Quality of radiology training and role of Royal Australian and New Zealand College of Radiology in supporting radiology trainees in NSW : results of the first radiology trainee survey

Introduction The Royal Australian and New Zealand College radiology training programme is a 5-year programme with a vast curriculum including reporting and research requirements. Undertaking training can be stressful for trainees who must balance their educational needs and work responsibilities. We undertook the first independent survey of New South Wales (NSW) radiology trainees to evaluate their perceptions about the quality of their training. Methods Focus groups with trainees from multiple NSW training sites were conducted to construct a survey which was then distributed to all NSW Radiology trainees (n = 118). Data from the survey were analysed, and factors correlating to the overall satisfaction with the programme were explored using Spearman's correlation. Results Survey response rate was 70.3%. Eighty-nine per cent of trainees were satisfied with their career choice, and 73% were satisfied with the training programme. Majority felt they had a good exposure to cases, modalities and access to resources to complete their training. Trainee satisfaction significantly correlated with a supportive work environment (r(s) = 0.83, P < 0.0001), which involved supportive consultants (r(s) = 0.75, P < 0.0001), good peer support (r(s) = 0.60, P < 0.0001) and their training site respecting work/life balance (r(s) = 0.62, P < 0.0001). As trainees progressed through the training programme, they became less satisfied, with trainees in years 3 and above being the most dissatisfied. Conclusion NSW radiology trainees are generally satisfied with their training programme and career choices. Trainee satisfaction correlated most strongly with supportive work environment, good consultant support, peer relationships and good work/life balance; satisfaction decreased for senior trainees

Quality use of diagnostic imaging in trauma, and the impact on emergency medical practice : a retrospective clinical audit

Purpose: The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients. Methods: A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered. Results: Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients. Conclusion: This study highlighted that most non-compliant imaging orders benefited the patient

Blunt thoracic aorta injuries : an Australian single centre's perspective

Background: Blunt thoracic aortic injuries (BTAI) are potentially life-threatening emergencies. The management paradigm has shifted from open repair to a predominantly endovascular approach. We evaluated the trends in managing BTAI at our centre over the last decade and compared them to current international guidelines. Methods: We retrospectively reviewed all patients who presented with BTAI to our level one trauma centre, Westmead Hospital, New South Wales, Australia between 1 January 2010 and 31 December 2019. Patient demographics, injury grade and location, imaging features, management details and outcomes were analysed. Results: BTAI is rare, with 39 patients identified at our institute over the last 10 years. Of these, seven died in the emergency department from their associated injuries (17.9%). Of the 32 survivors, 27 underwent surgical management with an endovascular stent-graft placement, and the remaining five patients were treated non-operatively. No patients were treated via an open surgical approach. All patients were diagnosed via computed tomography angiography. There were one death and two endoleaks amongst patients who underwent Thoracic endovascular aortic repair (TEVAR). The death occurred secondary to severe traumatic brain injury. Two patients illustrated neurological changes however these were associated with the original injury. No patients failed non-operative management. Conclusion: This study demonstrates that at our level one trauma centre, patients with BTAI are managed in accordance with international guidelines. All patients underwent computed tomography angiography for diagnosis and grading of injury. All patients requiring surgical management underwent TEVAR. Furthermore, our data support that select patients with grade I injuries can safely be managed non-operatively

Do delays in radiology lead to breaches in the 4-hour rule?

Aim: To assess trends in medical imaging requests before and after the 4-hour rule commenced and to assess the imaging time component of emergency department (ED) length of stay (LOS). Materials and Methods: Retrospective analysis of ED patients and imaging requests 1 year prior to and 3 years after implementation of the 4-hour rule (April to December for 2011e2014) was performed at a single adult tertiary referral Level 1 trauma hospital with Level 6 ED. Logistic regression was used to evaluate trends in the number of ED patient presentations, patient triage categories, and imaging requests for these patients. The imaging component of the total ED LOS was compared for patients who met the 4-hour target and patients who did not. Results: Compared to 2011 (before the 4-hour rule), ED presentations increased 4.74% in 2012, 12.7% in 2013, 21.28% in 2014 (p<0.01). Total imaging requests increased 23.05% in 2012, 48.04% in 2013, 60.77% in 2014 (p<0.01). For patients breaching the 4-hour rule, the mean time before radiology request was 2.4-2.8 hours; mean time from imaging request to completion was 1.2-1.3 hours; mean time from imaging completion to discharge from ED was the longest component of ED LOS (4.9-5.9 hours). Conclusions: There has been a significant increase in imaging requests, with a trend towards more CT and less radiography requests. Imaging requests for patients who breached the 4-hour target were made on average 2.4-2.8 hours after triage and average time after imaging in itself, exceeded 4 hours. Imaging is not likely a causative factor for patients breaching the 4-hour target

