The validity and reliability of the exposure index as a metric for estimating the radiation dose to the patient

Introduction With the introduction of digital radiography, the feedback between image quality and over-exposure has been partly lost which in some cases has led to a steady increase in dose. Over the years the introduction of exposure index (EI) has been used to resolve this phenomenon referred to as ‘dose creep’. Even though EI is often vendor specific it is always a related of the radiation exposure to the detector. Due to the nature of this relationship EI can also be used as a patient dose indicator, however this is not widely investigated in literature. Methods A total of 420 dose-area-product (DAP) and EI measurements were taken whilst varying kVp, mAs and body habitus on two different anthropomorphic phantoms (pelvis and chest). Using linear regression, the correlation between EI and DAP were examined. Additionally, two separate region of interest (ROI) placements/per phantom where examined in order to research any effect on EI. Results When dividing the data into subsets, a strong correlation between EI and DAP was shown with all R-squared values > 0.987. Comparison between the ROI placements showed a significant difference between EIs for both placements. Conclusion This research shows a clear relationship between EI and radiation dose which is dependent on a wide variety of factors such as ROI placement, body habitus. In addition, pathology and manufacturer specific EI’s are likely to be of influence as well. Implications for practice The combination of DAP and EI might be used as a patient dose indicator. However, the influencing factors as mentioned in the conclusion should be considered and examined before implementation

Does radiography advanced practice improve patient outcomes and health service quality? A systematic review

yesObjectives To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods Using the World Health Organisation definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs and data were systematically extracted using electronic data extraction proforma. Results 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n=7) focussing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The papers were generally considered to be of low to moderate quality with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No papers reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusions Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. Powered b

Establishing a method to support academic and professional competence throughout an undergraduate radiography programme

Purpose: Radiography degree programmes are coming under increasing pressurefrom the community to ensure that graduates have not only the necessary academic developmentbut also the practice-based skills. This study aims to establish a method of monitoringstudents’ progress towards, and ability to meet, academic and professional competencesthroughout a radiography programme.Methods: Questionnaires were designed for students and academic staff to determine thestages and standards of progress of competence development, and to inform the review processof the current assessment tools throughout the programme. A literature search identifiedthe appropriate pedagogy as a basis for devising the method. Another questionnaire was distributedto overseas radiography institutions to gain insights into other assessment practicesto validate the framework.Results and discussion: It was established that years of study rather than semester periodswere appropriate to allow students to meet the standards. Discrepancies were noted in theexpectations between academic staff (higher expectations) and students (more realistic) interms of the pace of development expected. As students progress at different rates, and donot experience the same clinical exposure, their ability to meet expectations may differand so both sets of expectations were combined as a range of criteria. A multi-dimensionalassessment approach should be adequate to gauge students’ progress but time and resourceeffectiveness has not yet been addressed. The portfolio was identified as the pedagogy capableof integrating all the competence assessment tools, linked by reflective writing, to gatherindividual outcomes into a whole, and form a holistic framework.Outcome: The portfolio framework will initially run as a voluntary activity and standards ofprogress corresponding to the students’ stages will be delivered to participants in advance.Participants will be required to select materials and reflect on these, as evidence of development.Faculty members will provide support and feedback to students and oversee the wholeprocess

National survey on the practice of radiation therapists in Australia

Introduction: Radiation therapy (RT), like many allied health professions, has lacked professional practice clarity, which until 2008 had not been comprehensively investigated. This manuscript describes the first phase of a three-phase project investigating the current and future practices of radiation therapists (RTs) in Australia. The aim of phase 1 was to define the practice of RTs in Australia. Methods: A quantitative approach was used to gain an understanding of RT practice. A national survey was distributed to RTs in Australia. Descriptive statistics and content analysis were used to analyse the data. RT practice was analysed in relation to core and non-core roles, where non-core roles were further divided into basic and advanced practices. Results: The data from the national survey were representative of the Australian RT population (n = 525). The current practice of RTs is presented in summary tables for each area of work (treatment, planning, simulation, mould room and general). Conclusion: This study provided clarification of RT practice and indicated there was a desire to relinquish administrative roles to focus on RT–specific practice. There was evidence that some advanced roles were currently practiced in Australia; however, there was no structure to support these roles and they were based only on local need. This study identified that the profession needs to consider how they will maintain core RT practice, while encouraging the development of new roles, and whether some roles need to be relinquished