Assessing the knowledge of CT radiographers regarding how CT parameters affect patient dose and image quality.

PURPOSE: The objective of this study was to assess the current knowledge of CT radiographers regarding the optimization of CT parameters and their consequential effects on both patient dose and image quality. METHOD: A nationwide, cross sectional study was conducted from the 2nd of January 2023 to 1st of March 2023 to evaluate CT radiographers' knowledge in managing CT parameters in Jordan. Recruitment involved convenience sampling where radiographers were invited to participate and complete the questionnaire. Descriptive statistics were used to report the normalized knowledge scores. Student's t-test and ANOVA were used to investigate and compare the outcomes between different subgroups. A forward stepwise linear regression was used to investigate the influence of a number of technologist related factors on the knowledge score. RESULTS: Three hundred and fifty-seven radiographers participated in the study, with a mean knowledge score of 69.0%. Participants with an academic master's degree had a significantly higher score of 72.1% compared to the ones with a diploma degree, with a score of 66.8% (p = 0.026). No statistically significant difference was found between radiographers that received additional training and the ones that did not. Furthermore, when investigating the effects of academic education, working sector, additional training and years of experience, only education had a statistically significant impact on the knowledge score. CONCLUSION: The results demonstrate that radiographers have an overall good understanding of CT parameters, with academic education having a significant influence on their performance.

Knowledge and practice of radiation protection in the operating theater among orthopedic surgeons.

Purpose: Many orthopedic procedures, particularly minimally invasive surgeries that require fluoroscopic imaging, present a radiation exposure risk to the orthopedic surgeon. Surgeons may have a higher risk of developing cancer if they receive significant amounts of radiation. Using personal protective equipment (PPE) and appropriate imaging device positioning, plays an important role in reducing the surgeon's radiation exposure. However, there is a lack of knowledge about the surgeon's radiation safety awareness and practices. Therefore, the aim of this study is to investigate the practices and radiation protection knowledge of orthopedic surgeons in the operating theater. Approach: A nationwide survey was conducted from October 2021 to January 2022 to evaluate the radiation protection practices and awareness of orthopedic surgeons in Jordan. Normalized practice and knowledge scores were evaluated through the survey and compared between different groups. Descriptive statistics were used to present the surgeon's practices and radiation protection knowledge. Student's t -test was used to compare the outcomes between surgeons that received radiation protection training and surgeons who did not. Using ANOVA analysis, we compared the score outcomes for all the other variables. Results: The surgeons that received radiation protection training had significantly higher practice score 39.6% compared with 31% for the group that did not have training ( p = 0.01 ). No statistically significant difference in the knowledge scores was found between the two groups. Although 91% of the surgeons reported using some kind of PPE, only 5.5% used a dosimeter badge during surgeries. Conclusion: There is an obvious deficit in radiation safety training of orthopedic surgeons.

Jordanian Radiologists' Perspectives and Application of Evidence-Based Radiology in Clinical Practice.

PURPOSE: To evaluate radiologists' education, knowledge and skills of research, attitude toward evidence-based radiology (EBR), understanding of terms and use of related published work in clinical practice and the association between these variables and sociodemographic characteristics. We also aim to assess the availability of resources and to identify sources and the main barriers to implementing EBR. MATERIALS AND METHODS: A total of 87 radiologists completed a questionnaire, which consisted of eight sections related to radiologists' demographic characteristics, and EBR-related questions. Descriptive statistics were used, and the association between EBR-related parts and sociodemographic characteristics was performed. RESULTS: Ninety-three percent of the radiologists believed that EBR is necessary in practice. Only 40% received formal training in search strategies and 29.9% in critical appraisal of research literature during academic preparation. Moreover, 21-62% of the respondents completely understand specific terms related to EBR. Sixty-three percent stated that they can access relevant databases and the Internet at workplace. Research articles were only used by 24% to make a clinical decision. Almost 50% reported that they read or reviewed ≤1 article per month. The primary barrier to implementing EBR was the lack of colleagues' support. Understanding terms and the number of articles used in clinical decision were significantly related to education (P-value=0.001, 0.007) and hospital section (P-value=0.002, 0.027) respectively. CONCLUSION: Radiologists showed positive attitude toward EBR. However, there is a lack in information resources, colleagues' support, use of published literature, understanding of research terms and the ability of radiologists to access relevant databases at workplaces.

