Oral Presentation

Transcription

Oral Presentation

Radiography…Beyond the 4th Dimension
Content
Part 1 Oral Presentation
1.1
Obstetric ultrasound scan utilization in selected hospital............................2
Stephen A. Bule
1.2
Functional transcranial Doppler sonography of language dominance in
healthy Chinese ................................................................................................3
Suk-Tak Chan, Siu-Ming Ng, Chun-Kit Mang, Po-Chun Pun, Chun-Yin Lo,
Siu-Fai Chun, Kenneth K. Kwong
1.3
Functional transcranial Doppler sonography of memory processing in
healthy Chinese ................................................................................................4
Suk-Tak Chan, Winnie W.Y. Kam, Candy K.W. Ho, Angel C.F. Chan, Freda
H.F. Tong
1.4
How safe is ultrasound? ..................................................................................5
Tania Griffiths
1.5
The result comparison of between US contrast agent, computed
tomography and post-operation in patients with renal mass: retrospective
study ..................................................................................................................6
Sang-Jin Kim
1.6
Ultrasound of the ovarian veins......................................................................7
Brian Starkoff
1.7
Grey scale and power Doppler sonography of normal and abnormal
cervical lymph nodes........................................................................................8
M. Ying, A.T. Ahuja, F. Brook
1.8
Grey scale and power Doppler sonography of neck nodes: Is Doppler
sonography indicated in every case? ..............................................................9
M. Ying, A.T. Ahuja
2.1
PACS application and implementaton strategies in a large scale regional
hospital: Start small and think big ...............................................................10
Wing-Chung Chan
2.2
Are digital images good enough? A comparative study of conventional
film-screen vs digital radiographs on printed images of total hip
replacement .................................................................................................... 11
K. Eklund, K. Jonsson, G. Lindblom, B. Lundin, J. Sanfridsson, M. Sloth, B.
Sivberg11
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2.3
Application of multi-slice helical in urinary tract disease..........................12
Shan-Su Huang, Ching-Cheng Yeh, Ping-Yi Ko, Shu-Huei Shen, RheunChuan Lee, Jia-Whia Chang
2.4
Investigation of multi-slice helical CT in cerebral neoplasms perfusion ..13
Wenhua Huang, Jianpin Qi, Jing Zhang
2.5
Computer Aided Detection(CAD) evaluation of mammography ..............14
Meoung-Mi Jang, Eun-Hye So, Seon-Hee Kim, Kyung-Mo Chung
2.6
The use of mobile CT in the SARS outbreak? The NNI experience .........15
Chee Weng, Avin Look
2.7
The roles of CT and MR in fat and obesity studies.....................................16
M.Y. Poon, Y.L. Chan
2.8
CT examination of heart ...............................................................................17
Daniel Vedlich
3.1
Comparison of different types of head and neck immobilisation system
used in radiotherapy centers of Hong Kong................................................18
Daniel W.I. Chan, Francis W.L. Cheung, Thomas S.M. Wong, Vincent C.K.
Lee, Lawrence C.C. Sham, Philip W.S. Ho, Aray K.L. Leung, Vincent W.C.
Wu
3.2
Design of generic margin for head and neck cancer IMRT, based on
measurement of weekly portal film: The issue of time dependent interfractional setup error.....................................................................................19
Y.T. Cheng, S.H. Chiu, W.S. Kung, W.C. Tsang
3.3
Targeted cancer therapy: a new hope for advanced breast cancer ...........20
F.W.K. Cheung, C.S. Kwok, M.K.L. Leung
3.4
A comparison of stereotactic radiotherapy (SRT) & 3 dimensional
conformal radiotherapy (3DCRT) in boosting nasopharyngeal carcinoma
(NPC) recurrence ...........................................................................................21
Tak-Shun Choi, Peter White, Michael Lee
3.5
Prone breast irradiation – the Royal Brisbane Hospital (RBH) experience
..........................................................................................................................22
A. O’Rourke, J. Tansley
3.6
To establish optimum dose referencing points for bladder and rectum in
intracavitary brachytherapy of cervical cancer..........................................23
Dominique H.M. Wong, Vincent W.C. Wu
3.7
A clinical trial on the effectiveness of a 98% aloe vera gel and aloe vera
based Vaseline as preventive measure of skin reaction for Ca breast
patients with chest wall irradiation ..............................................................24
M.Y. Yuen
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4.1
An Ontario Approach to Cancer Centre Development ..............................25
Dianne Belfour, Brenda Stephan
4.2
Conformal breast radiotherapy using asymmetric field and multi-leavecollimator (MLC) segmented technique: the difficulties and the way
forward............................................................................................................26
Isabel Lai-Chu Ho
4.3
Report of the particle therapy programme at iThemba LABS .................27
S. Schroeder, D.T.L. Jones, E.A. de Kock, J.E. Symons, D.E. Commin, S.
Rhoda, M.A. Loubser, F.V. Vernimmen, C.E. Stannard
4.4
A unique patient positioning system for proton stereotactic radiosurgery
..........................................................................................................................28
S. Schroeder, D.T.L. Jones, A.N. Schreuder, J.E. Symons, H. Ruther, G. van
der Vlugt, K.F. Bennett, A.D.B. Yates
4.5
Royal Brisbane Hospital (RBH) radiation therapy - On the move!..........29
Jessica Tansley
4.6
Plan optimization: Relative dose vs absolute dose. The implication in dose
optimization and experiences in Austin Health...........................................30
J. Wong, A. Rolfo, S. See, C. Mantle, D. Au-Yeung, M. Middleton, M. LyntonMoll, M. Lim Joon, S. Medwell
5.1
Quality criteria for chest x-ray .....................................................................31
G. Ericson, H. Milde
5.2
A sharing experience in the implementation of an ISO 9001-2000 quality
management system in a public clinical oncology department in Hong
Kong ................................................................................................................32
C.H. Lam
5.3
The use of quality check lists for managing patient workflow ..................33
E.M. Plowman
5.4
ISRRT workshop on quality assurance: standards, dose reduction .........34
Pawan Kumar Popli
5.5
Experiences on clinical audit in Finland......................................................35
T. Sipila
5.6
Is image reject analysis necessary for PACS ...............................................36
T.H. Wong, S.K. Ho
5.7
The meaning of digital quality manual for radiological units ...................37
Päivi Wood
6.1
Moving radiation therapy into the 21st century on the strength of
technology: A retrospective study of technology’s dynamic effect on
efficiency, effectiveness and patient care......................................................38
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S. Allman, A.L. Kind
6.2
Leadership role in staff retention .................................................................39
Rhonda Coleman
6.3
A web based risk management tool for medical imaging...........................40
Robert George
6.4
The corporatisation of radiology in Australia - the scene 3 years on........41
Robert George
6.5
radiation therapy practice.............................................................................42
Anneke L. Kind
6.6
Identifying shortages for medical radiation technologists (MRTs) in
Canada ............................................................................................................43
Richard Lauzon
6.7
Installation of radiology units in AIDS treatment centres in Africa .........44
Philippe Gerson
7.1
Applied evaluation of MR scans technique in the Study of Hypertensive
Rat Model .......................................................................................................45
Han-Fang Chen, Zhi-Qiang Ou, Heng-guo Li
7.2
The Application of Diffusion Tensor Imaging in the Acoustic Area ..........46
Shu-Chiou Chen, Wu-Dar Huang, Jon-Kway Huang, Hsiao-Wen Chung
7.3
The Impacts of Echo Time on 3D Time of Flight MR Angiography .........47
Yuan-Hong Fan, Charng-Gen Yang, Pyng-Yi Ger
7.4
Application of Smart Prep MRA in SPKT ..................................................48
JunWu Hu
7.5
Technical Investigation of MR DSA for Musculoskeletal Diseases of
Extremities......................................................................................................49
JunWu Hu
7.6
Language processing in native Cantonese speakers using auditory
stimulation: a functional MRI study ............................................................50
Wing-kit Lee, Suk-tak Chan, Sze-wing Tang, Kwok-wing Tang, Shing-shun
Lo, Kenneth K. Kwong
7.7
Influence of Contrast Media Dose in MR Angiography Image Quality of
the Carotid Arteries with the use of CENTRA Technique .........................51
YC Lin, YY Wai, CC Chen, MC Wong, SH Ng
7.8
Technical Investigation of Myocardiac MR perfusion ...............................52
Jingjing Rao
7.9
Clinic Application of MR Angiography in the Intracranial Venous System
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..........................................................................................................................53
Qun Yu, Xiangquan Kong, Dingxi Liu
7.10
The application of high pressure injector in the perfusion MR imaging
and angiography.............................................................................................54
Yinhua Zeng
8.1
A simple monitoring system of cumulative entrance skin doses of patients
during cardiac procedures ............................................................................55
D. Balman, G. Bibbo
8.2
Patient doses in CA and PTCA in Iceland ...................................................56
Gudlaugur Einarsson
8.3
The response characteristics of flat-panel detector to exposure factors ...57
Qingjun Li, Menglong Zhang, Yi Sun, Hongpu Zhao
8.4
Passing through the Epicentre: Some useful experience in adopting
infection control measures regarding the application of surgical face mask
..........................................................................................................................58
Chi Kei Victor Lo
8.5
An overview of interventional radiology services in Singapore General
Hospital ...........................................................................................................59
J.S. Loke, Chu-Chun Yang, Kenneth Yeo, Kumar R. Santosh, G.P. Cornelio,
Geraldo E.M. Jude
8.6
The evaluation of single exposure dual energy subtraction chest
radiography in the screening for lung metastasis .......................................60
Judy Yee-Ha Wong, Patrick Yau-Ming Lai, Fiona Brook, Humariah Cheung
8.7
The International Subarachnoid Aneurysm Trial (ISAT). Full one year
results and their effect on the management of subarachnoid haemorrhage
..........................................................................................................................61
J.A. Yarnold, R.S.C. Kerr, A.J. Molyneux
8.8
Lowering iodine concentration in contrast media for intravenous
urography using image processing ...............................................................62
A. Zulkarnain, K.H. Ng, B.J.J. Abdullah
9.1
Enhancing the RT student clinical experience: The Newcastle Mater
Hospital Department of Radiation Oncology ..............................................63
N. Chapman, S. Oultram
9.2
Internationally educated candidate experience on Canadian certification
exams...............................................................................................................64
Dorothy Gallagher, Richard Lauzon
9.3
An alternative approach to teaching the fundamentals of computed
tomography to undergraduate radiography students ................................65
v
Giovanni Mandarano
9.4
Evaluation of a journal club in a radiation oncology department ............66
D. Milinkovic, N. Field, C.B. Agustin
9.5
A learning needs assessment of the radiation therapists of the province of
British Columbia with respect to the information management system
VARiS vision ...................................................................................................67
Alison Mitchell
9.6
Educational issues and contemporary practice...........................................68
Pamela Rowntree
9.7
Viva voce to e-OSCE......................................................................................69
M. Tatlow
9.8
A study on teaching approach of radiographic simulation system with
medical imaging .............................................................................................70
C.S. Tsai, J.S. Lin, Y.C. Lin, K.H. Liu, Y.C. Huang, Y.C. Lin, H.H. Lin, C.C.
Lee, K.H. Chung
9.9
Incorporating reflective practice into the curriculum for the graduate
entry Master of radiation therapy course at Monash University..............71
C.A. Wright
10.1
Radiographer's role extension in protocol-driven IVU ..............................72
Holly Chui-Ping Chun
10.2
Projecting the future: Maintaining professional competency in a rapidly
changing environment ...................................................................................73
Dawn Fucillo, Lynn May
10.3
Evaluation of the clinical radiographic practice program .........................74
R.M Kekana
10.4
Expanded roles for medical radiation technolgists in Canada ..................75
Richard Lauzon, Dorothy Gallagher
10.5
Role development for therapeutic radiographers in the public hospitals in
Hong Kong......................................................................................................76
Peter White, Shara W.Y. Lee, Candy W.Y. Wong, Angus K.W. Lee, Don N.
Cheung
10.6
The development of advanced practice for radiographers in the United
States ...............................................................................................................77
Martino Sal
10.7
Radiographer as a member of the trauma team .........................................78
Lea Lukkarinen, Outi Vento
10.8
Expertise: Professional growth and the growth of the profession.............79
J.M. Yielder
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11.1
NSW radiation therapy PDY education program: A review of 2002 and
2003 programs ................................................................................................80
R. Beldham-Collins, C.B. Agustin
11.2
Possibilities for practitioner based research................................................81
Marilyn Baird
11.3
Research governance: Current issues for radiographers...........................82
R.A. Chesson, S. Mathers
11.4
Implementation of information technology in radiographic education- the
Singapore story...............................................................................................83
Jin-Hon Chin
11.5
Patient involvement in radiology research: evidence from a systematic
review ..............................................................................................................84
S.A. Mathers, J.M. Proctor, G.A. McKenzie, R.A. Chesson, E.M. Robertson
11.6
Applied learning to meet required graduate competences.........................85
J. McKay, K.C. Ng
11.7
Qualitative research design and approaches in radiography ....................86
Curtise K.C. Ng, Peter White
11.8
Making the link - image transmission between hospitals and higher
education institutions.....................................................................................87
Michael Tatlow
11.9
Through the barricades (Duran Duran, 1982) - e-learning, rich media and
firewalls ...........................................................................................................88
Michael Tatlow
12.1
Patient Satisfaction Questionnaire 20 of Radiography ............................889
Edward H.T. Chan
12.2
Art of care - what matter most .....................................................................90
Lai-Kuan Chan
12.3
The challenges - When the patient is not human ........................................91
Lai-Kuan Chan, Osman Asnawi
12.4
How to reduce the patient's radiation stress in interventional radiology?
..........................................................................................................................92
C. David
12.5
A review of patient support programs in a clinical oncology department 93
Ki-Man Ku
12.6
Professional ethics for radiographers ..........................................................94
F.I. Peer
12.7
Waiting lists in radiation oncology, are they predictable? .........................95
Greg Rattray
vii
12.8
X-ray department infection control measures: Experience from SARS
Hospital ...........................................................................................................96
Shirley Yeung
Part 2 Poster presentation
1US
Investigation of exercise effect and menstruation on bone status using
calcaneal quantitative ultrasound ................................................................98
YM Lai, SK Chan, WY Chan, MK Chow, KM Luk, VWY Hung, L Qin
2US
Association of carotid intima-media thickness with mesenteric,
preperitoneal and subcutaneous fat thickness ............................................99
KH Liu, YL Chan, JCN Chan, WB Chan
3US
Comparison of extended field of view and dual image ultrasound
techniques: accuracy and reliability of distance measurements in
phantom study..............................................................................................100
M Ying, MH Sin
4US
Evaluation of vascular pattern of cervical lymphadenopathy: a
comparison of colour Doppler, power Doppler and 3D power Doppler
sonography....................................................................................................101
M Ying, AT Ahuja
5CT
Quantum evaluation of shoulder-joint disease using three-dimension CT
data ................................................................................................................102
Y. Akiyama, M. Ishifuro, C. Fujioka, T. Yamaguchi, N. Abe, M. Kiguchi, J.
Takaba, T. Furukawa, Y. Mochiduki, K. Marukawa, K. Ito
6CT
Subcutaneous injection contrast media extravasation: 3-D CT appearance
........................................................................................................................103
Kyung-Mo Chung, Dae-Cheol Kweon, Heung-Seon Im, Oh-Sung Kwon,
Myeong-Goo Kim, Yong-Woo Lee
7CT
Detection of leukoaraiosis by extracranial arterial blood flow volume ..104
SS Ho, WM Lam, KS Wong
8CT
Computed tomography of the thorax for evaluating superior vena cava
obstruction: technical aspects .....................................................................105
Tsz Kwan Iu, Wai Kwong Cheng
9CT
The development of the extravasation detection accessory for preventive
extravasation in the computed tomography ..............................................106
Dae-Cheol Kweon, Seok-Hee Jeong, Heung-Seon Im, Oh-Sung Kwon,
Myeong-Goo Kim, Yong-Woo Lee
10CT The optimal scan delay time in spiral CT portography of posthepatitic
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cirrhosis.........................................................................................................107
Guo-min Liang
11CT CT and CT cardiac imaging ........................................................................108
Qi Wu, Ya Nan Wu, Ping Zhan
12CT Examination technique of brachiocephalic veins and superior vena cava
angiography with spiral CT and low concentration contrast media.......109
Ya-nan Wu, Shan-huai Zuo, Tong Qi, Qi Wu, Tie-lian Yu
13CT Technique study of CT perfusion imaging of liver.................................... 110
Shanhuai Zuo, Tong Qi
14RT Moving radiation therapy into the 21st Century on the strength of
organization and process ............................................................................. 111
Sharon Allman
15RT East meets west: A comparison of the provision and use of
complementary medicine in the oncology centres of England & Wales and
cancer patients in Hong Kong..................................................................... 112
P.N. Brown
16RT The patient selection criteria for receiving SRT & 3DCRT in boosting
NPC recurrence using the treatment parameters of SRT, physical
characteristics of the PTV and maximum target dose to OARs distances ...
........................................................................................................................ 113
Tak-shun Choi, White Peter, Micheal Lee
17RT A survey on the preference for Internet-based cancer information by
cancer patients and their relatives in Hong Kong..................................... 114
C.W.Y.Chung, M.Y.Y.Law, M.S.H.Chiu, L.W.M.Lee, B.T.Y Sung
18RT Deflection of clinical proton beams ............................................................. 115
Ohtani Hiroki, Kitamura Shouichi, Izumi Ogura, Fukushi Masahiro, Hiraoka
Takeshi
19RT Radiation oncology department integration into stanford cancer center
........................................................................................................................ 116
Diana Ho
20RT A dosimetric evaluation of conventional and conformal radiotherapy for
oesophageal cancer....................................................................................... 117
Po-Ming Kwok
21RT Risk assessment of radiation-induced malignancies based on the scatter
dose estimates for IMRT treatment in the head and neck region ........... 118
HY Lee, NS Chong, CL Liao, PW Shueng
22RT The influence of CT scan & reconstruction parameters on 3-D treatment
ix
planning system............................................................................................ 119
Wen-jie Lee, Cheng-guang Lin, Li-xin Chen
23RT A highly conformal universal treatment planning technique template
developed to solve challenges in the treatment of thoracic and
gastroesophagueal junction oesophagus cancers. .....................................120
S Leung, F Cheung, R Wong, J Price
24RT Whole face electron beam therapy using custom-made lens block for
angiosarcoma................................................................................................121
Chiao-Ling Liao, Ngot Swan Chong, Hsing-Yi Lee, Hui-Ju Tien, Pei-Wei
Shueng
25RT Analysis of accuracy and reproducibility in conformal radiotherapy of
NPC ...............................................................................................................122
Cheng-guang Lin, Da-yi Xiao, Zhen-yu Qi, Yu-qi Wu
26RT The use of an ABC device for Ca left breast radiation treatment in the
Tuen Mun Hospital, HKSAR ......................................................................123
Thomas Siu Ming Wong
27RT Influence of vacuum bag on direct measurement of depth for isocentric
posterior oblique field..................................................................................124
Jian-hua Wu, Yun-Fei Xia, Hua-Man Zhang, Qing Liu, Xing-Zhao Lian
28RT Optimization of the CTV-PTV margin with reference to parotid gland
dose for intensity-modulated radiation therapy in nasopharyngeal
carcinoma......................................................................................................125
Vincent W.C. Wu, Marco, C.H. Yau, Winky W.K. Fung, Taki M.C. Lee, Grace
C.K. Ng
29RT Evaluation of dose conformity in intensity-modulated and 3-dimensional
conformal radiotherapy...............................................................................126
Vincent W.C.Wu, Dora L.W. Kwong, Jonathan S.T. Sham
30QA Quality assurance of medical utilised X-ray units in Germany...............127
Susanne Huber
31QA DAP standard for DR and CR ....................................................................128
YM Poon, SK Yu, TH Wong
32QA An experimental study on compensation of density for region with great
difference between thickness in digital radiography ................................129
Soon Yong Son, Won Hong Lee, Yong Moon Lee
33QA Can PACS make clinical physicians happy? An outpatient department
model .............................................................................................................130
TH Wong, KK Leung
34PI
Exploring individual and organisational factors that may influence
x
radiation therapists' participation in career management strategies .....131
Caroline Davey
35PI
Establishing the higher education network for radiography in Europe/
HENRE .........................................................................................................132
Susanne Huber
36PI
Radiography in the new South Africa........................................................133
R.M Kekana
37PI
Early pioneers of ISRRT .............................................................................134
Niru O. Kolmannskog
38PI
An estimation of the supply and requirements of personnel resources for
medical radiological technologists in Taiwan ............................................135
Jsong-wen Wei﹐Tar-liang Shen, Fu-Du Chen
39MR Neuroimaging of language dominance in healthy Chinese: a structural
and functional MRI study ...........................................................................136
Suk-tak Chan, Kenneth K. Kwong
40MR The feasibility of using 1.5T clinical MR-scanner to perform diffusion
tensor imaging of in-vivo rat brain.............................................................137
Tak-Yeung Chan, Francis Kar-Ho Lee
41MR Reliability study in quantitative analysis of MRI CSF flow study...........138
P. Charnchaowanish
42MR The evaluation of MR cholangiopancreatography technique with
conventional SE protocol.............................................................................139
Yang Chu, Chending Jing, Yafei Wang
43MR MRI techniques in visualisation of anterior cruciate ligament ..............140
Igor Fuèkan
44MR A comparative study of MR FSEIR T1 technique and SE T1 in the
diagnosis of brain tumor .............................................................................141
Zhi-chao Lin, Han-fang Chen, Liang-Ping Luo
45MR Experimental study on having affect on an embryo of ICR mouse by
MRI ...............................................................................................................142
Meung Sun Ryu, Won Hong Lee
46MR Magnetic resonance angiography (MRA) of falling hemodialysis fistulas
........................................................................................................................143
Hsiu-Chen Shih, I-Kuang Chen, Chih-Hsing Wu, Yean-Wen Ni, Tze-Wan
Tang
47MR Basics of fMRI ..............................................................................................144
Andrej Sirnik
48MR Evaluation of MR imaging technique on prostate ....................................145
xi
Zhang Chen, Chen Min, Li Saying
49MR Comparison of the Brain MRI with 8Hrbrain phased-array coil and with
Head coil .......................................................................................................146
Zhang Chen, Chen Min, Yin Jing-jing
50MR Application of 3D-FIESTA sequence of MR imaging in the inner ear and
internal auditory canal ................................................................................147
Zhang Chen, Cai Kui, Yin Jingjing
51GR Dry versus wet laser imager: Image quality and stability........................148
S.C. Bansal, L.K Gupta, R. Bapuraj, M. Gulati, N. Khandelwaland, S. Suri
52GR Computed radiography in the Ugandan perspective................................149
Stephen A. Bule
53GR The angiographic projections for distal left circumflex of left-dominant
circulation in coronary arteriography .......................................................150
Kuang-Hua Chu, Chung-Li Huang, Lung-Kwang Pan, Ying-Tsung Chen,
Chih-Tai Ting
54GR The use of barium reflux study in patients with gastroesophageal reflux
disease and presentation of a new classification of gastroesophageal reflux
........................................................................................................................151
Hyuk Jang Dong, Soon Park Young
55GR A survey of patient dose variation for common general X-ray
examinations in Hong Kong radiology centers .........................................152
K.K.L.Fung, S.K.Chong, S.Y.Mok, M.C.Ho, Y.T. Wong
56GR Key question search in PACS : Digital imaging display quality assessment
........................................................................................................................153
Hong Guo, Qi Wu, Tong Qi, Fengtan Li
57GR A study of advanced transorbital technique using a magnification
function in PACS system .............................................................................154
Sang Hyun Kim, Ho Nam Koong, Hyung Ki Kim, Ki Tae Cho, Young Woo
Lee
58GR Patient's selection for extracorporeal shock wave lithotripsy for treatment
of common bile duct stones resistant to endoscopic extraction ...............155
Won-Hong Lee, Soon Yong Son, Cheon Kyoo Park, Cheong Chan Cho, Yong
Moon Lee
59GR An experimental comparison of imaging quality for CR/DR and
screen/film systems with oblique X-ray projection...................................156
Chuan-ya Liu, Chuan-you Lu, Shao-juan Song
60GR A comparative study of energy responses of CR system and screen-film
system ............................................................................................................157
xii
Yantao Niu
61GR Direct digital imaging in the hospital for children and adolescents ........158
E.Ornmark, P. Palmumaa, R. Rantala
62GR Imaging technique and radiation doses to neonates treated in PICU in
Finland ..........................................................................................................159
Minna Tikkanen, Anja Kettunen, Antti Servomaa
63GR Informational teaching and radiologic education......................................160
Qi Wu, Hong Guo
64GR The correlation between temperature and conserving time of laser films
printed by dry way and wet way ................................................................161
Yaping Yu, Qi Yang, Guoxiang Deng
65GR Median arcuate ligament syndrome: The contribution of combined
imaging modalities to diagnosis and treatment in a patient post liver
transplantation. A case report.....................................................................162
M.Zelicovich, Sh.Shklar
66GR The radiology department role in mass casualty events...........................163
M.Zelicovich, Sh.Shklar, A. Blank
67ER Radiography education in Uganda.............................................................164
Stephen A. Bule
68ER A free radiology dictionary made from abstract corpus of the "radiology"
and "radiographics"....................................................................................165
Mei-Yen Chang, Ying-Chou Sun, Chen-Fa Chang, Ping-Yi Ko, Michael M
Teng, Cheng-Yen Chang
69ER Determination of the best radiation dose using 188Re-MAG3-filled
balloon dilation on granulation tissue formation following stent placement
in a canine urethral model ..........................................................................166
Won-Chan Choi., Ji Hoon Shin, Tae-Hyung Kim, Eun Young Kim, ChulWoong Woo, Ho-Young Song
70ER Practice of objective structured clinical examination...............................167
Ohtani Hiroki, Senoo Atsushi, Sekine Norio, Fukushi Masahiro
71ER The radiographer's professional career model..........................................168
M Hirvonen-Kari, A Erkkilä ,R Järvenpää , T Koskimaa, M Mannila
72ER A newly designed pulsatile flow model for the evaluation of aortic stentgrafts..............................................................................................................169
Tae-Hyung Kim, Won-Chan Choi, Jin-Oh Lim, Chul-Woong Woo, Hyoung Jin
Lee, Young-Ran Kim, Yong-Moon Lee
73ER Discussion of quality criterion of big high densitylesionon the frontal chest
film.................................................................................................................170
xiii
Zhi-chao Lin, Zhong-yan Liu, Liang-pin Luo, Jin-chen Chen
74ER The expertise of the radiographer ..............................................................171
M Pawsey, M Hirvonen-Kari
75ER Improvement of knowledge of radiological technicians ...........................172
Xian-hui Run
76ER Modelling a living subject liver using Rapid Prototyping technique under
PACS environment.......................................................................................173
Fuk Hay Tang; Lawrence WC Chan; Martin Wong, Thomas YH Lau
77ER Concept analysis of radiography ................................................................174
Sorppanen S., Tikkanen M
78ER A study on teaching approach of radiographic simulation system with
medical imaging ...........................................................................................175
