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J Med Radiat Sci. 2017 March; 64(Suppl Suppl 1): 62–82.
Published online 2017 February 28. doi:  10.1002/jmrs.2_214
PMCID: PMC5333348

Sunday 26 March 2017

Sunday 26 March, 0900–1030 Medical Imaging – Breast imaging (Reach Beyond)

Towards tailored breast cancer screening

Jennifer Stone

University of Western Australia, Perth, Australia

Objective: Whilst population‐based mammographic screening provides the best chances of early detection of breast cancer, not all women have an equal opportunity to achieve an earlier diagnosis. Women not only differ in terms of their underlying risk, but also the sensitivity of their mammogram to detect abnormalities. Thus, the benefit of screening varies widely throughout the population, with majority of women being at very low absolute risk, yet in Australia most women are screened the same way (every 2 years between ages 50 and 74).

A stratified screening program ‐ where women of different categories of risk are recommended different screening intervals or supplemental screening – may be a more efficient and cost‐effective way of detecting breast cancer. Key risk factors could be measured at screening to identify women at different categories of risk: mammographic density and known breast cancer susceptibility genetic variants.

Methods: I will review the current evidence to support the conduct of a randomized controlled trial to compare breast screening outcomes in tailored screening interventions versus current practice.

Results: A clinical trial of the effectiveness of tailored screening interventions compared to current practice is a huge undertaking and several key pieces of information need to be estimated first. The success of such a trial requires careful investigation and input from an array of stakeholders.

Conclusion: A clinical trial of the effectiveness of tailored screening interventions compared to current practice would provide the evidence needed to support a paradigm shift towards tailored breast cancer screening programs in Australia.

Diseases of the male breast

Meredith Kessell

Royal Perth Hospital, Perth, Australia

The vast majority of symptomatic and all screening mammograms are performed on women, however a small portion of patients who present with breast symptoms are male. Less than 1% of breast cancers diagnosed occur in men,1‐4 however the overall prognosis for male patients with breast cancer is poorer than for women.3 Male patients may present with a palpable lump,1‐4 breast enlargement or tenderness,1‐4, skin changes,1‐3 nipple retraction or discharge,1‐4 or palpable axillary lymph nodes.1‐3

The first imaging test performed on men is a bilateral four view mammogram,1‐4 and this can be followed by ultrasound and biopsy if required.1‐4 Most symptomatic male patients do not have breast cancer.1‐3 Benign condition affecting men include gynecomastia,1‐4 fat necrosis,4 and lipomas.4 Gynecomastia is a benign enlargement of the male breast4, and is usually easily diagnosed with mammography.1‐3

Risk factors for male breast cancer include advancing age,1‐4 BRCA2 genetic mutation,1,2 prior chest radiation,1,2,4, Klinefelters syndrome1‐4 and exogenous estrogen drugs (used for treating prostate cancer and post gender reassignment surgery).1,3,4

Up to 90% of male breast cancers are ductal1‐4, with lobular cancers being very rare.1‐4 Treatment is similar to the treatment for women with breast cancer, and may include surgery, radiation therapy, chemotherapy and/or hormonal therapy.2

References

1. Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, Bassett LW. Imaging Characteristics of Malignant Lesions of the Male Breast. RadioGraphics 2006; 26: 993–1006.

2. Giordano SH. A Review of the Diagnosis and Management of Male Breast Cancer. The Oncologist 2005; 10: 471–479.

3. Chantra PK, So GJ, Wollman JS, Bassett LW. Mammography of the Male Breast. AJR 1995; 164: 853–858.

4. Appelbaum AH, Evans GFF, Levy KR, Amirkhan RH, Schumpert TD. Mammographic Appearance of Male Breast Disease. RadioGraphics 1999; 19: 559–568.

Contrast enhanced spectral mammography – a radiographer's experience

Carolyn Madeley

Royal Perth Hospital, Huntingdale, Australia

Contrast Enhanced Spectral Mammography is a new imaging technique which was introduced to Royal Perth Hospital as part of a clinical trial initially in 2013. Many challenges were faced by the radiographers during implementation of the procedure into the busy breast assessment centre. This presentation introduces the technique and its advantages and limitations.1 It then focuses on the introduction of CESM, the training required for the radiographers, and the issues which were encountered during the initial trial, which aimed to compare CESM with CEMRI for the staging of newly diagnosed breast cancer.2 In October 2016 two more trials will commence at RPH using this technique. This time we will be investigating its potential use in Breast Assessment, as well as for the diagnosis and staging of DCIS. Introducing CESM into the chaos of a BreastScreen Assessment clinic comes with its own logistical challenges for the radiographer and these will be discussed. Finally a brief look at the radiation dose implications associated with this technique from our data will be presented, as well looking at how the patients themselves tolerate the technique.3

References

1. Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thornton C, Moskowitz CS, Ferrara J, Morris EA. Bilateral Contrast‐enhanced Dual‐Energy Digital Mammography: Feasibility and Comparison with Conventional Digital Mammography and MR Imaging in Women with Known Breast Carcinoma. Radiology 2013; 266; 743–751.

2. Taylor DB, Hobbs,MM. Comparative evaluation of Contrast Enhanced Spectral Mammography (CESM) and Contrast Enhanced Magnetic Resonance Imaging (CEMRI) for local staging of breast cancer: Interim results from the CESM V study. The Breast 2015; 24; 303–304.

3. Hobbs MM, Taylor DB, Buzynski S & Peake RE. Contrast‐enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance. JMIRO 2015; 59; 300–305.

What the text can't teach. A junior radiographer's experience of mammography

Fatmah Elhouli

Western Health, Melbourne, Australia

Upon declaring oneself to people as a radiographer that performs mammography, the perception of the public, is that of breast compression. While this may be hard to deny, diagnostic mammography entails so much more. A professional in this field must be a listener, an empathetic supporter and a master of choosing one's words carefully.

Training in mammography, like much of any imaging technique or modality, focuses largely on the technical principles, such as positioning, work up and QC/QA maintenance. These fundamentals present to the trainee as likely to be some of the most difficult aspects to master. That said, this is not always the case. Rather, patient interaction and communication create the most complicated issues faced, not only in training, but on a regular basis for any junior radiographer.

An ability to judge a patients anxiety and to effectively communicate in a diagnostic setting is paramount. This can take some time to master and is a skill that requires a lifelong development process.

There is far more to mammography than just the technical. This presentation hopes to provide the experience of a junior radiographer as a point of reflection to the intricacies of mammography and more so, to effective patient care.

Sunday 26 March, 0900–1030 Medical Imaging – Breast/thorax (Reach Beyond)

Implementation of ultraviolet tattoos for breast radiotherapy patients

Lorraine Lewis

Northern Sydney Cancer Centre Department of Radiation Oncology, Sydney, Australia

Objective: Routine practice in radiotherapy has been the use of black tattoos for localisation of the treatment field. Occasionally patients have shown concerns about the poor cosmesis of this technique. This presentation explores the successful implementation process of tattoos visible only under ultra violet (UV) light.

Method: A professional tattooing artist was consulted, supplied white invisible tattoo ink, and trained senior staff members in its application. Initially patients were tattooed with the white ink at the supra clavicular junction and contra lateral breast at central axis. The midline and ipsilateral breast site still had black tattoos. Feedback was collected from simulation and treatment RTs and patients were also consulted about which tattoos they preferred. After feedback, pink UV ink at all locations was trialled for a further 34 patients.

Results: In 2011, 92 breast and chest wall RT patients had white UV tattoos, and from August 2012, all breast and chest wall RT patients receive Pink UV tattoos. It was also found that yellow tattoos were more visible in dark skinned patients. A patient has commented “I am so pleased that I do not have a constant visible reminder of my breast cancer and that I can wear low cut tops and no one would know that I had radiotherapy”. All staff are now trained to ensure consistency in tattooing technique.

