Academic literature on the topic 'Radiography academics'

Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT). Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice. Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs. Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically. Conclusion Wrist radiography does not influence management of patients presenting DQT. Level of Evidence This is a level III, diagnostic study.

Objectives: Kneeling stress radiographs are commonly used to evaluate posterior cruciate ligament (PCL) laxity. Patients, however, report significant pain, and reproducibility is challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement (PTD). Weighted gravity stress radiographs may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied. Hypothesis: weighted gravity radiographs will be more comfortable and produce similar PTD measurements when compared to the kneeling technique. Methods: Patients 18-70 years old with non-operatively or >6 months post-operatively treated PCL injuries (isolated or multi-ligamentous) were recruited from two academic level one trauma centers to undergo bilateral PCL stress radiographs. Exclusions: open/bilateral injuries, fractures. Patients underwent PCL stress radiographs by two randomly ordered methods. Kneeling stress views: patients knelt on padded scales (separate for each knee) with the padding distal to the tibial tubercle. Patients were verbally encouraged to place equal weight on both knees (scale outputs not visible to the patient). A digital radiography plate was placed between the legs to acquire bilateral lateral radiographs. Weighted gravity stress views: Patients lay supine with their hip and knee at 90°with the heel supported. A 20 lb weight was placed on the anterior tibia just distal to the tibial tubercle. A lateral radiograph was taken and then repeated on the contralateral leg. Images were anonymized and uploaded to PACS for measurement. Outcomes: side to side difference (SSD) in translation of the posterior tibial condyles relative to the posterior femoral condyles (primary outcome); patient-reported VAS knee pain (100 mm) during the radiographs; time required to acquire the images; patient preference for technique. Statistics: sample size = 31 patients to detect a 2 mm difference (α=0.05, power 80%, SD = 2.8 mm [Jung, 2006]). Paired t-tests were used to compare the SSD between the kneeling and weighted gravity methods, VAS pain, and time to complete the radiographs. Results: 40 patients (77.5% male, 34.5 ± 12.8yrs old, 65% left knee) were recruited. 42.5% had undergone PCL reconstruction. There was no difference between the two radiographic methods in the mean SSD (kneeling = 6.29 ± 4.58 mm, gravity = 6.82 ± 4.60 mm, p= 0.61). There was no difference in the total time required to perform the radiographs (kneeling = 307.3 s ± 140.5 s, gravity = 318.7 s ± 151.1 s, p= 0.73) or the number of radiographs taken to obtain acceptable images (kneeling = 3.6 ± 1.6, gravity = 3.7 ± 1.7, p= 0.73). The amount of weight placed on each knee during the kneeling views differed slightly but was not significant (affected = 21.5 ± 11.3 kg, unaffected = 26.1 ± 12.1 kg, p= 0.09). There was significantly less knee pain reported for the gravity views (kneeling = 31.8 ± 26.6, gravity = 4.0 ± 12.0, p < 0.0001). 94.6% of patients preferred the gravity method. Conclusion: Weighted gravity PCL stress radiographs should be considered for use in clinical practice as they produce similar posterior tibial translation values to the kneeling technique, do not rely on patient weightbearing, and provide significantly better patient comfort.

