Which actions will help the radiologic technologist maintain an effective relationship with adolescent patients during a radiographic examination?

Q: Which practice does the radiologic technologist follow when performing a radiographic examination quizlet?

Which practice does the radiologic technologist follow when performing a radiographic examination? Place the contact shield directly on the gonads of the patient.

Q: What precautions should be taken by a radiographer who must perform a radiographic examination on a pregnant patient quizlet?

What precaution should a pregnant radiologic technologist take while performing radiography? 1-Place more lead strips in the grid. 2-Place the second dosimeter at the waist level. 3-Decrease the source-to-image receptor distance..

Q: What is a key component to effective communication with a patient?

Physicians may consider five steps for effective patient-centered interviewing as shown in Table 1 10. The following four qualities are important components of caring, effective communication skills: 1) comfort, 2) acceptance, 3) responsiveness, and 4) empathy 11.

Q: Which type of wheelchair transfer does a radiologic technologist use while transferring a lightweight patient who has the ability to move from the wheelchair to the bed?

The radiologic technologist uses a standby assist type of transfer for a patient who is lightweight and has the ability to move from the wheelchair to the bed. The radiologic technologist uses the two-person lift to transfer patients who cannot bear weight on their lower extremities.

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A patient with a cardiovascular disorder comes in for an invasive radiologic imaging procedure. What sequence of approaches does the radiologic technologist follow to maintain effective communication with the patient?

1. Informed consent, verbal communication, patient questionnaire, procedure request review
2. Patient questionnaire, procedure request review, verbal communication, informed consent
3. Procedure request review, verbal communication, patient questionnaire, informed consent
4. Verbal communication, patient questionnaire, procedure request review, informed consent

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J Med Radiat Sci. 2019 Mar; 66(Suppl Suppl 1): 114–144.

Communication in paediatric radiography

Michael Burgin1, Hugh Byun1, Ana Paterson1, Micah Sia1, Baiyang Sun1, Samuel Vella1, Sharmaine McKiernan1

1University of Newcastle, New South Wales, Australia

Introduction: Paediatric radiography can be challenging at the best of times and radiographer communication is of extreme importance. In many cases, to provide a diagnostic image the communication skills of the radiographer must be exemplary. In many situations the radiographer's communication must incorporate both the child and the adult.

Aim: This presentation investigates the methods and principals involved in delivering effective communication in order to increase overall efficiency of a radiographic procedure and maximise patient care.

Method: From the literature, different paediatric presentations requiring different communication strategies will be explored. Children suffering from minor to severe injuries, the non‐cooperative and developmentally delay patient will be investigated.

Results: A list of principles for radiographers to use to effectively communicate with paediatric patients will be presented. Some of the most effective techniques include the use of positive body language, distraction techniques and the use of simple language.

Conclusion: Effective communication between paediatric patient and radiographer allows for an efficient diagnostic procedure. It is needed to produce a diagnostic image and more importantly to increase the quality of care for the patient.

Dementia: putting the pieces together

Amanda Burgess1, Grace Hatter1, Karla Ketteringham1, Jess Lines1, Emily Morris1, Natalie Strawhorn1, Sharmaine McKiernan1

1University of Newcastle, New South Wales, Australia

Background: Dementia encompasses a wide range of illnesses characterised by a decline in brain function. This poses a challenge for the radiographer in areas such as communication, gaining consent and ensuring patient safety.

Aim: This presentation will inform radiographers on common symptoms, presentations and behavioural challenges in regard to patients with dementia. Such information promotes greater patient care.

Method: The literature is explored on the different types and stages of dementia. How a radiographer can notice a patient with dementia and then communicate with and obtain consent. Finally diagnosing dementia on MRI or CT will be discussed.

Results: Dementia is not a single condition: Alzheimer disease, vascular and frontotemporal are some of the different types of dementia. Communication may be challenging as a dementia patient may have memory problems, difficulty with facial recognition, object identification and verbal communication. Some dementia patients may not have the ability to make decisions and therefore give consent for imaging and contrast injects. The radiographer must also be aware that a dementia patient is at greater risk of falling while in their care.

Conclusion: Radiographers need to obtain patient histories and establish the patient's capacity to make decisions and give consent. This can be difficult if the patient has dementia. Understanding dementia and how to approach such situations is vital for a radiographer to ensure comfort and safety of their patients.

Effect of anode and filter materials on radiation dose and image quality of different digital mammography systems for thick breast

Khaled Alkhalifah1, Ajit Brindhaban1, Akram Asbeutah1

1Kuwait University, Kuwait

Objective: To compare SNR and CNR for various targets; filter materials for various kVps; and compare the MGD for thick breast 20% glandular tissue and 80% fat tissue.

Methods: Two digital mammography units, tungsten (W) target, silver (Ag) and rhodium (Rh) as filter materials. The other dual target molybdenum (Mo) and Rh and dual filter Mo and Rh with three combinations. Mammographic phantom used 6 cm thick equal to 20% glandular tissue and 80% adipose tissue. The phantom was exposed 20 times, four times for each target/filter combinations. Three regions of interest for SNR were selected. SNR and CNR are calculated. The data was analysed by SPSS non‐parametric test.

Results: CNR for 34 kVp Rh filter is better for other kVps and provides a significant P = 0.027. CNR for Ag silver shows 34 kVp with Ag filter showing significant changes (P = 0.02). 28, 30, 32 and 34 kVps between Rh and Ag filters CNR is better in Ag compared to Rh P = 0.05. For Rh/Rh and Mo/Mo, 28 and 32 kVp is the best for CNR and SNR P < 0.05 respectively. To compare between the three targets Mo and W, it is significant that W/Ag can give better MGD for 34 kVp is 60% less than 28 Mo/Mo.

Conclusion: It is recommended to use 34 kVp and Ag filter for thick breast. That is giving the best CNR and reduction of patient breast dose 62% less compared to Rh filter and 28 kVp Mo/Mo.

Evaluation of the consequences of radiopharmaceutical pulmonary uptake on bone scan before total hip arthroplasty

Sanghyeong Kil1, Seung Hun Yeom1, Yung H. Lim1, Seong J. Kim1

1Pusan National University Yangsan Hospital, South Korea

Introduction: Bone scan using technetium‐labelled phosphates was shown to detect bone fractures and bone metastasis in the early stage more than plain radiographs.1 Therefore, bone scan has become one of the most frequently performed nuclear medicine imaging tests. However, non‐osseous radiopharmaceutical uptake on the bone scan is an unusual finding.2

Case presentation: A 58‐year‐old man with angina pectoris and coronary artery obstructive disease who received drug‐eluting stents at proximal‐left anterior descending artery was performed to 99mTc‐DPD bone scan for an evaluation of generalised pelvic bone pain and to distinguish avascular necrosis of femoral heads. Bone scan was performed 2 h after the intravenous injection of 925 MBq (25 mCi) technetium‐99 m dicarboxypropane diphosphonate (99mTc‐DPD). Whole body images were recorded using low energy high‐resolution collimator of the dual‐head gamma camera (Symbia E, Siemens Healthcare, Knoxville, USA).

Management and Outcome: 99mTc‐DPD uptake was noted on the right femoral head (avascular necrosis of femoral heads), right hip and right sacroiliac joint (suggesting traumatic bone lesion). Furthermore, bone scan images showed diffuse pulmonary uptake of 99mTc‐DPD.

Discussion: In normal bone scan, the lung is not visualised. The common causes of diffuse lung 99mTc‐DPD uptake are pulmonary calcification, renal failure, hyperparathyroidism, hypervitaminosis D.3–5 In this case, the causes of diffuse lung 99mTc‐DPD uptake may be due to stent thrombosis by drug‐eluting stents at proximal‐left anterior descending artery.

References

1. Holder LE. Radionuclide bone imaging in the early detection of fractures of the proximal femur (hip): multifactorial analysis. Radiology 1990;174(2):509‐15.

2. Gentili A, Miron SD, Bellon EM. Nonosseous accumulation of bone‐seeking radiopharmaceuticals. Radiographics 1990;10(5):871‐81.

3. Rosenthal DI, et al. Uptake of bone imaging agents by diffuse pulmonary metastatic calcification. American Journal of Roentgenology 1977;129(5):871‐4.

4. Coolens JL, Devos P, De Roo M. Diffuse pulmonary uptake of 99mTc bone‐imaging agents: case report and survey. European Journal of Nuclear Medicine 1985;11(1):36‐42.

5. Chan ED, et al. Calcium deposition with or without bone formation in the lung. American Journal of Respiratory and Critical Care Medicine 2002;165(12):1654‐69.

Evaluation of diagnostic usefulness for 3D T2 image during cervical MRI examination

Yeong G. Kwak1

1Chonbuk National University Hospital, Jeollabuk‐do, South Korea

Aim: To compare conventional 2D T2 TSE sagittal image and 3D T2 space sagittal image during cervical spine examination.

Methods: 20 hospital in‐patients with cervical spine pain were prescribed cervical spine MRI. There were 12 males (mean age = 42.23) and eight females (mean age = 40.38), with a mean age total of 41.52. One musculoskeletal radiology specialist and one orthopedics specialist evaluated the observation degree of anatomical structure for each sequence regarding conventional 2D T2 sagittal plane, 3D T2 sagittal plane and 3D T2 reconstruction oblique sagittal plane excluding history of all patients with a 5‐point Likert scale using one‐way ANOVA.

Results: As a result of comparing the mean of evaluated value, a high result was presented in the sequence of 3D T2 space reconstruction oblique sagittal plane, 3D T2 space sagittal plane and conventional 2D T2 sagittal plane in the neural foramen, intraspinal root and foraminal fat tissue. It was also revealed that a higher result is presented in conventional 2D T sagittal plane for CSF, spinal cord, bone and disc compared to 3D T2 space sagittal plane and 3D T2 space reconstruction oblique sagittal plane.

Conclusion: 3D T2 sequence is applied to patients who visit hospital with the chief complaint of radiculopathy and intervertebral disc herniation. This may be useful to aid diagnosis as it provides diagnostic information of high quality image regarding the neural foramen, intraspinal nerve root and fat tissue.

Should the lateral chest radiograph be a routine examination in the diagnosis of pneumonia in children?

Georgia Bell1, Rossene Kapsambelis1, Minh (Shayne) Chau1

1Flinders Medical Centre, South Australia

Background: Chest X‐rays are frequently used in the diagnosis of pneumonia in children.1 The lateral examination produces more than double the effective patient dose of the frontal examination and is associated with a higher repeat rate.2

Objective: To investigate whether the lateral chest X‐ray is necessary for the routine diagnosis of pneumonia in children.

Methods: Four databases (MedLine, PubMED, Cochrane and Scopus) were searched. Studies meeting the selection criteria were appraised by two reviewers using NHMRC guidelines and QUADAS‐2 tool.3

Results: Two retrospective studies and one random control trial were identified from the search. Despite the small body of evidence, the results were considered low risk, highly applicable and of high quality (Grade B Recommendation).3

Discussion: All the studies agreed that the combined frontal and lateral examinations was able to diagnose more pneumonias than the frontal only examination. However, there seems to be disagreement as to whether the amount is significant. One study assessed the impact on the clinical environment found that having the frontal examination only did not significantly change the clinical management of the patients in comparison to both examinations. No studies looked at the efficiency or costs associated with the lateral examination.

Conclusion: While the lateral chest X‐ray is important for characterising certain pathologies and may be useful for further investigation of some abnormal images, it should not be used routinely. More research is required to determine the clinical impact of the lateral chest X‐ray on the diagnosis of pneumonia in children.

References

1. Burgner D, Richmond P. The burden of pneumonia in children: an Australian perspective. Paediatric Respiratory Reviews 2005;6(2):94‐100.

2. Abdelhalim MAK, Darwish RAL, Al‐Ayed MS. Assessment of patient doses levels during x‐ray diagnostic imaging using TL dosimeters and comparison with local and international levels. Trends in Medical Research 2008;3(2):72‐81.

3. Coleman K, Weston A, Norris S, et al. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. 2009. Available at: https://www.mja.com.au/sites/default/files/NHMRC.levels.of.evidence.2008‐09.pdf (accessed 19 June 2018).

Diagnostic accuracy and radiation dose of DECT protocol for follow‐up imaging of EVAR compared to the standard triphasic protocol: a literature review

Minh (Shayne) Chau1

1Flinders Medical Centre, South Australia

Introduction: Contrast‐enhanced CT is good standard for the detection and classification of endoleaks for the surveillance of patients who have undergone endovascular aneurysm repair (EVAR).1 Although the triphasic protocol is efficient, after EVAR, patients are required to attend indefinite follow‐up and are exposed to substantial accumulative radiation dose and hence, increased lifelong risk of developing cancer.2

Objectives: This review aims to evaluate diagnostic performance of dual‐energy CT (DECT) in follow‐up examinations after EVAR and its radiation dose estimates compared to the standard triphasic protocol.

Methods: A systematic search was conducted on the following databases: MEDLINE, PubMed, and Scopus. Articles were screened against the inclusion and exclusion criteria. A narrative review was performed. A summary statistic table of the calculated mean effective dose, percentages in dose reduction and diagnostic performance of DECT were pooled.

Results: Five original articles were included. Compared to the triphasic protocol being the reference standard, data from the DECT acquisitions were observed to have 98–100% overall accuracy for the detection of type I and II endoleaks. The cumulative effective doses were significantly different (P < 0.001) between the protocols. The effective dose delivered in the DECT protocol was approximately 61% lower than that delivered to the patient by the standard triphasic protocol (11.1 mSv compared with 27.8 mSv).

Conclusion: DECT protocol can replace the standard triphasic protocol in follow‐up imaging after EVAR for the detection of type I and II endoleaks. This acquisition protocol also significantly reduces the effective dose to the patients.

References

1. Iezzi R, Cotroneo AR, Marano R, Filippone A, Storto ML. Endovascular treatment of thoracic aortic diseases: Follow‐up and complications with multidetector computed tomography angiography. Clinical Imaging 2008;32(5):416.

