Factors influencing University of Papua New Guinea medical imaging science students considering rural radiography careers.

INTRODUCTION: The aim of this research was to explore factors influencing students at the University of Papua New Guinea (UPNG) Bachelor of Medical Imaging Science (BMIS) choice to pursue rural radiography careers. METHODS: A survey and focus groups of BMIS students at the UPNG were undertaken. The survey included questions related to sociodemographic variables including gender, age, education, rural background and previous employment; and Likert-type scale questions exploring motivation for rural practice, the promotion of radiography through rural practice and the influence of birthplace and incentives to practice. Focus groups comprising convenience samples of six students each from the second, third and fourth years of study explored the promotion of rural radiography, community-based training internships, the benefits of rural practice and the influence of undergraduate training on future rural practice. RESULTS: There were 54 responses (94.7%) to the survey with strong interest (88.9%) in rural radiography practice; 96.3% (n=52) agreed that undergraduate rural training would also act as a motivator. Rural training was a stronger incentive for females than for males (p=0.02). Not being trained in conventional non-digital film screen imaging at UPNG was a strong barrier to rural practice; while being able to give back to the community, increased professional responsibility, cheaper living, job satisfaction and cultural exchange were all viewed as positive aspects of rural practice. Most students reported a benefit to rural practice, while acknowledging a lack of contemporary imaging equipment in rural facilities. CONCLUSION: The study demonstrated that UPNG BMIS students would contemplate careers in rural practice and provides evidence to support dedicated undergraduate rural radiography placement. It also highlights the dichotomy in urban and rural services, which suggests the need for greater emphasis on conventional non-digital film screen radiography in the undergraduate program to best support graduates to work and, importantly, work effectively in rural communities. As most students were from rural areas these results must be tempered by the fact that students may simply be wanting to return home rather than reporting explicit rural intent. A more comprehensive study of the medical imaging profession in PNG should be undertaken to validate this study.

Radiographers' decision-making processes in the movement of pain-afflicted adult trauma patients in planar diagnostic imaging.

INTRODUCTION: The need to balance pain management and radiographic image quality is at the forefront of patient care in diagnostic radiography. This study aimed to identify the decision-making that radiographers employ when undertaking planar diagnostic imaging for pain-afflicted adult trauma patients and the factors that influence these decisions. METHODS: A virtual focus group interview was undertaken with six experienced Australian radiographers using a realistic scenario and questions based on it. Thematic analysis was employed to explore how radiographers approached planar diagnostic imaging of trauma patients and what influenced decisions regarding patient movement. RESULTS: Five key factors in radiographers' decision-making were identified: assistance from the multidisciplinary team, understanding the patient, pain reduction methods, the patient being informed and radiographer competence. Radiographers were found to further utilise professional knowledge of image interpretation and anatomy and physiology, in conjunction with interpersonal capabilities, to undertake radiographic examinations. CONCLUSION: The decision-making process that informs the movement of pain-afflicted adult trauma patients is multifactorial, aligning with the broad healthcare principles of multidisciplinary teamwork, holistic management of the patient and professional knowledge and practice. Further research is needed to explore correlations with different patient groups to validate this research.

The influence of patient positioning on radiation dose in CT imaging: A narrative review.

BACKGROUND AND PURPOSE: Although it is fundamental for optimal scanner operation, it is generally accepted that accurate patient centring cannot always be achieved. This review aimed to examine the reported knowledge of the negative impact of patient positioning on radiation dose and image quality during CT imaging. Furthermore, the study evaluated the current optimisation tools and techniques used to improve patient positioning relative to the gantry iso-center. METHODOLOGY: A comprehensive search through the databases PubMed, Ovid, and Google Scholar was performed. Keywords included patient off-centring, patient positioning, localiser radiograph orientation, radiation dose, and automatic patient positioning (including synonyms). The search was limited to full-text articles that were written in English. After initial title and abstract screening, a total of 52 articles were identified to address the aim of the review. No limitations were imposed on the year of publication. RESULTS: Vertical off-centring was reported in up to 95% of patients undergoing chest and abdominal CT examinations, showing a significant influence on radiation dose. Depending on the scanner model and vendor, localiser orientation, bowtie filter used, and patient size, radiation dose varied from a decrease of 36% to an increase of 91%. A significant dose reduction was demonstrated when utilising an AP localiser, aligning with the trend for radiographers to off-center patients below the gantry iso-centre. Utilizing a 3D camera for body contour detection allowed for more accurate patient positioning and promoted further dose reduction. CONCLUSION: Patient positioning has shown significant effects on radiation dose and image quality in CT. Developing a good understanding of the key factors influencing patient dose (off-centring direction, localiser orientation, patient size and bowtie filter selection) is critical in optimising CT scanning practices. Utilising a 3D camera for body contour detection is strongly recommended to improve patient positioning accuracy, image quality and to minimise patient dose.

