Zainuddin, Zainul Ibrahim

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RESEARCH IN MEDICAL IMAGING – Radiographer’s Perspective ZAINUL IBRAHIM BIN ZAINUDDIN ASSISTANT PROFESSOR KULLIYYAH OF ALLIED HEALTH SCIENCES INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA  zainul@iiu.edu.my  Seminar on Research Methodology & Ethics in Medical Imaging 21-22 November 2009  Hospital Sultan Haji Ahmad Shah, Temerloh DDIR IIUM in collaboration with DID, Hoshas Research is creating new knowledge.  - Neil Armstrong Objectives of the presentation • To present the importance of research in medical imaging • To highlight the nature and areas of research for radiographers and the general medical imaging fraternity • To present some of the research done elsewhere in the areas of research identified.  If we knew what it was we were doing, it would not be called research, would it? - Einstein What is research in Medical Imaging? • A scientific undertaking to gain knowledge and understanding of aspects related to medical imaging, through the analysis of collected information derived from data collection methods, and communicating the understanding to others.   • Communicating the understanding can cause a change or reinforce current knowledge. "Imagination is more important than knowledge." - Einstein • To built up practice based on research done locally, for the local practice • To reduce overdependence on research findings done elsewhere        - Appreciate the uniqueness of the           Malaysian population • Fulfilling The concept of Evidence Based Practice (Evidence Based Radiography)   The importance of research in medical imaging "Anyone who has never made a mistake has never tried anything new." - Einstein • Appreciate that no two patients are alike: hence to individually tailor each patient to the examination. • long term, enormous benefits to patient and client groups and to the health service as a whole • To become a CEO : A means for professional advancement • A means for self actualisation (Maslow’s Heirarchy of Needs)  Be less curious about people and more curious about ideas. – Marie Curie • Different types of examinations  • Different types of patients  • Different types of imaging modalities  • Optimisation studies to optimise examination based on given conditions and modalities ; leading to individual tailoring of examinations    I was taught that the way of progress was neither swift nor easy. – Marie Curie  Research mindedness in Radiography Profession  V. Challen, S. Kaminskit and P. Harris Radiography 1996 2 , 139-151 • Professional development and advancing the profession are reasons individuals should be involved in research • Deterrents towards research:          - Time          -  Resources         -  lack of knowledge         -  motivation  In the fields of observation chance favors only the prepared mind.  - Louis Pasteur  Million dollar question.    What is needed to initiate research in Medical Imaging?  - Personal - Administrative Personal  • Realise the importance / relevance of research – professional obligation, do something good for the public, ( the person who might benefit from your research could be your next of kin) • Observe, contemplate, question, challenge • Read articles: replicate / duplicate research done elsewhere- see how they can fit for local use?   Imagination will often carry us to worlds that never were. But without it we go nowhere. – Carl Sagan • Develop interest in specific areas • Attend courses on how to start doing research. • Discuss / work with someone else :          - expand the interest        - working together towards a common           cause         - availability of grants,   Somewhere, something incredible is waiting to be known.  - Carl Sagan Administrative • A supportive environment for research, breaking away from traditional role of service orientated • Identify barriers towards research at the workplace • A Tranformational Leadership change that values research: A CEO approach         - opportunities for staff         - opportunities for the organisation  Why observe, contemplate, question, challenge? • Optimise the intellectual capabilty that Allah has bestowed upon us. • More than 200 times Allah challenges us to observe, contemplate, question, challenge.  If I have a thousand ideas and only one turns out to be good, I am satisfied. – Alfred Nobel What to Observe, contemplate, question, challenge? • Clinical Practice • Service development and evaluation • Radiation protection • Optimisation of technology • Health Technology Innovation and Assessment : Hybrid technology • Local standards • Development of new imaging protocols: MRI, CT • Tailored protocols • Education   Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young. The greatest thing in life is to keep your mind young.- Henry Ford Clinical practice  Patient satisfaction:  “Measuring mammography patient satisfaction” (Radiologic Technology, 2004  75 (6) 425-433)   Practice: “The awareness and implementation of infection control procedures among radiographers” (The Radiographer,  2002, 49 (2) 61-65)    Coming together is a beginning; keeping together is progress; working together is success. – Henry Ford Service development and evaluation  “Predictors of patient education by bone densitometry technologists” (Radiologic Technology; 2005; 76 (5) 354-364)   “Personal and professional development: a survey of radiographers employed in South West Region” (Radiography, 2001, 7 43-53)    Failure is simply the opportunity to begin again, this time more intelligently.