Can simulation-based education or other education interventions replace clinical placement in medical radiation sciences? A narrative review.

OBJECTIVES: In response to increasing student enrolment and workload pressures from the Covid-19 pandemic, a recent focus on health student preparation programs has been on curricula adaptations and replacement of clinical placement time with alternative education activities. The aim of the narrative review was to explore the current evidence relating to education activities in Medical Radiation Sciences (MRS) used to replace clinical placements or part of clinical placements. Medline, CINAHL and Web of Science databases were used to search for articles published between 2017 and 2022. Data from the literature was summarised into (1) planning and development of clinical replacement learning activities in MRS, (2) evaluation of clinical replacement activities, and (3) benefits and challenges of clinical replacement in MRS. KEY FINDINGS: Planning and development of clinical replacement learning activities in MRSrequires support from a wide range of stakeholders, and evidence from activities already implemented exists. Activities largely encompass an institution-specific focus. Developed clinical replacement activities use a blended approach, with simulation-based education (SBE) as a main teaching platform. Evaluation of clinical replacement activities are largely focused on students' achievement of learning objectives relating to practical and communication skills. Emerging evidence based on small student samples shows that clinical and clinical replacement activities provide similar results in terms of learning objectives. CONCLUSION: Benefits and challenges of clinical replacement in MRS are similar to those presented in the other health professions. The balance between quality and quantity of teaching and learning experiences for clinical skill development in MRS needs to be further investigated. IMPLICATIONS FOR PRACTICE: To meet the dynamic challenges of the health care environment and MRS profession, a major goal in the future will be to affirm the benefit of clinical replacement activities for MRS students.

Reef islands have continually adjusted to environmental change over the past two millennia.

Global environmental change is identified as a driver of physical transformation of coral reef islands over the past half-century, and next 100 years, posing major adaptation challenges to island nations. Here we resolve whether these recent documented changes in islands are unprecedented compared with the pre-industrial era. We utilise radiometric dating, geological, and remote sensing techniques to document the dynamics of a Maldivian reef island at millennial to decadal timescales. Results show the magnitude of island change over the past half-century (±40 m movement) is not unprecedented compared with paleo-dynamic evidence that reveals large-scale changes in island dimension, shape, beach levels, as well as positional changes of ±200 m since island formation ~1,500 years ago. Results highlight the value of a multi-temporal methodological approach to gain a deeper understanding of the dynamic trajectories of reef islands, to support development of adaptation strategies at timeframes relevant to human security.

Diagnostic performance of whole-body SPECT/CT in bone metastasis detection using 99mTc-labelled diphosphate: a systematic review and meta-analysis.

AIM: To evaluate the diagnostic performance of whole-body (WB) integrated single photon emission tomography (SPECT)/computed tomography (CT) in detecting bone metastasis (BM) and to investigate whether WB-SPECT/CT offered any additional benefit value compared to planar bone scintigraphy (PBS) with 99mTc-hydroxy-methylene diphosphonate or 99mTc methylene diphosphonate. MATERIALS AND METHODS: Medline, EMBASE, SCOPUS, Web of Science, and CINAHL were searched systematically up to 28 August 2019. All studies using histopathological analysis and/or follow-up imaging and clinical data as the reference standard were eligible for inclusion. RESULTS: Eleven studies (1,611 patients) were analysed. Based on patient analysis, the sensitivity, specificity, and area under the curve (AUC) of WB-SPECT/CT were 92% (92% confidence interval [CI], 89-95%), 95% (95% CI, 94-96%), and 0.9835, respectively, in the case of negative equivocal findings for BM, and 94% (95% CI, 91-96%), 94% (95% CI, 92-95%), and 0.9790, respectively, when regarded positive. On a lesion basis, these parameters were 91% (95% CI, 89-94%), 96% (95% CI, 94-97%), and 0.9906, respectively, in the case negative equivocal findings, and 92% (95% CI, 89-94%), 95% (95% CI, 94-97%), and 0.9898, respectively, when regarded positive. Comparing 1,265 patients from eight studies, higher sensitivity (92% versus 74%, p=0.04) and specificity for WB-SPECT/CT against PBS (93% versus 80%, p=0.01) in the case of positive equivocal findings; however, when regarded negative, WB-SPECT/CT demonstrated higher sensitivity (91% versus 70%, p=0.01), but no significant difference was apparent in specificity (94% versus 89%, p=0.07). CONCLUSION: Compared to PBS, WB-SPECT/CT had superior diagnostic accuracy in BM detection and exhibited a more reliable performance with less equivocal results.

