Exploring the translational challenge for medical applications of ionising radiation and corresponding radiation protection research.

BACKGROUND: Medical applications of ionising radiation and associated radiation protection research often encounter long delays and inconsistent implementation when translated into clinical practice. A coordinated effort is needed to analyse the research needs for innovation transfer in radiation-based high-quality healthcare across Europe which can inform the development of an innovation transfer framework tailored for equitable implementation of radiation research at scale. METHODS: Between March and September 2021 a Delphi methodology was employed to gain consensus on key translational challenges from a range of professional stakeholders. A total of three Delphi rounds were conducted using a series of electronic surveys comprised of open-ended and closed-type questions. The surveys were disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the field. Approximately 350 professionals were invited to participate. Participants' level of agreement with each generated statement was captured using a 6-point Likert scale. Consensus was defined as median ≥ 4 with ≥ 60% of responses in the upper tertile of the scale. Additionally, the stability of responses across rounds was assessed. RESULTS: In the first Delphi round a multidisciplinary panel of 20 generated 127 unique statements. The second and third Delphi rounds recruited a broader sample of 130 individuals to rate the extent to which they agreed with each statement as a key translational challenge. A total of 60 consensus statements resulted from the iterative Delphi process of which 55 demonstrated good stability. Ten statements were identified as high priority challenges with ≥ 80% of statement ratings either 'Agree' or 'Strongly Agree'. CONCLUSION: A lack of interoperability between systems, insufficient resources, unsatisfactory education and training, and the need for greater public awareness surrounding the benefits, risks, and applications of ionising radiation were identified as principal translational challenges. These findings will help to inform a tailored innovation transfer framework for medical radiation research.

The Development of Expertise in Radiology: In Chest Radiograph Interpretation, "Expert" Search Pattern May Predate "Expert" Levels of Diagnostic Accuracy for Pneumothorax Identification.

Purpose To investigate the development of chest radiograph interpretation skill through medical training by measuring both diagnostic accuracy and eye movements during visual search. Materials and Methods An institutional exemption from full ethical review was granted for the study. Five consultant radiologists were deemed the reference expert group, and four radiology registrars, five senior house officers (SHOs), and six interns formed four clinician groups. Participants were shown 30 chest radiographs, 14 of which had a pneumothorax, and were asked to give their level of confidence as to whether a pneumothorax was present. Receiver operating characteristic (ROC) curve analysis was carried out on diagnostic decisions. Eye movements were recorded with a Tobii TX300 (Tobii Technology, Stockholm, Sweden) eye tracker. Four eye-tracking metrics were analyzed. Variables were compared to identify any differences between groups. All data were compared by using the Friedman nonparametric method. Results The average area under the ROC curve for the groups increased with experience (0.947 for consultants, 0.792 for registrars, 0.693 for SHOs, and 0.659 for interns; P = .009). A significant difference in diagnostic accuracy was found between consultants and registrars (P = .046). All four eye-tracking metrics decreased with experience, and there were significant differences between registrars and SHOs. Total reading time decreased with experience; it was significantly lower for registrars compared with SHOs (P = .046) and for SHOs compared with interns (P = .025). Conclusion Chest radiograph interpretation skill increased with experience, both in terms of diagnostic accuracy and visual search. The observed level of experience at which there was a significant difference was higher for diagnostic accuracy than for eye-tracking metrics. (©) RSNA, 2016 Online supplemental material is available for this article.

Is the iPad suitable for image display at American Board of Radiology examinations?

OBJECTIVE: The study aimed to determine the acceptability of the iPad 3 as a display option for American Board of Radiology (ABR) examinations. SUBJECTS AND METHODS: A set of 20 cases for each of nine specialties examined by the ABR was prepared. Each comprised between one and seven images and case information and had been used in previous ABR Initial Certification examinations. Examining radiologists (n = 119) at the ABR oral Initial Certification examinations reviewed sets from one or more specialties on both a 2 MP LED monitor and on the iPad 3 and rated the visibility of the salient image features for each case. The Wilcoxon signed rank test was performed to compare ratings. In addition, a thematic analysis of participants' opinions was undertaken. RESULTS: When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty. CONCLUSION: The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.

THE IMPACT OF OBESITY ON ABDOMINAL CT RADIATION DOSE AND IMAGE QUALITY.

The aim of this study was to evaluate how iterative reconstruction can compensate for the noise increase in low radiation dose abdominal computed tomography (CT) technique for large size patients and the general impact of obesity on abdominal organ doses and image quality in CT. An anthropomorphic phantom layered with either none or a single layer of 3-cm- thick circumferential animal fat packs to simulate obese patients was imaged using a 128MDCT scanner. Abdominal protocols (n = 12) were applied using automatic tube current modulation (ATCM) with various quality reference mAs (150, 200, 250 and 300). kVs of 100, 120 and 140 were used for each mAs selection. Metal oxide semiconductor field effect transistor dosimeters (MOSFET) measured internal organ dose. All images produced were reconstructed with filtered back projection (FBP) and sinogram affirmed iterative reconstruction (SAFIRE) (3, 4 and 5) and objective noise was measured within three regions of interest at the level of L4-L5. Organ doses varied from 0.12 to 41.9 mGy, the spleen received the highest doses for both phantom sizes. Compared to the phantom simulating average size, the obese phantom was associated with up to twofold increase in delivered mAs, dose length product (DLP) and computed tomography dose index (CTDIvol) for the matched mAs selection (p < 0.05). However, organ dose increased by 50% only. The use of 100 kV resulted in a 40% lower dose (p < 0.05) compared to 120 kV and the associated noise increase was improved by SAFIRE (5) use, which resulted in 60% noise reduction compared to FBP (p < 0.05). When combined with iterative reconstruction, low kV is feasible for obese patients to optimise radiation dose and maintain objective image quality.

