Lived experiences of first-year radiation therapy students communicating with patients and radiation therapists - A qualitative review using interpretative phenomenological analysis.

INTRODUCTION: Radiation therapists must possess adaptable communication skills to manage patient-centred care and provide required technical information. Adaptive communication is also an expectation of undergraduate students to gain registration in Australia. The University Of Newcastle's Clinical Reasoning Module (CRM) prepares first-year radiation therapy students for clinical interactions. This research aims to reveal the lived experience of students after completing their first clinical placement. METHODS: An interpretative phenomenological analysis (IPA) approach was the chosen methodology. Audio-recorded semi-structured interviews were conducted with first-year students who had completed the CRM and attended their first placement. Two independent reviewers analysed each data set separately before discussing and agreeing on, and arranging themes into clusters to reveal substantive and sub-themes. RESULTS: Four students were interviewed. Five substantive themes were revealed; 'making sense of the CRM', 'the inner self',' the art of communication', 'the student as a learner' and 'clinical work'. Students' varied clinical experiences were evident, and the interviews allowed a de-brief mechanism. Students related the CRM to the clinical environment and revealed unexpected reactions and emotional responses during their placement. Examples include disclosing the reluctance of patients to interact and talking about dying, which became their new normal. CONCLUSION: This review allowed an opportunity to inquire into the lived experiences of radiation therapy students navigating their way through the clinical environment. Differences between student's emotional intelligence and level of communication reflected their ability to make sense of their experiences in the clinical setting. IMPLICATIONS FOR PRACTICE: While students appeared satisfied with the CRM in preparing them for clinical placement, providing regular de-brief sessions and reviewing clinical practice guidelines to better prepare for psycho-social issues encountered is recommended for overall student well-being.

Effect of communication skills training on radiation therapy student's confidence and interactions during their first clinical placement.

INTRODUCTION: The University of Newcastle, Radiation Therapy degree (RT) includes a clinical reasoning module that provides students with the opportunity to learn and practice communication skills before their first clinical placement. This study investigates students' perceptions of how well the module prepared them for placement and explores students' perceptions of their communication experiences during placement. METHODS: A single survey was administered to students four months following placement (six months after delivery of module), and included a request for perceptions pre-module, post-module and pre and post placement via an online survey comprising 46 closed, Likert scale and open-response questions. Assessment of changes in student confidence, the value of preparation for placement and perceptions concerning interpersonal skills with patients and radiation therapists (RTTs) were examined. Survey data was analysed quantitatively (counts, Fisher's exact) assessing statistical differences in confidence and Weighted Sum Average (WSA) of Likert scales. Qualitative findings were supported by written comments. RESULTS: Participants reported increasing confidence levels between pre-module (WSA - 1.13), and post-module (2.88), which was statistically significant (p = 0.039) and between pre-placement (2.0) and after placement (3.38), in their ability to communicate with patients. Similar changes in confidence were noted with interactions with RTTs (WSA scores 1.0, 2.13, 1.75, 3.25 resp). Students reported communication strategies prepared them well for patient interactions. Positive reinforcement from RTTs was acknowledged as creating immediate support of their current patient skills. CONCLUSION: Undertaking the clinical reasoning module successfully increased students' confidence and provided opportunities to develop appropriate communication skills for placement. IMPLICATIONS FOR PRACTICE: Increased levels of confidence and positive reinforcement from RTTs should positively impact students' knowledge and skills, and provide introspection for improvement for future placements.

Are radiographers an influencing factor in the radiation protection practices of speech-language therapists performing videofluoroscopic swallowing studies?

