Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review

INTRODUCTION

Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients.

METHODS

A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis.

RESULTS

The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI.

DISCUSSION

Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate.

IMPLICATIONS FOR PRACTICE

MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients' cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI.

Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion : A Systematic Literature Review

PURPOSE

This systematic review is aimed at synthesising the literature base to date on the frequency and topographical distribution of neuroanatomical changes seen on imaging following COVID-19 invasion with a focus on both the acute and chronic phases of the disease.

METHODS

In this study, 8 databases were systematically searched to identify relevant articles published from December 2019 to March 2022 and supplemented with a manual reference search. Data were extracted from the included studies and narrative synthesis was employed to integrate the findings.

RESULTS

A total of 110 studies met the inclusion criteria and comprised 119,307 participants (including 31,073 acute and 143 long COVID-19 patients manifesting neurological alterations) and controls. Considerable variability in both the localisation and nature of neuroanatomical abnormalities are noted along the continuum with a wide range of neuropathologies relating to the cerebrovascular/neurovascular system, (sub)cortical structures (including deep grey and white matter structures), brainstem, and predominant regional and/or global alterations in the cerebellum with varying degrees of spinal involvement.

CONCLUSION

Structural regional alterations on neuroimaging are frequently demonstrated in both the acute and chronic phases of SARS-CoV‑2 infection, particularly prevalent across subcortical, prefrontal/frontal and cortico-limbic brain areas as well as the cerebrovascular/neurovascular system. These findings contribute to our understanding of the acute and chronic effects of the virus on the nervous system and has the potential to provide information on acute and long-term treatment and neurorehabilitation decisions.

Explaining the practicum experiences of diagnostic radiography undergraduates in Australia and Ethiopia using the theory of human relatedness

INTRODUCTION

Practice learning is critical to the development of clinical skills; hence placements are a major component of all pre-registration radiography programmes. Nonetheless, dissatisfaction with practicum experiences is a common reason why students consider leaving such programmes. Providing effective placements which promote retention may not only require better appreciation of students' clinical reflections, but also a more fundamental understanding of the implicit criteria they use to appraise a practicum. This study applied the theory of human relatedness (THR) to the placement experiences of radiography undergraduates to identify the evaluative mechanisms which may underpin these experiences.

METHODS

A critical realist investigative approach was employed to reanalyse data regarding the practicum experiences of stakeholders involved in undergraduate diagnostic radiography programmes at two universities in Australia and Ethiopia against the eight core THR concepts, namely connectedness, disconnectedness, parallelism, enmeshment, belonging, reciprocity, mutuality, and synchrony.

RESULTS

The findings identified all states of relatedness and processes/social competencies of the THR within the placement experiences of these stakeholders. The degree of positive relatedness a radiography student experiences within a practicum, irrespective of the setting, may affect their clinical performance.

CONCLUSION

The findings support the argument that the THR may reflect an implicit set of criteria stakeholders use to evaluate clinical encounters. Additionally, these results are congruent with earlier investigations regarding the practicum reflections of other undergraduate healthcare students.

IMPLICATIONS FOR PRACTICE

To enhance student placement experiences, it is necessary to recognise the effect a student's sense of relatedness may have on their self-efficacy and proficiency, modifying pre-practicum preparation and assessment arrangements to inhibit disconnectedness and enmeshment, avoid the need for parallelism, and better cultivate connectedness, belonging, reciprocity, mutuality, and synchrony.

Graduate competencies, employability and the transnational Radiography workforce shortage: A systematic literature review of current pre-registration Radiography education and training models

INTRODUCTION

Transnational mobility of the Radiography workforce is challenged due to issues with standardisation of current education and training models which has added to the workforce shortage. To address the growing volume, scope and complexity of clinical Radiography service delivery, educational models need to be given a critical look for transnational relevance in modern times. This study aims to synthesise the characteristics of current pre-registration radiography educational programmes linked with effective knowledge, skill acquisition, and graduate employability to address the current workforce challenges through the development of newer training models.

METHODS

Using a mixed methods systematic review approach, secondary data was obtained from an EBSCOhost search involving key databases including MEDLINE, CINAHL, Academic Search Ultimate, ScienceDirect, and SCOPUS. Themes were developed following a result-based convergent data synthesis.

RESULTS

Forty articles met the predefined inclusion criteria following the study identification and screening phases. The included studies were conducted from across diverse settings including both low- and middle-income countries (LMIC) and high-income countries (HIC). Two broad themes were developed from the findings including: 1. Factors influencing graduate employability and 2) Radiography education and training programme characteristics.

CONCLUSION

The findings highlight and advocate for an innovative model for Radiography education and underscores the significance of graduates possessing multi-modality skills, varied competencies, and effective accreditation processes for training. Prioritising alignment with industry needs and holistic skill development is vital to closing the employability gap, ultimately improving graduate skills and competencies to address workforce shortage while improving patient care outcomes.

IMPLICATIONS FOR PRACTICE

Radiography training institutions should explore the development of new innovative models for multi-modality pre-registration education. This should offer adaptable routes that align seamlessly with the evolving regulatory, technological, and clinical trends.

Research and evidence-based practice in clinical radiography: A systematic review of barriers and recommendations for a new direction

INTRODUCTION

Existing literature provides valuable insight into the application of evidence-based practice (EBP) in Radiography; however, it primarily focuses on localised, context-specific scenarios within individual countries or institutions. This review aims to systematically explore the barriers to EBP and research implementation in clinical Radiography practice internationally.

