Royal College Of Radiologists Research Articles

E011 Magnetic resonance imaging in axial spondyloarthritis: usage, reporting times and scanning times - a service evaluation in a large tertiary centre

Abstract Background/Aims Rapid access to magnetic resonance imaging (MRI) of the spine and sacroiliac joints is essential for the timely diagnosis of axial spondyloarthritis (axSpA). A recent NASS/BRITSpA national FOI survey highlighted deteriorating waiting times to access MRI for the assessment of inflammatory back pain in the UK, with only 73% of Trusts reporting access within 8 weeks, compared to 90% in 2017. In addition, NHS England and the Royal College of Radiologists have recently published a target of 28 days for turn-around time (TAT) for a verified report to be provided after image acquisition in any circumstance. Aims: To evaluate the usage of MRI performed under the “inflammatory back pain protocol” at a large tertiary centre, including the time from MRI request to scan being performed, TAT for reporting and whether this has changed over time. Methods A service evaluation audit was conducted at Leeds Teaching Hospitals Trust (LTHT). MRIs of the spine and sacroiliac joints requested between December 2021 and May 2023 under the local “inflammatory back pain protocol” were identified by the radiology department. Data extracted from medical records included: indication for MRI request, time elapsed from request to scan, and from scan to verified report. Results A total of 668 MRI requests were identified. The commonest reason for MRI request was to aid the diagnosis of axSpA 75% (n = 501); followed by disease activity monitoring in established axSpA (16.7%, n = 111) and assessment of axial involvement in peripheral psoriatic arthritis, i.e. diagnosis of axPsA (8.5% n = 57 scans). The majority (92%) had a request to scan time of 8 weeks, with a TAT to report of 4 weeks (77%). However, a greater delay in TAT to verified report was seen from December 2022 to May 2023 with <45% of reports issued within 28 days, despite no change in scanning time. Causes identified were related to local workforce issues including delays in appointing new radiographers and radiology consultants. Conclusion The main reason for request of an MRI under the inflammatory back pain protocol at LTHT is to support making a diagnosis of axSpA. A significant number of patients were scanned for treatment monitoring and to diagnose axial psoriatic arthritis, although data on the utility of MRI for these indications are limited. Whilst nearly all patients were scanned within 2 months at all time periods, the TAT to report has significantly deteriorated since December 2022 in our region, due to workforce issues. Further understanding of the impact of workforce factors on service delivery in rheumatology is required. Disclosure J. Weddell: None. R. Shah: None. P. Robinson: None. A. Barr: None. C. Vandevelde: None. J. Freeston: None. D. McGonagle: None. H. Marzo-Ortega: None.

154 The 2023 Royal College of Radiologists (RCR) National re-audit of radical radiotherapy for Non small cell lung cancer (NSCLC) – changing Standards of Care in UK practice

154 The 2023 Royal College of Radiologists (RCR) National re-audit of radical radiotherapy for Non small cell lung cancer (NSCLC) – changing Standards of Care in UK practice

The Adhesive Capsulitis Corticosteroid and Dilation (ACCorD) randomized controlled trial.

Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia, physiotherapy, and joint injections; most people can be managed without an operation. Currently, there is variation in the type of joint injection: 1) CSI, thought to reduce the inflammation of the capsule reducing pain; and 2) HD, where a small volume of fluid is injected into the shoulder joint along with the steroid, aiming to stretch the capsule of the shoulder to improve pain, but also allowing greater movement. The creation of musculoskeletal hubs nationwide provides infrastructure for the early and effective management of frozen shoulder. This potentially reduces costs to individuals and the wider NHS perhaps negating the need for a secondary care referral. We will conduct a multicentre RCT comparing CSI and HD in combination with CSI alone. Patients aged 18 years and over with a clinical diagnosis of frozen shoulder will be randomized and blinded to receive either CSI and HD in combination, or CSI alone. Feasibility outcomes include the rate of randomization as a proportion of eligible patients and the ability to use routinely collected data for outcome evaluation. This study has involved patients and the public in the trial design, dissemination methods, and how to include groups who are underserved by research. We will disseminate findings among musculoskeletal clinicians via the British Orthopaedic Association, the Chartered Society of Physiotherapy, the Royal College of Radiologists, and the Royal College of General Practitioners. To ensure wide reach we will communicate findings through our established network of charities and organizations, in addition to preparing dissemination findings in Bangla and Urdu (commonly spoken languages in northeast London). If a full trial is shown to be feasible, we will seek additional National Institute for Health and Care Research funding for a definitive RCT. This definitive study will inform NICE guidelines for the management of frozen shoulder.