2. Tolia AJ, Landis R, Lamparello P, Rosen R, Macari M. Type II endoleaks after endovascular repair of abdominal aortic aneurysms: natural history. Radiology 2005;235(2):683‐6.

Establishment of faculty reference level in computed tomography in selective examinations in a single institution in South Australia

Minh (Shayne) Chau1

1Flinders Medical Centre, South Australia

Introduction: There have been several national and international publications relating to patient dose management, predominantly in the United States and European countries.1,2 In South Australia, no recent study has been published surveying common adult CT examinations. This study aims to establish a faculty reference level (FRL) for one scanner in our institution.

Methods: Data was retrospectively collected from our Toshiba Aquilion One Vision 320‐slice from 26 December 2016 to 26 June 2017. Examinations were separated as contrast or non‐contrast studies, and single phase or multi‐phases. Common CT examinations, including chest, chest/abdomen/pelvis, and abdomen/pelvis were reported. The median, mean (50th percentile) and 75th percentile for the dose spread were calculated according to the examination.

Results: There was a total of 1571 CT examinations performed between 26 December 2016 and 26 June 2017 using the Toshiba scanner in our institution; 262 of these examinations met the inclusion and exclusion criteria. The examinations for our Toshiba scanner (established as median value of CTDIvol and DLP) were distributed as CT chest contrast (n = 67, 25.6%, 6 mGy, 219.1 mGy.cm), CT chest non‐contrast (n = 41, 15.6%, 5.7 mGy, 190.6 mGy), CT abdomen/pelvis contrast (single phase) (n = 49, 18.7%, 6.5 mGy, 330.5 mGy.cm), CT abdomen/pelvis contrast (multi‐phase) (n = 33, 12.6%, 8.93 mGy, 1037.5 mGy.cm), CT abdomen/pelvis non‐contrast (n = 12, 4.6%, 10.1 mGy, 289.9 mGy.cm) and CT chest/abdomen/pelvis (n = 60, 22.9%, 7.15 mGy, 619.4 mGy.cm).

Conclusion: This data provided information that our own institution and others can use for quality improvement activities. Future research is required to allow for analysis to include more CT examinations in various scanners.

References

1. European Commission (EC) 2015. Radiation Protection No. 180 – Diagnostic reference levels in thirty‐six European countries (Part 2/2). Available at: https://ec.europa.eu/energy/sites/ener/files/documents/RP180%20part2.pdf (accessed 10 September 2017).

2. National Council on Radiation Protection and Measurements (NCRP). Reference levels and achievable doses in medical and dental imaging: recommendations for the United States. Report No. 172. Bethesda, Md: NCRP, 2012.

CaF2:Tm nanophosphor as gamma radiation and carbon beam dosimeter for radiotherapy

Anant Pandey1, Kanika Sharma1, Birendra Singh2, Pratik Kumar3

1Sri Venkateswara College, University of Delhi, Delhi, India 2Inter‐University Accelerator Center, New Delhi, Delhi, India 3All India Institute of Medical Sciences, New Delhi, Delhi, India

Objectives: To investigate the thermoluminescence (TL) properties of CaF2:Tm nanophosphor for the purpose of dosimetry of both gamma radiation and carbon ion beams used in radiotherapy. To develop a dosimeter that is independent of radiation type and energy.

Methods: Co‐precipitation technique was used to initially prepare nanoparticles of CaF2 which were later activated by thulium (0.1 mol%) using the combustion technique.1,2 X‐ray diffraction and transmission electron microscopy were used to characterise and confirm the preparation of the desired salt. 1.25 MeV of gamma radiation and 65 MeV of carbon (C6+) ion beam were used to irradiate the samples.

Results: Two major peaks were evident with a low temperature peak at around 107°C and a high temperature peak at around 157°C in case of gamma rays. The salt at hand exhibited a linear TL response for the complete range of studied doses i.e. 10–2000 Gy for both the temperature peaks. When the nanophosphor was exposed with 65 MeV of C6+ ion beam the shape and structure of the glow curves remained noticeably similar and the nanophosphor exhibited a linear TL response for the entire range of studied fluences, i.e. 5 × 1010 ions/cm2 to 1 × 1012 ions/cm2.

Discussion and Conclusion: A rangexs of tests such as batch homogeneity and reproducibility were also performed in order to define the final product. Thus, co‐precipitation method followed by combustion technique was successful in producing a dosimetric grade CaF2:Tm for dosimetry of gamma radiation as well as carbon (C6+) ion beam that are used in radiotherapy.

References

1. Salah N, Alharbi ND, Habib SS, Lochab SP. Luminescence properties of CaF2 nanostructure activated by different elements. Journal of Nanomaterials 2015;16(1):5.

2. de Vasconcelos DA, Barros VS, Khoury HJ, Asfora VK, Oliveira RA. Thermoluminescent dosimetric properties of CaF2:Tm produced by combustion synthesis. Radiation Physics and Chemistry 2016;121:75‐80.

The use of intraoperative computed tomography in complex spinal procedures

Xanthe Tusek1

1Royal Brisbane and Women's Hospital, Queensland, Australia

The use of intraoperative imaging has been fundamental for a range of different spinal procedures. Traditionally, intraoperative imaging involved standard fluoroscopy, however the more contemporary imaging modality of CT has been introduced. The use of intraoperative CT aids professionals in completing complex spinal procedures, resulting in improved patient outcomes and a reduced need for revision surgeries.1

This literature review aims to investigate the use of imaging in theatre for complex spinal surgery, with a focus on intraoperative CT in pedicle screw placement procedures, and its effect on patient outcomes.

During the past 10 years, the use of intraoperative CT has increased in complex spinal procedures.1,2 Pre‐operative imaging has proven to be inaccurate due to the flexible nature of the spine from the supine imaging position, to the prone operating position.1 In‐room scanning has thus been a more accurate solution in the demonstration of anatomy.1 The placement accuracy of fluoroscopically guided pedicle screws is between 84–94%.4 Multiple studies demonstrate statistically significant improvements with the use of intraoperative CT assisted spinal navigation, with an accuracy exceeding 98%.3,5 The mean radiation doses of these scans compare to half the dose of a 64‐slice CT scanner. 4

Due to the improved accuracy rates of screw placement using intraoperative CT guidance, revision surgeries are less frequent. This has created an improved safety profile for patients undergoing complex spinal procedures1 and can lead to increased savings of around $23,000 per patient.6

References

1. O'Brien J. The use of intraoperative CT and navigation for the treatment of spinal deformity in open and minimally invasive surgery. Spine 2017;42:S28‐S29.

2. Polly D, Fessler R, Sansur C, et al. Role of intraoperative imaging in spine surgery continues to expand [Internet]. Healio.com. 2014. Available at: https://www.healio.com/orthopedics/spine/news/print/spine‐surgery‐today/{f86ff5f5‐703f‐44e6‐9d68‐e3d7c8311fe5}/role‐of‐intraoperative‐imaging‐in‐spine‐surgery‐continues‐to‐expand [accessed 16 June 2018].

3. Tormenti M, Kostov D, Gardner P, Kanter A, Spiro R, Okonkwo D. Intraoperative computed tomography image‐guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery. Neurosurgical Focus 2010;28(3):E11.

4. Van de Kelft E, Costa F, Van der Planken D, Schils F. A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the o‐arm imaging system and stealthstation navigation. Spine 2012;37(25):E1580‐E1587.

5. Oertel M, Hobart J, Stein M, Schreiber V, Scharbrodt W. Clinical and methodological precision of spinal navigation assisted by 3D intraoperative o‐arm radiographic imaging. Journal of Neurosurgery: Spine 2011;14(4):532‐6.

6. Watkins IVR, Gupta A, Watkins III R. Cost‐effectiveness of image‐guided spine surgery. Open Orthopaedics Journal 2010;4(1):228‐33.

The three‐step weight bearing stand for imaging feet and ankles: better for the patient and better for the radiographers

Tanya Barnes1

1Princess Alexandra Hospital, Queensland, Australia

Objective: To assess the use of the three‐step weight bearing stand for imaging feet and ankles.

Background: At the Princess Alexandra Hospital our protocol is to image all feet and ankles erect if the patient is capable of it, most of which has previously been performed on CR (computed radiography). On a typical orthopaedic clinic we image approximately 20 patients in a two‐hour period and this would be repeated about four times during the week. This represents a great deal of bending and manual tasks for the radiographer.

The three‐step weight‐bearing stand can be used in conjunction with our existing wall stand, which utilises DR (direct radiography) and saves time. Its platform is approximately 60 cm from the floor, so staff no longer need to kneel on the floor to image weight bearing feet.

Princess Alexandra Hospital will be one of the first departments in Australia to utilise this equipment in combination with the wall stand.

Method: To conduct a survey of staff and patients on the new weight bearing stand (ethics approval gained) and to perform a data analysis of the findings.

Discussion: It is hoped that the use of the new weight‐bearing stand will reduce the risk of injury to staff, improve workflow and provide the patient with the most optimal imaging style of weight bearing: in short, making it better for the patient and better for the radiographer.

Reliability of modified Cobb angle measurements

Donald Hunter1, Suzanne Snodgrass2, Ishanka Weerasekara2, Darren Rivett2, Sharmaine McKiernan2

1BeechHealth, Australia 2University of Newcastle, New South Wales, Australia

Background: Kyphosis of the thoracic spine can be quantified by measuring the modified Cobb angle on a lateral thoracic spine radiograph. This measurement is important in showing disease progression in conditions such as osteoporosis, ankylosing spondylitis and Scheuermann's disease.

Objectives: To determine the intra‐rater and inter‐rater reliability of measuring the modified Cobb angle using the Merge PACS computer software.

Method: A random sample of 20 digital lateral thoracic spine radiographs were used from 78 participants in a cross‐sectional study investigating the possible relationship between thoracic posture and shoulder impingement syndrome. Two researchers, blinded to their first measurements, independently determined the modified Cobb angle from the digital images, using the Merge PACS software, by measuring the intersection of the lines formed from the extension of the top endplate of T1 and T10. Intraclass correlation co‐efficients (ICC) were calculated for both the intra‐rater and inter‐rater reliability for the modified Cobb angle calculations obtained by the two researchers.

Results: Intra‐rater reliability for measuring the modified Cobb angle from the digital radiographs was excellent for rater one (ICC2,1 = 0.99, 95% CI 0.98, 1.00) and good to excellent for rater two (ICC2,1 = 0.88, 95% CI 0.71, 0.95). Inter‐rater reliability was good to excellent (ICC2,1 = 0.89, 95% CI 0.73, 0.96).

Conclusions: The modified Cobb angle obtained from digital, lateral thoracic spine radiographs using the Merge PACS software had good to excellent intra‐rater and inter‐rater reliability. As such the measurement is a reliable way to quantify disease progression.

Innovative sectional anatomy imaging education for diagnostic radiography students: a case study of integrated virtual reality technology

Yobelli Jimenez1, Susan Miller1, Jillian Clarke1, Sarah Lewis1

1University of Sydney, New South Wales, Australia

Diagnostic radiography (DR) students must competently interpret diagnostic images. This involves fundamental knowledge of anatomical structures and spatial relationships, traditionally taught by didactic methods at our institution. An ongoing review of learning and teaching activities identified enhanced pedagogical opportunities with the implementation of a ‘flipped‐classroom’ approach and the support of a virtual reality education tool.1,2

The aim of this poster is to present the educational design research framework applied to the introduction of a 4‐week sectional anatomy education module in two DR professional units of study. Within a student‐centred context, the key objectives were to facilitate students’ understanding of sectional anatomy of the thorax, abdomen and pelvis, and immerse students in an interactive 3D sectional anatomy learning environment. The newly developed module consists of guided online learning (video lectures and aligned activities) followed by experiential, co‐operative learning in a tutorial based setting using the 3D Virtual Environment for Radiotherapy Training (VERT) system. Factors influencing the development process will be described, including barriers and facilitators in this phase. These include integration of technology, human and equipment resources, assessment alignment, and acceptability of the new learning approaches for students and staff. Continuing evaluation of the newly developed sectional anatomy imaging education module will drive future refinement and implementation cycles.

References

1. Hew KF, Lo CK. Flipped classroom improves student learning in health professions education: a meta‐analysis. BMC Medical Education 2018;18:38.

2. Jimenez YA, Hansen CR, Juneja P, Thwaites DI. Successful implementation of the Virtual Environment for Radiotherapy Training (VERT) for medical physics education: The University of Sydney's initial experience and recommendations. Australasian Engineering Physical Sciences and Medicine 2017;40:909‐16.

Better together: implementing MOSAIQ for a comprehensive cancer centre

Catherine Hubie1, Philippe De Feularde1

1Sir Charles Gairdner Hospital, Western Australia

Aim: To implement one oncology information system (OIS) for the Sir Charles Gairdner Hospital Comprehensive Cancer Centre and Perth Children's Hospital in Western Australia.

Background: In the new SCGH Comprehensive Cancer Centre and Perth Children's Hospital, there was a need to have one OIS for better communication and record keeping. Radiation oncology (RO) was using ARIA, whereas the other disciplines were using other hospital‐based or paper systems. MOSAIQ was chosen to combine all these systems. The multidisciplinary team worked to transfer and check the 37 000 patient records from ARIA to MOSAIQ and set up safe and efficient workflows.

Methods: Training was provided allowing construction of staff, location, quality checklist and billing libraries. Together, global areas such as demographics were agreed and developed. RO mapped current data from ARIA to MOSAIQ, with assistance from ElektaTM, over a 1‐year period, highlighting the importance of accurate record keeping, documentation, organisation and decision‐making. Liaison with external departments who had undergone this process was essential to be aware of the limitations and responsibilities of migrating data. Concurrently, workflows were being determined to ensure a smooth transition to a new database. Testing for machine safety and patient data transfer was essential to ensure that at ‘go‐live’ all patients were accurate.