C. S. Tsai, J. S. Lin, Y. C. Lin, K. H. Liu, Y. C. Huang, Y. C. Lin, H. H. Lin, C.
C. Lee, K. H. Chung
79ER Influence of entrances terms on study of radiology..................................176
Nevenka Volavek
80ER A web-based library of digital radiography ..............................................177
TH Wong, YM Poon, CM Kung
81ER Evaluation of In vivo dosimetry for TBI using diode ...............................178
Pei-Chieh Yu, Hank Chen, Ching-Jung Wu
82PC Communication enchancement project (CEP)..........................................179
Tat-Man Law
83PC Study and Utility of Tourniquets for the Femoral Artery Puncture........180
Jianping Li
84PC A protective study on asymmetric scan in chest CT examination ...........181
Jianping Li
85PC Study on the effect exposure level has on adjacent organs during
mammography .............................................................................................182
Yun-park Jae, Hwa-baek Il, Suk-moon Hee, Soo-cho Nam
86PC The examination of the Japanese women's psychology regarding to
mammography .............................................................................................183
Nobutaka Kasuya, Morikazu Amano
87NM Creation of FDG-PET normal database for easy Z-score imaging system
(eZIS).............................................................................................................184
Seisuke Fukuyama, Naoya Yamamoto, Seiya Hiyama
88NM The evaluation of factors which influence binding efficiency of modified
in vivo erythrocyte labeling technique .......................................................185
Han Kyung Seo
xiv
xv
Part 1
Oral Presentation
1
1.1
Obstetric ultrasound scan utilization in selected hospital
Stephen A. Bule
Radiology Department, Mulago Hospital Complex, Uganda
Ultrasound in Uganda had a humble beginning in the mid 1980s mainly offering
obstetric scanning with very few radiologist and no sonographers. Until now
ultrasound is not utilized to capacity.
I set out to establish why majority of patients for obstetric scan made it in the third
trimester. And whether it was possible to meet the proposed ultrasound guidelines for
Uganda which requires mothers to have at least a scan in the first 10 weeks GA or and
second trimester.
A prospective survey was carried out for a period of 3 months covering several
regions. 150 respondents participated who had at the time visited the hospital for
some clinical complaint.
The respondents age ranged 17-55, majority gravid 4 and lived in the vicinity of a
hospital. 72% felt it was not necessary to have a scan if not indicated, while 77% felt
it was the responsibility of the clinician to request. Personal, regional, educational and
socio-economical background played a role.
Pre-conceived ideology of radiation hazard, clinical necessity, and lack of adequate
information featured most.
The need to provide public awareness via mass media, during antenatal visits,
increase access and skilled manpower is recommended.
2
1.2
Functional transcranial Doppler sonography of language dominance in
healthy Chinese
Suk-Tak Chan (1), Siu-Ming Ng (1), Chun-Kit Mang (1), Po-Chun Pun (1), Chun-Yin
Lo (1), Siu-Fai Chun (1), Kenneth K. Kwong (2)
(1) Department of Optometry and Radiography, The Hong Kong Polytechnic
University, Kowloon, Hong Kong;
(2) Department of Radiology, Harvard Medical School, Boston, MA, USA
The purpose of this pilot study was to investigate the feasibility of using the
hemodynamic response function (HRF) to study Chinese language processing by
measuring blood flow velocity in the middle cerebral arteries using functional
transcranial doppler sonography (fTCD). The language dominance in the brain was
then determined in native speakers of Chinese, a logographic language.
Ten right-handed and six left-handed native Chinese speakers were studied by fTCD
for language dominance with an event-related language task, comparing synonyms
and Korean characters. The HRF for language processing was deconvolved from the
blood flow velocity in the left and right middle cerebral arteries.
All right-handers showed left brain dominance of Chinese language function. Four out
of six left-handers also showed left dominance, while two left-handers showed right
dominance in Chinese. A typical HRF was demonstrated in most of subjects in the
processing of Chinese language. Our small sample of subjects seemed to indicate that
there is a somewhat larger percentage of Chinese left-handers having right language
dominance, in comparision with previous reports on left-handers of other alphabetical
languages. A larger sample size would be needed to test this preliminary observation.
This study analyzed the fTCD data with new signal processing tools normally used
for PET/fMRI. We used deconvolution to derive an HRF which automatically
eliminates the problematic effects of the insonation angle on the blood flow velocities.
The HRF analysis is also well suited to the presentation of an event-related paradigm
with randomized stimuli.
3
1.3
Functional transcranial Doppler sonography of memory processing in
healthy Chinese
Suk-Tak Chan, Winnie W.Y. Kam, Candy K.W. Ho, Angel C.F. Chan, Freda H.F. Tong
Department of Optometry and Radiography, The Hong Kong Polytechnic University,
Kowloon, Hong Kong
The purpose of this pilot study was to investigate the feasibility of in assessing
hemispheric lateralization for memory by measuring blood flow velocity in the
middle cerebral arteries using functional transcranial doppler sonography (fTCD) in
healthy right-handed Chinese adults.
Twenty-five right-handed native Chinese speakers were studied by fTCD for memory
lateralization with a blocked 2-back memory task with alphabets during activation
phases and crosshairs during resting phases. The hemodynamic change and the
lateralization index for memory processing were derived from the blood flow velocity
in the left and right middle cerebral arteries.
The blood flow velocities in the middle cerebral arteries increased significantly during
activation phases, compared with those during resting phases. However, no
significant difference in the relative changes of the blood flow velocities in the middle
cerebral arteries was found between left and right sides. Hence the lateralization
index was zero for each of the subject.
Functional transcranial Doppler sonography successfully showed the increased
cerebral blood flow in both hemispheres upon neural activation. No laterality was
obtained. These results indicate the feasibility of functional transcranial Doppler
sonography in assessing the hemodynamic response of memory processing in healthy
right-handed Chinese adults. The determination of hemispheric dominance for
memory using fTCD needs to be verified by other imaging modalities such as
magnetic resonance imaging.
4
1.4
How safe is ultrasound?
Tania Griffiths
Monash University, Australia
The main purpose of this presentation is to give an overview of the biological effects
of ultrasound and the current position of research in this field.
The move away from regulation on output power levels to user onus on the operation
of medical ultrasound equipment requires the user to have a thorough understanding
of the processes involved i.e. the mechanisms of biological effects. Users are required
to make decisions about examination exposure to maximize benefit and minimize risk.
It is not possible to assume ultrasound equipment is safe just because it is available
commercially.
The presentation has four aims. Firstly, to provide an overview of the biological
effects of ultrasound and review the current literature in this area. Secondly, to
critically examine the use of the thermal and mechanical indices to assess the risk
posed to living tissue by medical ultrasound. Thirdly, to give an overview of the
limitations surrounding the current epidemiological data. The presentation will
conclude with an evaluation of the existing professional guidelines for the safe use of
medical ultrasound in light of the strengths and weaknesses of the current state of
knowledge about the issue.
5
1.5
The result comparison of between US contrast agent, computed
tomography and post-operation in patients with renal mass: retrospective study
Sang-Jin Kim
Seoul National University Hospital, Korea
Objectives: With the result of carrying out contrast enhanced US and CT study on
renal mass and result of surgical operation through retrospective study these authors
attempted to find out effectiveness of contrast enhanced US on renal mass.
Materials and Methods: From March 2003 to April 2004 patients who had contrast
enhanced US (n=134) and CT study (n=182) for renal mass became subjects of this
study. In terms of age distribution they were between 35 and 70 (average age 53.6)
and size of renal mass was 2.5 cm in average. Classification of disease was comprised
of 4 types which can be seen usually in renal mass: namely RCC(renal cell
carcinoma), TCC(transitional cell carcinoma), AML(angiomyolipoma) and cyst.
Among patients (n=104) who were subjected to contrast enhanced US comparison
and observation were made on the result of contrast enhanced US and CT study on the
patients who are required to have operation (n=77) and patients who had operation
after contrast enhanced US (n=57). Comparison and observation were made on the
result of CT study and result of operation for the patient who were required to have
operation (n=122) and patients who had operation (n=92) among the patients who had
contrast-enhanced US (n=162). Also comparison and observation were made on the
result of diagnosis and operation for the patients who were required to have operation
(n=50) and who had operation thereafter (n=45) among patients who had contrastenhanced US and CT study as well (n=58).
Results: In terms of result of contrast-enhanced US and result of operation in case of
RCC 40 cases out of 47 cases (85%) and in case of TCC 5 cases out of 6 cases (83%)
corresponded. Pertaining to result of CT study and operation with RCC 57 out of 75
cases (76%), TCC 10 out of 15 cases (72%) and in case of multiple cyst 3 cases were
corresponded. Pertaining to result of combined examination by contrast-enhanced US
and CT study and result of operation RCC 34 out of 38 cases (90%), TCC 4 out of 4
cases (100%) and in case of multiple cyst 3 cases were corresponded.
Conclusion: Result of examination by contrast-enhanced US in comparison with CT
study result showed relatively higher diagnostic accuracy therefore it will be a big
help for accurate diagnosis and effectiveness for pre-operation additional study for
renal mass patients.
6
1.6
Ultrasound of the ovarian veins
Brian Starkoff
Australian Institute of Radiography, Australian Sonographers Association,
Australasian Society for Ultrasound in Medicine
Reflux of blood down the ovarian veins can cause a number of painful and
debilitating symptoms including pelvic congestion syndrome, vulval varices and
recurrent lower limb varicose veins. The condition is able to be simply and
successfully treated, therefore it is important to obtain an accurate diagnosis.
Ultrasound has proven to be a useful non-invasive method for detecting this reflux.
The examination can be technically difficult, however the use of the correct technique
will lead to a diagnosis in the majority of cases.
An overview of the relevant anatomy and physiology will be presented as well as a
description of the sonographic technique used to investigate the haemodynamics of
the ovarian veins.
7
1.7
Grey scale and power Doppler sonography of normal and abnormal
cervical lymph nodes
M. Ying (1), A.T. Ahuja (2), F. Brook (1)
(1) Department of Optometry and Radiography, the Hong Kong Polytechnic
University;
(2) Department of Diagnostic Radiology and Organ Imaging, the Chinese University
of Hong Kong, Prince of Wales Hospital
Objective: Grey scale and power Doppler sonography is commonly used to evaluate
cervical lymph nodes. This study was undertaken to identify which of the features
used in ultrasound of cervical lymph nodes is readily applicable in routine clinical
practice.
Methods: Two hundred and eight-six patients with proven cervical lymphadenopathy
were included in the study. The largest node in each patient was included in the study
and the nature of the node was proven by fine-needle aspiration cytology or excision
biopsy. Lymph nodes were assessed for their grey scale and Doppler sonographic
features.
Results: Metastatic, lymphomatous and tuberculous nodes were round (63-94%) and
without echogenic hilus (57-91%). Sharp borders were found in metastatic and
lymphomatous nodes (56-100%), but uncommon in tuberculosis (49%). Peripheral or
mixed vascularity is common in metastatic, lymphomatous and tuberculous nodes, but
not found in reactive nodes. Except metastatic nodes from papillary carcinoma of the
thyroid which showed low resistance, metastatic nodes had a higher vascular
resistance than reactive nodes.
Micronodular echopattern is common in
lymphomatous nodes. Hyperechogenicity and punctate calcification are typical
features for metastatic nodes from papillary carcinoma of the thyroid. Intranodal
cystic necrosis, adjacent soft tissue edema, matting and displaced hilar vascularity are
common features in tuberculosis.
Conclusions: Using grey scale and power Doppler sonography, metastatic,
lymphomatous and tuberculous nodes are able to be identified and differentiated from
reactive nodes. Hyperechogenicity and punctate calcification help to differentiate
metastatic nodes of papillary thyroid carcinoma from metastatic nodes from other
cancers.
8
1.8
Grey scale and power Doppler sonography of neck nodes: Is Doppler
sonography indicated in every case?
M. Ying (1), A.T. Ahuja (2)
(1) Department of Optometry and Radiography, the Hong Kong Polytechnic
University;
of Hong Kong, Prince of Wales Hospital
Objective: Routine sonographic examination of neck nodes now includes both grey
scale and Doppler sonography. Although the addition of Doppler sonography to the
well established practice of grey scale sonography increases the amount of
information obtained by sonography, it also increases the examination time
particularly if spectral Doppler and estimation of vascular resistance is performed.
This study was therefore undertaken to evaluate whether Doppler sonography is
routinely indicated in every case or should its use be limited to those cases where grey
scale sonography is equivocal.
Method: We evaluated the grey scale and power Doppler sonograms of 101 fineneedle aspiration cytology (FNAC) proven metastatic nodes and 72 FNAC proven
non-metastatic nodes. All lymph nodes were evaluated with grey scale and power
Doppler sonography. The shape, echogenicity, internal architecture, vascular
distribution and vascular resistance of the lymph nodes were evaluated.
Results: Grey scale sonographic features evaluated in this study had a high sensitivity
(95%) and specificity (83%) in classifying metastatic and non-metastatic nodes.
Metastatic and non-metastatic lymph nodes that could not be classified by grey scale
sonography demonstrated Doppler features that helped in their correct identification.
Conclusion: Power Doppler sonography is not necessary for every case in routine
clinical practice but is essential and useful in patients where grey-scale sonography is
equivocal. In this study, power Doppler sonography aided in the diagnosis in 5% and
17% of patients with metastatic and non-metastatic nodes respectively.
9
2.1
PACS application and implementaton strategies in a large scale regional
hospital: Start small and think big
Wing-Chung Chan
Diagnostic Radiology Department, Tuen Mun Hospital, Tuen Mun, NT
The New Territory West Cluster (NTWC) of the Hospital Authority of Hong Kong
serves about a million people. Tuen Mun Hospital is the leading hospital of the cluster
with more than 1,600 beds. The annual imaging examinations performed, including
radiology and nuclear medicine, are about 400,000. To implement PACS in such
setting is not a simple thing. But we cannot ingnore the absolute benefits from the
application of PACS.
For the recent years, there are many new projects and construction works which has
been developed or is still under developing in this cluster, these including the
Ambulatory Care Centre (ACC), the Rehabilitation Block (RB) and the redevlopment
of a smaller scale district hosptial, the Pok Oi Hospital (POH). It is a good
opportunity and timing to make of the new projects and constructon works to start the
PACS and subsequently to extend the implementation to the whole cluster.
This paper describes the past and future road map for our PACS implementaton and
application. You will know (i) our first PACS was in the ACC, (ii) how to organize the
PACS administration team, (iii) the identifcation and trainings given to our PACS
administrators and managers, (iv) our PACS implementation strategies.
Similar to other systems with the employment of computer technology, PACS is
evolving very fast and sooner or later will become a standard system in the health care
service.To implement PACS effectively and efficiently requires tremendous human
efforts and on going montiroing. PACS is a good arena for radiographers to participate
as role extension. But the key point is how to acquire the required expertise or
knowledge.
10
2.2
Are digital images good enough? A comparative study of conventional
film-screen vs digital radiographs on printed images of total hip replacement
K. Eklund, K. Jonsson, G. Lindblom, B. Lundin, J. Sanfridsson, M. Sloth, B. Sivberg
Department of Radiology, Center for Medical Imaging and Physiology, Lund
University Hospital
Objectives: The aim was to evaluate the inter- and intra-observer variability and to
find differences in diagnostic safety between digital and analog technique in
diagnostic zones around hip prostheses.
Materials and method: In eighty patients who had had a Total Hip Replacement (THR)
for more than two years, a conventional image and a digital image were taken. Gruens
model of seven distinct regions of interest was used for evaluations. Five experienced
radiologists observed the seven regions and noted in a protocol the following
distances: stem-cement, cement-bone and stem-bone. All images were printed on hard
copies and were read twice. Weighted kappa analyses has been used. The two most
frequently loosening regions, stem-cement region 1 and cement-bone region 7, were
closely analysed.
Results: In region 1 the five observers had an agreement of 86.75-97.92% between
analog and digital images in stem-cement, which is a varied weighted kappa 0.29-0.71.
For cement-bone region 7 an agreement of 87.21-90.45% was found, which is a
varied weighted kappa of 0.48-0.58. All the kappa values differ significantly from nil.
Conclusions: The result shows that digital technique is as good as analog radiographs
for diagnosing possible loosening of hip prostheses.
11
2.3
Application of multi-slice helical in urinary tract disease
Shan-Su Huang, Ching-Cheng Yeh, Ping-Yi Ko, Shu-Huei Shen, Rheun-Chuan Lee,
Jia-Whia Chang
Department of Radiological, Taipei Veterans General Hospital
Purpose: To evaluate the value of multislice helical computed tomography (CT) with
curved 2D and 3D reformat imaging (CT urography) in the diagnosis of urological
disease.
Method: From March 2001 to Sep 2002, 80 patients received CT scan (GE QX/I) with
the range from kidney to urinary bladder within single breath hold. Arterial phase,
nephrographic phase and delayed phase were obtained with scan parameters as
follows: slice thickness 5 mm, speed 15 mm, HS mode, reformat thickness 2.5 mm,
and slice gap 1.25mm, Reformat images including curved multi-planner reformat,
MIP (maximum intensity projection), SSD (shaded surface display), VRT (volume
rendering technique) were made on compatible workstation (ADW 4.0).
Result: Of the 80 patients, 52 had ureter stone, 13 had urothelial carcinoma, 5 had
renal parenchymal tumor, 2 had ureteropelvic junction stenosis and 8 had nonurological disease.
Conclusion: 2D CT urography provided clear demonstration of kidney and urinary
tract and 3D images provided detail anatomical information of urological system. This
technique is quite helpful for the diagnosis and treatment of urological disease.
12
2.4
Investigation of multi-slice helical CT in cerebral neoplasms perfusion
Wenhua Huang, Jianpin Qi, Jing Zhang
The Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of
Science and Technology, China
Objective: To evaluate methods of perfusion imaging in cerebral neoplasms using
multi-slice helical CT and its clinical application.
Methods: Forty-two patients with newly diagnosed cerebral tumors underwent
perfusion imaging using multi-slice helical CT (MSCT). At first routine plain CT scan
(10mm/I) was performed to localize central slices of tumor, CT perfusion imaging
was performed later. We obtained two contiguous 10mm slices through the lesion
using cine scanning for a total of 50s at 80kVp and 200mA. Tube rotation speed was
1r/s and data were reconstructed at half-second intervals. We infused 50ml iodinated
contrast medium via an arm vein at 3.5m/s, beginning 5s before the start of the
scanning. Scanning images were transferred into ADW4.0 workstation to create and
analyze perfusion images and parameters, including blood flow (BF), blood volume
(BV), mean transit time (MTT) and permeability surface (PS).
Results: Perfusion images of all tumors can clearly and directly display tumor outlines
and quantitatively monitor blood perfusion status of tumor, clearly differentiate edema
and tumor. The values of BF, BV and PS showed remarkable increase in all cerebral
neoplasms.
Conclusion: MSCT perfusion imaging provides a precise and simple method to
quantitatively estimate blood perfusion status in cerebral neoplasms.
13
2.5
Computer Aided Detection(CAD) evaluation of mammography
Meoung-Mi Jang, Eun-Hye So, Seon-Hee Kim, Kyung-Mo Chung
Korean Radiological Technologists Association
Aim: To evaluate of breast cancer with computer-aided detection (CAD) of
retrospective study.
Materials and Methods: Digital mammograms were collected from breast center
evaluated by a CAD system (R2 Technology, Los Altos, California) embedded in fullfield digital mammography (Senographe 2000D; GE Medical Systems, Milwaukee,
Wisconsin) was used as aid to detect breast cancer patients were found during a 6
months period.
Results: Computer-aided-detection (CAD) systems have been detected suspicious
regions for masses or abnormalities clustered microcalcification. CAD system
detected breast cancers (59%), mass identified 31%.
Conclusion: This study indicates that the CAD improves of breast cancer detection
and is a clinically useful mammography imaging.