Conclusion: At the NSCC we have successfully implemented the use of UV tattoos for all breast/chest wall RT patients.

Supporting documents:

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Incorporating DIBH and VMAT into internal mammary node (IMN) irradiation in left‐sided breast cancer

Daisy Le Cerf, Beth Howard, Wee Loon Ong, Nigel Anderson, Amanda Phillips, Steven David

Peter MacCallum Cancer Centre, East Bentleigh, Australia

Objective: Regional nodal radiotherapy, including internal mammary nodes (IMN) in node positive breast cancer (BC) has recently demonstrated improved disease free survival.1,2,3 As a result, it is now increasingly incorporated into clinical practice. However, concern remains regarding increased risk of cardiac toxicities in left‐sided BC patients with IMN involvement. The aim of this study was to compare cardiac, lung and contralateral breast dosimetry between free‐breathing (FB) and deep‐inspiration‐breath‐hold (DIBH) techniques (±VMAT) in this patient cohort.

Methods: Twenty patients (11 post‐mastectomy, 9 post‐breast‐conserving) with left‐sided, node positive disease, treated with adjuvant radiotherapy (whole breast/chest wall plus IMN)) at our institution were included in this study. All patients were CT simulated with both FB and DIBH techniques. Differences in cardiac, lung and contralateral breast dosimetry between FB (3DCRT & VMAT) and DIBH (3DCRT) plans were evaluated.

Results: DIBH significantly reduced the heart dose (Dmean: 7.8 Gy to 2.8 Gy, P < 0.01; V25 Gy: 12% to 1%, < 0.01). DIBH also enabled significant reduction in left anterior descending (LAD) artery Dmean (33 Gy to 12 Gy, P < 0.01). Similarly, there was significant reduction in lung dose (Dmean: 8.7 Gy to 7.3 Gy, P < 0.01; V20 Gy: 17% to 14%, P < 0.001) when DIBH was employed. Preliminary VMAT results suggest encouraging cardiac avoidance.

Conclusion: DIBH facilitates significant cardiac avoidance in patients receiving IMN irradiation, reducing the long‐term risk of radiation‐induced cardiac toxicity. The results of this study demonstrate DIBH suitability in left‐sided node positive BC patients where the role of IMN irradiation is justified. Further investigation is warranted into the practical implication of VMAT for IMN irradiation.

References

1. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional Nodal Irradiation in Early‐Stage Breast Cancer. The New England journal of medicine. 2015; 373: 307–16.

2. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer. The New England journal of medicine. 2015; 373: 317–27.

3. Darby SC, Ewertz M, McGale P, Bennet AM, Blom‐Goldman U, Bronnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. The New England journal of medicine. 2013; 368: 987–98.

3D ultrasound image guided radiation treatment: assessment of seroma volume changes and feasibility study

Leigh Camilleri, Sara Condron, Jill Van Duuren, Clare Herbert

Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia

Objectives: To determine the feasibility and clinical application of 3D ultrasound within our department, a seroma monitoring observation study and retrospective audit of breast boost patients over a period of 8 months was performed. These two investigations were motivated by determining how variables such as surgical techniques, chemotherapy regimens, and the time between surgery and planning CT are related to tumour bed variations and ultimately the seroma visibility.

Method/Results: The seroma monitoring study included 8 patients and involved a baseline ultrasound (US) scan at the planning CT, and weekly seroma monitoring US scan during whole breast radiation. Comparisons in seroma volume were made between the treatment US scan and the baseline US scan. The results demonstrated significant change in seroma volume size across the cohort of patients prior to breast boost treatment.

Retrospective analysis of planning CT's from 68 breast boost patients enabled assessment of seroma visibility and whether 3D US imaging suitability could be predicted. The results demonstrated Clarity® imaging would have been feasible in 47% (n = 32) of the cases investigated in this audit. The majority of these suitable cases had no surgical clips but only a seroma present. Interestingly, 80% of non‐suitable cases (n = 25) had surgical clips placed at the tumour bed.

Conclusion: Clarity® proved to be a useful tool when assessing seroma changes, enabling tumour bed verification previously not considered. For suitable patients, the potential to modify field placement relative to a changing seroma and introduce adaptive treatment, has been of interest to the Clarity® Breast team.

Analysis of flattened and flattening filter free breast planning techniques with deep inspiration breath hold

Jenna Dean1, Joanne Phan1, Andrew Last1, Mahesh Chandroth1, Thomas Shakespeare2, Matthew Hoffmann1, Noel Aherne2, Carmen Hansen1

1Mid North Coast Cancer Institute, Port Macquarie, Australia 2Mid North Coast Cancer Institute, Coffs Harbour, Australia

Objectives: Deep inspiration breath hold (DIBH) has been shown to decrease doses to the heart and lungs for patients having left breast radiotherapy. The technique requires the patient to hold their breath during imaging and beam‐on time. Flattening filter free (FFF) beams deliver monitor units more rapidly than multiple flattened beams and would be expected to reduce treatment, and therefore, breath hold time. The aim of this study is to compare the dosimetry and treatment times for standard multiple flattened beam plans with those generated for the FFF beam.

Methods: DIBH scans from left breast patients were parallel‐planned using multiple‐flattened and FFF planning techniques. These included; tangential intensity modulated radiation therapy (IMRT), partial volumetric modulated arc therapy (VMAT) and full VMAT for each patient. Plans were normalised to cover the PTVeval with 95% of TD to allow for an accurate comparison between the plans and of doses to organs at risk. The quality assurance (QA) plans were then timed during delivery to ascertain the respective treatment delivery times.

Results: Data collection is ongoing and results will be discussed in the presentation.

Conclusion: Conclusions will be drawn once data collection and analysis has been completed. It is expected that the dosimetry for the techniques will be comparable, but that the FFF plans will be delivered over a shorter period of time than the flattened plans.

Feasibility study on the implementation of an automated IMRT planning script for whole breast radiotherapy

Callie Choong1, Kylie Dundas1,2, Vikneswary Batumalai1,2, Joanne Veneran1, Elise Pogson2, Miriam Boxer1, Mei Ling Yap1, Phillip Vial1, Gary Goozee1

1Liverpool Cancer Therapy, Sydney, Australia 2Ingham Institute, Sydney, Australia

Objectives: Currently all breast cancer patients at our centre are forward planned with 3D conformal radiotherapy (CRT). This technique can be time consuming and the resultant plan quality can vary depending on planner experience and expertise.1 An automated script was developed locally for research purposes,1,2 which could place tangential beams and run the first optimization calculation for an inverse planned intensity modulated radiation therapy (IMRT) technique for tangential breast radiotherapy. This study aimed to assess the feasibility of implementing an automated IMRT planning script and compare resources and dose distributions between scripted IMRT (S‐IMRT) and CRT for tangential breast radiotherapy.

Methods: Seven intact breast patients were identified for this prospective planning study and were first planned in Pinnacle using the standard CRT department protocol for treatment, and then with the IMRT script. Time to plan, coverage of target volumes, dose to critical structures and treatment times were evaluated for CRT and S‐IMRT.

Results: The overall S‐IMRT planning time was less than CRT (35 vs 70 min). 5/7 patients with CRT required 18‐MV, and all of these were planned successfully with S‐IMRT using 6‐MV. Coverage of target volumes and dose to critical structures were comparable between the two plans. S‐IMRT treatment time was less than CRT (2.7 vs 6.3 min).

Conclusions: S‐IMRT provides reduction of planning time and treatment time, while providing equal plans compared to CRT. This automated planning script is feasible and permits efficient use of resources, and can be done with existing equipment and personnel.

References

1. Jin H. A Semi‐automated Scripting Method for Breast Radiation Therapy Treatment Planning: Masters Thesis: University of Wollongong; 2014.

2. Dundas K, Jin H, Pogson E, Batumalai V, et al. Automated selection of gantry angle for tangential breast radiotherapy. J Med Imaging Radiat Oncol 2014; 58: 222.