Conclusion: With preparation, persistence, training and additional staff, MOSAIQ was implemented successfully. However, ongoing support from a dedicated OIS competent person is necessary. Ongoing training and documentation is required to become electronic.

Influence of different tube voltages and photon energies on spatial resolution of dual‐source CT using a newly developed iodine phantom

Wakiko Tani1, Noriyuki Negi1, Katsuhiro Ichikawa2

1Kobe University Hospital, Japan 2Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan

Purpose: To evaluate the influence of different tube voltages (TVs) and photon energies of monochromatic image on spatial resolution in a third‐generation dual‐source CT, using a newly developed iodine phantom.

Methods: A 26 cm diameter water phantom including a rod phantom simulating enhanced vessel with 13 mgI/mL was scanned with the dual‐source CT (SOMATOM Force, Siemens Healthcare). We used TVs of 70 and 120 kV; dual‐powered 70 and 120 kV. 40 keV monochromatic images of dual energy with 80 and Sn150 kV; 100 and Sn150 kV were also used. All CT data were reconstructed with filtered back projection (FBP) and ADMIRE (advanced modelled iterative reconstruction) with two different strengths of 3 and 5 (AD3 and AD5). To assess the spatial resolution of each image, a task‐based modulation transfer function (MTFtask) using circular edge technique was employed.

Results: Most of spatial resolutions were equivalent for FBP, except for the dual‐powered 70 kV which presented a little lower MTFtask. The 40 keV was not inferior to single‐powered kVs. AD3 and AD5 provided higher MTFtask, compared with the single‐powered FBP.

Conclusion: Among the examined settings, though the spatial resolution was maintained in the most of settings, the dual‐powered 70 kV presented a decreased MTFtask.

Dosimetric comparison of fast Monte Carlo with superposition/convolution algorithm in stereotactic lung radiotherapy on flattening filter free beams

Yan Y. Ng1, Jerome H. H. Yap1, James C. L. Lee1, Swee P. Yap1

1National Cancer Centre Singapore, Singapore

Objectives: The latest fast Monte Carlo algorithm (fMCA) within the Eclipse planning system is reported to be the closest to the most accurate Monte Carlo simulations. Dose differences for the current superposition/convolution algorithm (SCA) against fMCA for both dose to medium (Dm) and dose to water (Dw) reporting, in stereotactic lung radiotherapy on flattening filter free beams were quantified.

Methods: 20 lung SBRT plans were generated and recalculated on Dm and Dw with the same parameters. Total calculation time, relative dose differences (RDDs), Dmax of organs‐at‐risk (OAR), D2, D95 and Dmean of planning target volume (PTV), further segmented into PTV_Soft_Tissue, PTV_Lung_Tissue and PTV_Overlap_Chestwall were compared.

Results: PTV D95 and Dmean doses for Dm and Dw were lower than SCA. RDDs of 1.5% and 2.1% (P < 0.001) were observed for PTV D95 of Dw and Dm against SCA respectively. For the PTV_Overlap_Chestwall, D95 was 1.8% lower for Dm than both SCA and Dw. All dose parameters of D95, D2 and Dmean for PTV_Lung_Tissue were the lowest in Dm and highest in SCA. RDDs of 2.6% and 2.4% (P < 0.001) were recorded for Dm and Dw against SCA respectively. No significant dose differences were found for the PTV_Soft_Tissue and OARs across the different algorithms. Calculation time was approximately 1.57 times longer for fMCA than SCA.

Conclusion: Dm of fMCA predicts a lower dose to low density tissue and interface regions with varying densities as compared to SCA and Dw. This increased dose accuracy comes at the expense of increasing calculation time.

An evaluation of dosimetric effects of rotational setup errors on patients with retroperitoneal sarcomas undergoing radiotherapy using TomoTherapy

Melissa W. M. Koh1

1National Cancer Centre Singapore, Singapore

Background: Due to the often large tumour sizes and close proximity of organs at risk (OAR), it is challenging to administer therapeutic radiotherapy (RT) doses for patients with retroperitoneal sarcomas (RPS). Uncorrected rotational set‐up errors may potentially result in target misses and/or overdoses to OAR.1–3

Objectives: To evaluate the dosimetric impact of uncorrected residual rotational set‐up errors during RPS treatments for patients immobilised in vacuum bags, treated by TomoTherapy on the planning target volume (PTV) and OAR and to determine the optimal correction strategy for these patients.

Methods: The institution's ethics committee approved ethical exemption for this study. Seven patients were retrospectively assessed by matching their daily megavoltage CT (MVCT) scans (n = 190) to their planning CT scans. For each patient, three correction strategies were evaluated: 4 degrees of freedom (DOF) method (clinically applied corrections in three translational directions and roll rotation only), 6DOF‐BM method (bony anatomy 6DOF match) and 6DOF‐STM method (6DOF match to soft tissue target volume). The OAR in each MVCT were re‐contoured to account for inter‐fraction changes. Efficacy of each imaging matching method was evaluated by comparing recalculated plans with the original plan after respective corrections were applied.

Results: Rotational errors were found to be low. As a result, minimal impact on the PTV or OAR dose metrics was observed. All correction strategies were clinically acceptable, however, the 6DOF‐STM method was found to most closely match the planned metrics.

Conclusion: Uncorrected residual rotational set‐up errors of less than 3 degrees in RPS patients were unlikely to have significant impact on the dose metrics.

References

1. Wang H, Shiu A, Wang C, et al. Dosimetric effect of translational and rotational errors for patients undergoing image‐guided stereotactic body radiotherapy for spinal metastases. International Journal of Radiation Oncology*Biology*Physics 2008;71(4):1261‐71.

2. Amro H, Hamstra D, McShan D, et al. The dosimetric impact of prostate rotations during electromagnetically guided external beam radiation therapy. International Journal of Radiation Oncology*Biology*Physics 2013;85(1):230‐6.

3. Peng JL, Liu C, Chen Y, Amdur RJ, Vanek K, Li JG. Dosimetric consequences of rotational setup errors with direct simulation in a treatment planning system for fractionated stereotactic radiotherapy. J Appl Clin Med Phys 2011;12(3):3422.

Machine‐learning integration of CT histogram analysis to evaluate the composition of atheroscleotic plaque: validation with IB‐IVUS

Takanori Masuda1, Naoyuki Imada1, Noritaka Noda1, Yukari Yamashita1, Yorialki Matsumoto1, Takayuki Oku1

1Tsuchiya General Hospital, Hiroshima, Japan

Purpose: To determine whether machine learning with histogram analysis of coronary CT angiography (CCTA) yields higher diagnostic performance for coronary plaque characterisation than the conventional cut‐off method using the median CT number.

Methods: We included 78 patients with 78 coronary plaques who had undergone CCTA and integrated backscatter intravascular ultrasound (IBIVUS) studies. IB‐IVUS diagnosed 32 as fibrous‐ and 46 as fatty or fibrofatty plaques. We recorded the coronary CT number and seven histogram parameters (minimum and mean value, standard deviation (SD), maximum value, skewness, kurtosis and entropy) of the plaque CT number. We also evaluated the importance of each feature using the Gini index, which rates the importance of individual features. For calculations we used XGBoost. Using 5‐fold cross validation of the plaque CT number, the area under the receiver operating characteristic curve of the machine learning and the conventional cut‐off method was compared.

Results: The median CT number was 56.38 Hounsfield units for fibrous and 1.15 HU for fatty or fibrofatty plaques. The calculated optimal threshold for the plaque CT number was 36.1 ± 2.8 HU. By validation analysis, the machine learning yielded a significantly higher area under the curve than the conventional method (area under the curve 0.92 and 95%, CI 0.86–0.92 vs. 0.83 and 0.75–0.92, P = 0.001)

Conclusion: The machine learning was superior the conventional cut‐off method for coronary plaque characterisation using the plaque CT number on CCTA images.

An easy method to evaluate radiation peak skin dose in the coronary angiography by using a simulating phantom and thermoluminescent dosimeters

Kai C. Hsu1

1Kaohsiung Veterans General Hospital, Taiwan

Recently, percutaneous coronary interventions (PCI) has increased the average procedural radiation dose. This has increased the rate of radiation skin damage therefore monitoring radiation dose is necessary. In clinical settings, dose‐area‐product (DAP) and air‐kerma (AK) are used to estimate patient peak skin dose (PSD). However, these data are calculated by using presumptive mathematic equations, which ignores each individual patient characteristics and different projectors angles.

Our study aims to provide an easy method to record and estimate PSD with different tube angulation in the PCI setting. Thermoluminescnet dosimeters (TLDs) were used to measure radiation dose of Hp (10) and Hp (0.07) of the skin. We used cine mode with setting of 15 frames per second rate, recorded for 5 sec and repeated for five times. We tested with standard tube angulations, such as posteroanterior view, left anterior oblique (LAO) 90 degree view, right anterior oblique (RAO) 30 degree view, cranial 35 degree view and LAO 65 degree + caudal 20 degree view (spider view).

The results showed the spider view had highest radiation dose in DAP, Hp (10) and Hp (0.07). When the zoom‐in stage was used, DAP reduced, however AK and peak skin dose increased. Finally, we used values of skin dose of Hp (10) and Hp (0.07) compared to values of DAP in five groups, the value of PSD is about 0.5–1.3% of DAP. By sharing these experiences we provide a practicable method to estimate the PSD in the PCI for catherisation labs.

A dosimetric comparison of 3D‐CRT versus VMAT plans for bladder cancer

(Henry) Hung Do1

1Peter MacCallum Cancer Centre, Victoria, Australia

Background: Delivering accurate radiation therapy for bladder cancer remains challenging due to bladder filling during the time between pre‐treatment imaging and treatment delivery.1 At the Peter MacCallum Cancer Centre, three‐dimensional conformal radiotherapy (3D‐CRT) is the standard of care for bladder cancer irradiation. However, volumetric modulated arc therapy (VMAT) provides an alternative to deliver highly conformal treatment more rapidly. This retrospective planning study compared 3D‐CRT with VMAT techniques to determine if a reduction in delivery time was feasible with equivalent dosimetric outcomes, to mitigate the influence of bladder filling before treatment.

Methods: 3D‐CRT and VMAT plans were retrospectively generated for 20 patients with muscle‐invasive bladder cancer using the Varian Eclipse planning system. A single radiation therapist carried out all planning. Mean dosimetric conformity indices (CI) to CTV, PTV were compared, as were dose to OAR (femur heads and rectum). The estimated average treatment delivery time was also calculated.

Results: The preliminary results have indicated that, on average, VMAT plans delivered a 4% improvement to CI of both CTV and PTV and a 20% dose reduction to OAR. The VMAT estimated average treatment delivery time was 25% less than with equivalent 3DCRT plans.

Conclusion: VMAT presents dosimetric advantages over 3D‐CRT for muscle invasive bladder cancer with respects to target dose conformality, while enabling improved OAR avoidance. VMAT provides a more efficient radiotherapy alternative, which in turn, can minimise the influence of bladder filling and improve overall patient experience.

Reference

1. Foroudi F, Wong J, et al. Online adaptive radiotherapy for muscle‐invasive bladder cancer: results of a pilot study. Int J Radiation Oncology Biol Phys 2011;81(3):765–71.

Knowledge‐based planning as a real time review quality assurance feedback tool in the TROG 1501 SPARK trial

Olivia Cook1, Alisha Moore1, Robert Kaderka2, Kevin Moore2, Paul Keall3, Jarad Martin4

1TROG Cancer Research, New South Wales, Australia 2University of California, San Diego, CA, United States 3University of Sydney, New South Wales, Australia 4Calvary Mater Newcastle Hospital, New South Wales, Australia

Objective: This study aimed to demonstrate the feasibility and impact of knowledge‐based planning (KBP) feedback as part of the real time review (RTR) process for the TROG 1501 SPARK stereotactic prostate trial.

Methods: A knowledge based dose‐volume histogram (DVH) estimation model and automated planning routine were created using 34 SPARK RT plans that had previously been submitted as part of the TROG QA program. The KBP routine was applied to six subsequent patients pre‐treatment. A feedback report comparing the KBP generated DVH versus the initial plan was collated and sent to the site. Centres were asked to review the report and decide whether they would amend their clinical plan.

Results: Of the six patients, five were protocol compliant and one case was replanned due to a major protocol deviation. As a result of KBP feedback 2 out of 5 (40%) cases that were originally protocol compliant, were nevertheless replanned. Protocol dose constraints for all six cases were calculated and an average (mean dose) for each metric was generated. Overall, the rectum, bladder, penile bulb and urethra planning risk volume (PRV) demonstrated that an improved dose‐volume relationship could be achieved compared to the initial submission and was implemented in practice for the three resubmitted cases. Variable results were observed for the femoral heads, demonstrating a potential dose trade off (Table 1).

Conclusion: KBP feedback was successfully incorporated into the RTR process for the SPARK trial and demonstrated that both improvements to and validation of plan quality for OAR dosimetry could be achieved.

Do protons have a place in breast cancer radiotherapy? A literature review

Lisa Cunningham1, Eileen Giles2, Scott Penfold1, Hien Le1, Michala Short3

1Royal Adelaide Hospital, South Australia 2University of South Australia, South Australia 3The University of South Australia

Breast cancer is the most commonly diagnosed cancer among Australian women, with a mean age at diagnosis of 61 years. Current treatments are very effective with a 5‐year survival rate of 90%, so advancements in breast cancer treatment now focus on reducing late side effects after cancer therapy to ensure patients’ long‐term quality of life.

Radiotherapy is indicated in 87% of breast cancer cases. While traditionally delivered with X‐rays, delivering breast radiotherapy with protons could offer equivalent effectiveness, but with potentially lower doses to normal tissues such as the heart and lungs. In women with left‐sided breast cancer this dose reduction could translate to fewer treatment‐related heart complications in the long‐term. Interest in proton therapy for breast cancer is growing, and the possibilities of delivering treatment with reduced side effects to healthy tissues are being explored worldwide.