14
2.6
The use of mobile CT in the SARS outbreak? The NNI experience
Chee Weng, Avin Look
National Neuroscience Institute, Singapore
In the recent SARS (Severe Acute Respiratory Syndrome) outbreak, the challenge was
to provide an adequate radiology service for SARS patients. We share our experience
in the imaging of SARS patients using a mobile CT (Computed Tomography)unit in
TTSH (Tan Tock Seng Hospital).
The mobile CT was set up in a modified room next to the SARS ICU (Intensive Care
Unit). 3 radiographers from our department volunteered to provide a 24-hour CT
service. Full barrier nursing and infection control measures were observed in all cases.
Scan images were routed to and read from a remote PACS (Picture Archival
Communication System) workstation in the Neuroradiology department.
Since commencement of the service, more than 100 cases have been scanned with no
cross-infection so far, amongst the health care workers involved in this mobile CT
service. The scan images were also found to be adequate to achieve a diagnosis in all
cases.
The lessons learnt from this experience may help radiology departments in similar
crises in the future.
15
2.7
The roles of CT and MR in fat and obesity studies
M.Y. Poon, Y.L. Chan
Dept of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, N.T.,
Hong Kong
Obesity has reached epidemic proportion globally and is a major contributor to the
global burden of chronic disease and disability. The associated life-threatening
conditions include CVD problems, insulin resistance and type 2 diabetes, certain
types of cancers, and gallbladder diseases. To defend against obesity and its
associated medical problems, worldwide research efforts have been emphasized on
body fat and its related metabolic effects on blood pressure, cholesterol, triglycerides
and insulin resistance. CT and MR are well recognized as the gold standard and
reference technique for body adipose tissue measurement (macroscopic measurement).
They can produce sectional images showing both the quantity and distribution of body
fat, which are ones of the important clinical data in fat studies and weight control
programs. Some recent studies have introduced new applications of CT and MR on
measurement of cellular lipids level (microscopic measurement) which is helpful in
understanding the fat metabolism in organs, particularly in liver and skeletal muscle.
Technique and related considerations will be discussed in this presentation.
16
2.8
CT examination of heart
Daniel Vedlich
CT dept., IKEM, Prague, Czech Republic
The newest CT scanners offers possibility for standard proceeding of examinations
which were on the older scanners complicated and hardly practicable.
After upgrade of our old CT single row detector scanner to 16 row MDCT scanner
Siemens Sensation 16 we enlarge number and variety of examinations provided on
our department, and for 2 years we are making CT angios and CT imaging of heart as
standard and routine examinations.
The ECG triggered CT examination of heart is fast, non invasive and elegant type of
imaging of heart diseases, detection of atherosclerosis in coronary arteries, control
scan of provided aortic-coronary bypasses, and functional measurements of
myocardium.
There is a big future for this type of heart examination, which has benefit to
diagnostics of heart diseases.
17
3.1
Comparison of different types of head and neck immobilisation system
used in radiotherapy centers of Hong Kong
Daniel W.I. Chan (1), Francis W.L. Cheung (1), Thomas S.M. Wong (1), Vincent C.K. Lee
(1), Lawrence C.C. Sham (1), Philip W.S. Ho (1), Aray K.L. Leung (1), Vincent W.C. Wu (2)
(1) Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital,
Hong Kong
University, Hong Kong
Purpose: Accurate delivery of radiation fields required stringent immobilisation and
portal field verification, as well as knowledge of the set-up reproducibility. The
purpose this study was to compare five head and neck immobilisation systems
currently used in the radiotherapy centers of Hong Kong. The areas of comparison
included both the treatment accuracy and financial implication of the systems. Method
and Materials: Five radiotherapy centers in Hong Kong joined the study. Each center
recruited thirty NPC patients, they were immobilised with the same immobilisation
system. Lateral simulation field was taken for each patient before treatment. This
simulation film was then compared with the portal films taken on the initial treatment
day and weekly thereafter in the treatment machine. Field center deviations were
measured and compared. Errors like random error, systematic error and total
uncertainty were also calculated and compared. ANOVA was employed to compare
the differences amongst different centers. Material and manpower costs information
was supplied by the participating centers. Results: Altogether one hundred and fifty
patients were recruited. There were total one hundred and fifty simulation films and
over six hundred portal films were taken and analysed. The mean field center
deviation varied from 0.93mm(Hospital A) to 1.27mm(Hospital B). There were
statistically significant differences found between the Hospital A group with both the
Hospital B and Hospital C groups. The mean values of random errors varied from
0.72mm(Hospital A) to 1.04mm(Hospital D), systematic errors varied from
0.69mm(Hospital A) to 1.15mm(Hospital B) and total uncertainty varied from
1.01mm(Hospital A) to 1.44mm(Hospital B). There were also significant differences
amongst the five groups found in both the random errors and systematic errors
analysis. Conclusion: All five immobilisation systems can achieve very high treatment
accuracy. Using which type of material to construct the mask, Aquaplast or Cobex, is
not the guarantee of higher accuracy. However, the lower cost and lesser time of
construction favour thermoplastic mask.
18
3.2
Design of generic margin for head and neck cancer IMRT, based on
measurement of weekly portal film: The issue of time dependent inter-fractional
setup error
Y.T. Cheng, S.H. Chiu, W.S. Kung, W.C. Tsang
Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong
The Purpose of this study is to review and improve the effectiveness of the current
quality assurance by weekly verification portal films for head and neck IMRT cases.
The pre-treatment and weekly orthogonal portal films of 30 consecutive patients who
had undergone IMRT for head and neck cancers were retrospectively evaluated for
their spatial discrepancy throughout the course of treatment. All orthogonal portal
films were compared with the planning CT generated Digital Reconstructed
Radiographs (DRR) and Simulator Check Films. The motion analysis was done by
comparing 9 anatomical points. Any spatial discrepancy was recorded as translational
shifts in x, y, z directions. All data were taken weekly during the whole treatment
course to record the spatial shift in relation to time. The systemic and random setup
error in relation to time would be calculated by the mean and standard deviation
values.
No significant spatial discrepancy was observed among the first 3 sets (pre-treatment,
2nd and 3rd week) of orthogonal portal films. However, starting from the fourth week,
either horizontal rotations or right lateral shifts were observed on the AP portal films.
Up to 20% of the cases required adjustment accordingly and a modification was
confirmed by a subsequent radiograph. The spatial discrepancies of lateral portal films
were more significant than the AP portals. They include anterior-posterior
displacement (>50%), superior-inferior displace (>10%), head-chin tilt (>10%). The
lateral portal film repeat rate was subsequently increased from the 15% (4th week) to
60% (7th week).
The abandon of second and third weekly anterior-posterior portal film and additional
lateral portal films approaching to the end of treatment course are possible to improve
the effectiveness of the current routine weekly quality assurance procedure while
maintaining the accuracy of radiation delivery in IMRT of head-and-neck patients.
19
3.3
Targeted cancer therapy: a new hope for advanced breast cancer
F.W.K. Cheung, C.S. Kwok, M.K.L. Leung
Hong Kong
Overexpression of HER2, which occurs in 30% of human breast cancer, has been
shown to be associated with adverse prognosis. Herceptin, the first approved
humanized monoclonal anti-HER2 antibody, has yielded promising results with
regard to survival advantage in HER2-overexpressing metastatic breast cancer. To
expand its clinical potential, a novel fusion protein consisting of anti-HER2 antibody
and interleukin-2 was constructed.
In this study, the anti-tumor efficacy of this fusion protein supplemented with human
peripheral blood mononuclear (PBM) cells against HER2 positive lung metastases in
mice was evaluated. Seven-week-old SCID mice were randomly assigned into 4
groups of 8. The metastatic tumor model was developed by intravenous injections of
8,000,000 human SKOV3 tumor cells into each mouse on day 0. Treatment was
initiated on day 4 and consisted of daily intravenous administrations of 0.2 ml of
saline, 200,000 PBM cells in saline, 6 μg fusion protein, or 6μg fusion protein and
200,000 PBM cells for 3 consecutive days. All mice were sacrificed on day 28 and
Indian ink staining of lungs was performed.
One-way ANOVA analysis showed that there was significant difference in the
percentage of lung surface area covered by white metastatic foci among four groups
(p<0.05). Post-hoc Scheff test indicated that mice treated with a mixture of fusion
protein and PBM cells had statistically lower percentage when compared to other
three groups. Our results suggest that the fusion protein would have effective clinical
applications in the treatment of HER2 positive tumors refractory to conventional
therapies.
20
3.4
A comparison of stereotactic radiotherapy (SRT) & 3 dimensional
conformal radiotherapy (3DCRT) in boosting nasopharyngeal carcinoma (NPC)
recurrence
Tak-Shun Choi (1), Peter White (2), Michael Lee
Hong Kong
Objectives: To find out which external beam radiotherapy technique (SRT or 3DCRT)
is better for boosting recurrent NPC by comparing dose conformity and homogeneity
of target volume, and dose sparing effects on organs-at-risk.
Methods: 23 patients with residual or recurrent NPC that have been planned with
Xknife 4.0 (treatment planning system for SRT) were re-planned using Helax TMS
5.0 (treatment planning system for 3DCRT). There were 3 treatment arms in this study:
(1)
SRplanned target volume (PTV) was the gross target volume (GTV) plus a 2
mm margin
(2)
3DCRT - PTV was the same as arm (1)
(3)
3DCRT - target volume was the PTV of arm (1) plus a 5 mm margin
Conformity index and homogeneity index were used to compare dose conformity and
homogeneity respectively. Dose volume histograms (DVHs) and normal tissue
complication probability (NTCP) were also analyzed for the dose sparing effects on
OARs.
Results: Dose conformity and homogeneity of PTV in 3DCRT are much better than in
SRT (p<0.001). Dose sparing of the brainstem, optic chiasma, left/right optic nerves
and left/right eyes by SRT are significantly better than by 3DCRT (p<0.001).
However, there is no significant difference in dose sparing to spinal cord (p>0.05).
Conclusions: SRT and 3DCRT can be used to deliver a boost dose of radiation to
recurrent nasopharyngeal carcinoma, but 3DCRT is found to be more appropriate in
boosting recurrent NPC with respect to SRT.
21
3.5
Prone breast irradiation – the Royal Brisbane Hospital (RBH) experience
A. O’Rourke, J. Tansley
Australian Institute of Radiography
Aim: To evaluate the prone breast technique as it has evolved since implementation at
RBH Radiation Oncology.
Method and Materials: RBH Radiation Oncology introduced prone breast irradiation
in 1999. The treatment technique was introduced to overcome problems associated
with the radiation treatment of large pendulous breasts.
Since implementation, the prone breast technique has evolved due to technical
advances within the department. The introduction of; Elekta Precise linear
accelerators, a spiral multi-detector computerised tomography scanner and 3dimensional planning system have modified the way patients are planned and treated.
Results: In contrast to a supine treatment technique, the prone position has proved to
be stable and reproducible. Our experience has allowed us to reduce lung and heart
volumes. Maximum doses have decreased. Acute skin reactions are less common.
Conclusion: Prone breast irradiation is a feasible radiation therapy technique for select
patients. Preliminary results aim to compare mortality rates with those of
conventional breast radiation therapy techniques.
22
3.6
To establish optimum dose referencing points for bladder and rectum in
intracavitary brachytherapy of cervical cancer
Dominique H.M. Wong (1), Vincent W.C. Wu (2)
Hong Kong;
Objective: This study aimed to establish a new dose referencing system for bladder
and rectum in intracavitary brachytherapy of cervical cancer which can give a better
indication of the maximum organ doses than the current ICRU referencing system.
Methods: With the help of CT, the locations of the maximum bladder and rectal doses
of seven patients were determined. Based on the locations of maximum dose points, a
new dose referencing system was established. The clinical relevance of the new dose
referencing system was evaluated by studying the relationship of the new reference
doses with the severity of organ complications.
Results: There was no correlation between the ICRU reference doses and
development and severity of late complications for both bladder and rectum. With the
help of CT, the maximum doses to the bladder and rectum were found to be, on
average, 1.9 and 1.7 times higher than the ICRU reference doses respectively.
Making use of the locations of the maximum dose points, a new referencing system
was established. The new bladder reference dose was found to have positive
association with the severity of bladder complications (r=0.38). The new rectal
reference dose did not show correlation with severity of rectal complications.
Conclusion: Oncologists should be cautious when applying ICRU reference doses in
predicting complications because these doses are poor surrogates of complications
and maximum doses. With the new dose referencing system established in this study,
it is recommended to use the new bladder reference point to supplement the current
one.
23
3.7
A clinical trial on the effectiveness of a 98% aloe vera gel and aloe vera
based Vaseline as preventive measure of skin reaction for Ca breast patients with
chest wall irradiation
M.Y. Yuen
Clinical Oncology Department, Queen Mary Hospital, Hong Kong
Most breast cancer patients under going radiotherapy experience skin reactions.
Standard guidelines have been adopted in Hong Kong which may not be good enough
to avoid the occurrence of severe skin reaction. Several reports suggested that aloe
vera could facilitate the healing of radiation-induced skin ulceration and dermatitis in
humans. This study aimed to investigate aloe vera based Vaseline and 99% aloe vera
gel on their abilities to reduce the skin reaction for female breast cancer patients
undergoing radiotherapy. 98 Chinese female patients were randomized into three
groups: (1) patients used no skin care products (Gp-Nil); (2) patients used aloe vera
based Vaseline (Gp-Vase) and (3) patients used 99% aloe vera gel (Gp-Aloe). Results
showed that the mean maximum skin reaction grades were the lowest for Gp-Aloe,
followed by Gp-Nil and Gp-Vase (p > 0.05). For patients with lumpectomy, the
average times to develop deep erythema were 34.22, 30.69 and 40.9 days for Gp-Nil,
Gp-Vase and Gp-Aloe respectively (p>0.05) while the average times to develop
patchy moist desquamation were 43.33, 39.31 and 48.05 days respectively (p>0.05).
Similarly, for the patients with mastectomy, the average times to develop deep
erythema were 32.59, 31.5 and 37.17 days for Gp-Nil, Gp-Vase group and Gp-Aloe
(p=0.034 when compared Gp-Aloe with Gp-Nil) respectively while the average times
to develop patchy moist desquamation were 40.91, 40.13 and 40.50 days respectively
(p > 0.05). In conclusion, both aloe vera based Vaseline and 99% aloe vera gel would
not reduce the radiation induced skin reaction of Chinese female breast cancer
patients.
24
4.1
An Ontario Approach to Cancer Centre Development
Dianne Belfour, Brenda Stephan
Cancer Care Ontario
Objective:Cancer Care Ontario's mission states: "We will improve the performance of
the cancer system by driving quality, accountability and innovation in all cancerrelated services."To that end and with a view to providing care closer to home, a large
number of capital projects are underway in the Province of Ontario. These include
renovation of existing spaces and the building of new centres and or additional
radiation treatment rooms to house linear accelerators and various treatment
simulators.
Method: For these projects, user groups representing a broad variety of professional
and support personnel for each distinct project were encouraged to participate in
design development and to bring a wide range of ideas to the forefront. New
technologies challenged these user groups to ensure that spaces designed today will
meet tomorrows needs while maintaining a patient friendly environment that is non
threatening.
Results:This paper will address regional and cultural differences reflected in the
facility designs (interiors and exteriors) as well as design innovations. In the
Radiation Therapy areas we will present our approach to treatment room and control
area design, ergonomics as well as customizable millwork within the treatment rooms..
In Systemic Therapy we will present our approach to a range of patient and staff
needs and comforts as well as those needs within an adjacent pharmacy. Supportive
Care Programs underpin much of the activity within cancer centres and input from
these users will be shown as it affects many departments.
25
4.2
Conformal breast radiotherapy using asymmetric field and multi-leavecollimator (MLC) segmented technique: the difficulties and the way forward.
Isabel Lai-Chu Ho
Radiotherapy and Physics Department, Royal Free Hospital, Kilburn, London, U.K.
Objectives: Dose inhomogeneity is the major factor contributed to the severity of
post-radiotherapy complications came along with latencies of many years. Seventynine percent of UK radiotherapy centers are performing dosimetry planning based on
single central contour and 57% of them are obtained manually. This study attempts to
develop a class solution to improve dose inhomogeneity by using asymmetric and
MLC segmented technique with no significant increase in lung dose thence provide an
option to decrease cardiac dose and maintain a locally practicable planning and
treatment time.
Methods: Fifty patients attending for radiotherapy were scanned according to local
protocol. Selected patients will have a conventional two-dimensional (2D) treatment
plan plus four other plans planned with various segmented techniques: asymmetric
segments with and without wedge, MLC segments with and without wedge.
Conventional 2D and segmented technique are then compared retrospectively using
dose-volume-histogram of lung, heart and planning-target-volume (PTV). Hotspot
pattern and frequency are evaluated.
Result: Sixty-six percent of the 2D planned breast treatment shown hotspot outside
the ICRU recommendation. Segmented technique used in this study able to decrease
the hotspot to <107% with no significant increase to both lung and cardiac doses
observed. Segmented technique may also reduce the photon energy required in
conventional 2D planning. The gain was found to be similar for all patients
irrespective of breast size or lung volume.
Conclusion: Both asymmetric and MLC segmented techniques are found to be
superior to the conventional 2D planning which improve dose inhomogeneity
significantly without increase of lung and cardiac dose.
26
4.3
Report of the particle therapy programme at iThemba LABS
S. Schroeder, D.T.L. Jones, E.A. de Kock, J.E. Symons, D.E. Commin, S. Rhoda,
M.A. Loubser, F.V. Vernimmen, C.E. Stannard
Department of Radiation Oncology, Tygerberg Hospital Parow, South Africa;
Department of Radiation Oncology, Groote Schuur Hospital, Observatory, South
Africa
The 200 MeV cyclotron facility at iThemba LABS (Laboratory for Accelerator Based
Sciences) has been operational since 1987. It is the only nuclear particle facility in
Africa and the Southern Hemisphere and the only one world-wide where both fast
neutrons and high-energy protons is used for patient treatment. Between September
1988 and July 2004 a total of 1278 patients(40047 fields) had been treated on the
p(66/Be isocentric unit according to several protocols, including tumours of the head
and neck, salivary gland, breast, soft tissue, uterine sarcomas and paranasal
sinuses.An innovative post-collimator multiblade trimmer provides conformal
treatment capability.Between September 1993 and July 2004 a total number of 462
patients(8952) fields had been treated on the 200 MeV fixed horizontal proton therapy
unit, mainly for intracranial lesions. This facility incororates an unique automatic
patient positioning system. Plans for a Major Radiation Medical Centre(MRMC) is
currently being formulated and will house a comprehensive suite of the most advances
treatment and diagnostic facilities. After 15 years of operation, the nuclear particle
radiation therapy at iThemba LABS is well established. With proper planning is has
been shown that such a facility can be efficiently used as a multidisplinary facility to
accommodate a large number and variety of users. Conformal neutron and proton
therapy, mixed neutron and proton treatment schedules and fractionated radiosurgery
are all possible. There is no doubt that iThemba LABS can play a major role in
determining the future role of fast neutron and high-energy protons in radiation
therapy because of its position as the only particle facility in Africa and the Southern
Hemisphere, its superior facilities, on-site hospital, technological and scientific
expertise, the excellent medical services avaliable at the local referring hospitals
especially with the establishment of the Major Radiation Medical Centre(MRMC)
27
4.4
A unique patient positioning system for proton stereotactic radiosurgery
S. Schroeder, D.T.L. Jones, A.N. Schreuder, J.E. Symons, H. Ruther, G. van der Vlugt,
K.F. Bennett, A.D.B. Yates
Mechanical Engineering and Geomatics Department, University of Cape Town, South
Africa
The unique patient support and positioning system used at iThemba
LABS(Laboratory for Accelerator Based Sciences)for proton therapy makes use of
real-time digital stereophotogrammerty (SPG)techniques, which are commonly used
in land surveying,and is linked to the patient support system which is a computerised
adjustable chair with 5 degrees of freedom. During the patient positioning stage, a set
of three charge-coupled device(CCD) TV cameras out of eight positioned around the
isocentre, captures the video images thruogh a frame-grabber of the retroreflective
markers on the patient mask. These images are then analysed by a personal computer
uging SPG techniques. Since the positons of the video cameras and the direction of
the proton beam are accurately known in space , it is possible to calculate the position
of the centre of each of these reflective markers and hence the position of the
reference point in the treatment volume,relative to the beam axis. The effects of the
camera distortions, aspect ratio and perpspecive are taken into account in the
calculations. The co-ordinates of the beam entry point are also required and are
obtained from the treatment planning system. Spatial corrections to align the vector
between the beam entry point and the isocentre, which is in the treatment volume,
with the beam axis are then sent from the SPG computer to a second personal
computer which controls the patient support system (chair). Computer controlled
stepper motors move the chair by the required amounts to bring the treatmnet vector
directly into the proton beam. Additional information regarding the rotation angle of
the final patient collimator, to align the collimator with the outline of the treatment
volume, is also calculated by the first computer. It takes typically 2-3 iterations from
an arbitrary position to align the patient in the required orientation. Once the patient is
properly postioned,the system is set to monitor the positions of all the reflective
targets and hence the position of the treatment volume. The beam will be switched off
automatically if any of these targets move more that a preset amount. This automated
non-invasive patient positioning system allows state-of-the-art treatment techniques to
be used.
28
4.5
Royal Brisbane Hospital (RBH) radiation therapy - On the move!
Jessica Tansley
Australian Institute of Radiography, Australia
Aim: To discuss the trials and tribulations of maintaining a radiation therapy service
while relocating the department to a new facility.
Method and Materials: In January 2003, RBH Radiation Oncology relocated premises.
The new Radiation Therapy department was equipped with state of the art planning,
treatment and imaging equipment. This impacted significantly on work practices.
Strategies were implemented to train all staff on new equipment while still
maintaining a clinical service. New radiation therapy planning and treatment
techniques were introduced to maximise efficiency. Work-practices involving all
aspects of the department evolved to accommodate the new environment. During this
period, the success of our move was evaluated using staff surveys and patient
statistics.
Results: Staff surveys were conducted throughout the move. Surveys assessed morale,
efficiency and training. Results of the surveys were statistically analysed to
scientifically determine the success of the relocation. Patient statistics were assessed
over the period to determine if RBH Radiation Oncology maintained adequate levels
of service.
Conclusion: Moving a Radiation Therapy department is a harrowing experience!
Maintaining a significant patient workload while adapting to new equipment and
work-practices was a challenge. Survey results are testimony to a successful
relocation.
29
4.6
Plan optimization: Relative dose vs absolute dose. The implication in dose
optimization and experiences in Austin Health
J. Wong, A. Rolfo, S. See, C. Mantle, D. Au-Yeung, M. Middleton, M. Lynton-Moll,
M. Lim Joon, S. Medwell
Austin Health, Victoria, Australia
Plan optimization in radiation therapy is a process to create the most suitable plan for
patients undergoing radiation treatment. In Austin Health, CMS FOCUS is the 3D
computer system used for planning and it has two beam weight methods available, the
relative dose weighting mode and the absolute dose weighting mode.
The objective of this presentation is to compare the two different weighting modes in
CMS planning system.
In relative dose weighting mode, the beam weights and isodose lines are in relative
values. The individual beam weight usually adds up to 100 to represent 100%. One of
its fundamental feature is all beams usually have a common beam weight point for
dose calculation and prescription.
In absolute dose weighting mode, the beam weights and isodose lines are in absolute
values. It could enable the therapist to use sub-fields with multiple prescription points
in plan optimization.
This presentation will compare the characteristics and practical use in two
optimization modes. Examples will be used to demonstrate the major differences
between relative and absolute mode. The implication in dose optimization and
Austin’s preference will also be discussed.
