The prevalence of harassment of diagnostic radiography and radiation therapy students whilst on clinical placement in the Republic of Ireland.

Objective: To determine if student radiographers and radiation therapists experience harassment (verbal, physical or sexual) while on clinical placement and their awareness of policies in place to report such incidents.Methods: An online questionnaire developed from the World Health Organisation's questionnaire on workplace violence in healthcare and the higher education authority (HEA) national survey of student experiences of sexual violence and harassment in Irish HEIs was used. Undergraduate and postgraduate diagnostic radiography and radiation therapy students in the Republic of Ireland to be included and have completed a minimum of four weeks of clinical placement. Our of 256 students, 98 filled out the survey.Results: Forty-one per cent (n = 40) of students reported experiencing at least one incident of harassment. Thirteen per cent reported experiencing two forms of harassment, and 2 students reported experiencing verbal, physical and sexual harassment. Verbal harassment (n = 33) and sexual (n = 16) were the most common form of harassment while physical harassment was experienced 7 participants. Ninety-one per cent (n = 88) of participants reported they don't believe they have received sufficient training in dealing with incidents of physical, verbal or sexual harassment.Conclusion: Harassment of student radiographers and radiation therapists is occurring while on placement. Male patients are the modal perpetrator, and most incidents go unreported. Students are not empowered to report an incident of harassment and are sometimes unaware of how to report harassment.

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.

Repeatability of transient elastography in children.

BACKGROUND: Poorly performing diagnostic tests can impact patient safety. Clinical investigations must have good precision and diagnostic accuracy before widespread use in clinical practice. Transient elastography (TE) measures liver stiffness, a surrogate marker of liver fibrosis in adults and children. Studies to evaluate its repeatability and reproducibility (precision) in children are limited. Our aim was to determine (i) the normal range of TE measurements and (ii) the repeatability and reproducibility of TE in healthy children. METHODS: TE was performed in 257 healthy children, of whom 235 (91%, mean age 11.7 years, standard deviation (SD) 2.51, 107 were males (45.5%)) had two valid TE measurements performed, at least 24 h apart, by two operators under similar circumstances. High-quality TE images were obtained for each examination. RESULTS: The normal range of TE was 2.88-6.52 kPa. The mean difference between paired measurements was 0.044 (SD 0.4). The 95% limits of agreement ranged from -0.8 to +0.76 kPa for repeat measurements. There was a difference of >1 kPa between measurements in 61/235 (25.9%) children. The lack of precision was similar across all age groups. CONCLUSIONS: This study demonstrates that TE does not have acceptable precision in healthy children, because random measurement variation results in the lack of agreement between paired measurements. IMPACT: The precision and diagnostic accuracy of a new technology must be determined before it is deployed in children in order to ensure that appropriate clinical decisions are made, and healthcare resources are not wasted. TE is widely used to diagnose liver disease in children without adequate evaluation of the precision (repeatability) of TE either in healthy children or children with liver disease. This study demonstrates that TE does not have adequate precision in children. This study was performed in accordance with methods previously published for children. Refinements to the test protocol, such as duration of fasting or probe size, will have to be evaluated for their impact on precision and accuracy before the test is deployed in research studies or clinical practice.

3T MRI of the knee with optimised isotropic 3D sequences: Accurate delineation of intra-articular pathology without prolonged acquisition times.

OBJECTIVES: To investigate optimised isotropic 3D turbo spin echo (TSE) and gradient echo (GRE)-based pulse sequences for visualisation of articular cartilage lesions within the knee joint. METHODS: Optimisation of experimental imaging sequences was completed using healthy volunteers (n=16) with a 3-Tesla (3T) MRI scanner. Imaging of patients with knee cartilage abnormalities (n=57) was then performed. Acquired sequences included 3D proton density-weighted (PDW) TSE (SPACE) with and without fat-suppression (FS), and T2*W GRE (TrueFISP) sequences, with acquisition times of 6:51, 6:32 and 5:35 min, respectively. RESULTS: One hundred sixty-one confirmed cartilage lesions were detected and categorised (Grade II n=90, Grade III n=71). The highest sensitivity and specificity for detecting cartilage lesions were obtained with TrueFISP with values of 84.7% and 92%, respectively. Cartilage SNR mean for PDW SPACE-FS was the highest at 72.2. TrueFISP attained the highest CNR means for joint fluid/cartilage (101.5) and joint fluid/ligament (156.5), and the lowest CNR for cartilage/meniscus (48.5). Significant differences were identified across the three sequences for all anatomical structures with respect to SNR and CNR findings (p-value <0.05). CONCLUSION: Isotropic TrueFISP at 3T, optimised for acquisition time, accurately detects cartilage defects, although it demonstrated the lowest contrast between cartilage and meniscus. KEY POINTS: • Cartilage is better visualised with 3D TrueFISP than 3D SPACE sequences. • 3D TrueFISP is a reliable sequence for detecting low- and high-grade cartilage defects. • 3D TrueFISP at 3T provides excellent contrast between cartilage and joint fluid.

