Current and projected gaps in the availability of radiotherapy in the Asia-Pacific region: a country income-group analysis.

BACKGROUND: Cancer incidence and mortality is increasing rapidly worldwide, with a higher cancer burden observed in the Asia-Pacific region than in other regions. To date, evidence-based modelling of radiotherapy demand has been based on stage data from high-income countries (HIC) that do not account for the later stage at presentation seen in many low-income and middle-income countries (LMICs). We aimed to estimate the current and projected demand and supply in megavoltage radiotherapy machines in the Asia-Pacific region, using a national income-group adjusted model. METHODS: Novel LMIC radiotherapy demand and outcome models were created by adjusting previously developed models that used HIC cancer staging data. These models were applied to the cancer case mix (ie, the incidence of each different cancer) in each LMIC in the Asia-Pacific region to estimate the current and projected optimal radiotherapy utilisation rate (ie, the proportion of cancer cases that would require radiotherapy on the basis of guideline recommendations), and to estimate the number of megavoltage machines needed in each country to meet this demand. Information on the number of megavoltage machines available in each country was retrieved from the Directory of Radiotherapy Centres. Gaps were determined by comparing the projected number of megavoltage machines needed with the number of machines available in each region. Megavoltage machine numbers, local control, and overall survival benefits were compared with previous data from 2012 and projected data for 2040. FINDINGS: 57 countries within the Asia-Pacific region were included in the analysis with 9·48 million new cases of cancer in 2020, an increase of 2·66 million from 2012. Local control was 7·42% and overall survival was 3·05%. Across the Asia-Pacific overall, the current optimal radiotherapy utilisation rate is 49·10%, which means that 4·66 million people will need radiotherapy in 2020, an increase of 1·38 million (42%) from 2012. The number of megavoltage machines increased by 1261 (31%) between 2012 and 2020, but the demand for these machines increased by 3584 (42%). The Asia-Pacific region only has 43·9% of the megavoltage machines needed to meet demand, ranging from 9·9-40·5% in LMICs compared with 67·9% in HICs. 12 000 additional megavoltage machines will be needed to meet the projected demand for 2040. INTERPRETATION: The difference between supply and demand with regard to megavoltage machine availability has continued to widen in LMICs over the past decade and is projected to worsen by 2040. The data from this study can be used to provide evidence for the need to incorporate radiotherapy in national cancer control plans and to inform governments and policy makers within the Asia-Pacific region regarding the urgent need for investment in this sector. FUNDING: The Regional Cooperative Agreement for Research, Development and Training Related to Nuclear Science and Technology for Asia and the Pacific (RCA) Regional Office (RCARP03).

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.

Knowledge, attitudes and practice of infection prevention and control in the CT suite.

BACKGROUND: Infection, prevention, and control (IPC) practices are essential to protect patients and staff within healthcare facilities. Radiology departments cater to both inpatients and outpatients, and breaches of IPC practice have led to outbreaks of disease within healthcare facilities. This study aims to examine the knowledge, attitudes and practice (KAP) of computed tomography (CT) radiographers and nurses in their infection, prevention, and control (IPC) practice. The KAP components focuses on the CT environment, contrast injector use, and workplace factors that impact IPC practice. METHODS: A cross-sectional KAP survey was distributed online to Australian CT radiographers and radiology nurses across different institutions. The survey covered demographics, each KAP component, and workplace culture. Spearman's correlation was used to compare KAP scores. Kruskal-Wallis test was used to compare the KAP scores between demographic categories, and Chi Square was used to compare demographic data with workplace culture. RESULTS: There were 147 respondents, 127 of which were radiographers and 20 were nurses. There was a moderate positive correlation between knowledge and attitude for radiographers (rho = 0.394, p < 0.001). Radiographers also had a moderate positive relationship between attitudes and practice (rho = 0.466, p < 0.001). Both radiographers and nurses scored high in the knowledge section of the survey, but nurses had statistically significant higher practice scores than radiographers (p = 0.014). CT radiographers who had an IPC team in their workplace or worked in public hospitals, had statistically significant higher attitudes and practice scores. Age, education, and years of experience did not impact on KAP scores. CONCLUSION: The study found that radiographers and nurses had a good baseline knowledge of standard precautions. IPC teams and continued training is important to positively influence knowledge and attitudes of health professionals towards IPC practice. The KAP survey was a useful tool to assess the knowledge, attitudes, and practice on IPC of CT radiographers and nurses and identified areas for education, interventions, and leadership.

A pictorial presentation and the clinical use of the modified trauma axial (MTA) shoulder x-ray view.

Anteroposterior (AP) and lateral shoulder projections are routinely performed as part of a post-reduction shoulder x-ray series in the emergency department (ED). Research has shown that these projections alone are insufficient to demonstrate post-dislocation injuries, particularly Hill-Sachs and Bankart lesions. These concomitant pathologies are best demonstrated on axial shoulder projections but are difficult to obtain in trauma patients with limited range of motion. The diagnostic quality and the pathology demonstrated by different projections is crucial so that doctors and other ED staff can triage patients appropriately, radiologists can report on the presence or absence of post-dislocation shoulder injuries, and the orthopaedic team can plan for follow-up or treatment. Different modified axial views were reported to improve the post-dislocation pathology sensitivity in the shoulder series. However, all of these shoulder axial views require patient movement. The modified trauma axial (MTA) is an alternative projection that is suitable for trauma patients that does not depend on patient movement. This paper presents several cases where the MTA shoulder projection had clinical importance when used as part of the post-reduction shoulder series in the ED or radiology department.