INTRODUCTION: A videofluoroscopic swallowing study (VFSS) is a fluoroscopic examination conducted by radiographers and speech-language therapists (SLTs) to assess dysphagia. Given the potential of SLTs to feed patients during the procedure, they may be exposed to radiation. The research aimed to assess radiation protection practices utilised by SLTs to determine if radiographers have a role in providing ongoing practical education. METHODS: An online questionnaire was distributed to SLTs from six countries (Australia, Canada, Ireland, New Zealand, United Kingdom and United States of America). Responses were analysed quantitatively using frequencies and chi-square analysis (p = 0.05) and supported by written comments. RESULTS: A total of 224 responses were analysed. Thyroid shields (94%) were used more frequently than full aprons (72%). Differences (p < 0.0001) were seen between Australian and USA participants regarding the use and position of radiation monitors; 43% of Australian participants stating they always used a monitor, compared to 75% of USA participants. Nearly all Australian SLTs wore monitors under shielding (92%) and at waist level (69%), while USA participants reported wearing them outside shielding (97%) and at thyroid level (94%). Participants' radiation practice was influenced primarily by other SLTs (64%), followed by radiographers (57%). However, written comments revealed the significance of the radiographer in providing training as "radiographers are excellent at ensuring we [use] right equipment, stand in the right places and use exposure monitoring". CONCLUSION: SLTs did not always adopt the ICRP principle of shielding and there were inconsistencies with regards to the use and placement of radiation monitors. Radiographers are well positioned to provide advice with regards to safe practice. IMPLICATIONS FOR PRACTICE: Opportunities to enhance radiation protection practices are evident, as is the advising role of radiographers.

Radiation therapist health literacy training: A qualitative study exploring perceived barriers and attitudes.

INTRODUCTION: Health literacy (HL) is a universal issue in healthcare. While difficult to assess an individual's HL status, the onus is on the health provider to empower patients to seek understanding of health information provided to them. Universal HL training techniques include implementing plain language and the teach-back method. The research aims to explore the perceptions of Australian radiation therapists (RTTs) learning and implementation of these tools with patients. METHODS: RTTs attended two communication and HL workshops one week apart. Participants completed three anonymous surveys (before the first workshop, immediately after the second and three months post workshops) and a workshop evaluation was administered after the second workshop. Participants had the opportunity to provide written comments on all surveys and the evaluation form. A thematic analysis was performed on the written comments by two independent researchers. RESULTS: Five themes were revealed after the thematic analysis of the surveys. These themes were: improved patient understanding, impact on professional credibility, practice and timing of using methods, appearing to be condescending to educated patients and increased patient anxiety. The workshop evaluation assessment indicated the success of and improvement for future workshops and revealed seven themes. These were: learning from others, providing a safe environment to share experiences, to be open to learning new methods, more time for learning, role-play aversion, group sizing and thinking beyond the workshops. CONCLUSION: While strong evidence of using HL tools for improved patient understanding exists, this qualitative review revealed unexpected barriers with implementing both the plain language and teach-back method. IMPLICATIONS FOR PRACTICE: Barriers revealed during HL training could have patient flow on effects when checking for understanding. These challenges need further exploration, to inform all health professionals.

Radiation therapist health literacy training: Does learning alternate communication methods translate into improved confidence in patient interactions?

INTRODUCTION: Low health literacy can inhibit patients' understanding of radiation therapy (RT) procedures. An objective of this research was to develop training to educate Australian radiation therapists (RTTs) about tools that support low health literacy patients, namely plain language and the Teach Back method (TBM). Perceptions, clinical use of these tools and confidence levels (pre and post training) in occupational scenarios were evaluated. METHODS: RTTs attended two workshops one week apart. Three anonymous surveys (before the first workshop, immediately after the second and three months post workshops) were completed. Quantitative analysis included weighted sum averages of confidence levels and chi-square analysis. RESULTS: At baseline, 56% of participants had heard of 'health literacy', 93% 'plain language', while 26% knew about TBM. Confidence levels increased after the workshops, with improvement of confidence demonstrating significance (p < 0.05) in 3/7 scenarios. The use of 'plain language' assessed on the third survey during every interaction was higher than that anticipated by participants on the second survey (46% vs 39%), while the TBM was utilised less (0% vs 23%). CONCLUSION: Radiation therapists' confidence and use of alternative tools to improve patient understanding improved after attending training. IMPLICATIONS FOR PRACTICE: Ongoing encouragement using alternate communication methods are recommended to assist with strengthening patient outcomes.