Is there benefit to concurrent x-ray imaging of the wrist, forearm and elbow in paediatric patients following a fall on the outstretched hand?

INTRODUCTION: Concurrent X-ray imaging of the wrist, forearm and elbow in paediatric patients following a fall on the outstretched hand (FOOSH) is intended to minimise the risk of an undetected co-occurring injury and is typically performed on patients aged 0-10 years. The purpose of this study was to explore the benefit of this strategy and to identify if age could provide evidence for imaging. METHODS: A 12-month retrospective review of all X-ray examinations of the wrist, forearm and distal humerus of patients aged 0-10 years referred from the Emergency Department of Logan Hospital, Queensland was undertaken. The frequency, type and location of radiographic abnormalities and the requested examinations region of interest (ROI), referral notation and patient's age were recorded. Analysis was made by descriptive statistics. RESULTS: Four hundred and seventy-six examinations met the studies inclusion criteria, 4.8% (n = 23) identified an abnormality outside of the documented ROI. On review of the admission and treatment notes, 1.7% (n = 8) were deemed to have detected traumatic abnormalities as a direct outcome of concurrent imaging. No age-related evidence for imaging was identified. CONCLUSION: This study demonstrates limited benefit (1.7%) to concurrent imaging following a FOOSH. The results suggest that a thorough physical evaluation of the paediatric upper limb performed by the referrer is sufficient to accurately guide X-ray imaging. These findings have the potential to positively impact a reduction in the number of X-rays performed on paediatric patients and in turn contribute to limiting radiation dose. Further studies may be beneficial in verifying the study's findings.

The Impacts of Vertical Off-Centring, Localiser Direction, Phantom Positioning and Tube Voltage on CT Number Accuracy: An Experimental Study.

Background: This study investigates the effects of vertical off-centring, localiser direction, tube voltage, and phantom positioning (supine and prone) on computed tomography (CT) numbers and radiation dose. Methods: An anthropomorphic phantom was scanned using a Discovery CT750 HD­128 slice (GE Healthcare) scanner at different tube voltages (80, 120, and 140 kVp). Images employing 0° and 180° localisers were acquired in supine and prone positions for each vertical off-centring (±100, ±60, and ±30 mm from the iso-centre). CT numbers and displayed volume CT dose index (CTDIvol) were recorded. The relationship between dose variation and CT number was investigated. Results: The maximum changes in CT number between the two phantom positions as a function of vertical-off-centring were for the upper thorax 34 HU (0° localiser, 120 kVp), mid thorax 43 HU (180° localiser, 80 kVp), and for the abdominal section 31 HU (0° localiser, 80 kVp) in the prone position. A strong positive correlation was reported between the variation in dose and CT number (r = 0.969, p < 0.001); 95% CI (0.93, 0.99). Conclusions: Patient positioning demands an approach with a high degree of accuracy, especially in cases where clinical decisions depend on CT number accuracy for tissue lesion characterisation.

Australian perspectives on artificial intelligence in medical imaging.

INTRODUCTION: While artificial intelligence (AI) and recent developments in deep learning (DL) have sparked interest in medical imaging, there has been little commentary on the impact of AI on imaging technologists. The aim of this survey was to understand the attitudes, applications and concerns among nuclear medicine and radiography professionals in Australia with regard to the rapidly emerging applications of AI. METHODS: An anonymous online survey with invitation to participate was circulated to nuclear medicine and radiography members of the Rural Alliance in Nuclear Scintigraphy and the Australian Society of Medical Imaging and Radiation Therapy. The survey invitations were sent to members via email and as a push via social media with the survey open for 10 weeks. All information collected was anonymised and there is no disclosure of personal information as it was de-identified from commencement. RESULTS: Among the 102 respondents, there was a high level of acceptance of lower order tasks (e.g. patient registration, triaging and dispensing) and less acceptance of high order task automation (e.g. surgery and interpretation). There was a low priority perception for the role of AI in higher order tasks (e.g. diagnosis, interpretation and decision making) and high priority for those applications that automate complex tasks (e.g. quantitation, segmentation, reconstruction) or improve image quality (e.g. dose / noise reduction and pseudo CT for attenuation correction). Medico-legal, ethical, diversity and privacy issues posed moderate or high concern while there appeared to be no concern regarding AI being clinically useful and improving efficiency. Mild concerns included redundancy, training bias, transparency and validity. CONCLUSION: Australian nuclear medicine technologists and radiographers recognise important applications of AI for assisting with repetitive tasks, performing less complex tasks and enhancing the quality of outputs in medical imaging. There are concerns relating to ethical aspects of algorithm development and implementation.

