Secrets of success:the development of obstetric ultrasound in Scotland, 1963-1990

Abstract available: p.i

Barriers to Research Utilisation amongst Diagnostic Radiographers in the UK

Introduction: Lack of research uptake and utilisation compared to other Allied Health Professions prompted the publications of four consecutive research strategies by the Society and College of Radiographers in attempts to bridge the gap. Aims: The aim of this study was to find out perceived barriers to research utilisation amongst diagnostic radiographers in the UK. Methods: A descriptive cross-sectional survey was conducted in 2016. A random sample was used to select 1,080 radiographers who were sent a link to the web-based questionnaire. Results: The response rate was 72.8%. Most radiographers were Band 6 (n=296, 47.0%) holders. The commonly identified perceived barriers to research utilisation included lack of time for research-related activities, how to develop research questions, find relevant literature and lack of authority to change practice. It was found that 142(50.7%) of BSc and 26(44.0%) of MSc had difficulty in finding relevant literature. Interestingly, 20(40%) of the Band 8 radiographers perceived themselves to lack the authority to change practice. In the area of practice category, sonographers (n=35, 57.4%) were more likely to perceive themselves to lack authority in changing their practice. While there was a positive attitude to research utilisation, 198(31.4%) held the view that research was not in their scope of practice. A further 127(20.2%) felt radiologists and physicists should review research that were relevant to their practice. It emerged that highest educational qualification was associated with a higher probability of knowledge of research skills and attitude to research utilisation. Conclusions: The study concludes that dissemination mechanisms to facilitate research utilisation are lacking. Radiology service managers and the Society and College of Radiographers have key roles to play in research utilisation in terms of time allocation and training in research skills

Establishing an evidence-base for erect pelvis radiography : positioning, radiation dose and image quality

Purpose: Pelvic radiography using X-ray imaging has traditionally been used for the identification of hip joint changes, including the identification of pathologies such as osteoarthritis. For patients suffering from hip pain, the supine pelvis X-ray examination is one of the initial diagnostic steps. Despite this, many recent studies have recommended that the position should now be undertaken erect and not supine to reflect the functional appearances of the hip joint. This thesis aims to establish an evidence base for erect pelvis radiography, and it will include assessing radiographic positioning, radiation dose and image quality. Methods: The experimental work described in this thesis was conducted in three phases. Each phase has its own methods with the purpose of achieving a specific set of aims. Phase One was the evaluation of the postural effects of different erect (standing) positions in order to recommend an optimal one for erect pelvic radiography. Eight different erect positions were investigated. A sample group of 67 healthy people participated, and a range of spinal and pelvis measurements were acquired using a 3D video rasterography system (Diers) and an inclinometer.Phase Two was a phantom study evaluating the potential changes to radiation dose and image quality when moving between supine and erect imaging. Phase two was undertaken using three experiments (experiment #1, experiment #2 and experiment #3). Experiment #1 evaluated the impact of increased patient size on the radiation dose and image quality. In this experiment, animal fat was positioned anteriorly on a pelvic anthropomorphic phantom and the thickness increased incrementally in 1cm steps from 1 to 15cm. Image quality was evaluated physically and visually. The effective dose was calculated using Monte Carlo simulation software (PCXMC). During experiment #2, the anterior thicknesses for 109 patients, with a range of BMIs, who were referred for pelvis radiography, was measured in the erect and supine position. Experiment #3 evaluated the potential differences between the positions (supine and erect) in terms of image quality and radiation dose by modelling patient thickness changes between positions using the data obtained in experiment #2. An anthropomorphic phantom was used and modified (by adding additional fat) to simulate tissue changes for both erect and supine X-ray positions. Visual grading analysis was used (VGA) to evaluate image quality. The effective dose and absorbed dose were calculated using PCXMC.During Phase Three, 60 patients were imaged in erect and supine positions. The paired pelvis X-ray images were then compared, taking into account radiation dose and image quality.Results: Phase One demonstrated no statistical differences between the eight-different standing positions for pelvic and spine metrics (P>0.05). Results also demonstrated no significant postural differences between BMIs across all eight standing positions (P>0.05). Also, no differences (P>0.05) were identified in the pelvis and spinal metrics when comparing between males and females .Standing relaxed with feet internally rotated by 20°and the upper arms supported was a recommendation derived from this phase. Results from Phase Two showed an increase in effective dose (E) as the fat thickness increased. Also, all physical and visual image quality metrics decreased as fat thickness increased. Physical and visual image quality measures also decreased for erect images when compared to supine images, and the E also increased. 90kVp, 130/145 SID, using both outer chambers, were the recommended exposure parameters settings for obtaining erect pelvis X-ray images. Results from Phase Three showed that anterior patient thickness was 17% (P<0.001) higher in an erect position .The DAP and absorbed dose were 46% and 45% (P<0.001) greater in the erect position. Also, the effective dose was 67% (P<0.001) higher in the erect position when compared with supine. In regard to the image quality (IQ), that of the erect position decreased by 10% when compared with supine (P<0.001).Conclusion: The eight proposed standing positions could theoretically be suitable for erect pelvis imaging. People in a relaxed standing position, with their feet internally rotated by 20°and their upper arms supported would be recommended. In terms of IQ and radiation dose for erect positions, this position decreases image quality (both physical and visual) and increased radiation dose. Changes were largely due to the effect of gravity on the anterior soft tissue distribution. These issues should be considered and optimised more fully when deciding if to move from supine to erect pelvis imaging