Influence of radiology expertise on the perception of nonmedical images.

Identifying if participants with differing diagnostic accuracy and visual search behavior during radiologic tasks also differ in nonradiologic tasks is investigated. Four clinician groups with different radiologic experience were used: a reference expert group of five consultant radiologists, four radiology registrars, five senior house officers, and six interns. Each of the four clinician groups is known to have significantly different performance in the identification of pneumothoraces in chest x-ray. Each of the 20 participants was shown 6 nonradiologic images (3 maps and 3 sets of geometric shapes) and was asked to perform search tasks. Eye movements were recorded with a Tobii TX300 (Tobii Technology, Stockholm, Sweden) eye tracker. Four eye-tracking metrics were analyzed. Variables were compared to identify any differences among the groups. All data were compared by using nonparametric methods of analysis. The average number of targets identified in the maps did not change among groups [[Formula: see text] of 6 targets (range 5.6 to 6 [Formula: see text])]. None of the four eye-tracking metrics investigated varied with experience in either search task ([Formula: see text]). Despite clear differences in radiologic experience, these clinician groups showed no difference in nonradiologic search pattern behavior or skill across complex images. This is another viewpoint adding to the evidence that radiologic image interpretation is a learned skill and is task specific.

Establishment of diagnostic reference levels for CT trunk examinations in the western region of Saudi Arabia.

Diagnostic reference levels (DRLs) are an important optimisation tool, which aid in identifying abnormally high dose levels. These are currently not available in Saudi Arabia, and this research aims to remedy this. CT dose data (DLP and CTDIvol) were collected for a minimum number of 10 adult patients of average size (60-80 kg) presenting for a range of CT examinations from public hospitals in the western region of Saudi Arabia. These include routine chest, high-resolution chest (HRCT), pulmonary angiography (CTPA), abdomen and pelvis (AP) and the combined chest, abdomen and pelvis (CAP) CT examinations. Mean values for each site were calculated, and the 75th percentile of DLP and CTDIvol was used as a basis for DRLs. Data for 550 patients were collected from 14 hospitals over a 7-month period. The rounded third-quartile CTDIvol and DLP were 18 mGy and 630 mGy cm(-1) for chest CT, 20 mGy and 600mGy cm(-1) for HRCT, 18 mGy and 480 mGy cm(-1) for CTPA, 15 mGy and 800 mGy cm(-1) for AP, and 16 mGy and 1040 mGy cm(-1) for CAP, respectively. Regional DRLs have been proposed from this study. Dose variations across CT departments have identified an urgent need for optimisation to improve distribution of observed doses for CT examinations.

Flexible image evaluation: iPad versus secondary-class monitors for review of MR spinal emergency cases, a comparative study.

RATIONALE AND OBJECTIVES: Studies have highlighted the potential of handheld viewing devices for rapid diagnosis and increased smartphone usage among physicians and radiologists is known as is the clinical applicability of hand-held devices for computed tomography (CT) spinal injury cases. Magnetic resonance (MR), however, is the accepted gold standard for spinal imaging, providing visualization of both ligament and spinal cord pathology. This study investigated the diagnostic accuracy of the iPad, the most probable alternative display device outside the radiology environment and financially viable alternative, when reviewing emergency spinal MR images, in comparison with secondary-class LCD devices in the case of the interpretation of CT and MR imaging examinations. MATERIALS AND METHODS: In total 31 MR cases including both positives (n = 13) containing one of four possible presentations: spinal cord compression, cauda equine syndrome, spinal cord hemorrhage, or spinal cord edema and controls (n = 18) were reviewed. Ziltron iPad software facilitated the display of cases and the receiver operating characteristic (ROC) analysis. Thirteen American Board of Radiology board-certified radiologists reviewed all cases on both displays. Standardized viewing conditions were maintained. RESULTS: Dorfman-Berbaum-Metz multireader-multicase (DBM MRMC) analysis was performed including random readers/random cases, fixed readers/random cases and random readers/fixed cases. No differences of statistical significance (P ≤ .05) could be found in terms of area under the curve, sensitivity and specificity between the iPad and secondary-class display. CONCLUSION: The iPad performed with equal diagnostic accuracy when compared with the secondary-class LCD device after DBM MRMC analysis, demonstrating the iPad as an option to aid initial review of MR spinal emergency cases.