Investigating the benefits of deep inspiration breath hold (DIBH) mediastinal radiotherapy for Hodgkin's lymphoma

Karen McGoldrick

Peter MacCallum Cancer Centre, Cheltenham, Australia

Objectives: Routine Hodgkin's Lymphoma management includes mediastinal radiotherapy. Traditionally, this can be a very young patient group where toxicities must be carefully considered in treatment planning. The aim of this study is to investigate dosimetric and clinical feasibility of Deep Inspiration Breath Hold (DIBH) in mediastinal radiotherapy to minimise cardiac toxicity.

Methods: Five patients underwent DIBH and Free‐Breathing (FB) CT scans in treatment position. Both data sets were fused with a pre‐chemotherapy FB PET (pCFB‐PET) scan for target delineation. 3DCRT and IMRT plans were generated for each dataset (Eclipse, v13.6, Varian Medical Systems). Comparative plans were assessed relative to target coverage and cardiac toxicity, with the primary focus to determine the clinical feasibility of DIBH plans.

Results: Patients 1 and 5 were unsuitable for target delineation on DIBH Planning CT due to significant anatomical discrepancy from pCFB‐PET to DIBH‐CT.

Patients 2 and 4 demonstrated improved cardiac avoidance on DIBH‐3DCRT plans compared to FB 3DCRT plans (Heart Dmean reduction of 47% and 43% respectively). Whilst the IMRT plans provided superior dosimetry in these two patients, DIBH‐3DCRT's decreased conformality was clinically preferred to allow for any target volume delineation uncertainty. Comparatively, Patient 3 DIBH‐IMRT plan was clinically preferred, demonstrating acceptable target delineation and cardiac dose reduction.

Conclusion: Preliminary data in three of the five patients demonstrates a dosimetric benefit of DIBH in mediastinal radiotherapy. However, volume delineation uncertainty may limit clinical feasibility in the absence of alternative imaging protocols. As a result, a clinical protocol utilising pre‐chemotherapy DIBH‐PET is currently under development.

Sunday 26 March, 0900–1030 Medical Imaging Student prize winners (Reach Across)

Bird Fancier's lung

Ali Jackson

The University of South Australia, Adelaide, Australia

Learning Objectives:

• To examine the aetiology of Bird Fancier's Lung (BFL) disease.

• Detail the clinical presentations of patients who suffer from Hypersensitivity Pneumonitis (HP), in particular BFL.

• Investigate the different forms of diagnosis of BFL, and the best imaging modality to demonstrate HP.

• Explore the treatment options.

Background: This presentation is intended to bring light to an exceptionally rare respiratory condition known as Bird Fancier's Lung. This disease is a form of HP that is caused due to the exposure of avian proteins found in bird feathers, serum and excrement.1 Those at risk of this disease are people who work with or own many birds. Acute symptoms of a person suffering from BFL include dyspnea, fatigue, weight loss and fever like symptoms, which are normally seen within 4‐6 hours of exposure to the protein.2

Modality Comparison and Treatment: Multiple tests can assist in the diagnosis of BFL, including pulmonary function testing, laboratory analyses, hypersensitivity testing and biopsy.3 It can also be demonstrated on x‐ray images and high resolution CT scans that illustrate a physical change to the lung structure commonly known as a ‘ground glass’ appearance.4 Symptoms of BFL improve in the absence of the avian proteins, though alternate treatment can include corticosteroid therapy to speed the resolution of HP however it does not change the long‐term prognosis for patients.5

Conclusion: This presentation will educate radiographers of the aetiology, symptoms, clinical and radiographic features to diagnose BFL and the treatment options for this rare respiratory disease.

References

1. Cooper CJ, Teleb M, Elhanafi S, Ajmal S, Hernandez GT. Bird fancier's lung induced by exposure to duck and goose feathers. The American Journal of Case Reports. 2014; 15: 155–158. Available from: doi:10.12659/AJCR.890184 (Accessed 18th November 2016).

2. Farber HJ. Pediatric Hypersensitivity Pneumonitis Clinical Presentation. Available from: http://emedicine.medscape.com/article/1005107‐clinical#b4 (Accessed 18th November 2016).

3. Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X. Bird Fancier's Lung: a series of 86 patients. Medicine (Baltimore) 2008; 87(2): 110–30. Available from: doi: 10.1097/MD.0b013e31816d1dda (Accessed 18th November 2016).

4. Ribeiro‐Neto M, Parambil JG. Hypersensitivity Pneumonitis. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/hypersensitivity‐pneumonitis/ (Accessed 19th November 2016).

Sleep disturbance and the impact on cancer patients

Anna Lorenz1,2

1RMIT, Melbourne, Australia 2Epworth Radiaton Oncology, Melbourne, Australia

Little is known about the sleep quality in cancer patients. It can often go unrecognised and when acknowledged, can be poorly managed. It is estimated that the prevalence of sleep disturbance in cancer patients is double that of the general population.

The current literature identifies and measures many different types of sleep disturbance.

The type of sleep disturbance investigated by each study is influenced by the tool or method chosen for measurement. A different tool was used for each study. Studies used subjective or objective methods or a combination of both.

Many authors concluded that certain groups of cancer patients were more prone to sleep disturbance than others.

It is essential that an appropriate treatment regime be implemented to prevent the development of severe consequences due to sleep disturbance. Many different types of interventions have been suggested. The interventions can be categorised as pharmacologic or non‐pharmacologic.

It is clear that the topic of sleep disturbance in cancer patients needs to be explored more thoroughly. There is a need for the development of a standardised valid and reliable tool to measure sleep disturbance. There also needs to be more research into the interventions that can help reduce sleep disturbance. It is crucial that the type and cause of the sleep disturbance be identified in order to prescribe the most suitable intervention. As health professionals, it is important to be aware of the signs of sleep disturbance, ask patients if they are experiencing sleep problems and refer to appropriate services if necessary.

Investigation of diagnostic value and radiation dose for CT pulmonary angiography versus ventilation/perfusion scans in the evaluation of pulmonary embolism

Zhonghua Sun, Callum McRobert

Curtin University, Perth, Australia

Study Aim: To investigate the diagnostic value and dose of computed tomography pulmonary angiography (CTPA) for diagnostic evaluation of patients with pulmonary embolism (PE) when compared to ventilation/perfusion (V/Q) scans.

Materials and Methods: This is a retrospective study involving data analysis of patients with suspected PE in a large metropolitan hospital in WA over a period of 8.5 years. A total of 94 CTPA and V/Q cases investigating PE were collected through searching PACS database. Of these studies, 39 CTPA and 55 V/Q examinations were recorded. CTPA dose values in terms of volume CT dose index (CTDIvol) and dose length product (DLP), and the exposure factors (ranging from 80 kVp to 120 kVp) for these CTPA examinations was collected. The radioactivity for the isotopes/radiopharmaceuticals used in the Ventilation (Technegas Tc‐99 m) and Perfusion scans (Tc‐99 m MAA) were recorded. Effective dose for these studies was then calculated using a weighting factor of 0.011 for each of the Ventilation and Perfusion isotopes, 0.017 for the CTPA scans.

Results: Mean effective dose values for CTPA examinations tended to increase proportionally with increases to kVp technique. Effective dose values were as follows: 80 kVp (3.51 mSv), 100 kVp (4.75 mSv) and 120 kVp (10.89 mSv). The mean effective dose value for the Ventilation component of the V/Q was 7.60 mSv. The Perfusion component had a mean effective dose value of 2.11 mSv. The mean dose value for combined Ventilation/Perfusion studies totalled 9.71 mSv.

Contrast enhanced spectral mammography

Courtney Hughes

University Of Newcastle, Wamberal, Australia

Contrast Enhanced Spectral Mammography is a breast imaging technique that utilizes digital mammography along with contrast to demonstrate areas of increased uptake in the breast. This presentation will discuss the use of contrast enhanced mammography, how it works, the positives and negatives and research comparing CESM to Breast MRI.