Service Improvements and Workload Increases: Royal College of Radiologists (RCR) Re-Audit of Curative Intent Radiotherapy for Non-Small Cell Lung Cancer (NSCLC)

AimsThe Royal College of Radiologists (RCR) audit of radical radiotherapy (RR) for patients with non-small cell lung cancer (NSCLC) in 2013 concluded that there was under-treatment compared to international comparators and marked variability between cancer networks. Elderly patients were less likely to receive guideline recommended treatments. Access to technological developments was low. Various national and local interventions have since taken place. This study aims to re-assess national practice. Materials and methodsRadiotherapy departments completed one questionnaire for each patient started on RR for 4 weeks in January 2023. ResultsNinety-three percent of centres returned data on 295 patients. RR has increased 70% since 2013 but patients on average wait 20% longer to start treatment (p = 0.02). Staging investigations were often outside a desirable timeframe (79% of PET/CT scans). Advanced planning techniques are used more frequently: 4-dimensional planning increased from 33% to 90% (P < 0.001), cone beam imaging from 67% to 97% (p < 0.001) and colleague led peer review increased from 41% to 73% (P < 0.001). ConclusionThere have been significant improvements in care. There has been a considerable increase in clinical oncology workload with evidence of stress on the system that requires additional resourcing.

The Royal College of Radiologists National Vulvar Cancer Audit

AimThis audit examined UK vulvar cancer practice from March 2018 to January 2019 and compared this to standards from national and international recommendations. Follow-up data collection in 2020 examined patient outcomes and toxicity. Materials and MethodsAudit standards were based on Royal College of Radiologists (RCR) guidance and published literature. A web-based questionnaire was sent to the audit leads at all cancer centres in the UK. Prospective data collection included: patient demographics, tumour characteristics, radiotherapy indication, dosimetry, timelines and follow up data. The audit targets were 95% compliance of the RCR dose/fractionation schemes in definitive and adjuvant patients, 40% use of IMRT, 100% of radical patients treated as category 1 and 95% use of gap compensation for category 1 patients. Results34/54 UK Radiotherapy centres (63%) completed data entry for 152 patients. 23 out of 34 (68%) centres submitted follow-up data for 94 patients. One indicator exceeded the audit target; 98% of radical patients received IMRT. The indicators of RCR dose/fractionation compliance for adjuvant/definitive radiotherapy were achieved by 80%/43% for the primary, 80%/86% for elective lymph nodes and 21%/21% for pathological lymph nodes. Use of concomitant chemotherapy with radical radiotherapy in suitable patients was achieved by 71%. Other indicators demonstrated 78% treated as category 1 and 27% use of gap compensation. Acute toxicity was mostly related to skin, gastrointestinal and genitourinary sites. Grade 3 and Grade 4 toxicities were seen at acceptable rates within the radical and adjuvant groups. Late toxicity was mostly grade 0. ConclusionThis audit provides a comprehensive picture of UK practice. IMRT is widely used in the UK and treatment related toxicity was moderate. The dose fractionation was very heterogeneous. Designation of vulvar cancer as category 1 was not regularly followed for radical/adjuvant patients and there was minimal gap compensation during treatment.

