Radiation Technologists Research Articles

The radiographer's perspective on X-ray examinations in potentially pregnant patients; results of a focus group study among Dutch radiographers

IntroductionThe Netherlands does not have a national guideline for performing radiographic examinations on pregnant patients. Radiographic examination is a generic term for all examinations performed using ionizing radiation, including but not limited to radiographs, fluoroscopy and computed tomography. A pilot study amongst radiographers (Medical Radiation Technologists (MRTs)) showed that standardized practice of radiographic examinations on pregnant women is not evident between Radiology departments and that there is a need for a national guideline as the varying practice methods may lead to confusion and uncertainty amongst both patients and MRTs. MethodsFocus groups consisting of MRTs from several Radiology departments within the Netherlands were used to map ideas and requirements as to what should be included in the national guideline. Nine focus group sessions were organized with a total of 52 participants. Using a previous review (Wit, Fleur; Vroonland, Colinda; Bijwaard H. Pre-natal X-ray exposure and the risk of developing paediatric cancer; a systematic review of risk factors and a comparison of international guidelines. Health Physics 2021; 121 (3):225–233), the following key points were chosen as discussion topics for the focus group sessions: dose reduction, confirming pregnancy and risk communication. ResultsResults showed that the participating MRTs did not agree on the use of lead aprons. That the national guideline should include standardized methods to adjust parameters to decrease radiation dose. Focus group participants find it difficult to ask a patient's pregnancy status, especially when dealing with relatively young and old (er) patients. When communicating the level of risk associated with a radiographic examination the participating MRTs would like to be able to use examples and comparisons, preferably by means of a multilingual website. ConclusionA national guideline must include information on justification, available alternatives, dose reductions methods and confirmation of pregnancy requirements when fetal dose is a significant risk. Implications for practiceA national guideline ensures standardized practice can be implemented in Radiology departments, increasing clarity of the issues for both patients and MRTs.

Two-stage collaborative group testing does not improve retention of anatomy among students studying medical radiation technology

IntroductionTwo-stage collaborative group testing is an assessment format where students first complete a summative assessment independently, and then immediately convene in a small group to complete the same assessment again. Research on two-stage collaborative group testing has shown that it increases immediate learning, improves communication and teamwork, and can lead to enhanced retention of course material; the latter of which is especially important for basic anatomical concepts among health care professionals such as medical radiation technologists. However, such previous research has often employed quasi-experimental designs that may limit both internal and external validity. MethodsUsing a randomized crossover design with both quantitative and qualitative data analyses including robust intra-individual statistical comparisons, this research compared the educational impact of the two-stage collaborative group testing format (the COL condition) to traditional independent testing (the IND condition). Students (n=196) from two successive renditions of an introductory anatomy course were randomly assigned into groups of 3-5 students. Groups worked together throughout the term on various course elements, including three in-class, non-cumulative term tests (TTs). After practicing the collaborative format during TT1, during TT2 half the groups were assigned to the COL condition while the other half were assigned to the IND condition. Groups crossed over for TT3. All students completed a cumulative final examination independently, with performance data from that examination coded and extracted according to previous TT condition. Educational impact was evaluated as both immediate learning (by comparing IND and COL performance on the associated TT) as well as retention (by comparing final examination performance for topics previously IND tested versus previously COL tested). Students' qualitative reflections were coded into categories and juxtaposed against quantitative Likert-style feedback to comprehensively explore students’ perception of the testing format for evidence of enjoyment, acceptability, and influence on relevant CAMRT professional competencies. Results167 students (85%) consented to data inclusion, with a final course grade of 75.5 ± 10.0%. On average, TT performance was 13.6 ± 11.6% greater on the COL test (90.4 ± 7.6%) than the IND test (76.7 ± 14.3%) (p<0.01, r = 0.76), results that support immediate learning. Contrary to expectations, final examination performance specific to the two experimental conditions was similar, with students earning an average of 69.6 ± 18.3% on questions that pertained to material they were previously IND tested on, and 67.4 ± 19.1% on questions they were previously COL tested on (ns). Students' overall perceptions of the two-stage collaborative group testing format were overwhelmingly positive, with 84% indicating a belief that the format was a constructive learning opportunity and 74% recommending continued use. Written reflections revealed that students believed that collaborative testing enhanced their learning by both clarifying previous mistakes and reinforcing correct knowledge. Relevant CAMRT professional competencies included oral communication and interprofessional skills, capacity for productive teamwork, and collaborative practice. SignificanceAlthough the results of this study do not support the use of two-stage collaborative group testing for retention of course material, they simultaneously reveal how the testing structure may be uniquely beneficial to students studying within the field of medical radiation sciences while also presenting a pragmatic example of how to implement this unique testing format.