Optimised grid use in digital radiography

Ellen Stewart

The Prince Charles Hospital, Brisbane, Australia

Objectives: Anti‐scatter grid use improves image contrast but also requires an increase in radiation exposure of two times or more.1 With new technology in image receptors that are less sensitive to scatter radiation, it is important to investigate if the risk‐vs‐benefit scale of anti‐scatter grid usage still weighed the same.2,3 Dose increase factor and scatter‐to‐primary ratio are the measures utilised to determine grid effectiveness.4

Methods: The experiment performed for this study utilised a chest phantom, beam stop device, anti‐scatter grids, and both a new digital image receptor and an older computed radiography cassette. The grid state and kVp exposure factor was varied to represent a variety of imaging situations. The images produced were analysed through scatter‐to‐primary ratio, and dose increase factor.4,5

Results: Images made with the indirect digital radiography receptor had a lower scatter‐to‐primary for a non‐grid exposure when compared to a gridded computed radiography receptor image. On average computed radiography had higher measured scatter‐to‐primary ratios. kVp increase resulted in a non‐significant increase in scatter‐to‐primary ratio in all situations.

Conclusion: This study proved anti‐scatter grids are less effective in digital radiography even though the dose increase necessary remains the same. Anti‐scatter grid usage should be reconsidered in every situation given new DR technology.

References

1. Aichinger H. Radiation exposure and image quality in x‐ray diagnostic radiology: physical principles and clinical applications. New York; Berlin: Springer; 2004.

2. Luı´s Lanc, Silva A. Digital radiography detectors A technicaloverview: Part 1 + 2. Radiography 2008; 15.

3. Tanaka N, Naka K, Saito A, Morishita J, Toyofuku F, Ohki M, et al. Investigation of optimum anti‐scatter grid selection for digital radiography: physical imaging properties and detectability of low‐contrast signals. Radiological physics and technology 2013; 6: 54 – 60.

4. Maher KP. Comparison of scatter measurement techniques in digital fluoroscopy. Physics in medicine and biology 1993; 38: 1977.

5. Neitzel U. Grids or air gaps for scatter reduction in digital radiography: a model calculation. Medical physics 1992; 19: 475–81.

Sunday 26 March, 0900–1030 Combined MRS – Patient care (Reach Beyond)

Paediatric kV verification imaging exposure settings in radiation therapy: how low can we go?

Dominique Fogarty

Radiation Oncology Mater Centre, Brisbane, Australia

Objectives: When Radiation Oncology Mater Centre (ROMC) became the primary provider of paediatric radiation therapy in Queensland, paediatric kilo‐voltage (kV) imaging protocols for online image‐guided radiotherapy (IGRT) were developed. These protocols aimed to provide image quality to verify patient positioning whilst following ALARA and Image Gently principles. To the department's knowledge, this is the first time paediatric specific kV treatment verification imaging exposure protocols have been implemented in an Australian radiation therapy department. A study was conducted to prospectively evaluate image quality for paediatric kV exposures; identify if age group specific kV imaging exposures are appropriate; and to identify factors influencing a deviation from those settings. The outcomes of this study will be used to inform a review of paediatric kV imaging exposures used within the department.

Methods: KV exposure settings used for online IGRT for paediatric patients were recorded as well as radiation therapist perceptions of image quality. Patient factors such as separation, weight and treatment set‐up were also collected in order to evaluate their impact on image quality.

Results: Data collection and analysis is ongoing, however preliminary analysis is demonstrating that current paediatric kV exposure protocols are providing sufficient image quality for online kV image matching. Data collection and analysis is to be completed by November 2016 and will be presented.

Conclusions: It is anticipated that the age group specific kV exposure settings implemented for the department's paediatric population provide sufficient quality images while reducing kV exposure doses.

Clinical implementation of VMAT for paediatric craniospinal irradiation

Vaughan Geddes

Peter MacCallum Cancer Centre, Melbourne, Australia

Introduction: Cranio‐Spinal Irradiation (CSI) provides significant planning, treatment and quality assurance challenges due to the physical and cognitive growth considerations for paediatric patients. Conventional techniques combine the physical characteristics of both photon and electron beams to deliver dosimetry to complex target volumes whilst sparing critical healthy tissue. However, translation of planned dose to delivered dose can remain problematic. Volumetric modulated arc therapy (VMAT) provides an alternate solution to mitigate the challenges associated with the photon/electron technique. This presentation will discuss the clinical considerations and subsequent implementation of VMAT‐CSI in paediatric patients.

Discussion: Peter MacCallum Cancer Centre's introduction of new linear accelerators provided the impetus for transition to VMAT‐ CSI in paediatric patients. The inability to treat supine‐positioned electron fields through opaque carbon fibre couch tops instigated change in this treatment technique. Planning duration, junctional dose reproducibility and consequent impact on linear accelerator inefficiencies were addressed: these issues contribute to lengthier periods of undesirable patient anaesthesia, whilst placing increased demands on departmental resources.

Whilst VMAT provides a viable alternative to minimise many CSI challenges, the well documented low dose wash provides grounds for caution. In particular, in a patient cohort where late radiation effects are managed with extreme caution, plan optimisation beyond target conformity is essential.

Conclusion: VMAT provides a viable option for safe delivery of paediatric CSI. Whilst mitigating many treatment delivery inefficiencies, a cautious approach is recommended to ensure improved plan conformity is balanced against low dose wash of the VMAT technique in this vulnerable patient cohort.

The applicability of the Greulich & Pyle atlas when applied to multi‐cultural Australian children

Adam Steward, Talishia Scutella

Western Health, Maribyrnong, Australia

The Greulich & Pyle (G&P) Atlas is a method of determining bone age based on an atlas published by Dr William Walter Greulich and Dr Sarah Idell Pyle. The original study was performed in the 1930's with a study of upper socio‐economic level caucasian children in Ohio. To date, this method is still one of the most commonly used for bone age measurement by radiologists, and is often referred to as the ‘Gold Standard’ in calculating bone age.

To calculate bone age, radiographs of the left wrist are compared with the nearest matching reference radiographs provided in the atlas. Given the Atlas is now nearly 80 years old, and based on upper socio‐economic Caucasian children in the US, we must consider its relevance to modern times, particularly the current multi‐cultural nature of Australian society.

This is a retrospective audit reviewing the Western Health Picture Archive and Communication System (PACS). The purpose is to determine the relevance of the Greulich & Pyle Atlas for determination of bone age of paediatric patients in modern Australia and specifically any variance attributable to ethnicity. All paediatric patients that presented to the radiology department for x‐ray examinations of the left hand and wrist, over a 2 years period between 1st June 2014 and 1st June 2016 will be assessed. Bone Age will be determined using the Atlas and an average variance from the chronological age made. Studies will be separated by ethnicity to assess any cultural variances that may exist.

Renal disease in Northern Territory – a matter of life choices?

Tu Anh Dao, Cherie Kim

Medical Imaging Department Alice Springs Hospital, Alice Springs, Australia

At Alice Springs Hospital, 70 percent of hospital admissions, and 93 percent of renal dialysis services are provided to patients of Indigenous background.1 Moreover, the Northern Territory's Indigenous population reportedly has the highest incidence rate and prevalence of chronic kidney disease (CKD) in Australia.2 Unfortunately, there is a stigma associating CKD solely with alcohol abuse and high risk life‐style choices. Hence, it is crucial for us as radiographers at Alice Springs Hospital to gain an insight on the underlying causes of this complex disease. From our investigation, it is not just a single factor that causes such high incidence of CKD in Central Australia. It is rather a constitution of multiple risk factors that our patients are exposed to throughout different stages of their lives. Amongst these, biomedical and socioeconomic factors have the most significant impacts. Studies suggested that Indigenous patients may suffer from a genetic condition of nephron deficiency.3, 4 In addition, poor hygiene, poor infrastructure, poor nutrition and limited access to health services are the most predominant issues on the socioeconomic platform.5 Together, this leads to low birth weight, high rate of acute and chronic infections, diabetes and obesity. These are the major risk factors to the development of CKD. Perhaps it takes more than an effective alcohol intervention program to reduce the incidence rate of CKD in Central Australia.