Attitudes and knowledge of dental radiography amongst students of dentistry and related fields.

OBJECTIVES: This study aimed to evaluate the level of knowledge and attitude towards quality control in dental radiography amongst students of dentistry, allied dental sciences and radiologic technology programmes. METHODS: A cross-sectional survey was conducted using self-administered questionnaire on a convenience sample of 580 students from three universities in Jordan. The questionnaire was divided into sections that include personal sociodemographic variables, knowledge about quality assurance in dental radiography and attitude towards quality assurance in dental radiography. RESULTS: A total of 286 students completed the questionnaire (response rate = 49.3%), of whom 70% were women. The respondents' knowledge scores ranged from 12.2% (n = 35) to 35.2% (n = 100). The mean of the quality assurance knowledge scores for the whole study sample was 20.3% ± 14.5%, with no significant difference between men and women (p = .643). Allied dental sciences students showed significantly higher knowledge scores (25.0 ± 13.0) than dentistry (17.8 ± 14.40) or radiologic technology students (20.9 ± 14.8). The average attitude scores towards quality assurance in dental radiography were fairly good (69.5 ± 26.4) with no statistically significant differences by study programme. CONCLUSION: Knowledge of students about quality assurance in the three programmes is inadequate. The participants' attitude towards quality assurance was fairly good. The study provides feedback to dental schools to improve their curriculum by including quality assurance into student clinical practices. Further studies are requested to investigate the reasons behind this low level of knowledge.

The influence of breast density and key demographics of radiographers on mammography reporting performance - a pilot study.

INTRODUCTION: A high demand has been placed on radiologists to perform screen reads due to higher number of women undergoing mammography. This study aims to examine radiographer performance in reporting low compared with high-mammographic density (MD) images; and to assess the influence of key demographics of Jordanian radiographers on their performance. METHODS: Thirty mammograms with varied MD were reported by 12 radiographers using the Breast Imaging-Reporting and Data System (BI-RADS). Radiographer performance was measured using sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and area under the receiver operating characteristic curve (ROC AUC). Performance measures were compared between cases with low- and high-MD and between subgroups of radiographers according to key demographics. RESULTS: All performance measures were significantly higher in low- compared to high-MD cases (P value < 0.0). The mean sensitivity, specificity, PPV, NPV and ROC AUC were 0.58, 0.68, 0.67, 0.63 and 0.69 respectively. PPV was significantly different for readers who had different years of experience in mammography, hours and cases per week P value = 0.023, 0.01, 0.017 respectively. ROC AUC was significantly different for radiographers with different number of hours and cases performed per week (P value = 0.001 and 0.004 respectively). CONCLUSIONS: The results of this pilot study are encouraging however a more extensive study is required to determine if Jordanian radiographers are capable of successfully taking part in breast screen reading. The lack of skills and knowledge required for correct and consistent reporting of high-MD images highlights the need for any formal training in mammographic interpretation to focus on the dense breast.

Does mammographic density remain a radiological challenge in the digital era?

