SS 1914 - Radiography practice
Purpose: To validate the use of QSE for muscle elasticity mapping as a possible clinical and quantitative tool and to compare quantitatively the QSE mapping obtained in the vastus lateralis muscles of young adults when submitted to a program of training.
Methods and Materials: Twenty-eight healthy males volunteers (mean age 20 ± 3.3 years), participated in this study, divided into two groups: control group and training group. From the training group, 11 performed a concentric training and 9 submitted an eccentric training, during 15 weeks, on a total of 45 training sessions. All the participants were submitted to an ultrasound evaluation of the vastus lateralis on transverse plan before and after the 12 weeks of training program.
Results: It was found high intra-evaluation reliability for colour mapping values by QSE ultrasound. In few cases, ICC was below the acceptable 0.70 levels. Vastus lateralis muscle was defined as a soft tissue, with higher percentage of green colour, followed by the blue colour when in rest. In generally, there were significant differences on red colour percentage between the first and second evaluations and between the rest and contraction, showing on these two evaluations a less percentage of red colour that is an increase on the tissue hardness after dynamic exercise.
Conclusion: QSE is a useful technique for monitoring of musculoskeletal changings principally on long programs of training, by evaluating the elasticity of muscle structures.
Purpose: The aim of this study was to evaluate and improve the knowledge and ability of sonographers, who perform shoulder ultrasonography examinations, to detect pathological findings in shoulder x-ray images and furthermore, to examine which pathological findings can be reliably detected by sonographers. The focus of this study was to examine the interpretation process primarily in the evaluation of degenerative changes.
Methods and Materials: Study material consisted of 50 anonymised shoulder x-ray examinations of patients who had shoulder ultrasonography within two months of the x-ray study. Three sonographers evaluated research material independently, a semi-structured evaluation, of GH-joint, osteophytes, tendon calcification, acromial shape, subacromial space, AC-osteoarthritis and other observations. Musculoskeletal radiologist evaluated images blinded to the interpretation of sonographers. The results were compared between radiologist and sonographers.
Results: Sonographers’ detection rates compared to radiologist were; GH-joint 96,7%, GH-joint space 94%, GH-joint articular surfaces 81,3%, osteophytes 72,7%, tendon calcification 81,4%, acromial shape 69,3%, subacromial space 93,8%, AC-osteoarthritis 39,4% and other observations 76%.
Conclusion: Radiographers’ ability to interpret and report x-rays have been studied widely and good results have been reported in the interpretation of trauma x-ray images. In our study, sonographers (Radiographer University of Applied Sciences) performed well in detecting degenerative radiographic findings of shoulder x-ray images. GH-joint, GH-joint space and articular surfaces, tendon calcification and subacromial space were most accurately evaluated when compared to radiologist’s interpretation. The research material will be further utilised in education to improve the sonographers’ skills to evaluate AC-osteoarthritis, acromial shape and osteophytes.
Purpose: To characterise the thickness and echo-intensity of the quadriceps femoris muscle and analyse its relationship with gender, practice of sports, number of training and practice time.
Methods and Materials: 61 young individuals were submitted to an ultrasound examination to assess the thickness and echogenicity of the quadriceps femoris muscle, through the acquisition of images in longitudinal sections. The ultrasound images were processed using the Image J software and the data were analysed through SPSS 20.0.
Results: The quadriceps femoris muscle has an average thickness between 1.12 and 1.34 cm, and an echo-intensity between 74.83 and 81.65 values. There are significant differences in the thickness of the left and right medial vastus muscle between males and females and significant differences in the thickness and echo-intensity of the quadriceps femoris muscle in relation to the practice of sport and practice time.
Conclusion: The thickness of quadriceps femoris muscle is greater in males than in females; however, the opposite is observed regarding the echo-intensity of it. The practice of sports, number of workouts and practice time influence the echo-intensity and thickness of the quadriceps femoris muscle.
Purpose: The knowledge that radiographers have on bioethics (and the legal framework of care) can have a direct impact on the type and quality of care that patients receive. This work has the goal of knowing what kind of bioethics unit contents are taught to future radiographers.
Methods and Materials: Semi-structured interviews with accountable pedagogical coordinators and meta-analysis on available official information about curricular unit contents in the major official schools were performed on 22 colleges, 15 countries. Data was examined to exclude significant bias; for qualitative variables, frequencies and percentages were calculated; averages and standard deviations for quantitative ones.
Results: The characterisation of radiographers high-level education showed that only a minority (36%) have bioethics and/or deontology training, with the duration equal or more than 1 semester. Regarding the characterisation of type and quality of the education, bioethical contents revealed that the most pertinent alluded topics are Professional Skills (83%) and Awareness (90%). However, reference authors highlight that ethical behavior should focus on tolerance, prudence and discrimination capacity. These features are bioethics discipline characteristics. Therefore, they cannot be scattered by well-meaning programmes that do not develop critical and reflective ethical thinking.
