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.

Evaluating the knowledge and training of forensic pathologists and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa.

Background: Forensic radiography is an important component in forensic sciences. There seems to be a lack of recent studies in the literature on the knowledge and training of forensic pathologists and registrars performing forensic radiography at forensic pathology mortuaries in South Africa. Aim: To evaluate the knowledge and training of forensic pathologists (consultants) and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa. Setting: A prospective study was conducted at a conveniently selected forensic pathology mortuary located in the Free State province of South Africa. Method: Personnel performing forensic radiography at the selected mortuary were invited to participate in the study. An exploratory quantitative study design was used. The research tool was a self-administered questionnaire comprising open- and closed-ended questions. Four registrars and four consultants (n = 8) completed the questionnaire. Results: Training was only received on computed tomography (n = 1; 12.5%), the C-arm machine (n = 1; 12.5%) and the digital X-ray mobile machine (n = 1; 12.5%) Lodox on corpse positioning (n = 7; 87.5%) and setting of exposure factors (n = 2; 25%). Conclusion: Lack of training of the personnel performing forensic radiography, at the selected mortuary was identified. Training is required in image acquisition protocols, quality control tests of the X-ray machines, setting technical factors and operation of various X-ray machines. Contribution: Training of registered radiation workers who perform forensic radiography in mortuaries is essential to produce high-quality ionising radiation images and ensure their own and other staff members' safety.

Establishing ionising radiation safety culture during interventional cardiovascular procedures.

INTRODUCTION: The safety culture of an interventional laboratory was investigated in terms of the application of the three cardinal principles of radiation protection, namely distance, time and shielding. METHODS: The application of these principles was observed and recorded with a radiation safety-culture checklist that was compiled by consulting international recommendations. The checklist evaluated the optimal compliance, especially with reference to monitoring of staff exposure, distance from the X-ray source, fluoroscopy techniques pertaining to frame rate, protective devices and personal shielding. The effective radiation dose was measured to the eyes, thyroid, hands and feet of the cardiologist, nurse, floor nurse and radiographer by means of finger dosimeters that were readily available from the local radiation-protection dosimetry service. RESULTS: The results, after observing 11 procedures, indicated the absence of table and ceiling-suspended shields, and the distance of the cardiologist's and scrub nurse's feet from the X-ray tube were between 16 and 68 cm, with a mean distance of 59.7 and 58.5 cm, respectively. Most staff (91%) wore the dosimeter inside the lead apron at the collar level without eye protection. The highest dosimeter values recorded were 0.73 mSv to the hand of the cardiologist, 0.45 mSv to the eye of the cardiologist, 0.65 mSv to the hand of the scrub nurse, 0.54 mSv to the eye of the scrub nurse and 0.52 mSv to the foot of the scrub nurse. The dosimeter value to the radiographer's thyroid was 0.42 mSv. CONCLUSIONS: The dosimeter readings confirmed the highest doses were to the scrub nurse and hand of the interventionalist. The safety culture was non-compliant in terms of staff distance being too close to the X-ray tube, the absence of ceiling and table screens, the theatre door not always being completely closed, and for staff without lead eye glasses, wearing dosimeters outside the lead apron at the collar level.

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.

Design-based research for the development of a flexible learning environment.

BACKGROUND: Students enrolled for the Bachelor of Radiography degree at the Central University of Technology Free State in Bloemfontein, South Africa, spent many weeks off campus at hospitals during workplace learning. A design-based research approach was applied to analyse an educational problem, namely that students apparently fail to apply the theory of radiation safety regulations to protect themselves and patients. AIMS: The purpose of the study was to develop authentic activities and assessment for radiation safety requirements, to provide flexible learning in a blended environment to students off campus. SETTING: The second-year radiography students of 2016 and 2017 responded off campus to the QuestionPro survey. METHOD: Authentic learning and assessment opportunities were contextualised and compiled to align with learning outcomes of the safety regulations as confirmed during a Delphi process. Flexible learning opportunities were delivered via electronic mail (email) and WhatsApp. Assessment responses from the students were received via mobile phones with a Web-based software tool, QuestionPro. RESULTS: Of the 117 students, 92.3% responded to the QuestionPro survey. From the incorrect responses, learning areas that needed revision were identified, as well as the areas in the X-ray departments of the hospitals showing non-compliance with the requirements for radiation safety. CONCLUSION: The three outcomes of this design-based research included the formulation of design principles, a designed product in the form of a Website and professional development of the researcher. The design-based research principles that were tested involved the use of knowledge in real life and measuring if students were effective performers with acquired knowledge.

