A survey of the radiation safety practices of veterinary practitioners during portable equine radiography in Ireland.

Veterinary practitioners and other personnel involved in the examination are exposed to ionizing radiation while performing portable radiographs on horses. An online survey was distributed to all Veterinary Council of Ireland-registered practices where the self-reported practice profile is at least 20% equine work. The survey contained questions relating to radiation safety training, protocols, personal dosimetry and lead protection usage, repeat exposures, sedation, and personnel roles during the examination. The aim of the survey was to document the current radiation safety practices of equine veterinary practitioners during portable radiography. The results showed that although adherence to guidance set out by the Environmental Protection Agency (EPA) is reasonably good, compliance rates can be improved. Personal dosemeter usage and repeat rate reduction could particularly benefit from further improvement. This is of the utmost importance in ensuring that occupational radiation exposure to veterinary practitioners is kept to an absolute minimum during their daily practice.

Medical-surgical patients with untreated hazardous drinking: Randomized controlled trial of the DO-MoST intervention to improve health outcomes over 12-month follow-up.

INTRODUCTION: High prevalence and harmful consequences of hazardous drinking among medical-surgical patients underscore the importance of intervening with drinking to improve patients' health. This study evaluated a novel intervention, "Drinking Options - Motivate, Shared Decisions, Telemonitor" (DO-MoST). METHODS: In a randomized design, 155 medical-surgical patients with untreated hazardous drinking were assigned to enhanced usual care or DO-MoST, and followed 3, 6, and 12 months later. We conducted intent-to-treat and per-protocol analyses. RESULTS: For the primary outcome, percent days of alcohol abstinence in the past 30 days, intent-to-treat analyses did not find superior effectiveness of DO-MoST. However, per-protocol analyses found abstinence increased between 3 and 12 months among participants assigned to DO-MoST who engaged with the intervention (n=46). Among DO-MoST-assigned participants who did not engage (n=27), abstinence stayed stable during follow-up. Group comparisons showed an advantage on abstinence for Engaged compared to Non-Engaged participants on change over time. Intent-to-treat analyses found that DO-MoST was superior to usual care on the secondary outcome of physical health at 12 months; per-protocol analyses found that Engaged DO-MoST-assignees had better physical health at 12 months than Non-Engaged DO-MoST-assignees. DO-MoST-assignees had lower odds of receiving substance use care during follow-up than usual care-assignees. DISCUSSION: Patients engaged in DO-MoST showed a greater degree of abstinence and better physical health relative to the non-engaged or usual care group. DO-MoST may be a source of alcohol help in itself rather than only a linkage intervention. Work is needed to increase DO-MoST engagement among medical-surgical patients with untreated hazardous drinking.

Hazardous Drinking Interventions Delivered During Medical-Surgical Care: Patient and Provider Views.

Addressing hazardous drinking during medical-surgical care improves patients' health. This formative evaluation examined patients' consideration of options to change drinking and engage in treatment. It explored whether interventions such as "DO-MoST" overcome treatment barriers. We interviewed 20 medical-surgical patients with hazardous drinking in a trial of DO-MoST, and 16 providers. Analyses used a directed content approach. Patients were receptive to and comfortable discussing drinking during medical-surgical care. Interventions like DO-MoST (patient-centered, motivational approach to shared decision making) addressed some treatment barriers. Patients and providers viewed such interventions as helpful by building a relationship with a psychologist who facilitated self-awareness of drinking behaviors, and discussing connections between alcohol- and physical health-related problems and potential strategies to address drinking. However, both groups expressed concerns about individual and system-level barriers to long-term change. Interventions like DO-MoST bridge the gap between the patient's medical treatment episode and transition to other health care settings. TRIAL REGISTRATION: The study is registered on ClinicalTrials.gov (ID: NCT03258632).

Impact of torque tube reflection on bifacial photovoltaic single axis tracked system performance.

Among the racking elements of bifacial photovoltaic (PV) single-axis tracked systems, the torque tube (TT) introduces the most shading and reflection, increasing irradiance nonuniformity and electrical mismatch loss. We simulate the impact of TT shading and reflection on the irradiance profiles, electrical mismatch, and energy yield for central bifacial PV modules on one-in-portrait (1P) and two-in-portrait (2P) single-axis trackers. TT reflection increases annual irradiance in 1P and 2P systems by 0.17% and 0.30%, respectively. Overall, TT reflection increases the predicted instantaneous energy yield by up to 0.8% and 0.4%, and the annual energy yield by 0.11% and 0.18% in 1P and 2P systems, respectively.