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.

Frequency of paediatric medical imaging examinations performed at a European teaching hospital over a 7-year period.

OBJECTIVES: The aim of this retrospective cohort study was to gain an insight into frequencies by which a range of medical imaging (MI) examinations were performed on paediatric patients at the main acute general teaching hospital in Malta between 2008 and 2014. METHODS: Frequency data of MI examinations performed on paediatric patients were retrospectively collected from relevant information systems. All data was coded accordingly to facilitate data analysis. RESULTS: A total of 95,805 MI examinations were performed on 39,707 unique paediatric patients (<18 years) between 2008 and 2014. Overall, the total number of paediatric MI examinations performed decreased over time, with use varying depending on modality type and paediatric age. Coincidentally the use of ultrasound and MRI increased year after year. Some paediatric patients underwent at least three MI examinations involving the same anatomical region being scanned, and which may collectively contribute to effective doses exceeding 10 mSv. CONCLUSIONS: Knowledge of how MI examinations are used within the paediatric population can help practices evaluate and address any trends highlighted for particular examinations or age category of paediatric patients. Furthermore, awareness of current trends of MI in children can be helpful for the planning of future paediatric radiology departments. KEY POINTS: • Medical imaging (MI) examinations are commonly performed in paediatric patients. • In 7 years 95,805 examinations were performed on 39,707 paediatric patients. • Use of ultrasound and MRI in paediatric patients increased annually. • Highest frequency of MI examinations was observed in neonates/infants younger than 1 year. • Awareness of MI utilisation patterns and trends can help inform practice.

The impact of pediatric-specific dose modulation curves on radiation dose and image quality in head computed tomography.

BACKGROUND: The volume of CT examinations has increased with resultant increases in collective dose values over the last decade. OBJECTIVE: To analyze the impact of the tube current and voltage modulation for dose values and image quality of pediatric head CT examinations. MATERIALS AND METHODS: Head CT examinations were performed on anthropomorphic phantoms and four pediatric age categories before and after the introduction of dedicated pediatric curves for tube voltage and current modulation. Local diagnostic reference levels were calculated. Visual grading characteristic image quality evaluation was performed by four pediatric neuroradiologists and image noise comparisons were performed. RESULTS: Pediatric-specific modulation curves demonstrated a 49% decrease in mean radiation dose for phantom examinations. The local diagnostic reference levels (CTDIvol) for clinical examinations decreased by 52%, 41%, 46% and 40% for newborn, 5-, 10- and 15-year-old patients, respectively. Visual grading characteristic image quality was maintained for the majority of age categorizations (area under the curve = 0.5) and image noise measurements did not change (P = 0.693). CONCLUSION: Pediatric-specific dose modulation curves resulted in an overall mean dose reduction of 45% with no significant differences in subjective or objective image quality findings.

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.

Radiologist experience effects on contrast detection.

Current literature shows that radiologist experience does not affect detection tasks when the object does not require medical training to detect. However, the research was never sufficiently detailed to examine if the contrast detection threshold is also the same for radiologists versus nonradiologists. Previously, contrast threshold research was performed predominantly on nonradiologists. Therefore, any differences could lead to over- or under-estimation of the performance capabilities of radiologists. Fourteen readers, evenly divided between radiologists and nonradiologists, read a set of 150 mammogram-like images. The study was performed with the location of the objects known and unknown, requiring two separate readings. No difference in the contrast detection threshold between reader groups for either the location-unknown (4.9 just noticeable differences) or location-known (3.3 just noticeable differences) images was seen. The standard deviation for the location-unknown condition had no difference (p 0.91). But for the location-known condition, a significant difference (p 0.0009) was seen between radiologists and nonradiologists. No difference in contrast detection based on reader experience was observed, but decreased variance was seen with radiologists in the location-known condition.