Leading into the future: Revising nuclear medicine education across Canada to satisfy the newly imposed CAMRT leadership competency

IntroductionThe adoption of the CanMEDS framework into the 2024 competency profiles established by the Canadian Association of Medical Radiation Technologists (CAMRT) requires an increased focus on leadership education and training of student medical radiation technologists (MRTs). MethodsA literature review was used to explore current MRT novice leadership and to identify content that should be incorporated into Canadian nuclear medicine curricula to meet the leadership component of the CanMEDS framework. A table, summarizing leadership education currently provided in English-speaking Canadian nuclear medicine programs, is provided. ResultsA gap in leadership preparedness for medical radiation technologists as well as inconsistencies in leadership education within Canadian nuclear medicine curricula were identified. Content inclusions for leadership education is also provided. DiscussionRecommended content and strategies to revise MRT curricula are offered to enable effective healthcare leadership by MRTs. A specific focus on leadership areas such as technology adoption, radiation safety, and professional advocacy is recommended. The implications for nuclear medicine practice and education are described. ConclusionStandardized leadership education in nuclear medicine and medical radiation technology education will ensure MRTs are equipped with the skills required to lead effectively.

Estimation of the Need for Radiation Therapy Services According to the Incidence of Cancer in Colombia to 2035

PurposeTo estimate the supply and demand of current and future radiation therapy services by 2035 for Colombia. Methods and MaterialsThe present study was performed by surveying different radiation therapy services identified in Colombia through the Colombian Association of Radiation Oncology. The demand was estimated based on incident cases and published information on the use of radiation therapy by type of cancer. Future demand was estimated under the assumption that incidence rates do not change and therefore the change in the number of cases is due to the change in the age structure of the Colombian population. Sensitivity analyses were conducted on the percentage of radiation therapy use by type of cancer. A Monte Carlo simulation was carried out to estimate the distribution of cases requiring radiation therapy, the amount of equipment, and the number of staff needed for care with the use of this technology. ResultsIn total, Colombia has 69 linear accelerators, 2 radiosurgery equipment, 30 high-dose-rate brachytherapy pieces of equipment, 124 radiation therapy oncologists (113 working, 9 not working, and 2 not informed), and 275 radiation therapy technologists as of June 2020. It was estimated that to meet the current cancer burden the country would need a total of 162 radiation therapy oncologists, 121 medical physicists, and 323 radiation therapy technologists and to increase the number of radiation therapy technologists, radiation therapy oncologists, and medical physicists to 491, 246, and 184, respectively, to meet the disease burden by 2035 (73,684-88,743 cases per year). ConclusionsIn Colombia it is estimated that there is a deficit of human resources and technology for radiation therapy; therefore, there is need to investment resources from the public and private sectors to provide timely and quality care to cancer patients requiring this treatment.

PO-1988 Designing a radiation therapy technologist training program for online adaptive Radiation Therapy

PO-1988 Designing a radiation therapy technologist training program for online adaptive Radiation Therapy

OC-0314 Panoptes - a novel tool for teaching organ at risk delineation to radiotherapy technologists

OC-0314 Panoptes - a novel tool for teaching organ at risk delineation to radiotherapy technologists

OCCUPATIONAL DOSE ASSESSMENT FOR NUCLEAR MEDICINE AND RADIOTHERAPY TECHNOLOGISTS IN SAUDI ARABIA.