An investigation into interface pressure (ip) risk of healthy volunteers on modern medical imaging and radiotherapy tables

Background and RationalePressure ulcers (PUs) present significant threats to patients and cost billions of total healthcare expenditure. In radiography/radiotherapy, a potential for high interface pressure (IP) on radiography/radiotherapy tables may exist, however no study has investigated this to an acceptable scientific level.Thesis aimsThis thesis involved two-phases. The primary aim of phase one was to investigate whether IP risks exist on radiography/radiotherapy tables. The secondary aim was to assess the perception of pain and comfort on radiography/radiotherapy tables. The aim of phase two was to determine the impact of pressure relieving interventions on IP at jeopardy areas.Method and resultsIn the first phase, an Xsensor pressure mapping system was used to measure IP of jeopardy areas in healthy volunteers (26 females, 23 males; aged 18-59 (mean=34.6±10.5)) on three radiography/radiotherapy surfaces, after which they completed a pain and comfort questionnaire. ANOVA identified statistically significant differences in the mean IP for head, sacrum, and heels across the three surfaces (p≤0.001). Results indicated high IP values for head (75.9±6.9mmHg) on the radiotherapy table. This high IP could induce tissue breakdown, thereby increasing the risk of developing PUs in at risk populations. Volunteers experienced most pain whilst lying on the radiotherapy table. In phase two, a thin gel intervention with low radiation attenuation, which also has no impact on image quality, was assessed to reduce IP risks identified for the head. Pressure mapping was conducted on 20 healthy volunteers (14 males (70%) and six females (30%)); aged 25-53 years (mean=34.4±7.0). Paired-samples t-test indicated a statistically significant difference in the mean IP for the head with and without the intervention; both comparisons recorded mean IP values of 62.4±6.1 and 83.9±8.1 mmHg respectively, p≤0.001. Similarly, there was statistically significant difference in the PPI of the head with and without the intervention (mean=159.8±26.8, and mean=205.1±28.2mmHg respectively; p≤0.001).ConclusionIP risk exists for the head on radiotherapy tables. This could induce tissue injury in patients accessing prolonged interventional radiography and radiotherapy procedures for the head. A thin gel silicone intervention can reduce this risk. Further research is needed to assess its impact in at risk populations