FACTORS INFLUENCING SIZE-SPECIFIC DOSE ESTIMATES OF SELECTED COMPUTED TOMOGRAPHY PROTOCOLS AT TWO CLINICAL PRACTICES IN SOUTH AFRICA.

The study aimed to determine the factors that impact the size-specific dose estimate (SSDE) for computed tomography (CT) examinations of the chest-abdomen-pelvis and abdomen-pelvis protocols in two clinical radiology practices and evaluate the image quality of these protocols. Imaging parameters, protocols, dose metrics from the CT units and size-related parameters to calculate the SSDE were documented. The image quality of the CT images was assessed using an image subtraction algorithm. The SSDE increased as the volumetric CT dose index (CTDIvol), and the patient's body mass index increased, respectively. Significant differences (p < 0.001) occurred between the two hospitals regarding image quality. However, these differences were not indicative of differences in the diagnostic performances for task-based imaging protocols. Different clinical protocols should be reviewed to optimise dose. The inclusion of the pre-monitoring sequence, age of the machine and the scan requisition parameters impacted the SSDEs. Image quality should be assessed to evaluate the consistency of image quality between protocols applied by different CT units when assessing SSDEs.

A radiographic criteria checklist to determine reasons for errors, resulting in sub-optimal routine shoulder projections.

BACKGROUND: Optimal shoulder images must adhere to specific radiographic criteria before they are sent to the radiologist for reporting. Repeat x-rays of the shoulder may increase radiation exposure to the patient. AIM: The aims of this study were to determine whether images adhered to the required radiographic criteria for routine shoulder imaging and to identify possible reasons for non-adherence. SETTING: The study was conducted at an imaging department at a tertiary academic hospital in Bloemfontein, South Africa. METHODS: A criteria checklist compiled from literature was used to evaluate 578 routine shoulder images including anteroposterior (AP) with external rotation and lateral-Y (LAT-Y) projections. The checklist determined whether the shoulder images adhered to the criteria with regard to the anatomy included, positioning and technical factors, such as inclusion of the correct anatomical lead marker. Data were analysed using SAS Version 9.2 statistical software. RESULTS: More than 80% of the AP external rotation images included unnecessary anatomical structures owing to incorrect centring. In four out of seven criteria pertaining to positioning for AP external rotation imaging, at least 70% of images were performed incorrectly. Four-sided collimation was not present in more than 50% of both AP external rotation and LAT-Y images because of incorrect centring, while more than 30% of shoulder images presented with anatomical digital markers. CONCLUSION: The application of criteria required for shoulder imaging must be addressed at the participating imaging department to improve overall patient care. An in-service training session is recommended to enhance the radiographic technique with regard to routine shoulder projections.

The use of clickers to evaluate radiographer's knowledge of shoulder images.

BACKGROUND: Conducting research can be daunting, although applicable methods can facilitate the process. A study was performed at an imaging department pertaining to the routine shoulder projections, namely the anteroposterior (AP) external rotation and lateral-Y (LAT-Y) projections. AIM: The aim of the study was to determine if radiographers (qualified, supplementary, community service) and student radiographers (second-year diploma, third-year diploma, second-year bachelor) use the radiographic evaluation criteria to evaluate the routine shoulder projections. SETTING: The study was conducted at an imaging department in the Free State province, South Africa. METHODS: Participants had to complete a survey by means of a questionnaire that was compiled in Microsoft Excel and converted to an audience response system known as clickers. The questions addressed aspects of shoulder imaging with regard to positioning, exposure factors and the evaluation of routine shoulder projections. The data were analysed separately using statistics software SAS Version 9.2. Fisher's exact test was used to determine statistically significant differences between students and radiographers. RESULTS: More than 80% of students selected the AP (external rotation) X-ray image demonstrating optimal milliamperage per second whereas 43% of radiographers selected the correct image. More than 50% of radiographers and students indicated that a breathing technique and a short exposure time reduce motion during shoulder imaging. CONCLUSION: Using clickers eased the process of testing the participants' knowledge, and the results were available immediately after completion of the test. Clickers can contribute to and expedite the process of data analysis.

A radiographic criteria checklist to determine reasons for errors, resulting in sub-optimal routine shoulder projections

Background: Optimal shoulder images must adhere to specific radiographic criteria before they are sent to the radiologist for reporting. Repeat x-rays of the shoulder may increase radiation exposure to the patient. Aim: The aims of this study were to determine whether images adhered to the required radiographic criteria for routine shoulder imaging and to identify possible reasons for non-adherence. Setting: The study was conducted at an imaging department at a tertiary academic hospital in Bloemfontein, South Africa. Methods: A criteria checklist compiled from literature was used to evaluate 578 routine shoulder images including anteroposterior (AP) with external rotation and lateral-Y (LAT-Y) projections. The checklist determined whether the shoulder images adhered to the criteria with regard to the anatomy included, positioning and technical factors, such as inclusion of the correct anatomical lead marker. Data were analysed using SAS Version 9.2 statistical software. Results: More than 80% of the AP external rotation images included unnecessary anatomical structures owing to incorrect centring. In four out of seven criteria pertaining to positioning for AP external rotation imaging, at least 70% of images were performed incorrectly. Four-sided collimation was not present in more than 50% of both AP external rotation and LAT-Y images because of incorrect centring, while more than 30% of shoulder images presented with anatomical digital markers. Conclusion: The application of criteria required for shoulder imaging must be addressed at the participating imaging department to improve overall patient care. An in-service training session is recommended to enhance the radiographic technique with regard to routine shoulder projections

The use of clickers to evaluate radiographer's knowledge of shoulder images

Background: Conducting research can be daunting, although applicable methods can facilitate the process. A study was performed at an imaging department pertaining to the routine shoulder projections, namely the anteroposterior (AP) external rotation and lateral-Y (LAT-Y) projections. Aim: The aim of the study was to determine if radiographers (qualified, supplementary, community service) and student radiographers (second-year diploma, third-year diploma, second-year bachelor) use the radiographic evaluation criteria to evaluate the routine shoulder projections. Setting: The study was conducted at an imaging department in the Free State province, SouthAfrica. Methods: Participants had to complete a survey by means of a questionnaire that was compiled in Microsoft Excel and converted to an audience response system known as clickers. The questions addressed aspects of shoulder imaging with regard to positioning, exposure factors and the evaluation of routine shoulder projections. The data were analysed separately using statistics software SAS Version 9.2. Fisher's exact test was used to determine statistically significant differences between students and radiographers. Results: More than 80% of students selected the AP (external rotation) X-ray image demonstrating optimal milliamperage per second whereas 43% of radiographers selected the correct image. More than 50% of radiographers and students indicated that a breathing technique and a short exposure time reduce motion during shoulder imaging. Conclusion: Using clickers eased the process of testing the participants' knowledge, and the results were available immediately after completion of the test. Clickers can contribute to and expedite the process of data analysis