Massive corals maintain a positive carbonate budget of a Maldivian upper reef platform despite major bleaching event.

Coral reefs experienced the third global bleaching event in 2015-2016 due to high sea-surface temperature (SST) anomalies. Declines in net carbonate production associated with coral bleaching are implicated in reef structural collapse and cascading impacts for adjacent coral reef islands. We present the first carbonate budget study of a reef platform surface (reef crest and reef flat) in the southern Maldives and the first record of upper reef flat condition in the central Indian Ocean post the 2015-2016 coral bleaching event. Scleractinian corals were the primary carbonate producers, with live coral cover averaging between 11.1 ± 6.5 and 31.2 ± 21.8% and dominated by massive corals. Gross carbonate production rates averaged 5.9 ± 2.5 G (kg CaCO3 m2 yr-1). Bioerosion was estimated at 3.4 ± 0.4 G, resulting in an average net carbonate production rate of 2.5 ± 2.4 G. Comparison of results with a study of the fore-reef slope highlights major differences in post-bleaching carbonate budget state between the fore-reef slope and the reef platform surface. The positive reef flat carbonate budget is attributed to the persistence of massive corals (Porites spp. and Heliopora spp.) through the bleaching event.

Predicting wave overtopping thresholds on coral reef-island shorelines with future sea-level rise.

Wave-driven flooding is a serious hazard on coral reef-fringed coastlines that will be exacerbated by global sea-level rise. Despite the global awareness of atoll island vulnerability, little is known about the physical processes that control wave induced flooding on reef environments. To resolve the primary controls on wave-driven flooding at present and future sea levels, we present a globally applicable method for calculating wave overtopping thresholds on reef coastlines. A unique dataset of 60,000 fully nonlinear wave transformation simulations representing a wide range of wave energy, morphology and sea levels conditions was analysed to develop a tool for exploring the future trajectory of atoll island vulnerability to sea-level rise. The proposed reef-island overtopping threshold (RIOT) provides a widely applicable first-order assessment of reef-coast vulnerability to wave hazards with sea-level. Future overtopping thresholds identified for different atoll islands reveal marked spatial variability and highlight distinct morphological characteristics that enhance coastal resilience.

Rigid motion correction of dual opposed planar projections in single photon imaging.

Awake and/or freely moving small animal single photon emission imaging allows the continuous study of molecules exhibiting slow kinetics without the need to restrain or anaesthetise the animals. Estimating motion free projections in freely moving small animal planar imaging can be considered as a limited angle tomography problem, except that we wish to estimate the 2D planar projections rather than the 3D volume, where the angular sampling in all three axes depends on the rotational motion of the animal. In this study, we hypothesise that the motion corrected planar projections estimated by reconstructing an estimate of the 3D volume using an iterative motion compensating reconstruction algorithm and integrating it along the projection path, will closely match the true, motion-less, planar distribution regardless of the object motion. We tested this hypothesis for the case of rigid motion using Monte-Carlo simulations and experimental phantom data based on a dual opposed detector system, where object motion was modelled with 6 degrees of freedom. In addition, we investigated the quantitative accuracy of the regional activity extracted from the geometric mean of opposing motion corrected planar projections. Results showed that it is feasible to estimate qualitatively accurate motion-corrected projections for a wide range of motions around all 3 axes. Errors in the geometric mean estimates of regional activity were relatively small and within 10% of expected true values. In addition, quantitative regional errors were dependent on the observed motion, as well as on the surrounding activity of overlapping organs. We conclude that both qualitatively and quantitatively accurate motion-free projections of the tracer distribution in a rigidly moving object can be estimated from dual opposed detectors using a correction approach within an iterative reconstruction framework and we expect this approach can be extended to the case of non-rigid motion.

Mammography test sets: reading location and prior images do not affect group performance.