Informed consent guidelines for ionising radiation examinations: A Delphi study.

INTRODUCTION: Informed consent for ionising radiation medical imaging examinations is currently undertaken inconsistently in Australian radiographic practice. There is no uniform informed consent process, and opinions vary about how it should be undertaken, and by whom, if indeed it needs to be undertaken at all. To ensure that patients' rights are maintained, the informed consent process must be consistent, proactive in the provision of information, and must empower the patient to formulate and ask questions about their care, and to make voluntary decisions. METHODS: The Delphi technique utilises a group of experts whose individual responses are used to create a collective consensus on a process. This ten-expert (five radiographer, five radiologist) Delphi study examined a basic modelling of the process of informed consent for ionising radiation medical imaging examinations and made recommendations for an ideal process. RESULTS: A series of consensus statements were developed, seeking to rectify areas of the process that were inconsistent, unclear, or ethically unsound. These statements were then considered alongside current codes of professional practice, and Australian law on the duty of disclosure. A model of the ideal process was then developed using these consensus statements and adhering to codes of practice. CONCLUSION: The final process model has a continuity of care and a continuity of information provision. The model eliminates the radiographer as a delegatee, and emphasises physician involvement. The referrer and the radiologist have a shared responsibility of providing risk disclosure information. IMPLICATIONS FOR PRACTICE: For a non-pregnant adult, the ionising radiation dose from conventional radiography is considered insignificant, and does not require risk disclosure, ameliorating the time commitment needed for the process.

Barriers and pathways to informed consent for ionising radiation imaging examinations: A qualitative study.

INTRODUCTION: Informed consent for ionising radiation medical imaging examinations represents a recent change to medical imaging practice. This practice has not had a definitive and authoritative integration into clinical practice, and lack of direction has caused many health care professionals to be unsure of an appropriate consent methodology. Consent practices have been undertaken inconsistently and sometimes poorly. This research sought to investigate what barriers exist to meaningful informed consent, and what pathways are suggested to overcome these barriers. These views are then discussed in the context of practical health care consent practices. METHODS: A semi-structured interview explored the views of radiographers and radiologists on the practice of disclosing the ionising radiation risk of a clinical medical imaging examination. Qualitative data was analysed using a nominal method of quantitative transformation. Responses were reviewed, and a set of definitive themes constructed. Participants considered the influences, logistics and barriers to the informed consent process. Participants were then asked what pathways might be developed that would improve the process. RESULTS: Twenty-one (21) radiographer participants and nine (9) radiologists were interviewed. The barriers to consent identified issues of time constraints, lack of a unified message, and patient presentations. Pathways suggested included limiting the scope of the consent practice, sharing the consent responsibility, and formulation of definitive consent guidelines. CONCLUSION: A unified, definitive series of guidelines for informed consent for ionising radiation examinations would alleviate many of the identified barriers. Having the consent process consistently begin with the referring doctor would facilitate more meaningful consent.

Communication: Preparing undergraduate radiation therapy students for initial clinical patient interactions.

INTRODUCTION: Radiation therapy students need to demonstrate appropriate communication skills when entering the clinical environment. To assist students with preparation for their first clinical placement a clinical reasoning module comprising theory and practical sessions was developed. This paper describes the module and presents the results of student evaluations. METHODS: The module consisted of lectures, observational role-play and participatory role-play. Students were ultimately tasked with providing information to a simulated patient (SP). Each student received feedback independently from the SP, peers and facilitator. At the conclusion of the module, students had the opportunity to provide feedback via an anonymous survey (8 Likert scale questions with space for written comment). Data was analysed both quantitatively and qualitatively. RESULTS: Four hundred and thirty seven students were enrolled in the course between 2008 and 2016 and the response rate of the survey was 93%. Even though most students reported some level of anxiety before and during the role-play sessions, the majority of students perceived all aspects of the module to be extremely/very useful. The most useful aspect of the module (Likert scale assessment) was the feedback provided by the SP. The two most important themes arising from the thematic analysis were gaining an understanding of the role of the radiation therapist and the complexities of patient interactions. CONCLUSION: Overall, the module was deemed successful with students becoming conscious of newly acquired clinical knowledge whilst acknowledging patient feelings during interactions. Collaborative critiquing contributed to students' ability to self-reflect to improve clinical interactions.

