Exploring end of life care provision during medical imaging in hospitals: Analysis of survey data from the UK radiography workforce.

INTRODUCTION: Patients receiving end-of-life care often undergo medical imaging examinations in hospitals to inform symptom management and care. Yet little is known about the experiences of the radiography workforce who deliver it. This study aims to describe and explore experiences of the UK radiography workforce delivering medical imaging as part of patients' end-of-life care. METHODS: A mixed method cross-sectional online survey disseminated via social media and national organisations from September 2023 to January 2024. Diagnostic radiographers, assistant practitioners and radiology assistants involved in the medical imaging of patients receiving end-of-life care in UK hospitals. RESULTS: 120 valid responses were received. Most respondents received no education/training (91.6%) on the role of medical imaging in end-of-life care, despite 87.7% expressing a need for education, particularly around adopting supportive/palliative-centric communication techniques. Although most respondents (89.2%) had heard of end-of-life care, some had difficulty understanding the role of medical imaging in end-of-life care. Insufficient information provided on imaging requests hindered the workforces' ability to determine and understand the appropriate use of medical imaging during end-of-life care. These uncertainties exacerbated negative emotions, with 80.8% of respondents indicating that they felt emotional during or after imaging patients on end-of-life care. CONCLUSION: Educational and policy needs were identified around facilitating more supportive/palliative-centric communication techniques and providing the radiography workforce with the knowledge to better understand, explain, deliver and where necessary, challenge the use of medical imaging in end-of-life care. IMPLICATIONS FOR PRACTICE: This study has evidenced the important role the radiography workforce play in generalist end-of-life care. However, there is a need for training to support practitioners as well as appropriate policies to develop supportive and high-quality end-of-life care in medical imaging.

An exploration of factors involved in the roll out of a digital application in breast services: A case study approach.

INTRODUCTION: Acceptance of new technologies in health care, by those who use them as part of their role, is challenging with confounding contextual factors surrounding the acceptance of technology. As healthcare is rapidly digitising, stakeholder groups should be included in each stage of evaluation and implementation to allow opportunities to influence and contribute to digital health policies. This research employed a case study methodology to initiate an exploration into the factors associated with implementing a digital application into a mammography service. It examined the initial implementation and subsequent impact of the rollout of a digital application (VA) within a breast service in South Australia. METHODS: Stakeholders' opinions on team performance and feedback mechanisms of the digital application were evaluated through a staff questionnaire distributed through an online survey JISC. RESULTS: The incorporation of digitised technology into a service is evidently met with challenges. Although there is potential value in utelising automated feedback for workflow improvement and patient services, it appears imperative to provide targeted and developmental resources for educational development and staff well-being during the implementation phase. CONCLUSION: This case study approach delves into key discussion areas and serves as the initial insight into the implementation of a digital application. It could be regarded as a foundational reference for future evaluations of digital applications. IMPLICATIONS FOR PRACTICE: Research around digital fluency within the radiography profession requires further consideration. Under-utilisation or resistance may result in missed opportunities to enhance patient experiences and care outcomes and support staff wellbeing. Therefore, continued engagement and the encouragement of user feedback during the implementation phase are crucial to demonstrate future acceptance of digital applications in clinical settings.

Understanding experiences of the radiography workforce delivering medical imaging as part of patients' end of life care: An exploratory qualitative interview study.

INTRODUCTION: People nearing the end of life often require medical imaging in hospitals to manage symptoms and care, despite this little is known about the experiences of those delivering it. The aim of this study is therefore to explore the experiences of the radiography workforce delivering medical imaging as part of patients' end-of-life care. METHOD: Qualitative design using semi-structured interviews and thematic analysis. A total of 8 participants participated in the study including registered diagnostic radiographers (n = 5), imaging assistants (n = 2) and assistant practitioners (n = 1). All have been involved in the medical imaging of patients receiving end of life care in UK hospitals. RESULTS: Findings identified an absence of end of life care policy guidance and education accessible to radiography staff, limiting their ability to provide evidenced based care for those nearing the end of life during medical imaging examinations. Findings also suggest difficulty in identifying patients receiving end of life care further hindered staffs' ability to adapt their care to provide a more person-centred approach. Lastly, the workforce felt an accumulative emotional burden following their interactions with patients nearing the end of life. CONCLUSION: There is a clear need to develop policy and education to support the radiography workforce to ensure care is appropriately identified and adapted to those nearing the end of life. Furthermore, staff support and wellbeing needs to be considered. IMPLICATIONS FOR PRACTICE: Future research is required exploring the patient perspective to understand their experiences so that the education and practice provision is driven by patient need. International exploration of end of life care in medical imaging is recommended to explore whether similar challenges related to clinical practice exist in other countries.