Trend of contrast detection threshold with and without localization.

Published information on contrast detection threshold is based primarily on research using a location-known methodology. In previous work on testing the Digital Imaging and Communications in Medicine (DICOM) Grayscale Standard Display Function (GSDF) for perceptual linearity, this research group used a location-unknown methodology to more closely reflect clinical practice. A high false-positive rate resulted in a high variance leading to the conclusion that the impact on results of employing a location-known methodology needed to be explored. Fourteen readers reviewed two sets of simulated mammographic background images, one with the location-unknown and one with the location-known methodology. The results of the reader study were analyzed using Reader Operating Characteristic (ROC) methodology and a paired t test. Contrast detection threshold was analyzed using contingency tables. No statistically significant difference was found in GSDF testing, but a highly statistical significant difference (p value <0.0001) was seen in the ROC (AUC) curve between the location-unknown and the location-known methodologies. Location-known methodology not only improved the power of the GSDF test but also affected the contrast detection threshold which changed from +3 when the location was unknown to +2 gray levels for the location-known images. The selection of location known versus unknown in experimental design must be carefully considered to ensure that the conclusions of the experiment reflect the study's objectives.

Evaluation of image quality of diffusion weighted readout segmentation of long variable echo-trains MR pulse sequence for lumbosacral nerve imaging at 3T.

Background: Limited magnetic resonance (MR) pulse sequences facilitate lumbosacral nerve imaging with acceptable image quality. This study aimed to evaluate the impact of parameter modification for Diffusion Weighted Image (DWI) using Readout Segmentation of Long Variable Echo-trains (RESOLVE) sequence with opportunities for improving the visibility of lumbosacral nerves and image quality. Methods: Following ethical approval and acquisition of informed consent, imaging of an MR phantom and twenty healthy volunteers (n=20) was prospectively performed with 3T MRI scanner. Acquired sequences included standard two-dimensional (2D) turbo spin echo sequences and readout-segmented echo-planar imaging (EPI) DWI-RESOLVE using three different b-values b-50, b-500 and b-800 s/mm2. Signal-to-noise ratio (SNR), apparent diffusion coefficient (ADC) and nerve size were measured. Two musculoskeletal radiologists evaluated anatomical structure visualisation and image quality. Quantitative and qualitative findings for healthy volunteers were investigated for differences using Wilcoxon signed-rank and Friedman tests, respectively. Inter and intra-observer agreement was determined with κ statistics. Results: Phantom images revealed higher SNR for images with low b-values with 206.1 (±10.9), 125.1 (±45.2) and 59.2 (±17.8) for DWI-RESOLVE images acquired at b50, b500 and b800, respectively. Comparable results were found for SNR, ADC and nerve size across normal right and left sided for healthy volunteer images. The SNR findings for b-50 images were higher than b-500 and b-800 images for healthy volunteer images. The qualitative findings ranked images acquired using b-50 and b-500 images significantly higher than corresponding b-800 images (P<0.05). Inter and intra-observer agreements for evaluation across all b-values ranged from 0.59 to 0.81 and 0.83 to 0.92, respectively. Conclusions: The modified DWI-RESOLVE images facilitated visualization of the normal lumbosacral nerves with acceptable image quality, which support the clinical applicability of this sequence.

Education and training in radiation protection in Europe: results from the EURAMED Rocc-n-Roll project survey.

PURPOSE: To analyse the existing radiation protection (RP) education and training (E&T) capabilities in the European Union and identify associated needs, problems and challenges. METHOD: An online survey was disseminated via the EURAMED Rocc-n-Roll consortium network and prominent medical societies in the field of radiological research. The survey sections analyse the RP E&T during undergraduate, residency/internship and continuous professional development; RP E&T problems and legal implementation. Differences were analysed by European geographic regions, profession, years of professional experience and main area of practice/research. RESULTS: The majority of the 550 respondents indicated that RP topics are part of undergraduate curricula in all courses for their profession and country (55%); however, hands-on practical training is not included according to 30% of the respondents. The lack of E&T, practical aspects in current E&T, and mandatory continuing E&T were considered the major problems. The legal requirement that obtained higher implementation score was the inclusion of the practical aspects of medical radiological procedures on education (86%), and lower score was obtained for the inclusion of RP E&T on medical and dental school curriculums (61%). CONCLUSIONS: A heterogeneity in RP E&T during undergraduate, residency/internship and continuous professional development is evident across Europe. Differences were noted per area of practice/research, profession, and European geographic region. A large variation in RP E&T problem rating was also obtained.