This presentation will showcase the findings from a literature review that was conducted to investigate the use of proton therapy for early and advanced breast cancer. All dosimetric studies in the review reported reduced doses to healthy tissues with proton therapy when compared to X‐ray therapy. The review also identified the first randomised controlled trial underway in the US, comparing X‐ray and proton therapy for whole breast/chest wall irradiation including regional nodes. This literature review formed the basis for a retrospective dosimetric comparison of protons and X‐ray therapy for patients with left‐sided breast cancer carried out at the Royal Adelaide Hospital and University of South Australia.

Comparison of CT chest/abdomen/pelvis single pass dual injection imaging technique against conventional dual pass single injection technique

Wei Lim1, Leah Biffin1, Shane Reeves1, Son Nguyen1, Shezard Arnolda1

1Western Health, Victoria, Australia

Objective: Qualitative audit of single pass dual injection (SPDI) against dual pass single injection (DPSI) chest abdomen pelvis (CAP) examinations to assess the degree of radiation dose reduction with comparable image quality in oncology follow up CAP imaging.

Subject and Methodology: A retrospective audit was performed at Western Health Medical Imaging for patients receiving CAP examinations over a 6‐month period from October 2017 to March 2018. An SPDI protocol was introduced in October 2017 for oncology follow up scans. The audit included patients who received SPDI scans within the audit timeframe and had available data from previous DPSI scans within a 12‐month period. The dose length product (DLP) and CT Dose Index (CTDIvol) data was collected as a measure of radiation dose. Vascular enhancement was measured using the average radiodensity (in Hounsfield units) at the thoracic aortic arch, pulmonary artery, liver and spleen. Diagnostic image quality was assessed by multiple radiologists using a 100‐point scale. The audit project was approved by the Western Health Low Risk Human Research Ethics Panel.

Results: The results of the study suggest that the SPDI protocol demonstrates a median decrease in radiation dose of 28% with similar image quality to the DPSI studies.

Conclusion: The results suggest that the use of SPDI protocol have shown a decrease in radiation dose with similar image quality compared to the DPSI protocol.

The development of an emergency chest X‐ray tolerance document

Oumama H. Mohamed1, Daniel Sgualdino1

1Metro South Health – Logan Hospital, Queensland, Australia

Monitoring and evaluating X‐ray image quality, including the analysis of rejected images, is vital in promoting patient radiation safety.1,2 Chest radiographs account for 34% of rejected X‐rays at Logan Hospital Emergency Department in 2018. The purpose of this study was to develop an emergency chest X‐ray tolerance document to assist radiographers in determining whether a repeat chest radiograph is required.

The study undertaken was tri‐phasic. The first phase involved the examination of 200 emergency medical imaging request forms to identify common clinical indications for chest radiographs. The second phase involved the analysis of 6 months of rejected chest radiographs to identify the most common reasons for X‐ray rejection. The final phase involved the imaging of an adult anthropomorphic phantom to obtain frontal chest radiographs in varying degrees of malpositioning, relevant to the repeat criteria identified in phase two.

The tolerance document was divided into four sections according to the indications identified in phase one: cardiac pathology, collapse/consolidation/infection, pneumoperitoneum and pneumothorax. For each indication examples of acceptable and unacceptable degrees of tolerance, obtained in phase three, were demonstrated for the rejection criteria identified in phase two; anatomy cut‐off, tube angle and rotation. The tolerance document was then reviewed by a panel of radiologists and senior radiographers.

This study was successful in its aim of developing an emergency chest X‐ray tolerance document for the Logan Emergency Medical Imaging Department. Future research is required to test the documents effectiveness in reducing the number of rejected chest radiographs before its implementation.

References

1. Martin CJ, Sharp PF, Sutton DG. Measurement of image quality in diagnostic radiology. Applied Radiation and Isotopes 1999;50(1):21‐38.

2. Langer SG, Ramthun S, Bender C. Introduction to digital medical image management: departmental concerns. American Journal of Roentgenology 2012;198(4):746‐53.

Investigating the value of cone‐beam CT in head and neck cancer patients

Sulman Rahim1, Tomas Kron1, Nigel Anderson1, Tsien Fua1, Chen Liu1, Albert Tiong1

1Peter MacCallum Cancer Centre, Victoria, Australia

Objective: To compare agreement of head and neck (HN) radiotherapy CBCT and kV image verification, together with intra‐fraction motion and soft tissue changes throughout treatment.

Methods: 10 HN patients receiving ≥30 fractions of IMRT were prospectively recruited (departmental quality improvement committee approved). In addition to daily pre‐treatment 2D‐kV image verification, a weekly CBCT was acquired pre‐ and post‐treatment. CBCT images were reviewed offline to identify any residual positioning error and intra‐faction motion based on bony anatomy, combined with an assessment of any soft‐tissue changes.

Results: 132 CBCT images were acquired. The mean residual error between 2D‐kV and pre‐treatment CBCT was 0.2 mm (range 0–2 mm) in superior‐inferior (SI) plane; 0.3 mm (0–2) in right‐left (RL) plane and 0.5 mm (0–2) in anterior‐posterior (AP) plane. The maximum residual error (2 mm) was observed most frequently in the AP plane in 13.6% (9/66) of pre‐treatment CBCTs.

Mean intra‐fraction motion was 0.6 mm (0–2), 0.7 mm (0–2), 0.6 mm (0–2) in SI, RL and AP planes respectively, with mean rotation of 0.3 (range: 0–1.9 degrees), 0.25 (0–1.1) and 0.33 (0–1.4) degrees in the coronal, sagittal and transverse planes respectively. A qualitative soft tissue CBCT review detailed observations regarding weight loss (seven patients) and laryngeal displacement (four patients). Tumour regression was observed in a large majority (seven patients). No soft tissue changes required replanning.

Conclusion: CBCT bone‐match alone did not provide additional advantage to 2D‐kV imaging. However, various soft‐tissue changes warrant further investigation. As technology enables growing scope for improved target conformity, any future attempts for PTV margin reduction should integrate soft‐tissue matching into image verification protocols.1

Reference

1. Bujold A, Craig T, Jaffray D, Dawson LA. Image‐guided radiotherapy: has it influenced patient outcomes? Seminars in Radiation Oncology 2012;22(1):50‐61.

Do radiographers have a perfect memory?

Kathryn Whiteman1

1Sunshine Coast University Hospital, Queensland, Australia

Obtaining correct patient identification is the most important step of any radiographic examination. So, when performing our check, how certain are we that it is 100 percent correct? The implications of getting these details wrong are obvious, we don't want to unnecessarily irradiate or image the wrong person or body part.

Since the introduction of digital requesting in our emergency department we have moved away from paper imaging requests, as such radiographers are performing the patient identification checks without the patient's details in front of them, committing what the patient tells them to memory and then checking digitally or vice‐versa. Is this the most efficient and accurate method employed by radiographers to remember patients’ details? Information required for patient identification checks are stored in our short‐term memory (STM). Miller observed that the average person can hold seven items of information, plus or minus two, in their STM.1 Atkinson and Shiffrin noted that the duration of STM seems to be between 15 and 30 sec.2 Historically, radiographers have always been taught to make these checks with the paper request in front of them. Due to a change of practice are we at risk of making mistakes? In the near future, our hospital will be rolling out an entirely digital requesting system. Are we doing the best we can to ensure patient identification is correct in this digital era?

References

1. Miller GA. The magical number seven plus or minus two: some limits on our capacity for processing information. Psychological Review 1956;63(2):81‐97.

2. Atkinson RC, Shiffrin RM. The control of short‐term memory. Scientific American 1971;225(2):82‐90.

Post‐radiotherapy salivary gland changes in nasopharyngeal carcinoma

Vincent W. C. Wu1, Michael Ying1, Dora Kwong2, PL Khong2

1Hong Kong Polytechnic University, Hong Kong 2University of Hong Kong, Hong Kong

Introduction: Xerstomia is a common complication in nasopharyngeal cancer (NPC) patients after radiotherapy. It adversely affects the quality of life such as mastication, swallowing and speech.1 This study aimed to establish progression patterns of morphological and physiological changes of parotid and submandibular glands after radiotherapy and to study the correlations between their mean doses with the pattern of post‐radiotherapy changes.

Method: This was a longitudinal clinical study in which 25 newly diagnosed NPC patients treated by radical intensity modulated radiotherapy were recruited. Each subject underwent ultrasound examination, saliva test and completed a xerostomia questionnaire before the start of radiotherapy. Repeated examinations and questionnaire were conducted at 6, 12 and 18 months after the completion of radiotherapy. To estimate the doses to the glands, the subjects’ treatment plans were retrieved from the treatment planning system. In ultrasonography, the echogenicity of parotid and submandibular glands and haemodynamic condition were measured.2 Saliva test included the measurement of alpha‐amylase and salivary immunoglobulin A using commercially available assay kits.

Results and Conclusion: The post‐radiotherapy salivary glands were significantly smaller after radiotherapy. They also demonstrated lower vascular velocity, resistive and pulsatility indices when compared to pre‐treatment conditions. The degree of volume shrinkage and subjective severity of xerostomia demonstrated dose dependence. Subjectively, the xerostomia was most severe with the saliva flow rate dropped to minimum at 6 months after treatment and then followed by slight recovery afterward. The results of the alpha‐amylase and salivary immunoglobulin A tests also showed significant changes after treatment.

References

1. Jellema AP, Slotman BT, Doomaert P, et al. Impact of radiation‐induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer. Int J Radiat Oncol Biol Phys 2007;69(3):751‐60.

2. Cheng SCH, Ying MTC, Kwong DLW, Wu VWC. Sonographic appearance of submandibular glands in patients treated with external beam radiotherapy for nasopharyngeal carcinoma. J Clin Ultrasound 2013;41(8):472‐8.

Verification of effective dose calculated from dose length product: phantom study

Takayuki Oku1, Takanori Masuda1, Naoyuki Imada1, Yoriaki Matsumoto1, Yukari Yamashita1

1Tsuchiya General Hospital, Hiroshima, Japan

Objectives: The simplest method for estimating the effective‐dose (ED) in individual patients is by conversion from the dose‐length‐product (DLP) displayed on the CT‐console by using k‐factors.

We compared the estimated ED (e‐ED) obtained with the DLP and k‐factors with the actually measured ED (am‐ED) recorded on radio‐photoluminescence‐glass‐dosimeters (RPGDs) in three different anthropomorphic phantoms simulating paediatric subjects.

Methods: We used anthropomorphic phantoms simulating three different paediatric subjects and scanned them using a 64‐detector‐CT. We compared the e‐ED ‐obtained with the DLP and k‐factors with the am‐ED recorded on RPGDs.

Results: The estimated e‐ED ‐obtained in newborn of phantom was 2.7 μSv at 120 kvp, 2.48 μSv at 100 kvp and 2.48 μSv at 80 kvp, respectively. The actually measured am‐ED recorded in newborn of phantom was 2.62 μSv at 120 kvp, 2.52 μSv at 100 kvp and 2.33 μSv at 80 kvp, respectively.

The estimated e‐ED ‐obtained in 1‐year‐old of phantom was 2.22 μSv at 120 kvp, 2.08 μSv at 100 kvp and 2.12 μSv at 80 kvp, respectively.

The actually measured am‐ED recorded in 1‐year‐old of phantom was 3.17 μSv at 120 kvp, 2.88 μSv at 100 kvp and 2.39 μSv at 80 kvp, respectively.

The estimated e‐ED ‐obtained recorded in 5‐year‐old of phantom was 2.79 μSv at 120 kvp, 2.69 μSv at 100 kvp and 2.85 μSv at 80 kvp, respectively.

The actually measured am‐ED recorded in 5‐year‐old of phantom was 3.18 μSv at 120 kvp, 3.17 μSv at 100 kvp and 2.62 μSv at 80 kvp, respectively.

Conclusion: We ended with the error rate of e‐ED ranging from 2.0% (min) to 29.0% (max) using our CT‐equipment. Therefore, the effective‐dose of the subject can be obtained using the DLP value displayed on the console of the CT‐equipment.

Improving myocardial ischaemia diagnostic accuracy using myocardial perfusion and CT fusion imaging based 3D‐OSEM data

Yoshitaka Nakamura1

1Kokura Memorial Hospital, Japan

Background: It is important to evaluate myocardial ischaemia using myocardial perfusion imaging (MPI) or fractional flow reserve (FFR). On the other hand, attenuation correction (AC) with ordered subsets ‐ expectation maximisation (OSEM) iterative reconstruction (IR) significantly improves the diagnostic accuracy of stress‐only SPECT MPI in patients. Fusion imaging provides incremental diagnostic information compared to MPI alone.

Aim: Our aim is to compare the diagnostic accuracy of 3D‐OSEM fusion and various MPI for detecting ischaemia compared with FFR.

Methods: We retrospectively examined 60 patients (63 vessels) who underwent MPI, FFR and coronary computed tomography (CCT). We evaluated accuracy comparing the Quantitative Perfusion SPECT Summed Difference Score (QPS SDS) and cardio REPO® SDS (REPO SDS), Artificial Neural Network (ANN), 3D‐OSEM fusion, FFR as reference standard and matched ischaemic area and ischaemic vessel using fusion image.

Results: The diagnostic accuracy were QPS SDS 57.4%; REPO SDS 63.7%; ANN 62.6%; 3D‐OSEM fusion 68.4%. A decrease in artifacts and improvement in ischaemic contrast by 3D‐OSEM fusion therefore improved accuracy by decreasing false‐positive and false‐negative results.

Conclusion: 3D‐OSEM fusion image has high detectability of myocardial ischaemia and can be a novel diagnostic tool.