- Henry Ford Radiation protection • A practical demonstration of improved technique factors in paediatric fluoroscopy. Fenner JW, Morrison GD, Kerry J, West N. Br J Radiol. 2002 Jul;75(895):596-602 • Added copper filtration in digital paediatric double-contrast colon examinations: effects on radiation dose and image quality. Hansson B, Finnbogason T, Schuwert P, Persliden J.    Eur Radiol. 1997;7(7):1117-22.  “Evidence based practice: an experimental study to determine how different working practice affects eye radiation dose during cardiac catheterization” (Radiography, 2001, 7 21-30)   Optimisation of technology • Investigation of optimum X-ray beam tube voltage and filtration for chest radiography with a computed radiography system. Moore CS, Beavis AW, Saunderson JR. Br J Radiol. 2008 Oct;81(970):771-7. Epub 2008 Jul 28.  • Effect of X-ray tube parameters, iodine concentration, and patient size on image quality in pulmonary computed tomography angiography: a chest-phantom-study.     Szucs-Farkas Z, Verdun FR, von Allmen G, Mini RL, Vock P. Invest Radiol. 2008 Jun;43(6):374-81.   • MOORE CS, SAUNDERSON JR, and BEAVIS AW Investigating the exposure class of a computed radiography system for optimisation of physical image quality for chest radiography Br. J. Radiol., September 1, 2009; 82(981): 705 - 710.  If you think you can do a thing or think you can't do a thing, you're right. – Henry Ford  Innovation • Vassileva  J; A phantom for dose-image quality optimization in chest radiography  British Journal of Radiology 75 (2002),837-842 © 2002 The British Institute of Radiology  • Local Innovation: Use of Lead shielding in Lateral Pelvimetry.   Thinking is the hardest work there is, which is probably the reason why so few engage in it. – Henry Ford Innovation: Development of positioning aids • Head Clamps for Skull Radiography http://wikiradiography.com/page/Head+Clamps+for+Skull+Radiography  Local Innovation :  Mr. Bon Ka Kiong- won the PM Quality Award  Using the Lead Snake to Reduce Scatter Radiation -  Fuller MJ  http://www.wikiradiography.com/page/Using+the+Lead+Snake+to+Reduce+Scatter+Radiation Health technology assessment • Andriole  KP: Productivity and Cost Assessment of Computed Radiography, Digital       Radiography, and Screen-Film for Outpatient Chest Examinations Journal of Digital Imaging, Vol 15, No 3 (September) 2002: pp 161-169  • Reiner BI, Siegel EL, Carrino, JA et al SCAR Radiologic Technologist Survey: Analysis of the Impact of Digital Technologies on Productivity Journal of Digital Imaging Vol 15, No 3 (September) 2002: pp 132-140 • Gisella Gennaro and Cosimo di Maggio:  Dose comparison between screen/film and full-field digital mammography European Radiology May 2006     Local standards • Johnston DA and Brennan PC :Reference dose levels for patients undergoing common diagnostic X-ray examinations in Irish hospitals Br. J. Radiol. 2000 73: 396-402.   • Optimising the Hybrid technology in the local setting. (Film-screen and Digital technology) • Tailoring examinations to the different x-ray equipment: Example: Diagnostic Imaging Department at HOSHAS • Dose reference levels of the various equipment in the department. Development of new imaging protocols • Pfannenberg C, Aschoff P, Brechtel K et al : Value of contrast-enhanced multiphase CT in combined PET/CT protocols for oncological imaging Br. J. Radiol. 2007 80: 437-445.  • To visualise certain lesions • To individually tailor imaging protocols to patient characteristics.     CT Scanning • Mayo JR: Radiation Dose Issues in Longitudinal Studies Involving Computed Tomography The Proceedings of the American Thoracic Society 5:934-939 (2008) © 2008 The American Thoracic Society   • Li J, Udayasankar UK, Toth TL, Seamans J, Small WC, Kalra MK. Automatic patient centering for MDCT: effect on radiation dose. AJR Am J Roentgenol 2007;188:547–552.   Education • Chapman NA,  Oultram SC: Enhancing the RT student clinical experience: Newcastle Mater Hospital Radiation Oncology Department Radiography, Volume 13, Issue 2, May 2007, Pages 159-163  • Price R, Hopwood N, Pearc V: Auditing the clinical placement experience Radiography, Volume 6, Issue 3, August 2000, Pages 151-159  • Reeves S: Planning and implementing a collaborative clinical placement for medical, nursing and allied health students: A qualitative study Medical Teacher, Volume 30, Issue 7 2008 , pages 699 - 704   Summary • Appreciate the intellectual capacity that has been bestowed and use it to benefit mankind. • Radiographers should realise the importance of research in the context of their professional obligation towards providing the best medical imaging service to the public. • Submit that there are vast areas of research that can be undertaken.   Food for thought      How will future mankind benefit from our presence today? Reference • Christina Malamateniou : “Radiography and Research, a UK perspective” http://www.technologosaktinologos.eu/teekme/Christina_Malamateniou_Research_and_Radiography_for_TEEKME.pdf Accessed 26.9.09 online.  • Marilyn Baird, Engendering a research culture within the  radiography profession. Powerpoint Presentation 

Research in medical imaging: radiographer’s perspective

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Research in medical imaging: radiographer’s perspective

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