AIM: To examine how the location where reading takes place and the availability of prior images can affect performance in breast test-set reading. MATERIALS AND METHODS: Under optimized viewing conditions, 10 expert screen readers each interpreted a reader-specific set of images containing 200 mammographic cases. Readers, randomly divided into two groups read images under one of two pairs of conditions: clinical read with prior images and laboratory read with prior images; laboratory read with prior images and laboratory read without prior images. Region-of-interest (ROI) figure-of-merit (FOM) was analysed using JAFROC software. Breast side-specific sensitivity and specificity were tested using Wilcoxon matched-pairs signed rank tests. Agreement between pairs of readings was measured using Kendall's coefficient of concordance. RESULTS: Group performances between test-set readings demonstrated similar ROI FOMs, sensitivity and specificity median values, and acceptable levels of agreement between pairs of readings were shown (W = 0.75-0.79, p < 0.001) for both pairs of reading conditions. On an individual reader level, two readers demonstrated significant decreases (p < 0.05) in ROI FOMs when prior images were unavailable. Reading location had an inconsistent impact on individual performance. CONCLUSION: Reading location and availability of prior images did not significantly alter group performance.

Skeletal extension and calcification of reef-building corals in the central Indian Ocean.

Skeletal extension, density and calcification rate of 12 scleractinian coral species comprising 7 morphological groups were examined on the reef crest of Vabbinfaru platform, Maldives. Growth rates of coral specimens were measured over the period of February 2010-March 2011 using alizarin staining and direct measurements. Skeletal extension rate was highly variable between coral species. Colony morphology was a major control on the skeletal extension and calcification of coral specimens. Growth rates of Acropora and Porites corals were comparable to existing data recorded for Caribbean and Indo-Pacific reef provinces. Skeletal density was less variable between species and was typically consistent among morphological groups. Findings represent the first estimates of coral growth in the central Indian Ocean region and add to the limited growth studies available that have examined a broad range of coral growth morphologies in other reef-building regions.

Assessing reader performance in radiology, an imperfect science: lessons from breast screening.

The purpose of this article is to review the limitations associated with current methods of assessing reader accuracy in mammography screening programmes. Clinical audit is commonly used as a quality-assurance tool to monitor the performance of screen readers; however, a number of the metrics employed, such as recall rate as a surrogate for specificity, do not always accurately measure the intended clinical feature. Alternatively, standardized screening test sets, which benefit from ease of application, immediacy of results, and quicker assessment of quality improvement plans, suffer from experimental confounders, thus questioning the relevance of these laboratory-type screening test sets to clinical performance. Four key factors that impact on the external validity of screening test sets were identified: the nature and extent of scrutiny of one's action, the artificiality of the environment, the over-simplification of responses, and prevalence of abnormality. The impact of these factors on radiological and other contexts is discussed, and although it is important to acknowledge the benefit of standardized screening test sets, issues relating to the relevance of test sets to clinical activities remain. The degree of correlation between performance based on real-life clinical audit and performances at screen read test sets must be better understood and specific causal agents for any lack of correlation identified.

Strict X-ray beam collimation for facial bones examination can increase lens exposure.

OBJECTIVES: It is well accepted that collimation is a cost-effective dose-reducing tool for X-ray examinations. This phantom-based study investigated the impact of X-ray beam collimation on radiation dose to the lenses of the eyes and thyroid along with the effect on image quality in facial bone radiography. METHODS: A three-view series (occipitomental, occipitomental 30 and lateral) was investigated, and radiation doses to the lenses and thyroid were measured using an Unfors dosemeter. Images were assessed by six experienced observers using a visual grading analysis and a total of 5400 observations were made. RESULTS: Strict collimation significantly (p<0.0001) reduced the radiation dose to the lenses of the eyes and thyroid when using a fixed projection-specific exposure. With a variable exposure technique (fixed exit dose, to simulate the behaviour of an automatic exposure control), while strict collimation was again shown to reduce thyroid dose, higher lens doses were demonstrated when compared with larger fields of exposure. Image quality was found to significantly improve using strict collimation, with observer preference being demonstrated using visual grading characteristic curves. CONCLUSION: The complexities of optimising radiographic techniques have been shown and the data presented emphasise the importance of examining dose-reducing strategies in a comprehensive way.

An investigation of inconsistent projections and artefacts in multi-pinhole SPECT with axially aligned pinholes.