Spread and future of facilities optimising medical exposure dose in Japan

Naoki Kodama1, Yumi Kimura2, Yasuo Nakazawa2

1Niigata University of Health & Welfare, Japan 2The Japan Association of Radiological Technologists, Japan

Introduction: Gaining the public's trust in radiological examination requires a range of measures, such as technological support for maintaining and improving the quality of radiological examination for determining appropriate tests; optimisation of exposure factors for examination purposes; quality control of equipment; and appropriate explanations to alleviate patients’ anxiety regarding testing. By certifying and releasing the names of medical facilities that have demonstrated that they satisfactorily perform the above measures, JART can ease the public's fears regarding radiological examination.

Methods: Facilities that apply for certification first submit self‐completed documents for a preliminary inspection; facilities that pass this inspection then undergo an onsite inspection. Inspection items are divided into justification of actions and optimization of protection; for the latter, inspections are conducted for each modality. The certification must be renewed every 5 years.

Results: From 2005 to 2018, a total of 83 facilities across Japan obtained certification. All certified facilities receive a certificate and plate, which are displayed at the entrance in order to appeal to patients. Management of medical exposure was included in the medical fee in Japan. Radiation exposure control by the radiological technologist was gradually recognised.

Conclusions: The JART certification system enables all engaged in radiological examination to renew their awareness of medical exposure and to use medical radiation appropriately. Reducing exposure dose can greatly contribute to public health. The Japanese Medical Law will be revised in 2020. Radiation workers including radiological technologist must take more training. And, it is necessary to record medical exposure dose. In the future, JART's efforts will be more noticeable.

Paediatric radiography: does it play with your mind?

Fiona Franklin1, Pamela Rowntree2, Deborah Starkey2

1Lady Cilento Children's Hospital, Queensland, Australia 2Queensland University of Technology, Queensland, Australia

A radiographer in a paediatric medical imaging department faces many challenges on a daily basis many of which are unique to working in the paediatric field. Consequently, maintaining a positive state of mental health and wellbeing may be a challenge.

This poster provides a commentary on the available published literature regarding the mental health and wellbeing of radiographers working in a paediatric setting in line with the theme of working together as professionals caring for each other and our patients.

Radiographers with positive states of mental health and wellbeing are better able to help each other therefore more able to help their patients effectively and in turn making themselves and our profession better.

Radiation therapy in the adjuvant treatment of hyperkeratotic palmoplantar psoriasis

Madeline Andrae1, Bronwyn Shirley1, Tegan Le Lay1

1Townsville General Hospital, Queensland, Australia

Introduction: Psoriasis is an inflammatory autoimmune disease of the skin and nails, causing debilitating pain having an adverse effect on the patient's life. Typical treatment regimens involve topical and systemic therapies in combination with phototherapy. However, patients with extensive, chronic disease may encounter treatment resistance, with limited or no success of these therapies. Radiation therapy (RT) has been shown to be an effective treatment for benign skin lesions however, recommended dose, fractionation and long‐term follow up are limited within the literature making clinical implementation challenging. Furthermore, RT may induce the Koebner Phenomenon, exasperating the disease.1

Case presentation: This case study presents a patient with chronic hyperkeratotic palmoplantar psoriasis who was offered RT as a last chance effort.

Management: A total dose of 6 Gy was delivered using mega‐voltage and superficial kilo‐voltage energy. Challenges in delivering a homogenous dose to the feet were overcome with a custom water bath.

Outcome: Significant reduction in extent of disease was seen as a result, with the patient no longer wheelchair‐bound. Current follow‐up at 16 months post‐treatment describes maintenance of results, with flare‐ups manageable with previously ineffective topical and systemic agents.

Discussion: This case is a single example of RT as a successful treatment for chronic palmoplantar psoriasis however, a larger sample size and clinical trial is needed to ascertain dose and fractionation for optimal long‐term control. Implementation of such treatments within departments invites clinicians to further develop RT practices and provide much needed relief to a new cohort of patients with non‐malignant conditions.

Reference

1. Sumila M, Notter M, Itin P, Bodis S, Gruber G. Long‐term results of radiotherapy in patients with chronic palmo‐plantar eczema or psoriasis. Strahlentherapie und Onkol 2008;184(4):218‐23.

Radiotherapy for Dupuytren's disease: a handy option for preventing disease progression

Samantha Fetherston1, Frederick Ho1

1Shoalhaven Cancer Care Centre, New South Wales, Australia

Introduction: Dupuytren's disease (DD) is a benign condition causing palmar fascia thickening. It is incurable and often debilitating to patients in the contracture stages. Surgery is the most common treatment for contracture but is invasive and has issues with relapse and complications. Radiotherapy can prevent disease progression in early‐stage DD, potentially avoiding contracture and future surgery.

Case presentation: 50‐year‐old male presented with early‐stage DD of right hand with nodules increasing in number and size in the past 6 months. Palmer aspect of right hand contained three nodules overlaying the second and third metacarpal, no contracture or functional compromise. Patient has strong family history of DD. Patient was treated with 30 Gy of 9 MeV electrons in 10 fractions, delivered in two 5‐fraction phases spaced 7 weeks apart.

Management and Outcomes: Patient had no acute toxicities and the nodules had no change. At 16‐month follow‐up patient indicated a tight cord had begun to appear on the third finger with a small nodule on the palm of left hand. The same treatment regimen 30 Gy was delivered to the left hand. At 20 months since the initial treatment, there is no progression of either hand after radiotherapy treatment.

Discussion: We have now treated five patients for DD at our centre, with all undergoing future follow‐up appointments. Radiotherapy is effective to prevent disease progression for early‐stage DD.

Evaluation of knowledge‐based planning Rapidplan(15.6) in comparison to version(13.6) for prostate cancer radiotherapy: possibilities for improvement

Andrew Le1, James O'Toole1, Brian Porter1, John Atyeo2, Thomas Eade1,3

1Northern Sydney Cancer Centre, New South Wales, Australia 2Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia 3Sydney Medical School, New South Wales, Australia

Purpose: To compare the effectiveness of knowledge‐based planning 1,2 Rapidplan (RP)15.6 to version 13.6 for improving plan optimisation for prostate radiotherapy.

Methods: The RP plans of 57 patients were accessed from the ethically approved database (LNR/15/HAWKE/355) for use in this comparative study. Each plan was rated from one to four based on the number of optimisations performed to be clinically acceptable, with one requiring a single optimization and four requiring four or more optimisations. Plans rated between one and three were deemed successful. The details recorded to make plans clinically acceptable were divided into three categories: ‘Protocol differences’, ‘PTV and OAR violations’ and ‘Hot spot locations’.

Plans with a rating score greater than two are to be re‐planned using the newer RP15.6 and compared to the previous plan based on the number of optimisations to achieve an acceptable plan.

Results: Of the 57 plans in this study 13 were rated one, 26 were rated two, 11 rated three and seven rated four. Of the 44 plans given a rating of two or more, 19 received the score due to ‘Protocol differences’, 12 due to ‘PTV and OAR violations’ and 13 due to ’Hot spot locations’.

Conclusion: The plans produced by Rapidplan 13.6 had an overall success rating of 87.72%. Preliminary results from RP 15.6 suggest that the original RP plans rated with a two or more can be further improved using Multi Criteria Optimisation3 and additional dose levels, specifically in the categories of ‘PTV and OAR violations’ and ‘Hot spot locations’.

References

1. Moore KL, Brame RS, Low DA, Mutic S. Experience‐based quality control of clinical intensity‐modulated radiotherapy planning. International Journal of Radiation Oncology Biology Physics 2011;81(2):545‐51.

2. Appenzoller LM, Michalski JM, Thorstad WL, Mutic S, Moore KL. Predicting dose‐volume histograms for organs‐at‐risk in IMRT planning. Medical Physics 2012;39(12):7446‐61.

3. Saw CB, Li SC, Battin F, McKeague J, Peters C. External beam planning module of Eclipse for external beam radiation therapy. Medical Dosimetry 2018;43(2):195‐204.

Implementation of a proprietary iterative reconstruction algorithm recently validated for use in CT calcium score: an evaluation in clinical practice

Gordon Mander1, Loretta Carr1

1Darling Downs Hospital and Health Service, Queensland, Australia

Background: Coronary calcium score (CCS) is an established clinical tool used to estimate an individual's future risk of cardiovascular events, allowing the treating physician to tailor therapy appropriately.1 There is increasing recognition of the long‐term effects of medical ionising radiation. Iterative reconstruction results in reduced image noise, allowing dose reduction techniques without compromising imaging quality. A vendor‐specific iterative reconstruction algorithm that prospectively influences tube current selection has recently been validated for use in CCS (Adaptive Iterative Dose Reduction [AIDR‐3D], Canon Medical, Tokyo, Japan).2 This study aims to measure reduction in radiation dose following implementation of this in routine practice.

Methods: Data was collected retrospectively from the Picture Archiving and Communications System. All CCS scans performed on an Aquilion ONE (Canon Medical, Tokyo, Japan) at our institution were included. Comparison was made between groups that received the filtered back projection (FBP) protocol (n = 124) and the AIDR‐3D protocol (n = 37). Dose‐length‐product (DLP), height, weight, age, gender and heart rate were also recorded. Median and interquartile ranges (IQR) were calculated for both groups and statistical significance was calculated using Student's T test (two‐sided P‐values; significance at P < 0.05). An exemption of ethical review was granted (HREC/18/QTDD/66).

Results: Median (and IQR) DLP values of the CCS for the AIDR‐3D group was 42 (±49) mGy.cm and 175 (±74) mGy.cm for the FBP group (P < 0.001). The weight ranges for the FBP and AIDR 3D groups were similar, 93 ± 23 kg (45–192 kg) and 98 ± 24 kg (57–172 kg) (t = −0.85, P = 0.41), respectively.

Conclusion: Implementation of iterative reconstruction in CCS resulted in a 75% dose reduction in clinical practice.

References

1. Holvoet P, Jenny NS, Schreiner PJ, Tracy RP, Jacobs DR. The relationship between oxidized LDL and other cardiovascular risk factors and subclinical CVD in different ethnic groups: The Multi‐Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2007;194(1):245‐52.

2. Tang YC, Liu YC, Hsu MY, Tsai HY, Chen CM. Adaptive iterative dose reduction 3D integrated with automatic tube current modulation for CT coronary artery calcium quantification: comparison to traditional filtered back projection in an anthropomorphic phantom and patients. Academic Radiology 2018;8:1010‐7.

Optimising dose beyond the target in brain stereotactic radiotherapy

Erin Johns1

1Metro South Princess Alexandra Hospital, Queensland, Australia

Objectives: Stereotactic radiotherapy (SRT) delivers precise, high dose radiation to treat brain metastases. Although controlling areas of high dose is paramount, the variability in volume of brain receiving low doses is less well studied but is relevant in some patients. The aim of this project was to audit the consistency of SRT planning according to fixed factors (PTV size and location) and modifiable factors (planning technique) and to assess whether improvements to the protocol could be made.

Methods: Thirty‐eight clinical SRT plans delivered between July 2017 and March 2018 were retrospectively analysed. Factors including tumour size, location, plan optimisation constraints and dose‐volume parameters for normal brain were collected, evaluated and sent for statistical analysis.

Results: Median mean brain dose was 1.83 Gy (range 0.48–5.85 Gy) and there was a strong positive correlation with PTV size (correlation coefficient = 0.81 and P < 0.001). The volume of brain receiving 50% and 10% of the prescribed dose was also strongly positively correlated with PTV size.

Plans with additional optimisation parameters such as rings also resulted in less dose demonstrating reliable use of dose‐volume constraints in plan optimisation.

Tumour location also influenced the dose‐volume relationship, with lesions at the periphery of the brain resulting in less low dose than centrally located lesions. However, due to the sample size, did not reach statistical significance.

Conclusion: Audit of our SRT plans demonstrates consistent quality for low dose distribution in the brain. If additional data is compiled, reference to a continuously updated, in‐house library of cases could be used to assess plan quality.

Radiation safety measurement practice among radiological technologists working in Dhaka city in Bangladesh

Jahirul I. Bhuiyan1, Mosharaf H. Azad1, Nasima Sultana1, Hossain Md. Mofazzal2

1Bangladesh Association of Radiology and Imaging Technologist (BARIT), Dhaka, Bangladesh 2ICDDRB,Dhaka Bangladesh, Bangladesh

Objectives: The aim of the study was to reveal the facilities, knowledge and practices of radiation safety among radiological technologists working in radio‐diagnostic centres of Dhaka city in Bangladesh.

Materials and Methods: This study was a cross‐sectional descriptive study. Data were collected by the observation of 24 radio‐diagnostic centres directly by using checklist and interview of 105 respondents were taken by using pre‐tested interviewer administered questionnaire. Collected data were analysed by using Excel and SPSS.

Results: The study found that 75.75% of respondents have sound knowledge regarding radiation protection, control and safety assuring program.1,7 The study also revealed that 7.62% of respondents have excellent knowledge, 59.05% respondents have good knowledge, 10.47% respondents have average knowledge, and 22.86% respondents have poor knowledge on radiation protection, control and safety assuring program. The availability of radiation control, safety assurance and monitoring facilities were ±57%, but only ±29% respondents were practising radiation control and safely assuring program among 24 radio‐diagnostic centres in Dhaka city, which is very poor.2–5,7

Conclusion: Poor radiation control and safety assurance program practice by radiological technologists is a barrier to insuring radiation safety in radio‐diagnostic centres in Bangladesh.

References

1. Begum Z. Entrance surface dose measurement for some of the radiological patient in Bangladesh. Bangladesh Atomic Energy Commission, Dhaka, Bangladesh: IAEA‐CN‐85‐193; 2012.

2. International Organization for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Ionizing radiation, Part I: static and extremely low‐frequency electric and magnetic fields. Vol. 80. Lyon: IARC; 2002.

3. Havas M. Electromagnetic hypersensitivity: biological effects of radiation with emphasis on diabetes and multiple sclerosis. Electromagnetic Biol Med 2006;25:259‐68.

