Jordanian Radiologists' Perspectives and Application of Evidence-Based Radiology in Clinical Practice.

PURPOSE: To evaluate radiologists' education, knowledge and skills of research, attitude toward evidence-based radiology (EBR), understanding of terms and use of related published work in clinical practice and the association between these variables and sociodemographic characteristics. We also aim to assess the availability of resources and to identify sources and the main barriers to implementing EBR. MATERIALS AND METHODS: A total of 87 radiologists completed a questionnaire, which consisted of eight sections related to radiologists' demographic characteristics, and EBR-related questions. Descriptive statistics were used, and the association between EBR-related parts and sociodemographic characteristics was performed. RESULTS: Ninety-three percent of the radiologists believed that EBR is necessary in practice. Only 40% received formal training in search strategies and 29.9% in critical appraisal of research literature during academic preparation. Moreover, 21-62% of the respondents completely understand specific terms related to EBR. Sixty-three percent stated that they can access relevant databases and the Internet at workplace. Research articles were only used by 24% to make a clinical decision. Almost 50% reported that they read or reviewed ≤1 article per month. The primary barrier to implementing EBR was the lack of colleagues' support. Understanding terms and the number of articles used in clinical decision were significantly related to education (P-value=0.001, 0.007) and hospital section (P-value=0.002, 0.027) respectively. CONCLUSION: Radiologists showed positive attitude toward EBR. However, there is a lack in information resources, colleagues' support, use of published literature, understanding of research terms and the ability of radiologists to access relevant databases at workplaces.

Attitudes and knowledge of dental radiography amongst students of dentistry and related fields.

OBJECTIVES: This study aimed to evaluate the level of knowledge and attitude towards quality control in dental radiography amongst students of dentistry, allied dental sciences and radiologic technology programmes. METHODS: A cross-sectional survey was conducted using self-administered questionnaire on a convenience sample of 580 students from three universities in Jordan. The questionnaire was divided into sections that include personal sociodemographic variables, knowledge about quality assurance in dental radiography and attitude towards quality assurance in dental radiography. RESULTS: A total of 286 students completed the questionnaire (response rate = 49.3%), of whom 70% were women. The respondents' knowledge scores ranged from 12.2% (n = 35) to 35.2% (n = 100). The mean of the quality assurance knowledge scores for the whole study sample was 20.3% ± 14.5%, with no significant difference between men and women (p = .643). Allied dental sciences students showed significantly higher knowledge scores (25.0 ± 13.0) than dentistry (17.8 ± 14.40) or radiologic technology students (20.9 ± 14.8). The average attitude scores towards quality assurance in dental radiography were fairly good (69.5 ± 26.4) with no statistically significant differences by study programme. CONCLUSION: Knowledge of students about quality assurance in the three programmes is inadequate. The participants' attitude towards quality assurance was fairly good. The study provides feedback to dental schools to improve their curriculum by including quality assurance into student clinical practices. Further studies are requested to investigate the reasons behind this low level of knowledge.

The influence of breast density and key demographics of radiographers on mammography reporting performance - a pilot study.

INTRODUCTION: A high demand has been placed on radiologists to perform screen reads due to higher number of women undergoing mammography. This study aims to examine radiographer performance in reporting low compared with high-mammographic density (MD) images; and to assess the influence of key demographics of Jordanian radiographers on their performance. METHODS: Thirty mammograms with varied MD were reported by 12 radiographers using the Breast Imaging-Reporting and Data System (BI-RADS). Radiographer performance was measured using sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and area under the receiver operating characteristic curve (ROC AUC). Performance measures were compared between cases with low- and high-MD and between subgroups of radiographers according to key demographics. RESULTS: All performance measures were significantly higher in low- compared to high-MD cases (P value < 0.0). The mean sensitivity, specificity, PPV, NPV and ROC AUC were 0.58, 0.68, 0.67, 0.63 and 0.69 respectively. PPV was significantly different for readers who had different years of experience in mammography, hours and cases per week P value = 0.023, 0.01, 0.017 respectively. ROC AUC was significantly different for radiographers with different number of hours and cases performed per week (P value = 0.001 and 0.004 respectively). CONCLUSIONS: The results of this pilot study are encouraging however a more extensive study is required to determine if Jordanian radiographers are capable of successfully taking part in breast screen reading. The lack of skills and knowledge required for correct and consistent reporting of high-MD images highlights the need for any formal training in mammographic interpretation to focus on the dense breast.

0° vs. 180° CT localiser: The effect of vertical off-centring, phantom positioning and tube voltage on dose optimisation in multidetector computed tomography.