National Survey of Current Follow-up Protocols for Patients Treated for Endometrial Cancer in the UK

AimsThe aim of this study was to establish a baseline of national practice for follow-up after treatment for endometrial cancer in the UK. Materials and methodsAn online cross-sectional survey was developed and distributed through the Royal College of Radiologists via an email link to the audit leads of radiotherapy centres in the UK. The survey was conducted from November 2021 to 5 January 2022. The main themes assessed in the survey were the form, frequency and duration of follow-up practices. ResultsThere were a total of 43/61 (70%) complete responses. 93% of centres had a standard follow-up protocol and 7% who did not have a follow-up protocol discharged patients after the post-operative review. Five centres (13%) used molecular profiling to inform follow-up practices.Patient-initiated follow-up was mainly used in the cohort of patients who had surgery alone with no adjuvant treatment (68%, (19/28)). In the cohort who had face-to-face follow-up, the majority had pelvic examinations as part of their review and total follow-up for five years.93% of respondents are interested in a national follow-up protocol. ConclusionOur data shows that there is national variation in practise with regard to follow-up of women treated for endometrial cancer. Many of the follow-up practises are based on conventional follow-up regimens and these may fail to address the more holistic needs of cancer survivors. Recent publication of updated guidance from the British Gynaecological Cancer Society may help standardise practise and provide a more relevant approach to follow-up for women treated for endometrial cancer.

Assessing the impact of structured reporting on learning how to report lung cancer staging CT: A triple cohort study on inexperienced readers

PurposeTo assess the clinical utility of chest computed tomography (CT) reports for non-small-cell lung cancer (NSCLC) staging generated by inexperienced readers using structured reporting (SR) templates from the Royal College of Radiologists (RCR-SR) and the Italian Society of Medical and Interventional Radiology (SIRM-SR), compared to traditional non-systematic reports (NSR). MethodsIn a cohort of 30 NSCLC patients, six third-year radiology residents reported CT examinations in two 2-month-apart separate sessions using NSR in the first and NSR, RCR-SR, or SIRM-SR in the second. Couples of expert radiologists and thoracic oncologists in consensus evaluated completeness, accuracy, and clarity. All the quality indicators were expressed on a 100-point scale. The Wilcoxon signed ranks, and Wilcoxon-Mann Whitney tests were used for statistical analyses. ResultsResults showed significantly higher completeness for RCR-SR (90 %) and SIRM-SR (100 %) compared to NSR (70 %) in the second session (all p < 0.001). SIRM-SR demonstrated superior accuracy (70 % vs. 55 %, p < 0.001) over NSR, while RCR-SR and NSR accuracy did not significantly differ (60 % vs. 62.5 %, p = 0.06). In the second session, RCR-SR and SIRM-SR surpassed NSR in completeness, accuracy, and clarity (all p < 0.001, except p = 0.04 for accuracy between RCR-SR and NSR). SIRM-SR outperformed RCR-SR in completeness (100 % vs. 90 %, p < 0.001) and accuracy (70 % vs. 62.5 %, p = 0.002), with equivalent clarity (90 % for both, p = 0.27). ConclusionsInexperienced readers using RCR-SR and SIRM-SR demonstrated high-quality reporting, indicating their potential in radiology residency programs to enhance reporting skills for NSCLC staging and effective interaction with all the physicians involved in managing NSCLC patients.

Local education measures are insufficient at ensuring timely imaging in acute pancreatitis