BACKGROUND: The low subject contrast between cancerous and fibroglandular tissue could obscure breast abnormalities. PURPOSE: To investigate radiologists' performance for detection of breast cancer in low and high mammographic density (MD) when cases are digitally acquired. MATERIAL AND METHODS: A test set of 60 digital mammography cases, of which 20 were cancerous, were examined by 17 radiologists. Mammograms were categorized as low (≤50%) or high (>50%) MD and rated for suspicion of malignancy using the Royal Australian and New Zealand College of Radiology (RANZCR) classification system. Radiologist demographics including cases read per year, age, subspecialty, and years of reporting were recorded. Radiologist performance was analyzed by the following metrics: sensitivity; specificity; area under the receiver operating characteristic (ROC) curve (AUC), location sensitivity, and jackknife free-response ROC (JAFROC) figure of merit (FOM). RESULTS: Comparing high to low MD cases, radiologists showed a significantly higher sensitivity (P = 0.015), AUC (P = 0.003), location sensitivity (P = 0.002), and JAFROC FOM (P = 0.001). In high compared to low MD cases, radiologists with <1000 annual reads and radiologists with no mammographic subspecialty had significantly higher AUC, location sensitivity, and JAFROC FOM. Radiologists with ≥1000 annual reads and radiologists with mammography subspecialty demonstrated a significant increase in location sensitivity in high compared to low MD cases. CONCLUSION: In this experimental situation, radiologists' performance was higher when reading cases with high compared to low MD. Experienced radiologists were able to precisely localize lesions in breasts with higher MD. Further studies in unselected screening materials are needed to verify the results.

Factors Affecting Compliance of Infection Control Measures among Dental Radiographers.

OBJECTIVES: To assess the level of dental radiographers' compliance with infection control measures and to evaluate the factors affecting their compliance. METHODS: The study included 175 dental radiographers. Compliance with infection control was evaluated with a self-administered questionnaire consisting of 33 questions related to vaccination, hand hygiene (HH), personal protective equipment (PPE), disinfection and sterilization, and use of surface barriers. Pearson's chi-square test was used to compare compliance between subgroups of radiographers. RESULTS: 64.6% of participants were females, and 62.9% was younger than 30 years. 13.0% of the sample population had >10 years of experience and 28.0% take radiographs for >20 patients/day. 66.9% of participants wash their hands before/after taking radiographs. 26.3% of participants had vaccination against hepatitis B, tetanus, and tuberculosis. 12.6% fully use PPE, 10.9% perform complete disinfection and sterilization, and 16.0% apply all kinds of surfaces barriers. Vaccination was significantly affected by age, gender, and practice type. HH was affected by years of experience and number of patients radiographed per day. PPE was influenced by number of hours worked per week and patients radiographed daily. Disinfection and sterilization was affected by practice type and years of experience. The use of surface barriers was affected by age, practice type, and number of patients radiographed/day. CONCLUSIONS: The current study indicated poor compliance with infection control practices among dental radiographers. We recommend continuing educational programs and training courses to increase dental radiographers' awareness of local and international infection control guidelines and to enhance their implementation of these guidelines.

Knowledge, Attitude and Practice Around Breast Cancer and Mammography Screening Among Jordanian Women.

BACKGROUND: Breast cancer is the most common occurring cancer in women worldwide. To guide current breast cancer screening program, the level of knowledge about breast cancer should be evaluated. This study aims to ascertain the level of breast cancer knowledge including risk factors, signs and symptoms, and early detection methods, especially mammography screening. METHODS: The study was conducted among 1353 Jordanian women from the public using a self-administered questionnaire. Responses to the knowledge test were summed for an overall knowledge score. Comparisons between socio-demographics and knowledge, attitude and practice were also measured using a Chi-square test. RESULTS: About 76% of participants were aware that breast cancer is the most common cancer among women in Jordan. About 53.7% of our participants were rated as having an intermediate level of knowledge regarding risk factors, and 44% were rated as having a good to an excellent level of knowledge about breast cancer signs and symptoms. The participants' level of education was the main factor identified as influencing the participants' knowledge of the risk factors, signs and symptoms, and knowledge of early detection methods of breast cancer. The study sample was rated as having an intermediate level of knowledge regarding mammography screening; however, their participation in this screening method was low. CONCLUSION: Although Jordanian women had an acceptable level of knowledge of breast cancer, the screening rates for mammography were low. These findings suggest that there is a need to provide extra awareness programs for Jordanian women to improve their breast cancer knowledge and practice.

Practices of Infection Control Among Dental Care Providers: A Cross Sectional Study.