References

1. Department of Health Northern Territory Government 2014, Annual Report 2013‐14, Department of Health Northern Territory Government, <http://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/613/1/DoH%20Annual%20Report%202013‐2014.pdf>.

2. Australia& New Zealand Dialysis& Transplant Registry (ANZDATA Registry) 2016, 38th Report, Chapter 12: Indigenous People and End Stage Kidney Disease, ANZDATA, Adelaide, Australia, viewed 3 March 2016 http://www.anzdata.org.au.

3. Brenner BM, Garcia DL, Anderson 1988, ‘Glomeruli and blood pressure: Less of one, more of the other?’, Am J Hypertens, vol. 1, pp. 335–34.

4. Brenner BM, Mackenzie HS 1997, ‘Nephron mass as a risk factor for progression of renal disease’, Kidney Int Suppl ,vol. 63, pp.124–127.

5. Hoy W, White A, Tipiloura B, Singh G, Sharma S, & Bloomfield H, et al. 2014, ‘The influence of birthweight, past poststreptococcal glomerulonephritis and current body mass index on levels of albuminuria in young adults: the multideterminant model of renal disease in a remote Australian Aboriginal population with high rates of renal disease and renal failure’, Nephrol Dial Transplant vol.31, no.6, pp. 971–977. https://doi.org/10.1093/ndt/gfu241.

Dementia care in radiography

Rachel Challen, Lee‐Fay Low, Mark McEntee

The University of Sydney, Sydney, Australia

Background: When performing diagnostic imaging on patients with dementia, memory deficits, loss of executive functions and disruptive behaviours pose a unique challenge. There is abundant literature on the radiographic diagnosis of dementia; however, there is almost no research with a clinical focus on the needs of people with dementia as part of radiography practices.

Aim: To explore experiences of dementia patient care in the radiology department through the viewpoints of people with dementia, their carers and practicing radiographers.

Methods: A cross‐sectional qualitative design was used. Four people with dementia and six carers participated in semi‐structured interviews where their experiences of radiography scans were elicited. Eight practicing radiographers participated in a focus group where their experiences in scanning people with dementia were discussed. Interviews and the focus group were transcribed and thematically analysed.

Results: Participants described positive and negative experiences with radiography. Preliminary themes related to negative radiography encounters were stigma and stereotyping, poor communication, difficult physical environments, lack of education about dementia, time pressures, abuse and the exclusion of carers. Themes relating to positive radiography encounters were effective communication, carer partnership, patient focus, modifying the physical environment, flexibility, reduced waiting time and respecting personhood.

Conclusion: People with dementia and their carers can experience poor care in radiology. Many themes were common across people with dementia, carers and radiographers. Findings suggest that increased knowledge about dementia and partnership with carers may reduce these negative experiences and improve patient care.

Electronic skin brachytherapy: the first Australian Elekta Esteya® experience

Natalie Meagher, Belinda Petherick, Catherine Di Stasi, Peter Gorayski, Bess Sutherland, Michael Poulsen

Radiation Oncology Centres, Gold Coast University Hospital, Southport, Australia

The Elekta Esteya® unit is classified as electronic brachytherapy (EBT) due to the use of a high dose rate (HDR) x‐ray source placed close to (or in contact with) the target area on skin. The benefits of EBT include: low energy source, high dose rate and short treatment times ranging between 2 and 3 min. The sharp penumbra, accurate source positioning, and steep fall‐off makes EBT suitable for superficial skin lesions. Additionally, it can be used without the additional radiation safety considerations such as room shielding requirements associated with brachytherapy radioisotopes. The Elekta Esteya® is a portable EBT unit which uses circular applicators of 10–30 mm diameter for treatment of lesions up to 20 mm in size and 5 mm depth.

This work presents an overview of the first Australian experience using the Elekta Esteya® unit for EBT skin treatments. The advantages and limitations of EBT over superficial radiation therapy (SXRT) are explored, including differences between dose and fractionation schemes. Clinical diagnosis, exclusion criteria, skin grading of the lesions and their trends in size, location and depth are outlined. A preliminary analysis of patients treated on the first Elekta Esteya® unit in Australia is also presented.

Sunday 26 March, 1100–1230 Medical Imaging ‐ Advanced Practice / Radiographer Commenting (Reach Beyond)

Advanced practice radiographers: what can be achieved?

Nick Woznitza1,2

1Homerton University Hospital, London, United Kingdom 2Canterbury Christ Church University, Canterbury, United Kingdom

Radiology worldwide has seen significant and sustained increases. A critical review of the literature will place current practice in the United Kingdom into international context, and emphasise key milestones and developments. Data from a single acute hospital in London, United Kingdom, will be presented as an exemplar of best practice to highlight the possible contribution of radiographer advanced practice to effective, efficient and patient focused radiology.

Reaching for new heights: Logan Hospital radiographer commenting

Michael Neep, Cameron Brown

Metro South Health, Queensland Health, Brisbane, Australia

Objectives: During uncertain economic times, where the costs of supplying a health service to an ageing Australian population is increasing faster than economic growth;1 cost effective innovations are integral to the continuation of suppling a high quality service. One such innovation suggested is a radiographer formally documenting their professional interpretive opinion on the radiographs they provide. This is particularly relevant in Emergency Departments when a radiologist report isn't available within 4 h and a timely diagnosis is required.2 This report will investigate the effectiveness of a permanently implemented Radiographer Commenting Service within the Emergency Department of Logan Hospital.

Methods: A total of 3355 radiological examinations were reviewed from January 15 – July 15 2016. The range of adult and paediatric examinations incorporated in the review included the appendicular and axial skeleton including the chest and abdomen. Each examination was compared to the radiologist's reports so that true negative/positive and false negative/positive values could be allocated. This allowed sensitivity, specificity and diagnostic accuracy to be analysed. Mean scores were calculated.

Results: The comparison reported an overall average of 91.11% accuracy in providing a radiographer comment. The mean values calculated for sensitivity and specificity were 67.54% and 98.80%, respectively.

Conclusion: The results indicate that radiographers can provide a consistently accurate and timely service to compliment a radiologist report and emergency clinician's assessment. This is a reliable and effective enhancement of the radiographer's role within the multi‐disciplinary team. Ideally, this service can and should be implemented within emergency departments nationally.

References

1. Australian Treasury. Intergenerational Report. Australian Government, Canberra. 2010.

2. Eastgate P, Davidson R, McPhail SM. Radiographic imaging for traumatic ankle injuries: a demand profile and investigation of radiological reporting timeframes from an Australian tertiary facility. Journal of foot and ankle research. 2014; 7: 1.

ASMIRT advanced practice pathway – update

Nadine Thompson

Sydney Adventist Hospital, Westmead, Australia

ASMIRT's Advanced Practice Pathway opened in April 2014 with three avenues for members to utilise in their pursuit of Advanced Practitioner status. One of these avenues, the champion pathway, closed in December 2015. APAP will be presenting the updates to the application process, assessment timeline and feedback expectations. This presentation will provide delegates with information pertaining to Advanced Practice in Australia for Radiographers and Radiation Therapists.

Sunday 26 March, 1100–1230 Combined MRS – Volunteer & outreach (Reach Beyond)

Reaching beyond our hospital walls – exploring radiotherapy in Vietnam

Vu Huynh

Hoc Mai Medical Foundation, The University of Sydney, Sydney, Australia

My volunteering journey has been one of the most rewarding experiences in my life, but it didn't always feel like this. There were definitely times where I would question the whole concept, trying to make sense of the numerous challenges that arose. However it would be because of these very challenges that would lead me to come to some personal realisations that would forever transform the way I think and allow me to personally grow.