This study estimated the occupational radiation dose received by nuclear medicine and radiotherapy technologists in Saudi Arabia. A retrospective analysis of personal dosemetry data of 1243 nuclear medicine and radiotherapy technologists from 28 medical centers across Saudi Arabia from 2015 to 2019 was conducted. Thermoluminescent dosemeters were employed to monitor the occupational radiation dose. For the study period, the average annual values for nuclear medicine and radiotherapy technologists were found to be 1.22mSv (SD=1.00mSv) and 0.73mSv (SD=0.40mSv) for Hp(10) and 1.23mSv (SD=1.07mSv) and 0.72mSv (SD=0.41mSv) for Hp(0.07), respectively. The work routines of nuclear medicine technologists cause them to be exposed to higher radiation doses than radiotherapy technologists. The occupational doses for all technologists were found to be below the annual dose limits, which indicates satisfactory working conditions in terms of radiation protection.

Determining pregnancy status

In April 2019, the American Association of Physicists in Medicine (AAPM) recommended the discontinuation of gonadal and fetal shielding as routine practice [1]. Recently, the Canadian Association of Medical Radiation Technologists (CAMRT) released a similar position statement echoing the recommendation of the AAPM [2]. Position statements from national bodies help initiate change in our profession. Position statements consolidate the latest research on relevant topics and can propel implementation of new recommendations in practice.

Training of radiation therapy technologists in Asia-Pacific region low and middle income countries.

Training of radiation therapy technologists in Asia-Pacific region low and middle income countries.

Bridging the Radiotherapy Education Gap in Africa: Lessons Learnt from the Cape Town Access to Care Training Programme Over the Past 5 Years (2015-2019).

The role of radiotherapy (RT) in cancer care is well described, with a clear correlation between access to radiotherapy and overall survival. Cancer mortality rates in Africa are substantially higher than those of the rest of the world, which may be partly attributed to lack of RT access and insufficient human resources. The Access to Care (A2C) Cape Town RT training programme was created in 2014 with the aim of supplementing practical RT training in the region, focusing on clinics moving from 2 to 3D conformal radiotherapy (3DCRT). The programme makes use of hybrid teaching methods, including pre-course e-learning followed by 17 on-site days of free-thinking design exercises, didactic learning, hands-on treatment planning computer sessions (39% of total teaching time), virtual simulation training and departmental demonstration sessions. Email support is offered to all teams for 3 months after each course to develop clinical protocols. Thirteen teams (radiation oncologist, medical physicist and radiation therapy technologist) from Africa attended the course between 2015 and 2019, with additional participants from seven South African and four international centres. E-learning done on the LäraNära training platform was only successful once formal progress tracking was introduced in 2019 (34% vs. 76% test completion rate). Delays between course attendance and initial clinical use of equipment proved to be detrimental to knowledge retention, with some centres having to send a second team for training. The course will be modified for remote teaching in 2021, to make provision for the global changes in travel due to Covid-19.

Musculoskeletal symptoms among radiation technologists in Saudi Arabia: prevalence and causative factors.

Radiation technologists usually perform several physical tasks as part of their work routine that are related to imaging equipment and handling patients. These kinds of physical activities increase their risk of developing musculoskeletal symptoms (MSS). To determine the prevalence and causative factors of MSS among radiation technologists in Saudi Arabia. A previously validated and published questionnaire was sent electronically to 800 radiation technologists in Saudi Arabia. It focused on the presence and prior diagnosis of MSS. Questions to determine risk factors were included. A total of 381 responses were obtained. MSS were indicated by 326 responders (85.6%). Furthermore, it was reported that 309 responders (81.1%) spent more than 2 h per day in awkward postures. Of the responders, 164 (43%) stated that they worked 4 h per day on a personal computer or PACS. The most frequently selected reasons for MSS included patient transfer (50.6%), chairs (38.5%), lead aprons (25.6%), moving heavy equipment (23.1%), and fixed table height (19.4%). An association between work-related MSS and gender was observed (χ2(1) = 5.338; P = 0.021). Similarly, an association between work-related MSS and age was also observed (χ2(3) = 48.58; P = 0.000). Radiation technologists in Saudi Arabia reported a fairly high incidence of MSS, more commonly among female and senior workers. To have a better and safer workplace for radiation technologists, this study suggests preventive measures on organizational and individual levels.