BACKGROUND: A wide range of microorganisms poses a threat to patients and dental care teams. Implementation of safety guidelines is thus essential to prevent infection in dental clinics. AIM: To investigate the level of infection-control practices among dental health-care providers in Jordan. METHODS: A self-administered questionnaire was distributed to dental care providers from hospitals, academic institutions, and dental centres. The questionnaire covered sociodemographic variables, professional characteristics, and recommended guidelines of infection control. RESULTS: A total of 190 questionnaires were obtained out of 500 distributed questionnnaires (response rate: 38%). Females accounted for 62.6% of the sample and 64.7% were dentists. The majority was vaccinated against hepatitis B (82.1%) and wash their hands as usual behavior before (66.3%) and after (83.2%) treatment. Approximately 87.9% wear gloves and 78.9% wear masks while performing dental procedures. Autoclave sterilization and puncture-resistant containers for sharp instruments were used by 90.5% and 88.4%, respectively. The majority (81.0%) had protocols for emergency treatment of needle stick or other sharps accidents. High volume evacuation was used in 28.6% of public hospitals compared to 19.4% in academic institutions (P<0.01). In addition, surface barriers for dental unit surfaces were used by 70.2% of private dental clinics, 50% of public hospitals, and 36.1% of academic institutions (P<0.001). Finally, compared to dentists, dental support staff showed low compliance with infection-control guidelines. CONCLUSION: The overall practice of infection-control measures among the participants is very good. Educational programs and training strategies should be implemented to maximize and enhance the compliance of the dental care providers with infection-control guidelines.

Mammographic Breast Density Profile of Jordanian Women With Normal and Breast Cancer Findings.

PURPOSE: To document the mammographic breast density (MBD) distribution of Jordanian women and the relationship with MBD with age. Correlation between breast cancer diagnosis and density was also explored. METHODS: A retrospective review of 660 screening mammograms from King Abdullah University Hospital was conducted. Mammograms were classified into 2 groups: normal (return to routine screening) and breast cancer and rated using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) 5th edition for MBD. The association between MBD and age was assessed by descriptive analyses and Kruskal-Wallis test. To compare between normal and breast cancer groups, chi-square post hoc tests with Bonferroni adjustment was used. RESULTS: Groups consisted of 73.9% (n = 488) normal group and 26.1% (n = 172) breast cancer group. A significant inverse relationship was demonstrated between age and MBD among the normal (r = -.319, P < .01) and breast cancer group (r = -.569, P < .01). In total, 69% (n = 336) of women in the normal group and 71% (n = 122) in the breast cancer group and 79.1% (n = 159) of the normal group and 100% (n = 48) of the breast cancer group aged 40 to 49 years reported high MBD (ACR BI-RADS c or d). CONCLUSIONS: Most of women in both the normal and breast cancer groups evidenced increased MBD. Increased MBD was inversely proportional to age. As MBD has a known link to increased breast cancer risk and the decreased sensitivity of mammography and it is vital that future screening guidelines for Jordanian women consider the unique breast density distribution of this population.

The implications of increased mammographic breast density for breast screening in Jordan.

INTRODUCTION: Mammographic breast density is associated with a four to six times increased risk for breast cancer. Mammographic breast density varies by ethnicity, geographical region and age. The aim of this study was to document for the first time the mammographic breast density of Jordanian women and to explore its relationship with age. METHODS: Mammograms completed at King Abdullah University Hospital (Irbid, Jordan) between January 2016 and August 2018 were retrospectively reviewed and classified for breast density using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS). Descriptive analyses and Kurskal-Wallis test were used to examine the association between age and mammographic breast density. RESULTS: A total of 659 mammograms were reviewed. A significant inverse relationship was observed between age and breast density (P < 0.001). In women aged 40-49 years, 83.2% had dense breasts (ACR BI-RADS (c) and (d)). This percentage decreased to 59.8% of women aged 50-59 years; 38.4% of women in their 60s and 37.9% of women aged 70 years or older (ACR BI-RADS (c) only). CONCLUSION: The mammographic breast density of Jordanian women has been shown to be high across all age groups. Increased mammographic breast density is associated with increased breast cancer risk and renders mammography a less effective technique for the early detection of breast cancer. Breast cancer screening of Jordanian women should be individualised to develop screening protocols and include additional adjunct imaging to best manage women at high risk.