Males in mammography - A narrative review of the literature.

OBJECTIVE: There is a worldwide shortage of radiographers qualified to perform mammography. One solution is the employment of male radiographers. This literature review aims to assess the scope of information available that covers the prospect of males being employed in a breast screening setting. The review specifically focuses on the incidence of males employed as mammographers, training options and client perceptions of males performing breast imaging. KEY FINDINGS: Some countries employ male mammographers, though this is limited. There is contradictory information regarding the education of male radiography students in mammography. Several studies have indicated that clients of breast screening services would be open to males performing mammographic procedures, while others have reported strong opposition. The client's level of education, marital status and ethnicity affected their perception. CONCLUSION: The review has shown that the employment of male radiographers in mammography may work better in some countries and in some subgroup of clients than others. The review has also highlighted some of the barriers that needs to be overcome if the widespread inclusion of men in mammography were to be successfully implemented. These include the use of chaperones and providing client choice in the gender of radiographer.

Describing ionising radiation risk in the clinical setting: A systematic review.

INTRODUCTION: Meaningfully explaining the risk of an ionising radiation examination is a challenging undertaking. Patients must contextualise the risk against the expected benefit of the imaging examination, often in a situation of heightened emotion. This systematic review seeks to explore the literature to identify what techniques are advocated for disclosing the risk to patients of ionising radiation from clinical medical imaging examinations. METHODS: A systematic review of peer-reviewed literature was undertaken. Electronic databases were searched to identify peer-reviewed, full-text articles published in English from 1990. Original articles discussing techniques for disclosing ionising radiation risks in the clinical setting were included. The reference lists of the included articles were searched for unpublished articles and reports of use. RESULTS: Sixteen papers out of 5959 unique titles met the inclusion criteria. The data was extracted independently by two researchers and assessed for quality using the Joanna Briggs Institute critical appraisal tools. CONCLUSION: The two most commonly cited techniques for disclosing ionising radiation risk is to compare risk to the risk of common life events, and to describe risk as an additive risk to the baseline risk of cancer. The most commonly cited communication strategy was a graphical representation of the data, but simple language is also advocated. The use of a pictograph represents a technique which satisfied the advocated techniques of most articles.

Barriers and incentives for choosing to specialise in mammography- A survey of Australian undergraduate diagnostic radiography students.

INTRODUCTION: There is a projected shortage of radiographers working in breast screening in Australia. This study aimed to examine the perceived barriers and potential incentives among current undergraduate diagnostic radiography students to train, specialise and work in mammography. METHODS: A survey was undertaken to assess students' experience of six modalities during both University study and clinical practice. Students were asked to rank their priority of which they would want to specialise and if training and working in mammography was an option. RESULTS: From 248 students invited to participate, 101 students replied to the survey. Students indicated that they had been taught all modalities, however not all students had experienced them on clinical placement. Most students had observed or performed ultrasound (US) (90%, 90%), Computed Tomography (CT) (97%, 75%) and fluoroscopy (80%, 52%), though very few had experience of mammography (55%, 8%). US, CT, and MRI were the modalities that most students would like to specialise in. Male students reported being discriminated against working in mammography as this is "female only" work. CONCLUSION: Students have more clinical access to the major modalities of US, CT and MRI, and this appears to be a major factor into why student wish to specialise in these modalities. Role extension and higher wages were given as possible incentives that would make specialising in Mammography more appealing. The gender divide may have to be bridged to enable crucial recruitment as male students feel discriminated against.