METHODOLOGY

A mixed-method systematic review was implemented to obtain data from primary studies of qualitative, quantitative and mixed-methods designs. Articles were searched between June and July 2023 from the following scientific databases: PubMed, Medline, CINAHL, Science Direct and manual search dating from 2003 to July 2023. The reviewed studies were subjected to data extraction and results-based convergent synthesis.

RESULTS

A total of 376 articles were identified through electronic database search and citation screening after the removal of duplicates. Thirty-one studies met the predetermined inclusion criteria and were included for this review. The challenges to EBP implementation in clinical Radiography are broadly themed around professional and personal obligations, motivation and organisational culture, knowledge and skill gaps, resources and opportunities, and institutional governance.

CONCLUSION

Globally, clinical radiographers perceived a high level of motivation and interest towards research activities. However, numerous barriers were reported such as insufficient time allocation for research, lack of resources, lack of research culture and inadequate research-related skills and knowledge. A transition towards greater evidence-based practice precipitates the quality of clinical Radiography services, augmenting efficiency in the workflow process and enriching patient experience.

IMPLICATIONS FOR PRACTICE

Radiography managers must develop strategies that aim to stimulate radiographers to initiate research projects. Beyond allocation of protected time, managers should inspire staff participation in research activities through implementation of effective departmental level culture and governance for quality service delivery and improved patient care.

Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review

INTRODUCTION

The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services.

METHOD

An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis.

RESULT

Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD.

DISCUSSION

This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments.

CONCLUSION

The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services.

Experiences and perceptions of men following breast cancer diagnosis: a mixed method systematic review

BACKGROUND

Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts.

METHODS

All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines.

RESULTS

Of the studies screened (n = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1-Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3-Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures.

CONCLUSIONS

Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials.

TRIAL REGISTRATION

PROSPERO Registration No. CRD42021228778.

Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice

INTRODUCTION

Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research.

METHODS

A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings.

RESULTS

A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel.

CONCLUSIONS

Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare.

IMPLICATIONS FOR PRACTICE

Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.

Vetting of medical imaging referrals: A scoping review of the radiographers' role

INTRODUCTION

Vetting and treatment verification, are now an expectation of threshold radiography competencies at qualification. Radiographer-led vetting contributes to the expedition of patients' treatment and management. However, the current state and the role of the radiographer in vetting medical imaging referrals remains unclear. This review aims to explore the current state and associated challenges to a radiographer-led vetting and offer directions for future research by addressing knowledge gaps.

METHOD

The Arksey and O'Malley methodological framework was employed for this review. This includes a comprehensive search using key terms relating to radiographer-led vetting across relevant databases: Medline, PubMed, AMED and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles were screened for eligibility and information extracted and analysed descriptively to map the available evidence.

RESULTS

1149 studies were identified with 12 articles included for this review after duplicates were removed. The findings indicate existence of some radiographer-led vetting activities in practice; however, the scope of this practice is associated with a large variance across settings. Key challenges relating to radiographer-led vetting include referral selectivity, medical professional dominance, and lack of clinical indication on referrals.

CONCLUSION

Radiographers vet various categories of referrals depending on jurisdictional policies and more clarity in regulation, advanced practice training and change in workplace culture is needed to support radiographer-led vetting.

IMPLICATION FOR PRACTICE

Radiographer-led vetting should be championed across settings through formalised training to widen the scope of advance practice and career progression pathways for radiographers as a means of ensuring optimal use of resources.

Knowledge, perceptions, and expectations of Artificial intelligence in radiography practice: A global radiography workforce survey

BACKGROUND

Artificial Intelligence (AI) technologies have already started impacting clinical practice across various settings worldwide, including the radiography profession. This study is aimed at exploring a world-wide view on AI technologies in relation to knowledge, perceptions, and expectations of radiography professionals.

METHODS

An online survey (hosted on Qualtrics) on key AI concepts was open to radiography professionals worldwide (August 1st to December 31st 2020). The survey sought both quantitative and qualitative data on topical issues relating to knowledge, perceptions, and expectations in relation to AI implementation in radiography practice. Data obtained was analysed using the Statistical Package for Social Sciences (SPSS) (v.26) and the six-phase thematic analysis approach.

RESULTS

A total of 314 valid responses were obtained with a fair geographical distribution. Of the respondents, 54.1% (157/290) were from North America and were predominantly clinical practicing radiographers (60.5%, 190/314). Our findings broadly relate to different perceived benefits and misgivings/shortcomings of AI implementation in radiography practice. The benefits relate to enhanced workflows and optimised workstreams while the misgivings/shortcomings revolve around de-skilling and impact on patient-centred care due to over-reliance on advanced technology following AI implementation.

DISCUSSION

Artificial intelligence is a tool but to operate optimally it requires human input and validation. Radiographers working at the interface between technology and the patient are key stakeholders in AI implementation. Lack of training and of transparency of AI tools create a mixed response of radiographers when they discuss their perceived benefits and challenges. It is also possible that their responses are nuanced by different regional and geographical contexts when it comes to AI deployment. Irrespective of geography, there is still a lot to be done about formalised AI training for radiographers worldwide. This is a vital step to ensure safe and effective AI implementation, adoption, and faster integration into clinical practice by healthcare workers including radiographers.