Breast Cancer Diagnostic Efficacy in a Developing South-East Asian Country

Background: Breast cancer, is increasing in prevalence amongst South East (SE) Asian women, highlighting the need for high quality, early diagnoses. This study investigated radiologists' detection efficacy in a developing (DC) and developed (DDC) SE Asian country, as compared to Australian radiologists. Methods: Using a test-set of 60 mammographic cases, 20 containing cancer, JAFROC figures of merit (FOM) and ROC area under the curves (AUC) were calculated as well as location sensitivity, sensitivity and specificity. The test set was examined by 35, 15, and 53 radiologists from DC, a DDC and Australia, respectively. Results: DC radiologists, compared to both groups of counterparts, demonstrated significantly lower JAFROC FOM, ROC AUC and specificity scores. DC radiologists had a significantly lower location sensitivity than Australian radiologists. DC radiologists also demonstrated significantly lower values for age, hours of reading per week, and years of mammography experience when compared with other radiologists. Conclusion: Significant differences in breast cancer detection parameters can be attributed to the experience of DC radiologists. The development of inexpensive, innovative, interactive training programs are discussed. This nonuniform level of breast cancer detection between countries must be addressed to achieve the World Health Organisation goal of health equity.

Toward Improving Breast Cancer Imaging: Radiological Assessment of Propagation-Based Phase-Contrast CT Technology.

RATIONALE AND OBJECTIVES: This study employs clinical/radiological evaluation in establishing the optimum imaging conditions for breast cancer imaging using the X-ray propagation-based phase-contrast tomography. MATERIALS AND METHODS: Two series of experiments were conducted and in total 161 synchrotron-based computed tomography (CT) reconstructions of one breast mastectomy specimen were produced at different imaging conditions. Imaging factors include sample-to-detector distance, X-ray energy, CT reconstruction method, phase retrieval algorithm applied to the CT projection images and maximum intensity projection. Observers including breast radiologists and medical imaging experts compared the quality of the reconstructed images with reference images approximating the conventional (absorption) CT. Various radiological image quality attributes in a visual grading analysis design were used for the radiological assessments. RESULTS: The results show that the application of the longest achievable sample-to-detector distance (9.31 m), the lowest employed X-ray energy (32 keV), the full phase retrieval, and the maximum intensity projection can significantly improve the radiological quality of the image. Several combinations of imaging variables resulted in images with very high-quality scores. CONCLUSION: The results of the present study will support future experimental and clinical attempts to further optimize this innovative approach to breast cancer imaging.

A review of factors influencing radiologists' visual search behaviour.

This narrative literature review aims to identify the various factors that have significant impact on radiologists' visual search patterns. Identifying the factors that influences readers' visual search behaviour helps to understand their perception and interpretation of medical images, which in turn could lead to the development and implementation of effective strategies that could aid in improving the ability to detect abnormalities. Databases including PubMed, MedLine, Web of Science and ScienceDirect were searched using terms 'visual search', 'eye-tracking', 'radiology OR radiography', 'mammogram OR mammography' published since the early 1960s until June 30, 2016. Some of the factors that have been identified to significantly influence radiologists' visual search patterns were (i) readers' expertise, (ii) Satisfaction of Search, (iii) readers' visual fatigue, (iv) readers' confidence in reporting abnormalities, (v) training received and (vi) readers' prior knowledge. Readers' level of expertise was the factor that has been identified to have the most significant impact on their visual search pattern. Eye-tracking studies have shown the differences in visual search patterns of readers with different levels of experience and not so surprisingly, more experienced readers have shown effective visual search strategies. Readers' expertise has also been found to have significant impact in their confidence in reporting abnormalities and their ability to discriminate lesions from background structures in medical images.

X-Ray Phase-Contrast Technology in Breast Imaging: Principles, Options, and Clinical Application.

OBJECTIVE: The purpose of this article is to review different x-ray phase-contrast breast imaging techniques and their potential application in clinical settings. CONCLUSION: Phase-contrast imaging depicts not only the absorption contrast but also the refraction contrast of the transmitted x-ray beam. Early data suggest that this new modality may overcome some of the diagnostic limitations associated with current clinically available mammography systems and that it has potential for improving breast cancer detection.