Visual grading experiments and optimization in CBCT dental implantology imaging: preliminary application of integrated visual grading regression.

This study uses a general formulation of integrated visual grading regression (IVGR) and applies it to cone beam computed tomography (CBCT) scan data related to anatomical landmarks for dental implantology. The aim was to assess and predict a minimum acceptable dose for diagnostic imaging and reporting. A skull phantom was imaged with a CBCT unit at various diagnostic exposures. Key anatomical landmarks within the images were independently reviewed by three trained observers. Each provided an overall image quality score. Statistical analysis was carried out to examine the acceptability of the images taken, using an IVGR analysis that was formulized as a three-stage protocol including defining an integrated score, development of an ordinal regression, and investigation of the possibility for dose reduction through estimated parameters. For a unit increase in the logarithm of radiation dose, the odds ratio that the integrated score for an image assessed by observers being rated in a higher category was 3.940 (95% confidence interval: 1.016-15.280). When assessed by the observers, the minimum dose required to achieve a 75% probability for an image to be classified as at least acceptable was 1346.91 mGy·cm2 dose area product (DAP), a 31% reduction compared to the 1962 mGy·cm2 DAP default dosage of the CBCT unit. The kappa values of the intra and inter-observer reliability indicated moderate agreements, while a discrepancy among observers was also identified because each, as expected, perceived visibility differently. The results of this work demonstrate the IVGR's predictive value of dose saving in the effort to reduce dose to patients while maintaining reportable diagnostic image quality.

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.

A review of mammographic image quality in Papua New Guinea.

INTRODUCTION: To report for the first time the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate (PGMI) image evaluation system (IES); and to benchmark the image quality against BreastScreen Australia (BSA) National Accreditation Standards (NAS). METHODS: A retrospective image quality analysis of the de-identified mammograms of 102 women imaged at the Port Moresby General Hospital (PMGH) was undertaken using the PGMI IES. Each craniocaudal (CC) and mediolateral oblique (MLO) image was assigned a grade and the reasons for the grade recorded. Age was recorded in years. Simple frequency analysis was undertaken and comparison with BSA NAS 2.4 was made. RESULTS: Women were aged between 25 and 74 years. There were 111 CC views and 109 MLO views. The most frequent individual grade for the CC view was G (83.8%) and for the MLO view M (72.48%); and for a routine series (four images), P and G combined (14.8%). Non-visualisation of the IMA (28%), nipple not in profile (26%) and short length of pectoral muscle (12%) were the most cited reasons for assigning an M grade. CONCLUSION: The reported image quality is not commensurate with that required by BSA (P and G > 50%) and while common positioning errors can be rectified through education and training, it is also important to recognise the complex challenges faced by PNG radiographers in obtaining mammographic images that extend beyond education and training and reflect the emerging nature of the modality as well as wider health, economic and other issues. This work raises the need for national standards, dedicated equipment, and radiographer education to best serve the women of PNG.

The reliability of CT numbers as absolute values for diagnostic scanning, dental imaging, and radiation therapy simulation: A narrative review.