4. Wertheimer N, Savitz DA, Leeper E. Childhood cancer in relation to indicators of magnetic fields from ground current sources. Bio‐electromagnetic 1995;16:86‐96.

5. Kavet R, Zaffanella LE, Daigle JP, Ebi KL. The possible role of contact current in cancer risk associated with resident in radiation zone. Bio‐electromagnetic 2000;21:538‐53.

6. Marks TA, Ratke CC, English WO. Stray voltage and developmental, reproductive and other toxicology problems in dogs, cats and cows: a discussion. Vet Hum Toxicol 1995;37:163‐72.

7. Begum M. Status of radiation protection in Bangladesh. BAEC, Dhaka; 2012.

Advanced medical imaging and its application in Bangladesh

Jahirul I. Bhuiyan1, Md. Shah Alam Khan1, Khaza M. Uddin1, Mosharaf H. Azad1

1Bangladesh Association of Radiology and Imaging Technologist (BARIT), Dhaka, Bangladesh

Objective: The field of medical imaging has grown tremendously due to the improvement in technologies and advancement in digital and communication system all over the world, Bangladesh is not lacking behind. For the past 5 years there has been significant advancement in the field of radiology and imaging with the introduction of cutting edge technologies along with development high tech manpower in terms medical technologists.

Methods: Advancement of medical‐imaging facilities (both government and non‐government) with the latest equipment for the different modalities throughout the country were studied by onsite visits. Data were collected from the patients, institutions and supplier of the equipment in these facilities.

Results: The development and improvement in advanced technologies is widely credited as leading to earlier and more accurate diagnoses and treatment of disease using non‐invasive or less invasive techniques. However, the new methods for improved image reconstruction, image segmentation, modelling of organs, as well as methodical improvements of non‐linear image registration algorithms, are presented together with the application of image analysis methods in different medical disciplines are also progressing in Bangladesh but this needs more effort and assistance from advanced sources.

Conclusion: Imaging modalities are helpful for accurate diagnosis and the earlier the diagnosis the better the prognosis as most diseases can be cured if detected early.

Simultaneous acute stroke and myocardial infarct: a case study

Ben McBrien1, Dean Davies1

1Princess Alexandra Hospital, Queensland, Australia

Introduction: This case presents the unusual patient story of an acute stroke presentation, immediately followed by myocardial infarct (MI). The patient received treatment of cardiac stent and endovascular clot retrieval (ECR).

Case presentation: The 80‐year‐old woman presented to the emergency department with dysphasia and decreased GCS. She was taking rivaroxaban. Non‐contrast CTA and brain perfusion imaging confirmed a cerebral embolus at the terminal internal carotid artery into M1 segment.

Management: While in the interventional radiology receiving bay, before ECR, the patient displayed signs of MI. She was then urgently transferred to the cardiac cath lab, where successful stent treatment was undertaken. After PCI, the patient returned to CT scan for another brain perfusion scan, which demonstrated the evolving stroke. The patient returned to IR and underwent successful ECR.

Outcome: With the involvement of the ED interventional radiology and cardiology, successful cardiac and neurology treatments were administered. A fine demonstration of hospital departments being ‘Better Together’.

Discussion: This case, unusually, shows brain perfusion imaging on the same patient only 2 h apart. It is a rare opportunity to compare imaging of an evolving embolic stroke.

Evaluation software of radiotherapy for oesophageal

Fang Ren1

1Xijing Hospital, Shaanxi, China

Objective: To design clinical software that can evaluate the therapeutic effect of radiotherapy on oesophageal cancer.

Materials and Methods: The software for assessment of therapeutic efficacy was developed in Windows by using Matlab programming software, which contains five modules: 3D registration and segmentation, global histogram comparison, voxel‐by‐voxel analysis, adjustable colour map and volumetric data. Therapeutic efficacy was evaluated with MRI performed before and 1 month after treatment. Imaging data of 25 patients with oesophageal cancer were analysed retrospectively. All cases underwent anatomical T2 weighted imaging and diffusion weighted imaging (DWI).

Results: The software segments 3D tumour for further analysis, demonstrates changes of apparent diffusion co‐efficient (ADC) value before and after radiotherapy, performs intuitional tumour response to treatment and computes volumetric data.

Conclusion: With high‐performance and reliability, the software helped clinical doctors to evaluate the therapeutic efficacy of radiotherapy and determine patients’ follow‐up treatment in the early postoperative period.

Radiation therapy treatment of Kaposi sarcoma using customised 3D bolus

David Jong1

1Peter MacCallum Cancer Centre, Victoria, Australia

Introduction: Kaposi sarcoma (KS) is a rare cancer that develops in HIV infected patients.1

Radiation therapy is a treatment option for KS patients.2 As a skin disease, the anatomical site can often be challenging to treat due to the rapidly changing contour and the need to optimise skin dose using various forms of bolus. 3D printed bolus is a relatively new technology that can offer an accurate alternative to traditional techniques to provide a preferred dosimetric distribution.3

Case presentation: This case presents a 39‐year‐old HIV‐positive male with a 10‐year diagnosis of KS for recommended palliative radiation therapy.* On examination, he displayed raised nodular skin lesions causing severe pain and lymphedema on both feet, resulting in poor mobility. He was initially treated with chemotherapy however due to complications treatment was ceased. The likelihood of disease progression prompted consideration for radiotherapy treatment.

Management and Outcome: The patient was prescribed 20 Gy in 10 fractions daily to each foot. A CT scan was utilised to delineate the target area. Bolus was constructed utilising data from the planning system and then fabricated using a 3D printer and evaluated against planned bolus requirements. The customised 3D bolus was then tailored to the patient's feet by employing stabilisation equipment and treated with image‐guided verification.

Discussion: 3D customised bolus enabled effective delivery of radiation therapy in the case of KS to bilateral feet. It provides a feasible solution to traditional techniques and has the potential to expand its purpose in radiotherapy.3

References

1. Sullivan RJ, Pantanowitz L, Casper C, Stebbing J, Dezube BJ. Epidemiology, pathophysiology, and treatment of Kaposi sarcoma‐associated herpes virus disease: Kaposi sarcoma, primary effusion lymphoma, and multicentric castleman disease. Clinical Infectious Diseases 2008;47(9):1209‐15.

2. PDQ® Adult Treatment Editorial Board. PDQ Kaposi Sarcoma Treatment. Bethesda, MD: National Cancer Institute. Available at: https://www.cancer.gov/types/soft‐tissue‐sarcoma/patient/kaposi‐treatment‐pdq (accessed 26 July 2018).

3. Kim SW, Shin HJ, Kay CS, Son SH. A customized bolus produced using a 3‐dimensional printer for radiotherapy. PLoS ONE 2014;9(10):e110746.

*Permission was given by the patient to publish

Comparison of soft tissue and bone‐based matching for accuracy of volumetric modulated arc therapy in laryngeal and hypopharyngeal cancers

Sze Y. Sin1, Melvin L. K. Chua1

1National Cancer Centre Singapore, Singapore

Background: Robust quality assurance is crucial in head and neck (HN) radiotherapy (RT), since inferior dosimetry has been shown to compromise survival in HN cancer patients.1 Image guidance using cone‐beam computed tomography (CBCT) has enabled precise soft tissue anatomical‐based matching of tumour targets. The accuracy of soft tissue‐based matching versus conventional bone‐based matching in HN cancer patients treated with VMAT was investigated.

Methods: 11 patients with newly diagnosed laryngeal and hypopharyngeal cancers who underwent definitive VMAT were recruited. CBCTs obtained from day 2 to 6 (N = 55) were analysed. The soft tissue matching focussed on the region of interest, including the target volume and the organs at risk (OAR) contours, while bone matching covered the anatomical vertebrae of C1–2, C5–7, the occiput and the mandible. Shifts from 3D planes (x‐, y‐, z‐axis) were recorded; soft tissue anatomical‐based matching was considered as ground truth.

Results: Significant differences were observed between soft tissue and bone‐based matching in all directions; mean differences were 0.9 mm (range 0.2–2.2 mm), x‐direction; 1.3 mm (range 0.4–4 mm), y‐direction; 1.9 mm (range 0.2–6.4 mm) z‐direction. Magnitude of shifts also differed across the 5 days, with maximum shifts observed in the z‐direction. Importantly, this discrepancy corresponded to a mismatch between treated and planned GTV targets in 5 out of 11 patients; on average of 10 of 55 reviewed CBCTs.

Conclusions: Significant discrepancy between soft tissue and bone‐based matching in laryngeal and hypopharyngeal RT were noticed. Profoundly, this inaccuracy affects tumour localisation and potentially compromises overall tumour control.

Reference

1. Peters LJ, O'Sullivan B, Giralt J, et al. Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol 2010;28.

Impact of dental splint on dose reduction to the oral cavity in head and neck patients undergoing radiation therapy

Yuen N. Y. Loh1, Desiree Chen1, Chong M. Tay2, Teng H. Tan1, Cho H. F. Ho1, Ivan W. K. Tham1

1Department of Radiation Oncology, National University Cancer Institute Singapore, National University Health System, Singapore 2University Dental Cluster, National University Hospital, National University Health System, Singapore

The aim of this IRB obtained study is to assess the utility of a dental splint in head and neck (HN) cancer irradiation during intensity modulated radiation therapy (IMRT) with the intention to reduce dose to normal surrounding healthy tissue in the oral cavity region.

We analysed the maximum and mean doses of the oral cavity of seven HN patients planned for IMRT and treated with a dental splint. Each patient had a customised dental splint consisting of a polymethylmethacrylate (PMMA) acrylic plate that was moulded from the teeth impression of either the upper of lower jaw. We simulated a plan that assumed no dental splint in place and compared the doses between the two plans. The simulated plans were done by re‐contouring the space occupied by the dental splint as the oral cavity, assuming the tongue would flop superiorly into the oral cavity space if there was no dental splint and the mouth closed. The new oral cavity was assigned an electron density of 1 and the plan recalculated. The paired Wilcoxon signed‐ranked test was used for statistical analysis, with P < 0.05 deemed as statistical significance. The maximum dose to the oral cavity with and without dental splint was 6354 and 7136 cGy respectively (P = 0.016) while the mean dose was 3704 and 3822 cGy respectively (P = 0.125).

There was a significant reduction to the maximum dose received by the oral cavity with the dental splint. Further studies simulating the patient with and without a dental splint should be conducted to validate the results.

Establishing facility dose reference levels in endoscopic retrograde cholangiopancreatography

Caitlin Haimes1, Chloe Johnston1

1Sydney Adventist Hospital, New South Wales, Australia

Endoscopic retrograde cholangiopancreatography (ERCP) is performed at Sydney Adventist Hospital (SAH) by a consultant gastroenterologist. This procedure is performed under fluoroscopic guidance assisted by a radiographer. After discrepancies in screening times (ST) between gastroenterologists were observed, concerns were raised about radiation safety and a lack of radiation protection measures. For ERCP examinations, neither National Diagnostic Reference Level (DRL) nor Facility Dose Reference Levels (fDRL) have been established by ARPANSA or SAH respectively.1

Data was collected over a 12‐month period and included total screening time, dose area product (DAP) and performing gastroenterologist and radiographer for 77 ERCP procedures. Average ST and fDRL were calculated as well as individual ST and DRL for each gastroenterologist.

An average screening time of 133.6 sec and fDRL 1507.11 μGym2 was calculated. From these calculations, one of the gastroenterologists had significantly higher recorded dose range.

It is difficult to determine the reason for a particular gastroenterologist to have higher recorded dose values. There are many potential reasons for discrepancy including experience, confidence, degree of case difficulty and lack of radiation safety knowledge.2,3 There is no correlation between radiographers and recorded dose values.

Establishing fDRLs for ERCP procedures has proven to be an effective way to provide optimal range of radiation dose to ensure radiation safety for patients and staff. This method has increased continuing education and awareness of radiation safety in ERCP. Individual DRL, fDRLs and average screening times are to be distributed to gastroenterologists and radiographers to be reviewed again in 12 months.

References

1. ARPANSA. 2018. Image guided interventional procedures DRLs in more detail. Available at: https://www.arpansa.gov.au/research‐and‐expertise/surveys/national‐diagnostic‐reference‐level‐service/igip/in‐more‐detail (accessed 27 July 2018).

2. Saukko E, Henner, Ahonen S. Radiation exposure to patients during endoscopic retrograde cholangiopancreatography: a multicentre study in Finland. Radiography 2015;21(2):131‐5.

3. Saukko E, Henner A, Nieminen M, Ahonen S. The establishment of local diagnostic reference levels in endoscopic retrograde cholangiopancreatography: a practical tool for the optimisation and for quality assurance management. Radiation Protection Dosimetry 2016;173(4):338‐44.

Surface guided positioning versus tattoos for positioning of breast cancer patients

Winnie Phong1

1ICON Cancer Centres, Victoria, Australia

Objectives: Current standard of care is to apply tiny tattoos to patients to ensure they are in the same position for treatment as they were for their planning scan. For patients with breast cancer, these markers may remind them of their diagnosis as well as reduce their body confidence and self ‐esteem.1 Surface guided radiation therapy (SGRT) is an alternative method of verifying patient position. SGRT aims to eliminate the need for permanent tattoos for patient positioning by tracking the patient's surface during set‐up and treatment. The purpose of this study is to observe if translations and rotations seen in 2D/2D image matching correlates to the shifts displayed by AlignRT (VisionRT, London, UK).

Method: Retrospectively review 2D/2D images of breast cancer patients positioned with tattoos to compare translations/rotation against values showed in AlignRT.

Results: To be presented.

Conclusion: This study shows that the translations and rotations seen in 2D/2D imaging is similar those of AlignRT in positioning of breast patients. The results are comparable to other published studies investigating surface guided patient positioning for breast set‐ups.2,3 AlignRT may help improve daily treatment set‐up for patients receiving treatment to their breast.