Background:A substantial proportion of primary care osteoarthritis (OA) consultations are associated with an X-ray request (1,2). Uncertainty exists regarding the ability of radiography to improve a clinical OA diagnosis, and the over-use of radiography may lead to inappropriate referrals due to severe radiographic features that do not correlate with patients’ symptoms. Additionally, there are cost implications of unnecessarily imaging such a prevalent disease. As evidence questions the utility of routine radiography in OA, the extent to which radiography is supported by international guidelines is unknown.Objectives:To undertake a systematic review and narrative synthesis of UK and international guideline recommendations on the role of radiography in the diagnosis of OA.Methods:A systematic search of eleven electronic databases (including EMBASE, MEDLINE CINAHL, Epistemonikos and Guideline Central) and the websites of nine professional organisations (including NICE, Royal College of Radiologists (RCR), EULAR, and the American College of Radiology (ACR)) identified the most recent evidence-based guidelines produced by professional organisations on the role of imaging in OA. Guidelines not addressing the role of radiography in the diagnosis of OA were excluded, as were non-English and spinal OA guidelines. Each title was screened by one reviewer whilst each abstract and full text underwent dual screening. A single reviewer, using a standard proforma, undertook data extraction. Each guideline was independently appraised by two reviewers using the AGREE II tool. A narrative synthesis of the nature and consistency of OA radiographic recommendations was performed.Results:18 evidence-based OA guidelines published between 1998-2019 were included. These guidelines considered OA at any joint (n=8), or at the knee (n=3), hip (n=2), hand (n=2), wrist (n=1), foot (n=1), and ankle (n=1). Seven guidelines were produced by European organisations; four guidelines were produced by EULAR. Guidelines were targeted at general practitioners (n=11), radiologists (n=7), rheumatologist (n=4) and orthopaedic surgeons (n=3). Using the AGREE II tool, the identified guidelines scored highly on rigour of development (mean score 69%) but poorly on applicability (32%). All 18 guidelines recommended X-rays as the first-line modality, where imaging was indicated. A clinical diagnosis of OA without radiographic confirmation was recommended by all eleven guidelines produced by organisations represented general practitioners, with seven guidelines justifying this due to a poor correlation between radiographic features and clinical symptoms. Only three guidelines explicitly discouraged the routine use of radiography for the diagnosis of OA and only two guidelines reassured practitioners of a low probability of missing serious pathology when not routinely requesting radiographs. Guidelines produced by organisations representing radiologists were more supportive of radiography. The ACR recommended radiographic confirmation in patients suspected to have OA at the hand, wrist, hip, knee, ankle, and foot. Conversely, the RCR recommended radiographic confirmation in patients suspected to have OA at the hand, feet, and hip, but not the knee.Conclusion:Differences in guideline recommendations on the utility of radiography in OA appear related to country/region, professional organisation, and joint. The use and utility of radiography in OA may need to be reviewed in light of a shift towards remote consultations, a change that has been accelerated by COVID-19 in many countries.References:[1]Yu D, Jordan K, Bedson J, Englund M, Blyth F, Turkiewicz A et al. Population trends in the incidence and initial management of osteoarthritis: age-period-cohort analysis of the Clinical Practice Research Datalink, 1992–2013. Rheumatology. 2017;56(11):1902-1917.[2]Brand C, Harrison C, Tropea J, Hinman R, Britt H, Bennell K. Management of Osteoarthritis in General Practice in Australia. Arthritis Care & Research. 2014;66(4):551-558Acknowledgements:JJE is funded by an Academic Clinical Lectureship from the National Institute for Health Research (NIHR) for this research project (CL-2016-10-003). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.Disclosure of Interests:None declared

Technology has changed the world of radiography, setting the request for development and promotion of radiography occupation. This article focuses on key factors of education for radiologic technologist / radiographer. The important role of EFRS in promoting and developing advanced educational standards and qualifications for radiographers is elaborated. Harmonization and development of radiographer’s profession following technological development considers cooperation among educational institutions, employers and professional bodies, within the framework of European and national legislation. Society should provide the conditions for further education. Obtaining a master's and / or doctoral degree, and integration in teaching and research activities, helps transform radiographers into leadership roles within their departments.

Objectives: The long time interval between teaching anatomy courses to students and the courses on extraoral radiographs results in forgetting the location of radiographic anatomic landmarks without any retention; therefore, it is necessary to use other educational techniques due to short duration of educational courses. To this end, the present study was undertaken to evaluate the effect of a combination of lectures and computer techniques on teaching extraoral radiographs to undergraduate dental students. Methods: In the present interventional study, dental students entering the university in the same year (referred to as one class) were divided into two groups; one group received conventional teaching and one group received combinational teaching technique. Students entering the next year were taught using the same teaching techniques. The results were compared between groups and classes. Results: Comparison of the results of the first test between the two classes showed significant differences between the two groups (P<0.001). Comparison of the results of the second test between the two classes revealed no significant differences in the conventional method (P=0.76); however, the combination technique exhibited significant differences (P=0.006). In the first test, comparison of the two techniques in the students entering the university in 2006 showed no significant differences (P=0.055); however, students entering the university in 2007 exhibited significant differences (P=0.03). In the second test, comparison of the two techniques in both classes revealed significant differences (P<0.001).Conclusion: If more time is allocated to the combination technique, learning improves even in a short time. This method can replace the conventional method to teach interpretation of extraoral radiographs after evaluation of academic level of the studies. Keywords: Computer-assisted learning; extra-oral radiography; lecture;