Development and evaluation of a deep knowledge and skills based assignment: Using MRI safety as an example.

INTRODUCTION: Using magnetic resonance imaging (MRI) safety as an example, this paper discusses the development of an innovative multiple-step assignment task designed to increase student engagement and learning of important concepts. The paper also summarises student feedback about the assessment as well as thematic analysis of categories thought important to students. METHOD: A multi-step assignment was designed. Step one was the reading of a MRI safety article, step two was the construction and submission of 5 short answer questions believed to be important concepts of understanding and step three was the answering of 15 questions compiled from all student questions by the course coordinator. The motivation to answer the course coordinator compiled questions was the knowledge that five of these questions would be in the end of course examination. At the completion of the assignment, students were asked to complete an anonymous on-line questionnaire about the assignment task. Thematic analysis was used to gather data on what students perceived to be the most and least important concepts in the article. RESULTS: All students replying to the survey stated that they understood why MRI safety is an important topic and 79% reported this assignment was both a positive learning experience and provided understanding of the topic. Only 18% of students believed that they would have learned more through a formal lecture. CONCLUSION: The design of this assignment task can be used in any course, not just in medical radiation science, where student learning and understanding is critical.

Medical imaging and informed consent - Can radiographers and patients agree upon a realistic best practice?

INTRODUCTION: For radiographers, gaining informed consent with our patients represents a challenging undertaking. Reconciling the need to gain meaningful consent with time pressures represents one challenge, as does differing expectations of how risk communication should be undertaken. Different methods and thresholds of risk disclosure are considered, with the aim of finding a realistic best practice. METHODS: A cross-sectional study of radiographers and members of the public was undertaken. Participants were asked their preferences for how they would like to receive ionising radiation risk information. This included the health care professional(s) most suited to provide the information, the media through which the information was delivered, and the technique for delivering the information. In addition, participants were asked to consider hypothetical scenarios in which they were a patient receiving an ionising radiation examination, and to give the threshold of ionising radiation cancer risk which they would consider material. These scenarios considered variations in the cancer-onset time, and the accuracy of the test. RESULTS: One hundred and twenty-one (121) radiographer participants and one hundred and seventy two (172) members of the public met the inclusion criteria and completed the survey. There was strong agreement in the most appropriate media, and person, to disclose risk, as well as what represents a significant risk. There was considerable agreement in risk delivery technique. However, some of the agreed-upon strategies may be challenging to achieve in clinical practice. CONCLUSION: Radiographers and patients fundamentally agree upon risk communication strategies, but implementing some strategies may prove clinically challenging.

Ionising radiation risk disclosure: When should radiographers assume a duty to inform?

INTRODUCTION: Autonomy is a fundamental patient right for ethical practice, and informed consent is the mechanism by which health care professionals ensure this right has been respected. The ethical notion of informed consent has evolved alongside legal developments. Under Australian law, a provider who fails to disclose risk may be found to be in breach of a duty of disclosure, potentially facing legal consequences if the patient experiences harm that is attributable to an undisclosed risk. These consequences may include the common law tort of negligence. Ionising radiation, in the form of a medical imaging examination, has the potential to cause harm. However, stochastic effects cannot be attributable to a specific ionising radiation event. What then is the role of the Australian medical imaging service provider in disclosing ionising radiation risk? METHODS: The ethical and legal principles of informed consent, and the duty of information provision to the patient are investigated. These general principles are then applied to the specific and unusual case of ionising radiation, and what responsibilities apply to the medical imaging provider. Finally, the legal, professional and ethical duties of the radiographer to disclose information to their patients are investigated. RESULTS: Australian law is unclear as to whether a radiographer has a common law responsibility to disclose radiation risk. There is ambiguity as to whether stochastic ionising radiation risk could be considered a legal disclosure responsibility. CONCLUSION: While it is unlikely that not disclosing risk will have medicolegal consequences, doing so represents sound ethical practice.