Conclusion: The educational environment should combat the incongruence of these results. If future professionals do not learn and integrate the importance of bioethics for clinical practice, patients may suffer needlessly and their self-determination rights are ignored. To avoid this situation priority to bioethics should be given, ensuring mandatory character in training plans of all these professionals.
Purpose: Purpose work related injuries can affect staff well-being, decrease productivity and cause early career ending. The objective of this study is to determine whether our sonographers are suffering work related pains that require intervention and their awareness of ergonomics in comparison to a nationwide trend.
Methods and Materials: A questionnaire was conducted for the multinational practicing sonographers at an 800 bed tertiary care hospital. The general ultrasound sub-section was selected. The intervention, paediatric and women imaging sub-sections were excluded.
Results: 13 sonographers were involved.11 (85%) were females and 2 (15%) were males. Seven (54%) were Saudi’s, five (38%) were Philipinos and one (8%) was Sudanese. Response rate was 100%. Only 3(23%) were fully aware of ergonomics. 8 (62%) were suffering from various musculoskeletal pains compared to 89 (78%) nationwide of whom 58 (51%) suffered more severely and may consider leaving the profession. The vast majority of our staff 12 (92%) said they were over worked.
Conclusion: The issues of ergonomics are rarely addressed by management or staff. Our sonographers are mostly unaware of ergonomics. They are at risk of work related injuries and burn out syndrome but less than the nationwide pattern. An in-service education session was conducted by a physiotherapist. Subsequently regular staff exercise and stretching program was implemented at short breaks resulting in morale boosting. Impact on sick leave records was not studied.
Purpose: To evaluate define (geometry tag error) in planning station in patient with metal frame before gamma knife radiosurgery.
Methods and Materials: 34 patients with gamma knife metal frame were assessed (20 by head TxRx, 4 by flex small, 10 by head matrix lower plus body). Aera 1.5T scanner was used with CIVCO planning accessories. 3 coil configurations were tested: 2 flex small combinations, head TxRx, head matrix lower plus body matrix 18. All patients were scanned with Leksell localiser and gamma plan station. Т2 TSE and Т1 VIBE with spatial resolution 1.0х1.0х1.0mm were used.
Results: The results of define due to using flex small coil and TxRx coil were 0.9±0.3. Satisfactory define (0.4±0.1) in planning station were reached with combination Head matrix lower plus Body Matrix 18, by channels increasing and scanning protocols optimisation. In these cases, B1 filter and reduced EC sensitivity were activated, and gradient system regime was changed from fast to low Sar.
Conclusion: CIVCO accessories and coils combination of head matrix lower plus body matrix 18 are useful for gamma knife treatment planning (in difference with standard protocols and coils).
Radiation exposure assessment in educational setting: spine surgical programme with procedures simulated on cadavers
Purpose: Assess the amount of radiation dose in the spine surgical intervention in an educational setting, carried out in the dissection room using cadavers for training, and to evaluate if the exposure level is between the limits imposed by legislation to radiographers or medical students.
Methods and Materials: To evaluate the effective dose received by students, dosimetric evaluations were carried out in 6 students (five radiographers and one doctor) using thermoluminescent dosimeters (TLD-100) by (LiF:Mg,Li); bandwidth of 10μGy-10Gy, placed under the apron shield. In one student positioned in the place of the main surgeon, wrist and eye dosimeters were also used. The fluoroscopy time was obtained from the dose report print from the equipment (Ziehm Vision Vario 3D) used in pulsed emission mode. The data collection occurred during the all course time - 3 days.
Results: The effective dose measured under the apron for the whole body and in the eye gave the value of 0,00mSv for all students. The effective dose results for the wrist were 0,69mSv Hp(0,07) and 0,74mSv Hp(10). The total time of exposition was between [11,51min-15,78Max]. The correlation between the cumulative dose and the exposition time was weak (R=0,29).
Conclusion: The radiation dose was lower than the limits imposed by legislation. We concluded that the training programs using fluoroscopy in cadavers revealed to be safe. It is safeguard the radiological protection for the students in lab area applying simulated techniques in cadaver, using the best practices that mimics the surgical theatre.
Purpose: To demonstrate the role of CT and MRI examinations on the post-mortem analysis of a corpse.
Methods and Materials: In this case study, a person had to die in a violent manner by suicide or homicide (in these circumstances a conventional autopsy is mandatory according the nacional law) within the hospital area. For data collection purposes, the pathologist gave permission to be recorded during the course of conventional autopsy, and the radiology department agreed to perform the post-mortem imaging. The imaging was carried out with a 16 slices CT scanner and a 1.5 Tesla MRI.