INTRODUCTION: Patient positioning is an essential consideration for the optimisation of radiation dose during CT examinations. The study objectives seek to explore the effects of vertical off-centring, localiser direction (0° and 180°), and phantom positioning (supine and prone) on radiation dose, using three different tube voltages in multidetector computed tomography (MDCT) imaging. METHODS: The trunk of a PBU-60 anthropomorphic phantom was imaged using a Discovery CT750 HD - 128 slice (GE Healthcare). Images employing 0° and 180° localisers were acquired in supine and prone orientation for each combination of vertical off-centring (±100, ±60 and ±30 mm) and different tube voltages (80, 120 and 140 kVp), using the system's automatic tube current modulation (ATCM) function. The displayed volume CT dose index (CTDIvol ) and dose length product (DLP) were recorded. RESULTS: With incremental table off-centring of ±100 mm, the dose at 120 kVp in the supine position ranged from 63% to 196% (0° localiser) and from 66% to 191% (180° localiser) as compared to iso-centre. While in the prone position, the dose ranged from 62% to 195% (0° localiser); and 62% to 193% (180° localiser), with a notable dose increase at higher tube voltages. Dose variation and vertical off-centring showed a significant relationship for both 0° and 180° localisers (r = 0.94 and 0.96, respectively, P < 0.001). The CTDIvol variation between supine and prone phantom positions at ±100 mm off-centring was 0.22 mGy (2.9%), and 0.19 mGy (2.3%) when the 0° and 180 ° localisers were utilised, respectively. CONCLUSIONS: Phantom off-centring and localiser direction evidenced large dose variation. It is recommended that the 0° localiser is employed during CT examinations, in order to minimise the potential additional radiation dose which may result from off-centring and the use of lower tube voltages where clinically appropriate.

Does mammographic density remain a radiological challenge in the digital era?

BACKGROUND: The low subject contrast between cancerous and fibroglandular tissue could obscure breast abnormalities. PURPOSE: To investigate radiologists' performance for detection of breast cancer in low and high mammographic density (MD) when cases are digitally acquired. MATERIAL AND METHODS: A test set of 60 digital mammography cases, of which 20 were cancerous, were examined by 17 radiologists. Mammograms were categorized as low (≤50%) or high (>50%) MD and rated for suspicion of malignancy using the Royal Australian and New Zealand College of Radiology (RANZCR) classification system. Radiologist demographics including cases read per year, age, subspecialty, and years of reporting were recorded. Radiologist performance was analyzed by the following metrics: sensitivity; specificity; area under the receiver operating characteristic (ROC) curve (AUC), location sensitivity, and jackknife free-response ROC (JAFROC) figure of merit (FOM). RESULTS: Comparing high to low MD cases, radiologists showed a significantly higher sensitivity (P = 0.015), AUC (P = 0.003), location sensitivity (P = 0.002), and JAFROC FOM (P = 0.001). In high compared to low MD cases, radiologists with <1000 annual reads and radiologists with no mammographic subspecialty had significantly higher AUC, location sensitivity, and JAFROC FOM. Radiologists with ≥1000 annual reads and radiologists with mammography subspecialty demonstrated a significant increase in location sensitivity in high compared to low MD cases. CONCLUSION: In this experimental situation, radiologists' performance was higher when reading cases with high compared to low MD. Experienced radiologists were able to precisely localize lesions in breasts with higher MD. Further studies in unselected screening materials are needed to verify the results.

Factors Affecting Compliance of Infection Control Measures among Dental Radiographers.

OBJECTIVES: To assess the level of dental radiographers' compliance with infection control measures and to evaluate the factors affecting their compliance. METHODS: The study included 175 dental radiographers. Compliance with infection control was evaluated with a self-administered questionnaire consisting of 33 questions related to vaccination, hand hygiene (HH), personal protective equipment (PPE), disinfection and sterilization, and use of surface barriers. Pearson's chi-square test was used to compare compliance between subgroups of radiographers. RESULTS: 64.6% of participants were females, and 62.9% was younger than 30 years. 13.0% of the sample population had >10 years of experience and 28.0% take radiographs for >20 patients/day. 66.9% of participants wash their hands before/after taking radiographs. 26.3% of participants had vaccination against hepatitis B, tetanus, and tuberculosis. 12.6% fully use PPE, 10.9% perform complete disinfection and sterilization, and 16.0% apply all kinds of surfaces barriers. Vaccination was significantly affected by age, gender, and practice type. HH was affected by years of experience and number of patients radiographed per day. PPE was influenced by number of hours worked per week and patients radiographed daily. Disinfection and sterilization was affected by practice type and years of experience. The use of surface barriers was affected by age, practice type, and number of patients radiographed/day. CONCLUSIONS: The current study indicated poor compliance with infection control practices among dental radiographers. We recommend continuing educational programs and training courses to increase dental radiographers' awareness of local and international infection control guidelines and to enhance their implementation of these guidelines.

Knowledge, Attitude and Practice Around Breast Cancer and Mammography Screening Among Jordanian Women.