CONCLUSION

Advancement of AI technologies and implementation should be accompanied by proportional training of end-users in radiography and beyond. There are many benefits of AI-enabled radiography workflows and improvement on efficiencies but equally there will be widespread disruption of traditional roles and patient-centred care, which can be managed by a well-educated and well-informed workforce.

Clinical audit and research in radiography practice: An exploration of the English landscape

BACKGROUND

Research and clinical audit are central to the quality improvement (QI) process in healthcare; whereas research produces new knowledge, clinical audit establishes if practice is meeting set standards. Thus, radiographers have responsibility to engaging in these QI activities. This study aimed to explore radiographers' understanding, attitudes and level of involvement in clinical research and audit across England.

METHODS

A cross-sectional survey using an online questionnaire for data collection over a 6-week period was employed. The questionnaire consisted of open and closed ended questions. Participants were recruited through social media. The quantitative data obtained was analysed using Statistical Package for Social Sciences (SPSS) Version 26 (IBM Inc, Armonk, NY) whilst content analysis was used to analyse the free-response data.

RESULTS

A total of 100 valid responses were obtained after exclusion of 45 partial and/or incomplete responses. Radiographers showed a positive attitude towards involvement in research and audit with overall mean score of 3.85 (SD 0.80) and 4.01 (SD 0.80), respectively. Of the respondents, 35.7% (n = 35/98) were currently involved in clinical audit projects whilst 78.6% (n = 77/98) have previously been involved. Radiographers with postgraduate degrees were significantly more likely to have initiated research, 61.5% (n = 16/26) (p = 0.01) and to have previously been involved with research, 80.8% (n = 21/26) (p = 0.02). A significant association between radiographers' role and implementation of changes, following an audit (p = 0.03) was noted. Similarly, a significant association was noted between radiographers' role and initiation of research (p = 0.05).

CONCLUSION

Clinical radiographers in England showed a positive attitude towards research and audit. However, this did not translate into actual participation in research and audit activities.

IMPLICATIONS FOR PRACTICE

The need to stimulate clinical radiographers' interest in clinical audit and research is highlighted. Additionally, the findings support the rationale for managers to give more support including protected time to radiographers to engage in QI activities.

Normalization of impaired emotion inhibition in bipolar disorder mediated by cholinergic neurotransmission in the cingulate cortex

The muscarinic-cholinergic system is involved in the pathophysiology of bipolar disorder (BD), and contributes to attention and the top-down and bottom-up cognitive and affective mechanisms of emotional processing, functionally altered in BD. Emotion processing can be assessed by the ability to inhibit a response when the content of the image is emotional. Impaired regulatory capacity of cholinergic neurotransmission conferred by reduced M₂-autoreceptor availability is hypothesized to play a role in elevated salience of negative emotional distractors in euthymic BD relative to individuals with no history of mood instability. Thirty-three euthymic BD type-I (DSM-V-TR) and 50 psychiatrically-healthy controls underwent functional magnetic resonance imaging (fMRI) and an emotion-inhibition paradigm before and after intravenous cholinergic challenge using the acetylcholinesterase inhibitor, physostigmine (1 mg), or placebo. Mood, accuracy, and reaction time on either recognizing or inhibiting a response associated with an image involving emotion and regional functional activation were examined for effects of cholinergic challenge physostigmine relative to placebo, prioritizing any interaction with the diagnostic group. Analyses revealed that (1) at baseline, impaired behavioral performance was associated with lower activation in the anterior cingulate cortex in BD relative to controls during emotion processing; (2) physostigmine (vs. placebo) affected behavioral performance during the inhibition of negative emotions, without altering mood, and increased activation in the posterior cingulate cortex in BD (vs. controls); (3) In BD, lower accuracy observed during emotion inhibition of negative emotions was remediated by physostigmine and was associated with cingulate cortex overactivation. Our findings implicate abnormal regulation of cholinergic neurotransmission in the cingulate cortices in BD, which may mediate exaggerated emotional salience processing, a core feature of BD.

Longitudinal Structural Brain Changes in Bipolar Disorder: A Multicenter Neuroimaging Study of 1232 Individuals by the ENIGMA Bipolar Disorder Working Group

BACKGROUND

Bipolar disorder (BD) is associated with cortical and subcortical structural brain abnormalities. It is unclear whether such alterations progressively change over time, and how this is related to the number of mood episodes. To address this question, we analyzed a large and diverse international sample with longitudinal magnetic resonance imaging (MRI) and clinical data to examine structural brain changes over time in BD.

METHODS

Longitudinal structural MRI and clinical data from the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) BD Working Group, including 307 patients with BD and 925 healthy control subjects, were collected from 14 sites worldwide. Male and female participants, aged 40 ± 17 years, underwent MRI at 2 time points. Cortical thickness, surface area, and subcortical volumes were estimated using FreeSurfer. Annualized change rates for each imaging phenotype were compared between patients with BD and healthy control subjects. Within patients, we related brain change rates to the number of mood episodes between time points and tested for effects of demographic and clinical variables.

RESULTS

Compared with healthy control subjects, patients with BD showed faster enlargement of ventricular volumes and slower thinning of the fusiform and parahippocampal cortex (0.18 <d < 0.22). More (hypo)manic episodes were associated with faster cortical thinning, primarily in the prefrontal cortex.

CONCLUSIONS

In the hitherto largest longitudinal MRI study on BD, we did not detect accelerated cortical thinning but noted faster ventricular enlargements in BD. However, abnormal frontocortical thinning was observed in association with frequent manic episodes. Our study yields insights into disease progression in BD and highlights the importance of mania prevention in BD treatment.

Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems

Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.

Subcortical volumes across the lifespan: Data from 18,605 healthy individuals aged 3-90 years

Age has a major effect on brain volume. However, the normative studies available are constrained by small sample sizes, restricted age coverage and significant methodological variability. These limitations introduce inconsistencies and may obscure or distort the lifespan trajectories of brain morphometry. In response, we capitalized on the resources of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to examine age-related trajectories inferred from cross-sectional measures of the ventricles, the basal ganglia (caudate, putamen, pallidum, and nucleus accumbens), the thalamus, hippocampus and amygdala using magnetic resonance imaging data obtained from 18,605 individuals aged 3-90 years. All subcortical structure volumes were at their maximum value early in life. The volume of the basal ganglia showed a monotonic negative association with age thereafter; there was no significant association between age and the volumes of the thalamus, amygdala and the hippocampus (with some degree of decline in thalamus) until the sixth decade of life after which they also showed a steep negative association with age. The lateral ventricles showed continuous enlargement throughout the lifespan. Age was positively associated with inter-individual variability in the hippocampus and amygdala and the lateral ventricles. These results were robust to potential confounders and could be used to examine the functional significance of deviations from typical age-related morphometric patterns.

Greater male than female variability in regional brain structure across the lifespan

For many traits, males show greater variability than females, with possible implications for understanding sex differences in health and disease. Here, the ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) Consortium presents the largest-ever mega-analysis of sex differences in variability of brain structure, based on international data spanning nine decades of life. Subcortical volumes, cortical surface area and cortical thickness were assessed in MRI data of 16,683 healthy individuals 1-90 years old (47% females). We observed significant patterns of greater male than female between-subject variance for all subcortical volumetric measures, all cortical surface area measures, and 60% of cortical thickness measures. This pattern was stable across the lifespan for 50% of the subcortical structures, 70% of the regional area measures, and nearly all regions for thickness. Our findings that these sex differences are present in childhood implicate early life genetic or gene-environment interaction mechanisms. The findings highlight the importance of individual differences within the sexes, that may underpin sex-specific vulnerability to disorders.

Cortical thickness across the lifespan: Data from 17,075 healthy individuals aged 3-90 years

Delineating the association of age and cortical thickness in healthy individuals is critical given the association of cortical thickness with cognition and behavior. Previous research has shown that robust estimates of the association between age and brain morphometry require large-scale studies. In response, we used cross-sectional data from 17,075 individuals aged 3-90 years from the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to infer age-related changes in cortical thickness. We used fractional polynomial (FP) regression to quantify the association between age and cortical thickness, and we computed normalized growth centiles using the parametric Lambda, Mu, and Sigma method. Interindividual variability was estimated using meta-analysis and one-way analysis of variance. For most regions, their highest cortical thickness value was observed in childhood. Age and cortical thickness showed a negative association; the slope was steeper up to the third decade of life and more gradual thereafter; notable exceptions to this general pattern were entorhinal, temporopolar, and anterior cingulate cortices. Interindividual variability was largest in temporal and frontal regions across the lifespan. Age and its FP combinations explained up to 59% variance in cortical thickness. These results may form the basis of further investigation on normative deviation in cortical thickness and its significance for behavioral and cognitive outcomes.

Impact of the Covid-19 pandemic on clinical radiography education: Perspective of students and educators from a low resource setting

Introduction

The COVID-19 pandemic has had significant impact on clinical radiography educational activities including teaching, research, and clinical placement. The study aimed to investigate the impact of the COVID-19 pandemic on clinical radiography education in a low-resource setting from the perspectives of students and educators.

Methods

A cross-sectional online survey was conducted between December 2020 and March 2021. Participants included student radiographers and educators from six clinical radiography training institutions in Ghana. Conventional descriptive statistics, frequency, and thematic text analysis were undertaken.

Results

291 valid responses were received involving 277 students and 14 educators. Most of the respondents, predominantly students did not find the online platforms for learning user-friendly. Key challenges to clinical radiography training during the pandemic included poor internet connectivity (73.8%), inadequate time for academic discussions (50.9%), and the reluctance of health facilities to accept students for clinical placement (51%). Challenges with data collection and the provision of supervision were issues associated with research activities.

Discussion

The findings suggest the COVID-19 pandemic has had significant impact on clinical radiography education in Ghana and other countries of similar resource availability.

Conclusion

Clinical radiography training institutions need to customize approaches to education. Adopting blended learning approaches as well as the use of simulation to augment practical placement opportunities are new modes of instruction that will maximize learning experience.

Radiographer's confidence in managing patients with claustrophobia during magnetic resonance imaging

INTRODUCTION

Claustrophobia is a major problem experienced by some patients referred for magnetic resonance imaging (MRI). This results in significant costs and delays to healthcare service provision due to appointment cancellations or patients' inability to complete MRI examinations. Radiographers may use several strategies to effectively manage patients with claustrophobia during MRI. This study aimed to determine radiographer's confidence in managing patients with claustrophobia and evaluate the perceived effectiveness of the intervention approaches employed.

METHODS

With institutional ethical approval, an online survey was conducted (15th September to 9th November 2020) among Kuwaiti MRI radiographers. The survey was designed to obtain information relating to participant demographics and the perceived confidence of radiographers in their use of interventions to manage claustrophobia during MRI procedures. Data obtained were analysed using the Statistical Package for the Social Sciences (v.26).