Understanding diagnostic test accuracy studies and systematic reviews: A primer for medical radiation technologists

Diagnostic test accuracy studies are performed in order to determine the value of a diagnostic test. Primary studies of diagnostic accuracy describe the accuracy of a test calculated using the number of true and false positive and negative cases of a given diagnosis of interest. Systematic reviews of diagnostic test accuracy are performed to identify accuracy of a test but also to investigate where the test might sit in a diagnostic pathway or determine how different tests compare against each other. This introductory discussion paper aims to give the reader an overview of the various features in primary and secondary diagnostic test accuracy study designs for medical imaging professionals.

A Canadian experience of palliative advanced practice radiation therapy TIPS: Training, implementation, practice and sustainability.

The concept of the Advanced Practice Radiation Therapist (APRT) was created in 2004, in response to pressures on the radiation treatment sector in Ontario. This led to development, piloting and integration of the Clinical Specialist Radiation Therapist (CSRT) into Ontario’s cancer care framework. A national certification process, competency profile and protected title of APRT(T) were established in 2017, under the Canadian Association of Medical Radiation Technologists (CAMRT), in collaboration with Cancer Care Ontario/Ontario Health. This report describes the approach to development, validation and measuring impact of the CSRT role in Ontario, specifically in palliative care (pCSRT). It also presents information to assist jurisdictions interested in developing a pCSRT position, describing competency development, assessment, and assumption of practice, and providing some keys to success. This is foundational for consistent expansion of the pCSRT role to other regions to continue to increase system capacity while improving the quality of cancer care.

Medical physicists in radiology – present status in AFOMP region

The wide use of ionization radiation in healthcare and increasing high radiation procedures like computed tomography [CT] and interventional radiology [IR] procedures have raised serious safety and health concerns for both patients and health professionals necessitating establishment of a radiation protection culture. Responsibilities for radiation protection in the imaging team lies on the radiologists, radiation technologists and medical physicists. However the role of the medical physicist [MP] in radiology imaging is not as well established as it is in radiation oncology. In radiation oncology, clinical medical physicists are mandatory by law but many radiology departments currently operate without MP, though international standards and requirements mandates the role of the MP in radiation protection in radiology. The Asia Oceania Federation of Organizations for Medical Physics [AFOMP] has 19 National Member Organizations [NMO] as members and 2 NMO’s as affiliate members from Asia–Pacific region covering about 4.5 billion population with majority of countries are less-developed countries with lack of appropriate infrastructure and funding, lack of regulations regarding requirement of MPand, awareness of radiation protection. We have carried out survey by sending a questionnaire to AFOMP member countries to get the information about number of MP in radiotherapy, radiology and related details. We have received response from 21 countries, the data collected is analyzed and found that 16/21 counties have MP in radiology and number of MP vary from 0.94% to 69.9% as compared 21/21 countries having MP in radiotherapy varies from 16.7% to 94.4%.

The role of radiation therapy technologist in interventional radiotherapy (brachytherapy) in Italy: Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Association of Radiation Therapy and Medical Physics Technologists (AITRO) joint project.