BACKGROUND: Breast cancer is the most common occurring cancer in women worldwide. To guide current breast cancer screening program, the level of knowledge about breast cancer should be evaluated. This study aims to ascertain the level of breast cancer knowledge including risk factors, signs and symptoms, and early detection methods, especially mammography screening. METHODS: The study was conducted among 1353 Jordanian women from the public using a self-administered questionnaire. Responses to the knowledge test were summed for an overall knowledge score. Comparisons between socio-demographics and knowledge, attitude and practice were also measured using a Chi-square test. RESULTS: About 76% of participants were aware that breast cancer is the most common cancer among women in Jordan. About 53.7% of our participants were rated as having an intermediate level of knowledge regarding risk factors, and 44% were rated as having a good to an excellent level of knowledge about breast cancer signs and symptoms. The participants' level of education was the main factor identified as influencing the participants' knowledge of the risk factors, signs and symptoms, and knowledge of early detection methods of breast cancer. The study sample was rated as having an intermediate level of knowledge regarding mammography screening; however, their participation in this screening method was low. CONCLUSION: Although Jordanian women had an acceptable level of knowledge of breast cancer, the screening rates for mammography were low. These findings suggest that there is a need to provide extra awareness programs for Jordanian women to improve their breast cancer knowledge and practice.

Practices of Infection Control Among Dental Care Providers: A Cross Sectional Study.

BACKGROUND: A wide range of microorganisms poses a threat to patients and dental care teams. Implementation of safety guidelines is thus essential to prevent infection in dental clinics. AIM: To investigate the level of infection-control practices among dental health-care providers in Jordan. METHODS: A self-administered questionnaire was distributed to dental care providers from hospitals, academic institutions, and dental centres. The questionnaire covered sociodemographic variables, professional characteristics, and recommended guidelines of infection control. RESULTS: A total of 190 questionnaires were obtained out of 500 distributed questionnnaires (response rate: 38%). Females accounted for 62.6% of the sample and 64.7% were dentists. The majority was vaccinated against hepatitis B (82.1%) and wash their hands as usual behavior before (66.3%) and after (83.2%) treatment. Approximately 87.9% wear gloves and 78.9% wear masks while performing dental procedures. Autoclave sterilization and puncture-resistant containers for sharp instruments were used by 90.5% and 88.4%, respectively. The majority (81.0%) had protocols for emergency treatment of needle stick or other sharps accidents. High volume evacuation was used in 28.6% of public hospitals compared to 19.4% in academic institutions (P<0.01). In addition, surface barriers for dental unit surfaces were used by 70.2% of private dental clinics, 50% of public hospitals, and 36.1% of academic institutions (P<0.001). Finally, compared to dentists, dental support staff showed low compliance with infection-control guidelines. CONCLUSION: The overall practice of infection-control measures among the participants is very good. Educational programs and training strategies should be implemented to maximize and enhance the compliance of the dental care providers with infection-control guidelines.

Mammographic Breast Density Profile of Jordanian Women With Normal and Breast Cancer Findings.

PURPOSE: To document the mammographic breast density (MBD) distribution of Jordanian women and the relationship with MBD with age. Correlation between breast cancer diagnosis and density was also explored. METHODS: A retrospective review of 660 screening mammograms from King Abdullah University Hospital was conducted. Mammograms were classified into 2 groups: normal (return to routine screening) and breast cancer and rated using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) 5th edition for MBD. The association between MBD and age was assessed by descriptive analyses and Kruskal-Wallis test. To compare between normal and breast cancer groups, chi-square post hoc tests with Bonferroni adjustment was used. RESULTS: Groups consisted of 73.9% (n = 488) normal group and 26.1% (n = 172) breast cancer group. A significant inverse relationship was demonstrated between age and MBD among the normal (r = -.319, P < .01) and breast cancer group (r = -.569, P < .01). In total, 69% (n = 336) of women in the normal group and 71% (n = 122) in the breast cancer group and 79.1% (n = 159) of the normal group and 100% (n = 48) of the breast cancer group aged 40 to 49 years reported high MBD (ACR BI-RADS c or d). CONCLUSIONS: Most of women in both the normal and breast cancer groups evidenced increased MBD. Increased MBD was inversely proportional to age. As MBD has a known link to increased breast cancer risk and the decreased sensitivity of mammography and it is vital that future screening guidelines for Jordanian women consider the unique breast density distribution of this population.

The implications of increased mammographic breast density for breast screening in Jordan.