RESULTS

A total of 144 valid responses were obtained. Of the respondents, 82% (n = 118) were confident that they could support claustrophobic patients during MRI examinations. Almost all respondents (97.9%, n = 141) employed various claustrophobia reduction and relaxation techniques to improve patient experience and increase scan completion rates. There was a significant association between radiographer's level of education (r_s = +0.18, p = 0.028) and experience (r_s = +0.33, p < 0.001) with their confidence managing claustrophobic patients. While participating radiographers considered lectures and training the most effective methods to improve their skills in managing such patients, educating claustrophobic patients prior to their MRI scan was the most effective technique for facilitating scan completion.

CONCLUSION

Kuwaiti MRI radiographers are confident in applying different claustrophobic management techniques to improve patient compliance. Patient education, through supportive discussion, prior to their MRI examination was identified as the most effective intervention for managing claustrophobia.

IMPLICATIONS FOR PRACTICE

Patient education before MRI examination is necessary to enhance their experience and optimise scan completion rates. In addition, it is essential that MR radiographers develop their practical competence in supporting patients with claustrophobia during their scans.

Radiographers' perspectives on the emerging integration of artificial intelligence into diagnostic imaging: The Ghana study

INTRODUCTION

The integration of artificial intelligence (AI) systems into medical imaging is advancing the practice and patient care. It is thought to further revolutionise the entire field in the near future. This study explored Ghanaian radiographers' perspectives on the integration of AI into medical imaging.

METHODS

A cross-sectional online survey of registered Ghanaian radiographers was conducted within a 3-month period (February-April, 2020). The survey sought information relating to demography, general perspectives on AI and implementation issues. Descriptive and inferential statistics were used for data analyses.

RESULTS

A response rate of 64.5% (151/234) was achieved. Majority of the respondents (n = 122, 80.8%) agreed that AI technology is the future of medical imaging. A good number of them (n = 131, 87.4%) indicated that AI would have an overall positive impact on medical imaging practice. However, some expressed fears about AI-related errors (n = 126, 83.4%), while others expressed concerns relating to job security (n = 35, 23.2%). High equipment cost, lack of knowledge and fear of cyber threats were identified as some factors hindering AI implementation in Ghana.

CONCLUSIONS

The radiographers who responded to this survey demonstrated a positive attitude towards the integration of AI into medical imaging. However, there were concerns about AI-related errors, job displacement and salary reduction which need to be addressed. Lack of knowledge, high equipment cost and cyber threats could impede the implementation of AI in medical imaging in Ghana. These findings are likely comparable to most low resource countries and we suggest more education to promote credibility of AI in practice.

Impact of artificial intelligence on clinical radiography practice: Futuristic prospects in a low resource setting

OBJECTIVES

Current trends in clinical radiography practice include the integration of artificial intelligence (AI) and related applications to improve patient care and enhance research. However, in low resource countries there are unique barriers to the process of AI integration. Using Ghana as a case study, this paper seeks to discuss the potential impact of AI on future radiographic practice in low-resource settings. The opportunities, challenges and the way forward to optimise the potential benefits of AI in future practice within these settings have been explored.

KEY FINDINGS

Some of the barriers to AI integration into radiographic practice relate to lack of regulatory and legal policy frameworks and limited resource availability including unreliable internet connectivity and low expert skillset.

CONCLUSION

These barriers notwithstanding, AI presents a great potential to the growth of medical imaging and subsequently improving quality of healthcare delivery in the near future. For example, AI-enabled radiographer reporting has a potential to improving quality of healthcare, especially in low-resource settings like Ghana with an acute shortage of radiologists. In addition, futuristic AI-enabled advancements such as synthetic cross-modality transfer where images from one modality are used as a baseline to generate a corresponding image of another modality without the need for additional scanning will be of particular benefit in low-resource settings.

IMPLICATIONS FOR PRACTICE

The urgent need for inclusion of AI modules for the training of the radiographer of the future has been suggested. Recommendations for development of AI strategies by national societies and regulatory bodies will harmonise the implementation efforts. Finally, there is need for collaboration between clinical practitioners and academia to ensure that the future radiography workforce is well prepared for the AI-enabled clinical environment.

Artificial intelligence in medical imaging practice in Africa: a qualitative content analysis study of radiographers' perspectives

Purpose

Studies have documented the clinical potentials of artificial intelligence (AI) in medical imaging practice to improving patient care. This study aimed to qualitatively explore the perception of radiographers relating to the integration of AI in medical imaging practice in Africa.

Methods

The study employed a qualitative design using an open-ended online instrument administered between March and August 2020. Participants consisted of radiographers working within Africa during the time of the study. Data obtained were analysed using qualitative content analysis. Six themes of concerns were generated: expectant tool; career insecurity; cost of new technology, equipment preservation and data insecurity; service delivery quality; need for expanding AI awareness.

Results

A total of 475 valid responses were obtained. Participants demonstrated a positive outlook about AI in relation to clinical quality improvement, competent diagnosis, radiation dose reduction and improvement in research. They however expressed concerns relating to the implementation of this technology, including job security and loss of core professional radiographer skills and roles. In addition, concerns regarding AI equipment maintenance, lack of awareness about AI and education and training opportunities were evident.

Conclusion

Awareness of the importance of AI in medical imaging practice was acknowledged; however, concerns relating to job security, data protection must be given critical attention for successful implementation of these advanced technologies in medical imaging in Africa. Inclusion of AI modules in the training of future radiographers is highly recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-021-01028-z.

