Factors influencing University of Papua New Guinea medical imaging science students considering rural radiography careers.

INTRODUCTION: The aim of this research was to explore factors influencing students at the University of Papua New Guinea (UPNG) Bachelor of Medical Imaging Science (BMIS) choice to pursue rural radiography careers. METHODS: A survey and focus groups of BMIS students at the UPNG were undertaken. The survey included questions related to sociodemographic variables including gender, age, education, rural background and previous employment; and Likert-type scale questions exploring motivation for rural practice, the promotion of radiography through rural practice and the influence of birthplace and incentives to practice. Focus groups comprising convenience samples of six students each from the second, third and fourth years of study explored the promotion of rural radiography, community-based training internships, the benefits of rural practice and the influence of undergraduate training on future rural practice. RESULTS: There were 54 responses (94.7%) to the survey with strong interest (88.9%) in rural radiography practice; 96.3% (n=52) agreed that undergraduate rural training would also act as a motivator. Rural training was a stronger incentive for females than for males (p=0.02). Not being trained in conventional non-digital film screen imaging at UPNG was a strong barrier to rural practice; while being able to give back to the community, increased professional responsibility, cheaper living, job satisfaction and cultural exchange were all viewed as positive aspects of rural practice. Most students reported a benefit to rural practice, while acknowledging a lack of contemporary imaging equipment in rural facilities. CONCLUSION: The study demonstrated that UPNG BMIS students would contemplate careers in rural practice and provides evidence to support dedicated undergraduate rural radiography placement. It also highlights the dichotomy in urban and rural services, which suggests the need for greater emphasis on conventional non-digital film screen radiography in the undergraduate program to best support graduates to work and, importantly, work effectively in rural communities. As most students were from rural areas these results must be tempered by the fact that students may simply be wanting to return home rather than reporting explicit rural intent. A more comprehensive study of the medical imaging profession in PNG should be undertaken to validate this study.

A review of mammographic image quality in Papua New Guinea.

INTRODUCTION: To report for the first time the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate (PGMI) image evaluation system (IES); and to benchmark the image quality against BreastScreen Australia (BSA) National Accreditation Standards (NAS). METHODS: A retrospective image quality analysis of the de-identified mammograms of 102 women imaged at the Port Moresby General Hospital (PMGH) was undertaken using the PGMI IES. Each craniocaudal (CC) and mediolateral oblique (MLO) image was assigned a grade and the reasons for the grade recorded. Age was recorded in years. Simple frequency analysis was undertaken and comparison with BSA NAS 2.4 was made. RESULTS: Women were aged between 25 and 74 years. There were 111 CC views and 109 MLO views. The most frequent individual grade for the CC view was G (83.8%) and for the MLO view M (72.48%); and for a routine series (four images), P and G combined (14.8%). Non-visualisation of the IMA (28%), nipple not in profile (26%) and short length of pectoral muscle (12%) were the most cited reasons for assigning an M grade. CONCLUSION: The reported image quality is not commensurate with that required by BSA (P and G > 50%) and while common positioning errors can be rectified through education and training, it is also important to recognise the complex challenges faced by PNG radiographers in obtaining mammographic images that extend beyond education and training and reflect the emerging nature of the modality as well as wider health, economic and other issues. This work raises the need for national standards, dedicated equipment, and radiographer education to best serve the women of PNG.

Correlation of the BI-RADS assessment categories of Papua New Guinean women with mammographic parenchymal patterns, age and diagnosis.

INTRODUCTION: Women with increased breast density are at increased risk of breast cancer. The aim of this research is to evidence for the first time the mammographic breast findings of Papua New Guinean (PNG) women and the relationship between Breast Imaging-Reporting and Data System (BI-RADS) assessment, mammographic parenchymal patterns (MPPs) and age. METHODS: A retrospective analysis of 1357 mammograms of women imaged at the Pacific International Hospital (PIH) from August 2006 to July 2010 was undertaken. Mammographic findings were categorised using the BI-RADS Atlas® 5th Edition. MPPs were recorded for each woman using the Tabár Pattern I-V classification system. Age was recorded in years. Statistical analysis was by descriptive analysis and Kruskal-Wallis with Dunn's post-test and Spearman's rho correlation for inferential analysis. RESULTS: True pathological findings (benign and malignant); BI-RADS 2-5 were noted in 111 women (8.2%); 1242 (91.5%) were negative. BI-RADS categories for malignancy were reported in 16 (88.9%) of women aged 30 to 60 years. The lower risk Tabár Type I, II and III MPPs were associated with 94.4% (n = 17) of malignancies. Linear correlations between variables were weak and not statistically significant: age and Tabár pattern r = 0.031, P = 0.0261; age and BI-RADS r = 0.018, P = 0.517; Tabár pattern and BI-RADS r = 0.020, P = 0.459 (n = 1357). CONCLUSION: There was no correlation demonstrated between BI-RADS category, age and MPP. Importantly, there was no correlation demonstrated between BI-RADS categories 4 and 5 for breast malignancy and high-risk Tabár Type IV and V MPPs. The results of this study again reflect that the incidence of breast cancer in PNG cannot be explained by breast density and suggest that any formalised screening program in PNG has a target age group aimed at women younger than that of Western screening programs.

Mammographic parenchymal patterns and breast cancer risk in New South Wales North Coast Aboriginal and Torres Strait Islander women.

INTRODUCTION: The objective of the study was to document the distribution of mammographic parenchymal patterns (MPP) of Indigenous Australian women attending BreastScreen New South Wales (NSW) North Coast, to profile breast cancer risk as it relates to breast density and to explore the correlation between MPP, breast size as described by the posterior nipple line (PNL) and age. METHODS: Ethics was granted from CQUniversity Human Research Ethics Committee, NSW Population Health Services Research Ethics Committee and the Aboriginal Health and Medical Research Council Ethics Committee. A quantitative retrospective analysis reviewed 502 screening mammograms against the Tabár I-V MPP classification system. The PNL was measured in millimetres (mm) and the age of the patient documented. RESULTS: A statistically significant variation in the distribution of MPP (P < 0.0001) was demonstrated, with patterns of I (23.9%), II (45.6%), III (10.4%), IV (15.9%) and V (4.2%). Statistically significant differences were noted in the age of subjects between patterns (P = 0.0002). Patterns I and V demonstrated statistically significant lower ages than II, III and IV (all P < 0.05). Pattern V demonstrated a statistically significant lower age than pattern I (P = 0.0393). Pattern V demonstrated a statistically significant lower PNL value than all other patterns (all P < 0.001/P < 0.0002); pattern II was statistically significantly higher in PNL value than all other patterns (P < 0.002/P < 0.001). No significant relationship was noted between PNL and age. CONCLUSION: The study demonstrated that no identifiable or unique distribution of MPP was noted in this snapshot of Indigenous women. A larger study of Indigenous Australian women is required for validation.