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

Design-based research for the development of a flexible learning environment

Background: Students enrolled for the Bachelor of Radiography degree at the Central University of Technology Free State in Bloemfontein, South Africa, spent many weeks off campus at hospitals during workplace learning. A design-based research approach was applied to analyse an educational problem, namely that students apparently fail to apply the theory of radiation safety regulations to protect themselves and patients. Aims: The purpose of the study was to develop authentic activities and assessment for radiation safety requirements, to provide flexible learning in a blended environment to students off campus. Setting: The second-year radiography students of 2016 and 2017 responded off campus to the QuestionPro survey. Method: Authentic learning and assessment opportunities were contextualised and compiled to align with learning outcomes of the safety regulations as confirmed during a Delphi process. Flexible learning opportunities were delivered via electronic mail (email) and WhatsApp. Assessment responses from the students were received via mobile phones with a Web-based software tool, QuestionPro. Results: Of the 117 students, 92.3% responded to the QuestionPro survey. From the incorrect responses, learning areas that needed revision were identified, as well as the areas in the X-ray departments of the hospitals showing non-compliance with the requirements for radiation safety. Conclusion: The three outcomes of this design-based research included the formulation of design principles, a designed product in the form of a Website and professional development of the researcher. The design-based research principles that were tested involved the use of knowledge in real life and measuring if students were effective performers with acquired knowledge

Neonatal chest image quality addressed through training to enhance radiographer awareness.

BACKGROUND: Diagnostic radiographers working in the neonatal intensive care unit primarily aim to produce an image of optimal quality using optimal exposure techniques without repeating exposures, to keep neonatal radiation dose to a minimum. OBJECTIVES: The aim of the study was to determine whether radiographers were producing optimal quality chest images and, if not, whether additional training could contribute to reaching this goal in the Free State Province of South Africa. METHODS: Neonatal chest image quality was determined in the Neonatal Intensive Care Unit by using a checklist based on and compiled from published guidelines to evaluate the quality of 450 randomly-selected images. Thereafter, a training programme was designed, based on the evaluation criteria of the checklist and image quality areas identified. The training also referred to positioning techniques that should be applied to ensure optimal image quality. After presentation of the training, 450 newly-produced neonatal chest images were evaluated. These images were selected through purposive sampling as this evaluation only included images of participating radiographers who completed the training. RESULTS: Image quality that showed significant improvement included a reduction in electrocardiogram lines superimposed on chest anatomy, a tendency to centre closer to thoracic vertebra four, and visible four-sided collimation on images. Image quality areas with no significant enhancement were the absence of lead markers and radiation shielding. CONCLUSION: The study has shown that a training programme has the potential to improve neonatal chest image quality.

The application of polymethylene waxes as conditioning agent in hair relaxers.

Hair relaxers are harsh chemical treatments that leave the hair dull, dry and limp. There is a constant need for improvement of these products to make them milder and incorporate conditioning properties. Because of the high pH of relaxer or hair straightening systems, most quaternized (conditioning) ingredients are unstable and slowly break down to release ammonia over time, having no conditioning effects by the time the consumers use them. This paper discusses the partial substitution of the fatty alcohols that are traditionally used in relaxer systems with polymethylene wax and the benefits derived from using them. The study included the investigation of synergies among the ingredients, the stabilities of the various systems and comparisons with commercially available systems. The polymethylene wax, used in combination with the mineral oil gel and phosphate salt, coats the hair during the relaxing process, leaving it shiny, soft and conditioned as opposed to the poor condition of the hair relaxed by traditional, commercially available NaOH and LiOH relaxers. An additional benefit of using polymethylene wax in relaxer systems is that the conditioning agents that are normally added to the neutralizing shampoo to repair or mask the damage as a result of the relaxing process can be omitted.