BACKGROUND AND PURPOSE: The purpose of this review was to examine the reported factors that affect the reliability of Computed Tomography (CT) numbers and their impact on clinical applications in diagnostic scanning, dental imaging, and radiation therapy dose calculation. METHODS: A comprehensive search of the literature was conducted using Medline (PubMed), Google Scholar, and Ovid databases which were searched using the keywords CT number variability, CT number accuracy and uniformity, tube voltage, patient positioning, patient off-centring, and size dependence. A narrative summary was used to compile the findings under the overarching theme. DISCUSSION: A total of 47 articles were identified to address the aim of this review. There is clear evidence that CT numbers are highly dependent on the energy level applied based on the effective atomic number of the scanned tissue. Furthermore, body size and anatomical location have also indicated an influence on measured CT numbers, especially for high-density materials such as bone tissue and dental implants. Patient off-centring was reported during CT imaging, affecting dose and CT number reliability, which was demonstrated to be dependent on the shaping filter size. CONCLUSION: CT number accuracy for all energy levels, body sizes, anatomical locations, and degrees of patient off-centring is observed to be a variable under certain common conditions. This has significant implications for several clinical applications. It is crucial for those involved in CT imaging to understand the limitations of their CT system to ensure radiologists and operators avoid potential pitfalls associated with using CT numbers as absolute values for diagnostic scanning, dental imaging, and radiation therapy dose calculation.

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.

The COVID-19 BreastScreen Department - beyond the pandemic.

The first wave of the COVID-19 pandemic in Australia forced a temporary closure of BreastScreen Australia services. Now reopened, the BreastScreen experience has been redefined for both staff and clients and the journey to the 'new BreastScreen normal' is continually evolving in response to the ongoing threat of COVID-19 and government directives on health policy. Many changes mirror those undertaken in the wider community and emphasise wellness to attend, hygiene and social distancing. Importantly, radiographers have been identified as having a high-risk role and have had to modify positioning techniques and cleaning regimes accordingly. Beyond the pandemic, the 'new normal' needs to be one which enables well women to continue screening with a visible sense of reassurance that all that can be done is being done to ensure the safe and continued early detection of breast cancer.

COVID-19 impact on undergraduate teaching: Medical radiation science teaching team experience.

The COVID-19 crisis has caused a number of significant challenges to the higher education sector. Universities worldwide have been forced to rapidly transition to online delivery, working at home, and disruption to research while concurrently facing the longer-term impacts in institution financial reform. Here, the impact of COVID-19 on academic staff in the medical radiation science (MRS) teaching team at Charles Sturt University are explored. While COVID-19 imposes potentially the greatest challenge many of us will experience in our personal and professional lifetimes, it also affords the opportunity to objectively re-evaluate and, where appropriate, re-design learning and teaching in higher education. Technology has allowed rapid assimilation to online learning environments with additional benefits that allow flexible, mobile, agile, sustainable, culturally safe and equitable learning focussed educational environments in the post-COVID-19 "new normal".

Correlation of the BI-RADS assessment categories of Papua New Guinean women with mammographic parenchymal patterns, age and diagnosis.

INTRODUCTION: Women with increased breast density are at increased risk of breast cancer. The aim of this research is to evidence for the first time the mammographic breast findings of Papua New Guinean (PNG) women and the relationship between Breast Imaging-Reporting and Data System (BI-RADS) assessment, mammographic parenchymal patterns (MPPs) and age. METHODS: A retrospective analysis of 1357 mammograms of women imaged at the Pacific International Hospital (PIH) from August 2006 to July 2010 was undertaken. Mammographic findings were categorised using the BI-RADS Atlas® 5th Edition. MPPs were recorded for each woman using the Tabár Pattern I-V classification system. Age was recorded in years. Statistical analysis was by descriptive analysis and Kruskal-Wallis with Dunn's post-test and Spearman's rho correlation for inferential analysis. RESULTS: True pathological findings (benign and malignant); BI-RADS 2-5 were noted in 111 women (8.2%); 1242 (91.5%) were negative. BI-RADS categories for malignancy were reported in 16 (88.9%) of women aged 30 to 60 years. The lower risk Tabár Type I, II and III MPPs were associated with 94.4% (n = 17) of malignancies. Linear correlations between variables were weak and not statistically significant: age and Tabár pattern r = 0.031, P = 0.0261; age and BI-RADS r = 0.018, P = 0.517; Tabár pattern and BI-RADS r = 0.020, P = 0.459 (n = 1357). CONCLUSION: There was no correlation demonstrated between BI-RADS category, age and MPP. Importantly, there was no correlation demonstrated between BI-RADS categories 4 and 5 for breast malignancy and high-risk Tabár Type IV and V MPPs. The results of this study again reflect that the incidence of breast cancer in PNG cannot be explained by breast density and suggest that any formalised screening program in PNG has a target age group aimed at women younger than that of Western screening programs.

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.

Full-field digital mammography: the '30% rule' and influences on visualisation of the pectoralis major muscle on the craniocaudal view of the breast.