Head movement during cerebral CT perfusion imaging of acute ischaemic stroke : characterisation and correlation with patient baseline features

Purpose: To quantitatively characterise head motion prevalence and severity and to identify patient-based risk factors for motion during cerebral CT perfusion (CTP) imaging of acute ischaemic stroke. Methods: The head motion of 80 stroke patients undergoing CTP imaging was classified retrospectively into four categories of severity. Each motion category was then characterised quantitatively based on the average head movement with respect to the first frame for all studies. Statistical testing and principal component analysis (PCA) were then used to identify and analyse the relationship between motion severity and patient baseline features. Results: 46/80 (58%) of patients showed negligible motion, 19/80 (24%) mild-to-moderate motion, and 15/80 (19%) considerable-to-extreme motion sufficient to affect diagnostic/therapeutic accuracy even with correction. The most prevalent movement was “nodding” with maximal translation/rotation in the sagittal/axial planes. There was a tendency for motion to worsen as scan proceeded and for faster motion to occur in the first 15 s. Statistical analyses showed that greater stroke severity (National Institutes of Health Stroke Scale (NIHSS)), older patient age and shorter time from stroke onset were predictive of increased head movement (p < 0.05 Kruskal-Wallis). Using PCA, the combination of NIHSS and patient age was found to be highly predictive of head movement (p < 0.001). Conclusions: Quantitative methods were developed to characterise CTP studies impacted by motion and to anticipate patients at-risk of motion. NIHSS, age, and time from stroke onset function as good predictors of motion likelihood and could potentially be used pre-emptively in CTP scanning of acute stroke

Characterization of the Intel RealSense D415 Stereo Depth Camera for Motion-Corrected CT Imaging

A combination of non-contrast CT (NCCT) and CT Perfusion (CTP) imaging is the most common regime for evaluation of acute ischemic stroke patients. CTP-based image analysis is known to be compromised by patient head motion. However, there is currently no technique to compensate for intra-frame head motion during CTP acquisition. In this work, we investigated the feasibility of using the small form factor Intel RealSense D415 stereo depth camera to obtain accurate head pose estimates for intra-frame motion correction in CTP. First, we quantitatively evaluated head movement in a cohort of 72 acute stroke cases. Then we characterized the performance of the Intel D415 against ground-truth robotic motion and the clinically validated OptiTrack marker-based motion tracking system. The results showed that head motion during CTP imaging of acute stroke of patients is extremely common, with around 50% of patients moving > 5 mm and 1 deg and around 20% moving 10-100 mm and rotating 3-20 deg. The pose accuracy of the Intel for controlled robotic motion was approximately 5 mm and 2 deg. For translations and rotations, respectively. For human head motion using the OptiTrack as ground truth, the accuracy was approximately 4 mm (except for lateral motion) and 1.25 deg, respectively. Although poorer than what is needed clinically, there is a lot of potential to optimize performance and potentially achieve an accuracy consistently around 1 mm and 1 deg

Reduction of scan duration and radiation dose in cerebral CT perfusion imaging of acute stroke using a recurrent neural network

Objective. Cerebral CT perfusion (CTP) imaging is most commonly used to diagnose acute ischaemic stroke and support treatment decisions. Shortening CTP scan duration is desirable to reduce the accumulated radiation dose and the risk of patient head movement. In this study, we present a novel application of a stochastic adversarial video prediction approach to reduce CTP imaging acquisition time. Approach. A variational autoencoder and generative adversarial network (VAE-GAN) were implemented in a recurrent framework in three scenarios: to predict the last 8 (24 s), 13 (31.5 s) and 18 (39 s) image frames of the CTP acquisition from the first 25 (36 s), 20 (28.5 s) and 15 (21 s) acquired frames, respectively. The model was trained using 65 stroke cases and tested on 10 unseen cases. Predicted frames were assessed against ground-truth in terms of image quality and haemodynamic maps, bolus shape characteristics and volumetric analysis of lesions. Main results. In all three prediction scenarios, the mean percentage error between the area, full-width-at-half-maximum and maximum enhancement of the predicted and ground-truth bolus curve was less than 4 ± 4%. The best peak signal-to-noise ratio and structural similarity of predicted haemodynamic maps was obtained for cerebral blood volume followed (in order) by cerebral blood flow, mean transit time and time to peak. For the 3 prediction scenarios, average volumetric error of the lesion was overestimated by 7%-15%, 11%-28% and 7%-22% for the infarct, penumbra and hypo-perfused regions, respectively, and the corresponding spatial agreement for these regions was 67%-76%, 76%-86% and 83%-92%. Significance. This study suggests that a recurrent VAE-GAN could potentially be used to predict a portion of CTP frames from truncated acquisitions, preserving the majority of clinical content in the images, and potentially reducing the scan duration and radiation dose simultaneously by 65% and 54.5%, respectively