Exploring the role of healthcare organisations in increasing women's participation in breast-screening in the United Arab Emirates.

The study explored the role of healthcare organisations in Ras Al Khaimah, United Arab Emirates, in improving women's breast cancer awareness and screening participation in a multi-cultural society. In-depth interviews were conducted with eight representatives from five healthcare organisations involved in breast cancer campaigns in RAK including hospitals, clinics, and universities. The interviews were analysed using thematic analysis. The organisations' campaigns focused on breast cancer awareness, providing free doctor consultations or clinical breast examinations, and where possible, offering free or subsidised screening or health checks. Breast campaigns and free screening were often limited to October, breast cancer awareness month, but breast screening clinics held more frequent awareness campaigns year-round to focus on increasing screening participation. Collaboration between institutions helped strengthen campaigns along with multiple advertising mediums to reach more women. The representatives believed that campaigns have resulted in greater breast cancer awareness and proactive attitudes among women. There were a variety of strategies used in breast cancer campaigns in RAK, and the involvement of nurses and collaboration between organisations can help strengthen breast cancer campaigns.

Optimising Awareness and Knowledge of Breast Cancer Screening for Nurses Through Train-the-Trainer Workshops.

Nurses play an important role in educating patients on breast cancer and have a positive influence in encouraging women to participate in breast screening. This current study aimed to use a train-the-trainer model to improve the level of knowledge of nurses on breast cancer and screening in Ras Al Khaimah, United Arab Emirates. The study also focused on the nurses' ability to train other nurses in assisting women to engage in breast screening. This interventional study used a mixed-method design. Seventeen female nurses (aged 28-60 years) were recruited from public and private health centers and participated in a breast cancer train-the-trainer workshop. They completed a survey before and after the workshop. The surveys included a series of open and closed questions to assess their knowledge of breast cancer symptoms, risk factors, diagnosis, and patient communication. The study found that nurse participants had good baseline knowledge of breast cancer topics, including breast self-examinations, clinical breast examinations, and mammography. Responses were deemed accurate if they answered open-ended questions without incorrect information and correct options were selected in the quantitative sections. However, training improved the detail and accuracy of the participant responses. Training also improved the confidence of nurse participants to teach other women and nurses how to perform breast self-examinations and provide breast cancer information. There were significant increases in nurse participants' knowledge of risk factors (p < 0.001, r = 0.6) and symptoms (p = 0.003, r = 0.5). The nurse participants perceived that health education was the best means of encouraging women to participate in breast screening.

Women's Breast Cancer Knowledge and Health Communication in the United Arab Emirates.

In the United Arab Emirates (UAE), women's participation in breast cancer screening is low, and women are commonly diagnosed in advanced stages. This study investigated women's attitudes towards breast cancer screening, their use of health services in the UAE emirate of Ras Al Khaimah, and their preferred medium for breast cancer information. In this qualitative study, six focus groups were conducted with Emirati (n = 28) and non-Emirati (n = 26) women as Ras Al Khaimah is a highly multi-cultural region. Women were separated into different age groups (25-34, 30-44, 44+) so as to obtain perspectives of young (n = 16), middle (n = 19), and older women (n = 19). The focus group transcripts were analysed using thematic analysis. Women recognised that any breast change should be checked by a doctor, and that women with symptoms or those at higher risk may need to have breast screening earlier than the recommended starting age. However, participants wanted more information from doctors or other health personnel. Women had observed breast cancer information and campaigns advertisements in multiple media but recommended greater use of social media and WhatsApp to disseminate information. Overall, women had positive attitudes towards breast cancer screening but wanted more breast cancer awareness campaigns year-round and better access to screening.

Examining the Relationship between Emotional Intelligence, Leadership Attributes and Workplace Experience of Australian Chief Radiographers.

INTRODUCTION: Emotional intelligence (EI) is a person's ability to control their emotions and be empathetic and it influences how a person interacts with others. EI has been linked to strong job performance parameters such as leadership, and is an important attribute for health leaders, including chief radiographers. This study aimed to investigate the relationship between EI scores and leadership attributes of Australian chief radiographers. METHODS: A pilot study with a cross-sectional survey design was used. A convenience sample of potential participants (n = 70) were contacted and given unique codes to access the United Kingdom's National Health Service Leadership Self-Assessment Tool (LSAT) and the Trait-EI Questionnaire Short-Form (TEIQue-SF). Demographic information was collected on age, years of experience, and hospital size. In total, 22 chief radiographers from NSW and Victoria from a variety of medical imaging departments completed the TEIQue-SF, and 18 completed both questionnaires. Spearman's rank-order correlation and Kruskal-Wallis H test were used for analysis. RESULTS: Chief radiographers from larger hospitals (>500 beds, n = 6) had lower scores for the TEIQue-SF sociability factor than smaller hospitals (P = .057; n = 22). Chief radiographers with <10 years' experience (n = 6) had higher scores for the LSAT "Developing Capability" dimensions than those with more experience (P = .043; n = 18). CONCLUSIONS: This study demonstrated relationships between years of experience, hospital size, EI, and leadership behaviours of Australian chief radiographers. Overall, increasing years of experience as a chief radiographer was associated with a reduction across some EI and LSAT factors. The findings could be used as a starting point to provide increased support to senior leaders of the profession to aid leadership and job performance.