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

An experimental intervention study assessing the impact of a thin silicone gel surface overlay on interface pressure

Introduction. The incidence of pressure ulcers (PUs) presents a substantial threat to patients, especially geriatric patients, those with restricted mobility, and patients suffering from chronic diseases such as cancer. PUs creates a huge financial burden on healthcare authorities and patients, costing billions to treat and manage. Radiography and radiotherapy patients may experience medical device related (MDR) PUs and studies have shown that high interface pressure (IP) values exist for the head when placed on an X-ray table without a mattress. These high IP values pose a PU risk to patients, especially those accessing prolonged radiography/radiology and radiotherapy procedures. The current study assessed the impact on IP values for the head from using a thin silicone gel surface overlay during radiographic procedures and identified whether this reduced the risk of PUs. Materials and Methods. A calibrated XSENSOR pressure mat was used to measure IP for the head on an X-ray table with and without a thin silicone gel surface overlay. Prior to pressure mapping, the silicone gel surface overlay was assessed for its impact on radiation attenuation and image quality. Results. Study participants were 14 males (70%) and six females (30%), with an age range of 25–53 years (mean = 34.4 ± 7.0). Paired-samples t-test results indicated that there was a statistically significant decrease in the mean IP for the head on the X-ray table without the silicone gel surface overlay (mean = 83.9 ± 8.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 62.4 ± 6.1 in mmHg), p ≤ 0.001 . Paired-samples t-test results indicated that there was a statistically significant decrease in the mean peak pressure index (PPI) for the head on the X-ray table without the silicone gel surface overlay (mean = 205.1 ± 28.2 in mmHg) and the X-ray table with the gel surface overlay (mean = 159.8 ± 26.8 in mmHg), p ≤ 0.001 . Conclusions. The use of a thin silicone gel surface overlay could reduce IP risk for the head by approximately 25%. The reduction in IP risk could have a significant impact in reducing the risk of developing a PU. To ensure maximum benefit, the silicone gel surface overlay should be evaluated to address the specific needs within radiography and radiotherapy planning and treatment settings

Compression force variability in mammography in Ghana – a baseline study

Introduction: Breast compression during mammographic examinations improves image quality and patient management. Several studies have been conducted to assess compression force variability among practitioners in order to establish compression guidelines. However, no such study has been conducted in Ghana. This study aims to investigate the compression force variability in mammography in Ghana. Methods: This retrospective study used data gathered from 1071 screening and diagnostic mammography patients from January, 2018–December, 2019. Data were gathered by seven radiographers at three centers. Compression force, breast thickness and practitioners' years of work experience were recorded. Compression force variability among practitioners and the correlation between compression force and breast thickness were investigated. Results: Mean compression force values recorded for craniocaudal (CC) (17.2 daN) and mediolateral oblique (MLO) (18.2 daN), were within the recommended values used by western countries. Most of the mammograms performed – 80% – were within the National Health Service Breast Screening Programme (NHSBSP) range. However, 65% were above the Norwegian Breast Cancer Screening Programme (NBCSP) range. Compression forces varied significantly (p = 0.0001) among practitioners. Compression forces increased significantly (p = 0.0001) with the years of work experience. A weak negative correlation (r = −0.144) and a weak positive correlation (r = 0.142) were established between compression force and breast thickness for CC and MLO projections respectively. Conclusion: This initial study confirmed that although wide variations in compression force exist among practitioners in Ghana, most practitioners used compression forces broadly within the range set by the NHSBSP. As no national guidelines for compression force currently exist in Ghana, provision of these may help to reduce the range of variations recorded. Implications for practice: Confirmation of variations in compression will guide future practice to minimize image quality disparities and improve quality of care