Digital radiography reject analysis of examinations with multiple rejects: an Australian emergency imaging department clinical audit.

INTRODUCTION: The largest source of manmade ionising radiation exposure to the public stems from diagnostic medical imaging examinations. Reject analysis, a form of quality assurance, was introduced to minimise repeat exposures. The purpose of this study was to analyse projection-specific reject rates and radiographic examinations with multiple rejects. METHODS: A retrospective audit of rejected radiographs was undertaken in a busy Australian metropolitan emergency digital X-ray room from March to June 2018. The data were collected by reject analysis software embedded within the X-ray unit. Reject rates, and reasons for rejection for each X-ray projection were analysed. RESULTS: Data from 11, 596 images showed overall reject rate was 10.3% and the overall multiple reject rate was 1.3%. The projections with both a high number and high percentage of rejects were antero-posterior (AP) chest (175, 18.1%), AP pelvis (78, 22.5%), horizontal beam hip (61, 33.5%) and horizontal beam knee (116, 30.5%). The projections with both a high frequency and multiple reject rate were horizontal beam knee (32, 8.4%) and horizontal beam hip (17, 9.3%). The top reasons for multiple rejects were positioning (67.1%) and anatomy cut-off (8.4%). CONCLUSIONS: The findings of this study demonstrated that projection-specific reject and multiple reject analysis in digital radiography is necessary in identifying areas for quality improvement which will reduce radiation exposure to patients. Projections that were frequently repeated in this study were horizontal beam knee and horizontal beam hip. Future research could involve re-auditing the department following the implementation of improvement strategies to reduce unnecessary radiation exposure.

The use of virtual reality computed tomography simulation within a medical imaging and a radiation therapy undergraduate programme.

INTRODUCTION: The use of virtual reality (VR) simulation in the education of healthcare professionals has expanded into the field of medical radiation sciences. The purpose of this research was to report on the student experience of the integration of VR education for both medical imaging (MI) and radiation therapy (RT) students in learning computed tomography (CT) scanning. METHODS: A survey was performed to evaluate students' perceived confidence in performing diagnostic and planning CT scans in the clinical environment following VR CT simulation tutorials. Students from both MI and RT participated in providing quantitative and qualitative data. RESULTS: The MI students (n = 28) and RT students (n = 38) provided quantitative results linking their engagement (perceived usefulness, ease of use, enjoyment) with their perceived confidence. The 15 (54%) MI students who recorded a maximum engagement score had a mean confidence score 1.02 higher than the students not fully engaged (Fisher's exact test 14.549, P = 0.00). The results from the RT cohort revealed 68% of students agreed or strongly agreed to the addition of VR CT simulation helping in the learning of CT. CONCLUSION: It can be concluded that the integration of innovative learning opportunities such as VR CT simulation has the potential to increase student confidence and improve student preparation for the clinical environment.

Qualitative Evaluation of a Novel 3D Volumetric Radiotherapy Segmentation Tool.

INTRODUCTION: A novel 3D volumetric segmentation tool allows the user to outline using a small number of points on a range of planes. Unique 3D volumetric "sculpting" tools enable editing of the resulting structures across multiple slices concurrently. This article reports the results of radiation oncologists' preclinical evaluation of the tool. METHODS: Three clinicians outlined prostate and seminal vesicles on 14 data sets using the traditional slice-by-slice method and the new 3D tool. The project gathered focus-group feedback to gather rich data relating to clinician perceptions of the new 3D outlining paradigm. Emergent themes were identified and categorised for discussion. RESULTS: Radiation oncologists reported high levels of satisfaction with the outlines arising from both paradigms. The volumetric sculpting was a challenge, but participants enjoyed using points in orthogonal planes and felt that the paradigm had potential value in terms of speed and smooth volume creation. CONCLUSION: This study has demonstrated that a 3D volumetric outlining system is felt to have potential value by radiation oncologists for accelerating clinician-directed prostate and seminal vesicle segmentation. The new tool was well-received and reported to be capable of producing very rapid and smooth volumes. The novelty of the approach required significant training input and a radically different approach of minimal point placement. Further testing of this software with a less time-poor cohort may be indicated to gain reliable quantitative data relating to the impact on segmentation time.

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.