INTRODUCTION: Mammographic breast density is associated with a four to six times increased risk for breast cancer. Mammographic breast density varies by ethnicity, geographical region and age. The aim of this study was to document for the first time the mammographic breast density of Jordanian women and to explore its relationship with age. METHODS: Mammograms completed at King Abdullah University Hospital (Irbid, Jordan) between January 2016 and August 2018 were retrospectively reviewed and classified for breast density using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS). Descriptive analyses and Kurskal-Wallis test were used to examine the association between age and mammographic breast density. RESULTS: A total of 659 mammograms were reviewed. A significant inverse relationship was observed between age and breast density (P < 0.001). In women aged 40-49 years, 83.2% had dense breasts (ACR BI-RADS (c) and (d)). This percentage decreased to 59.8% of women aged 50-59 years; 38.4% of women in their 60s and 37.9% of women aged 70 years or older (ACR BI-RADS (c) only). CONCLUSION: The mammographic breast density of Jordanian women has been shown to be high across all age groups. Increased mammographic breast density is associated with increased breast cancer risk and renders mammography a less effective technique for the early detection of breast cancer. Breast cancer screening of Jordanian women should be individualised to develop screening protocols and include additional adjunct imaging to best manage women at high risk.

Compliance With Radiation Protection Practices Among Radiologists.

BACKGROUND: Radiologists are at higher risk of adverse health effects due to their occupational radiation exposure; therefore, applying protection techniques is imperative. Studies on radiologists' compliance in this regard are scarce. We aimed to assess compliance with radiation safety practices among radiologists. METHODS: Questionnaires were distributed to radiologists in tertiary hospitals. The questionnaire was designed to assess compliance in three domains: using personal protective devices, using exposure-reduction techniques during fluoroscopic exposures, and using personal dose-monitoring devices. Descriptive analysis of the compliance was performed. RESULTS: Sixty-two radiologists were included in the analysis. Use of leaded aprons and thyroid shields was commonplace, whereas only 3.2% ever use leaded eyeglasses. About half of the radiologists always considered reducing the time of exposure and avoided exposure by the primary beam, and the other half did that sometimes. Most of the radiologists (66.1%) always complied with reducing the number of unnecessary exposures, and the rest only complied sometimes. Most of the radiologists (93.5%) always used single personal dose-monitoring devices, most commonly at the neck level over the collar. There was no difference in compliance between different sexes, position descriptions, hospital types, hospital sizes, or years of experience. CONCLUSION: Future compliance improvement strategies for radiologists should focus on use of thyroid shields and leaded eyeglasses and use of exposure-reduction techniques during fluoroscopic operations.

Mammographic density and cancer detection: does digital imaging challenge our current understanding?

RATIONALE AND OBJECTIVES: To investigate the impact of breast density on the performance of radiologists when mammograms are digitally acquired and displayed. MATERIALS AND METHODS: A total of 150 craniocaudal digital mammograms including 75 cases with cancer were examined by 14 radiologists divided into two groups: those who read more (six) and less (eight) than 2000 mammograms per year. Cases were classified as low or high mammographic density. For both types of cases, detection of cancers within and outside the dense fibroglandular tissue was investigated. The performance of radiologist was measured using jack-knife free-response receiver operating characteristic (JAFROC) figure of merit (FOM). RESULTS: Radiologists with over 2000 annual reads had significantly higher JAFROC FOM (P = .03) for high (0.76) mammographic density compared to low (0.70) mammographic density cases. When lesions overlaid the fibroglandular tissue, cases with high mammographic density compared to low mammographic density displayed increased location sensitivity for all radiologists (P = .03) and for those radiologists reading more than 2000 mammograms annually (P = .04), whereas JAFROC FOMs increased for all radiologists (P = .05). No significant changes were observed when the lesion was outside the fibroglandular region. CONCLUSIONS: Increased mammographic density improves the performance of experienced radiologists when using digital mammograms. This finding, which does not align with those previously reported for film screen systems, may be because of windowing/leveling opportunities available with digital images.

How mammographic breast density affects radiologists' visual search patterns.

RATIONALE AND OBJECTIVES: To determine the impact of mammographic breast density on the visual search process of radiologists when reading digital mammograms. MATERIALS AND METHODS: Institutional review board approval was obtained. A set of 149 craniocaudal digital mammograms were read by seven radiologists, and observer search patterns were recorded. Total time examining each case, time to first hit the lesion, dwell time, and number of hits per area were calculated. The nonparametric Mann-Whitney U test was used for statistical evaluation. RESULTS: In both low- and high-mammographic density cases, significant increases were observed in the time to first hit lesions when they were located outside, compared to overlying fibroglandular dense tissue (P = .001). Significantly longer dwell time (P = .003) and greater number of fixations (P = .0003) were observed when the lesions were situated within--rather than outside--the dense fibroglandular tissue. CONCLUSIONS: Increased mammographic breast density changes radiologists' visual search patterns. Dense areas of the parenchyma attracted greater visual attention in both high- and low-mammographic density cases, resulting in faster detection of lesions overlying the fibroglandular dense tissue, along with longer dwell times and greater number of fixations, as compared to lesions located outside the dense fibroglandular regions.