References

1. Clow B, Allen J. Psychosocial impacts of radiation tattooing for breast cancer patients. Can Woman Stud 2010;28:46‐52.

2. Chen A, Lyatskaya Y, Killoran J, et al. Prospective study of infrared‐guided patient setup for fractionated thoracic radiation. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2017;06(03):313‐22.

3. Walter F, Freislederer P, Belka C, Heinz C, Söhn M, Roeder F. Evaluation of daily patient positioning for radiotherapy with a commercial 3D surface‐imaging system (Catalyst™). Radiation Oncology 2016;11(1):154.

Spine phantom comparability study of Cobb angle measurement of scoliosis using digital radiographic imaging

Patrick Y.‐M. Lai1, Ni Chung1, Yi‐Hong Cheng1, Hiu‐Lam Po1, Wai‐Kit Ng1, Kam‐Ching Cheung1, Ho‐Yin Yung1

1Department of Health Technology and Informatics, The Hong Kong Polytechnic University, HKSAR, China

Objectives: Scoliosis evaluation by radiography is the mainstay method.1 This study aimed to examine the compatibility between computed radiography (CR), digital radiography (DR) and biplanar linear radiography (EOS) for scoliotic quantification by evaluating the reliability and agreement of different imaging methods and assessing the predictability of CR and DR for EOS measurement.

Methods: A flexible spine phantom was used to simulate 32 different scoliotic curves ranged 10–60°. Each curvature was imaged using DR, CR and EOS accordingly. Cobb angle was measured on each image twice by each of the six observers independently with a 2‐week interval. Intraclass correlation co‐efficient (ICC), Bland‐Altman plot and linear regression analysis were used to evaluate the reliability, agreement and prediction of Cobb angle measurement respectively.

Results: Excellent intra‐observer reliability (ICC > 0.9) and good inter‐rater reliability (ICC = 0.84 for EOS; 0.739 for CR; 0.877 for DR) for each method were obtained. Bland‐Altman plots demonstrated good limit of agreement (±5°) between imaging methods without fixed or proportional bias. Regression analyses showed coefficient of determination with 0.980 for CR versus EOS measurements, and 0.973 for DR versus EOS measurements.

Discussion: The three imaging methods enabled reliable and accurate Cobb angle measurements for scoliosis.2,3 However, the volume rendering offered by EOS is advantageous in that it allows treatment and monitoring of 3D deformity such as scoliosis.4 With the limited availability of EOS, CR and DR are demonstrated to be reliable alternatives in scoliosis monitoring as evident in the comparability of Cobb angle measurement.

References

1. Malfair D, Flemming AK, Dvorak MFet al. Radiographic evaluation of scoliosis: review. AJR Am J Roentgenol 2010;194(3 Suppl):S8‐22.

2. Pruijs J, Hageman M, Keessen W, Van Der Meer R, Van Wieringen J. Variation in Cobb angle measurements in scoliosis. Skeletal Radiology 1994;23(7):517‐20.

3. Blumer S, Dinan D, Grissom L. Benefits and unexpected artifacts of biplanar digital slot‐scanning imaging in children. Pediatric Radiology 2014;44(7):871‐82.

4. Ilharreborde B, Sebag G, Skalli W, Mazda K. Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low‐dose system. European Spine Journal 2013;22(11):2382‐91.

Detection and measurement of solitary lung nodule using sub‐millisievert low‐dose computed tomography: an anthropomorphic phantom study

Patrick Y.‐M. Lai1, Wing‐On Chong1, Cherry C.‐W. Chou1, Edwin L.‐T. Pang1, Uranus P.‐Y. Wong1, Katy Y.‐K. Yau1, King‐Kwong Chan1

1Department of Health Technology and Informatics, The Hong Kong Polytechnic University, HKSAR, China 2Department of Radiology & Imaging, Queen Elizabeth Hospital, Hong Kong, HKSAR, China

Objective: CT is effective in managing lung cancer through the recognition of nodules,1,2 while iterative reconstruction (IR) optimises image quality and radiation dose. This study aims to investigate the effects of IR with sub‐millisievert low‐dose CT protocol on image quality, nodule detection and measurement.

Methods: The American College of Radiology CT accreditation phantom and the Kyoto‐Kagaku thorax phantom Lungman were scanned using full‐dose (FD) and low‐dose (LD) CT protocols. Image quality was assessed on spatial resolution, uniformity and noise level. Observers’ performance in nodule detection was evaluated using a receiver operating characteristic (ROC) study on 200 CT images with and without a simulated solitary lung nodule. Accuracy of nodule volume measurements was compared between FDCT and LDCT images.

Results: Effective dose was 2.646 and 0.812 mSv for FDCT and LDCT protocols, respectively. Both FDCT and LDCT images showed consistent uniformity (±5 HU). Spatial resolution of FDCT and LDCT images were comparable (8.l vs. 7.l p/cm). FDCT images exhibited less noise than LDCT images (125 vs. 221 HU). Observers’ performance in nodule detection using LDCT was comparable to FDCT (area under ROC curve > 0.87, P < 0.05). There was no significant difference in nodule measurement between LDCT and FDCT images (nodule ≥5 mm, 95% confidence intervals ≤25% limit).

Conclusion: LDCT showed more image noise but comparable spatial resolution to FDCT. Sub‐millisievert thoracic LDCT with IR offered nodule detection and measurement comparable to FDCT while achieving a 69% dose reduction.

References

1. Carter BW, Lichtenberger III JP, Wu CC, Munden RF. Screening for lung cancer: lexicon for communicating with health care providers. AJR 2017;20:1‐7.

2. National Lung Screening Trial Research Team; Aberle DR, Adams AM, Berg CD, et al. Reduced lung‐cancer mortality with low‐dose computed tomographic screening. N Engl J Med 2011;365:395‐409.

A work in progress… but already a success story

Sue Greig1

1Australasian College for Infection Prevention and Control ACIPC, New South Wales, Australia

As a healthcare professional I know only too well what the diagnosis of cancer can mean.

This is a case presentation not about cancer but about teamwork. How important working as a team is to the success of the treatment and management of the disease, patient and significant others who are directly and indirectly affected.

At 88 years of age my father never thought he would be spending several months visiting radiation oncology services on a daily basis. He required radiation for cancer in his throat. It was a challenging time for all members of the family but with the support of a great care team we all emerged out the other end and now face the prospect of sustaining recovery.

None of this would have been successful if we had not had a team approach to this fight. The team was led by two key people: my father and his radiation oncologist working together to achieve the best possible outcome.

A comparison of optical coherence technology versus ‘Volcano’ in the analysis of coronary artery disease in a cardiac catheterisation laboratory

Melinda Lombardo1, Caitlyn Cook1

1Princess Alexandra Hospital, Queensland, Australia

In 2018 the Cardiac Cath Lab at the Princess Alexandra Hospital (PAH) invested in two new pieces of intravascular imaging equipment to complement and eventually replace the existing intravascular ultrasound (IVUS) machine. The first piece of equipment that was introduced was an optical coherence tomography (OCT) machine manufactured by St Jude. This widely used technology was a first for the hospital's cath lab. The second machine was a ‘Volcano’ manufactured by Phillips. The Volcano is a machine that houses multiple intravascular capabilities such as IVUS and fractional flow reserve under the same roof, eliminating the need for these two separate pieces of equipment. Since the equipment's introduction, they have been successfully utilised to assess the extent of vessel disease and to further characterise segments of plaque in effected vessels. This information in conjunction with the imaging provided by the coronary angiogram has allowed for a more thorough investigation into vessels affected with coronary artery disease and has aided in the treatment decision process and follow up imaging post‐percutaneous coronary intervention.

As both of these modalities are relatively new to the department, a literature review was conducted to assess which machine was more suitable in certain situations. A comparison of the two modalities was also investigated, identifying the positives and limitations of each machine in respect to vessel analysis. This literature review was performed in an effort to expand the clinical knowledge of the radiographers and other cardiac cath lab staff.

Contrast or bleed? Using dual energy for differentiation in post‐thrombectomy patients

Max Tomsia1, Brian Connaughton1

1Princess Alexandra Hospital, Queensland, Australia

Neurological thrombectomy cases require a 24‐h post‐procedural unenhanced CT head scan to look for haemorrhagic transformation within the infarct. High attenuation signal can frequently be seen on unenhanced CT in these patients within the core infarct and is impossible to differentiate between iodine staining or haemorrhagic transformation. Evaluation of these images has always been subjective with no true diagnosis.

Dual energy CT is an established imaging modality in differentiation of iodine and haemorrhage in high density lesions, post‐clot retrieval or after contrast administration.¹ Dual energy CT involves acquiring two simultaneous attenuation datasets at a high and low kV. The ratio of the difference in Hounsfield units in these two datasets gives us the ability to accurately differentiate different tissues. Utilising three material decomposition and iodine maps, virtual non‐contrast images are created on the Syngo VIA workstation.²

A Siemens Dual Source CT scanner was utilised to accurately differentiate between iodine staining and/or haemorrhagic transformation in patients that underwent clot retrieval (see Figure). This is a robust method of differentiating between haemorrhage and/or iodine staining.¹

The ability to accurately differentiate between iodine staining and haemorrhage in post‐thrombectomy patients in a single scan has numerous benefits. The treating team can adapt anticoagulant therapy with confidence, nursing time spent doing regular observations is greatly reduced if no haemorrhage is identified, patients can be expedited to rehabilitation wards and radiation dose from repeat scans is eliminated.

References

1. Tijssen M, Hofman P, Stadler A, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. European Radiology 2013;24(4).

2. Li JH, Du YM, Huang HM. Accuracy of dual‐energy computed tomography for the quantification of iodine in a soft tissue‐mimicking phantom. Journal of Applied Clinical Medical Physics 2015;16(5).

Usefulness of 3D magnetic resonance angiography and fluoroscopy image fusion in angiography

Shohei Mito1

1Kitahara International Hospital, Japan

Three‐dimensional (3D) image fusion technique optimises angiographic procedures. Catheterisation of cerebral vessels at aortic arch often requires iodinated contrast medium and additional fluoroscopy.

In this study, we examined the accuracy of the 3D image fusion (INNOVA IGS630 vision2, GE Healthcare, USA) of the magnetic resonance angiography (MRA) and the fluoroscopy imaging for aortic arch, and used the pre‐angiographic MRA for guidance during angiography and determined the workflow simply.

Twenty‐four patients were prepared the MRA of aortic arch before angiography. The 3D image fusion of the MRA and fluoroscopy demonstrated a high accuracy for aortic arch visualisation and successful guidance of the catheterisation in all 24 patients examined. The workflows of the angiography were determined as follows: (1) The 3D MRA of aortic arch was performed with routine MRI before angiography; (2) Distal aortic arch outline was overlaid on 2D live fluoroscopy manually. Pre‐angiographic MRA‐fluoroscopy image fusion guidance during angiography could help to support angiographic workflow while reducing exposure time and contrast media volume. Therefore, this study suggests possibility that this procedure improved the safety of patients.

Radiotherapy for non‐malignant disease: Graves’ ophthalmopathy

Beatrice Tanner1

1Northern Cancer Service, Tasmanian Health Service, Tasmania, Australia

Graves’ ophthalmopathy (GO) is a progressive autoimmune disorder of the thyroid. It results in the enlargement of the extra ocular muscle, bulging of the eyes and vision loss. Predominant treatment methods such as corticosteroids often cause severe side effects, impacting the patient's quality of life. Radiotherapy for non‐malignant diseases such as GO is used with palliative intent as an alternate treatment option to harsh corticosteroid therapies. The anti‐inflammatory and immunosuppressive effects of radiotherapy lay the foundations of the well‐established method of treatment. Radiotherapy predominantly inhibits disease progression, improves the patient's quality of life by removing the need for harsh drugs and in some cases improves vision acuity.

There is an array of differing low dose prescriptions recommended for orbital irradiation. This presentation will discuss findings from the literature regarding the utilisation of 3D conformal radiation therapy techniques and more controversial modulated approaches in GO management. Further, the rationale for the clinical delivery of orbital irradiation will be discussed along with a review of multiple cases studies, analysing their associated prescription regimens and outcomes.

Efficacy of salvage stereotactic radiosurgery for recurrent high‐grade glioma with prior radiation therapy

Mary Costantini1

1GenesisCare, Victoria, Australia

Background: Radiation therapy (RT) remains the most effective post‐operative treatment for high‐grade glioma (HGG). 90% of patients with HGG will experience recurrence soon after initial RT.1 Stereotactic radiosurgery (SRS) and fractionated SRS (fSRS) has been utilised in the management of glioma as a boost after conventional RT. Currently, median survival for HGG has remained stagnant at around 14.6 months, however current research shows the use of a boost via SRS to increase survival at the time of recurrence. This review aims to determine the efficacies of dose escalation via salvage SRS to manage recurrent HGG.

Method: A retrospective review was carried out from eight separate studies; patients underwent conventional RT in conjunction with an SRS boost for HGG after local recurrence. Primary endpoints assessed were overall survival and radiation induced toxicities. All patients underwent initial RT of up to 60 Gy and then underwent an SRS boost.

Results: The primary end point was median survival and radiation induced toxicities. From the time of initial RT to local failure was overall 7 months.3 The SRS boost given at the time of local failure, increased survival on average by 10 months.2 Low‐grade toxicities were noted such as nausea and fatigue, minimal Grade 3 toxicities such as radiation‐induced necrosis were noted.

Conclusions: Local recurrence remains the predominant pattern of failure for patients with HGG. Salvage SRS has been demonstrated to have favourable and safe outcomes for recurrent HGG.

References

1. Fogh SE, Andrews DW, Glass J, et al. Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high‐grade gliomas. J Clin Oncol Off J Am Soc Clin Oncol 201020;28(18):3048‐53.