30
5.1
Quality criteria for chest x-ray
G. Ericson, H. Milde
Dept. of Thoracic Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
Objectives: Each year around 45.000 chest radiography examinations are performed
at our institution. Of these 10.000 are bedside. All radiographers have to be able to
perform this examination in a reproducible and uniform way. In order to achieve the
best result there is a need for simple and reliable methods.
Methods: Therefore, a quality project was initiated in April 2001 with the aim to
examine several parameters in the examination procedure such as ergonomics,
hygiene, nursing, radiation protection and image quality. After having made an
inventory, we first develop a new method for bedside examinations. The patient was
examined in an as much upright position as possible both in AP and lateral projections
and with air gap technique for the lateral view.
Results:
Four radiographers and three radiologists compared the new technique
with the old one and assessed the effect on image quality in keeping with to EUcriteria. The new method is more ergonomically correct with preserved or slightly
increased image quality. The inventory showed that we already worked in a
hygienically correct way. A discussion about nursing aspects was initiated by the
project and will be continued. The introduction of air gap technique for the lateral
view has resulted in a reduction in radiation dose by three mAs-steps. An education
plan was made for the radiographers.
Conclusion: It is important to evaluate existing methods. Our new method meant
better ergonomics for the staff and increased dose to the patient.
31
5.2
A sharing experience in the implementation of an ISO 9001-2000 quality
management system in a public clinical oncology department in Hong Kong
C.H. Lam
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong
Kong
Through competition on an international level, all businesses including healthcare
industry are beginning to acknowledge the need for the International Standard for
Organization (ISO) 9000 registration as a virtual necessity. The first priority in
medical oncology is increasing safety and accuracy in drug administration and
radiation delivery, but to our knowledge no oncology department in Hong Kong has
yet planned or achieved recognized quality certification. We, as a clinical oncology
department in a reputation public hospital, attempted to achieve this certification since
2001. In this presentation, our experiences in the implementation of a specific Quality
Management System (QMS) and the road to attaining ISO accreditation are addressed.
The entire ISO certification took 18 months to process. It began when the Chief of
Service of the Clinical Oncology Department decided to pursue ISO 9000 registration
and shortly a corporate steering committee was formed. An outside consultant and a
third party registrar were selected, corresponding trainings were then provided to core
managers and other departmental staff. Developing an Internal Quality Auditing
system and standardization of documents were also crucial to facilitate process
improvement in QMS. The consultant finally conducted a pre-certification audit, and
one month later the certification audit was performed. As a result of ISO 9001-2000
certification, the department has started a formal QMS, the new standard clearly
identifies that quality may be manifested in processes and systems, not only products.
However, a successful ISO 9000 registration is not the end of the work process; an
effective QMS should be maintained by continuous auditing.
32
5.3
The use of quality check lists for managing patient workflow
E.M. Plowman
Radiation Therapy Department, New Zealand
The Regional Cancer Treatment Service, Palmerston North, New Zealand installed
LANTIS at the end of 1999. It was initially purchased as a Treatment Verification
system but its potential for expanded use was quickly recognised, producing
efficiency gains in many areas. One of the options within LANTIS is Quality
Checklists (QCLs) which are used in managing patient workflow.
A Quality Checklist is a table of procedures, tasks, or activities typically undertaken
in the course of managing a patient. It is an electronic equivalent of paper check
sheets which require items to be ticked off. These are completely configurable- to
reflect the specific tasks that a particular department requires. They help to maintain
consistent treatment quality through monitoring a patient’s progress against specified
standards.
The major advantages that have proven to be very beneficial to our department, with
this new system, are that it is an electronic medical record- another step towards a
paperless department, you can remotely append QCLs- so the booking process will
occur immediately; it automatically generates task list; ensuring consistent treatment
quality against the departments specified standard. In conclusion QCLs have given
enhanced workflow via: Improved communication, improved accountability and an
ease of prioritisation.
33
5.4
ISRRT workshop on quality assurance: standards, dose reduction
Pawan Kumar Popli
Dept. of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
The Dept. of Radio-diagnosis, All India Institute of Medical Sciences (AIIMS), New
Delhi INDIA & ISRRT (International Society of Radiographers & Radiological
Technologists) hosted the ISRRT workshop on Quality Assurance: Standards, Dose
Reduction and Cost Effectiveness in Radiation Medicine during 2-5 December, 2003.
This was the first ever workshop organised by ISRRT in this part of world.
Radiographers, from various parts of North India participated in this workshop. The
participants were carefully selected from the smaller & remote hospitals in the region.
The participants were given thorough theoretical & hands on practical exercises by
the faculty & staff of ISRRT & AIIMS. The whole programme was planned to be
highly interactive.
The participants were extremely enthusiastic, responsive and participated in each &
every activity of the workshop. They enjoyed the Presentations, Group Activities,
Group Discussions, Practical Demonstrations & Hands on Exercises. The interest &
commitment shown by participants was remarkable.
In the post workshop feed back, all participants appreciated the Quality, Method, and
Contents of presentations. They scaled the value of workshop 8-10 in the 10 point
scale. Most of the participants suggested having permanent centre of excellence on
WHO pattern, for a huge Nation like India. They committed to promote the culture of
QA through ‘train the trainer’ concept. The feedback collected after six months has
confirmed their commitment. They have done their best to improve radiographic
quality at their workplaces. This workshop brought a positive change in Image
Quality, in the region served which is the real success/achievement.
34
5.5
Experiences on clinical audit in Finland
T. Sipila
The Society of Radiographers in Finland
Clinical audits were introduced by the European Union in the Medical Exposure
Directive (MED) in 1997. According to the MED directive clinical audits are a
systematic examination or review of medical radiological procedures which seeks to
improve the quality of patient care. The objective is to avoid unnecessary or excessive
exposure to radiation and to improve the quality and effectiveness of medical uses of
radiation.
Finland has been among the first countries to start clinical audits in Europe. The MED
directive was implemented in the Finnish legislation in 2000. The law requires
clinical audits to be performed where radiation is used for medical purposes.
According to the radiation act, the clinical audit has to be done in every clinic using
medical radiation before the 12th of May 2005 and the audit has to be carried out
every five years.
The auditors are experienced professionals who perform as auditors, outwith their
normal work and they work in pairs (radiographer and physician). The auditors
monitor agreed standards of good medical practise, legal requirements and safety
aspects.
Clinical audits cover the whole radiological procedure. Clinical audits are an
evaluation of functions and documentation, and concentrate on work of health care
professionals, who should be appropriately educated. The auditors produce an
independent assessment, and report on the findings and make recommendations. The
clinic decides which actions it will take based on the recommendations of the clinical
audit.
Clinical audits are a review of success in implementing the justification and
optimization principles and radiation safety. Reduction of ionising radiation is the
most significant benefit of clinical audits. Clinical audits help to develop the quality
system which suggests a mechanism to prevent mistakes. The benefits of clinical
audit will be discussed in detail in the presentation.
35
5.6
Is image reject analysis necessary for PACS
T.H. Wong, S.K. Ho
Diagnostic Radiology Department, Tuen Mun Hospital, Tuen Mun, N.T., Hong Kong
Objectives: In a filmless environment, the technologist must accept responsibility for
appropriate delivery of all images to the Picture Archival and Communication System
(PACS). Quality Control (QC) processes must be there to verify that all examinations
performed and all images acquired reach the PACS in their perfect state; substandard
images are rejected whenever detected. Image reject analysis- a method for capturing
rejects should be developed as part of the total quality assurance plan. Data should be
collected and analyzed, with results reported to the management and staff. Training
should be implemented, as to minimize the rejection rate when it is due to human
errors or PACS devices should be calibrated when errors come up include workflow
flaws, software and hardware problems.
Methods: During a total period of 24 months, divided into 2 equal periods, 4373
rejected images were analyzed and are assigned into 9 categories. The reject reasons
were predefined following a preliminary study and were input into the remarks
column by technologist every time an image was rejected. After the first period,
corrective measures were devised accordingly and implemented. Then the rejected
images of the second period were analyzed.
Result and Conclusion: In the first period, the image rejection rate in relation to all
images in PACS was 1.48%. In the second period, the image rejection rate was
lowered to 0.97%. To conclude, errors will always occur in PACS; QC is the key to
detecting errors, while training and calibration are the keys to averting them.
36
5.7
The meaning of digital quality manual for radiological units
Päivi Wood
Society of Radiographers in Finland
The digital quality manual is reference source of information for everyone in
everyday work and serves as a perfect introduction tool for newcomers.
The value placed on the importance of a "Quality Manual" for all staff working within
the medical radiation field is obvious to all, but not enough thorough work is done to
produce it. Often, the manual has been put together by a small group of experts with a
limited range of knowledge of other professions, and key personnel from those other
professions are not consulted in the development process of a quality manual.
A digital quality manual can be the foundation on which radiological clinics can start
to develop quality work. Being in digital format, its controllability is better and is
simultaneously available to everyone. In this example case, the quality manual is
compatible with ISO 9000 certification system. The digital quality manual guides the
clinic through the milestones along the quality path. It gives examples and ideas
which can be brought into the clinics procedures. Some easy examples of self
evaluation/clinical audit have also been attached. The manual also helps the users to
improve the clinics quality standards and guides towards "good practice".
The digital manual is flexible too; for example allowing the addition of good x-ray
archive to supplement the written word explanations with pictures and video clips. It
basically has no limits. It is the framework on which clinics can develop their
individually tailored good quality practices manual.
37
6.1
technology: A retrospective study of technology’s dynamic effect on efficiency,
effectiveness and patient care
S. Allman, A.L. Kind
Vancouver Centre & British Columbia Cancer Agency
This study is presented in two parts and reveals the positive impact of acquiring new
technology (hardware and software) on both process and practice. The study spans
almost 10 years, providing acknowledged data that supports the acquisition of the new
technology.
In 1995-1996, the British Columbia Cancer Agency (BCCA) undertook a
restructuring of its organization. Together with changes in governance, the BCCA
also made a conscious decision to move to one vendor in order to upgrade and renew
its radiation therapy equipment and programs. Varian could provide the hardware and
software necessary to provide a more seamless process within the radiation therapy
service. Changes in how the work was done and by whom, provided the final piece of
the solution.
Part one of the presentation will focus on the changes to process, incorporating both
technology and new tools. Critical path steps will be discussed, including the
introduction of new roles and structure. Acquiring the new technology in itself
presented challenges that led to innovative solutions, e.g. interfacing Varis with Elekta
treatment units.
Part two of the presentation will describe the implementation of improved patient care
processes, integrating care through the realignment of appropriate provider skill sets.
It will also describe the effect of change on recruitment and retention and how the
work environment transformed to support the goals of the BCCA in 2005.
38
6.2
Leadership role in staff retention
Rhonda Coleman
Radiation Oncology Department, Sir Charles Gairdner Hospital, Perth,
Western Australia
The international shortage of radiation therapists is a function of the number of
trainees and the attrition rate of qualified staff. The leader/manager plays a pivotal
role in retaining good staff. When government budgets are under stress health and
education funding are often early casualties. Replacement as well as additional
treatment machines and training positions are either deferred or cut from the budget.
This stress of waiting lists and shortages of new graduates cause qualified staff to look
at relocating to other locations that they believe may be more enjoyable to work in
than their stress ridden department.
These shortages result in many centres restructuring to reduce the number of tasks
done by radiation therapists and maximising the number of treatment hours. Extended
hours of operation are also often implemented at the same time because of the lack of
machines due to funding restrictions. This chicken and egg situation can quickly
spiral into a department that is 90% service focused, 9% patient focused and 1% staff
focused.
When a department becomes spends more effort on staff retention the result is staff
become challenged and motivated. This change in attitude improves the ease of
implementation of new technologies and treatment regimes and attracts radiation
therapists from other centres around the world.
The author has implemented this in 3 centres in Canada and Australia. This
presentation will focus on the practical implementation of such a program and the
pivotal role the leader/manager of the department plays in making this change.
39
6.3
A web based risk management tool for medical imaging
Robert George
Consultant to the I-Med, Medical Imaging Group, Australia
Risk Management is now a major focus in Medical Imaging world wide, with
increasing litigation and Professional Indemnity insurance premiums becoming a
major cost burden.
There have been few professional software aids available to assist with the
identification and prioritisation of the many risks associated with Medical Imaging.
An excellent, web based, Hospital orientated product has now been adapted to
interface with the multiple sites and modalities of a very large Private Radiology
Group.
This presentation addresses and demonstrates the need for such a system, it's
development process, and it's evolution to a pilot stage.
The integration of electronic incident reporting is also discussed and demonstrated.
40
6.4
The corporatisation of radiology in Australia - the scene 3 years on.
Robert George
Consultant to the I-Med, Medical Imaging Group – Australia
At the World Congress in Amsterdam in 2002 the dramatic changes to the face of
Radiology in Australia and the implications for Technologists were discussed.
There have now been even further, more wide reaching decisions which have the
potential to change the delivery of Medical Imaging services even more.
3 years on, we can review the impact and consequences of these changes and look
further into the future and see how technologists may use this remarkably changed
scene to their potential advantage.
41
6.5
technology: A retrospective study of technology’s dynamic effect on radiation
therapy practice
Anneke L. Kind
BC Cancer Agency, Vancouver, British Columbia, Canada
This study is the second of a two part presentation that reveals the positive impact of
acquiring new technology (hardware and software) on radiation therapy practice. The
study spans almost 10 years, providing acknowledged data that supports the
acquisition of this new technology.
the solution.
This presentation will focus on the effect of changes to process on practice that allows
the radiation therapists to work across the modules. In both treatment planning and
treatment delivery. The new technology provided the platform on which the radiation
therapists were able to acquire new knowledge and then integrate that knowledge into
new practice standards. The roles of other health care professionals within the
radiation therapy program were also enhanced and led to improved quality patient
care. Recruitment and retention issues have also been positively impacted. Through
this technological reorganization, radiation therapists are better able to contribute to
the research focus of the BCCA as it moves into a new strategic direction, a direction
where translational research will lead to improved treatment and care.
42
6.6
Identifying shortages for medical radiation technologists (MRTs) in
Canada
Richard Lauzon
Canadian Association of Medical Radiation Technologists (CAMRT), Ottawa, Ontario,
Canada
Little direct survey data has been available to determine the actual shortages of MRTs
in Canada. Nevertheless, there are estimation techniques that can be employed to try
to predict current personnel shortages, as well as more direct survey approaches. This
presentation will describe how such approaches were used in reports supplied to
provincial and national government agencies to assist them in their public policy
mandates and publications, and to help forecast future needs.
43
6.7
Installation of radiology units in AIDS treatment centres in Africa
Philippe Gerson
Department of Radiology, Hotel Dieu de Paris, Paris, France
Objectives: Many ambulatory AIDS treatment centres have been put in place in
French Africa because of the French Red Cross. It was then decided that it was
necessary to installed small radiology units to help doctors in their diagnosis and their
treatment of the disease..
Methods: We will look at the type of material needed while respecting the cost, the
maintenance and the use in this type of country. We will also look at how to organize
such an installation: personnel recruitment, radiation protection of the equipment,
working conditions while respecting the cultural and economical reality of the
countries. We will also present the type of exams needed and those achievable due to
circumstances.
Results: What are the results after a few years of functioning, the advantages, the
disadvantages, the future projects on this continent and elsewhere in particular in Asia.
Conclusion: AIDS has not decrease anywhere in the world and in particular in Africa
and Asia where the consequences for the populations and the economy are terrible.
Even if radiology presents a small interest in the diagnosis and treatment of this
epidemic each of us must be able to contribute in the battle against this scourge.
44
7.1
Applied evaluation of MR scans technique in the Study of Hypertensive
Rat Model
Han-Fang Chen, Zhi-Qiang Ou, Heng-guo Li
Medical Imaging Center, No.1 Affiliated Hospital, Medical College of Jinan
University, China
Objective: To explore the value of MR technique in the study of hypertensive rat
model.
Methods: 19 cases of Sprague-Dawley (SD) adult rat, weight from 200~250 gram,
reproduced hypertensive model, measured the blood pressure before and after
operation. At mean time, axial T1WI, T2WI, FLAIR and coronal T2WI were
performed, then one rat was killed at random, whose brain was made in pathology.
Their pathological changes and MRI findings were analyzed in details.
Results: A rat died at the 3rd month after operation, large area infarction was seen on
MRI. Enlargement of lateral ventricle appeared in a rat of the 8th and a rat of the 10th
month after operation. The strip shape hyperintensities at paraventricle were clear
detected only on T2WI in a rat of the 10th month after operation. The changes above
mentioned were shown best on T2WI. The pathological changes in the enlargement of
lateral ventricle and the strip shape hyperintensities were proliferation of gliocytes,
vacuolar degeneration and demyelination. MRI findings and pathology were normal
in the rest rats.
Conclusions: T2WI is valid mean to study hypertensive rat model, which can reveal
the pathological changes of rat brain.
45
7.2
The Application of Diffusion Tensor Imaging in the Acoustic Area
Shu-Chiou Chen, Wu-Dar Huang, Jon-Kway Huang, Hsiao-Wen Chung
Department of Radiology, Mackay Memorial Hospital, Taiwan
Purpose: The study used diffusion tensor imaging (DTI) to evaluate relationship of the
white matter in the acoustic areas, including Heschl gyrus (HG) and Superior
Temporal gyrus (STG).
Materials and methods: We conducted the current study, from July to September 2004,
we recruited 23 patients (healthy subjects, n= 12, clinical- diagnosed acoustic lesion,
n=11, among which 3 had cerebellopontine angle(C-P A) tumor. MR examination
were performed on a 1.5 Tesla MR scanner (Twin speed, GE, USA) with standard
head coil. Coronal section DTI was performed to cover the area of HG and STG using
a single-shot spin-echo echo-planar imaging sequence with TR=4000ms, field of
view=22cm, slice thickness=5.0mm, matrix size=160x160, NEX=4, number of
diffusion encoding direction was 25. Fractional anisotropy (FA) maps were
subsequently derived from the DTI images.
Results: Average FA value for healthy subjects was 0.301 for HG (0.312 and 0.290 in
the right and left white matter of HG, respectively) higher than the average FA of
0.242 for STG (0.255 and 0.228 in the right and left STG, respectively). Subjects with
hearing disorder had average FA of 0.298 for HG (0.315 and 0.282 in the R’T and L’T)
and 0.235 for STG (0.231 and 0.239 in the R’T and L’T). Average FA map was 0.301
(0.312 and 0.290 in the R’T and L’T HG) and they higher than that average FA map
was 0.242 (0.255 and 0.228 in the R’T and L’T STG); and the case had hearing
disorder’s HG average FA map was 0.298 (0.315 and 0.282 in the R’T and L’T), STG
average FA map was 0.235 (0.231 and 0.239 in the R’T and L’T). Patients with C-P A
tumor showed average FA of 0.273 for HG and 0.226 for STG, both lower than those
found in healthy volunteers and hearing disorder’s cases.
Conclusions: The application of DTI to the visualization of white matter fiber tracts is
relatively new in clinical practice. The findings of this study could be well explained
by our general understanding that the primary auditory cortex is located in the first
HG. The average FA map was not significantly altered in hearing disorders. The 3
tumor lesion in the C-P A cistern were found to slightly reduce the average FA of HG
and STG .The DTI did not show obvious signal loss.
46
7.3
The Impacts of Echo Time on 3D Time of Flight MR Angiography
Yuan-Hong Fan, Charng-Gen Yang, Pyng-Yi Ger
Taipei Veterans General Hospital, Taiwan
Purpose: To further investigate the impacts of echo time (TE) on 3D time of flight MR
angiography (3DTOFMRA) in background tissue suppression and vascular
demonstration.
Materials and methods: We conducted the current study, in a three months time from
February to April 2004 on 10 patients. The patients were referred to us for head MR
examinations due to brain vascular disorders (arteriovenous malformations and dural
arteriovenous fistulas). All examinations were performed on 1.5 Tesla
superconductive MR scanners (Signa, GE, USA) with standard head coil. In addition
to routine pulse sequences, we included two sets of 3DTOFMRA with the following
parameters: TR=40ms, flip angle=20, FOV=22cm, slice thickness=1.8mm, matrix
size=224x224 and NEX=1. The only difference of these two sets of 3DTOFMRA was
the change of echo time (I.e. TE=4.2ms and TE=6.9ms).
Results: In 100% (10/10) of the patients, 6.9ms of echo time 3DTOFMRA resulted in
the better tissue suppression of background and more clear display of maximum
intensity projection of brain parenchymal arteries; 90% (9/10) of the patients, MRA
source images displayed brain parenchymal arteries more clear. However, in one
patient 4.2ms images better demonstrated vessels those travel through skull bone. We
didn’t find long- echo-time-induced motion phase errors on 6.9 ms images. However,
6.9ms induced more metal artifact in two patients.
Conclusions: It is concluded that 6.9ms of echo time, obviously, eliminates the
background contamination on 3DTOFMRA. It increases the visual conspicuity of
brain arteries and improves the clinical application of 3DTOFMRA on brain.
47
7.4
Application of Smart Prep MRA in SPKT
JunWu Hu
To investigate the application of Smart Prep MRA in SPKT and evaluate this method
Methods: 5 cases with SPKT were collected from Jan, 2001 to June, 2002. All cases
underwent Smart Prep MRA based on MRCP and MRU following conventional MR
examination.Breath-holding was needed when scan began, and breath-holding time
was 23sec including 3 phases.Contrast medium was injected after conventional
examination finished. The dosage of contrast medium was 0.3mmol/kg(totle dosage
30ml), and the rate was 3ml/sec. Medrad Srectris MR injector was utilized. All
source images of Smart Prep MRA were handled with IVI software package.
Results: Distal end of the abdominal aorta, internal and external iliac arteries, major
transplanted arteries and 1~2 level branches all displayed well. Among them, 3 cases
with abnormality of blood vessels were proved by DSA 1 case with acute rejection
reaction of pancreas showed vascular branches of pancreas were occlusive. The other
1 case showed that aneurysm of splenic artery formed, and the connection of blood
vessels and proximal end of inferior pancreaticoduodenal artery(Figure). The third
case with acute rejection reaction of kidney and accompany renal infarction showed
distal end and proximal end of renal arteries were occlusive
Conclusion: Smart Prep MRA can increase significantly arterial S/N, decrease
flowing artifacts and improve the qualities of MRA images
48
7.5
Technical Investigation of MR DSA for Musculoskeletal Diseases of
Extremities
JunWu Hu
To study the technique of MR DSA in the use of musculoskeletal diseases of
extremities.
Methods: Following conventional MRI, dynamic 3D-SPGR was performed in 13
cases with surgically- and pathologically-proved musculoskeletal diseases in limbs,
using RT 10.3 or 12.5ms, ET 1.9 or 2.8ms, flip angle 300, Nex 1, and scan time
32s.Having been processed by subtraction from mask image, the source images were
reconstructed with MIP.
Results: Of 13 cases, 2 were located in upper extremities and 11 in lower extremities.
The diseases included malignant soft tissue tumor (n=2),vascular lesion
(n=7),malignant skeletal tumor (n=2)and benign skeletal tumor (n=3). MR DSA well
displayed the feeding artery in 3 out of 4 cases with fixed aneurysm. Two cases with
small subcutaneous cavernoma demonstrated enhancement though their feeding
arteries were not revealed. It was still helpful to the diagnosis as their enhancement
was consistent with arterial enhancement. One case of malignant fibrous histiocytoma
showed several tumor feeding arteries and pressure sign of the arteries.
