An evaluation of paediatric projection radiography in Ireland

Radiographers' perceptions on the quality of managing general radiographic paediatric examinations through the use of a reflective tool

INTRODUCTION

Paediatric patients are a vulnerable population that require additional care by healthcare professionals. Quality managing these examinations ensures that effective and quality care is provided to individual patients, whilst encouraging consistency within the medical imaging department. This study explored radiographers' perspectives on quality management strategies of general radiographic paediatric examinations using a paediatric imaging reflective checklist.

METHODS

A quantitative descriptive research design with qualitative questions was used through a purposive sampling method from both public and private Australian diagnostic imaging qualified radiographers who had experience in paediatric imaging examinations. The paediatric imaging service reflective tool consisted of 65 items in total. Data analysis entailed Microsoft Excel version 16.16.6 and Jamovi version 2.3.21 for the closed-ended questions and for the open-ended responses a thematic analysis.

RESULTS

The participation rate was 13.2% and the most significant findings were: lead shielding was still being used at their organisation, despite recent recommendations to suspend its use; access to paediatric patient related information resources is limited; there was no involvement of families and communities regarding policy development or quality improvement measures as advocated in literature; and there was a need for enhanced specialised paediatric education, training and protocols.

CONCLUSION

Using the paediatric patient-centred imaging reflective checklist, radiographers had an opportunity to identify quality improvement indicators as well as issues that could further enhance best practice principles. Further studies could inform on the validity of this reflective tool.

Typical median effective radiation doses using an anthropomorphic bone fracture phantom for initial radiographic skeletal surveys in the investigation of suspected physical abuse

BACKGROUND

A series of 31 radiographs is recommended by the Royal College of Radiologists (RCR) when investigating suspected physical abuse (SPA).

OBJECTIVE

To determine the radiation dose delivered for skeletal surveys performed for SPA in Victorian radiology departments based on their local protocols.

MATERIALS AND METHODS

A 5-year-old paediatric bone fracture phantom was radiographed at five radiology sites using both the RCR recommended protocol and, where applicable, the local departmental SPA protocol. The radiation doses were measured and recorded. These were scaled down to estimate the effective radiation doses for a 2-year-old child at each site and the associated radiation risks estimated.

RESULTS

The median effective dose for all radiographic projections in the RCR skeletal survey radiographic series was 0.09 mSv. The estimated risk of radiation-induced cancer and radiation-induced death from cancer for 2-year-old children is classified as "very low," with girls having a higher risk than boys.

CONCLUSION

The median effective radiation dose for the RCR skeletal survey for imaging in SPA was 0.09 mSv resulting in a "very low" additional risk of radiation-induced cancer. The authors will now aim to ascertain whether whole-body CT skeletal survey can replace the radiographic series for imaging in SPA while maintaining a comparable radiation dose.

The Use of Digital Side Markers (DSMs) and Cropping in Digital Radiography

INTRODUCTION

This article explores two phenomena in the general radiography environment-the increasing use of digital side markers (DSMs) by radiographers and the possibility for radiographers to "crop" radiographs post-exposure. This article offers originality by identifying the rationales of radiographers when using digital equipment.

METHODS

This study formed part of a larger ethnographic study undertaken in the United Kingdom (UK). Participant observation and semi-structured interviews were used. Overt participant observation identified cropping and DSM placement within the X-ray room. Semi-structured interviews later supported and/or refuted the rationale for DSMs and cropping clinically.

RESULTS

Two themes are discussed. First, radiographers support the use of DSMs by suggesting that mistakes will happen regardless of using an ASM and/or DSM. Furthermore, it is proposed that ASMs and DSMs can be interchangeably used in practice. Second, radiographers acknowledge the use of cropping ensuring their radiographs resemble "a textbook image." This leads to question the optimum use of collimation in the clinical environment and how it may go unnoticed.

CONCLUSION

This article concludes by recognizing some challenges digital radiography currently provides. The rationale and continuing use of DSMs and cropping of radiographs by radiographers highlights alternate complexities with digital technology in the clinical environment and how we may best overcome such challenges that influence the profession.

Image-Guided Radiotherapy in Paediatrics: A Survey of International Patterns of Practice

BACKGROUND AND PURPOSE

Image-guided radiation therapy (IGRT) is widely used in the treatment of various tumour types in both adult and paediatric patients. However, there are no international guidelines on its optimal use in paediatric radiotherapy. This study proposes to evaluate the current patterns of practice regarding IGRT policy in paediatric patients compared with adult patients through an international survey.

MATERIALS AND METHODS

A five-item questionnaire was created to address IGRT protocols for paediatrics and adults. International Paediatric Radiation Oncology Society members were eligible to partake and were contacted via email (number = 119).

RESULTS

Forty-three members have responded to the survey. Most (65%) centres did not have separate written IGRT protocols for paediatric and adult patients. The imaging frequency used was the same for adults and paediatrics in up to 74% of the centres responded, and scanning parameters used were different in adults and paediatrics in 47% of the centres for central nervous system treatment. Different measures to decrease exposure dose from IGRT in paediatrics have also been explored.

CONCLUSION

Despite the extensive use of IGRT internationally, most centres use a series of site-specific protocols that fail to consider patient age or size. Given the desire to reduce radiation exposure in the paediatric patient cohort, further research is warranted to develop consensus guidelines on optimal IGRT use.