Predicting the role of touchless technologies within diagnostic radiography: Results of an international survey.

INTRODUCTION: The evolution of technology within healthcare is continuing at a rapid rate. Touchless technologies (i.e. those involving gestures and voice commands) are rapidly being integrated into daily life. The aim of this study was to investigate the potential role for such technologies within diagnostic radiography. METHODS: An online survey was developed, piloted and deployed using SurveyMonkey as part of an online radiology congress. Eligible respondents were radiographers or radiologic technologists, including students. The survey covered ten themes relating to the potential role of touchless technologies within diagnostic radiography. Results were analysed using descriptive and inferential statistics. RESULTS: 155 people completed the questionnaire. 100 (64.9%) were women and clinical experience ranged from 13.5 (0-40) years. The majority, 54 (35.1%), had a Bachelor's degree with respondents being from 23 different countries (five continents). 34 (21.9%) respondents did not personally own nor intended to purchase touchless technologies. 89 (84.8%) respondents saw themselves using touchless technologies, if available on current imaging equipment. 25 (16.0%) respondents reported that they currently have access to touchless technologies within their workplace. 88 (81.5%) and 67 (65.0%) respondents reported that they saw voice and gesture controls as being key in improving exam efficiency. CONCLUSION: Participants clearly perceived a role for touchless technologies within diagnostic radiography. Access to such technologies is not yet widely available within X-ray rooms. Voice activated technologies appear more appealing that gesture-based aids. The primary role for such technologies was defined by participants as focusing on improving examination efficiency. IMPLICATIONS FOR PRACTICE: Touchless technologies have been identified and as important and potentially useful in diagnostic radiography. Collaboration between healthcare institutions, industry and academia is required to design and successfully implement these technologies into practice.

Low-dose chest CT and the impact on nodule visibility.

INTRODUCTION: The need to continually optimise CT protocols is essential to ensure the lowest possible radiation dose for the clinical task and individual patient. The aim of this study was to explore the effect of reducing effective mAs on nodule detection and radiation dose across six scanners. METHODS: An anthropomorphic chest phantom was scanned using a low-dose chest CT protocol, with the effective mAs lowered to the lowest permissible level. All other acquisition parameters remained consistent. Images were evaluated by five radiologists to determine their sensitivity in detecting six simulated nodules within the phantom. Image noise was calculated together with DLP. RESULTS: The lowest possible mAs achievable ranged from 7 to 19 mAs. The two highest mAs setting (17 mAs + 19 mAs) had kV modulation enabled (100 kV instead of 120 kV) which consequently resulted in a higher nodule detection rate. Overall nodule detection averaged at 91% (range 80-97%). Out of a possible 180 nodules, 16 were missed, with 12 of those 16 being the same nodule. Noise was double for the Somatom Sensation scanner when compared to the others; however, this scanner did not have iterative reconstruction and it was installed over 10 years ago. There was a strong correlation between image noise and scanner age. CONCLUSION: This study highlighted that nodules can be detected at very low effective mAs (<20 mAs) but only when other acquisition parameters are optimised i.e. iterative reconstruction and kV modulation. Nodule detection rates were affected by nodule location and image noise. IMPLICATIONS FOR PRACTICE: This study consolidates previous findings on how to successfully optimise low-dose chest CT. It also highlights the difficulty with standardisation owing to factors such as scanner age and different vendor attributes.

Mobile chest imaging of neonates in incubators: Optimising DR and CR acquisitions.

INTRODUCTION: Neonates are a particularly vulnerable patient group with complex medical needs requiring frequent radiographic examinations. This study aims to compare computed radiography (CR) and direct digital radiography (DDR) portable imaging systems used to acquire chest x-rays for neonates within incubators. METHODS: An anthropomorphic neonatal chest phantom was imaged under controlled conditions using one portable machine but captured using both CR and DDR technology. Other variables explored were: image receptor position (direct and incubator tray), tube current and kV. All other parameters were kept consistent. Contrast-to-noise ratio (CNR) was measured using ImageJ software and dose-area-product (DAP) was recorded. Optimisation score was calculated by dividing CNR with the DAP for each image acquisition. RESULTS: The images with the highest CNR were those acquired using DDR direct exposures and the images with lowest CNR were those acquired using CR with the image receptor placed within the incubator tray. This is also supported by the optimisation scores which demonstrated DDR direct produced the optimal combination with regards to CNR and radiation dose. The CNR had a mean increase of 50.3% when comparing DDR direct with CR direct respectively. This was also evident when comparing DDR and CR for in-tray acquisitions, with CNR increasing by a mean of 43.5%. A mean increase of 20.4% was seen in CNR when comparing DDR tray exposures to CR direct. CONCLUSION: DDR direct produced images of highest CNR, with incubator tray reducing CNR for both CR and DDR. However, DDR tray still had better image quality compared to CR direct. IMPLICATIONS FOR PRACTICE: Where possible, DDR should be the imaging system of choice for portable examinations on neonates owing to its superior image quality at lower radiation dose.

Optimising image quality and radiation dose for neonatal incubator imaging.

