Together or Separate: What is best practice when imaging bilateral hands for rheumatoid arthritis examinations?

INTRODUCTION: A current gap identified in medical imaging (MI) literature is a standardised approach to bilateral hand examinations. This examination performed concurrently or unilaterally results in different effects on radiation dose and image quality, both of which are important to the diagnostic and follow-up imaging of rheumatoid arthritis (RA) patients. METHODS: An experimental study was undertaken using anthropomorphic hand phantoms at the Queensland University of Technology (QUT) MI Simulation laboratory. Images of the hand were acquired individually and then concurrently with both hands together. Radiation dose was calculated by observing dose area product (DAP) reading on a digital radiography system, with the additional use of an exposure metre as a secondary data collection method. Image quality was quantified through measuring distortion caused by beam divergence, by exploring the separation of two metal rings fixed to the hand phantom. RESULTS: The overall radiation dose was higher for the unilateral technique by 10.15% at the digital radiography system console and 11.96% recorded by the exposure metre. In the second part of the experiment, the unilateral technique produced 0 mm of distortion when the phantom was positioned in the central part of the beam. The concurrent technique demonstrated an average of 3.65 mm of distortion, when both hands were positioned with the central part of the beam between them. CONCLUSION: The unilateral technique should be performed for bilateral hand examinations. The increase in distortion from the concurrent technique is clinically significant, as the diagnostic grading of RA is measured in millimetre increments. The additional overall examination dose is minimal when compared to the improvement in image quality.

The proportion of computed tomography kidneys, ureters and bladder (CTKUB) scans that comply with scan extent protocol in an emergency department: a clinical audit and dose ramification study.

INTRODUCTION: To assess computed tomography kidneys, ureters and bladder (CTKUB) scan extent protocol compliance and associated doses in the Emergency Department (ED) of an Australian tertiary hospital. METHODS: A retrospective clinical audit of 150 consecutive ED CTKUB cases was completed. For each patient, scan extent compliance at the superior (kidneys) and inferior (pubic symphysis) borders, in reference to the protocol was recorded. Compliance and non-compliance (over-/under-scanning) was identified, described (superior/inferior), quantified (via IMPAX measurements) and recorded via a purpose-built audit tool. In addition, a PBU40 phantom was scanned to assess the percentage of dose (DLP) increase per centimetre of over-scanning to contextualise results. RESULTS: A notable non-compliance with department protocol was noted. Eight cases (5.3%) demonstrated overall CT scan extent compliance. The remaining 142 cases (94.7%) demonstrated some form of non-compliance; superiorly, inferiorly or both. Analysing the 150 superior and 150 inferior data points independently, the most common non-compliance was over-scanning at the kidneys by 4 cm to5 cm (19 cases, ~10% extra DLP) beyond tolerance and over-scanning inferiorly at the pubic symphysis by 1 cm to 2 cm (29 cases, ~6.4% extra DLP). Estimated dose increases of up to 35% to 45% were found when clinical audit results were simulated using a PBU40. CONCLUSIONS: Over-scanning is a predominant occurrence in CTKUB scans in this department. Reasons for over-scanning weren't investigated. It's anticipated this audit will lead to greater awareness of scan extent compliance and dose ramifications of non-compliance. The usage of more easily identified anatomical landmarks and a follow-up audit is suggested.

The development and evaluation of a medical imaging training immersive environment.

INTRODUCTION: A novel realistic 3D virtual reality (VR) application has been developed to allow medical imaging students at Queensland University of Technology to practice radiographic techniques independently outside the usual radiography laboratory. METHODS: A flexible agile development methodology was used to create the software rapidly and effectively. A 3D gaming environment and realistic models were used to engender presence in the software while tutor-determined gold standards enabled students to compare their performance and learn in a problem-based learning pedagogy. RESULTS: Students reported high levels of satisfaction and perceived value and the software enabled up to 40 concurrent users to prepare for clinical practice. Student feedback also indicated that they found 3D to be of limited value in the desktop version compared to the usual 2D approach. A randomised comparison between groups receiving software-based and traditional practice measured performance in a formative role play with real equipment. The results of this work indicated superior performance with the equipment for the VR trained students (P = 0.0366) and confirmed the value of VR for enhancing 3D equipment-based problem-solving skills. CONCLUSIONS: Students practising projection techniques virtually performed better at role play assessments than students practising in a traditional radiography laboratory only. The application particularly helped with 3D equipment configuration, suggesting that teaching 3D problem solving is an ideal use of such medical equipment simulators. Ongoing development work aims to establish the role of VR software in preparing students for clinical practice with a range of medical imaging equipment.