Conclusion: MR DSA has many advantages, such as short scan time, high quality
imaging, and rich information. It, therefore, plays an important role in the diagnosis of
musculoskeletal diseases.
49
7.6
Language processing in native Cantonese speakers using auditory
stimulation: a functional MRI study
Wing-kit Lee, Suk-tak Chan, Sze-wing Tang, Kwok-wing Tang, Shing-shun Lo,
Kenneth K. Kwong
Hong Kong.
Introduction: The determination of hemispheric dominance for language is an
important component in neurosurgical planning. Previous functional studies have
demonstrated that major language processing areas at the inferior frontal (Brocas area)
and posterior temporal gyri (Wernickes area) were activated by auditory stimuli with
the basic component of syllables, for example, English vowels and Mandarin
consonants. The purpose of this functional magnetic resonance imaging (fMRI) study
was to investigate the feasibility of using auditory stimuli with the rhymes in
Cantonese, a major southern Chinese dialect, in the determination of language
processing areas, and hence the language dominance, in native Cantonese speakers.
Materials and Method: 12 right-handed native Cantonese speakers aged 18 to 30 years
were studied by functional magnetic resonance imaging (fMRI) for language
processing areas with scanning on a Siemens Sonata 1.5 Tesla scanner with high
resolution FLASH scan & EPI BOLD scan. The paradigm was consisting of an eventrelated auditory recognition task with 2 conditions: Cantonese rhymes and filtered
pitch (I.e. rhymes filtered to retain the duration and the tone of the rhymes only).
Results: A more significant functional activation at the bilateral superior temporal
gyrus was observed in direct comparison between Cantonese rhymes and filtered
pitch in auditory recognition task. Our result is consistent with previous reports,
which proposed that superior temporal gyrus was involved in phonology. Brain
activations at the inferior frontal gyrus by auditory recognition task cannot be
demonstrated as clearly as that by visual language task in the previous studies.
Conclusion: Our findings suggest that superior temporal gyrus has activation in
auditory task. Differences of the language processing network between auditory and
visual stimuli need to be taken into account when interpreting the language
dominance from such brain activations. A larger sample size with different auditory
language conditions would be needed for further investigation.
50
7.7
Influence of Contrast Media Dose in MR Angiography Image Quality of
the Carotid Arteries with the use of CENTRA Technique
YC Lin, YY Wai, CC Chen, MC Wong, SH Ng
MRI Center, Chang Gung Medical Center at Linkou, Taiwan
Objectives: To evaluate usefulness of contrast-enhanced time-robust angiography
(CENTRA) in carotid arteries with reduced dose of contrast material.
Methods: A total of 44 patients with clinical indications for angiography for the
carotid arteries were examined with MR at 1.5T by using a fluoroscopically
monitored, manually triggered, randomly segmented k-space ordering pulse sequence.
Patients were randomly assigned into two groups according to the dose of contrast
medium administrated: group 1 referred to 0.2mmol/kg and group 2 to 0.1mmol/kg of
gadolinium chelate. They were all injected at the same rate (2ml/sec). The signal-tonoise (SNR) and contrast-to-noise (CNR) ratio of five regions of interest were
calculated. The overall image qualities and the degree of venous overlay were ranked
by two blinded readers on a five-point scale.
Result: The SNRs and CNRs at the brachiocephalic artery were greater in group 1
than those in group 2 (p<0.05), but there were no statistically significant difference at
the region of both carotid bifurcation and both intracranial internal carotid arteries
(p>0.05). There were also no statistically significant differences in the evaluation of
overall image quality and degree of venous overlay (p>0.05).
Conclusion: With the use of CENTRA technique, the dose of gadolinium
administrated in carotid MR angiography can be reduced while maintaining
comparable image quality with the standard dose.
51
7.8
Technical Investigation of Myocardiac MR perfusion
Jingjing Rao
With the improvement of MR hardware and software, fast imaging sequences are
developed and practised, the whole dynamic process of medium passing through
myocardium can be captured by enough temporal resolution and special resolution.
However, mastering and using the myocardiac perfusion technique accurately are the
key to obtain the stable curve and the diagnostic images. Images of 20 myocardiac
perfusion patients are analyzed involved from Jan 2001 to Dec 2003 to study the new
technique of myocardiac MR perfusion.
Methods: 20 cases with myocardiac ischemia or infarction were divided into two
groups. There were 10 cases in each group. Group A was test group 0.1mmol/kg (total
amount 10ml) of contrast agent was administered and 3ml/sec of injection rate with
high pressure injector was used in Group A. Sequently, the short axis scan using
FGRET and Fastcard-GRE performed with cardiac gating and breath-holding Group
B was control group. Double dose 20ml was administered and the rapid hand injection
was used in Group B. Sequently, the same scan condition with Group A performed in
Group B.
Results: The perfusion curves of Group A were much more stable than those of
Group B. The quantitative indicators of Group A were significant in statistics.
Moreover, the perfusion images were qualified to the diagnostic standard
Conclusion: Stable perfusion curves can be obtained by using accurate perfusion
technique. Utilizing the technique appropriately can provide more accurate perfusion
indicators for clinic.
52
7.9
Clinic Application of MR Angiography in the Intracranial Venous System
Qun Yu, Xiangquan Kong, Dingxi Liu
Chinese Society of Imaging Technology, China
Objective: To investigate the optimal techniques and sequences of intracranial MR
Venography (MRV) and to evaluate its value in diagnosis and clinical application in
the intracranial venous system.
Methods:
Using 2D-TOF-MRA, 2D-PCA and 3D-CE-MRA combined with
maximum intensity projection (MIP), muti-plane reconstruction (MPR) and digital
subtraction MRA (DSMRA) . MRV imaging was performed on 20 healthy subjects
and 20 patients with cranial venous sinus thrombosis (CVST) and intracranial tumor
related to venous sinus. MRV imaging results were observed and the optimal
sequences of intracranial venous system in MRV were formulated.
Results: Of 20 patients, 13 cases with CVST and 7 cases with intracranial tumor
related to venous sinus were demonstrated by 3D-CE-MRA , and confirmed by
surgery and clinical follow-ups with 100% true positive. Visualization of the
complicated region and minor sinus was better with 3D-CE-MRA than with 2D-PCA
and 2D-TOF-MRA.
Conclusion: The MR venography with 3D-CE-MRA combined 2D-PCA and 2DTOF-MRA is the optimal sequences for the intracranial venous system. MRV plays an
important role in making preoperative evaluation and in guiding clinical management.
53
7.10
The application of high pressure injector in the perfusion MR imaging
and angiography
Yinhua Zeng
To evaluate the clinic value of high pressure injector in application of the perfusion
MRI and angiography.
Methods: 30 cases of brain tumor were performed perfusion MRI, 28 of vascular
disease performed routine enhanced MRI and 5 of coronary heart disease performed
myocardium perfusion imaging. During the procedure a Medrad Spectris MR injector
was used at bolus injection of contrast agent via upper extremity. According to the
size of vessel and lesion, preset was the flow speed, flow amount and injection time,
and the area of the interest was subsequently scanned with short or delay time using
corresponding program. As a control, 12 other cases of brain tumor were performed
perfusion MRI with manual injection and their time intensity curves were
comparatively analyzed.
Results: Of 42 cases with brain tumors, 30 were proved by operation and pathology, 6
by surgical results in another hospital and 6 by biopsy. 28 cases of vascular diseases
were proved by IADSA. The MR angiograms of vascular diseases in 28 and
myocardium perfusion MR imaging in 5 reached the diagnostic standard. The cures of
brain blood perfusion in the group with high pressure injector was superior to those
with manual injection.
Conclusion: The pressure injector can maintain the flow speed and the concentration
of the contrast agent to accomplish the accurate perfusion. According to the program
of the perfusion imaging and angiography being performed, the injection rate and
time can also be adjusted to do precisely the exams mentioned previously.
54
8.1
A simple monitoring system of cumulative entrance skin doses of patients
during cardiac procedures
D. Balman, G. Bibbo
Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
At the Women’s and Children’s Hospital, for cardiac procedures, we have established
a linear relationship between dose area product (DAP) measured with diamentors
fitted on the hospital’s biplane angiography equipment and cumulative entrance skin
doses (CESD) to paediatric patients. Recently the image intensifiers of the biplane
imaging systems were replaced and more data was collected to update this
relationship. We have found that this relationship is critical in providing real time
feedback to the cardiologist during the procedure for them to be aware of the skin
dose delivered to the patient particularly during lengthy and complex interventional
procedures. This allows the cardiologist to take measures in preventing radiation
induced skin injuries in patients.
55
8.2
Patient doses in CA and PTCA in Iceland
Gudlaugur Einarsson
Icelandic Radiation Protection Institute, Iceland
Purpose: To investigate the level of patient dose in routine coronary angiography (CA)
and percutaneous transluminal coronary angioplasty (PTCA) and compare it with
recommended diagnostic reference levels (DRL) and "trigger level" To evaluate peak
skin dose in view of possible deterministic effects.
Materials and Methods: During 38 CA and 39 PTCA procedures patient and exposure
data was collected. The patient dose was registered using a dose area product (DAP)
meter, with an transmission ionisation chamber mounted on the under-couch x-ray
tube. Peak skin dose (PSD) was measured with a zinc cadmium sensor that was
placed on the skin of the patient in the position that was estimated to receive the
maximum radiation.
Results: The values from CA and PTCA where comparable with reported values, with
the mean DAP of 23,1 and 59,4 Gycm2 respectively and fluoroscopy time of 4,7 and
15,2 minutes. The DAP values are lower than the Nordic Guidance level for PTCA
and other for CA. The PSD measurements gave a maximum reading of 68 and 541
mGy respectively, which is also comparable to levels reported elsewhere. There is no
correlation between PSD and other individual procedure and patient variables. Using
published conversion factors for PSD from DAP, the calculated maximum skin dose
for CA and PTCA can be further estimated around 0,3 and 1,4 Gy respectively.
Conclusion: The level of patient doses in CA and PTCA are well below the
recommended DRL and the "trigger level" of 300 Gycm2. Measured PSD and
estimated PSD from DAP indicate that the possibility of deterministic effects is
present.
56
8.3
The response characteristics of flat-panel detector to exposure factors
Qingjun Li, Menglong Zhang, Yi Sun, Hongpu Zhao
Radiographic Association of China, Shandong,China
Objective: From the response of flat panel detector (FPD) to kV,mA and exposure
time(s),the optional combination of exposure parameters were studied.
Materials and Method: Digital Radiography (DR) system, 0.5mm copper plate (or
aluminum steps), and the statistic software of Excel were used. 0.5mm copper filter or
aluminum steps were exposed respectively under variable individual exposure
factors(kV,mA,exposing time and mAs). Meanwhile setting for chest procedure was
utilzed. The grey valuse of fixed pionts were measured by means of the DR system.
Results: 1. The image grey value of the chosen points increased almost linearly with
increasing kV within 100kV, after which the increase was slower. 2. The grey value
increased almost linearly from 40mA to 630mA. 3.The grey value changes for
exposure time were similar to those of mA.
Conclusion: The optimal kV for chest digital radiography is 100kV or so. The grey
level values almost reach the maximum point at 100kV when the FFD and mAs are
fixed.If the penetration of x-ray is enough ,the best way to increase the grey value is
to increase the mA or the exposure time or mAs.
57
8.4
Passing through the Epicentre: Some useful experience in adopting
infection control measures regarding the application of surgical face mask
Chi Kei Victor Lo
Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital
Shatin, Hong Kong
During the SARS crisis, a lot of protective measures had been taken to avoid cross
contamination between individuals. Full personnel protective gears had to be applied
in Ultra-High risk / High risk areas. It becomes extremely hot and the eye shield
would become foggy periodic change of the N95 mask was inevitable as the whole
mask would be easily soaked by sweat and condensed water from the perspiration. An
alternation of the protective gear combination can help to eliminate the irritant. The
use of a simple surgical mask with visor on top of the N95 mask could give the
suggested protection to the medical personnel. Presence of suspected droplets
contaminates from patients cough could also be indicated by the light vibration
movement of the visor.
On the patient's side we must ensure the patient to put on the Surgical mask / N95
mask properly before performing any radiographic positioning but it will be difficult
for certain types of patient for example the pediatrics and the geriatrics.
Radiographers may need to persuade the patient to adopt the infection control
measures but sometimes if the metal strip on the surgical mask / N95 mask obscure
the area of interest in radiography (for example during SXR), we might need to ask
the patient to adjust the metal strip slightly away from the point of interest or
temporarily apply the mask upside down in order to avoid the artifact.
58
8.5
An overview of interventional radiology services in Singapore General
Hospital
J.S. Loke, Chu-Chun Yang, Kenneth Yeo, Kumar R. Santosh, G.P. Cornelio, Geraldo
E.M. Jude
Diagnostic Radiology, Singapore General Hospital, Singapore
Interventional radiology begins its service in mid-1970s with the advances of
medical imaging and development of tools such as balloon catheters. In the early days,
the interventional radiologists pioneered the coronary angiography. Today,
interventional procedures are no longer limited to the coronary region as new type of
procedures being developed to diagnose and treat patient.
Singapore General Hospital is one of the largest tertiary hospital in Singapore
with the capacity of 1,400 beds serving both inpatients and outpatients. The
department of diagnostic radiology holds 2 level in one of the building block.
Currently, there are 3 DSA-capable equipment being utilized by the interventional
team as well as neuro-radiology services. On a busy day, 10-15 cases were performed
varying from simple case such as venous line insertion to therapeutic case like
embolization and arterio-venous graft thrombolysis.
The purpose of this presentation is to give an overview of the type of
procedures being done in SGH. This will include example of different cases done and
discussion of the current role of radiographer in the team. Monthly statistics of cases
done will be analyze as well.
In conclusion, interventional radiology service has become a first line of
treatment preferred by clinician and patients. Radiographer needs to be competent and
versatile to adapt as the VIR service develops.
59
8.6
The evaluation of single exposure dual energy subtraction chest
radiography in the screening for lung metastasis
Judy Yee-Ha Wong (1), Patrick Yau-Ming Lai (2), Fiona Brook (2), Humariah Cheung (1)
(1) Department of Diagnostic Radiology and Organ Imaging, Prince of Wales
Hospital, N.T., Hong Kong;
University, Kowloon, Hong Kong
Pulmonary metastases presented as metastatic nodules are commonly seen in patients
with known malignancies. Traditionally, conventional chest radiography and
Computed Tomography (CT) are the imaging tools used for screening.
Single-exposure dual energy subtraction chest radiography (SEDE) is a digital
subtraction imaging technique that applies in projection chest radiography. The
removal of overlying rib shadows through digital subtraction greatly improves the
detectability of nodules. Also, the tissue-subtracted image of SEDE provides a more
accurate differential diagnosis. Comparing with CT, SEDE may offer a simple,
accurate imaging method for screening of metastasis nodules.
In the present study, the diagnostic accuracy of CT using a local protocol was
compared with SEDE in lung metastases screening. A total of 94 patients (mean age
50.4) with known malignancies were recruited prospectively and retrospectively.
About half of the cases were with metastatic nodules. Total number of nodules noted
in diseased cases was 299 with a mean of 6.6 nodules per subject. Four radiologists
participated in a Receiver Operating Characteristic (ROC) analysis.
Results show that there is no significant difference in the areas under the ROC curves
of both CT and SEDE using paired t-test (p<0.05). However, CT demonstrates
significantly more nodules than SEDE. SEDE demonstrates only 46.3% of the total
nodules noted by CT with the lowest detection rate (12.5%) for nodules smaller than
0.5cm. The finding indicates a limitation of SEDE in identifying the exact number of
nodules in patients with lung metastases. For patients that present with minute
nodules, CT is comparably superior.
60
8.7
The International Subarachnoid Aneurysm Trial (ISAT). Full one year
results and their effect on the management of subarachnoid haemorrhage
J.A. Yarnold, R.S.C. Kerr, A.J. Molyneux
Neurovascular Research Unit, The Radcliffe Infirmary, Oxford, UK
Introduction: The first results from the International Subarachnoid Aneurysm Trial
(ISAT) were published in the Lancet in October 2002.
Methods: ISAT is a multicentre randomised controlled trial (RCT) comparing the
policies of endovascular versus neurosurgical treatments of aneurysmal subarachnoid
haemorrhage (SAH) in an eligible population. Patients were considered suitable for
randomisation if there was uncertainty as to which was the best method of treatment.
Neurological outcome was measured at two months and one year post randomisation
using the modified Rankin Scale. Neuropsychological outcome was measured at three
months and one year in certain centres in the UK. There were 2143 patients entered
into the trial from 43 centres. ISAT ceased recruitment in May 2002.
Results: One year data have now been analysed in all patients. Results demonstrate a
significant reduction in both relative and absolute risk in patients who were
randomised to an endovascular treatment policy. These results have had a profound
effect on the treatment of patients with SAH in certain areas of the world.
Conclusion: This paper will describe the full one year results along with new data on
epilepsy and health economics. It will also discuss the impact that the results have
already had on the management of patients with aneurysmal subarachnoid
haemorrhage and the treatments offered to them.
61
8.8
Lowering iodine concentration in contrast media for intravenous
urography using image processing
A. Zulkarnain, K.H. Ng, B.J.J. Abdullah
Faculty of Health Sciences, MARA University of Technology, Petaling Jaya,
Selangor, Malaysia
The objective of this study is to lower iodine concentration of low osmolar contrast
media that will provide optimum diagnostic quality for intravenous urography images
using computed radiography. Lower iodine concentration would help contribute to
lesser nephrotoxic effects. A phantom study, consisting of a series of polyethylenetubes filled with iodinated contrast was imaged using Fuji type C, ST-VI
photostimulable imaging plates. A clinical study was then carried out at the
Department of Radiology, University of Malaya Medical Centre to compare image
quality. The study involved 90 patients and a total of 180 images were evaluated.
Image quality was evaluated subjectively by recognition of anatomical structures and
an estimation was made of image contrast, sharpness and overall quality by using a
modified Commission of European Communities quality criteria for diagnostic
radiographic images and patient exposures. We found that iodine contrast levels can
be reduced significantly and still give diagnostic quality images. It was found that for
an equivalent body-mass index, there is no statistical difference between the routinely
used 300mg ml-1 and contrast media of 200 and 250mg ml-1 concentrations
(Wilcoxon Sign test, p<0.05). The clinical investigation suggested that contrast media
concentrations can be reduced as much as 16 to 33% and still deliver a diagnostic
image.
62
9.1
Enhancing the RT student clinical experience: The Newcastle Mater
Hospital Department of Radiation Oncology
N. Chapman, S. Oultram
Department of Radiation Oncology, Newcastle Mater Hospital, NSW, Australia
In 2004, the New South Wales (NSW) State Government in Australia provided
funding for five clinical, consultant, radiation therapist positions, specialising in
clinical education. Radiation Therapy Educators (RTEs) positions where developed in
response to the attrition rate in Medical Radiation Science (MRS), Radiation Therapy,
courses in NSW and the subsequent impact on qualified radiation therapist numbers.
The Radiation Oncology Department at the Newcastle Mater Hospital (NMMH) was
granted three year funding for one of the RTE positions. It appointed two radiation
therapists (RTs) in a job-share capacity.
The RTEs at the NMMH had a blank canvas to draw on to produce a comprehensive
program to support undergraduate MRS students from Sydney and Newcastle
Universities. The RTEs utilised concepts regarding clinical education, adult learning
and preceptorship in the development of the program. The program involved
implementation of an orientation program and department wide preceptors to facilitate
learning in the clinical environment. The undergraduate program was adapted
specifically to student learning, by utilising needs assessments and learning contracts,
in addition to specialised tutorials. This enabled the department to augment the
students clinical experience
The program is also focused on establishing baseline data, where little has existed
previously. Hence providing justification for the initiatives the RTEs have developed
and in the long term, substantiating the NSW State Government decision in
implementing the RTE position. Preliminary data indicates that the program, although
still in it’s infancy, appears to be addressing the needs of the students resulting in
enhancement of their clinical experience.
63
9.2
Internationally educated candidate experience on Canadian certification
exams
Dorothy Gallagher, Richard Lauzon
CAMRT, Canada
In 2003, 187 certification examination candidates indicated they were educated
outside of Canada. This is a dramatic increase annually from the early 1990’s, and the
trend continued in 2004. Unfortunately, the pass rate for international candidates is
significantly lower than for Canadian-educated candidates. During the fall of 2004,
the Canadian Association of Medical Radiation Technologists (CAMRT) will be
looking at factors that might explain the substantial differences in exam results. In
addition, observations will be made on organizational and governmental activities to
address the special problems faced by internationally-educated candidates. As
successful national certification exam performance is a precursor to employment in
Canada, such issues have relevance for international labour mobility and addressing
national personnel shortages.
64
9.3
An alternative approach to teaching the fundamentals of computed
tomography to undergraduate radiography students
Giovanni Mandarano
Australian Institute of Radiography, Australia
Traditionally, the teaching of computed tomography (CT) scanning techniques has
included a combination of lectures and laboratory sessions. Within the undergraduate
framework of the Bachelor of Radiography and Medical Imaging at Monash
University, a new multi-faceted approach is currently underway in the teaching of CT.
This approach extends from the traditional setting in order to establish a relevant link
to CT scanning techniques, the clinical setting and achieving positive learning
outcomes. The overriding aim of this presentation is to demonstrate how this is
achieved through the following methodology and features: 1) The Student Oriented
Learning About Radiology (SOLAR) computer programme, unique to Monash
University, introduces students to case-based clinical scenarios. 2) Pre clinical CT
scanning skills are developed through authentic tasking exercises with the use of
scanning human cadavers. 3) CT images of anatomy, pathology and artefacts are
provided to students on CD-ROM which includes formative assessment activities. 5)
The university intranet is utilised to create an online community were instantaneous
communication (teacher to student and student to student) leads to immediate
clarification of content and material delivered maximises efficient use of student
study time. Feedback received from students overwhelmingly agree that this multipronged approach to content delivery helps them achieve far greater learning
outcomes, and many clinical centres report smoother student integration into the CT
clinical environment, thus preparing the individual student for active participation.
65
9.4
Evaluation of a journal club in a radiation oncology department
D. Milinkovic (1), N. Field (1), C.B. Agustin (2)
(1) School of Medical Radiation Sciences, Faculty of Health Sciences, University of
Sydney, Australia;
(2) Radiation Therapist Educator, Radiation Oncology Network, Australia
The journal club at the Radiation Oncology Network’s Westmead Campus was
implemented in 2004 as an educational tool for the evaluation and utilisation of
professional research. It aimed to achieve this by creating a supportive environment
for radiation therapists to critically review and discuss current and relevant research
literature as well as placing this literature in the context of their own clinical setting.
The journal club participants consist mainly of radiation therapists however radiation
physics staff and radiation oncology nurses also attended a number of sessions. It was
held once a month (over a nine month period) and each session was repeated to allow
as many staff as possible the opportunity to attend. The literature was selected based
on its relevance to radiation oncology and radiation therapy and reviewed using
clearly structured guidelines. At the conclusion of this nine month period participants
were asked to complete a questionnaire evaluating the structure of the journal club as
well as it’s ability to achieve it’s original goal of encouraging staff to evaluate and
utlise professional research. This paper will outline the structure of the journal club,
the rationale behind this structure and discuss the evaluation of the first nine months
of its implementation.
66
9.5
A learning needs assessment of the radiation therapists of the province of
British Columbia with respect to the information management system VARiS
vision
Alison Mitchell
Radiation Therapy, BC Cancer Agency, Vancouver Centre, British Columbia, Canada
Background: All four radiation therapy centres in the Province of British Columbia,
Canada use the information management system VARiS Vision for managing patient
data and images. The goals of this project were to identify the learning needs of the
radiation therapists with respect to VARiS Vision and their preferred training method.