Category: Midfoot/Forefoot Introduction/Purpose: The burden of midfoot arthritis is staggering. Foot osteoarthritis affects over 16% of all adults over the age of 50, interfering with activities of daily living and leisure. Non-operative management often culminates in fluoroscopic guidance injections. Its management is troublesome for surgeons as conservative treatment is maximized because its surgical solution is oftentimes fraught with nonunions and other complications. The purpose of this study was to see how well surgeons are able to predict midfoot and transverse tarsal joint osteoarthritis on x-rays as it compares to CT and MRI scans. Methods: We reviewed the records of 117 patients (146 feet) with a diagnosis code of midfoot osteoarthritis who were treated from 2015 to 2019 at an academic medical center by a single surgeon. The mean age was 63.2 +- 10.7 years. The average BMI was 31.2 +- 6.4. Each of those patients had both plain radiographs and either a CT or MRI scan. Patients had weight-bearing anteroposterior and lateral radiographs according to a standardized protocol. Radiographs and advanced images were graded separately for the presence of joint space narrowing, subchondral cysts, and other signs of arthritis. We then compared how frequently a radiograph predicted an arthritic midfoot or transverse tarsal joint as compared to a CT scan or MRI using a paired t test. Results: The most common joints affected by arthritis were the 2nd TMT (83.5% by X-ray; 88.4% by CT) and 3rd TMT (71.9% by X-ray; 68.4% by CT). Advanced imaging showed a significantly higher rate of arthritis in the 1st, 4th, and 5th TMT as compared to X-rays. Only 20.2% of patients’ radiographs had a direct correlation with their CT scan. A CT scan showed one or two more affected joints by 23.6% and 17.6 % respectively, and rarely showed one or two less joints affected by arthritis, 6.8% and 0.6% respectively. Based on this data, a radiograph’s sensitivity and specificity vary wildly-from 86.0% and 57.8%, respectfully in the 3rd TMT to 43.8% and 96.0%, respectfully in the 1st TMT. Conclusion: Radiographs vary quite drastically in their sensitivities and specificities in diagnosing osteoarthritic joints in the midfoot and transverse tarsal joints. If intending to treat midfoot osteoarthritis with fluoroscopic injections, we recommend not relying on plain radiographs, but advanced imaging.

Objective This study aims to define a reliable protocol for radiographic identification of placement and tip foldover of newly designed precurved and straight electrodes. Study Design Prospective imaging study. Setting Academic institution. Methods Three models of cochlear implants (Cochlear, MED-EL, and Advanced Bionics) were inserted into fresh cadaveric specimens (n = 2) in 3 configurations (normal positioning in the scala tympani, intracochlear tip foldover, and placement into the vestibular system) for a total of 9 implant scenarios. Specimens were imaged with plain radiography in Stenvers projection, as well as by high-resolution computed tomography. Results Electrode placement and presence or absence of electrode tip foldover were easily identified in all 9 scenarios on plain radiography based on the described technique. Each was confirmed with high-resolution computed tomography. Plain film temporal bone images of new electrode designs with proper and improper placement are provided for reference. Conclusion A defined protocol for intraoperative plain film radiography allowed for reliable imaging of 3 newly designed cochlear implant electrodes and immediate identification of extracochlear placement and tip foldover. Findings may be used for intraoperative confirmation of electrode array placement.

Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2011<br>This thesis records a study undertaken by a radiography lecturer at a satellite campus of a University of Technology (UoT) in the Western Cape Province of South Africa. The study investigated the academic writing practices of first year Radiation Science learners and focused on an intervention to assist learners to enhance their academic writing competence. Three research questions were addressed: 1. What did radiography learners perceive to be the factors that enabled and constrained their academic writing competence during the first year of academic study?; 2. What were the 2010 first year learners’ perceptions of the changes in their academic writing following an academic writing intervention?; and 3. According to the 2010 first year lecturers, how did the academic writing of the learners change following the intervention? To answer these questions, the research comprised two qualitative approaches: firstly a case study approach, to gain an in-depth understanding of learner writing in radiography; then the insights gained allowed for the design of an appropriate academic writing intervention, carried out in two action research spirals. Thereafter the intervention was evaluated for its impact on learners’ writing competence. The findings and interpretations from this study culminated in a forward looking model that is recommended for use by radiography educators to enhance first year learners’ academic writing competence. The model reflects a zone for the optimal enhancement of academic writing competence for entry-level learners. This ‘zone’ is created in the region of overlap of three contributing factors: collaborative guidance and support, peer mentoring and technology. The model also represents applicable underlying theories (critical theory, constructivism, and academic literacies theory) which provide the theoretical framework for enhanced academic writing competence.

Dissertation submitted in fulfilment of the requirements for the degree Master of Technology: Radiography in the Faculty of Health and Wellness Sciences, 2008<br>Introduction Research to date has not been able to agree whether spatial abilities can be developed by practice. According to some researchers spatial ability is an inherited cognitive ability, compared to spatial skills that are task specific and can be acquired through formal training. It is commonly assumed that radiographers require general cognitive spatial abilities to interpret complex radiographic images. This research was conducted to investigate second year radiography students’ three-dimensional thinking skills pertaining to film-viewing assessments. Materials and methods The experimental research strategy was mainly applied together with correlation research. Two trials were run (in 2005 and 2006). The sample group consisted of fifteen second year diagnostic radiography students in 2005 and twenty-three second year diagnostic radiography students, of the same institution, in 2006. Each year group was randomly divided into a control group and an intervention group. Two instruments were used, that is a film-viewing assessment and a three-dimensional test, Academic Aptitude Test (University) (AAT) nr. nine: Spatial Perception (3-D). The whole class completed this basic spatial aptitude test, as well as a base-line film viewing assessment, which focused on the evaluation of technique/anatomy of second year specialised radiographic projections. The marks that the students achieved in the fore-mentioned tests were compared, to determine if there was any correlation between their performances in the different tests. A curricular intervention, which was intended to improve applied three-dimensional skills, was subsequently applied. The students executed certain modified radiographic projections on parts of a human skeleton. For each radiographic projection, the students had to draw the relation of the X-ray beam to the specific anatomical structures, as well as the relation of these structures to the film. The related images of these projections were also drawn. With each of the following sessions, films including images of the previous session were discussed with each student. After the intervention, the whole class wrote a second film-viewing assessment. The marks achieved in this assessment were compared to the marks of the initial film-viewing assessment to determine the influence of the intervention on the performance of the intervention group. Following this assessment, for ethical reasons, the same intervention took place with the control group. A third film-viewing assessment was then written by all the diagnostic second year students to evaluate the overall impact of the intervention on the applied three-dimensional skills of the class. The marks of both the 2005 and 2006 classes (intervention classes) were compared to the marks achieved by former classes from 2000 to 2004 (control classes), in film-viewing assessments to evaluate the role of the curricular intervention over the years. The students again completed the three-dimensional test, Spatial Perception (3-D) to evaluate the impact of the intervention on students’ general three-dimensional cognitive abilities. These marks were also compared to the marks of the third filmviewing assessment, to determine if there was any correlation between the students’ performances in the different tests. Results The intervention groups did not perform significantly better in film-viewing assessments after the intervention, compared to the control groups, but reasonable differences, favouring the intervention group, were achieved. Statistical significance was achieved in film-viewing assessments with both year groups after the whole class had the intervention. The intervention year groups also performed significantly better than the previous year groups (without the intervention) in film-viewing assessments. The performance in general three-dimensional cognitive abilities of the group of 2006 improved significantly after the intervention, but on the contrary, the performance of the group of 2005 declined. There was a small intervention effect on the performance of the group of 2006. Only a weak to moderate correlation between the marks of the students achieved in the three-dimensional tests and the marks achieved in the film-viewing assessments, was found. Conclusion The contrasting evidence between the data of the two groups (2005 and 2006) in the three-dimensional tests and the small intervention effect on the performance of the group of 2006, makes the intervention not applicable for the increase of general spatial abilities. The results of this research show that the applied three-dimensional skills of radiography students in interpreting specialised and modified projections can be improved by intensive practice, independent of their inherited spatial abilities.