INTRODUCTION: To investigate compliance to the '30% rule' and key factors which may influence visualisation of the pectoralis major muscle (PMM) on the craniocaudal (CC) view of the breast. METHODS: A retrospective review of 2688 paired full-field digital mammography (FFDM) CC view mammograms of women attending BreastScreen NSW between August and October 2015 was undertaken. PMM visualisation and measurements of PMM width and length, compressed breast thickness, the posterior nipple line (PNL) and age were recorded. Statistical analysis was performed using descriptive and inferential statistics to investigate associations between key breast measurements, age and PMM visualisation. RESULTS: PMM visualisation was reported in 10.4% of images unilaterally (one breast, left or right only), 14.1% bilaterally (both left and right breasts) and 24.5% overall (unilateral and bilateral combined). There was little or no correlations between PMM length or width and age, breast compressed thickness or PNL. Multiple logistic regression analysis found that up to 15% of the variance in visualisation of the PMM was accounted for by the predictors overall. While some predictors provided a statistically significant contribution to the model, the contribution was small and the odds ratio for all predictors approximated 1. CONCLUSION: This research could not replicate the '30% rule', and visualisation of the PMM was determined not to be influenced by the variables investigated. The significance of the 'rule' itself must be challenged where the vast majority of images (70-85%) do not comply, and there is no requirement for repeat imaging if the 'rule' is not met. Further research should be undertaken to validate this study including analysis of diagnostic images for comparison.

Current practice in mammographic imaging of the augmented breast in Australia.

AIM: This study seeks to document the imaging series used in contemporary Australian practice for imaging the augmented breast, with a secondary focus on differences in practice and opinion between BreastScreen Australia and diagnostic imaging services. METHODS: A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and was assessable during December 2017 and January 2018. The questionnaire investigated: years of experience, facility type and location, image acquisition systems, appointment times, patients imaged per week, technique and imaging series used, use of limited compression views, rationale for variation in imaging series and the use of ultrasound. Descriptive statistics were produced for all variables with chi-squared tests used for comparisons between categorical variables. RESULTS: The most frequently used series was the eight-image Eklund ID technique 64% and 59% (submuscular) and 68% and 58% (subglandular) for BSA and diagnostic services, respectively. Eighteen different combinations of projections were reported with eight combinations common to both subglandular and submuscular imaging. The majority of participants attributed imaging series preferences to dose reduction and radiologist preference. CONCLUSION: This research has demonstrated varied approaches to the routine imaging of women with breast implants and identified the need for the establishment of dedicated evidence-based imaging protocols to ensure that regardless of which setting a woman attends that they receive standardised imaging with minimal dose and maximum breast coverage. This is a reassurance that is not applicable to current practice.

Mammography image quality and evidence based practice: Analysis of the demonstration of the inframammary angle in the digital setting.

AIM: The aim of this study is to determine the clinical rates of the demonstration of the inframammary angle (IMA) on the mediolateral oblique (MLO) view of the breast on digital mammograms and to compare the outcomes with current accreditation standards for compliance. Relationships between the IMA, age, the posterior nipple line (PNL) and compressed breast thickness will be identified and the study outcomes validated using appropriate analyses of inter-reader and inter-rater reliability and variability. Differences in left versus right data were also investigated. METHOD: A quantitative retrospective study of 2270 randomly selected paired digital mammograms performed by BreastScreen NSW was undertaken. Data was collected by direct measurement and visual analysis. Intra-class correlation analyses were used to evaluate inter- and intra-rater reliability. RESULTS: The IMA was demonstrated on 52.4% of individual and 42.6% of paired mammograms. A linear relationship was found between the posterior nipple line (PNL) and age (p-value <0.001). The PNL was predicted to increase by 0.48 mm for every one year increment in age. The odds of demonstrating the IMA reduced by 2% for every one year increase in age (p-value = 0.001); are 0.4% higher for every 1 mm increase in PNL (p-value = 0.001) and 1.6% lower for every 1 mm increase in compressed breast thickness, (p-value<0.001). There was high inter- and intra-rater reliability for the PNL while there was 100% agreement for the demonstration of the IMA. CONCLUSION: Analysis of the demonstration of the IMA indicates clinically achievable rates (42.6%) well below that required for compliance (50%-75%) to known worldwide accreditation standards for screening mammography. These standards should be aligned to the reported evidence base. Visualisation of the IMA is impacted negatively by increasing age and compressed breast thickness but positively by breast size (PNL).