Method: A web-based survey tool was developed and distributed electronically to all
214 radiation therapists. Radiation therapists self-assessed their current level of
knowledge and understanding of VARiS Vision using a five point ranking.
Results: Two centres have identified a small need for training in the use of VARiS.
Three centres have identified significant needs for training in the use of Vision. 40%
of the respondents indicated that one-on-one training was their preferred method of
training with another 30% preferring instructor led group training in a computer
laboratory.
Conclusions: There is an identified need to provide minimal training in the use of
VARiS in two centres and extensive training in the use of Vision in three centres. The
radiation therapists prefer to receive one-on-one training.
67
9.6
Educational issues and contemporary practice
Pamela Rowntree
Discipline Leader Medical Radiations, Queensland University of Technology,
Australia
The role of the radiographer and radiation therapist has changed with the development
of a range of new equipment and techniques. In some countries role expansion has
seen areas of practice extended in tandem with these technological changes. In
preparing students for contemporary professional practice course providers have to
ensure a balance between the past, current and future roles of medical radiations
practitioners. Issues such as equipment provided in laboratories, computer facilities,
course content emphasis and clinical placement opportunities will be considered in
this paper, for a university based degree program. This paper will present some of the
challenges in preparing students for the future while ensuring current practice needs
are met.
68
9.7
Viva voce to e-OSCE
M. Tatlow
London South Bank University, UK
In any practical healthcare course, there is an inherent need to assess the knowledge
and skill of the students as a measure of clinical ability and more importantly to
protect the public.
Traditionally, this has been assessed by the viva voce. More recently, the OSCE has
been used, as it is less subjective. The latter has been proven to be an excellent
assessment tool, it does however have one major draw back, it is incredibly resource
intensive, Experiences in my own institution, have highlighted this difficulty. In the
June 2004 assessment period 24 staff days were taken up with administrating and/or
participating in the OSCE assessment of 120 students across three cohorts and 2
programmes. Even on cursory examination it can be seen that this is not an efficient
use of staff time or resources.
In their paper of 2004, Palarm et al detailed their experiences of developing and
running an electronic Objective Structured Clinical Examination (e-OSCE). He chose
to use proprietary web development software, and content located locally on a CDROM in each candidates computer.
His rational for use was one of limited resources and parity of access. The purpose of
this paper is to propose a model whereby Palarm’s original experiences can be built
upon and expanded using networked resources, such as a Managed Learning
Environment (MLE), video streaming and rich media. This review will explore such
areas a plagiarism, resources resource development, and scalability the discussion will
revolve around a generic MLE.
69
9.8
A study on teaching approach of radiographic simulation system with
medical imaging
C.S. Tsai, J.S. Lin, Y.C. Lin, K.H. Liu, Y.C. Huang, Y.C. Lin, H.H. Lin, C.C. Lee,
K.H. Chung
The Association of Radiologic Technologists of the Republic of China (ARTROC) ,
Taiwan
Objectives: In this study, a radiographic simulation system which combined medical
imaging was designed and performed for teaching and clinical training purposes.
Materials and methods: The radiographic parameters and procedures containing
positioning skills and x-ray medical images were chosen to be as the input unit of
system. The operating pulses are converted by analog to digital signal
converter(ACDs). The signals from x-ray device simulator are accepted and processed
by 8051 microprocessor unit, and then, the processed data are sent to the server
through RS-232C serial port. The server receives the medical image databases of the
corresponding addresses that come from the 8051 microprocessor unit, and displays
the medical image on monitor. In this system, the 8051 microprocessor unit and the
server are driven by the use of assembly language and basic language, respectively.
Results and conclusion: The results from radiographic images on skull, chest,
abdomen, extremity bone, confirm the applicability of the study and meet the
requirement of clinical digital medical image processes. The advantanges of
radiographic simulation system include easy portable operation, no radiation risk and
no high voltage. In addition, it can be also used as the auxiliary tools for teaching
image interpretation and radiographic skill, as well as for clinical training.
70
9.9
Incorporating reflective practice into the curriculum for the graduate
entry Master of radiation therapy course at Monash University
C.A. Wright
Department of Medical Imaging and Radiation Sciences, Monash University,
Melbourne, Victoria, Australia
Introduction: Reflective practice is an integral aspect of the curriculum for
undergraduate and post-graduate courses. It is often a challenge initially to engage
students in the reflective process and for them to understand its relevance. This has
been observed particularly at the commencement of the course in students who have
come from a purely scientific background.
Discussion: The paper discusses how reflective practice has been incorporated into
the teaching, learning and assessment strategy and curriculum development for the
Master of Radiation Therapy. Its use as a tool to facilitate contextualisation of the
academic and clinical components of the course will be considered. The methods of
teaching, learning and assessment which incorporate reflective practice, such as the
SOLART case based learning and assessment tool (Student Orientated Learning
About Radiation Therapy) will be discussed in the context of adult learning theory.
The structure of the Clinical Studies program will also be discussed in relation to its
design and how it facilitates students to develop and acknowledge their reflective
capacity.
Conclusion: Incorporating reflective practice into the curriculum has provided the
students with a ‘tool kit’ which can be used to demonstrate their learning from both
academic and clinical experiences. Reflective Practice is essential if we are to produce
newly qualified Radiation Therapists who are equipped at the stage of entry into the
profession with the skills necessary to demonstrate that they are responsible,
accountable practitioners and to facilitate their continued professional development.
71
10.1
Radiographer's role extension in protocol-driven IVU
Holly Chui-Ping Chun
Radiology Department, New Territories East Cluster, Hong Kong
Objective: Since April 2002, protocol-driven Intravenous urographies (IVU) are
performed by radiographers in the New Territories East Cluster in Hong Kong. A
protocol gives guidelines for filming sequence. Radiologists report the films
afterwards. Neither radiologists nor nurses are posted in the IVU room. The objective
of this paper is to report the results of this process redesign exercise.
Methods: From the beginning, comprehensive quality assurance and auditing
programs are in action. Data are analyzed one year after implementation. By
compiling the results, the quality of protocol-driven IVU is described.
Results: A total of 2,451 IVUs were performed during the first year. The waiting time
had been reduced from 4 months to 7 weeks. The major outcome indicator for
efficacy is commitment of radiology report. In a randomized trial, the rates of partially
or cannot answer clinical questions were 12% and 16% for protocol and non-protocol
driven IVU respectively. A total of 2,398 venipunctures were analyzed. The overall
success rate was 99%. Mean radiation dose of protocol IVU (8.72 Gycm2) is far less
than the dosage (20 or 40 Gycm2) acceptable by international standard. The cost
reduction was estimated to be 27% or US$64 per exam. Therefore, the team estimated
that US$157,000 had been saved for the year.
Conclusion: Through radiographer's role extension and process-redesign, a new
patient service emerged. The service is both effective and economical, while
maintaining quality.
72
10.2
Projecting the future: Maintaining professional competency in a rapidly
changing environment
Dawn Fucillo, Lynn May
American Society of Radiologic Technologists (ASRT), United States
This presentation will provide an overview of the trends that will shape the radiologic
technology workforce and workplace of the future. Based on environmental scan
research commissioned by the ASRT under the title of "Future Scan", factors both
inernal and external to the profession have been identified and analyzed. The results
of this research with projections for the future as well as the implications for
maintaining professional competency in a rapidly changing environment will be
presented.
73
10.3
Evaluation of the clinical radiographic practice program
R.M Kekana
Radiography Department, University of Johannesburg, Johannesburg, South Africa
A survey to determine the effectivness of the Clinical Radiographic program for the
National diploma Diagnostic Radiography at the University of Johannesburg was
initiated in 2002 and is still carrying on.This was prompted by the learners remarks
regarding the way the clinical assessments were conducted by the various lecturers
and clinical tutors.
A questionnaire was used to collect data. The questionnaire was made of both the
closed and open-ended questions so as to gather both qualitative and quantitative
information. Learners are expected to complete these just beforethey hand in their
clinical books at the end of the academic year. To supplement the information
collected via the quaestionnires, focus group interviews were also conducted.
Results of the survey were later brought to the attention of all involved in the learner
assessments for the clinical Radiographic practice subject.This was done in the form
of a workshop which was organized by the university and facilitated by the education
expert. The assessors acknowledged the fact that they did not have a measuring
instrument to use when conducting these assessment. They then came to the
conclusion that the assessment criteria be diseigned by the clinical coordinator in
consultation with both the assessors and the learners. They feel that the assessment
criteria will help eliminate the inconsistency and subjectevity among various people
who conduct clinical assessments. Whether this will really improve the standards is
still to be seen.
74
10.4
Expanded roles for medical radiation technolgists in Canada
Richard Lauzon, Dorothy Gallagher
CAMRT, Canada
In January 2004, a random sample of radiologists in Canada were surveyed about
expanded roles for medical radiation technologists (MRTs). Preliminary analysis of
the data makes it clear that MRTs are currently performing numerous advanced roles,
and further that a significant proportion of radiologists support further delegation of
radiological functions to suitably qualified technologists. A draft report is currrently
being written for presentation to the Joint Workgroup of the Canadian Association of
Radiologists (CAR) and the Canadian Association of Medical Radiation Technologists
(CAMRT). The survey was based upon an instrument produced by the American
Registry of Radiologic Technologists (ARRT)on behalf of the American College fo
Radiologists (ACR)and the American Society of Radiologic Technologists (ASRT).
The data will have implications for the development of professional development
courses and increased specialty certification in Canada.
75
10.5
Role development for therapeutic radiographers in the public hospitals in
Hong Kong
Peter White, Shara W.Y. Lee, Candy W.Y. Wong, Angus K.W. Lee, Don N. Cheung
Hong Kong
Objective: To identify the factors which determine the possibility of role development
for therapeutic radiographers in public hospitals in Hong Kong.
Methods: Questionnaires were sent to Clinical Oncologists, Nurses, Medical
Physicists and Therapeutic Radiographers, at all ranks, in four clinical oncology
departments. Information was sought on role development, and nature of extended
role tasks that should be undertaken by therapeutic radiographers. Both open and
closed questions were used to ascertain views. Individual, semi-structured interviews
were conducted to further explore views of therapeutic radiographers. For open-ended
questions, data were analyzed thematically by grouping similar opinions; while for
closed questions, data were analyzed by both descriptive statistics and independentsamples t-test.
Result: 132 questionnaires were returned from a total of 285 dispatched (46.32%).
The majority of subjects (77.10%) felt that role development in therapeutic
radiography would have a positive impact on oncology services. Medical
dominance?was ranked first as a barrier to role development (Mean: 2.86; SD: 1.78).
Radiographers would tend not to extend their roles by taking up tasks previously
performed by oncologists: for example, radiographers would not want to prescribe
drugs to patients with radiation side-effects (57.58%), while 83.33% of oncologists
also disagreed with this being performed by radiographers. Other professionals
(nurses and medical physicists) held reserved views in delegating their tasks to
radiographers, even after accredited clinical training.
Conclusion: Role development is one way to relieve the increasing workload in
clinical oncology departments, through efficient work distribution. It also increases
the status of therapeutic radiographers and the profession within the health care
setting.
76
10.6
The development of advanced practice for radiographers in the United
States
Martino Sal
Academic Division, American Society of Radiologic Technologists, Albuquerque,
New Mexico, United States
Through the cooperative efforts of the American Society of Radiologic Technologists
(ASRT), The American Registry of Radiologic Technologists (ARRT) and The
American College of Radiology (ACR), a physician extender role titled the
"radiologist assistant" has been developed in the United States to provide
radiographers with advanced practice career opportunities and also to enhance
radiology services and patient care. This presentation will outline the roles and
responsibilities of the radiologist assistant as well as the educational and certification
requirements for practice. It will also highlight similarities and differences with
advanced practice roles for radiographers in the United Kingdom and those under
development in other countries.
77
10.7
Radiographer as a member of the trauma team
Lea Lukkarinen, Outi Vento
X-ray department, Helsinki University Hospital, Toolo Hospital, Helsinki, Finland
Toolo Hospital, part of the Helsinki University Hospital, is the biggest trauma hospital
in Scandinavia. Located in Helsinki, the capital city of Finland, the hospital provides
services for a population of 1.4 million people. Imaging in Toolo hospital is totally
digitalized, with both radiological images and references in electronical form. Pictures
are stored in PACS (picture archiving and communication system). The whole
hospital have the access to them whenever needed.
Our presentation covers trauma protocol, which is used in the emergency ward of
Toolo Hospital. The protocol is inteded for the primary care and examination of
trauma patients. The trauma protocol defines the roles and responsibilities of
emergency room personnel. It has clarified the patient care process and also
radiological examinations.
In the emergency room, the attending radiologist performs fast focused assessment
with sonography for trauma and radiographer obtaines anteroposterior (supine) chest
and pelvic radiography.
After the initial examination MSCT (multislice computed tomography) is performed
by the radiogapher according to trauma protocol:
1. Head scan
2. Face scan (when necessary)
3. Cervical spine scan
4. Whole body scan (with I.V. contrast medium)
After the MSCT, the radiographer prepares 2D reformatted images. Use of
reformatted images reduces the need for further radiological examinations. If
necessary, other x-ray images (e.g. limbs) are obtained after the MSCT scan.
The radiographer is responsible for the safety and diagnostic quality of all the above
mentioned radiological examinations. The radiographer, a member of the trauma team,
plays a vital role in providing efficient and safe primary care.
78
10.8
Expertise: Professional growth and the growth of the profession
J.M. Yielder
Unitec New Zealand; NZ Institute of Medical Radiation Technologists, New Zealand
In the current climate of rapid change in medical imaging, it is important to examine
the factors contributing to our development as professionals. This presentation will
examine the nature of professional expertise, including contributing factors such as
career progression, CPD, role development and job satisfaction. It will draw on
research findings from a major study of expertise carried out in New Zealand, and
multiple smaller studies in associated areas, and integrate them to form an
understanding of where medical imaging is currently heading in New Zealand in the
face of change and chronic short staffing. The study on expertise used data gathered
from interviews and critical incident recording from expert medical imaging
practitioners in Auckland, New Zealand, over an extended time frame.
The presentation will highlight what it means to be an expert in medical imaging, and
suggest that we need to look at the "big picture". Of professional development to
enable practitioners to move towards a high level of practice. This includes the need
to develop a career progression with enhanced role responsibilities, supported by
education, to attract and retain an intelligent, competent workforce. It will illustrate
that it is imperative that we invest in research and planning if we wish the profession
to not only develop and be responsive to the demands of the evolving era, but also to
lead medical imaging beyond the fourth dimension.
79
11.1
NSW radiation therapy PDY education program: A review of 2002 and
2003 programs
R. Beldham-Collins (1,2), C.B. Agustin (2)
(1) University of Sydney, Australia;
(2) Westmead Hospital, Department of Radiation Oncology
In 1995 the first Bachelor degree students in Radiation Therapy graduated in the state
of New South Wales (NSW). To compensate for the reduced clinical hours in the
degree program a Professional Development Year (PDY) was added to their training.
Additionally to assist the RT PDY practitioner in the transition from the academic
setting into the busy clinical environment the NSW Radiation Therapy Chief’s group
introduced the NSW state Radiation Therapy Professional Development Year (RT
PDY) educational program. The RT PDY practitioners were invited to attend a oneday program hosted by nine radiation oncology centres in NSW on topics associated
with cancer care at their hospital such as patient care, physics, radiation therapy
techniques, professional issues and communication skills. Based on the program
evaluation performed by the RT PDY practitioners, this article examines the
implementation of the NSW state RT PDY educational program in 2002 and 2003.
The process and impact evaluation results are reviewed with trends and
recommendations discussed. The results clearly showing the RT PDY practitioners
agree to strongly agree with the teaching style (2002 – 75%, 2003 – 87.2%) and
content (2002 – 86.1%, 2003 – 89.4%) featured within the program. Whilst
coordinators do predict the program is meeting its initial objectives long term impact
evaluation of past participants is recommended to ensure the program does assist in
the transition from the academic to clinical setting.
80
11.2
Possibilities for practitioner based research
Marilyn Baird
Department of Medical Imaging and Radiation Sciences, School of Biomedical
Sciences, Victoria, Australia
Increasingly, the broader community is demanding that professional decision making
is defensible in terms of current scientific evidence. Practice must be “evidence
based”. At the same time practitioners are expected to engage in life long learning
and apply a critical perspective to their work. The 4 - year Bachelor of Radiography
and Medical Imaging offered by Monash University takes seriously these expectations.
Graduates from the course are expected to possess knowledge and understanding
about the scientific method and to actively link science with practice.
This paper has two broad aims. Firstly, to inform practitioners about the nature of
scientific research and the relationship between the evidence based paradigm and
research. Secondly, the paper aims to demonstrate how undergraduate students are
prepared to meet these new professional expectations. Through the use of relevant
examples, the paper will describe the key features of scientific research and its rules.
The paper will then demonstrate how the evidence based movement has broadened
the opportunities for practitioner based research. Finally, the paper will describe how
undergraduate students are prepared for modern health care practice through an
examination of the professional development projects completed in the clinical studies
program and the range of research projects undertaken in final year of the course.
81
11.3
Research governance: Current issues for radiographers
R.A. Chesson, S. Mathers
Health Services Research Group, RGU, Dept of Diagnostic Imaging, NHS Grampian,
UK
Research governance has been adopted by educational establishments in the United
Kingdom (UK) in order to ensure that health and social care research is carried out to
high scientific and ethical standards. All health researchers including radiographers
should now be compliant with the legal requirements of the key elements such as the
Data Protection Act, systems to ensure financial integrity and the Health and Safety
Acts.
There are three major reasons why research governance is necessary: i) increasing
numbers of public bodies expect it, as those funding research are required to be
accountable for their financial investments; ii) to manage risk as research misconduct
is reported to be increasing and iii) to safeguard the public, who have the right to
expect high ethical, financial and scientific standards.
It has been claimed that the resultant increase in bureaucracy has meant novice
researchers have been dissuaded from carrying out research by these new
requirements and current researchers are spending more time completing forms than
actually carrying out research. On the other hand a formal structure is in place which
helps to promote more efficient practices, encourages open and honest
communication and high ethical practices.
In this presentation the practical applications of implementing research governance
will be described. It will also be argued that in fact research governance necessitates i)
the improvement in the quality of research; ii) brings about improved training for
novice researchers and iii) protects the researchers from an increasing litigious society.
82
11.4
Implementation of information technology in radiographic education- the
Singapore story
Jin-Hon Chin
Department of Radiography, School of Health Sciences, Nanyang Polytechnic,
Republic of Singapore
In the last 10-15 years, Information Technology has grown by leaps and bounds, and
are playing a significant role in the delivery of Radiographic Education courses.
Multimedia and interactive learning are the buzz words nowadays.
Therefore, radiographic educators must be flexible in adapting their roles from
traditional lecturers to that of "facilitators of learning". It means "going back to
school" for many educators, grappling with educational technology and also adjusting
their mindset to plan and improve innovative methods of imparting and sharing
knowledge and skills in Radiation Medicine. The presentation will describe the
growing use of educational technology, and the efforts of the Radiography academic
staff in the School of Health Sciences, Nanyang Polytechnic, in planning and
implementing information technology in the learning environment.
83
11.5
Patient involvement in radiology research: evidence from a systematic
review
S.A. Mathers (1,2), J.M. Proctor (1,2), G.A. McKenzie (2), R.A. Chesson (1), E.M.
Robertson (2)
(1) HSRG, RGU;
(2) Department of Clinical Radiology, NHS Grampian, Aberdeen, Scotland, U.K.
Background: Health professionals such as surgeons have identified patient based
outcomes for example health related quality of life to measure the effectiveness of
interventions. Annually the number of radiological procedures continues to increase,
and the effectiveness of the interventions is usually based on the clinical outcomes of
the procedure as defined by the clinicians. Patient based outcomes describe the
outcome as defined by the patients. Research has demonstrated these are very
different to the clinicians outcomes. This study sought to establish i) the prevalence of
outcome measures used and ii) establish the use of patient based outcomes in
radiology departments.
Methods and materials: Papers were identified by searching electronic databases such
as Medline, (1990 - 2004). The protocol followed that recommended by the York
NHS Centre for Reviews and Dissemination (UK). A total of 47 key words were used
such as radiology, outcomes, efficacy, and patent satisfaction.
Results: A total of 112 citations described outcome measures in radiology. Further
scrutiny using a data extraction form developed specifically to focus on the research
content and quality of individual papers, identified 24 describing patient related
outcomes. In seven papers patient outcome was the primary focus of the research. A
further four papers focussed on the procedure but subsequently contacted patients to
establish their health status and wellbeing post- procedure.
Conclusions: There is a dearth of outcome measurement in radiology, with little
evidence of patient based research. It is recommended that a culture of outcome
measurement in radiology be developed with attention to the inclusion of patient
based outcomes.
84
11.6
Applied learning to meet required graduate competences
J. McKay, K.C. Ng
Kowloon, Hong Kong
Introduction: Changes and developments in the radiography profession indicate the
need for learning processes to be reviewed such that students develop an applied
understanding of their learning, and can gain the skills necessary to continue
development throughout their career. It is necessary for our education programmes to
ensure that graduating radiographers are relevant within the current professional
context, and that they are prepared and able to manage changing professional
environments and roles. This requires us to concentrate not only on syllabus content,
but also a broader generic development to encourage the attributes required to
embrace career challenges.
The Hong Kong Polytechnic University programme team have put in place teaching
and learning strategies that aim to make students the owners of what they learn, and to
encourage an applied understanding of the theory and knowledge that they manage.
Methods: Subject and teaching quality feedback has been used to assess the degree to
which learning formats meet the required objectives. A survey study using focus
group interviews and questionnaire was recently conducted to determine the attributes
and competences required of a fresh graduate to the profession to enable them to meet
the challenges of their profession.
Conclusion: There is an increase in students' perception that they have met the
objectives of the subjects studied, and they have indicated their preference for the
more challenging learning format. The outcomes from the survey have informed
redevelopment of the undergraduate degree to include profession specific and
associated generic requirements.
85
11.7
Qualitative research design and approaches in radiography
Curtise K.C. Ng, Peter White
Hong Kong
Introduction: Radiography as with other health care professions aims towards
establishing full professional recognition and a recognized research background is
considered an essential component of this. Usually, emphasis is placed on quantitative
research which focuses on the deductive component of the scientific confirmatory
method. However, the inductive and exploratory effect of qualitative research
provides insight to certain topics of which little is known, suggesting that qualitative
research methods also have an important role to play.
Objectives: 1. To identify the main qualitative research traditions; 2. To review these
traditions in terms of their different applications, areas of inquiry, and strengths and
weaknesses according to the nature of the study.
Methods: A comprehensive literature review has been conducted using the CINAHL,
MEDLINE and ScienceDirect databases and the keywords qualitative research,
ethnography, phenomenology, grounded theory, historical research and radiography.
Articles included in the review are those with a focus on qualitative research in health
care disciplines.
Result: Ethnography, phenomenology, grounded theory and historical research
provide opportunities to explore intra- and inter-professional issues, clinical practice,
and patient and health delivery issues in Radiography. Radiographers need to be
proactive in developing research skills and an understanding of qualitative methods
will offer greater scope for individuals to participate in research opportunities.
Conclusion: Quantitative and qualitative studies are equally important in increasing
the professional identity of Radiography. The usefulness of qualitative research should
not be ignored, but rather used appropriately and rigorously when the research
question is best answered using inductive and exploratory measures.