Abstract Aims The Royal College of Radiologists (RCR) has outlined specific criteria for imaging in acute pancreatitis. The presence of pancreatic necrosis, free intraperitoneal fluid and extensive perihepatic fat stranding is associated with worse outcome. Timely computed tomography (CT) scanning 72 to 96 hours following onset of symptoms leads to more accurate diagnosis of pancreatic necrosis. Furthermore, ultrasound examination of the gallbladder is also recommended within 24 hours of admission to demarcate cause. Methods Two plan-do-study-act (PDSA) cycles were run between January to October 2022 and January to September 2023 in the surgical emergency unit. 50 patients were randomly selected amongst all pancreatitis admissions for each cycle. Outcome measures were percentage of CT scans adhering to optimal timing and percentage of ultrasound scans that were carried out within the first 24 hours. Cycle 1 findings were presented locally to staff as a teaching intervention. Results CT scans were performed in 60% and 66% of patients in cycle 1 and 2, respectively. Of these, 39% and 70% had optimal CT scan timing during cycle 1 and 2, respectively. Furthermore, only 33% of patients had US scans performed within 24 hours of admission during both cycles. Conclusion The above findings suggest that local teaching interventions are inadequate at meeting the recommended standard of 95% compliance defined by the RCR. This is likely due to rotating staff, lack of knowledge and incomplete prompting when ordering imaging. Further audit with an information technology based intervention is suggested to improve compliance.

Reducing inappropriate plain abdominal film requests from the emergency department in accordance with The Royal College of Radiologists (RCR) iRefer guidelines

Reducing inappropriate plain abdominal film requests from the emergency department in accordance with The Royal College of Radiologists (RCR) iRefer guidelines

Decreasing Lens Irradiation on Brain Imaging: A Multi-CT Scanner Quality Improvement Project.

Cataracts, a leading global cause of blindness, are associated with ionising radiation exposure. This audit aimed to enhance lens exclusion during non-contrast head computed tomography (CT) scans at Newham University Hospital (NUH) using two CT scanners. A retrospective audit of non-contrast head CT scans at NUH excluded scans for trauma and imaging of orbital structures. A one-week audit in April 2023 assessed lens exclusion, compared to the Royal College of Radiologists (RCR) standards. A total of 101 consecutive scans were analysed and 63 (62%) scans were included in the final study. Thirty-eight percent of the scans were excluded according to the exclusion criteria of head, neckand facial traumas, orbital infectionsand papilledema. Results were presented, followed by a three-month radiographer re-education period, emphasizing gantry tilt and patient positioning. A reaudit in August 2023 evaluated outcomes. For the reaudit, 183 consecutive scans were analysed, with 131 (72%) scans included in the final studyand 52 (28%) scans excluded according to the same exclusion criteria as the first audit. Lens exclusion in non-contrast head CT scans improved significantly from 0/63 (0%) compliance to 19/131 (14.50%) (p=0005) compliance with the standards. Variability in radiographer practices, 'near misses' and time constraints were identified as challenges. Staff turnover impacted compliance. This audit has shed light on a critical aspect of patient care in the field of radiology. This research underscores the importance of rigorous and standardised protocols in radiological procedures, particularly when it comes to protecting the lens of the eye. By enhancing lens exclusion during non-contrast head CT scans, we have taken a significant step in mitigating the risk associated with ionising radiation exposure. Although substantial improvements were made, achieving the RCR audit standard remained elusive. Ongoing re-education, reauditsand a multidisciplinary approach are necessary to optimise radiographer adherence and reduce ionising radiation exposure to the lens during head CT scans.This quality improvement project proves thatcontinued emphasis on gantry tilt and patient positioning in radiographer education and training can make a significant difference in patient safety.As we move forward, let us remember that even small improvements can make a big difference in safeguarding the health and well-being of patients.

Adherence of Radiological Investigation Requests from Medical Wards, to Royal College of Radiologists’ Guidelines