Perceptions of Australian clients towards male radiographers working in breast imaging: Quantitative results from a pilot study.

AIM: Breast cancer is the second most common cause of cancer-related death in Australian women, therefore early breast cancer detection is essential. Female radiographers currently conduct breast screening in Australia; however there is a projected shortage. With many women already feeling apprehensive about attending a breast examination, possible proposals to fill this shortage must be carefully considered. Training male radiographers is one proposal however, this raises some gender concerns. This study aimed to pilot an investigation into whether it would change women's willingness to attend breast screening if conducted by a male radiographer. METHOD: A questionnaire completed by 146 women aged over 40 asked questions on attitude, initial reaction and how they would proceed if attended to by a male in three clinical situations (Mammography; Ultrasound and Breast Surgery). RESULTS: The results revealed that women would have had their mammogram (90%), ultrasound (95%) and surgery (100%) conducted by a male, though some would have preferred a female for mammography (25%), ultrasound (24%) and surgery (12%). A total of 9% of women agreed to the statement 'If there were male radiographers I would not return for another screening appointment' and 9% agreed to the statement 'if I heard there could be male radiographers it would change my opinion of Breast Screening for the worse'. CONCLUSIONS: This first Australian study investigating the perceptions of women to male radiographers in the breast screening arena suggest that a mix of male and female radiographers could be accommodated and indicates the need for a larger national survey.

Barriers and incentives for choosing to specialise in mammography: Qualitative analysis.

AIM: There is a projected shortage of radiographers working in breast screening and this study aimed to examine comments from open response questions from a mixed methods survey of current diagnostic radiography students on their perceptions of working in mammography. METHOD: The survey asked three open ended questions: Justification of choice of modality in which they would want to specialise, why they believed there was a shortage of radiographers working in breast screening and any other comment about mammography. RESULTS: Reasons given for specialising in any modality was interest, feature of a modality, amount of clinical exposure during the degree program, personal issues and career prospects. Few current diagnostic radiography students indicated that they would be interested in specialising in breast imaging. They considered there to be a shortage of radiographers as breast imaging was seen to be repetitive, high pressure, intimate and gender biased. Lack of education, clinical exposure, limited career prospects and low pay were also discussed. CONCLUSIONS: Increasing education to the modality during the degree, allowing males to be involved in breast imaging and promoting part-time work in mammography while also working in other modalities may alter the perception that mammography offers a limited career pathway.

A systematic review of dietary intake after laparoscopic adjustable gastric banding.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is currently one of the most popular surgical obesity treatments worldwide. Although dietary modification is recognised as a key factor in determining weight loss and health outcomes post surgery, existing evidence regarding changes in dietary intake after LAGB has not been systematically evaluated. This is essential for developing best-practice dietetic guidelines for the management of LAGB patients. The aim of this systematic review was to evaluate the current evidence base regarding changes in dietary intake after LAGB. METHODS: A literature search of Medline, EMBASE, Scopus, Cinahl and the Cochrane Library from 1990 to February 2010 was conducted to identify original studies that assessed dietary intake in adults who have undergone LAGB. RESULTS: Only 11 articles (10 separate studies) met inclusion criteria. Although the strength of the evidence base is limited by the small number of studies, observational study designs and methodological weaknesses, the results indicate that short-term positive changes occur post surgery, including reduced caloric intake, contributed to by reductions in fat, carbohydrate and protein intake. Issues including optimal macronutrient intake, diet quality and longer-term sustainability of reduced food intake remain largely unexplored. Because no dietary intervention studies were identified, evidence-based dietary strategies that may help optimise weight loss outcomes and other health outcomes remain unknown. CONCLUSIONS: There is a paucity of high-quality evidence regarding changes in dietary intake after LAGB. Further well-designed, dietary-based intervention research will be beneficial to better establish dietetic management guidelines for optimising outcomes for individuals who have LAGB.