Verification of DICOM GSDF in complex backgrounds.

While previous research has determined the contrast detection threshold in medical images, it has focused on uniform backgrounds, has not used calibrated monitors, or has involved a low number of readers. With complex clinical images, how the Grayscale Standard Display Function (GSDF) affects the detection threshold and whether the median background intensity shift has been minimized by GSDF remains unknown. We set out to determine if the median background affected the detection of a low-contrast object in a clustered lumpy background, which simulated a mammography image, and to define the contrast detection threshold for these complex images. Clustered lumpy background images were created of different median intensities and disks of varying contrasts were inserted. A reader study was performed with 17 readers of varying skill level who scored with a five-point confidence scale whether a disk was present. The results were analyzed using reader operating characteristic (ROC) methodology. Contingency tables were used to determine the contrast detection threshold. No statistically significant difference was seen in the area under the ROC curve across all of the backgrounds. Contrast detection fell below 50 % between +3 and +2 gray levels. Our work supports the conclusion that Digital Imaging and Communications in Medicine GSDF calibrated monitors do perceptually linearize detection performance across shifts in median background intensity. The contrast detection threshold was determined to be +3 gray levels above the background for an object of 1° visual angle.

Agreement Between International Radiologists on the Appropriateness and Urgency in Lumbar Spine MRI Referrals.

Purpose: To determine how radiologists across health-care jurisdictions internationally assess the appropriateness and urgency levels of lumbar spine Magnetic Resonance Imaging MRI referrals. Patients and Methods: Clinical information was extracted from 203 lumbar spine MRI referrals. Texts were divided into 10 datasets and embedded into a software to facilitate the classification process. Participant radiologists were recruited at the Image Perception Lab, at the Radiological Society of North America Congress, 2019 and through the institution radiology network. Radiologists were asked if they use referral guidelines in their practices. Radiologists assigned appropriateness and urgency levels based on the referral text. Appropriateness level descriptors were: indicated, indicated but needs more information or not indicated. Urgency levels were categorized: urgent, semi-urgent, or not urgent. All cases containing neurological symptoms with/without red flags were extracted and exact agreement between radiologists' responses on the indication status was calculated. Results: Seventy radiologists from 25 countries participated; 42% of participants indicated non-use of referral guidelines. Poor-moderate radiology agreements were recorded for appropriateness and referral urgency level decisions. 79.6% of responses indicated that cases containing neurological symptoms with/without red flags were indicated for scanning. Conclusion: Despite referral guidelines promotion, nearly half of participants stated non-usage. Subsequently, a varied agreement levels were found in assigning the appropriateness of the referrals. Appropriateness of referrals with neurological symptoms (with/without red flags) recorded good agreement.

Education and training in radiation protection in Europe: an analysis from the EURAMED rocc-n-roll project.

BACKGROUND: A Strengths, weaknesses, opportunities and threats analysis was performed to understand the status quo of education and training in radiation protection (RP) and to develop a coordinated European approach to RP training needs based on stakeholder consensus and existing activities in the field. Fourteen team members represented six European professional societies, one European voluntary organisation, two international healthcare organisations and five professions, namely: Medical Physicists; Nuclear Medicine Physicians; Radiologists; Radiation Oncologists and Radiographers. Four subgroups analysed the "Strengths", "Weaknesses", "Opportunities" and "Threats" related to E&T in RP developed under previous European Union (EU) programmes and on the Guidelines on Radiation Protection Education and Training of Medical Professionals in the EU. RESULTS: Consensus agreement identified four themes for strengths and opportunities, namely: (1) existing structures and training recommendations; (2) RP training needs assessment and education & training (E&T) model(s) development; (3) E&T dissemination, harmonisation, and accreditation; (4) financial supports. Weaknesses and Threats analysis identified two themes: (1) awareness and prioritisation at a national/global level and (2) awareness and prioritisation by healthcare professional groups and researchers. CONCLUSIONS: A lack of effective implementation of RP principles in daily practice was identified. EuRnR strategic planning needs to consider processes at European, national and local levels. Success is dependent upon efficient governance structures and expert leadership. Financial support is required to allow the stakeholder professional agencies to have sufficient resources to achieve a pan European radiation protection training network which is sustainable and accredited across multiple national domains.