Background: Radiological investigation requests get rejected by vetting radiologists, if they do not adhere to Royal College of Radiologists (RCR) guidelines and Ionizing Radiation (Medical Exposure) Regulations - IR(ME)R 2017 guidelines. This leads to significant delays for all three parties involved: the requesting clinician, the radiologist who vets the investigation, and the patient whose management is affected. Hence radiological investigation requests, which are the main means of communication between the referring clinician and the radiologist, should be appropriately filled in to facilitate the justification process and to optimize patient management. Aims/purpose: To evaluate the adherence of radiological investigation requests of inpatients from medical wards at University Hospitals of Leicester, to RCR guidelines and identify improvement areas, thereby reducing preventable patient delays. Methods: Data from 500 investigation requests of adult inpatients for common modalities of imaging (CT, X-Ray, and MRI) from medical wards at University Hospitals of Leicester were collected across two audit cycles, omitting any patient-identifiable information, and were analyzed for their completeness and adherence to RCR protocols. Results: Based on the analysis, inadequacies of imaging requests were identified, both in completion and adherence to RCR guidelines. In the initial audit cycle, even though more than 90% of the 250 investigation requests analysed contained clinical history, the name of requesting clinician and the question to be answered, only 64% of the investigation requests contained clinical examination or relevant investigation findings. In comparison to more than 94% of MRI and X-Ray requests, only 68.6% of CT requests adhered to RCR and IR(ME)R 2017 guidelines. In order to raise awareness and educate, the audit findings and recommendations were presented in a local medical teaching session within the hospital, and the same was propagated among medical doctors, through an online flyer. During the re-audit, another 250 radiological investigation requests were evaluated, where 73.3% of the requests included relevant clinical examination and/or investigation results and 76% of the CT requests adhered to iRefer guidelines for indication. Conclusion: Radiological investigation requests get rejected if it does not adhere to RCR guidelines for completeness (1) or indication (in compliance with IR(ME)R 2017)(3). This in turn results in delays in patient management. This could be minimized by increasing awareness about the above guidelines and the need for adhering to the same, thereby making sure all the necessary details are filled in and the investigation being requested is appropriate for the clinical indication. Keywords: Radiology, Audit, Medicine.

Radiology reporting of incidental osteoporotic vertebral fragility fractures present on CT studies: results of UK national re-audit

To describe a UK-wide re-audit of the 2019 Royal College of Radiologists (RCR) audit evaluating patient-related data and organisational infrastructure in the radiological reporting of vertebral fragility fractures (VFFs) on computed tomography (CT) studies and to assess the impact of a series of RCR interventions, initiated to raise VFF awareness, on reporting practice and outcomes. Patient specific and organisational questionnaires largely replicated those utilised in 2019. The patient questionnaire involved retrospective analysis of between 50 and 100 consecutive, non-traumatic CT studies which included the thoracolumbar spine. All RCR radiology audit leads were invited to participate. Data collection commenced from 1 April 2022. Data were supplied by 129/194 (67%) departments. One thousand five hundred and eighty-six of 7,316 patients (21.7%) had a VFF on auditor review. Overall improvements were demonstrated in key initial/provisional reporting results; comment on spine/bone (93.2%, 14.4% improvement, p<0.0002); fracture severity assessment (34.7%, 8.5% improvement, p=0.0007); use of recommended terminology (67.8%, 7.5% improvement, p=0.0034); recommendations for further management (11.7%, 9.1% improvement, p<0.0002). The 2022 national re-audit confirms improvements in diagnostic performance and practice in VFF reporting. Continuing work is required to build on this improvement and to further embed best practice.

Preventing post-contrast acute kidney injury and hypersensitivity reactions: UK national audit

To audit UK radiology departmental protocols related to the prevention of Iodine-based contrast media (ICM) adverse drug reactions (ADRs) and to assess their compliance with the Royal College of Radiologists (RCR) endorsed Royal Australian and New Zealand College of Radiologists' 2018 Iodinated Contrast Guidelines. Questionnaires were sent to all UK acute National Health Service (NHS) providers treating adult patients with an audit lead registered with the RCR (162 providers encompassing 211 hospital radiology departments). The questionnaire included three main sections: renal function screening, renal protection regimens, and hypersensitivity reactions prevention and follow-up. Data collection was conducted between April and July 2022. Sixty-one per cent (129/211) of departments responded, representing 67% of eligible providers. An independent imaging services provider supplied one additional set of data (n=130 overall). Of the responding departments, for post-contrast acute kidney injury (PC-AKI), 41% and 56% had the recommended risk assessment for inpatients and outpatients, respectively. Renal function testing was often over-utilised, and their results were applied improperly. Sixty-eight per cent of departments used the advised threshold for considering renal protection. For hypersensitivity reactions, 9% of departments had the correct risk assessment. Thirty-six per cent of departments had the correct risk mitigation protocol for identified high-risk patients. The documentation and follow-up for hypersensitivity reactions were similarly inadequate. Local protocols on preventing ICM ADRs were largely non-compliant with RCR guidelines. Departments need to update their protocols in line with current evidence to avoid iatrogenic morbidity or unnecessary tests and over-precaution.

