated effects of VCE administration on X-ray-induced oxidative toxicity in blood of smoker and nonsmoker X-ray technicians. Twenty technicians and 30 healthy age-matched subjects control were used in the study. Ten of the X-ray technicians and 15 of the control were smokers. Blood samples were taken from the control. Oral vitamin C (500 mg) and vitamin E (150 mg) were daily supplemented to the smoker and nonsmoker X-ray technicians for 5 weeks. Blood samples were taken from the X-ray technicians after and before 5 weeks. Plasma and erythrocytes lipid peroxidation (LP), reduced glutathione (GSH) levels, erythrocytes glutathione peroxidase (GSH-Px), and plasma antioxidant vitamin concentrations were investigated in control and X-ray technicians with smoker and nonsmoker. Plasma and erythrocytes LP levels were higher in the total X-ray group and smoker X-ray group than in control and nonsmoker X-ray group, respectively although the LP level was decreased by the VCE treatment. The plasma vitamin C, vitamin A, vitamin E, and beta-carotene concentrations were lower in the X-ray group than in control although their concentrations were increased by the treatment. The erythrocytes GSH level and GSH-Px activity were found to be higher in the treatment group than in the X-ray group. Plasma GSH level was not found to be different in all group. Reactive oxygen species may play role in the mechanism that has been proposed to explain the biological side effect of X-ray radiation and smoke. VCE prevents the smoke and X-ray-induced oxidative stress to strengthen antioxidant vitamin concentrations in the blood of the technicians.

Use of a petroleum-based bolus for photon radiation therapy of distal extremities in dogs.

While skin sparing is an advantage of megavoltage beams, in certain clinical situations the planning target volume includes the skin surface and a skin sparing effect is not desirable. A tissue equivalent material, termed build up bolus, is used in these situations to provide adequate absorbed dose at the surface of the skin. However, an irregular patient contour can lead to air gaps between the build up bolus and the skin surface, which may result in variability in radiation dose across the target volume. The shape of the canine distal hind extremity is irregular, and commercially available bolus materials do not conform well to this region. The purpose of this study was to assess the dose homogeneity achieved using a petroleum-based bolus material, in combination with a commercially available sheet bolus, for radiation treatment of the canine tarsus. Repeated setups were performed to mimic daily treatment setups in the clinic setting, and computed tomographic scans were performed after each setup. Dose distribution achieved with a cobalt therapy machine and a 6 MV linear accelerator was assessed using three-dimensional treatment planning software. The dose to the clinicaltarget volume fell within 95% and 107% of the prescribed dose for both treatment machines, which is considered clinically acceptable by the authors. This petroleum-based bolus is equivalent to water in its photon attenuation, conforms well to an irregular patient contour, and retains its shape after positioning. Applications to other anatomical sites could be considered.

Evaluation of a radiographer-provided barium enema service.

AIM: Radiographers performed and reported 5516 double contrast barium enemas (RDCBEs) over 4 years to October 2001. This study was undertaken to assess the accuracy of RDCBE and the sensitivity for diagnosing colorectal cancer (CRC). METHOD: A total of 224 consecutive outpatient RDCBEs were reported; normal (C1), diverticulosis (C2), diverticulosis with filling defect (C3), diverticulosis & other pathology (C4) and abnormal (C5). RDCBEs were then reported by a radiologist (AL, NS) and the two reports compared. Of 450 CRCs, 153 had undergone DCBE; 152 RDCBEs. Reports were analysed to establish concurrence between radiographer and radiologist and final CRC diagnosis. RESULTS: By category: C1 - 37%, C2 - 31%, C3 - 21%, C4 - 11%, C5 - 0%. C4s included polyps (50%), cancer (12.5%), disrupted anastomosis (8%) and colitis (4%). There was no discrepancy between RDCBE and radiologist reports. Radiology and CRC diagnosis agreed in 145 of 152 DCBEs. There were three exclusions: DCBEs occurred outside the study period (2), one only with raised possibility of malignancy. Of eight remaining RDCBEs, seven were false negatives and one false positive. Sensitivity score for RDCBE was 94.5%. Double reporting by a radiologist did not improve sensitivity. CONCLUSION: RDCBEs are as accurate as those performed by radiologists and have a very high sensitivity for CRC. In a time of ever increasing demands for complex staging investigations for CRC and interventional radiology, the ACPGBI needs to reconsider its guidelines on radiographers not only performing but also reporting DCBE.

Online planning and delivery technique for radiotherapy of spinal metastases using cone-beam CT: image quality and system performance.

PURPOSE: To assess the feasibility of an online strategy for palliative radiotherapy (RT) of spinal bone metastasis, which integrates imaging, planning, and treatment delivery in a single step at the treatment unit. The technical challenges of this approach include cone-beam CT (CBCT) image quality for target definition, online planning, and efficient process integration. METHODS AND MATERIALS: An integrated imaging, planning, and delivery system was constructed and tested with phantoms. The magnitude of CBCT image artifacts following the use of an antiscatter grid and a nonlinear scatter correction was quantified using phantom data and images of patients receiving conventional palliative RT of the spine. The efficacy of online planning was then assessed using corrected CBCT images. Testing of the complete process was performed on phantoms with assessment of timing and dosimetric accuracy. RESULTS: The use of image corrections reduced the cupping artifact from 30% to 4.5% on CBCT images of a body phantom and improved the accuracy of CBCT numbers (water: +/- 20 Hounsfield unit [HU], and lung and bone: to within +/- 130 HU). Bony anatomy was clearly visible and was deemed sufficient for target definition. The mean total time (n = 5) for application of the online approach was 23.1 min. Image-guided dose placement was assessed using radiochromic film measurements with good agreement (within 5% of dose difference and 2 mm of distance to agreement). CONCLUSIONS: The technical feasibility of CBCT-guided online planning and delivery for palliative single treatment has been demonstrated. The process was performed in one session equivalent to an initial treatment slot (<30 min) with dosimetric accuracy satisfying accepted RT standards.

The role of the GI radiographer: a United Kingdom perspective.

CONTEXT: Since the 1990s radiographers in the United Kingdom have expanded their role in gastrointestinal (GI) radiology, first by performing double-contrast barium enema (DCBE) examinations independently and later by interpreting and reporting the results of these exams. OBJECTIVE: This article will trace the evolution of GI radiographers in the United Kingdom, evaluate their success and explore how the U.K. experience could apply to American radiologist assistants. METHODS: The authors surveyed the professional literature to determine the historical context in which GI radiographers emerged and assess how their performance on DCBE exams compares with radiologists' performance. RESULTS: DCBE exams performed by GI radiographers have been shown to be efficient, cost effective and safe. In addition, GI radiographers have helped reduce waiting and turnaround times for DCBE exams. SUMMARY: The success of GI radiographers in the United Kingdom offers assurance that radiologist assistants can benefit American patients, radiologists and radiologic technologists.

Comparison of radiologists and technologists in the performance of air-contrast barium enemas.

OBJECTIVE: The purpose of this study was to determine whether the rate of polyp detection and the quality of air-contrast barium enema (ACBE) procedures performed by technologists differ from those performed by radiologists. CONCLUSION: Our results showed that well-trained certified technologists can perform ACBE similar in overall quality and accuracy to ACBE performed by attending physicians and residents. Training technologists to perform ACBE may help to alleviate the radiology staffing shortage in the United States.