Australian radiographers' and radiation therapists' experiences during the COVID-19 pandemic

INTRODUCTION

Radiographers and radiation therapists are key patient-facing health practitioners supporting the delivery of optimal patient care during the COVID-19 pandemic. The aim of this research was to investigate the impact of COVID-19 on clinical service delivery and well-being of these healthcare professionals in Australia.

METHODS

A cross-sectional online survey of Australian radiographers and radiation therapists was conducted in June-July 2020. The survey collected data on demographic characteristics, and the impact of COVID-19 on professional practice, infection control and workplace-related stress.

RESULTS

A total of 218 responses were received. Changes in work hours (P < 0.001) and workload (P = 0.022) were experienced due to COVID-19. Diagnostic radiographers reported increased procedural pressure on mobile radiography, computed tomography and general radiography. For radiation therapists, most pressure included areas of simulation and linear accelerator. PPE was in short supply at the start of the pandemic, and at the time of the study, shortages were identified for all PPE items. There was no difference in PPE supply reported by diagnostic radiographers and radiation therapists except for hand sanitiser (P = 0.003). Respondents experienced increased personal stress (61.4%) and anxiety (58.2%) at work due to COVID-19. In addition, their work caused increased stress to their family, partners or friends (57.4%).

CONCLUSIONS

COVID-19 has resulted in changes to clinical working patterns and service delivery. PPE shortages, as well as increased workplace-related stress, were identified. Workplaces should seek to mitigate the pandemic impact through the provision of adequate PPE for safe practice as well as implement strategies to support and enhance staff well-being.

Impact of the COVID-19 pandemic on clinical radiography practice in low resource settings: The Ghanaian radiographers' perspective

INTRODUCTION

The COVID-19 pandemic has altered the professional practice of all healthcare workers, including radiographers. In the pandemic, clinical practice of radiographers was centred mostly on chest imaging of COVID-19 patients and radiotherapy treatment care delivery to those with cancer. This study aimed to assess the radiographers' perspective on the impact of the pandemic on their wellbeing and imaging service delivery in Ghana.

METHODS

A cross-sectional survey of practising radiographers in Ghana was conducted online from March 26th to May 6th, 2020. A previously validated questionnaire that sought information regarding demographics, general perspectives on personal and professional impact of the pandemic was used as the research instrument. Data obtained was analysed using Microsoft Excel® 2016.

RESULTS

A response rate of 57.3% (134/234) was obtained. Of the respondents, 75.4% (n = 101) reported to have started experiencing high levels of workplace-related stress after the outbreak. Three-quarters (n = 98, 73.1%) of respondents reported limited access to any form of psychosocial support systems at work during the study period. Half (n = 67, 50%) of the respondents reported a decline in general workload during the study period while only a minority (n = 18, 13.4%) reported an increase in workload due to COVID-19 cases.

CONCLUSION

This national survey indicated that majority of the workforce started experiencing coronavirus-specific workplace-related stress after the outbreak. Albeit speculative, low patient confidence and fear of contracting the COVID-19 infection on hospital attendance contributed to the decline in general workload during the study period.

IMPLICATIONS FOR PRACTICE

In order to mitigate the burden of workplace-related stress on frontline workers, including radiographers, and in keeping to standard practices for staff mental wellbeing and patient safety, institutional support structures are necessary in similar future pandemics.

The radiology workforce's response to the COVID-19 pandemic in the Middle East, North Africa and India

INTRODUCTION

This study aimed to investigate the response of the radiology workforce to the impact of the coronavirus disease 2019 (COVID-19) pandemic on professional practice in India and eight other Middle Eastern and North African countries. It further investigated the levels of fear and anxiety among this workforce during the pandemic.

METHODS

A quantitative cross-sectional study was conducted using an online survey from 22 May-2 June 2020 among radiology workers employed during the COVID-19 pandemic. The survey collected information related to the following themes: (1) demographic characteristics, (2) the impact of COVID-19 on radiology practice, and (3) fear and (4) anxiety emanating from the global pandemic.

RESULTS

We received 903 responses. Fifty-eight percent had completed training on infection control required for handling COVID-19 patients. A large proportion (79.5%) of the respondents strongly agreed or agreed that personal protective equipment (PPE) was adequately available at work during the pandemic. The respondents reported experiences of work-related stress (42.9%), high COVID-19 fear score (83.3%) and anxiety (10%) during the study period.

CONCLUSION

There was a perceived workload increase in general x-ray and Computed Tomography imaging procedures because they were the key modalities for the initial and follow-up investigations of COVID-19. However, there was adequate availability of PPE during the study period. Most radiology workers were afraid of being infected with the virus. Fear was predominant among workers younger than 30 years of age and also in temporary staff. Anxiety occurred completely independent of gender, age, experience, country, place of work, and work status.

IMPLICATIONS FOR PRACTICE

It is important to provide training and regular mental health support and evaluations for healthcare professionals, including radiology workers, during similar future pandemics.