As cancer becomes increasingly prevalent in the developing world, and as we in Australia become more technically and technologically advanced, I definitely do believe that it is within our “reach” to make a difference. But as to how we effectively go about making that difference seems to be a confusing and complex question that is too often than not given a simplistic answer.

Reaching out for support: adolescent and young adult survivorship

Nina Lin

Queensland University of Technology, Brisbane, Australia

Adolescent and young adult (AYA) cancer patients face unique challenges. In addition to facing the typical cognitive, physical, psychological and emotional development of adolescence, AYA cancer patients must also cope with the physical and psychosocial implications of a cancer diagnosis. These include establishing their identity after cancer, confronting their mortality, surviving with physical handicaps and being burdened with a fear of recurrence.

Healthcare professionals caring for AYA cancer survivors may need to help the patient transition from a paediatric setting for their primary care to an adult setting for their ongoing follow‐up.1 Additionally, they must also be equipped to care for the unique survivorship issues associated with AYA patients. The aim of cancer treatment should be to achieve functional cure, which is the ability to integrate into society without significant disabilities.2 As cancer has both a physical and psychological impact on a patient's life, holistic and multi‐disciplinary care is integral to achieving functional cure.

This presentation will discuss the challenges adolescent cancer survivors face and methods healthcare professionals can employ to help AYA achieve the most optimal outcomes.

References

1. Kinahan KE, Sanford S, Sadak KT, Salsman JM, Danner‐Koptik K, Didwania A. Models of Cancer Survivorship Care for Adolescents and Young Adults. Semin Oncol Nurs 2015; 31: 251–259.

2. Halperin, EC. The cancer problem in children. In: Halperin EC, Constine LS, Tarbell NJ, Kun LE. Pediatric Radiation Oncology. Lippincott Williams & Wilkin, Philadelphia. 2011; 1–11.

Dry July Shave Off – experiences and outcomes of a viral fundraising initiative

Mark Udovitch

Liverpool and Macarthur Hospital, Sydney, Australia

Dry July is an Australian charity which traditionally encourages participants to give up alcohol for the month of July to raise funds for patient‐centric initiatives at cancer therapy centres. The Dry July Shave Off was an initiative established by Liverpool Cancer Therapy Centre (LCTC) to raise funds to improve the experiences of cancer patients at Liverpool Hospital. The aim of this presentation is to share the experiences and outcomes of the viral ‘Dry July Shave Off’ fundraising campaign.

LCTC staff impersonated over 50 celebrities to raise awareness about the Dry July Shave Off initiative. The images of celebrity impersonations were posted on Facebook, Instagram and Tumblr social media platforms. The campaign had significant exposure at a national and international level, appearing in online publications in North America, Europe, Asia and Africa; such as the Daily Mail UK, MTV UK, Huffington Post, Upworthy, Vanity Fair Italy and Cosmopolitan Magazine in Hungary. Team leader Mark Udovitch discussed the Dry July Shave Off in segments on Channel 9's TODAY show, Channel 7's The Daily Edition and on ‘Evenings with Kumi Taguchi’ on ABC 702 Radio. Our story was also shared on Facebook by Hollywood actor Ashton Kutcher, Kardashian matriarch Kris Jenner and WWE wrestler Hulk Hogan.

At the end of the campaign, 18 LCTC staff shaved their heads, cut significant lengths of their hair, or shaved their beards. In total, the LCTC Radiation Oncology team raised over $36,000 and came first in the nation on the Top Teams Leaderboard for Dry July!

Reach out: the road to Mandalay, Nay Pi Taw & Yangon

Carolyn McGregor

Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia

In collaboration with Sydney University's Institute for Global Health, eight radiation therapists from the Northern Sydney Cancer Centre and the Central Coast Cancer Centre spent a total of 3 months volunteering in three Radiation Therapy centres in Myanmar in 2015. In keeping with ‘opening’ Myanmar to the world, the Ministry of Health has increased funding for radiotherapy staffing and equipment. However there is no specific undergraduate or post‐graduate course for radiation therapy with most departments staffed by Radiography graduates who then learn radiotherapy techniques “in‐house”.

With information gleaned from an introductory visit to Myanmar by the Institute for Global Health, and insights from a volunteer physicist on her recent experiences in Yangon, we set about gathering resources and designing assessment tools and feedback from each centre from both local staff and each volunteer. Learning Burmese was also attempted, with varying degrees of success!

The first three volunteers in each city encountered different challenges, both technical and cultural. Existing departmental hierarchies in two of the departments created difficulties in trying to introduce treatment and quality assurance protocols in line with international standards. Our challenge was to effect change in a collaborative manner, mindful of building lasting connections for exchange.

This paper explores each volunteer's experiences and will include analysis of assessment tools plus feedback from repeat visits in 2016.

Radiology outreach in Sri Lanka – an overview

Marilyn Zelesco

Lead Sonographer, Medical Imaging Department, Fiona Stanley Hosptial, Perth, Australia

In 2015, the Royal Australian and New Zealand College of Radiologists (RANZCR) granted travel funds for 2 radiologists and 2 sonographers to travel to Sri Lanka to run workshops in Contrast Enhanced Ultrasound (CEUS). The aims of this International Development Fund grant were:

• To introduce the technique of CEUS to Sir Lankan radiologists

• To provide theory, technique and practical demonstrations of CEUS

• By training a core group of radiologists, to encourage and facilitate the ongoing dissemination of CEUS in Sri Lanka.

The radiology group were : Associate Professor Richard Mendelson (RPH), Dr Padmini Hewavitharana (RPH), Mrs Marilyn Zelesco (FSH) and Mrs Elvie Haluszkiewicz (FSH).

The rationale for undertaking this project was that advanced imaging modalities such as CT and MRI are limited outside of major Sri Lankan centres – CEUS provides an excellent, safe and relatively cheap alternative to CT & MRI in many applications.1,2,3

The workshops were conducted in Columbo, Galle and Kandy from March 23 – 27, 2016 inclusive. Over 130 Sri Lankan radiologists, radiology registrars and medical practitioners attended these three workshops. A total of 33 patients were scanned across these centres.

This talk is an overview of the outreach program, with the hope of promoting more medical imaging professionals to participate in overseas opportunities.

References

1. Catalano O, Nunziata A, Lobianco R, and Siani A. 2005. The real‐time harmonic contrast material–specific US of focal liver lesions. RadioGraphics 25: 333‐349. Contrast Harmonic Imaging. 2006.

2. Soye J, Mullan C, Porter S, Beattie H, Barltrop A, and Nelson W. The use of contrast‐enhanced ultrasound in the characterization of focal liver lesions. Ulster Medical Journal 2007; 76: 22–25.

3. Luigi Bolondi, “The appropriate allocation of CEUS in the diagnostic algorithm of lvier lesions; a debated issue” Guest editorial in Ultrasound in medicine and Biology journal, Vol 39, no 2, pp 183 –185, 2013.