A thesis submitted in fulfilment of the requirements for the degree Master of Technology: Diagnostic Radiography in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology, 2012<br>Complete, accurate and justified radiological examination requests are prerequisite to radiological exposures. However, global research shows evidence of high numbers of incomplete and inaccurate requests as well as that up to 77% radiological exposures are unjustified. Plain lumbar spine and plain skull radiology examinations are reported as being procedures that generate high dose and a low diagnostic yield. This study was designed to objectively measure the completeness, accuracy and justification of these two examinations in an effort to make inferences that will contribute to an improved radiology service. This research could therefore have positive effects on optimisation of radiation protection in Zimbabwe. Methodology A non participatory prospective descriptive analytical document review of quota sampled radiological request forms for 200 plain skull and 200 plain lumbar spine examinations was employed. Data was captured using structured data collection instruments designed and tested by the researcher for this study. The instrument was designed using the IAEA-HHS4 (2010) minimum prescribed request data as a framework and adding additional form fields found to be relevant through a review of all identified radiological request template forms in use at the research site. Data analysis involved central tendency measures and inferential statistics. Results: The central tendency demonstrated for the two examinations was that generally referrers for plain lumbar spine and for plain skull radiology would respectively provide 38.9 +/- 0.6% and 40.2+/-0.5% overall examination request information. This information was significantly below expectation. There was however no significant difference between the samples’ means for the two examinations. The tendency demonstrated in patient information for lumbar spine and skull requests was that generally referrers would respectively provide 48.4 +/- 0.8% and 49.5+/- 0.8% patient information. These values were inclusive of each other and they were significantly (p=0.00 Sig.) below expectation. There was however no significant difference between the two examinations’ data. The tendency demonstrated for examination information was that referrers for the research site would generally provide 29.8+/-0.8% (lumbar) and 32.6+/-0.8% (Skull) examination information. These values were significantly (p=0.000 Sig.) below expectation and demonstrated a significant difference between the sample means for the two examinations. With respect to referrer information, the tendency demonstrated was that generally referrers for plain lumbar spine and for plain skull examinations would respectively provide 38+/- 1% and 38.5 +/- 0.8% referrer identification information. These were significantly below expectation (p= 0.000 Sig.) but there was no significant difference between the samples’ means with respect to referrer information. With respect to accuracy of request data, it was observed that 5% plain lumbar spine and 3% plain skull requests were specific in so far as information documented on request forms could unambiguously identify the area to be imaged. It was also observed that 22.5% (lumbar spine) and 12% (skull) examination requests were indicated and therefore justified. All requests forms were found to be legible. Conclusions: Generally, referrers to this research site tend to provide incomplete, inaccurate and unjustified radiological request data. The observed levels of completeness, accuracy and justification of requests were generally consistent between the two examinations relative to expectation. These levels had medico-legal implications and negative effects on optimisation of radiation protection to patients. Further research to establish causes of this variance in referral behaviour is recommended. The researcher also recommends further research to establish whether there is an association between requested examination and completeness, accuracy and justification of diagnostic radiology examination requests. Keywords: Radiation protection, radiological request, complete request, accurate request, justified request, plain skull imaging, plain lumbar spine imaging.