Assessing the impact of binaural and non-binaural auditory beat intervention to pain and compression in mammography.

INTRODUCTION: Pain and discomfort has a negative impact on a patient's overall experience and may impact on subsequent re-attendance to mammography. Pain during mammography remains a significant issue. Assessment of interventions to reduce levels of pain associated with mammography are essential to increase attendance to breast services and improve user experience. METHODS: Participants (n = 60) were invited to take part in the study at one hospital Trust within the UK. Postal invitations were sent 2 weeks prior to appointment to patients older than 40 years with previous mammography attendance at the same Trust to allow for comparison of previous and current pain scores/compression values. Patients were randomised into 3 groups: Binaural music (BM), non-binaural music (NBM) and standard care (C). A numerical rating scale (NRS) was used to rate pain. RESULTS: Patient tolerance is increased by the application of both the non-binaural and binaural music. Binaural music was most effective in improving patient tolerance (p = 0.02). When applied compression increased some patients recorded less pain, which may have implications to image quality and radiation dose for patients. Binaural music reduces the perception of mammographic pain within this data set. CONCLUSION: 5 min exposure to binaural music improves patient experience and tolerance for mammography which could be utilised to improve attendance rates in screening and symptomatic services. IMPLICATIONS FOR PRACTICE: There is an indication for further research looking at application prior and during interventional biopsies. Music intervention can be offered to patients in the severe pain category who refuse mammography. It is acknowledged from these findings that the introduction of BM and NBM prior to mammography would be a low risk, cost effective intervention within the hospital setting.

The diagnostic value and accuracy of ultrasound in diagnosing hydatidiform mole: A systematic review and meta-analysis of the literature.

INTRODUCTION: Hydatidiform moles are the most common type of gestational trophoblastic disease. Internationally the incidence of hydatidiform moles is 1-2:1000 pregnancies. Early detection of women with hydatidiform moles is preferential, as these women are at a higher risk of developing other gestational trophoblastic disease. Despite Ultrasound being the most common modality used to diagnose hydatidiform moles, its diagnostic value and accuracy throughout all trimesters remains uncertain. Thus, the aim of this review was to explore and evaluate the diagnostic value and accuracy of Ultrasound in diagnosing hydatidiform mole throughout all trimesters of pregnancy. METHODS: The databases MEDLINE and CINAHL were searched between 2004 and 2021. Included studies were quality assessed using the Mixed Methods Appraisal Tool. RESULTS: A total of 8 studies were included. The narrative synthesis identified four themes: Misdiagnosis, Complete and Partial molar pregnancy, Operator dependency and Gestational age. The meta-analysis highlighted although the sensitivity of ultrasound for diagnosing hydatidiform moles is relatively low at 52.2%, the specificity was high at 92.6%. CONCLUSION: While histological examination remains the gold standard for detecting hydatidiform moles, our review made evident that ultrasound is a beneficial diagnostic tool in the detection of Hydatidiform moles, especially alongside other diagnostic investigations. This review has highlighted and collated the main barriers and facilitators to diagnosing hydatidiform moles using ultrasound. IMPLICATION FOR PRACTICE: Findings suggest that although sonographic detection of hydatidiform moles remains a diagnostic challenge, seeking a second opinion or repeating scans before making a final diagnosis should be embedded into clinical practice.

A JAFROC study of nodule detection performance in CT images of a thorax acquired during PET/CT.

PURPOSE: Two types of CT images (modalities) are acquired in PET/CT: for attenuation correction (AC) and diagnosis. The purpose of the study was to compare nodule detection and localization performance between these two modalities. METHODS: CT images, using both modalities, of an anthropomorphic chest phantom containing zero or more simulated spherical nodules of 5, 8, 10 and 12 mm diameters and contrasts -800, -630 and 100 HU were acquired. An observer performance study using nine observers interpreting 45 normal (zero nodules) images and 47 abnormal images (1-3 nodules; average 1.26) was conducted using the free-response receiver operating characteristic (FROC) paradigm. Data were analysed using an R software package implemented jackknife alternative FROC (JAFROC) analysis. Both empirical areas under the equally weighted AFROC curve (wAFROC) and under the highest rating inferred ROC (HR-ROC) curve were used as figures of merit (FOM). To control the probability of Type I error test alpha was set at 0.05. RESULTS: Nodule detection as measured by either FOM was significantly better on the diagnostic quality images (2nd modality), irrespective of the method of analysis, [reader averaged inter-modality wAFROC FOM difference = -0.07 (-0.11,-0.04); reader averaged inter-modality HR-ROC FOM difference = -0.05 (-0.09, -0.01)]. CONCLUSION: Nodule detection was statistically worse on images acquired for AC; suggesting that images acquired for AC should not be used to evaluate pulmonary pathology.