White matter microstructure and structural networks in treatment-resistant schizophrenia patients after commencing clozapine treatment: A longitudinal diffusion imaging study

This study investigates changes on white matter microstructure and neural networks after 6 months of switching to clozapine in schizophrenia patients compared to controls, and whether any changes are related to clinical variables. T1 and diffusion-weighted MRI images were acquired at baseline before commencing clozapine and after 6 months of treatment for 22 patients with treatment-resistant schizophrenia and 23 controls. The Tract-based spatial statistics approach was used to compare changes over time between groups in fractional anisotropy (FA). Changes in structural network organisation weighted by FA and number of streamlines were assessed using graph theory. Patients displayed a significant reduction of FA over time (p<0.05) compared to controls in the genu and body of the corpus callosum and bilaterally in the anterior and superior corona radiata. There was no correlation between FA change in patients and changes in clinical variables or serum level of clozapine. There was no changes in structural network organisation between groups (F(7,280)=2.80;p = 0.187). This longitudinal study demonstrated progressive focal FA abnormalities in key anterior tracts, but preserved brain structural network organisation in patients. The FA reduction was independent of any clinical measures and may reflect progression of the underlying pathophysiology of this malignant form of schizophrenia illness.

The integration of artificial intelligence in medical imaging practice: Perspectives of African radiographers

INTRODUCTION

The current technological developments in medical imaging are centred largely on the increasing integration of artificial intelligence (AI) into all equipment modalities. This survey assessed the perspectives of African radiographers on the integration of AI in medical imaging in order to offer unique recommendations to support the training of the radiography workforce.

METHODS

An exploratory cross-sectional online survey of radiographers working within Africa was conducted from March to August 2020. The survey obtained data about their demographics and perspectives on AI implementation and usage. Data obtained were analysed using both descriptive and inferential statistics.

RESULTS

A total of 1020 valid responses were obtained. Majority of the respondents (n = 883,86.6%) were working in general X-ray departments. Of the respondents, 84.9% (n = 866) indicated that AI technology would improve radiography practice and quality assurance for efficient diagnosis and improved clinical care. Fear of job losses following the implementation of AI was a key concern of most radiographers (n = 625,61.3%).

CONCLUSION

Generally, radiographers were delighted about the integration of AI into medical imaging, however; there were concerns about job security and lack of knowledge. There is an urgent need for stakeholders in medical imaging infrastructure development and practices in Africa to start empowering radiographers through training programmes, funding, motivational support, and create clear roadmaps to guide the adoption and integration of AI in medical imaging in Africa.

IMPLICATION FOR PRACTICE

The current study offers unique suggestions and recommendations to support the training of the African radiography workforce and others in similar resource-limited settings to provide quality care using AI-integrated imaging modalities.

Progression of neuroanatomical abnormalities after first-episode of psychosis: A 3-year longitudinal sMRI study

The location, extent and progression of longitudinal morphometric changes after first-episode of psychosis (FEP) remains unclear. We investigated ventricular and cortico-subcortical regions over a 3-year period in FEP patients compared with healthy controls. High resolution 1.5T T1-weighted MR images were obtained at baseline from 28 FEP patients at presentation and 28 controls, and again after 3-years. The longitudinal FreeSurfer pipeline (v.5.3.0) was used for regional volumetric and cortical reconstruction image analyses. Repeated-measures ANCOVA and vertex-wise linear regression analyses compared progressive changes between groups in subcortical structures and cortical thickness respectively. Compared with controls, patients displayed progressively reduced volume of the caudate [F (1,51)=5.86, p=0.02, Hedges' g=0.66], putamen [F (1,51)=6.06, p=0.02, g=0.67], thalamus [F (1,51)=6.99, p=0.01, g=0.72] and increased right lateral ventricular volume [F (1, 51)=4.03, p=0.05], and significantly increased rate of cortical thinning [F (1,52)=5.11, p=0.028)] at a mean difference of 0.84% [95% CI (0.10, 1.59)] in the left lateral orbitofrontal region over the 3-year period. In patients, greater reduction in putamen volume over time was associated with lower cumulative antipsychotic medication dose (r=0.49, p=0.01), and increasing lateral ventricular volume over time was associated with worsening negative symptoms (r=0.41, p=0.04) and poorer global functioning (r= -0.41, p=0.04). This study demonstrates localised progressive structural abnormalities in the cortico-striato-thalamo-cortical circuit after the onset of psychosis, with increasing ventricular volume noted as a neuroanatomical marker of poorer clinical and functional outcome.

In vivo hippocampal subfield volumes in bipolar disorder—A mega‐analysis from The Enhancing Neuro Imaging Genetics through Meta‐Analysis Bipolar Disorder Working Group

The hippocampus consists of anatomically and functionally distinct subfields that may be differentially involved in the pathophysiology of bipolar disorder (BD). Here we, the Enhancing NeuroImaging Genetics through Meta‐Analysis Bipolar Disorder workinggroup, study hippocampal subfield volumetry in BD. T1‐weighted magnetic resonance imaging scans from 4,698 individuals (BD = 1,472, healthy controls [HC] = 3,226) from 23 sites worldwide were processed with FreeSurfer. We used linear mixed‐effects models and mega‐analysis to investigate differences in hippocampal subfield volumes between BD and HC, followed by analyses of clinical characteristics and medication use. BD showed significantly smaller volumes of the whole hippocampus (Cohen's d = −0.20), cornu ammonis (CA)1 (d = −0.18), CA2/3 (d = −0.11), CA4 (d = −0.19), molecular layer (d = −0.21), granule cell layer of dentate gyrus (d = −0.21), hippocampal tail (d = −0.10), subiculum (d = −0.15), presubiculum (d = −0.18), and hippocampal amygdala transition area (d = −0.17) compared to HC. Lithium users did not show volume differences compared to HC, while non‐users did. Antipsychotics or antiepileptic use was associated with smaller volumes. In this largest study of hippocampal subfields in BD to date, we show widespread reductions in nine of 12 subfields studied. The associations were modulated by medication use and specifically the lack of differences between lithium users and HC supports a possible protective role of lithium in BD.