Breast surface radiation dose during coronary CT angiography: reduction by breast displacement and lead shielding.

OBJECTIVE: The purpose of this study was to prospectively evaluate the effect of cranial breast displacement and lead shielding on in vivo breast surface radiation dose in women undergoing coronary CT angiography. SUBJECTS AND METHODS: Fifty-four women (mean age, 59.2 ± 9.8 years) prospectively underwent coronary 64-MDCT angiography for evaluation of chest pain. The patients were randomly assigned to a control group (n = 16), breast displacement group (n = 22), or breast displacement plus lead shielding group (n = 16). Thermoluminescent dosimeters (TLDs) were placed superficially on each breast quadrant and the areolar region of both breasts. Breast surface radiation doses, the degree of breast displacement, and coronary image quality were compared between groups. A phantom dose study was conducted to compare breast doses with z-axis positioning on the chest wall. RESULTS: A total of 1620 TLD dose measurements were recorded. Compared with control values, the mean breast surface dose was reduced 23% in the breast displacement group (24.3 vs 18.6 mGy, p = 0.015) and 36% in the displacement plus lead shielding group (24.3 vs 15.6 mGy, p = 0.0001). Surface dose reductions were greatest in the upper outer (displacement alone, 66%; displacement plus shielding, 63%), upper inner (65%, 58%), and areolar quadrants (44%, 53%). The smallest surface dose reductions were recorded for A-cup breasts: 7% for the displacement group and 3% for the displacement plus lead group (p = 0.741). Larger reductions in surface dose were recorded for B-cup (25% and 56%, p = 0.273), C-cup (38% and 60%, p = 0.001), and D-cup (31% and 25%, p = 0.095) sizes. Most of the patients (79%) had either good (< 50% of breast above scan range) or excellent (< 75% of breast above the scan range) breast displacement. No significant difference in coronary image quality was detected between groups. The phantom dose study showed that surface TLD measurements were underestimates of absorbed tissue dose by a mean of 9% and that a strong negative correlation exists between the amount of cranial displacement and breast dose. CONCLUSION: Use of breast displacement during coronary CTA substantially reduces the radiation dose to the breast surface.

Identifying lumbosacral plexus nerve root abnormalities in patients with sciatica using 3T readout-segmented echo-planar diffusion weighted MR neurography.

OBJECTIVES: To investigate the accuracy of Diffusion Weighted Imaging (DWI) using the Readout Segmentation of Long Variable Echo-trains (RESOLVE) sequence in detecting lumbosacral nerve abnormalities. METHODS: Following institutional ethics committee approval, patients with sciatica-type lower limb radicular symptoms (n = 110) were recruited and prospectively scanned using 3T MRI. Additional participants (n = 17) who underwent neurophysiological testing (EMG/NCV), were also prospectively studied. In addition to routine lumbar spine MRI, a DWI-RESOLVE sequence of the lumbosacral plexus was performed. Two radiologists, blinded to the side of patient symptoms, independently evaluated the MR images. The size and signal intensity changes of the nerves were evaluated using ordinal 4-point Likert-scales. Signal-to-noise ratio (SNR), apparent diffusion coefficient (ADC) and size were measured for affected and normal nerves. Inter-observer agreement was determined with kappa statistics; κ. RESULTS: In patients who did not undergo EMG/NCV testing (n = 110), the DWI-RESOLVE sequence detected lumbosacral nerve abnormalities that correlated with symptoms in 36.3% (40/110). This is a similar percentage to patients who underwent EMG/NCV testing, which was positive and correlated with symptoms in 41.2% (7/17). Inter-observer agreement for evaluation of lumbosacral nerve abnormalities was excellent and ranged from 0.87 to 0.94. SNR and nerve size measurements demonstrated statistically significant differences for the L5 and S1 nerves (p value < 0.05) for patients who did not undergo EMG/NCV testing. CONCLUSION: The DWI-RESOLVE sequence is a promising new method that may permit accurate detection and localization of lumbar nerve abnormalities in patients with sciatica.

Subjective Versus Quantitative Methods of Assessing Breast Density.

