Opinions, attitudes and practices of Australian neurologists with regard to epilepsy and driving.

INTRODUCTION: Austroads Guidelines for fitness to drive were promulgated in 2003. Epilepsy was one of the conditions included and this paper reports results of a survey of Australian neurologists regarding opinions and practices relevant to the guidelines. METHODS: The survey was developed, piloted and Human Research Ethics Committee approved. Members of the Australian Association of Neurologists received three mailings and results were analysed. RESULTS: Almost 70% of 236 surveyed indicated assessment of epilepsy and driving with <9% not doing so--establishing approximately 77% response for eligible neurologists. Most questions achieved 90% response. Almost 90% respondents assessed epilepsy and 70% found the guidelines helpful. Seventy-seven per cent endorsed doctor assessors although half discounted General Practitioners as insufficiently knowledgeable and half advocated that only neurologists evaluate potential drivers with epilepsy. Most respondents supported reporting recalcitrant patients; yet only <30% did so. Three-quarters favoured licences carrying a warning to self-report and two-thirds felt that product information should identify driving implications. Although many questions attracted expected responses, the surprise was the large undecided numbers, which were greater than expected. Neurologists were more lenient than prescribed by the guidelines with neither consensus for controlled epilepsy nor mandatory driving restrictions. CONCLUSION: Respondents supplied predictable answers regarding ideal circumstances; yet most did not report recalcitrant patients. Most claimed to adhere to the guidelines and yet advocated more lenient driving restrictions that may allow preventable accidents. There was agreement between neurologists and guidelines for more rigorous restrictions for commercial drivers although again neurologists were more lenient. There is need for prospective research on epilepsy and driving.

Film based scatter measurement in mammography.

Film based measurements of scatter to primary ratio (s/p) have been made using the "beam stop" technique. Phantom material, radiographically equivalent to 100% glandular tissue, 100% adipose tissue and 50% glandular: 50% adipose tissue was used. These measurements have been made at 25 and 28 kVp for non grid and 28 and 30 kVp with grid for phantom thicknesses varying from 3 cm to 7 cm and 'D shaped' field sizes varying from 80 to 290 cm2. Results indicate that s/p is predominantly uniform across a mammographic image with a reduction towards the edge of the phantom. The values for s/p agree with previously published values determined from Monte Carlo calculation. Scatter primary ratio was found to be directly proportional to phantom thickness with little effect from field size. The effect of beam energy was significant in the non-grid case but reduced in significance with the use of a grid. The average measurement error was estimated at 4.5%. No variation in scatter primary ratio was detected between glandular and adipose phantom materials in this study.