PurposeInterventional radiotherapy (IRT, brachytherapy and intra-operative radiotherapy) is a complex treatment approach that requires a multi-professional approach. The aim of this work was to assess the role of radiation therapy technologist (RTT) in IRT team, with a special focus on brachytherapy as well as to define more appropriate ways to improve skills and training to promote cooperation of multi-professional team.Material and methodsA nationwide survey consisting of 16 questions was proposed between April and May 2020, with collaboration between the Italian Association of Radiation Therapy and Medical Physics Technologists (AITRO) and the Interventional Radiotherapy Study Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO). The survey was sent through the AITRO contact list to RTTs’ contacts from all Italian radiotherapy (RT) departments.ResultsA total of 37 answered questionnaires returned (36% of all contacts reached), each from different center. 23 centers (62%) presented with dedicated team for IRT treatments, while 15 centers (41%) had dedicated RTT staff. The majority of RTT (86%) did not consider undergraduate training adequate to acquire the skills required to work in IRT departments or units.ConclusionsThis survey underlines the need of additional education and training for RTTs that should focus on treatment management optimization in development of an IRT multi-professional team. Specific updates could be the key to develop further collaboration and to improve cancer patient care.

A practical implementation of risk management for the clinical introduction of online adaptive Magnetic Resonance-guided radiotherapy.

Background and PurposeThe clinical introduction of on-table adaptive radiotherapy with Magnetic Resonance (MR)-guided linear accelerators (Linacs) yields new challenges and potential risks. Since the adapted plan is created within a highly interdisciplinary workflow with the patient in treatment position, time pressure or erroneous communication may lead to various possibly hazardous situations. To identify risks and implement a safe workflow, a proactive risk analysis has been conducted.Materials and MethodsA process failure mode, effects and criticality analysis (P-FMECA) was performed within a group of radiation therapy technologists, physicians and physicists together with an external moderator. The workflow for on-table adaptive MR-guided treatments was defined and for each step potentially hazardous situations were identified. The risks were evaluated within the team in order to homogenize risk assessment. The team elaborated and discussed possible mitigation strategies and carried out their implementation.ResultsIn total, 89 risks were identified for the entire MR-guided online adaptive workflow. After mitigation, all risks could be minimized to an acceptable level. Overall, the need for a standardized workflow, clear-defined protocols together with the need for checklists to ensure protocol adherence were identified among the most important mitigation measures. Moreover, additional quality assurance processes and automated plan checks were developed.ConclusionsDespite additional workload and beyond the fulfilment of legal requirements, execution of the P-FMECA within an interdisciplinary team helped all involved occupational groups to develop and foster an open culture of safety and to ensure a consensus for an efficient and safe online adaptive radiotherapy workflow.

Feasibility of using ultrasound in ambulances in Saudi Arabia.

BACKGROUNDIn developed countries, the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies, and this of course does not apply to Arab countries, as there are no current studies to support this. Therefore, this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.AIMTo measure the demand for ultrasound equipment in ambulances in Saudi Arabia.METHODSA cross-sectional study of five different groups of participants including radiation technologists, emergency physicians, paramedics, Red Crescent managers and the public. Email and social media were used to deliver a questionnaire to these groups. The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.RESULTSEach group had some knowledge on ultrasound and its benefits. More than 50% in each study group supported the availability of ultrasound in ambulances. Additionally, 60% of emergency physicians reported that they had difficulties in venous access, checking the presence of internal bleeding, recognizing pregnancy in trauma cases, and inserting endotracheal tubes, and the majority of them confirmed the effective role of ultrasound in achieving such tasks. Almost all paramedics (93.33%), physicians (98.89%), and Saudi Red Crescent managers (96.3%) emphasized the importance of communication between ambulance staff and emergency departments. Moreover, most physicians (77.78%), and technologists (82.73%) supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.CONCLUSIONMost of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.