In order to find a consistent, simple and time-efficient method of assessing mammographic breast density (MBD), different methods of assessing density comparing subjective, quantitative, semi-subjective and semi-quantitative methods were investigated. Subjective MBD of anonymized mammographic cases (n = 250) from a national breast-screening programme was rated by 49 radiologists from two countries (UK and USA) who were voluntarily recruited. Quantitatively, three measurement methods, namely VOLPARA, Hand Delineation (HD) and ImageJ (IJ) were used to calculate breast density using the same set of cases, however, for VOLPARA only mammographic cases (n = 122) with full raw digital data were included. The agreement level between methods was analysed using weighted kappa test. Agreement between UK and USA radiologists and VOLPARA varied from moderate (κw = 0.589) to substantial (κw = 0.639), respectively. The levels of agreement between USA, UK radiologists, VOLPARA with IJ were substantial (κw = 0.752, 0.768, 0.603), and with HD the levels of agreement varied from moderate to substantial (κw = 0.632, 0.680, 0.597), respectively. This study found that there is variability between subjective and objective MBD assessment methods, internationally. These results will add to the evidence base, emphasising the need for consistent, simple and time-efficient MBD assessment methods. Additionally, the quickest method to assess density is the subjective assessment, followed by VOLPARA, which is compatible with a busy clinical setting. Moreover, the use of a more limited two-scale system improves agreement levels and could help minimise any potential country bias.

A Comparison of MRI Radiographers' Knowledge in Saudi Arabia and the Republic of Ireland in Relation to Image Quality Management, for Abdomen and Pelvic MRI Examinations.

PURPOSE: The purpose of this article was to qualitatively compare current MRI radiographers' knowledge from Saudi Arabia and the Republic of Ireland in relation to MR image quality for abdominal and pelvic MRI examinations. METHODS AND MATERIALS: Semistructured interviews were designed to investigate the professional role of radiographers towards image quality management, personal development in MRI, and training in relation to image quality improvement. Public, private, military, and academic hospitals in the Western region of the Kingdom of Saudi Arabia participated, as did a range of public and private Irish centres. Clinical specialist radiographers (CSRs)/supervisors, and MR radiographers working in MR completed the interviews. These were recorded, coded, and transcribed. RESULTS: Sixty-one MR radiographers and CSRs/supervisors within 11 MRI departments in the Kingdom of Saudi Arabia and 11 MRI departments in the Republic of Ireland participated in this study. Three themes resulted by using a qualitative data analysis program called NVivo: (1) health care professional and the cultural attitudes with regards to the scope of professional roles, (2) factors affecting image quality, and (3) departmental policy. Participants' knowledge of image quality varied and challenges to achieving optimal quality levels were noted. Differences in clinical practice between countries were identified, as was the impact of clinical experience and levels of education. CONCLUSION: Differences in attitude and clinical practice between Saudi and Irish radiographers and CSRs/supervisors working in MRI departments were identified. There is a need for further training and subsequent assessment of professional skills, including developing postgraduate opportunities, particularly for Saudi radiographers, to support radiographers in the routine management of MR image quality.

Computer-aided detection tool development for teaching chest radiograph pattern recognition to undergraduate radiography students: A context needs and capability analysis.

BACKGROUND: Medical imaging (MI) education has experienced a shift aligned with the advances in technology and the role played by radiographers in pattern recognition. This has led to increased use of technology-enhanced teaching and simulated learning approaches (e.g. computer-aided detection [CAD] tools) which also support the increasing requirement to develop pattern-recognition skills at undergraduate level. However, the development of these approaches need to be explored and planned carefully to be context-relevant. AIM: The aim of this study was to explore and describe the need for and capability of a CAD tool for teaching chest radiography pattern recognition in an undergraduate radiography programme. SETTING: The setting was a university that offers MI education. METHOD: The study employed a qualitative descriptive design with an interpretive research paradigm. Purposive sampling was used to recruit information-rich participants for a focus group interview. Information-rich participants were considered to be those who were involved in teaching clinical skills, such as those required in pattern recognition, to radiography students. Data were transcribed verbatim and analysed in a step-by-step approach. RESULTS: Three main themes emerged: (1) a structured approach to enhance implicit skills is critical in the CAD tool design; (2) an authentic tool which is able to simulate real-world experiences in image analysis is essential; and (3) a tool which encourages self-directed learning using a wide variety of pathological conditions would be ideal. CONCLUSION: The results of this study are essential in guiding radiography educators in designing CAD tools for teaching chest radiography pattern recognition.