500 CT imaging requests in Major Trauma Patients

Abstract Introduction There is a correlation between adequate CT Trauma orders and accuracy of radiological reporting. In this audit, the aim is to improve accuracy of reporting by following the Royal College of Radiologists (RCR) indications for polytrauma CT imaging in the document ‘Standards of practice and guidance for trauma radiology in severely injured patients, 2nd edition’. Standard 7 in this guidance states that a CT request in the trauma setting should comply with the Ionising Radiation (Medical Exposure) Regulations justification regulations in the same way as any other request for imaging involving ionising radiation. Method Clinical information in CT orders of 57 major trauma patients in the East Midlands Major Trauma Centre were reviewed against ‘Standards of practice and guidance for trauma radiology in severely injured patients, 2nd edition’. The request should have two essential pieces of information: mechanism of injury and suspected injuries. In these 57 patient, 96% had appropriate requests. Since the target is 100%, an email was sent out and a teaching session was carried out to improve practice. A second cycle including 80 patients in the same centre was carried out. Results Before intervention, 96% of the CT in major trauma patients were compliant with guidelines. After intervention, this improved to 100%. Conclusion Compliance with RCR criteria improved after intervention, this surely helped avoid unnecessary radiation exposure and enhanced radiological reporting in major trauma patient scans.

Adequacy of completion of radiology request forms at St. Francis' Hospital of Katete District: A clinical audit in Zambia.

Most imaging examinations use ionising radiation which causes biological effects on the body. For this reason, only justified examinations should be requested by adequately completing the radiology request form (RRF) by clinicians. The RRF allows radiographers and radiologists to assess if the benefit outweighs the risk associated with medical radiation exposure. Inadequately or incorrectly filled RRFs leads to unnecessary radiation exposures, imaging errors, and delays in performing the examination. Therefore, this study aimed at auditing the adequacy of completion of general RRFs at St. Francis' Hospital of Katete District in Zambia. This was a quantitative study in which RRFs for general radiography from January to December 2020 were audited. Data were collected retrospectively using a checklist from a total of 974 RRFs. The filled-in forms were assessed for completeness of information related to the patient, examination, and referring clinician. Data were analysed using descriptive statistics. The standard of completeness was based on the Royal College of Radiologists (RCR) guidelines requiring all the designated variables completed on the RRF. Most N=881(90.5%), RRFs were incompletely filled. With regards to patient's identification, the findings revealed N=4(0.5%), N=597(61.3%), N=3(0.4%), and N=2(0.3%) RRFs devoid of patient's name, hospital number, age, and gender, respectively. Regarding the examination, the findings revealed N=3(0.4%), N=68(7%), N=449(46.2%), and N=336 (37%) RRFs devoid of requested examination, indication, clinical history, and level of urgency, respectively. Regarding the referrer, the findings revealed N=135(13.9%), N=173(17.8 %), N=472(48.5%), and N=31(3.2%) RRFs were devoid of information relating to the ward, clinicians' name, referring department, and signature, respectively. This audit reports that most of the RRFs were incompletely filled-in at St. Francis' Hospital. Furthermore, the hospital number, clinical history and level of urgency were the frequently unfilled variables. Overall, there were gaps in completion of RRFs requiring remedying.

