Can a profession exist without research?

Radiography combines science, technology and patient care to provide an essential role in medical diagnosis and treatment. The term ‘profession’ has existed in the Oxford English Dictionary from the 15th century and argues that a profession is an occupation where professional knowledge is applied by someone who has undertaken prolonged training and obtained a formal qualification (Oxford English Dictionary Online; 2007). For most of history, professions have based their practices on expertise derived from experience passed down in the form of tradition. Even in health care, many practices have still not been justified by evidence and as such there are areas of uncertainty.peer-reviewe

Generalised Elliptic Functions

We consider multiply periodic functions, sometimes called Abelian functions, defined with respect to the period matrices associated with classes of algebraic curves. We realise them as generalisations of the Weierstras P-function using two different approaches. These functions arise naturally as solutions to some of the important equations of mathematical physics and their differential equations, addition formulae, and applications have all been recent topics of study. The first approach discussed sees the functions defined as logarithmic derivatives of the sigma-function, a modified Riemann theta-function. We can make use of known properties of the sigma function to derive power series expansions and in turn the properties mentioned above. This approach has been extended to a wide range of non hyperelliptic and higher genus curves and an overview of recent results is given. The second approach defines the functions algebraically, after first modifying the curve into its equivariant form. This approach allows the use of representation theory to derive a range of results at lower computational cost. We discuss the development of this theory for hyperelliptic curves and how it may be extended in the future.Comment: 16 page

Unmasking quality: exploring meanings of health by doing art

This paper arises from a presentation at the ‘Quality in Healthcare’ symposium at Cumberland Lodge, England, in 2013. MK, CR and SH conceived the paper and led the writing of the manuscript. JF, JL-D, AC, DE contributed substantially to the intellectual content of the paper through providing critical commentary and interpretation. All authors read and approved the final manuscript

An investigation into the validity of utilising the CDRAD 2.0 phantom for optimisation studies in digital radiography

Objectives: To determine if a relationship exists between low contrast detail (LCD) detectability using the CDRAD 2.0 phantom, visual measures of image quality (IQ) and simulated lesion visibility (LV) when performing digital chest radiography (CXR). Methods: Using a range of acquisition parameters, a CDRAD 2.0 phantom was used to acquire a set of images with different levels of image quality. LCD detectability using the CDRAD 2.0 phantom, represented by an image quality figure inverse (IQFinv) metric, was determined using the phantom analyser software. A Lungman chest phantom was loaded with two simulated lesions, of different sizes / placed in different locations, and was imaged using the same acquisition factors as the CDRAD phantom. A relative visual grading analysis (VGA) was used by seven observers for IQ and LV evaluation of the Lungman images. Correlations between IQFinv, IQ and LV were investigated. Results: Pearson’s correlation demonstrated a strong positive correlation (r=0.91; p<0.001) between the IQ and the IQFinv. Spearman’s correlation showed a good positive correlation (r=0.79; p<0.001) and (r=0.68; p<0.001) between the IQFinv and the LV for the first lesion (left upper lobe) and the second lesion (right middle lobe), respectively. Conclusions: From results presented in this study, the automated evaluation of LCD detectability using CDRAD 2.0 phantom is likely to be a suitable option for IQ and LV evaluation in digital CXR optimisation studies

Deriving bases for Abelian functions

We present a new method to explicitly define Abelian functions associated with algebraic curves, for the purpose of finding bases for the relevant vector spaces of such functions. We demonstrate the procedure with the functions associated with a trigonal curve of genus four. The main motivation for the construction of such bases is that it allows systematic methods for the derivation of the addition formulae and differential equations satisfied by the functions. We present a new 3-term 2-variable addition formulae and a complete set of differential equations to generalise the classic Weierstrass identities for the case of the trigonal curve of genus four.Comment: 35page

Construction and validation of a low cost paediatric pelvis phantom

PURPOSE: Imaging phantoms can be cost prohibitive, therefore a need exists to produce low cost alternatives which are fit for purpose. This paper describes the development and validation of a low cost paediatric pelvis phantom based on the anatomy of a 5-year-old child. METHODS: Tissue equivalent materials representing paediatric bone (Plaster of Paris; PoP) and soft tissue (Poly methyl methacrylate; PMMA) were used. PMMA was machined to match the bony anatomy identified from a CT scan of a 5-year-old child and cavities were created for infusing the PoP. Phantom validation comprised physical and visual measures. Physical included CT density comparison between a CT scan of a 5-year old child and the phantom and Signal to Noise Ratio (SNR) comparative analysis of anteroposterior phantom X-ray images against a commercial anthropomorphic phantom. Visual analysis using a psychometric image quality scale (face validity). RESULTS: CT density, the percentage difference between cortical bone, soft tissue and their equivalent tissue substitutes were -4.7 to -4.1% and -23.4%, respectively. For SNR, (mAs response) there was a strong positive correlation between the two phantoms (r>0.95 for all kVps). For kVp response, there was a strong positive correlation between 1 and 8 mAs (r=0.85), this then decreased as mAs increased (r=-0.21 at 20 mAs). Psychometric scale results produced a Cronbach’s Alpha of almost 0.8. CONCLUSIONS: Physical and visual measures suggest our low-cost phantom has suitable anatomical characteristics for X-ray imaging. Our phantom could have utility in dose and image quality optimisation studies. Keywords: Pelvis phantom, low-cost, dose optimisation, validation, development