86
11.8
Making the link - image transmission between hospitals and higher
education institutions
Michael Tatlow
Department of Allied Health Professions, London South Bank University, London,
U.K.
Purpose: The acquisition of suitable radiographic images for teaching level has,
historically, always been one of co-operation, and an inherently time consuming
process. This research explores the possibility of employing a web based PACS
systems to select and transmit images from behind a hospital firewall to a PACS
server, sited within the higher education community. It should be noted that this
research will still be on going at the time of the ISRRT conference.
Methods: The project is a joint collaboration between a number of London based
hospital’s Imaging Departments, a medical imaging company and London South Bank
University. Between the various organisations, a theoretical model for image
transmission has been developed, and is currently being trialed.
The model consists of access to a web based PACS environment, and a number of
internet services which are permitted to transmit data through hospital and higher
education institution firewalls by default.
It is intended that the model will provide a mechanism to create a repository of
images for use in the teaching arena, which in turn reflect current imaging techniques
and trends.
Results: The proposed model of image delivery, accompanied by application of the
web based PACS technology will enable the investigation into the migration of
traditional courses, which inherently require the use of high quality images to the
medium of e-learning.
Conclusion: The project is in its early years; however indicators are that the proposed
model will function as expected, as it is using technologies that have been proven in
previous cases.
87
11.9
Through the barricades (Duran Duran, 1982) - e-learning, rich media and
firewalls
Michael Tatlow
Department of Allied Health Professions, London South Bank University, London,
U.K.
The development of the Internet technologies has seen an explosion in its use within
both healthcare and education.
Both of these communities have exploited these technologies to enhance the services
provided to their users, that is, patients and students respectively.
The provision of pre-registration healthcare education requires a combination of
academic and clinical experiences. The clinical component is delivered within a
suitable practice environment.
It is envisaged that with the wider involvement of information and communication
technologies (ICT), that students will receive support and content via this media.
The security requirements for the health and education networks have developed to a
stage where they can exist reasonably comfortably in the wider community of the
Internet.
To maintain the security of the networks, limitations need to be imposed on what
content can be transmitted through the respective network firewalls. The requirements
of the education sector are less restrictive than those of the healthcare providers, but
equally important.
The restrictions on the type of content that is able to be delivered to the learners
desktop presents challenges for those education providers who have embraced the use
of ICT to support learners working in practice placement.
This presentation will explore some of the issues, which are present in the delivery of
e-learning, how these can affect the delivery of the material, and finally what step can
be taken to overcome some of the more fundamental hurdles.
The discussion will be generic in nature, and lessons learnt can be applied to any of
the commercial available learning environments, such as WebCT and Blackboard.
88
12.1
Patient Satisfaction Questionnaire 20 of Radiography
Edward H.T. Chan
Diagnositic Radiology Department, Ruttonjee Hospital, Wanchai, Hong Kong
This study is trying to produce a reliable and detail patient satisfaction survey tools
for the Medical Imaging Department. Traditionally, many departments have their own
patient satisfaction survey questionnaire for their quality assurance. However, their
questionnaires are usually not more than five questions, such as the general attitude,
the tidiness, the waiting time and the temperature. It is good for the routine
monitoring or formality but it cannot tap the detail performance of their staff and
facilities for planning the improvement. In this study, the Chinese version Patient
Satisfaction Questionnaire 20 of Radiography (PSQ-20 Rad) was developed from the
original version of the RAND's Patient Satisfaction Questionnaire short form (PSQ18). RAND Corporation is a nonprofit worldwide research organization providing
objective analysis and effective solutions. They had developed many survey tools for
the medical service such as HIV-PARSE, Epilepsy Surgery Inventory-55, and etc.
According to the original instrument manual, the minor modifications to the wording
of statements are acceptable. The terms of the original PSQ-18 will be modified to
suit assessing the performance of radiographers. The validity of the Chinese version
PSQ-20 Rad will be tested by back translation using an expert of translation and a
research expert panel of the hospital. The reliability was tested by statistical analysis.
300 questionnaires were sent and collected and had the internal consistence testing.
The reliability analysis of the PSQ18 by Cronbach's Alpha was 0.8342. It is greater
than 0.8 which is the rule of thumb of reliability coefficient.
89
12.2
Art of care - what matter most
Lai-Kuan Chan
The Malaysian Society Of Radiographers, Malaysia
Introduction: Science of care and art of care are the most important aspect in medicine.
With advancement in technologies, there is no dispute about the quality in science of
care. With increase quality in science of care, have quality in art of care also increase?
This is the aspect that many patient, radiography educators and also public are having
doubt. With the increase in numbers of litigation on radiological practitioner, it is time
to have a look at the problem that concerns quality of care.
Objective: To study the attitude and things that matter most to the future radiographers.
Material: Questions were asked on things matter most to the final year student when
they take the role of a radiographer and also the role of the patient. The answers
obtained were analyzed.
Result: To be discussed during presentation
Conclusion: Art of care depend mainly on the attitude and how the student look at the
things that matter most to them. To be a good radiographer one has to love the patient.
90
12.3
The challenges - When the patient is not human
Lai-Kuan Chan, Osman Asnawi
The Malaysian Society Of Radiographers, Malaysia
Introduction: Veterinary radiography is another branch of Radiography that is not
commonly practice by the Malaysian Radiographer. At present, there is only one
Malaysian trained radiographer who is doing veterinary radiography. The most
interesting issue is this radiographer was trained to do human radiography but to
practice veterinary radiography. This paper is to share and discuss on the problems,
challenges and his experience in veterinary radiography.
Objective: The main objective is to identify the problems and challenges in Veterinary
Radiography and eventually get the solution in improving quality in veterinary
radiography.
Method: Observation, case study, reference and practical are the various learning
methods use for improving skill.
Result: To be discussed.
Conclusion: Veterinary radiography is totally different from human radiography. The
basic training obtain in a imaging college has benefited the radiographer who has no
training in veterinary radiography to work with animal. The aspects that need more
learning are animal anatomy and positioning techniques.
91
12.4
How to reduce the patient's radiation stress in interventional radiology?
C. David
Interventional Radiology, Ikem, Prague, Czech Republic
The number of interventional radiological procedures is growing every year. The
progress in therapeutic methods and the rapid development of new technologies for
diagnostic and interventional radiology allows to perform greater number of
examinations and more complicated procedures. It was expected, that modern
technologies could decrease the radiation dose of patients, but it showed not to be true.
More and more difficult procedures require perfect quality of the fluoroscopic image
and long term catheterization resulting in prolonged fluoroscopic time. That is the
cause of higher radiation dose for patients and staff members. During some
interventional performances (TIPS, embolisation, renal stenting) measured cumulative
dose was higher than 5 Gy. This dose can result in well known stochastic and
deterministic radiation effects. Even some radiation skin injuries after interventional
procedures were reported in the literature. And that is why we have to try to reduce
the patients radiation dose by all possible ways. The aim of my paper is to show the
main possible measures of the reduction of these patient's radiation doses and
introduce effects of some arrangements for the dose reduction, which was confirmed
by experimental measurements. Results of experimental measurements I shall
demonstrate in my paper, of course. Also, I should like to underline the role of
radiographers on this field.
92
12.5
A review of patient support programs in a clinical oncology department
Ki-Man Ku
Clinical Oncology Department, Pamela Youde Nethersole Eastern Hospital, Hong
Kong
The treatment of cancer is a major life stress followed by a range of physical,
psychosocial and spiritual difficulties. Patient support programs have long been
recognized as an important contribution towards treatment compliance, treatment side
effect coping skills and other informational, emotional benefits. Moreover, it enhances
staff-patient partnership; promote peer group support and continuous improvement of
services through patient survey.
During the last four years, six patient support programs were conducted in our
department. The organizing professionals include clinical oncologists, radiographers,
nurses and social worker. More than twenty staff and eighty patients as well as their
relatives were participated in each program. The programs, which last for two hours,
consist of entertainment performances, ex-patient sharing, peer group support and
filling of the survey questionnaires for feedback and suggestions on the clinical
services.
The following areas were reviewed: 1) the effectiveness, 2) the inter-profession
cohesiveness, 3) the client's satisfaction after joining the program, and 4) the
difficulties and limitations of the program.
Despite the review was moderate-most lack a theoretical framework, detailed program
description and measuring instruments, benefits on the patients psychosocial needs,
the multidisciplinary communication and the continuous clinical services
improvement were identified. Difficulties of conducting patient support programs
include lack of suitable place, department support, scarce resources, and staff's
voluntary participation. The findings will be useful to decision-makers concerned
with psychosocial well being of patients undergoing cancer treatment.
93
12.6
Professional ethics for radiographers
F.I. Peer
Nuclear Medicine Department, Inkosi Albert Luthuli Central Hospital, Durban, South
Africa
Ethics and professionalism are fundamental in providing good radiographic practice.
Health professionals need to develop and maintain an adequate knowledge of key
components of the laws and regulations that affect their patients and practices. The
law does not always establish positive duties, that is, what one should do, to the extent
that professional ethics does. The current understanding of professional ethics is based
on the principles from which positive duties emerge.
Corresponding to the rights and privileges conferred on registered radiographers are
certain ethical obligations. These ethical duties towards patients and society demand
that ethical guidelines be formulated for all health professionals. The ethical
guidelines should formulate the general ethical duties of members of the profession.
It would be impossible to create guidelines that would cover every possible real-life
situation. The health professional would need ethical reasoning to navigate the day-today actions based on professional ethical guidelines.
The aim of this presentation is to provide guidelines for radiographers to address
some of the challenging ethical dilemmas that they are confronted with on a daily
basis so as to improve the quality of care provided to patients.
94
12.7
Waiting lists in radiation oncology, are they predictable?
Greg Rattray
Cancer Care Services, Royal Brisbane and Women, Queensland, Australia
Objective: To develop a model that would provide an accurate prediction of the
impact that alterations in clinical conditions would have on a waiting list for a specific
radiation oncology service.
Method: Historical referral patterns for a five year period were retrospectively
obtained and modeled into an average referral value per calendar month. Data on
current referrals and treatment courses being commenced per month was collected.
This data was used to develop a mathematical model that calculates the impact on the
waiting list that current and altered clinical practices will produce. A computer
program was written using Visual Basic to provide a user friendly interface to the data
model.
Results: The validity of the model has been prospectively tested over a period of 6
months. The model was run from the beginning of March 2004 and matched to actual
monthly values. A comparison of the predicted and actual values demonstrated an
average variation in the number of clinical days delay of less than 5% (= 1.5 days)
and an average variation in the number of patients on the waiting list each month of
less than 5% (= 10 patients).
Conclusion: This model has proven reliable in predicting the waiting list for the
department supplying the initial data. Therefore it can be used with confidence to
predict the impact of altering clinical conditions will have on a waiting list. The
model could be utilized by other departments providing they have the historical data
to enter into the model.
95
12.8
X-ray department infection control measures: Experience from SARS
Hospital
Shirley Yeung
X-ray Department, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong
Kong
The outbreak of SARS in March 2003 caused the Wong Tai Sin Hospital to transform
into the SARS patients Hospital. Faced with the unknown infectious diseases
challenges, our Hospital Chief Executive led the team of staffs to convert the previous
convalescence hospital to a SARS hospital. We adopt a 'reverse Operating Theatre
Concept' as our Infection Control Principle. We prepared a lot of proactive measures
to achieve our SARS mission: staffs have zero infection and patients have no cross
infection. At the heart of our management team, we build up a mutual trust among
staffs across the rank by means of transparent communication with fast and accurate
information sharing. The facility Management team offered their timely support and
latest information technologies to help us to set up the video conference and all
hardware required by the infection control policy. Last but not the least, a whole
hearted commitment from the health care staffs was the key to our successful
implementation of the contingency procedures and environment improvement. We
fulfilled our objective without any staff infected during the 4-months 'SARS Mission'
duty.
96
Part 2
Poster Presentation
97
1US
Investigation of exercise effect and menstruation on bone status
using calcaneal quantitative ultrasound
YM Lai (1), SK Chan (1), WY Chan (1), MK Chow (1), KM Luk (1), VWY Hung (2),
L Qin (2)
(1) Department of Orthopaedics and Traumatology. The Chinese University of Hong
Kong, China; (2) Department of Optometry and Radiography. The Hong Kong
Polytechnic University, China.
Objective: The study investigates the effect of high impact exercise and menstruation
on bone status in young women using calcaneal quantitative ultrasound (QUS).
Methods: Seventy-one Chinese female university students aged 18-23 were recruited
and categorized into four groups: exercise with (n=18) and without (n=10) regular
menstruation; non-exercise with (n=28) and without (n=15) regular menstruation,
Questionnaire was administered to collect data on their medical history,
anthropometric characteristics and calcium intake. Subjects with clinical history or
medications known to affect bone metabolism were excluded. Foot dimensions were
recorded. QUS parameters of both feet [speed of sound (SOS), broadband ultrasound
attenuation (BUA) and stiffness index (SI)] were measured using a calcaneal
ultrasound densitometer.
Results: Anthropometric characteristics, calcium intake and foot dimensions were
matched among the groups. There was no significant difference in QUS parameters
between the dominant and non-dominant foot (p> 0.05). SOS, BUA and SI were 2.4%,
6.1 % and 15.3% significantly higher in exercise group than non-exercise group
irrespective of menstrual regularity (p < 0.05). BUA and SI were 6.9 % and 11.6 %
significantly higher in regular menstruation group than the irregular menstruation
group irrespective of the exercise effect (p<0.05). No interaction effect was found
between menstruation regularity and exercise on QUS parameters (p> 0.05).
Conclusion: Both the effects of exercise and regular menstruation were osteogenic in
terms of bone density and structure as reflected in the QUS parameters. Doing regular
high impact exercise could help women with irregular menstruation to accrue peak
bone mass and optimize bone structure, which may imply its significance in the
retardation of bone loss and reduce osteoporotic fracture.
98
2US
Association of carotid intima-media thickness with mesenteric,
preperitoneal and subcutaneous fat thickness
KH Liu (1), YL Chan (1), JCN Chan (2), WB Chan (2)
(1) Department of Medicine and Therapeutics. The Chinese University of Hong Kong,
The Prince of Wales Hospital, Hong Kong
(2) Department of Diagnostic Radiology and Organ Imaging
Background and Objectives: Sonographic measurement of carotid intima-media
thickness (IMT) is an established surrogate marker for atherosclersosis which was
shown to be associated with obesity. Visceral fat drained by portal vein is believed to
play a critical role in obesity-related complications. The sonographic measurement of
visceral fat thickness, particularly mesenteric fat thickness, was found to a major
explanatory variable for multiple cardiovascular risk factors. Given the intimate
relationships between visceral fat, cardiovascular risk factors and atherosclerosis, we
hypothesize that there are independent relationships between mesenteric fat and
carotid IMT.
Materials and Methods:
Two hundred and eighty-two Chinese subjects (M:129,
F:153; mean BMI: 23.8 kg/m2; age range 20-68 years) were recruited. Maximum
carotid IMT as well as maximum mesenteric, pre-peritoneal and subcutaneous fat
thickness were measured by carotid and abdominal ultrasound examinations
respectively. Blood pressure was measured by sphygmomanometer. Fasting plasma
glucose, insulin concentration and resistance, total cholesterol, high-density
lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides were
assessed by blood taking.
Results: On univariate analysis, both mesenteric and preperitoneal fat thickness were
correlated with carotid IMT, while subcutaneous fat thickness showed no association.
The mesenteric fat thickness showed stronger association with carotid IMT (r=0.35)
than preperitoneal fat thickness (r=0.28). On stepwise multiple regression analysis,
mesenteric fat thickness was an independent determinant of carotid IMT after
adjustment for subcutaneous and preperitoneal fat thickness. Mesenteric fat thickness
remained to be an independent determinant after further adjustments for conventional
cardiovascular risk factors. Age, gender, systolic blood pressure and insulin resistance
were the other independent determinants for carotid IMT.
Conclusion: Mesenteric fat thickness measured on ultrasound showed significant
association with carotid IMT, lending further support to the linking role of portal
adipose tissue in obesity-related atherosclerosis. Measurement of mesenteric fat
thickness may be a useful indicator of regional fat distribution in the assessment of
cardiovascular risks.
99
3US
Comparison of extended field of view and dual image ultrasound
techniques: accuracy and reliability of distance measurements in phantom study
M Ying, MH Sin
Department of Optometry and Radiography, the Hong Kong Polytechnic University,
Hong Kong
Objective: This study was undertaken to investigate and compare the accuracy and
reliability of dual image and extended field of view (EFOV) ultrasound techniques in
distance measurements using acoustic phantoms.
Method: Ten tissue phantoms were constructed and were scanned twice by two
operators with an interval of three days. Measurements of various known distance
(ranging from 4.6 to 7.2 cm) in the phantoms were made with dual image and EFOV
ultrasound.
Results: Results showed that both dual image and EFOV ultrasound have a high
accuracy and reliability in distance measurements, with the EFOV ultrasound (r =
0.997-0.998, reproducibility = 99.8%, repeatability = 98.2-99.8%) being slightly more
accurate and reliable than dual image ultrasound (r = 0.948-0.981, reproducibility =
94.6%, repeatability = 89.6-97.9%).
Conclusion: EFOV ultrasound has a higher accuracy and reliability than dual image
ultrasound in distance measurements. However, the dual image ultrasound is a useful
alternative with a high accuracy and reliability when EFOV ultrasound is not
available.
100
4US
Evaluation of vascular pattern of cervical lymphadenopathy: a
comparison of colour Doppler, power Doppler and 3D power Doppler
sonography
M Ying (1), AT Ahuja (2)
(1) Department of Optometry and Radiography, the Hong Kong Polytechnic University;
of Hong Kong, Prince of Wales Hospital, Hong Kong
Objective: This study was undertaken to compare the performance of colour Doppler,
power Doppler and three-dimensional (3D) power Doppler sonography in the
assessment of vascular pattern and vessel displacement of cervical lymphadenopathy.
Method: Colour Doppler, power Doppler and 3D-power Doppler sonograms of 145
cervical nodes were reviewed (metastases n=60, lymphoma n=30, tuberculosis n=23,
reactive n=25, Kimura disease n=7). Sonograms of the three imaging modes were
reviewed separately with an interval of 2 weeks. Lymph nodes were assessed for the
vascular pattern (hilar, peripheral or mixed) and the presence/absence of displacement
of hilar vascularity. In the assessment of displacement of hilar vascularity, only lymph
nodes which showed hilar or mixed vascularity in the three imaging modes were
included in the analysis.
Results: Results showed that there was a high level of agreement between colour
Doppler and power Doppler sonography in assessment of vascular pattern (k=0.914),
whereas the level of agreement between colour Doppler and 3D-power Doppler
sonography (k=0.484) and between power Doppler and 3D-power Doppler
sonography (k=0.452) were low. There was a high level of agreement in the
assessment of displacement of hilar vascularity among the three imaging modes
(colour Doppler and power Doppler, k=0.942; colour Doppler and 3D-power Doppler,
k=0.808; power Doppler and 3D-power Doppler, k=0.865).
Conclusion: In the assessment of vascular pattern of cervical lymphadenopathy,
colour Doppler and power Doppler sonography have a similar performance and are
useful in the evaluation. However, accurate assessment of the vascular pattern of
cervical nodes may be difficult in 3D-power Doppler sonography. In the assessment
of displacement of hilar vascularity, the performance of colour Doppler, power
Doppler and 3D-power Doppler sonography are similar.
101
5CT
Quantum evaluation of shoulder-joint disease using threedimension CT data
Y. Akiyama (1), M. Ishifuro (1), C. Fujioka (1), T. Yamaguchi (1), N. Abe (1), M.
Kiguchi (1), J. Takaba (1), T. Furukawa (1), Y. Mochiduki (2), K. Marukawa (3), K.
Ito (3)
(1) Radiology, Division of Medical Intelligence and Informatics, Japan
(2) Orthopedics, Division of Medical Intelligence and Informatics, Japan
(3) Radiology, Division of Medical Intelligence and Informatics, Japan
Purpose: To evaluating quantitatively the status of the scapula and glenoid in
shoulder-joint disease using three dimensional CT (3DCT) data, and to understand the
grade of an injury. This is useful in selecting subsequent treatment plan.
Method and Materials: Spiral CT (Light speed QX/I, GE Medical System) of the
shoulder was performed on 180 patients (49 women and 131 men, between 12 and 84
years old) who had rotator cuff injury or a dislocation disease. Reconstruction was
performed with 2.5mm slice thickness and 1.25mm reconstruction increment.
Results: The area of the glenoid in the normal shoulder, in a dislocation case and in a
rotator cuff injury case were an average of 711 sq mm, 611 sq mm and 770 sq mm,
respectively and became smaller in the dislocation case. The distribution of
minetalization of the subchondral bone plate (DMSB) is used as a parameter for the
individual stress distribution of joint. About DMSB in the normal case, the front
portion of glenoid showed high CT value.However, it is at the case which repeats
pitching operation, such as a baseball player, The high value appeared in the back
portion of glenoid. This is related with what is depended on movement of the arm.
Conclusion: Using 3DCT data, we are able to evaluate three-dimensional dissection of
the shoulder quantitatively, and 3DCT offers useful information. With future imageprocessing technology, if fusion technique to other modality such as MR imaging,
more abundant information will be acquired.
102
6CT
Subcutaneous injection contrast media extravasation: 3-D CT
appearance
Kyung-Mo Chung, Dae-Cheol Kweon, Heung-Seon Im, Oh-Sung Kwon, MyeongGoo Kim, Yong-Woo Lee
Diagnostic Radiology, Seoul National University Hospital, Korea
Purpose:
We report case from accidental extravasation of contrast material. Largevolume
extravasation in adult during spiral contrast-enhanced CT.
Materials and Methods:
The contrast material extravasated amount was 47 mL. Patient had swelling of the
dorsum right hand. Extravasation injury site was CT scanning.
Results:
Extavasation case has been performed using five separate display techniques: axial,
multi planar reformation (MPR), maximum intensity projection (MIP), volume
rendering, and shaded-surface display (SSD).
Conclusion:
We introduce extravasatiion with its findings CT and Three-Dimensional Appearance.
103
7CT
Detection of leukoaraiosis by extracranial arterial blood flow
volume
SS Ho (1), WM Lam(1), KS Wong(2)
(1) Department of Diagnostic Radiology and Organ Imaging, Prince of Wales
Hospital, Hong Kong, (2) Department of Medicine and Therapeutics, Prince of Wales
Hospital, Hong Kong
Background and Purpose: Leukoaraiosis is associated with an increased risk of stroke
and cognitive impairment. It is common in both neurologically symptomatic and
asymptomatic elderly. Cerebral hypoperfusion is proposed to be the precursor of
leukoaraiosis. The abnormality is readily detected by computed tomography (CT) and
magnetic resonance imaging (MRI). A simple and non-irradiating technique that can
be used to predict leukoaraiosis is clinically valuable
Methods: The present study investigated total extracranial arterial blood flow volume
as a means of estimating total cerebral blood flow by color velocity imaging
quantification (CVIQ) in 50 stroke patients. The CVIQ findings were then correlated
with CT brains of the patients for evidence of leukoaraiosis which was presented as
hypoattenuated areas in the deep white matters.
Results: Significant difference existed between total extracranial arterial blood flow
volume between patients with and without leukoaraiosis (p = 0.02). A low total
extracranial arterial blood flow volume 600 mL/min was highly predictive of
leukoaraiosis with a positive predictive of 86.7%, a negative predictive value of
85.7%, a sensitivity of 72.2%, a specificity of 93.8% and an overall accuracy of
86.0%.
