Review article – Optimisation of exposure parameters for spinal curvature measurements in paediatric radiography

This review aims to identify strategies to optimise radiography practice using digital technologies, for full spine studies on paediatrics focusing particularly on methods used to diagnose and measure severity of spinal curvatures. The literature search was performed on different databases (PubMed, Google Scholar and ScienceDirect) and relevant websites (e.g., American College of Radiology and International Commission on Radiological Protection) to identify guidelines and recent studies focused on dose optimisation in paediatrics using digital technologies. Plain radiography was identified as the most accurate method. The American College of Radiology (ACR) and European Commission (EC) provided two guidelines that were identified as the most relevant to the subject. The ACR guidelines were updated in 2014; however these guidelines do not provide detailed guidance on technical exposure parameters. The EC guidelines are more complete but are dedicated to screen film systems. Other studies provided reviews on the several exposure parameters that should be included for optimisation, such as tube current, tube voltage and source-to-image distance; however, only explored few of these parameters and not all of them together. One publication explored all parameters together but this was for adults only. Due to lack of literature on exposure parameters for paediatrics, more research is required to guide and harmonise practic

The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device.

OBJECTIVE:The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis. METHODS:Measurements were made in 19 women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 67 ± 5 years, and 14 women without hyperkyphosis (thoracic kyphosis angle <50°), mean age 63 ± 6 years. Sagittal thoracic and lumbar curvature and mobility of the spine were assessed with the Spinal Mouse during neutral standing, full spinal flexion, and full spinal extension. Tests were performed by the same examiner on 2 days with a 72-hour interval. The intrarater reliability of the measurements was analyzed using the intraclass correlation coefficient, standard error of measurement and minimal detectable change. RESULTS:Intraclass correlation coefficients ranged from 0.89 to 0.99 in both groups. The standard errors of measurement ranged from 1.02° to 2.06° in the hyperkyphosis group and from 1.15° to 2.22° in the normal group. The minimal detectable change ranged from 2.85° to 5.73° in the hyperkyphosis group and from 3.20° to 6.17° in the normal group. CONCLUSIONS:Our results indicated that the Spinal Mouse has excellent intrarater reliability for the measurement of sagittal thoracic and lumbar curvature and mobility of the spine in older women

A New Educational Program to Improve Posture and Quality of Life Among Students by Means of the Feldenkrais Method and a New Program: MAP-Motion and Posture

Newborns possess a natural ability for correct body posture, but most of us lose this ability to the extent of causing damage and consequently a decline in quality of life. Damage can be manifested in pain (mainly in the back), decline in functioning, and damage to emotional aspects of life. To examine the nature of the connection between body posture and quality of life by focusing on the question of whether and how practicing the well-known Feldenkrais method or the unknown Motion and Posture (MAP) method improves quality of life and body posture. The study was conducted among 243 students. An educational program for correct posture was conducted with physical exercises derived from both the Feldenkrais method and the new MAP method. The study employed a mixed-methods approach, and the tools utilized were two questionnaires, a digital inclinometer, Visual Analog Scale (VAS), and a metric tape measure. A positive trend of improvement was found both in the participants’ quality of life and posture. The qualitative measurement found a connection between improvement in quality of life and improvement in posture. The participants in the MAP program had an advantage over the participants in the Feldenkrais program. The innovation of the present study is in presenting the importance of posture for quality of life. This study is a new construct for understanding quality of life as a synergy between emotional and physical aspects that draws on improving posture by means of the Feldenkrais and MAP methods

OPTIMAX research summer school: um projeto pedagógico para a promoção da investigação em radiologia

Porquê este projeto? Conhecimentos, aptidões, competências; desenvolvimento de competências (instrumentais, interpessoais, sistémicas); contributo para uma concepção de carácter multidimensional do estudante, preparando-o para apreender a importância da investigação, preparando-o para uma profissão de saúde; as novas soluções tecnológicas, a par da inovação e a mudança nos cuidados de saúde e dos processos de trabalho, constituem hoje os desafios do presente e do futuro para os profissionais de saúde [o desenvolvimento da tecnologia e da informática, a educação e a prática baseada na evidência (investigação), as mudanças nos processos de trabalho, o trabalho em equipa, a dimensão internacional]; a investigação e o seu impacto na profissão (desenvolvimento de conhecimentos próprios das profissões, autonomia, impacto positivo nas práticas profissionais, benefício do doente); a investigação auxilia no processo de definição dos parâmetros de uma profissão (nenhuma profissão terá um desenvolvimento sustentado sem o contributo da investigação; é através da investigação que se constitui um domínio de conhecimentos baseados na evidência que permitam as boas práticas); apostar num projeto associado à investigação, com uma base científica que contribua para uma melhor educação e prática profissional visando assegurar a credibilidade da profissão; aprendizagem centrada no estudante; adopção de metodologias de ensino que promovam a autonomia, o raciocínio, a capacidade crítica e a resolução de problemas

Measuring spinal and trunk shape using an electromagnetic sensor.