INTRODUCTION: Neonates often require imaging within incubators however limited evidence exists as to the optimal method and acquisition parameters to achieve these examinations. This study aims to standardise and optimise neonatal chest radiography within incubators. METHODS: A neonatal anthropomorphic phantom was imaged on two different incubators under controlled conditions using a DR system. Exposure factors, SID and placement of image receptor (direct v tray) were explored whilst keeping all other parameters consistent. Image quality was evaluated using absolute visual grading analysis (VGA) with contrast-to-noise ratio (CNR) also calculated for comparison. Effective dose was established using Monte Carlo simulation using entrance surface dose within its calculations. RESULTS: VGA and CNR reduced significantly (p < 0.05) whilst effective dose increased significantly (p < 0.05) for images acquired using the incubator tray. The optimal combinations of parameters for incubator imaging were: image receptor directly behind neonate, 0.5 mAs, 60 kV at 100 cm SID, however, if tray needs to be used then these need to be adapted to: 1 mAs at maximum achievable SID. Effective dose was highest for images acquired using both incubator tray and 100 cm SID owing to a decrease in focus to skin distance. There is significant increase (p < 0.01) in VGA between using 0.5 mAs and 1 mAs but an apparent lack of increase between 1 and 1.5 mAs. CONCLUSION: Using the incubator tray has an adverse effect on both image quality and radiation dose for incubator imaging. Direct exposure is optimal for this type of examination but if tray needs to be used, both mAs and SID need to be increased slightly to compensate. IMPLICATIONS FOR PRACTICE: This study can help inform practice in order to both standardise and optimise chest imaging for neonates in incubators.

A systematic review of incubator-based neonatal radiography - What does the evidence say?

OBJECTIVES: This systematic review aimed to explore the impact of incubator design (canopy, mattress, and mattress support) on neonatal imaging in terms of imaging technique, radiation dose and image quality. KEY FINDINGS: A systematic literature review was performed by searching multiple healthcare databases. Following study selection and extraction, 7 articles were deemed eligible and included within the study. Of these 7 studies, six were experimental phantom based with the remaining one being a retrospective analysis. Four studies reported a percentage reduction in beam attenuation for incubator components ranging from 12% to 72% with one other study reporting a reduction but with no numerical data. This wide variation in radiation beam attenuation from the incubator components was correlated with image quality within five studies, two suggesting reduced image quality when using the incubator tray under the mattress support whilst the other three found no significant difference. Although the seven studies reported that incubator components reduced X-ray beam intensity, there was limited evidence on whether this required an increase in exposure factors. Only one study suggested increasing exposure parameters to accommodate for the increase in beam attenuation when using an incubator tray. CONCLUSION: The literature clearly demonstrates that with existing incubator designs, there is considerable beam attenuation between placing the image receptor directly behind the neonate as oppose to the incubator tray. However, this radiation beam attenuation is not well correlated to neonatal radiation dose or image quality effects and therefore is very confusing when considering clinical implementation. IMPLICATIONS FOR PRACTICE: This review highlights the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.

Imaging neonates within an incubator - A survey to determine existing working practice.

INTRODUCTION: There is limited and confusing evidence within the literature regarding the optimal techniques when imaging neonates within incubators; in particular, whether to place the image receptor directly behind the neonate or in the incubator tray. For this reason, radiology departments across Wales and North West England were surveyed to explore existing working practice with regards to incubator imaging. METHOD: A self-designed survey was developed using a systematic approach. The survey was sent to 31 radiology departments across Wales and North West England whom had a neonatal unit in order to assess existing techniques used when imaging neonates within the incubator. The survey was split into three main domains: 1) general/demographics, 2) exposure factors and technique, and 3) incubator design. RESULTS: Nineteen departments responded (64%) demonstrating a wide variation in practice for incubator imaging. The minimum and maximum exposure factors used for neonatal chest x-ray imaging varied from 55 kV to 65 kV and 0.5 mAs-2 mAs. Fifty-eight percent of departments used the incubator tray as standard practice with the remaining forty two percent not using the tray for various reasons including, image quality, artefacts and misalignment. Sixty-three percent of departments use the maximum achievable SID for incubator imaging which demonstrates wide variability as the SID would be dependent upon: incubator design, portable machine and radiographer height. CONCLUSION: The survey demonstrates a wide variation in existing practice for neonatal incubator imaging. IMPLICATIONS FOR PRACTICE: This study supports the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.

The experience of patients participating in a small randomised control trial that explored two different interventions to reduce anxiety prior to an MRI scan.

INTRODUCTION: This paper reports qualitative findings from within a larger randomised control trial where a video clip or telephone conversation with a radiographer was compared to routine appointment letter and information sheet to help alleviate anxiety prior to their MRI scan. METHODS: Questionnaires consisting of three free-text response questions were administered to all of the 74 patients recruited to the MRI anxiety clinical trial. The questionnaire was designed to establish patients' experiences of the intervention they had received. These questionnaires were administered post-scan. Two participants from each trial arm were also interviewed. A thematic approach was utilised for identifying recurrent categories emerging from the qualitative data which are supported by direct quotations. RESULTS: Participants in the interventional groups commented positively about the provision of pre-MRI scan information they received and this was contrastable with the relatively indifferent responses observed among those who received the standard information letter. Many important themes were identified including the patients needs for clear and simplified information, the experience of anticipation when waiting for the scan, and also the informally acquired information about having an MRI scan i.e. the shared experiences of friends and family. All themes highlighted the need for an inclusive and individually tailored approach to pre-scan information provision. CONCLUSION: Qualitative data collected throughout the trial is supportive of the statistical findings, where it is asserted that the use of a short video clip or a radiographer having a short conversation with patients before their scan reduces pre-scan anxiety.