Sunday 26 March, 1100–1230 Radiation Therapy Student prize winners (Reach Across)

DIBH & lung cancer: effects on tumour immobilisation, patient morbidity & dose escalation

Leelyn Hall, Anneleise Parker

University of Newcastle, Callaghan, Australia

There have been numerous studies undertaken into the implementation of Deep Inspiration Breath Hold (DIBH) Radiation Therapy (RT) for patients with Lung Cancer, in particular Non Small Cell Lung Cancer (NSCLC). Due to the anatomy of the Thorax, patients receiving RT to the lung often have larger treatment volumes to account for tumour motion and geometric uncertainties.1 As a result there is increased occurrence of radiation related toxicities such as radiation pneumonitis and oesophagitis. By immobilising tumour motion with a DIBH technique, superior/inferior tumour motion has been found to have reduced by 10 mm compared to free breathing (a mean reduction of 70.2%).2

In the past there have been difficulties with dose escalation with a major dose limiting factor being increased irradiation of normal lung tissue. However, as the use of DIBH has allowed for a combination of reduced treatment margins and lowered doses to nearby structures there can be a possibility of escalating doses to the CTV for the same normal tissue complication probability (NTCP). Increasing prescription from 69.4 Gy to 87.9 Gy has been implemented without any increased toxicity risk.3

While NSCLC has a relatively poor survival rate, implementing a DIBH technique for Radiation Therapy has the potential to increase local control rates and increased quality of life due to a reduction in treatment related toxicities

References

1. Giraud P, Morvan E, Claude L, Mornex F, Le Pechoux C, Bachaud J et al. Respiratory Gating Techniques for Optimization of Lung Cancer Radiotherapy. J Thorac Oncol 2011; 6: 2058–2068.

2. Hanley J, Debois M, Mah D, Mageras G, Raben A, Rosenzweig K et al. Deep inspiration breath‐hold technique for lung tumors: the potential value of target immobilization and reduced lung density in dose escalation. Int J Radiat Oncol Biol Phys 1999; 45: 603–611.

3. Rosenzweig K, Hanley J, Mah D, Mageras G, Hunt M, Toner S et al. The deep inspiration breath‐hold technique in the treatment of inoperable non–small‐cell lung cancer. International J Radiat Oncol Biol Phys 2000; 48: 81–87.

Design and development of a web‐based learning resource for radiation therapy students

Hayden Juriansz

Curtin University, Perth, Australia

It is a truism that learning comes with experience, however it may be difficult for beginning radiation therapy students to gain sufficient early experience in practical tasks that might enable them to feel confident and prepared to advance their professional capabilities. The implementation of web‐based learning is becoming more popular, particularly in healthcare fields, with it being shown to have a positive effect on student learning.

As part of a final‐year student project, a website has been designed and developed for radiation therapy students to assist in their learning of aspects relating to their clinical practice. The aim of the website is to better prepare students for their clinical placements by providing a supportive tool to link their academic knowledge to their clinical practice. The website utilises images and videos of clinical situations and authentic examples to promote radiation therapy students understanding of how certain practical clinical tasks are performed. The website incorporates topics that, based on real radiation therapy students’ personal experiences, provide the opportunity to benefit learners. While the website is in the early stages of development, peer feedback indicates that this resource has the potential to increase the confidence of students, thereby allowing them to get more out of their clinical experience.

The viability of surgical clips for the use in breast radiation therapy

Millie Taylor‐Brown, Katrina Smith, Nicola Jones, Kate Bartholomew

Queensland University of Technology, Brisbane, Australia

Objectives: The diagnosis of early stage breast cancer is increasing, accurate target localisation for Partial Breast Irradiation (PBI) and boost Radiation Therapy (RT) is essential to reduce the risk of recurrence. As tumour bed visualisation is hindered by minimal seromas and cosmesis‐preserving surgical techniques, this review aims to evaluate the viability of surgical clips for tumour bed localisation in breast radiotherapy.

Methods: A literature search of full‐text English articles published between 2009‐2016 in PubMed and Embase was conducted. The included studies evaluated the accuracy and reproducibility of surgical clips.

Results: Analysis of 10 articles indicated that surgical clips significantly aided in tumour bed localisation, improving the Cavity Visualisation Score (CVS) and intersection volume. Their use in treatment verification is justified, with a maximum residual error of 5 mm towards the centre of gravity. The use of 5‐6 clips gave the most accurate delineation; however, a minimum of 4 clips placed at four cardinal points of the cavity were found to be adequate. One study suggested gold fiducial markers were superior to surgical clips; however, further research needs to be conducted in this area.

Conclusion: Surgical clips are viable for accurate visualisation of tumour bed localisation in breast RT as they offer a stable, reproducible surrogate for treatment verification. Further research is required to formulate a standard Australian protocol for the use of surgical clips.

The use of hydrogel spacers in prostate cancer radiation therapy

Michael Mazzotta

University of South Australia, Adelaide, Australia

Learning Objectives:

• Provide knowledge of the clinical applications of hydrogel spacers for prostate cancer patients receiving high dose radiation therapy (HDRT) treatment.

• Detail the common procedural application of hydrogel spacers for HDRT treatment

• Identify the dosimetric and clinical advantages, considerations and risks associated with the use of hydrogel spacers

Background: This presentation is aimed at educating medical radiation practitioners on the use of hydrogel spacers in HDRT. It includes the typical procedural application of hydrogel spacers in the clinical environment, as well as what benefits and challenges this presents dosimetrically and clinically.

Summary of Key Points: Treating prostate cancer with HDRT using dose escalation can present challenges regarding patient side effects. The use of advanced treatment techniques has allowed dose escalation to treat the planning target volume (PTV) to greater doses, improving the tumour control probability. The use of temporarily inserted hydrogel spacers can be used to create a greater separation between the PTV and the rectum (primary organ at risk), decreasing the volume of high dose radiation to the adjacent rectal tissue. Reductions in high dose radiation to the rectum are correlated with reductions in long term side effects and complications for the patient. Resultantly, there is the potential for further dose escalation, hypofractionation or stereotactic radiation therapy to improve the tumour control probability and prognosis for prostate cancer patients.

Conclusion: This presentation will explore the clinical application, benefits and risks associated with the use of hydrogel spacers in high dose radiation therapy of prostate cancer.

Attitudes towards patients with disability in a clinical setting: A survey of undergraduate radiography students

Pratik Vageesh, Nabita Singh, Michal Schneider

Department of Medical Imaging and Radiation Sciences, Monash University, Australia

Background: As future healthcare professionals, radiography students need to be equipped with the appropriate knowledge, skills and attitudes to be able to provide high‐quality care and produce diagnostic images for patients with disability. The objective of this study was to evaluate the attitudes of undergraduate radiography students towards patients with physical, intellectual or a combination of both disability categories in a clinical setting.

Methods: Undergraduate radiography students at Monash University were recruited for the study. A mixed‐method, anonymous survey was developed and distributed in hard copies. Results were stratified by year level of study, gender and previous experience with disability. Chi‐squared and ANOVA tests were used to analyse the quantitative data. Thematic analysis was conducted on the open‐ended responses.

Results: Of 277, a 188 (68%) radiography students participated in the study. Overall, radiography students have a relatively positive attitude towards disability in the clinical setting. Female students appear to have more positive attitudes than male students towards intellectual disability (= 0.008). Years of study and previous experience with disability appear to have a significant influence on the attitudes of students towards patients with disability (P < 0.05). Most students want to provide optimal care to disabled patients but felt ill‐equipped to deal with them.

Conclusions: There is a strong sense of duty‐of‐care towards disabled patients among radiography students. However, students do not seem sufficiently prepared to deal with disabled patients in the clinical setting. Educational interventions may be required to improve students’ management of disabled patients.

Keywords: attitudes, disabled patients, healthcare, radiography students.

Sunday 26 March, 1100–1230 Combined MRS – Workforce (Reach Within)

Reaching across: a collaborative education initiative to address sonography workforce shortage in New Zealand

Jenny Sim

The University of Auckland, Auckland, New Zealand

Background: New Zealand is currently experiencing a severe shortage of sonographers. The situation is compounded by the intense nature of clinical supervision which negatively impacts on sonographer productivity and further limits training capacity. To address the national shortage, the University of Auckland, along with the public and private sectors and Health Workforce New Zealand (HWNZ) came together in a collaborative venture to jointly support and accelerate sonography training.

Objectives: The new education initiative aimed to prepare sonography trainees to be more ‘work ready’ thereby reducing the supervision burden of sonographers.