Current abdominal X-rays practice in accident and emergency

IntroductionDes analyses bibliographiques antérieures ont révélé que les radiographies de l'abdomen (RXA) effectuées dans les services d'urgence et d'accident avaient une faible sensibilité, un taux élevé d'imagerie complémentaire et un taux de non-alignement par rapport aux lignes directrices du Royal College of Radiologists (RCR). Une étude a été réalisée pour examiner la pratique actuelle dans le but de formuler des recommandations pour améliorer la pratique, ce qui peut réduire l'exposition des patients aux rayonnements, tout en réorientant les ressources vers d'autres priorités. MéthodologieUne étude a été réalisée dans l'un des plus grands services d'urgence du Royaume-Uni, conformément aux lignes directrices du RCR. Toutes les demandes de RXA émanant des services d'urgence, quel que soit l'âge du patient, au cours d'une période de 28 jours, ont fait l'objet d'une évaluation rétrospective. Les patients n'appartenant pas au service des urgences et les examens abandonnés en raison d'un manque de coopération de la part des patients ont été exclus. RésultatsLe nombre total de demandes de RXA reçues par le service d'imagerie des urgences était de 169, dont 28 répondant aux critères d'exclusion. Sur les 141 demandes incluses, cinq demandes non justifiées ont été rejetées à juste titre. Les 136 demandes restantes ont été acceptées et réalisées, mais seulement 115/136 (84,6 %) d'entre elles étaient justifiées. Les indications justifiées et injustifiées les plus courantes étaient l'obstruction et les calculs rénaux, respectivement. Seulement 4 % des RXA signalées présentaient des anomalies pathologiques, tandis que 45/136 patients ont bénéficié d'une imagerie plus poussée. ConclusionLa faible proportion de résultats significatifs fait écho à des études antérieures, suggérant une surutilisation de la RXA. Plus de 80 % des demandes non conformes ont été effectuées, et la sensibilisation aux directives de justification peut être renforcée par la gouvernance clinique, des affiches ou un algorithme présenté précédemment. Le taux d'imagerie supplémentaire de 32,4 % enregistré dans cette étude, par opposition au taux de 73,7 % rapporté dans la littérature antérieure, mérite l'attention. Implications pour la pratiqueL'arrêt du recours excessif à la RXA peut minimiser la dose de rayonnement reçue et soulager la pression croissante en matière d'imagerie et de rapports, ce qui peut servir à d'autres patients qui bénéficieraient autrement de ces services.

Towards equality: gender representation at the Royal College of Radiologists' Annual Scientific Meeting 2014-2021.

Background: Conferences facilitate career advancement, but gender imbalances in public fora may negatively impact both women and men, and society. We aimed to describe the gender distribution of presenters at the UK's 2014-2021 Royal College of Radiologists' (RCR) Annual Scientific Meeting. Methods: We extracted data on presenter name, role and session type from meeting programmes. We classified gender as male or female using names, records or personal pronouns, accepting the limitations of these categories. We classified roles by prestige: lead, other (speakers and workshop faculty), proffered paper or poster presenters. We calculated odds ratios (OR) and 95% confidence intervals (CI) for associations between gender and binary outcomes using logistic regression. Results: Women held 1,059 (37.5%) of 2,826 conference roles and presented 9/27 keynotes. Compared to men, women were less likely to hold other roles such as speakers and workshop faculty (OR 0.72 95% CI 0.61-0.83), and more likely to present posters (OR 1.49 95% CI 1.27-1.76). There were 60 male-only and eight women-only multi-presenter sessions. Sessions led by women had higher proportions of women speakers. The odds of roles being held by women increased during online meetings during COVID in 2020 and 2021 (OR 1.61, 95% CI 1.36-1.91) compared to earlier years. Conclusion: The proportion of women presenters and keynote speakers reflects that of RCR membership, but not of wider society. Disadvantage starts from the earliest career stages, prejudicing career opportunities. Efforts to improve inclusion and diversity are needed; focusing on lead roles and hybrid online/in-person formats may accelerate change.

Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience

To enhance ultrasound teaching delivery to radiology trainees using a simulation course matched to the 2021 Royal College of Radiologists (RCR) curriculum. An ultrasound simulation training course was designed for specialty trainees (ST) 1 in radiology, which was based on the 2021 RCR curriculum and covered the top ultrasound training priorities. The course was piloted initially on two occasions in a 1-day format to the August 2021 and the March 2022 ST1 intake trainees. Based on the feedback, a comprehensive 4-day course was developed and delivered between October and December 2022 for the August 2022 ST1 intake, funded by Health Education England. The outcomes measured were subjective trainee feedback using numerical scores and free text. All King's College Hospital NHS Foundation Trust radiology ST1 trainees from the August 2021 to the August 2022 intake participated in ultrasound simulation training. The training matched the RCR curriculum and increased the trainees' confidence and competency in medical ultrasound. Ultrasound simulation training can be successfully delivered to ST1 trainees to match the 2021 RCR curriculum and enhance training in medical ultrasound for radiologists.

ASSESSMENT OF REFERRING CLINICIAN'S ADHERENCE TO ROYAL COLLEGE OF RADIOLOGISTS GUIDELINES FOR ABDOMINAL RADIOGRAPHY

Introduction: One of the commonest complaints encountered in the emergency department is acute abdominal pain and the most common investigation ordered to evaluate it is an abdominal X-ray (AXR). However many studies have shown that AXR has a low diagnostic yield and this investigation may be overused. So in order to optimize the sensitivity of AXR, the Royal College of Radiologists (RCR) introduced the iRefer guidelines. Aims: This study aims to assess referring clinicians' adherence to iRefer guidelines for abdominal radiography. And to determine whether the professional status of the referring clinician inuences their adherence to the guideline. Methodology: This is a retrospective study of consecutive adult patients, who presented to a rural tertiary care center between October 2020 and March 2021. Indications for AXR and clinician seniority were determined from the radiology request slips. The appropriateness of imaging was determined by comparing the indication for abdominal radiographs to iRefer guidelines by the Royal College of Radiology. Data was then analyzed accordingly. Results: Our study included 100 patients. 22% of abdominal radiographs were requested according to the iRefer guidelines while 78% were against the guidelines (p-Value = 0.0001). Out of 22 radiographs adhering to iRefer Guidelines, 7 radiographs were normal and 15 were abnormal (14 correct and 1 incorrect in comparison to gold standard). Also, out of 78 radiographs not adhering to the guidelines, 59 radiographs were normal and 19 were abnormal (5 correct and 14 incorrect). Conclusion: The accuracy of detected abnormalities, if we adhere to iRefer guidelines, is 93%. Therefore, we need to follow the iRefer guidelines for every abdominal X-ray. Non-adherence to iRefer guidelines leads to unnecessary exposure of a patient to radiation and increased cost of treatment. To improve the patient's management we need to educate and inform the doctors of different levels about the guidelines.

The clinical applications of interventional radiological techniques in obstetrics and gynaecology

Key content Uterine artery embolisation can be used as a minimally invasive technique for the management of benign gynaecological conditions refractory to other medical treatments. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists (RCR) recommend the use of interventional radiology (IR) techniques for the prophylaxis and management of postpartum haemorrhage. Interventional radiologists can percutaneously drain post‐operative collections or tubo‐ovarian abscesses. Interventional radiology plays a role in the management of early pregnancy complications such as ectopic pregnancy and gestational trophoblastic disease. Interventional radiology can aid the care of patients with gynaecological malignancies. Learning objectives To understand the various IR techniques applicable to obstetrics and gynaecology To understand the risk and benefit profiles of these techniques To understand when the techniques could be appropriate and how they compare to surgical alternatives Ethical issues There are limited data regarding the use of some IR procedures owing to the ethical issues of using experimental techniques to treat pregnant women or women who wish to conceive. The availability of IR procedures is hospital specific so treatment is not available to all who may benefit.