Multiple pinholes are advantageous for maximizing the use of the available field of view (FOV) of compact small animal single photon emission computed tomography (SPECT) detectors. However, when the pinholes are aligned axially to optimize imaging of extended objects, such as rodents, multiplexing of the pinhole projections can give rise to inconsistent data which leads to 'ghost point' artefacts in the reconstructed volume. A novel four pinhole collimator with a baffle was designed and implemented to eliminate these inconsistent projections. Simulation and physical phantom studies were performed to investigate artefacts from axially aligned pinholes and the efficacy of the baffle in removing inconsistent data and, thus, reducing reconstruction artefacts. SPECT was performed using a Defrise phantom to investigate the impact of collimator design on FOV utilization and axial blurring effects. Multiple pinhole SPECT acquired with a baffle had fewer artefacts and improved quantitative accuracy when compared to SPECT acquired without a baffle. The use of four pinholes positioned in a square maximized the available FOV, increased acquisition sensitivity and reduced axial blurring effects. These findings support the use of a baffle to eliminate inconsistent projection data arising from axially aligned pinholes and improve small animal SPECT reconstructions.

High-resolution imaging of the large non-human primate brain using microPET: a feasibility study.

The neuroanatomy and physiology of the baboon brain closely resembles that of the human brain and is well suited for evaluating promising new radioligands in non-human primates by PET and SPECT prior to their use in humans. These studies are commonly performed on clinical scanners with 5 mm spatial resolution at best, resulting in sub-optimal images for quantitative analysis. This study assessed the feasibility of using a microPET animal scanner to image the brains of large non-human primates, i.e. papio hamadryas (baboon) at high resolution. Factors affecting image accuracy, including scatter, attenuation and spatial resolution, were measured under conditions approximating a baboon brain and using different reconstruction strategies. Scatter fraction measured 32% at the centre of a 10 cm diameter phantom. Scatter correction increased image contrast by up to 21% but reduced the signal-to-noise ratio. Volume resolution was superior and more uniform using maximum a posteriori (MAP) reconstructed images (3.2-3.6 mm(3) FWHM from centre to 4 cm offset) compared to both 3D ordered subsets expectation maximization (OSEM) (5.6-8.3 mm(3)) and 3D reprojection (3DRP) (5.9-9.1 mm(3)). A pilot (18)F-2-fluoro-2-deoxy-d-glucose ([(18)F]FDG) scan was performed on a healthy female adult baboon. The pilot study demonstrated the ability to adequately resolve cortical and sub-cortical grey matter structures in the baboon brain and improved contrast when images were corrected for attenuation and scatter and reconstructed by MAP. We conclude that high resolution imaging of the baboon brain with microPET is feasible with appropriate choices of reconstruction strategy and corrections for degrading physical effects. Further work to develop suitable correction algorithms for high-resolution large primate imaging is warranted.

A morphometric study of the pelvi-ureteric junction and review of the pathogenesis of upper ureteric obstruction.

A morphometric analysis has been made of the normal human pelvi-ureteric junction and upper ureter. There was found to be no anatomically definable pelvi-ureteric junction. Muscle bundles of renal pelvis and upper ureter run a spiral course and do not form clear-cut layers. There is a great normal variation of thickness of the renal pelvic and ureteric muscularis, as well as of the total thickness of these structures. Smaller, but sometimes still large differences, are seen between right and left pelvi-ureteric specimens of individual patients. Suggested normal ranges of thickness are: (1) Renal pelvis: total thickness 340-1300 micrometers, muscularis 270-1100 micrometer. (2) Upper ureter: total thickness 450-1000 micrometer, muscularis 240-790 micrometer. No neurones are present in the renal pelvis or upper ureter. The possible etiologies of pelvi-ureteric obstruction are discussed.

Fatal haematemesis from an aorto-oesophageal fistula of obscure aetiology: a case report.

Endoscopy, aortography and laparotomy failed to demonstrate a high aorto-oesophageal fistula of obscure aetiology in a woman presenting with haematemesis. Recognition of Chiari's triad: mid-thoracic pain, sentinel arterial haemorrhage, and final exsanguination after a symptom-free interval, and therapeutic embolization as a mode of therapy, are discussed.

Analgesic nephropathy complicated by development of transitional cell carcinoma of the renal pelvis and ureter.

A case is described of analgesic nephropathy with papillary necrosis, calcification, osseous metaplasia and the development of papillary transitional cell carcinoma of the renal pelvis and ureter. Seven similar cases are summarized, and the literature briefly reviewed with particular reference to aetiological factors and associated clinical findings.