An assessment of exposure indices in computed radiography for the posterior-anterior chest and the lateral lumbar spine.

Studies have indicated that computed radiography (CR) can increase radiation dose to the patient, leading to potential biological effects. Although manufacturers have set parameters to safeguard against overexposure, it is unclear whether these are being used by radiographers or if their recommended values are consistent with the ALARA principle. The research aims are to investigate (i) whether radiographers are producing images with exposure indices within the manufacturers recommended range (MRR); (ii) the phenomenon of exposure creep, and (iii) the relationship between exposure indices (EIs) and radiation dose. A retrospective analysis of exposure indices over an 18-month period for the posteroanterior (PA) chest and lateral (LAT) lumbar spine at two centres using Kodak 800 and 850 CR systems was conducted. A phantom study was performed to assess the relationship between EI and entrance surface dose (ESD) for fixed and varying tube potentials. Kodak recommends that images have EIs between 1700 and 1900. Thirty percent of LAT lumbar spine examinations at hospital B and 38% of PA chest examinations at hospital A were produced with EIs below 1700. In the phantom study, when using a varied tube potential (70-125 kVp) and maintaining a constant EI of 1550, ESD was reduced by 56%. All clinical and phantom images were assessed to be of a diagnostic quality. The retrospective results indicate that there is a potential to reduce the MRR and optimize patient dose. There is also evidence to suggest that EI is not a reliable indicator of patient dose. The authors recommend that staff training is essential on these newer systems.

Dose implications of fluoroscopy-guided positioning (FGP) for lumbar spine examinations prior to acquiring plain film radiographs.

Fluoroscopy is increasingly being used as a positioning device prior to obtaining plain film radiographs. This is particularly true for those examinations where the type of projection and habitus of the patient present difficulties. An example is the examination of the lumbar spine; especially the L5/S1 projection. The purpose of this study was to determine the effect of fluoroscopy-guided positioning (FGP) on patient dose. The study assessed the difference in dose-area product (DAP) between conventional film-screen radiography (FSR) and a FGP assisted series of the lumbar spine. DAP values were monitored on 102 patients (50 FSR, 52 FGP) over 7 (4 FSR, 3 FGP) study sites. The median values for all FGP and FSR procedures were 8.3 Gy cm(2) and 12.5 Gy cm(2), respectively. The differences in doses were attributed to lower mAs and tighter collimation used in FGP assisted procedures. The study has demonstrated that it is possible to achieve lower DAP values using FGP. What now has to be asked is whether FGP should be acknowledged and further introduced into clinical practice. If so, there is a need for careful monitoring and reporting of dose so that strict protocols can be set in place to ensure the ALARA principle is enforced.

Towards in vivo TLD dosimetry in mammography.

While phantoms are used for quality control assessment of the mammography unit, in vivo dose measurements are necessary to account for the variation in size and composition of the female breast. The use of thermoluminescent dosimeters (TLDs) in mammography has been limited due to TLD visibility. The aim of this current investigation was to access the suitability of a paper-thin LiF:Mg,Cu,P TLD (GR-200F) for in vivo dosimetric mammography measurements. The visibility of GR-200F has been directly compared with LiF:Mg,Cu,P TLDs (GR-200A) using a number of commercially available phantoms. The phantoms of thickness 2-5 cm were imaged over the range of tube potentials (24-28 kVp) used clinically. Both types of TLD were placed on the surface of the phantoms allowing assessment of visibility, entrance surface dose (ESD) and field homogeneity. In vivo assessment of ESD and visibility was also carried out on a volunteer undergoing a routine mammography examination. The positions of the GR-200F TLDs were not identified either on the image of the Leeds TOR(MAM) phantom or the patient mammograms. The average ESD for the Leeds phantom was 8.8 mGy, while the patient ESD was 13 mGy. It is now possible to perform in vivo measurements with the potential of increasing the accuracy of the doses measured for women that do not conform to a standard breast thickness or density.