This dissertation presents a contrast-enhancement algorithm called Artifact-Suppressed Adaptive Histogram Equalization (ASAHE). This algorithm was developed as part of a larger effort to replace the film radiographs currently used in radiology departments with digital images. Among the expected benefits of digital radiology are improved image management and greater diagnostic accuracy. Film radiographs record X-ray transmission data at high spatial resolution, and a wide dynamic range of signal. Current digital radiography systems record an image at reduced spatial resolution and with coarse sampling of the available dynamic range. These reductions have a negative impact on diagnostic accuracy. The contrast-enhancement algorithm presented in this dissertation is designed to boost diagnostic accuracy of radiologists using digital images. The ASAHE algorithm is an extension of an earlier technique called Adaptive Histogram Equalization (AHE). The AHE algorithm is unsuitable for chest radiographs because it over-enhances noise, and introduces boundary artifacts. The modifications incorporated in ASAHE suppress the artifacts and allow processing of chest radiographs. This dissertation describes the psychophysical methods used to evaluate the effects of processing algorithms on human observer performance. An experiment conducted with anthropomorphic phantoms and simulated nodules showed the ASAHE algorithm to be superior for human detection of nodules when compared to a computed radiography system's algorithm that is in current use. An experiment conducted using clinical images demonstrating pneumothoraces (partial lung collapse) indicated no difference in human observer accuracy when ASAHE images were compared to computed radiography images, but greater ease of diagnosis when ASAHE images were used. These results provide evidence to suggest that Artifact-Suppressed Adaptive Histogram Equalization can be effective in increasing diagnostic accuracy and efficiency.

Thesis submitted in fulfilment of the requirements for the degree: Master of Technology: Radiography (Therapy) Faculty of Health and Wellness Sciences Cape Peninsula University of Technology, 2012<br>The focus of this study is to investigate the level at which quality management (QM) objectives, according to ISO standards, are met by the radiation oncology staff as well as doctors referring patients and patients receiving treatment at an oncology department. The study was undertaken at an academic hospital in the Western Cape, South Africa. The study addressed the following research question: “Do the QM system and practices at the division of Radiation Oncology at an academic hospital comply with ISO standards?” Radiation therapy is the treatment of cancer with ionizing radiation. The department has Quality Assurance (QA) practices that assure the safe, consistent delivery of radiation to the target volumes that are defined for treatment from a technical point of view. Errors or incidents are inevitable and an understanding of when, why and how they occur could assure that systems are put into place to help minimize the frequency with which they occur. In order to do this, a systematically planned programme should be documented and implemented to assure that the treatment delivered meets the required standards. Such a programme is called a Quality Management System (QMS) and it must involve the documentation of all the processes that could influence or is involved in the treatment of patients. This includes the managerial, the psycho-social as well as the technical treatment planning processes. An important process is the identification of the QM objectives. Furthermore, the current levels of satisfaction with the QM programme needs to be assessed in order to improve the QMS. The approach of the study is twofold. Firstly, the ISO standards regarding the first three QM objectives were identified and documented from literature and documents. The three QM objectives identified were: i) staff satisfaction and morale, ii) referring doctor satisfaction and iii) patient satisfaction. Secondly, the existing QM practices were investigated by means of an organisational satisfaction survey audit conducted with the staff in the department, the doctors referring patients to the department and the patients getting treatment at the department. The staff members were represented by a self-selecting sample group of 44 participants that completed a self-administered survey questionnaire. The referring doctors were also a self-selecting sample group of 64 participants that received a mailed or hand-delivered survey questionnaire. The patient group was a statistically calculated proportion sample of 230 patients that were interviewed with a structured administered survey questionnaire by the researcher. The analysis of the data was layered and triangulated by means of identification of perspectives from different groups of people involved in the same setting. The first layer of analysis involved deconstructing and discussing the ISO documents, guidelines and policies in order to establish the required ISO standards regarding the three QM objectives researched in this study. The second layer of analysis involved quantitative descriptive analysis methods used to analyse the data generated by the Likert-scale questions. The third layer of analysis involved the analysis of the narrative data from the open questions of the questionaires and structured interviews with the patients where content thematic analysis allowed categories to emerge by means of pattern matching. A benchmark of 50% was established from literature for satisfaction levels to be considered acceptable. The findings of this study are expressed in terms of meeting this benchmark. In the staff group, five quality indicators were investigated. Three out of the five indicators of staff satisfaction (60%) met the 50% benchmark, which indicates that the department is meeting the standards set for this QM objective. The three indicators that met the benchmark were: i) working environment, ii) physical environment and safety and iii) job description. The two indicators not meeting the benchmark were i) recognition and ii) re-imbursement. In the referring doctor group a total of three quality indicators were investigated and two (66%) met the benchmark. The two indicators that met the benchmark were i) telephone etiquette and ii) patient management. The indicator not meeting the benchmark was follow-up reports. Therefore, the quality indicators for this specific QM objective are also meeting the standard required. The results for the last QM objective, patient satisfaction, shows that the seven indicators investigated have all (100%) met the benchmark set for satisfaction. The seven quality indicators investigated were i) administration, ii) atmosphere and comfort, iii) cleanliness of the department, iv) professionalism, v) information sharing, vi) cleanliness and safety in the ward and vii) patients’ general comfort in the ward. The content analysis resulted in recommendations that were categorised as follows: i) specific recommendations according to the thematic content, ii) practical recommendations for future audits and iii) recommendations regarding the proposed QMS for the department. An important outcome of this study was the establishment of baseline data regarding these three QM objectives and the development of shortened survey questionnaires for use in future organisational survey audits. In conclusion, it is argued that quality improvement should be seen as a continuous, structured process using a system that can create participation throughout the department to plan and implement processes that would meet and exceed the expectations and demands of the clients and staff utilizing the services of the department. This process, together with the structure provided by the ISO 9000 set of standards, is a valuable guideline for the development of a comprehensive QMS. This thesis was an initial step towards a scientifically documented, implemented and regulated QMS that could guide the department in working towards achieving their set objectives and eventually towards attaining Radiation Therapy specific accreditation.

Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2012<br>Background and purpose The primary aim of this study was to analyse the accuracy and reproducibility of radiation treatment to patients with nasopharyngeal carcinoma at the only tertiary teaching and referral hospital in Kenya. The secondary objective was to review literature on quality assurance procedures that would result to provision of quality radiation treatment to this group of patients. Materials and method During the period May 2011 to March 2012, 35 patients with head and neck cancer comprising of 27 patients with nasopharyngeal carcinoma, 7 with paranasal sinus carcinoma and 1 with lymphoma falling within the enrolment criteria were treated using Equinox cobalt-60 unit with the same beam arrangement and were studied prospectively. Radical radiotherapy was delivered using conventional 2D technique in a routine dose of 60-66Gy to the primary and 50Gy to lymph nodes with additional dose to residual neck nodes. During the period of their treatment, a lateral portal image was taken once weekly. Four film image pairs were obtained per patient with each patient positioned and immobilised in an individualised Orfit thermoplastic mask and a head and neck support. The 4 portal images were compared to a corresponding simulator film taken during simulation planning. Deviations from the varied bony landmarks were measured on the portal images and simulator image from the centre of the radiation beam.

Thesis (M. Tech.) -- Central University of Technology, Free State, 2008<br>Motivated by the challenges associated with demonstrating the cervicothoracic junction, a study was conducted at Pelonomi Regional Hospital from May 2006 to June 2007. In this study, two projections of the cervicothoracic junction were done, with the only difference between them being the orientation of the arms. One projection was done using the swimmer’s projection and the other using an adaptation of the swimmer’s projection where the orientation of the arms was reversed. The sample, consisting of 45 patients, was referred from the emergency department and wards. Most of the patients (95.5%) were examined using a computed radiography system providing digital images that were printed using a laser film printer. Other patients were examined using conventional film/screen systems. The objectives of this study were to compare the two imaging techniques with reference to diagnostic quality of the projections, diagnosis of pathology and repeat rate. Radiographers obtained the two projections of the cervical spine; the researcher collected the images and distributed these to three participating radiologists on a rotational basis. The radiologists evaluated the films using a set of criteria; a biostatistician analysed the results of these evaluations. In all the criteria of image quality the swimmer’s projection showed better results. There were also, however, instances where the adapted swimmer’s had better results. The differences in percentages were not significant enough to show any statistical difference between the resultant images of the two techniques. No valid deduction could be made in relation to the demonstration of pathology due to variable instances of pathology evaluated by the radiologists. The repeat rate of the adapted swimmer’s projection compared well with the swimmer’s projection. Though the swimmer’s projection had better results for most of the criteria used in this study, no unequivocal, statistically significant evidence of it demonstrating C7-T1 better could be found. What was evident was the validity of the adapted swimmer’s projection as an alternative under certain conditions. Knowing that there is an alternative method to visualising the C7- T1 junction could be beneficial not only to radiography, but also to our patients. In cases where the swimmer’s projection is not possible due to extremity injuries, an alternative arm orientation can be useful. The alternative can also address the problem regarding multiple repeats of the swimmer’s projection.