A novel method for comparing radiation dose and image quality, between and within different X-ray units in a series of hospitals

Objectives: To develop a novel method for comparing radiation dose and image quality (IQ) to evaluate adult chest X-ray (CXR) imaging among several hospitals. Methods: CDRAD 2.0 phantom was used to acquire images in eight hospitals (17 digital X-ray units) using local adult CXR protocols. IQ was represented by image quality figure inverse (IQFinv), measured using CDRAD analyser software. Signal to noise ratio (SNR), contrast to noise ratio (CNR) and conspicuity index (CI) were calculated as additional measures of IQ. Incident air kerma (IAK) was calculated using a solid-state dosimeter for each acquisition. Figure of merit (FOM) was calculated to provide a single estimation of IQ and radiation dose. Results: IQ, radiation dose and FOM varied considerably between hospitals and X-ray units. For IQFinv, the mean (range) between and within the hospitals were 1.42 (0.83-2.18) and 1.87 (1.52-2.18), respectively. For IAK, the mean (range) between and within the hospitals were 93.56 (17.26 to 239.15) µGy and 180.85 (122.58-239.15) µGy, respectively. For FOM, the mean (range) between and within hospitals were 0.05 (0.01 to 0.14) and 0.03 (0.02-0.05), respectively. Conclusions: The suggested method for comparing IQ and dose using FOM concept along with the new proposed FOM, is a valid, reliable and effective approach for monitoring and comparing IQ and dose between and within hospitals. It is also can be beneficial for the optimisation of X-ray units in clinical practice. Further optimisation for the hospitals /X-ray units with low FOM are required to minimise radiation dose without degrading IQ

Comparative analysis of radiation dose and low contrast detail detectability using routine paediatric chest radiography protocols

Objectives: To compare low contrast detail (LCD) detectability and radiation dose for routine paediatric chest X-ray (CXR) imaging protocols among various hospitals. Methods: CDRAD 2.0 phantom and medical grade polymethyl methacrylate (PMMA) slabs were used to simulate the chest region of four different paediatric age groups. Radiographic acquisitions were undertaken on 17 X-ray machines located in eight hospitals using their existing CXR protocols. LCD detectability represented by image quality figure inverse (IQFinv) was measured physically using the CDRAD analyser software. Incident air kerma (IAK) measurements were obtained using a solid-state dosimeter. Results: The range of IQFinv, between and within the hospitals, was 1.40-4.44 and 1.52-2.18, respectively for neonates; 0.96-4.73 and 2.33-4.73 for a 1-year old; 0.87-1.81 and 0.98-1.46 for a 5-year old and 0.90-2.39 and 1.27-2.39 for a 10-year old. The range of IAK, between and within the hospitals, was 8.56-52.62 µGy and 21.79-52.62 µGy, respectively for neonates; 5.44-82.82 µGy and 36.78-82.82 µGy for a 1-year old; 10.97-59.22 µGy and 11.75-52.94 µGy for a 5-year old and 13.97-100.77 µGy and 35.72-100.77 µGy for a 10-year old. Conclusions: Results show considerable variation, between and within hospitals, in the LCD detectability and IAK. Further radiation dose optimisation for the four paediatric age groups, especially in hospitals /X-ray rooms with low LCD detectability and high IAK, are required. Keywords: Paediatric chest radiography, CDRAD phantom, low contrast detail detectability and radiation dose

Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks

Background NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual’s ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. Methods NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. Results The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50–75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with ‘White British’ ‘Black Caribbean’ and ‘Indian’ patients most likely to take up a NHS Health Check. However, patients from ‘Any Other White Background’ and ‘Black African’ were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. Conclusions The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities

Inferred changes in El Niño–Southern Oscillation variance over the past six centuries

It is vital to understand how the El Niño–Southern Oscillation (ENSO) has responded to past changes in natural and anthropogenic forcings, in order to better understand and predict its response to future greenhouse warming. To date, however, the instrumental record is too brief to fully characterize natural ENSO variability, while large discrepancies exist amongst paleo-proxy reconstructions of ENSO. These paleo-proxy reconstructions have typically attempted to reconstruct ENSO's temporal evolution, rather than the variance of these temporal changes. Here a new approach is developed that synthesizes the variance changes from various proxy data sets to provide a unified and updated estimate of past ENSO variance. The method is tested using surrogate data from two coupled general circulation model (CGCM) simulations. It is shown that in the presence of dating uncertainties, synthesizing variance information provides a more robust estimate of ENSO variance than synthesizing the raw data and then identifying its running variance. We also examine whether good temporal correspondence between proxy data and instrumental ENSO records implies a good representation of ENSO variance. In the climate modeling framework we show that a significant improvement in reconstructing ENSO variance changes is found when combining information from diverse ENSO-teleconnected source regions, rather than by relying on a single well-correlated location. This suggests that ENSO variance estimates derived from a single site should be viewed with caution. Finally, synthesizing existing ENSO reconstructions to arrive at a better estimate of past ENSO variance changes, we find robust evidence that the ENSO variance for any 30 yr period during the interval 1590–1880 was considerably lower than that observed during 1979–2009