2. Martinez‐Carrillo M, Tovar‐Martin I, Zurita‐Herrera M, et al. Salvage radiosurgery for selected patients with recurrent malignant gliomas. BioMed Res Int 2014;2014:657953.

3. Combs SE, Widmer V, Thilmann C, Hof H, Debus J, Schulz‐Ertner D. Stereotactic radiosurgery (SRS): treatment option for recurrent glioblastoma multiforme (GBM). Cancer 2005;104.

A feasibility review of deep inspiration breath‐hold treatment for gastric lymphoma

Anelyn Chui1, Ruwani Jayaweera1, Claire Goodwin1, Alison Cray1

1Peter MacCallum Cancer Centre, Victoria, Australia

Background: Deep inspiration breath hold (DIBH) offers the ability to reduce heart dose in left side breast cancers and mediastinal lymphomas.1 Similarly, the stomach is prone to respiratory induced motion, and a breath hold technique may be beneficial in reducing heart dose for gastric malignancies. Given the curative outcomes and the long life expectancy of patients with gastric lymphoma, it is proposed DIBH could be effective in reducing the risk of treatment related heart toxicity.

Method: The aim of this review was to evaluate the efficacy of using DIBH during gastric region radiotherapy to reduce heart toxicity. Given the high number of left sided breast DIBH and free breathing (FB) CT datasets available, 20 breast patients were selected as a surrogate for comparison where the scan length extended past the stomach. Retrospective analysis of the overlap between the stomach and heart in DIBH and FB states was conducted.

Results: Five patients were excluded from the analysis due to inadequate volumes. Results from the remaining 15 patients showed that the volume of overlap between stomach and heart decreased with DIBH in 80% of cases. In six patients, there was no overlap between the organs when the patient was in breath hold.

Conclusion: The review indicated that using DIBH during radiation therapy to the stomach region can reduce dose to the heart when compared with FB. Based on this analysis, it is proposed DIBH technique may be beneficial in the minimisation of heart toxicity in the treatment of gastric lymphomas.

Comparison of mammography, ultrasound and MRI in invasive ductal carcinoma: case report

Wen H. Chen1, Mei W. Su1, Mein K. Gueng1

1Taichung Veterans General Hospital, Taiwan

Purpose: To use the case to compare the visibility of invasive ductal carcinoma on digital breast tomosynthesis (DBT) images and 2D mammograms and ultrasound and MRI images.

Materials and Methods: A 44‐year‐old asymptomatic woman presented to our institution for routine screening breast study. The patient had a family history of breast cancer. Physical examination was normal.

Results: Breast appears to have abnormalities in the DBT and 2D mammograms (the BI‐RADS 0). The MOHW system recalled the patient to undergo ultrasound examination. The result was (BI‐RADS 3) so the patient made an appointment for an outpatient MRI scan (BI‐RADS 4A). Later this was confirmed as an invasive ductal carcinoma (IDC).

Conclusion: Tomosynthesis is specific for dense breasts but requires rethinking for radiation dose. Different instruments have different characteristics and blind spots, combined examination can improve their diagnostic rate.

How procedural and technical optimisations improved the quality and safety of long‐length biplanar X‐ray examinations at the Sydney Adventist Hospital

Tony Vuong1

1Adventist Healthcare, New South Wales, Australia

A dedicated bi‐planar X‐ray imaging system [EOS Imaging] uses gas filled particle detectors and slot scanning technology to produce low‐dose long length digital radiographs. It allows continuous visualisation of the whole spine and lower limbs in the erect weight‐bearing position, without geometric distortion in the cranio‐caudal direction. In 2011, Adventist Healthcare Ltd was the first organisation to install and use this system in the southern hemisphere. In the following years, several other systems have been installed at different sites across Australia. Since previous literature already exists to validate the image quality and dose saving capability of this technology, this presentation is focussed on sharing practical tips from end users at Australia's first and longest running provider of this emerging modality. This presentation describes the initial challenges we faced when implementing this new technology and how we overcame those problems. Topics covered include: advantages and limitations, contraindications, common image quality issues, safety risks and their management, common errors and adverse events. By working together with the patient, other health professionals and understanding the possibilities of new technology we truly can have a great service by being Better Together.

Hsinwei Liu1, Lian Wu1, Huichieh Hu1

1Taipei City Hospital, Heping Branch, New Taipei city, Taiwan

We report a case with a concomitant ruptured anterior communicating artery (A‐com) aneurysm and an intact left middle cerebral artery (MCA) aneurysm in an adult male, in whom the initial CT presentation was pure bilateral subdural haemorrhage (SDH) without subarachnoid haemorrhage. The SDH was noted more at right cerebral convexity. During an operation, a ruptured A‐com aneurysm adhered to the subarachnoid space with adjacent subdural haemorrhage was noted and the medial‐inferior orientation of the aneurysm may explain the distribution of SDH. The left MCA aneurysm was intact. Subsequent vitreous haemorrhage related to intracranial hypertension was also noted at the right eye. Although rare, a ruptured aneurysm should be included in the differential diagnosis of pure acute subdural haemorrhage, especially in the absence of head injury. And further studies including interventional angiography and CT angiography should be considered.

Post‐prostatectomy intra‐fraction motion management: how much do our patients move during treatment and how to decrease the risk of geographic miss

Linda Bell1, Regina Bromley1, Thomas Eade1,2, George Hruby1,2, Andrew Kneebone1,2

1Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, New South Wales, Australia 2Northern Clinical School, University of Sydney, New South Wales, Australia

Objectives: Published research into intra‐fraction motion management in post‐prostatectomy radiotherapy (PPRT) is limited and usually involves specialist equipment.1 The aim of this ethics approved retrospective study was to assess intra‐fraction motion in PPRT using cone‐beam computed tomography (CBCT) and determine how to decrease the risk of prostate bed geographic miss (GM) associated with this movement.

Methods: 46 PPRT patients were selected. Pre‐ and post‐treatment soft tissue matched CBCT scans were taken on a median of nine fractions. Twenty‐four patients (cohort 1) were assessed for intra‐fraction motion and prostate bed GM. A strategy was devised to try and reduce prostate bed GM recurrence for patients who had a GM in the first three fractions. Larger planning target volumes (PTV) were applied to these patients and the prostate bed GM rates reassessed. This strategy was retrospectively assessed on cohort 1 and on a further 22 patients (cohort 2).

Results: See Table 1. The intra‐fraction motion median (range) in all 46 patients was 0.07 cm (−1.91 to 0.84 cm) vertically, 0 cm (−0.58 to 0.70 cm) longitudinally, and 0 cm (−0.65 to 0.37 cm) laterally. Prostate bed GM was detected in 11.4% of these fractions. If the 17 patients with prostate bed GM in the first three fractions were replanned with larger PTV margins, only two patients continued to have GM.

Conclusion: Intra‐fraction motion does affect the accuracy of PPRT. Assessing the first three fractions can help to reduce subsequent prostate bed GM.

Table 1. Results of intra‐fraction motion in post‐prostatectomy radiotherapy

Reference

1. Klayton T, Price R, Buyyounouski MK, et al. Prostate bed motion during intensity‐modulated radiotherapy treatment. Int J Radiation Oncol Biol Phys 2012;84:130‐6.

Table 1. Results of intra‐fraction motion in post‐prostatectomy radiotherapy

Clinical experience of CCTA by 64‐detector‐roll CT and comparison with diagnostic coronary catheterisation

Huichieh Hu1

1Taipei City Hospital, New Taipei City, Taiwan

Objective: This study aims to compare the results of non‐invasive coronary CT angiography (CCTA) and invasive cardiac catheterisation to evaluate the accuracy of CCTA performed in our hospital, and to enhance the diagnostic reliability.

Methods: The study collected data from patients who had received CCTA and cardiac catheterisation within 1 month. The Tree VR images were review by radiologist with Advantage Workstation to analyse the diameter of coronary artery cross section. A cardiologist read the images of cardiac catheterisation. All coronary artery in both groups were divided into 15 segments. The diameter narrowing percentage of each segment were compared between each both groups.

Results: There are seven patients: six males and one female. A total of 105 sections were available in the analysis. Consistency was found in 97 segments, while discrepancy in eight segments. The accuracy rate is 92%. If the criteria are set at any vessel of 50% stenosis each person, then sensitivity of CCTA for cardiac catheterisation suggestion is 100%.

Conclusion: The results of this study highlight the fact that CCTA can be viewed as a preliminary examination to cardiac catheterisation treatment for patients who have family history or uncertain cardiovascular disease symptoms.

Planning is better together in the cloud

Paul Kane1, Billie Mudie1, Kate Chadwick1, Alannah Flockton1, Darien Montgomerie2, Sean Watson3

1University of Otago, New Zealand 2Bowen Icon Cancer Centre, New Zealand 3Varian Medical Systems, New South Wales, Australia

Background: Treatment planning skills are a central focus for the Bachelor of Radiation Therapy offered by the University of Otago. Historically, we used Eclipse™ to drive the teaching of planning skills. Maintaining a local installation of Eclipse required significant financial resources and created timetabling, equity of access and staffing pressures. In collaboration with Varian, we explored cloud delivery as a more sustainable solution. Cloud delivered applications allow users to access the product irrespective of the device they use or their geographical location.

Outcomes: Over the next 1–2 years we tested this system in our teaching and learning environment for usability, scalability and reliability in a manner not possible in clinical departments. The greatest benefit for us has been flexibility in curriculum delivery; we are no longer tied to specific equipment, in a specific physical space, at specific times. Our cloud‐delivered system met our needs and provided the manufacturer unique insights into their own product.

Discussion: The idea of remote planning is not a new one but this collaborative development has opened the door to teaching and learning opportunities previously unavailable. As a national education provider, we place students in New Zealand and Australian clinical centres. The cloud‐based planning system allows us to extend our learning environment to those geographically separated sites and foster a team approach to the students’ learning. Increasing collective learning moves future practitioners further away from ‘this is how we do it here’ and closer towards ‘this is the best way to treat my patients’.

The feasibility of implementing a tailored exercise and nutrition program for breast cancer patients receiving radiation therapy, improve QoL outcomes

Laura Feighan1

1University of Newcastle & Radiation Oncology Centres, Queensland, Australia

Introduction: Current evidence confirms the positive effects exercise and nutrition (EN) can have on an individual physically, mentally and emotionally. The quality of life (QoL) facets including anxiety, depression, fatigue, self‐esteem, sexual wellbeing, upper‐limb impairments and sleep disturbance experienced by breast cancer patients undergoing radiation therapy (RT) could be mitigated by EN if customised to suit their particular needs.1–3

Objectives: To determine the QoL experienced by breast RT patients and to suggest possible interventions to improve QoL. The survey seeks insight into patients’ EN routines, whether there have been changes due to cancer diagnosis and to assess the likelihood of patients undertaking an EN intervention during RT treatment. The survey will evaluate radiation oncology (RO) staff confidence/ability in recommending EN as an intervention.

Methods: Two surveys (one for breast RT patients and one for RO staff) will be circulated to various New South Wales and Queensland RO departments. The survey includes questions on demographic information, data on patient diagnosis and treatment focus and questions on EN before and after diagnosis.

Conclusion: We anticipate that the results from the survey will indicate that QoL is affected during RT treatment, with a range of changes to EN habits as a result. Therefore support of patients through the implementation of an EN program for breast RT patients will improve QoL. Data from this study is preliminary, further research is needed to outline the details of the EN program that would be most effective.

References

1. Cerprnja D, Maka K. Implementation of an exercise program in breast cancer rehabilitation to improve shoulder outcomes: a pilot study. The Internet Journal of Allied Health Sciences and Practice 2015;13.

2. Biddle S, Mutrie N. Psychology of physical activity determinants, well‐being and interventions. Library of Congress Cataloging in Publication Data 2008, 2nd edn.

3. Flaskerud J. Mood and food. Mental Health Nursing 2015;36:307‐10.

Which practice does the radiologic technologist follow when performing a radiographic examination quizlet?

Which practice does the radiologic technologist follow when performing a radiographic examination? Place the contact shield directly on the gonads of the patient.

What precautions should be taken by a radiographer who must perform a radiographic examination on a pregnant patient quizlet?

What precaution should a pregnant radiologic technologist take while performing radiography? 1-Place more lead strips in the grid. 2-Place the second dosimeter at the waist level. 3-Decrease the source-to-image receptor distance..

Shadow shield..

Flat contact shield..

Square-shaped shield..

Diamond-shaped shield..

What is a key component to effective communication with a patient?

Physicians may consider five steps for effective patient-centered interviewing as shown in Table 1 10. The following four qualities are important components of caring, effective communication skills: 1) comfort, 2) acceptance, 3) responsiveness, and 4) empathy 11.

Which type of wheelchair transfer does a radiologic technologist use while transferring a lightweight patient who has the ability to move from the wheelchair to the bed?

The radiologic technologist uses a standby assist type of transfer for a patient who is lightweight and has the ability to move from the wheelchair to the bed. The radiologic technologist uses the two-person lift to transfer patients who cannot bear weight on their lower extremities.

Which actions will help the radiologic technologist maintain an effective relationship with adolescent patients during a radiographic examination?

How do you want to study today?

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Contrast or bleed? Using dual energy for differentiation in post‐thrombectomy patients

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Radiotherapy for non‐malignant disease: Graves’ ophthalmopathy

Efficacy of salvage stereotactic radiosurgery for recurrent high‐grade glioma with prior radiation therapy

A feasibility review of deep inspiration breath‐hold treatment for gastric lymphoma

Comparison of mammography, ultrasound and MRI in invasive ductal carcinoma: case report

How procedural and technical optimisations improved the quality and safety of long‐length biplanar X‐ray examinations at the Sydney Adventist Hospital

Spontaneous bilateral subdural haemorrhage related to ruptured anterior communicating aneurysm: a case report

Post‐prostatectomy intra‐fraction motion management: how much do our patients move during treatment and how to decrease the risk of geographic miss

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