All members of the oral healthcare team have a part to play in patient management, and the team is comprised of the lead dentist (plus other colleagues in the dental practice), the dental nurse, hygienist, receptionist, laboratory technician, and possibly a dental therapist. In the UK, registered dental nurses can take further qualifications in teaching, oral health education, and radiography, and can specialize in other aspects of dentistry, including orthodontics, oral surgery, sedation, and special care. If the dentist wishes to have a second specialist opinion regarding a difficult diagnosis, formulating a care plan or even executing it, they may refer the patient to a specialist dentist working in another practice, or to a hospital-based consultant specialist in restorative dentistry. These specialists have undergone further postgraduate clinical and academic training and gained qualifications enabling them to be registered as specialists with the General Dental Council (GDC) in the UK in their specific trained fields (e.g. endodontics, periodontics, prosthodontics), or have further specialist training in restorative dentistry. The lead dentist will act as a central hub in the coordinating wheel of patient management, possibly outsourcing different aspects of work to relevant specialist colleagues, as spokes of that wheel. This is the clinical environment in which patients are diagnosed and treated. This room has traditionally been known as the ‘dental surgery’, but a more appropriate modern description might be the ‘dental clinic’, as much of the more holistic care offered to patients within its four walls will be non-surgical in the first instance. The operator and nurse must work closely together. To be successful, each must build up an understanding of how the other works. The clinic consists of a dental operating chair with an attached or mobile bracket table carrying the rotary instruments and 3-1 air/water syringe (and possibly the light-cure unit and ultrasonic scaler), work surfaces (which should be as clutter-free as possible for good-quality infection control; see later), cupboards for storage, and two sinks, one for normal hand washing and another for decontaminating soiled instruments prior to sterilization. Often the surgery will also house an X-ray unit for taking intra-oral radiographs. Most clinics are designed to accommodate right-handed practitioners, in terms of the location of many of the instruments and controls.

Large Central Scientific Facilities such as the ESRF (the European Synchrotron Radiation Facility) and ILL (the European centre for neutron research), were set up to provide scientists with the advanced facilities they need to exploit neutron and synchrotron X-ray beams for scientific research. Engineers also conduct research at these Facilities, but this is less common as most practicing engineers generally have little or no knowledge of neutron or X-ray scattering, or of their considerable potential for engineering research, model validation, material development and for fatigue and failure analysis. FaME38 is the new joint support Facility for Materials Engineering, located at ILL-ESRF, set up to encourage and to facilitate engineering research by engineers at these facilities. It provides a technical and knowledge centre, a materials support laboratory, and the additional equipment and resources that academic and industrial engineers need for materials engineering research to become practicable, efficient and routine. It enables engineers to add the most advanced scientific diffraction and imaging facilities to their portfolio of diagnostic tools. These include non-destructive internal and through-surface strain scanning, phase analysis, radiography and tomography of engineering components. Synchrotron X-ray and neutron diffraction strain mapping is particularly suited for the rigorous experimental, non-destructive, validation of Finite Element and other computer model codes used to predict residual stress fields that are critical to the performance and lifetimes of engineering components. This paper discusses the FaME38 facility and demonstrates its utility in gaining fundamental insight into mechanical engineering problems through examples, including studies of railway rails, welds and peened surfaces that demonstrate the potential of neutron of synchrotron X-ray strain scanning for the determination of residual stress fields in a variety of engineering materials and critical components.