A critical component in the clinical assessment of spinal and trunk disorders is the analysis of posture. Currently the gold-standard is restricted by repeated radiation exposure and whilst alternative surface methods are available, these are limited to detection of spinal shape only. To date, no surface method has been extended to also quantify trunk shape. In order to address this, the aims of this research were 1) develop a method for measuring spinal and trunk shape using an electromagnetic system; 2) determine the validity and reliability of this method and 3) explore the optimal data processing for this method. Using a repeated measures design, data were collected on phantom models of different shapes using an electromagnetic system. This provided the three- dimensional co-ordinates from which spine and trunk angles were derived. The 6th order polynomial fit was deemed optimal for spinal shape measurements with an electromagnetic system. These measurements were highly reliable (ICC = >0.999), highly repeatable (MDC = <0.018º, SEM = <0.007º) and shown to be valid compared to a flexicurve method. The Lowess function was recommended for trunk shape measurements as it yielded good-to-excellent repeatability (ICC = 0.809-0.999), high absolute reliability (MDC = 0.18-4.0º, SEM = 0.06-0.07º) and angles derived were valid compared to a flexicurve method. This study addressed a clinical need by developing a novel method for measuring trunk shape in addition to spinal shape using a surface method which was shown to be valid and reliable. Exploration of the method’s optimal data processing techniques found the 6th order polynomial fit and Lowess function to be best for spinal shape and trunk shape measurements respectively. Additionally, whilst it is recommended that tangent lengths should not be used interchangeably, the tangent length chosen should not significantly affect measurements if used consistently. Meanwhile, the method’s non-invasive, non-ionising and low-cost features make it clinically attractive. Therefore, this research holds future prospects for the examination and monitoring of disease and treatment outcomes as well as, the understanding of many disorders, such as scoliosis. Although further research is warranted, this method has the potential for use in routine clinical practice

OPTIMAX 2014 - Radiation dose and image quality optimisation in medical imaging

Medical imaging is a powerful diagnostic tool. Consequently, the number of medical images taken has increased vastly over the past few decades. The most common medical imaging techniques use X-radiation as the primary investigative tool. The main limitation of using X-radiation is associated with the risk of developing cancers. Alongside this, technology has advanced and more centres now use CT scanners; these can incur significant radiation burdens compared with traditional X-ray imaging systems. The net effect is that the population radiation burden is rising steadily. Risk arising from X-radiation for diagnostic medical purposes needs minimising and one way to achieve this is through reducing radiation dose whilst optimising image quality. All ages are affected by risk from X-radiation however the increasing population age highlights the elderly as a new group that may require consideration. Of greatest concern are paediatric patients: firstly they are more sensitive to radiation; secondly their younger age means that the potential detriment to this group is greater. Containment of radiation exposure falls to a number of professionals within medical fields, from those who request imaging to those who produce the image. These staff are supported in their radiation protection role by engineers, physicists and technicians. It is important to realise that radiation protection is currently a major European focus of interest and minimum competence levels in radiation protection for radiographers have been defined through the integrated activities of the EU consortium called MEDRAPET. The outcomes of this project have been used by the European Federation of Radiographer Societies to describe the European Qualifications Framework levels for radiographers in radiation protection. Though variations exist between European countries radiographers and nuclear medicine technologists are normally the professional groups who are responsible for exposing screening populations and patients to X-radiation. As part of their training they learn fundamental principles of radiation protection and theoretical and practical approaches to dose minimisation. However dose minimisation is complex – it is not simply about reducing X-radiation without taking into account major contextual factors. These factors relate to the real world of clinical imaging and include the need to measure clinical image quality and lesion visibility when applying X-radiation dose reduction strategies. This requires the use of validated psychological and physics techniques to measure clinical image quality and lesion perceptibility

Optimising image quality for medical imaging

OPTIMAX 2016 was held at the University of Salford in Greater Manchester. It is the fourth summer school of OPTIMAX with other renditions having been organized at the University of Salford (2013), ESTeSL, Lisbon (2014) and Hanze UAS, Groningen (2015). For OPTIMAX 2016, 72 people participated from eleven countries, comprising PhD, MSc and BSc students as well as tutors from the seven European partner universities. Professional mix was drawn from engineering, medical physics/ physics and radiography. OPTIMAX 2016 was partly funded by the partner universities and partly by the participants. Two students from South Africa and two from Brazil were invited by Hanze UAS (Groningen) and ESTeSL (Lisbon). One student from the United Kingdom was funded by the Nuffield Foundation. The summer school included lectures and group projects in which experimental research was conducted in five teams. Each team project focus varied and included: optimization of full spine curvature radiography in paediatrics; ultrasound assessment of muscle thickness and muscle cross-sectional area: a reliability study; the Influence of Source-to-Image Distance on Effective Dose and Image Quality for Mobile Chest X-rays; Impact of the anode heel effect on image quality and effective dose for AP Pelvis: A pilot study; and the impact of pitch values on Image Quality and radiation dose in an abdominal adult phantom using CT. OPTIMAX 2016 culminated in a poster session and a conference, in which the research teams presented their posters and oral presentations. This book comprises of two sections, the first four chapters concern generic background information which has value to summer school organization and also theory on which the research projects were built. The second section contains the research papers in written format. The research papers have been accepted for the ECR conference, Vienna, 2017 as either oral presentations or posters

Optimax 2016 : peer observation of facilitation

In August 2016, a 3-week research Summer School was delivered at University of Salford. The Summer School, known as ‘OPTIMAX’ was in its fourth year of delivery. Previous iterations were held in the Netherlands (2015), Portugal (2014) and Salford (2013). The purpose of OPTIMAX is to facilitate collaborative international and interdisciplinary research between university academics and students. This offers an exceptional opportunity not only for students, but also for tutors who want to develop their facilitation skills. The project reported here used tutor observers (i.e. tutors who attend the summer school, in an observational capacity only, to develop their own skills as teachers) to observe, identify and reflect on a range of facilitation practices for managing the diverse OPTIMAX research groups. The project presents a description of the peer-observation method we used and highlights a number of findings related to facilitator strategies that appeared to influence group dynamics and learning. These observations are then used to make recommendations about how OPTIMAX tutors can be prepared for their facilitation experience