Development of an Irish national policy for the management of pregnant or potentially pregnant patients that are referred for a procedure involving the use of ionising radiation.

OBJECTIVES: The management of pregnant or potentially pregnant patients who are referred for medical imaging procedures involving ionising radiation has proven to be a challenge for healthcare providers in Ireland. This has been confirmed by a number of regulatory agencies including the Environmental Protection Agency who have reported poor compliance with legislation, inadequate documentation and sub-optimal patient care. METHODS: An expert group was established to examine the issues that were at the root of these problems and produce recommendations for improvement. The issues highlighted by the group included a lack of clarity and consensus around a number of workflow issues such as exam categorisation, criteria to reasonably rule out pregnancy, dealing with paediatric patients and a protocol to allow urgent high fetal dose examinations to proceed when pregnancy cannot be excluded. The absence of a standardised national pregnancy declaration form was also identified as a contributory factor to poor regulatory compliance. RESULTS: The group produced a pregnancy policy template that healthcare providers could adopt which clarified the issues that were identified and included a standardised adult and paediatric pregnancy declaration form. The implementation of the policy template was subsequently assessed via a survey of a number of radiology departments and a representative referrer group. CONCLUSIONS: The results of these surveys revealed a substantial uptake of the template along with overall satisfaction with the contents. They also demonstrated a reduction in the use of the clinical waiver system which had been highlighted as a cause of sub-optimal patient care. KEY POINTS: • The management of pregnant or potentially pregnant patients referred for medical imaging procedures involving ionising radiation is challenging. • A new national pregnancy policy template was developed by an expert group and has been widely adopted by healthcare institutions in Ireland.

Practical radiation dosimetry across a variety of CBCT devices in Radiology.

Cone beam technology is becoming more prominent in Radiology. In our hospital we have an extremity CT, an O-arm and a number of C-arms offering 3D capabilities. Each of these modalities use cone beam CT (CBCT) technology to image the area of interest in one single rotation. Traditional CTDI metrics for radiation dosimetry in CT depend on narrow beam geometry. The relevance of the CTDI as a dose indicator for cone beam scanning is contentious due to underestimation of dose lying outside the standard 100 mm chamber length and CTDI phantoms being of insufficient length. In an attempt to better quantify dose from cone beam scanning, alternative methodologies have been developed which attempt to counter the limitations of CTDI methodologies. In this comparison study we utilised the CBCT methodologies outlined in (i) IAEA Report 5, (ii) EFOMP's protocol on QC in CBCT and (iii) conventional CTDI measurement and tested them on various CBCT systems used in Radiology. These methods were chosen as they use equipment that is typically available to a diagnostic imaging physicist. We determine that the EFOMP protocol and the conventional CTDI method produce the best estimate of the radiation output for quality control purposes. Our conclusion is that the EFOMP protocol is the fastest and easiest method to measure a CBCT metric but it is not always accessible. For the systems in our hospital we will adopt the EFOMP protocol for open systems (C-arms) and perform CTDIVol measurements using conventional techniques on enclosed systems (O-arm and extremity CT).

Perception of medical radiation risk in Ireland: Results of a public survey.

The Basic Safety Standards (BSS) directive 2013/59/EURATOM places a new emphasis on the practitioner and/or referrer to inform the patient of the benefits and risks associated with radiation dose. To communicate effectively, a prior knowledge of what a person comprehends is beneficial. The aim of this study was to evaluate the Irish public's current level of understanding of ionising radiation and its associated risks. We designed a survey consisting of ten multiple choice questions and asked members of the public to respond. There were 326 responses to the public survey. All survey data was collected anonymously using snowball sampling. Overall, the data collected from this survey indicates that the respondents do not have a clear understanding of radiation risks. In particular there was a misunderstanding in which modalities use ionising radiation and there was a perceived limit in the number of X-rays a person can have in a year, implying that the public have not been informed of the principle of justification. Patients must be presented with the benefits of an exam involving ionising radiation together with a clear explanation of the risks.