Development of nuclear medicine image quality assessment criteria for use in a technologist peer review program

Introduction/backgroundA peer learning program includes the process of peer review, which is the act of performing a secondary review of a peer's work using pre-defined criteria. The Technologist Image Quality Assessment Criteria Project (TIQACP) was initiated to develop and evaluate such criteria for use by technologists for assessment of image quality in Nuclear Medicine (NM). MethodsA NM clinical expert panel was assembled, comprising 14 technologists, radiologists, and educators from five imaging centres and an academic institution with associated medical imaging training programs. Project design was guided by consensus-based methodology that included three phases: (1) image quality assessment criteria development, based on literature search and expert review (2) image quality assessment criteria refinement, based on consensus-building exercises (panel surveys, discussions, ranking exercise, and time trial) (3) external validation performed via a national survey of NM technologists, facilitated by the Canadian Association of Medical Radiation Technologists. ResultsThe first phase generated 8 key evidence sources, including textbooks, NM journals and guidelines from professional associations that were reviewed by the expert panel leads and led to a preliminary list of 11 criteria. As part of the second phase, the preliminary list was reviewed via online surveys and panel discussions. Preliminary discussions led to an initial expansion of the list to include 18 criteria. This list required an average of 9 min (range: 7–11 min) for review, which was deemed prohibitive by the panel. A ranking exercise identified ‘all required anatomy is clearly identified’ as the most relevant criteria and ‘Image quality demonstrates no breakdown of the radiopharmaceutical’ as the least relevant criteria. Panel discussion also highlighted need to eliminate criteria that were not applicable to all settings. These insights led to an updated list of nine criteria organized into four categories. National validation was supported by 47 NM technologists from across Canada. Respondents were in agreement that the criteria reflected the core elements of image quality in NM (94% agree to strongly agree), were familiar (97%) and were relevant to their current practice setting (88%). The final list was thus not changed based on the survey. Discussion/conclusionThe TIQACP utilized an inclusive process that engaged a range of subject matter experts and the broader NM community to ensure buy-in of the final criteria. These criteria have subsequently been embedded in peer review software that has been implemented into a robust peer learning program for technologists designed to promote a culture of continuous improvement and knowledge sharing amongst front-line staff.

The Behavioural Display of Compassion in Radiation Therapy: Purpose, Meaning and Interpretation

IntroductionProviding high quality patient care is a worldwide standard of proficiency across the radiographic workforce. As compassion and compassionate behaviours are considered synonymous with patient-centred care, the focus of professional practice throughout healthcare should be on a system that places compassion at its heart.Inadequate care and dispassionate practice have been blamed for failings within the National Health Service. United Kingdom healthcare legislation has been criticised for its failure to provide meaning or clarity to practical compassionate care. Consequently, it has hindered the ability of National Health Service Trusts, service delivery managers and Medical Radiation Technologists to interpret and implement policy recommendations regarding compassionate practice at a local level. AimsTo support the implementation of compassionate legislation, the study sought to understand the perspectives of those in receipt and those delivering compassionate practice. The research aimed to develop a context specific definition of compassion and identify commonly recognised compassionate behaviours. This article reports on the display of compassion through the behaviours of Medical Radiation Technologists. Methods/materialsCo-production underpinned the qualitative methodological inquiry and design of the research. Eleven focus groups were conducted, five with Medical Radiation Technologists three with cancer patients and care-givers and three with student Medical Radiation Technologists. On completion of thematic analysis from those groups, three co-production workshops were conducted, integrating the data to ensure the co-produced findings were equally representative of the perspectives of the three participant groups. ResultsAn understanding of compassionate display is illustrated through the construction of a conceptual framework. The findings established observable behaviours which a Medical Radiation Technologist must engage in to undertake compassionate display. Three compassionate behavioural classifications were established through the analysis; ‘embodied connection’, ‘characteristic expression’ and ‘indicative communication’. A Medical Radiation Technologist must engage in all the three core behaviours to gain comprehension of the patient and person. Comprehension enables the Medical Radiation Technologist to establish practices that aim to address the compassionate needs of the patient. Discussion/conclusionAdoption of the behaviours by Medical Radiation Technologists should enhance compassionate care received by patients within clinical practice. The conceptual framework provides both a theoretical and practical understanding of compassionate display, making it a valuable tool for training and assessment.

Suspension Microesophagoscopy for Foreign Body Removal in Children.

View Video S1 Laryngoscope, 131:E2066–E2068, 2021