Analysis of effective and organ dose estimation in CT when using mA modulation: A single scanner pilot study.

INTRODUCTION: Effective dose (ED) estimation in CT examinations can be obtained by combining dose length product (DLP) with published ED per DLP coefficients or performed using software. These methods do not account for tube current (mA) modulation which is influenced by patient size. The aim of the work was to compare different methods of organ and ED estimation to measured values when using mA modulation in CT chest, abdomen and pelvis examinations. METHOD: Organ doses from CT of the chest, abdomen and pelvis were measured using digital dosimeters and a dosimetry phantom. ED was calculated. Six methods of estimating ED accounting for mA modulation were performed using ImPACT CTDosimetry and Dose Length Product to ED coefficients. Corrections for the phantom mass were applied resulting in 12 estimation methods. Estimated organ doses from ImPACT CTDosimtery were compared to measured values. RESULTS: Calculated EDs were; chest 12.35 mSv (±1.48 mSv); abdomen 8.74 mSv (±1.36 mSv) and pelvis 4.68 mSv (±0.75 mSv). There was over estimation in all three anatomical regions. Correcting for phantom mass improved agreement between measured and estimated ED. Organ doses showed overestimation of dose inside the scan range and underestimation outside the scan range. CONCLUSION: Reasonable estimation of effective dose for CT of the chest and abdomen can be obtained using ImPACT CTDosimetry software or k-coefficients. Further work is required to improve the accuracy of ED estimation from CT of the pelvis. Accuracy of organ dose estimation has been shown to depend on the inclusion or exclusion of the organ from the scan range.

Effect of reconstruction methods and x-ray tube current-time product on nodule detection in an anthropomorphic thorax phantom: A crossed-modality JAFROC observer study.

PURPOSE: To evaluate nodule detection in an anthropomorphic chest phantom in computed tomography (CT) images reconstructed with adaptive iterative dose reduction 3D (AIDR(3D)) and filtered back projection (FBP) over a range of tube current-time product (mAs). METHODS: Two phantoms were used in this study: (i) an anthropomorphic chest phantom was loaded with spherical simulated nodules of 5, 8, 10, and 12 mm in diameter and +100, -630, and -800 Hounsfield units electron density; this would generate CT images for the observer study; (ii) a whole-body dosimetry verification phantom was used to ultimately estimate effective dose and risk according to the model of the BEIR VII committee. Both phantoms were scanned over a mAs range (10, 20, 30, and 40), while all other acquisition parameters remained constant. Images were reconstructed with both AIDR(3D) and FBP. For the observer study, 34 normal cases (no nodules) and 34 abnormal cases (containing 1-3 nodules, mean 1.35 ± 0.54) were chosen. Eleven observers evaluated images from all mAs and reconstruction methods under the free-response paradigm. A crossed-modality jackknife alternative free-response operating characteristic (JAFROC) analysis method was developed for data analysis, averaging data over the two factors influencing nodule detection in this study: mAs and image reconstruction (AIDR(3D) or FBP). A Bonferroni correction was applied and the threshold for declaring significance was set at 0.025 to maintain the overall probability of Type I error at α = 0.05. Contrast-to-noise (CNR) was also measured for all nodules and evaluated by a linear least squares analysis. RESULTS: For random-reader fixed-case crossed-modality JAFROC analysis, there was no significant difference in nodule detection between AIDR(3D) and FBP when data were averaged over mAs [F(1, 10) = 0.08, p = 0.789]. However, when data were averaged over reconstruction methods, a significant difference was seen between multiple pairs of mAs settings [F(3, 30) = 15.96, p < 0.001]. Measurements of effective dose and effective risk showed the expected linear dependence on mAs. Nodule CNR was statistically higher for simulated nodules on images reconstructed with AIDR(3D) (p < 0.001). CONCLUSIONS: No significant difference in nodule detection performance was demonstrated between images reconstructed with FBP and AIDR(3D). mAs was found to influence nodule detection, though further work is required for dose optimization.

Comparison of effective dose and lifetime risk of cancer incidence of CT attenuation correction acquisitions and radiopharmaceutical administration for myocardial perfusion imaging.

