Developing and evaluating an undergraduate radiology teaching programme

Abstract

Clinical Radiology 69 (2014) S1eS9 S6 HSG demonstrates the contour of the uterine cavity, the Fallopian tubes and the degree of intra-peritoneal contrast spillage. It can detect congenital anomalies, malignancies, submucosal fibroids, polyps, adhesions, adenomyosis, hydrosalpinx and SIN. The main contraindications are pregnancy, active pelvic inflammation, PV bleeding and recent uterine or tubal surgery. Complications include abdominal cramping, PV spotting, pelvic infection and contrast reaction. HSG is performed in the first half of the menstrual cycle thus reducing the incidence of intravasation of contrast. A vaginal speculum is inserted with the patient in the lithotomy position followed by cervical catheterisation. Contrast is then injected under fluoroscopic guidance. A typical examination includes frontal views of the pelvis with spot images demonstrating the uterine endometrial contour, filled fallopian tubes and bilateral intraperitoneal contrast spillage. We present a historical overview of the procedure and a pictorial review of the equipment used and the common pathologies encountered as well as some rare and unusual cases. Developing and evaluating an undergraduate radiology teaching programme Authors: Collette L. Stadler*, Shishir Karthik, Chirag N. Patel, Raneem Albazaz, Fahmid U. Chowdhury Purpose: To develop and evaluate a new radiology teaching programme for medical students based on the RCR undergraduate curriculum (2012). Methods and materials: Using Kern’s 6-step curriculum development approach, a programme of 12 one-hour, weekly small-group teaching sessions was delivered by a faculty of 10 consultant radiologists in a radiology academy setting to a targeted group of learners (5th yearmedical students). Two complete cycles of the programmewere evaluated through feedback questionnaires, attendance records and a final assessment. Results: The instructional programme was well received by students as indicatedby the feedback scoresona Likert 5-point scale,with amean ( SD) overall rating for the sessions of 4.6 ( 0.4) out of 5. This was maintained in the second cycle of the programme, while mean student attendance increased by 56%. The majority of students (94%) ’strongly agreed’ that the programmehad increased their knowledgeof radiology.At thefinal informal assessment held at the end of both teaching cycles, using problem-based learninganda singlebest answer format, participants achieveda satisfactory mean ( SD) score of 75( 12)% and 72( 6)%, respectively. Conclusion: It is feasible for a team of radiologists to organise and deliver a focused programme of radiology teaching, based on the RCR undergraduate curriculum, to a targeted group of undergraduate medical students in order to improve their knowledge of clinical radiology. What can be learnt from twelve thousand plain films? Authors: Martin Hennessy*, Nigel Raby Purpose: At Glasgow’s Western Infirmary, Emergency Department practitioners electronically tag radiographs with a ’sticky note’ to inform the reporting radiologist of their interpretation of the image. One year’s data were reviewed to determine whether this process had a beneficial impact on patients’ care or on the interpretation accuracy of the practitioners. Methods and materials: All data were obtained from the Radiology Information System and where necessary, Clinical Portal. Any discrepant reports were further investigated by looking for follow-up radiographs, Emergency Department attendances, orthopaedic clinics or procedures. Results: 12,341 radiographs (excluding chest and abdominal radiographs) were performed. 165 clinically relevant errors were detected. Most errors were made when evaluating the upper limb, specifically the hand and * Guarantor and correspondent: Collette L Stadler * Guarantor and correspondent: Martin Hennessy * Guarantor and correspondent: Michael Kay * Guarantor and correspondent: Yasmin Khaleghi wrist. Proportionally ’sticky notes’ were least often submitted for spine radiographs. There was some evidence of improved accuracy over the course of a year, with the fewest errors being in July the end of the academic year for most trainees. Conclusion: ’Sticky notes’ allow quick detection of clinically significant errors in initial interpretation of radiographs in the Emergency department. This clear benefit to patients is supplemented by improved accuracy in plain film interpretation by Emergency Department practitioners, in terms of fewer missed fractures. What effect does the dual-energy CT dose penalty have in practice? Authors: Michael Kay*, Katherine J. Bevan, David J. Breen Purpose: Dual energy CT tools such as iodine mapping and virtual unenhanced studies remain underutilised at our institution due to a perceived radiation penalty. We have compared doses incurred using conventional & dual energy scanning during our practice for an identical clinical indication. Methods and materials: To allow dose comparison, two comparable protocols for follow up after renal tumour cryoablation were chosen, one of which is a dual energy protocol. Conventional CT; Non-contrast renal, late arterial chest & abdomen, PV abdomen & pelvis. Dual Energy CT; Conventional late arterial chest, dual energy (arterial) renal, conventional PV abdomen & pelvis. Data from May 2010eDecember 2013 was collected retrospectively. 24 conventional CTs (from the same scanner) & 29 dual energy CTs were included. Total DLP and DLP values for individual phases were recorded from the PACS record. Patient width & depth at the level of the right renal artery were measured as a surrogate for patient size. Results: Total dose using the dual energy protocol was lower for thinner patients but there is an approximate patient abdominal circumference, 38.5 inches, above which conventional CT then yields a lower dose and the average dose/patient size curves for the different scanning techniques diverge. Conclusion: We have demonstrated there is a dose reduction using this dual energy protocol for thinner patients. Doses for larger patients can be significantly higher with dual energy scanning. Study of radiological imaging cost awareness Authors: Yasmin Khaleghi*, Pierre Dutey-Magni, Dylan Tsukagoshi Purpose: To determine the cost awareness of common radiological studies among referrers. The extent by which referrers under/over-estimate imaging tariffs is quantified and aims to identify variations between different staff groups and specialities. Methods and materials: An online survey (n 1⁄4 263) was conducted among clinical staff working at the Royal Free Hospital (N 1⁄4 1126) to estimate the average assumed costs of imaging and dispersion of responses. The sample was selected from the HR employee database and stratified by staff group and speciality. Respondents estimated the 2012-13 NHS tariff for 8 common imaging investigations. Their views on financial aspects of radiological investigations and training needs were requested. Results: Provisional results (38.2% of the target sample) suggest a strong tendency to overestimate NHS tariffs; approximately 83% for chest XRays, 200% for abdominal X-Rays/barium swallows and 150% for other procedures. On average and across all procedures, consultants and foundation trainees have the lowest dispersion and highest accuracy, whilst speciality trainees and non-medical referrers exhibit higher error in their responses.