Impact of the COVID-19 pandemic on radiography practice: findings from a UK radiography workforce survey

OBJECTIVES

Radiographers are key patient-facing healthcare professionals involved in many aspects of patient care. The working patterns and professional practice of the radiography workforce (RW) has been altered during the COVID-19 pandemic. This survey aimed to assess the impact of the pandemic on radiography practice in the United Kingdom (UK).

METHODS

An online cross-sectional survey of the UK RW was performed (March 25th to April 26th, 2020). The survey sought information regarding 1. Demographics 2. Impact of the pandemic on professional practice 3. Infection prevention/control and 4. COVID-19 related stress. Data collected was analysed using the Statistical Package for Social Sciences (v.26).

RESULTS

A total of 522 responses were received, comprising n = 412 (78.9%) diagnostic and n = 110 (21.1%) therapeutic RW categories from across the UK. 12.5% (65/522) of the respondents were redeployed. Redeployment did not appear to contribute (p = 0.31) to work-related stress. However, fear of contracting the infection and perceived inadequate personal protective equipment (PPE) were identified as key contributors to stress during the study period. Compared to the therapeutic RW, a significantly higher proportion of the diagnostic RW identified fear of being infected as a major stressor (166/412 (40.3%) vs 30/110 (27.3%), p = 0.01).

CONCLUSION

This survey has demonstrated changes to clinical practice, in particular to working patterns, service delivery and infection prevention and control were key contributors to workplace-related stress during the pandemic.

ADVANCES IN KNOWLEDGE

Timely and adequate staff training and availability of PPE as well as psychosocial support during future pandemics would enhance quality patient and staff safety.

Cognitive and Clinical Predictors of Prefrontal Cortical Thickness Change Following First-Episode of Psychosis

The association of neuroanatomical progression with cognitive and clinical deterioration after first-episode of psychosis remains uncertain. This longitudinal study aims to assess whether i)impaired executive functioning and emotional intelligence at first presentation are associated with progressive prefrontal and orbitofrontal cortical thinning ii)negative symptom severity is linked to progressive prefrontal cortical thinning. 1.5T MRI images were acquired at baseline and after 3.5 years for 20 individuals with first-episode psychosis and 18 controls. The longitudinal pipeline of Freesurfer was employed to parcellate prefrontal cortex at two time points. Baseline cognitive performance was compared between diagnostic groups using MANCOVA. Partial correlations investigated relationships between cognition and negative symptoms at baseline and cortical thickness change over time. Patients displayed poorer performance than controls at baseline in working memory, reasoning/problem solving and emotional intelligence. In patients, loss of prefrontal and orbitofrontal thickness over time was predicted by impaired working memory and emotional intelligence respectively at baseline. Moreover, exploratory analyses revealed that the worsening of negative symptoms over time was significantly related to prefrontal cortical thinning. Results indicate that specific cognitive deficits at the onset of psychotic illness are markers of progressive neuroanatomical deficits and that worsening of negative symptoms occurs with prefrontal thickness reduction as the illness progresses.

Progressive subcortical volume loss in treatment-resistant schizophrenia patients after commencing clozapine treatment

The association of antipsychotic medication with abnormal brain morphometry in schizophrenia remains uncertain. This study investigated subcortical morphometric changes 6 months after switching treatment to clozapine in patients with treatment-resistant schizophrenia compared with healthy volunteers, and the relationships between longitudinal volume changes and clinical variables. In total, 1.5T MRI images were acquired at baseline before commencing clozapine and again after 6 months of treatment for 33 patients with treatment-resistant schizophrenia and 31 controls, and processed using the longitudinal pipeline of Freesurfer v.5.3.0. Two-way repeated MANCOVA was used to assess group differences in subcortical volumes over time and partial correlations to determine association with clinical variables. Whereas no significant subcortical volume differences were found between patients and controls at baseline (F(8,52) = 1.79; p = 0.101), there was a significant interaction between time, group and structure (F(7,143) = 52.54; p < 0.001). Corrected post-hoc analyses demonstrated that patients had significant enlargement of lateral ventricles (F(1,59) = 48.89; p < 0.001) and reduction of thalamus (F(1,59) = 34.85; p < 0.001), caudate (F(1,59) = 59.35; p < 0.001), putamen (F(1,59) = 87.20; p < 0.001) and hippocampus (F(1,59) = 14.49; p < 0.001) volumes. Thalamus and putamen volume reduction was associated with improvement in PANSS (r = 0.42; p = 0.021, r = 0.39; p = 0.033), SANS (r = 0.36; p = 0.049, r = 0.40; p = 0.027) and GAF (r = -0.39; p = 0.038, r = -0.42; p = 0.024) scores. Reduced thalamic volume over time was associated with increased serum clozapine level at follow-up (r = -0.44; p = 0.010). Patients with treatment-resistant schizophrenia display progressive subcortical volume deficits after switching to clozapine despite experiencing symptomatic improvement. Thalamo-striatal progressive volumetric deficit associated with symptomatic improvement after clozapine exposure may reflect an adaptive response related to improved outcome rather than a harmful process.