OBJECTIVE: To measure the organ dose and calculate effective dose from CT attenuation correction (CTAC) acquisitions from four commonly used gamma camera single photon emission CT/CT systems. METHODS: CTAC dosimetry data was collected using thermoluminescent dosemeters on GE Healthcare's Infinia™ Hawkeye™ (GE Healthcare, Buckinghamshire, UK) four- and single-slice systems, Siemens Symbia™ T6 (Siemens Healthcare, Erlangen, Germany) and the Philips Precedence (Philips Healthcare, Amsterdam, Netherlands). Organ and effective dose from the administration of (99m)Tc-tetrofosmin and (99m)Tc-sestamibi were calculated using International Commission of Radiological Protection reports 80 and 106. Using these data, the lifetime biological risk was calculated. RESULTS: The Siemens Symbia gave the lowest CTAC dose (1.8 mSv) followed by the GE Infinia Hawkeye single-slice (1.9 mSv), GE Infinia Hawkeye four-slice (2.5 mSv) and Philips Precedence v. 3.0. Doses were significantly lower than the calculated doses from radiopharmaceutical administration (11 and 14 mSv for (99m)Tc-tetrofosmin and (99m)Tc-sestamibi, respectively). Overall lifetime biological risks were lower, which suggests that using CTAC data posed minimal risk to the patient. Comparison of data for breast tissue demonstrated a higher risk than that from the radiopharmaceutical administration. CONCLUSION: CTAC doses were confirmed to be much lower than those from radiopharmaceutical administration. The localized nature of the CTAC exposure compared to the radiopharmaceutical biological distribution indicated dose and risk to the breast to be higher. ADVANCES IN KNOWLEDGE: This research proved that CTAC is a comparatively low-dose acquisition. However, it has been shown that there is increased risk for breast tissue especially in the younger patients. As per legislation, justification is required and CTAC should only be used in situations that demonstrate sufficient net benefit.

Pressure and breast thickness in mammography--an exploratory calibration study.

OBJECTIVE: To perform a calibration study to provide data to help improve consistency in the pressure that is applied during mammography. METHODS: Automatic readouts of breast thickness accuracy vary between mammography machines; therefore, one machine was selected for calibration. 250 randomly selected patients were invited to participate; 235 agreed, and 940 compression data sets were recorded (breast thickness, breast density and pressure). Pressure (measured in decanewtons) was increased from 5 daN through 1-daN intervals until the practitioner felt that the pressure was appropriate for imaging; at each pressure increment, breast thickness was recorded. RESULTS: Graphs were generated and equations derived; second-order polynomial trend lines were applied using the method of least squares. No difference existed between breast densities, but a difference did exist between "small" (15×29 cm) and "medium/large" (18×24/24×30 cm) paddles. Accordingly, data were combined. Graphs show changes in thickness from 5-daN pressure for craniocaudal and mediolateral oblique views for the small and medium/large paddles combined. Graphs were colour coded into three segments indicating high, intermediate and low gradients [≤-2 (light grey); -1.99 to -1 (mid-grey); and ≥-0.99 (dark grey)]. We propose that 13 daN could be an appropriate termination pressure on this mammography machine. CONCLUSION: Using patient compression data we have calibrated a mammography machine to determine its breast compression characteristics. This calibration data could be used to guide practice to minimise pressure variations between practitioners, thereby improving patient experience and reducing potential variation in image quality. ADVANCES IN KNOWLEDGE: For the first time, pressure-thickness graphs are now available to help guide mammographers in the application of pressure.

ROCView: prototype software for data collection in jackknife alternative free-response receiver operating characteristic analysis.

ROCView has been developed as an image display and response capture (IDRC) solution to image display and consistent recording of reader responses in relation to the free-response receiver operating characteristic paradigm. A web-based solution to IDRC for observer response studies allows observations to be completed from any location, assuming that display performance and viewing conditions are consistent with the study being completed. The simplistic functionality of the software allows observations to be completed without supervision. ROCView can display images from multiple modalities, in a randomised order if required. Following registration, observers are prompted to begin their image evaluation. All data are recorded via mouse clicks, one to localise (mark) and one to score confidence (rate) using either an ordinal or continuous rating scale. Up to nine "mark-rating" pairs can be made per image. Unmarked images are given a default score of zero. Upon completion of the study, both true-positive and false-positive reports can be downloaded and adapted for analysis. ROCView has the potential to be a useful tool in the assessment of modality performance difference for a range of imaging methods.