Errors in Mammography Cannot be Solved Through Technology Alone

Mammography has been the frontline screening tool for breast cancer for decades. However, high error rates in the form of false negatives (FNs) and false positives (FPs) have persisted despite technological improvements. Radiologists still miss between 10% and 30% of cancers while 80% of woman recalled for additional views have normal outcomes, with 40% of biopsied lesions being benign. Research show that the majority of cancers missed is actually visible and looked at, but either go unnoticed or are deemed to be benign. Causal agents for these errors include human related characteristics resulting in contributory search, perception and decision-making behaviours. Technical, patient and lesion factors are also important relating to positioning, compression, patient size, breast density and presence of breast implants as well as the nature and subtype of the cancer itself, where features such as architectural distortion and triple-negative cancers remain challenging to detect on screening. A better understanding of these causal agents as well as the adoption of technological and educational interventions, which audits reader performance and provide immediate perceptual feedback, should help. This paper reviews the current status of our knowledge around error rates in mammography and explores the factors impacting it. It also presents potential solutions for maximizing diagnostic efficacy thus benefiting the millions of women who undergo this procedure each year.

RELATIONSHIP BETWEEN RADIATION DOSE AND IMAGE QUALITY IN DIGITAL BREAST TOMOSYNTHESIS.

This phantom-based study aimed to examine radiation dose from digital breast tomosynthesis (DBT) and digital mammography (DM) and to assess the potential for dose reductions for each modality. Images were acquired at 10-60 mm thicknesses and four dose levels and mean glandular dose was determined using a solid-state dosemeter. Eleven readers assessed image quality and compared simulated lesions with those on a reference image, and the data produced was analysed with the Friedman and Wilcoxon signed-rank tests. For a phantom thickness of 50 mm (typical breast thickness), DBT dose was 13 % higher than DM, but this differential is highly dependent on thickness. Visibility of masses was equal to a reference image (produced at 100 % dose) when dose was reduced by 75 and 50 % for DBT and DM. For microcalcifications, visibility was comparable with the reference image for both modalities at 50 % dose. This study highlighted the potential for reducing dose with DBT.

Effect of radiologists' experience on breast cancer detection and localization using digital breast tomosynthesis.

OBJECTIVES: The objectives are To to compare the diagnostic performance of combined digital breast tomosynthesis (DBT) and digital mammography (DM) with that of DM alone, as a function of radiologists' experience with DBT. METHODS: Ethical committee approval was obtained. Fifty cases (27 cancer, 23 normal), each containing both digital mammography (DM) and digital breast tomosynthesis (DBT) images, were reviewed by 26 radiologists, divided into three groups according to level of experience with DBT (none, workshop experience, and clinical experience). The radiologists' diagnostic performance using DM was compared with that using DM + DBT, and evaluated by area under receiver-operating characteristic curve (AUC), jackknife free-response receiver-operator characteristics figure of metric (JAFROC FOM), sensitivity, location sensitivity, and specificity. RESULTS: For all readers combined, performance using DM + DBT was significantly higher than for DM alone by both AUC (0.788 vs 0.681, p < 0.001) and JAFROC FOM (0.745 vs 0.621, p < 0.001). Similar results were obtained for readers with no DBT experience (AUC 0.775 vs 0.682, p = 0.004; JAFROC FOM 0.695 vs 0.603, p = 0.016) and with clinical DBT experience (AUC 0.789 vs 0.681, p = 0.042; and JAFROC FOM 0.764 vs 0.632, p = 0.031). CONCLUSIONS: Addition of DBT to DM significantly improves radiologists' diagnostic performance whether or not they have prior DBT experience. KEY POINTS: • Adding DBT to DM increased the number of detected cancers • DBT + DM led to more accurate localization of breast cancers than DM • Addition of DBT improved radiologists' performance regardless of prior DBT experience • High-volume radiologists with different DBT experience levels performed similarly on DM + DBT.