Results: Both techniques viewed fluid in the thoracic cavity. Imaging did not detect the presence of sand in the larynx, pharynx, trachea and oesophagus, unlike conventional autopsy, but detected unspecific foreign bodies. In this parameter, the conventional autopsy was superior. However, this difficulty can be easily overcome since there are software programmes that enable the study of the tracheal lumen and the bronchial tree. In this case the imaging examinations were sufficient to determine the cause of death (drowning).
Conclusion: Literature reviews have shown good correlation between both techniques and this particular case study has shown that there was certainly a good congruence between the two modalities. The virtual method preserves the forensic evidence and, at the same time, represents an alternative to religious communities which do not accept the conventional autopsy. Virtual autopsy also creates another intervention field for radiographers, contributing to their professional development.
Comparative study of plain radiography from three digital acquisition systems applied to works of Art
Purpose: In order to reinforce the cooperation between radiologic centres and the museums and enlarge the job-market of the Radiographers, this study aimed to give a contribution for a better understanding about the process used in the characterisation of radiography in painting and to optimise the exposition’s parameters in 3 systems, comparing them.
Methods and Materials: With the help of an expert in Museology and Art History it was selected 5 paintings produced with different materials and techniques. The paintings underwent to three acquisition systems making a total of 21 images: 1-DR Siemens MultixSelect-DR; 2-CR Siemens Multix Pro combined with AGFA IP MD4.0 detector and scanner AGFA ADC Solo and 3-CR tube YXLON SMART 160E/0,4 belonging to José Figueiredo Lab from investigation and conservation of cultural heritage. All acquisition procedures were reproduced in all systems. Four observers classified the images: 2 experts in medical imaging and 2 in art. The dimensions of the check-list were: support conservation state; distinctness; contrast; contour; creative and technique process; components and materials.
Results: Globally the best images ranked by experts were obtained with the system 2 where was possible to see the fine contours, the brushstrokes or the matting of the canvas. However the system 3 gives some details inexistent in the others. The best acquisition parameters were the recommended by National Gallery's studies.
Conclusion: Radiography field and the knowledge of radiographers, through CR systems, may increase the image quality to expertise advice, validation and authentication of works of Art.
An investigation into interface pressure (IP) and pressure ulcer (PU) risk of healthy volunteers whilst lying on medical imaging and radiotherapy tables
Purpose: Determine whether IP risks exist on radiography/radiotherapy tables; determine the impact of a pressure relieving intervention on IP jeopardy areas.
Methods and Materials: Baseline study: An Xsensor pressure mapping system was used to measure IP of jeopardy areas in healthy volunteers (26 females, 23 males; aged 18-59 (mean=34.6±10.5)) on three radiography/radiotherapy tables. Volunteers also completed a pain/comfort questionnaire. Significant differences exist for mean IP for head, sacrum, and heels across the three tables (p≤0.001). Highest IP was recorded for the head (75.9±31.2mmHg) on the radiotherapy/planning table. This IP could induce tissue breakdown, predisposing to PU. Most pain occurred when lying on the radiotherapy table.
Results: Intervention study: A thin gel surface overlay, with low radiation attenuation, was assessed to reduce IP risk to the head. Pressure mapping was conducted on 20 healthy volunteers aged 25-53 years (mean=34.4±7.0). Significant difference in the mean IP with and without the intervention was identified (mean IP values of 62.4±6.1 and 83.9±8.1mmHg respectively, p≤0.001). There was a significant difference in the peak pressure index (PPI) of the head with and without the gel intervention (mean=159.8±26.8, and mean=205.1±28.2mmHg respectively, p<0.05).
Conclusion: IP and therefore PU risk exists for the head on radiotherapy/planning tables. A suitable intervention can reduce this risk. Further research is needed to assess interventions and also PU risk to high risk populations.
Purpose: The purpose of this study was to develop free software, at low cost and with minimal time to evaluate the image quality in dental and maxillo-facial cone beam computed tomography (CBCT).
Methods and Materials: A polymethyl methacrylate (PMMA) phantom, CQP-IFBA, was scanned in three CBCT units with seven protocols. A macro-programme was developed, using ImageJ free software, to automatically evaluate the image quality parameters. The image quality evaluation was based on eight parameters: uniformity, signal to noise ratio (SNR), noise, contrast to noise ratio (CNR), spatial resolution (SR), artefact index, geometric accuracy and low contrast.
Results: The image uniformity was dependent on the applied protocols, as well as the noise. Regarding the CNR, the structures of high densities were more sensitive to the effect of scanning parameters. There were no significant differences between SNR and CNR in centered and peripheral objects. The geometric accuracy showed that all the distance measurements were lower than the real value. Low contrast resolution was influenced by scanning parameters and the 1mm rod was not depicted in three CBCT units. The smaller voxel sizes presented higher spatial resolution. There were no significant differences among protocols regarding artefact presence.
Conclusion: The package (phantom and macro) developed provided a fast, low cost and reproducible method for evaluation of image quality parameters in CBCT.