Methods: Trainees attended a 12‐week intensive course on campus full time. The curriculum framework focused on building sonographer core competencies, with equal emphasis on the development of critical thinking and psychomotor skill of ultrasound scanning. An independent evaluator was appointed by HWNZ to determine the quality of the course and the impact of the trainees on supervision burden and workplace productivity.

Results: The evaluation reports that the trainees were ‘work ready’; with the trainees out performing students who have not undergone the 12‐week intensive course. The clinical supervision burden was reduced without compromising on quality of clinical practice.

Conclusion: This accelerated model represents a departure from the traditional model by having trainees to commence their initial training full time at the University. The project also marks the coming together of the tertiary institution, public, and private providers in Auckland. With the successful conclusion of the pilot study, radiology providers now jointly contribute to the funding of the intensive course.

References

Acknowledgment: This 2‐year pilot study was funded by the Health Workforce New Zealand to provide a staff student ratio of 1:3. The University of Auckland thanked the Northern Regional Alliance of District Health Boards and the Auckland private radiology sector for the support of this accelerated model of sonography training.

Australian National Radiation Dose Register (ANRDR) review

Cameron Lawrence

Arpansa, Melbourne, Australia

The use of radiation has provided significant benefits to society; however this brings associated radiological risks requiring assessment, control and monitoring. Where the radiological risk is significant a monitoring program must be established to determine the radiation doses of exposed workers. In alignment with international best practice these records must be maintained until the worker attains the age of 75, and at least 30 years after cessation of work resulting in occupational exposure.

The Australian National Radiation Dose Register (ANRDR) was established in 2010 by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), with the support of Government and the Uranium Mining Industry, to serve as a repository of radiation dose records for exposed workers.

The ANRDR provides workers the ability to record and track their exposure across multiple jurisdictions and employers while ensuring the long term maintenance and security of the dose records. It has helped to ensure harmonisation and optimisation of radiation protection practices across the uranium mining and milling industry.

Since 2014 the ANRDR has had complete coverage of the uranium mining and milling industry. During 2015/16 the ANRDR incorporated the dose records from some Commonwealth licence holders and Mineral Sand mining operators. The ANRDR will continue to expand, working with State and Territory regulators and organisations to continue its work for the incorporation of dose records for all occupationally exposed workers.

This presentation will provide a review of the ANRDR, its expansion to the medical sector and the benefits to employers and workers.

I'm not a forensic radiographer…Am I?

Edel Doyle

International Association of Forensic Radiographers, Geelong, Australia

The word “forensic” originates from the Latin word “forensis”, pertaining to the forum (Roman Law Courts) and is defined as belonging to or relating to the courts of law.

Forensic radiography therefore, relates to the application of a range of clinical imaging techniques, including radiography, ultrasound, CT and MRI to answering questions relating to the law.1

Radiography has been used for forensic purposes since x‐rays were discovered by Roentgen in 1895.2 Images derived from a forensic examination may be used as evidence in court to help visually demonstrate injuries sustained during a physical assault or non‐accidental injury. Imaging can also be used to build a physical profile of an individual which can assist in identifying that person. This is based on unique anatomical features demonstrated radiographically.

The forensic applications of radiography have evolved rapidly over the last century. In the hospital setting, the following imaging modalities have been documented of being of value in the forensic investigation:

• Plain film appendicular and axial radiography

• Intra‐oral (dental) radiography

• Fluoroscopy

• Computed tomography (CT)

• Magnetic resonance (MR) imaging

• Nuclear Medicine

• Ultrasound

Many radiographers may be involved in forensic imaging in their normal clinical workload because any radiography/clinical imaging examination could potentially be forensic in nature. Radiographers therefore need to ensure that they work within the scope of relevant codes of professional practice and legislation for the provision of safe and effective forensic imaging services.

References

1. Society and College of Radiographers, International Association of Forensic Radiographers. London: SOR UK; 2014

2. Thali M, Viner M, Brogdon B. Brogdon's forensic radiology. Boca Raton, FL: CRC Press; 2011.

Expanding the role of the radiation therapist: Benefits for the individual and the organisation

Claire Goodwin

Peter MacCallum Cancer Centre, Melbourne, Australia

Introduction: Professional and career development is becoming increasingly important to emerging radiation therapists, with many junior leaders eager to broaden their knowledge and skillset. Opportunities often arise within organisations for clinical staff to expand their knowledge and delve into administrative or project roles. Radiation Therapists are equipped with a skillset that puts them in a good position to apply for different roles within an organisation which can provide an excellent opportunity to build capacity personally, and within the radiation therapy team.

Discussion: Radiation therapists are often equipped with outstanding organisation, time management and communication skills, as well as excellent attention to detail. Professionals with this skillset are commonly sought after when looking to fill roles such as redesign facilitators, project managers and operational support positions. Transferring the skills developed as a radiation therapist to a different role can provide opportunities to develop broader project and operational knowledge, which can in turn be applied back in a radiation therapy department. Taking the leap to apply for a role that is different to the one originally trained for can be a very challenging, yet rewarding experience, and one that will further enhance the capability of the individual.

Conclusion: This presentation will reflect on the challenges and benefits of taking on a different role within an organisation, and how challenging the status quo can be of benefit to both the radiation therapist and the radiotherapy department.

Learning with, from and about each other: developing an interprofessional programme

Karen Coleman, Ben Darlow, Eileen McKinlay, Louise Beckingsale, Sarah Donovan, Peter Gallagher, Ben Gray, Hazel Neser, Meredith Perry, Sue Pullon

University of Otago, Wellington, New Zealand

In recent times there has been a drive to establish interprofessional education (IPE) programmes for pre‐registration students within Schools of Medicine and Health Sciences.1 Sometimes these programmes grow organically and sometimes they are mandated by university governance. Although much is written about the benefits of IPE,2 the student outcomes and impact on health professional teamwork and patient outcomes; there is less guidance for educators on how to develop an interprofessional education programme.

The University of Otago, Wellington (UOW) developed an IPE programme in 2011 and included largely senior clinically‐focused students in the disciplines of dietetics, medicine, physiotherapy and from 2014 radiation therapy.3

The IPE educator team were already employed in university academic or research‐only roles and have the clinical backgrounds of dietetics, educational psychology, medicine, midwifery, nursing, physiotherapy, and radiation therapy.

This presentation provides guidelines from an educator perspective, for establishing and sustaining an IPE programme. These guidelines are developed from formal research and evaluation, as well as common sense. Each IPE programme will be different and how these guidelines are applied will depend on local factors such as organisational support, educator involvement, student numbers and disciplines. However a commonality will be the rich learning for both IPE educators and the students who take part. An exciting example of ‘Reaching Across’.

References

1. Centre for the Advancement of Interprofessional Education. (2016). Retrieved 11 August, 2016, from http://caipe.org.uk/resources/defining‐ipe/.

2. Darlow B, Coleman K, McKinlay E, et al. The positive impact of interprofessional education: a controlled trial to evaluate a programme for health professional students. BMC Medical Education 2015; 15: 98. doi: 10.1186/s12909‐015‐0385‐3.

3. Darlow B, Donovan S, Coleman K, et al. What makes an interprofessional education programme meaningful to students? Findings from focus group interviews with students based in New Zealand. Journal of Interprofessional Care 2016; 30: 355‐361. doi: 10.3109/13561820.2016.1141189.

Sunday 26 March, 1330–1500 Closing Ceremony

Building an olympian mindset – Performing under pressure

Gavin Freeman

Business Olympian Group, Melbourne, Australia

Building an Olympian mindset is achievable – but it will take everything you have to give. The beauty is that every person has the capability of developing their own version.

We explore deep insights into my model of preforming under pressure with a strong message on how you the individual can develop a resilient, focused, disciplined and motivated approach to life and work.

Walking away from this presentation you and your team will have specific examples the impact of pressure and how we can learn to block it out or even make it your friend. The presentation is designed to be highly experiential.


Articles from Journal of Medical Radiation Sciences are provided here courtesy of Wiley-Blackwell