Conclusions: CVIQ was accurate in predicting leukoaraiosis in stroke patients. The
findings in this study warrants a large prospective study to investigate the application
of CVIQ in "normal" elderly population as a first-line investigation for leukoaraiosis
prior to MRI or CT.
104
8CT
Computed tomography of the thorax for evaluating superior vena
cava obstruction: technical aspects
Tsz Kwan Iu, Wai Kwong Cheng
Diagnostic Radiology, Tuen Mun Hospital, Hong Kong
Obstruction of the superior vena cava (SVC) frequently occurs in a variety of
malignant and benign diseases. Identifying the underlying cause of venous
obstruction and the level of venous blockage are important in the diagnosis and the
treatment of SVC obstruction. Contrast-enhanced computed tomography (CT) is
widely considered to be a reliable technique for defining the cause of SVC obstruction.
This article will review the technical aspects, such as patient preparation/positioning,
acquisition parameters, contrast medium administration and post-processing
techniques, in diagnosing superior vena cava obstruction using CT, with an emphasis
put on discussing about the scanning techniques used in Tuen Mun Hospital of Hong
Kong. Through this review, it is intended to assist CT radiographers performing the
examination, and increase the overall smoothness and efficiency of the examination.
105
9CT
The development of the extravasation detection accessory for preventive
extravasation in the computed tomography
Dae-Cheol Kweon, Seok-Hee Jeong, Heung-Seon Im, Oh-Sung Kwon, Myeong-Goo
Kim, Yong-Woo Lee
Diagnostic Radiology, Seoul National University Hospital, Korea
Purpose: To assess the ability of an extravasation detection accessory (EDA) system
to detect clinically important extravascular injection of iodinated contrast material
delivered with an automated power injector.
Materials and Methods: Thirty six patients referred for contrast material enhanced
body computed tomography studied in a prospective, observation study in which the
EDA system was used to identify and interrupt any injection associated with clinically
important extravasation.
Results: The presence or absence of extravasation was definitively established with
helical CT at the injection site (injection rate, 2.0-2.5 mL/sec). There were two true
positive, extravasation volumes 22-25mL. The EDA system had a sensitivity in the
detection of clinically important extravasation.
Conclusion: The EDA system is safe and accurate in the monitoring of intravenous
injections for extravasation, which may prove especially useful in CT applications.
106
10CT The optimal scan delay time in spiral CT portography of posthepatitic
cirrhosis
Guo-min Liang
The Department of Radiology of Tangdu Hospital,Fourth Military Medical University,
China
To optimize the scan delay time for spiral CT portography (SCTP) by using timedensity curves in normal individuals and posthepatitic cirrhosis patients.
Methods: 20 normal individuals and 18 patients with posthepatitic cirrhosis were
involved in this study. Single-level dynamic CT scanning was performed at the level
of the first hilus, the contrast dose was 1.5mL kg-1, injection speed was 3 mL s-1,
starting scan from 15s to 120s with 5s intervals. CT value of the portal vein and liver
were calculated at identical slice and the time-density curves was drawn.
Results: The average maximal value of the portal vein in normal group and cirrhotic
group were (180.81) Hu, (158.86) Hu.The time of peak enhancement were (53.64)s
and (64.53)s, respectively, the peak time were (64.48)s and (74.86)s, respectively. The
maximal density differences between the portal vein and liver parenchyma (P-L) in
two groups were (89.96)Hu and (72.83)Hu, respectively, and it was observed at
(49.50)s, respectively.
Conclusion: In SCTP, the optimal contrast dose was 1.5mLkg-1, injection speed was 3
mLs-1, In order to demonstration portal vein tributaries clearly, optimal scan delay
time in normal individuals and cirrhotic individuals should be 40s and 50s,
respectively.
107
11CT
CT and CT cardiac imaging
Qi Wu, Ya Nan Wu, Ping Zhan
Radiology Department of Tianjin Medical University General Hospital. P.R. of China
Cardiac Imaging using CT is a demanding technology. Not only is high spatial
resolution required for imaging small structures such as the coronary arteries, but high
temporal resolution must also be achieved for diastole and systole imaging of the
heart.
During the past three decades, since the beginning of the CT used in the 70s, cardiac
imaging by CT is a extravagant wish. With the improvement and development of CT
technology, from third generation CT in the 80s, to slip-ring CT. Spiral CT which
including real-time scanning and sub-milliseconds scanning technology through
multi-detectors rows CT, the velocity of scanning and imaging have increased
tremendously. They were used widely and spread to heart and vessel system. Special
MDCT with the use of ECG-Synchronized techniques, segmentation and tailored
reconstruction algorithms, it not only has made cardiac imaging true, but became a
multi-purpose exams tools of heart detectives.
This paper is a short overview on the history of the developments in CT technology as
it relates to cardiac imaging.
108
12CT Examination technique of brachiocephalic veins and superior vena cava
angiography with spiral CT and low concentration contrast media
Ya-nan Wu, Shan-huai Zuo, Tong Qi, Qi Wu, Tie-lian Yu
Tianjin Medical University General Hospital, China
Purpose: To discuss the diagnostic Value of brachiocephalic veins and superior vena
cava angiography with low concentration contrast media when these vessels were
blocked by some diseases, such as tumors ; To eliminate the disturbance of the artifact
caused by the high concentration of the contrast media in the early phase of the
conventional chest CT scan ; To display the occlusion of brachiocephalic veins and
superior vena cava perfectly whereas conventional contrast CT scan could not do
well ; To improve the image quality and find appropriate scan protocol.
Material and methods: 16 patients in our hospital were evaluated by a spiral CT
scanner (GE Hispeed CT/I), who were suspected as occlusion of superior vena cava
by plain CT scan. First, based on the state of the patient, diluted low concentration
contrast media was chosen to take angiography of brachiocephalic veins and superior
vena cava,which was injected by bilateral or left antecubital vein. Twenty minutes
later , conventional concentration contrast media was injected by any other side ( if
the left side first ,then the other ) in order to get another comparative examination.
Results: Based on the clinical experience, the appropriate concentration of the contrast
media was 45 mgI/100ml. Under this concentration, the brachiocephalic veins and
superior vena cava were display clearly in all of the 16 case (10 of them were injected
by both side, 6 of them by left side), and no disturbance of the artifact . Among these
cases, 6 of them were caused by lung cancer; 7 of them by lymphogenous tumor; 2 of
them by metastatic tumor; 1 of them by thymoma.
Conclusion: This technique is brief and convenient. No similar study has been
conducted in my country. By using low concentration contrast media, the disturbance
of the artifect caused by high concentration contrast media in the brachiocephalic
veins and superior vena cava was reduced obviously. These vessels were displayed
better than concentration contrast CT scan. Combining the both technique, we could
display the main lesions and the brachiocephalic veins and superior vena cava in one
examination. It provided us some useful informations for guiding the diagnose and
therapy of some congenital variations and tumors, espically for making theraputic and
operative decisions.
109
13CT
Technique study of CT perfusion imaging of liver
Shanhuai Zuo, Tong Qi
Tianjin Medical University Genenral hospital, China
Objective: The aim was to explore an optimal CT scanning sequence,the calculation
method of perfusion parameters and the technique of image reconstraction for CT
perfusion imaging of liver,hoping for a reliable examination method that suits for
Chinese people. Hence, the technique could be widely applied clinically.
Materials and Methods:Perfusion CT was performed in twenty patients without any
obvious hepatic disorders and malignant tumors after clinical confirmation. After
plain CT scanning of the whole liver,a single slice through the portal hepatis was
repeatedly scanned for 45s during a single breath-holding after 7s~9s of intravenous
bolus injection of 40ml~50ml nonionic contrast media at a rate of 4 ml/s~5ml/s. Five
perfusion parameters such as HAP, PVP, TLP, HPI, PPI were obtained with maximum
slope method,every perfusion parameter was calculated by non-correction and
correction calculation method respectively, then the difference was compared between
two calculation methods.four images such as HAP,PVP,HPI,PPI were reconstracted
with modified-deconvolution method,perfusion parameters were measured at the
corresponding images respectively,the results were compared with the maximum
slope method.
Results:Only PVP had not obvious difference between the two calculation methods.
normal parenchyma appeared as intermediate perfusion at the HAP image ,and as high
perfusion at the PVP image,the appearance of which at the HPI image,and the PPI
image were similar to that at the HAP image and the PVP image respectively.HAP
and PVP measured at the reconstracted images,TLP,HPI and PPI calculated by
HAP,PVP ,the resultes had not obvious difference compared with that of maximum
slope method.
Conclusions:First,the methods is a optimal and practical scanning method of CT
perfusion,by which the process of hemodynamic change of tissue and structure can be
aproximately reflected. Second,the perfusion parameters calculated by correction
method is near to the physiologic state. Third,the perfusion images reconstructed by
modefied-deconvolution method can directly display the pefusion character of blood
flow of normal liver. This method is a simple and practical. CT pefusion image
reconstraction method is worth for further clinical application and widely spread.
110
14RT
Moving radiation therapy into the 21st Century on the strength of
technology: A retrospective study of technology’s dynamic effect on organization
and process
Sharon Allman
BC Cancer Agency, Vancouver, Canada
This study is the first of a two part presentation that reveals the positive impact of
acquiring new technology (hardware and software) on process. The study spans
almost 10 years, providing acknowledged data that supports the acquisition of this
new technology.
the solution.
This presentation will focus on the changes to process, incorporating both technology
and new tools. Critical path steps will be discussed, including the introduction of new
roles and structure. Acquiring the new technology in itself presented challenges that
led to innovative solutions, e.g. interfacing Varis with Elekta treatment units. One of
the main consequences of the new technology was a dramatic reduction in the waiting
times for radiation therapy treatment and the ability to schedule the treatment units
according to actual requirements.
As the new technology was introduced, it allowed the BCCA re-evaluate and refine its
business, resulting in its ability to position the radiation therapy program to respond to
changes in strategic direction in 2005.
111
15RT
East meets west: A comparison of the provision and use of
complementary medicine in the oncology centres of England & Wales and cancer
patients in Hong Kong
P.N. Brown
Cardiff University, United Kingdom
Objectives: To compare provision and utilisation of Complementary Medicine (CM)
within oncology centres in England & Wales against that of cancer patients in Hong
Kong, based on findings from the author’s PhD study and related to a BSc project
undertaken in Hong Kong by Cheung Sai Man.
Methods: In England and Wales postal questionnaires and semi-structured interviews
with health professional groups administering therapies. In Hong Kong, Cheung
distributed self-administered questionnaires to cancer patients, identifying usage rates/
types and perceptions towards CM.
Results: In England & Wales 41/56 oncology centers (73%) utilize therapies ranging
from aromatherapy (32, (78%)), relaxation/visualization (26, (63%)), to acupuncture
(11,(27%)), and shiatsu/ acupressure (5,(12%)). 31 (76%) use CM to relieve
stress/anxiety/tension and/or improve general well being. 17 (41%) use it for pain
relief/ control. Nurses are main providers (51% (21) centers). Of centers not offering
CM, nine considered its usage but had not implemented it, six citing financial
resources, three that medical staff were opposed. In Hong Kong of 108 patients
((54%), n=200) using CM, Chinese Herbal Medicine (93 (86%)) was the most popular,
Chi Gong (15(10%)) and acupuncture (8 (7.4%)). 66% of users believed CM would
boost their immune system, 48% that it could relieve side-effects of conventional
treatment. 67.5% (135) felt oncology departments should provide CM.
Conclusion: CM is being increasingly utilized and provided in oncology centers in
England and Wales whilst cancer patients in Hong Kong want it to be provided in
oncology centers alongside conventional cancer treatment
112
16RT
The patient selection criteria for receiving SRT & 3DCRT in
boosting NPC recurrence using the treatment parameters of SRT, physical
characteristics of the PTV and maximum target dose to OARs distances
Tak-shun Choi, White Peter, Micheal Lee
Hong Kong
Objectives: With an acceptable level of critical structure sparing, the author undertook
a study aimed to find out (I) correlation between the dose conformity/homogeneity
and treatment parameters of SRT (the number of isocentres and total arc angles used).
(ii) correlation between the dose conformity/homogeneity and physical characteristics
of the target volume (dimensions, positions and shape of target volume) in SRT and
3DCRT. (iii) the maximum dose to the target volume and minimum distances between
the target volume and OARs in SRT and 3DCRT. The result of such studies can be
used to decide whether SRT or 3DCRT is better for the patient.
Methods: 23 patients with residual or recurrent NPC were studied. A conformity index
and homogeneity index were used to compare dose conformity and homogeneity
respectively. The relationships between the treatment parameters of SRT (number of
isocentres used and total arc angles)/physical characteristics of the target volume (size,
shape, maximum dimensions in X, Y and Z-axis and relative position of target volume)
and dose conformity/homogeneity were studied.
Results: In SRT, dose conformity is correlated with the number of isocentres,
dimensions and size of target volume (p<0.05). Dose homogeneity is correlated with
the number of isocentres, total arc angles and size of target volume (p<0.05). For
3DCRT, dose conformity and homogeneity are correlated with size and dimensions of
target volume (p<0.05). There is no significant relationship between shape of PTV
and dose conformity/homogeneity for both SRT and 3DCRT (p>0.05). The closer the
distance between the PTV and OARs in 3DCRT, the higher the maximum dose
received by OARs (p<0.05), but the same did not definitely apply to SRT.
Conclusions: Selection criteria are established to identify the better technique. They
are the number of isocentres, total arc angles required to give an acceptable plan in
SRT and anterior-posterior (AP) dimensions of target volume. By using a larger
number of isocentres or a large amount of total angles, the worse the dose
homogeneity of PTV will be in SRT in relation to 3DCRT. The greater the dimension
of PTV in the AP direction, the better the conformity of PTV in SRT than in 3DCRT.
113
17RT A survey on the preference for Internet-based cancer information by
cancer patients and their relatives in Hong Kong
C.W.Y.Chung, M.Y.Y.Law, M.S.H.Chiu, L.W.M.Lee, B.T.Y Sung.
The Hong Kong Polytechnic University, Hong Kong
Objectives: To evaluate the preference of cancer patients and relatives on Internetbased information and to identify the benefits obtained.
Methods: From January to March 2004, cancer patients and relatives were recruited as
subjects in two Hong Kong oncology departments. Two sources of information, the
Cancer Resource Centre (CRC) and the Internet, were introduced to the subjects. The
Hong Kong Cancer Fund (HKCF) website was adopted as the unique Internet source
in this project. A questionnaire surveying the preference on information sources was
given to subjects. Data collection and statistical analysis were performed.
Results: 105 questionnaires were given to subjects and a total of 99 were available for
analysis. The response rate was 94.29%. Sixty-six subjects were cancer patients (67%)
and 33 were relatives (33%). Thirteen (72%) out of 18 subjects regarded the Internet
as a better information source than the CRC. Overall, subjects were satisfied with the
two sources. Subjects were benefited from Internet-based information in knowledge
and emotional support. Statistically significant differences (p<0.05) existed between
education level and age with Internet preference. No statistically significant
differences (p>0.05) were found between gender and subject status (I.e. patients vs
relatives) with Internet preference.
Conclusion: A substantial number of subjects preferred accessing the Internet to
obtain cancer information. Young population with a high education level was more
likely to use the Internet as a cancer information source. The benefits obtained in
knowledge and emotional support further consolidated the supporting role of Internetbased information in cancer treatment.
114
18RT
Deflection of clinical proton beams
Ohtani Hiroki (1), Kitamura Shouichi (1), Izumi Ogura (1), Fukushi Masahiro (1),
Hiraoka Takeshi (2)
(1)Tokyo Metropolitan University of Health Sciences,
(2)National Institute of Radiological Sciences, Japan
Objectives:
An edge effect will be a field of 70 MeV proton beam by a scatter from a collimator,
and it has an influence on a lateral dose distribution. A deflection of a proton and a
secondary charged particle was tried, the spread by the straggling was restrained and
it was made some help for improvement of a dose distribution by adding a magnetic
field to the beam in this study.
Methods:
Ionization chamber and a diode dosimeter were installed in each depth of the water
phantom side. Lorentz force was occurred to each direction using a regular magnet
simultaneously with irradiation of 70 MeV proton beam, and a deflection of a charged
particle was performed and the dose by each depth was measured.
Result:
The decrement of the dose was high to give a magnetic field at the water phantom
surface and 1 cm depth. And the measure became big relatively from 1 cm depth to 5
cm depth around the range, but the decrement was low value.
Conclusion:
For the magnetic field in the water phantom, it was confirmed that the direction where
Lorentz force functions is decided and is different in the direction where a proton and
an electron deflect. A possibility that a secondary electron spins and loses range was
indicated by the strength of the magnetic field, and a dose decline was admitted.
115
19RT Radiation oncology department integration into stanford cancer center
Diana Ho
Stanford University Medical Center, United States
Stanford University new $147 million outpatient Cancer Center opened on March 1,
2004. The 165,000- square- foot facility is more than double the space Stanford had
previously dedicated to outpatient cancer services in the hospital. There are 47
faculty offices in the center for oncologist to be near one another as they work in
teams to treat the patients.
Radiation Therapy treatment and procedures rooms, Physics, Physician and
Administrative offices occupied the entire 50,000 square- foot ground floor. There
are seven linear accelerator and four simulator vaults. One of the simulator vaults is
shielding for High Dose Rate Brachytherapy.
The goal of the Radiation Oncology Department is to move its entire operation into
the Cancer Center over a weekend without service interruptions and operate at a
single site. To achieve this goal, three new linear accelerators, an Acuity simulator
and a PET/CT scanner were purchased.
The Radiation Oncology Department ceased its operation on Friday, Feb. 27, 2004
and continued its operation in the Cancer Center on Monday, March 1, 2004 without
any service interruptions. In addition, the department also migrated from film to
digital over the same weekend.
This presentation will focus on the planning and execution of equipment acquisition
and installation; information technology network infrastructure challenges: network
connectivity testing for radiation therapy treatment planning systems and treatment
delivery along with the physicians, staff and existing equipment move plan.
116
20RT A dosimetric evaluation of conventional and conformal radiotherapy for
oesophageal cancer
Po-Ming Kwok
Department of Clinical Oncology, Hong Kong
For a long time, oesophageal tumours have been treated by conventional twodimensional radiotherapy (2DRT). However, 2DRT calculation algorithm has
inherent deficiencies and accuracy of target localisation is limited. Although, threedimensional conformal radiotherapy (3DCRT) is desirable, more resources are needed
to implement 3DCRT. If it is not superior in dosimetry, the rationale for it to replace
2DRT is questionable. The objective of the study is to evaluate the dosimetric
advantages and disadvantages of 2DRT treatment plan and 3DCRT treatment plan in
treating oesophageal cancer.
Thirteen patients with oesophageal cancer were accrued retrospectively (1998-1999)
to the study to carry out dosimetric evaluation between 2DRT and 3DCRT. For each
patient, a two-phase 2DRT plan was retrospectively created to carry out dosimetric
comparison with a two-phase 3DCRT plan, which the patient was treated with 3DCRT
and 2DRT computer planning were carried out with standardised criteria for
dosimetric comparison.
The effectiveness of each plan was assessed using DVH. On average, the dose
delivered to 90% of the PTV in 3DCRT plan was 30.0% higher than that in 2DRT
plan; however, dose to the lung was similar in both treatment approaches. Also, in
3DCRT plan, the mean spinal cord dose and mean heart dose were 16.7% and 10.3%
less respectively.
In conclusion, the data collected demonstrates that 3DCRT plans have promising
dosimetric advantages over 2DRT plans for treating oesophageal cancer. Moreover,
escalation of phase II prescribed dose from 30Gy to 38Gy is suggested (I.e. total dose
of 68Gy) in 3DCRT plans.
117
21RT
Risk assessment of radiation-induced malignancies based on the
scatter dose estimates for IMRT treatment in the head and neck region
HY Lee, NS Chong, CL Liao, PW Shueng
Department of Radiation Oncology, Far Eastern Memorial Hospital, Taiwan
Objectives: With advances in therapeutic technology and the use of combined
treatment modalities, the survival time of cancer patients has been extended to many
years. Intensity modulated radiation therapy (IMRT) techniques deliver more than in
monitor units with respect to conventional treatment technique to give equivalent
target dose. The potential risks of radiation-induced second malignancies will increase
and the cost-benefit may need to be re-evaluated.
Methods: A conventional technique using parallel opposed treatment fields has been
compared with IMRT technique. Both techniques were used to treat head and neck
lesions with 6-MV photon beam. Thermoluminescence dosimeters (TLD) have been
applied to measure the scatter dose for each treatment technique. The nominal
probability coefficient for lifetime risk of excess fatal cancer, recommended by the
ICRP 60 has been used for risk estimates based on the measured scatter dose.
Results and Conclusion: The estimated risks of secondary cancers increased from
3.46% for conventional technique to 3.91% for IMRT technique for one phantom case
in this elementary study.
118
22RT
The influence of CT scan & reconstruction parameters on 3-D
treatment planning system
Wen-jie Lee, Cheng-guang Lin, Li-xin Chen
Cancer Center , Sun Yat-Sen University, China
Objective: To evaluate the influence of CT scan & reconstruction parameters on the
accuracy of image reconstruction in 3-D treatment planning system (TPS). Methods:
The standard calibration phantom with lead markers was scanned by Siemens
Somatom Plus 4 CT simulator under different CT scan & reconstruction parameters.
The acquired images were registrated by ADAC pinnacle3 TPS, and the reconstructed
phantom by TPS was then compared with real phantom. The Catphan phantom
No.412 was also scanned to measure the full width half maximum (FWHM) of CT
Slice Sensitive Profile (SSP) for each CT scan. The influence of FWHM variation of
CT SSP on the accuracy of image reconstruction in 3-D TPS was thus investigated.
Results: The variation of CT scan & reconstruction parameters has little effect on
image reconstruction in both anterior-posterior and right-left directions. However, it
can affect the accuracy of image reconstruction in superior-inferior direction (i.e.,
along the axis that CT scan indexing). Further study demonstrates that CT scan slice
thickness and reconstruction method may affect the FWHM of CT SSP, which in turn
can impact on the accuracy of axial image reconstruction. Conclusion: The geometric
error of axial image reconstruction increases with the increase of CT scan slice
thickness, due to CT partial volume effect. Large helical Pitch and wide
reconstruction mode are subject to partial volume effect, resulting from the increase of
scan slice thickness. Also, partial volume effect can worsen the resolution of digitally
reconstructed radiograph (DRR) in 3-D TPS.
119
23RT
A highly conformal universal treatment planning technique
template developed to solve challenges in the treatment of thoracic and
gastroesophagueal junction oesophagus cancers.
S Leung, F Cheung, R Wong, J Price
University of Toronto, Ontario, Canada
Objectives: Using a universal treatment technique template to solve challenges on
treatment planning of Thoracic and Gastroesophageal Junction Oesophagus cancers,
thus increasing efficiency of the planning process.
Methods: Patient was CT scanned in supine position with both arms up above head in
chest board; no additional immobilization devices were necessary. Preliminary
isocentre was selected and tattooed according to the anatomical location of tumour.
Isocentre must locate at mid-separation of patient. Radiation Oncologist delineated
GTV and CTV. Radiation Therapist added margins of 0.5-1.0cm circumferentially and
1.5cm sup/inf as PTV.
The highly conformal template consisted of 6 coplanar fields. AP/PA fields were
weighted each at 34%. 4 oblique fields (75? 105? 255? And 285? Were weighted each
at 8%. Two of these oblique fields must completely spare spinal cord and occasionally
a PA segment field weight 10% was added to ensure PTV was covered adequately.
Results: 25 patients were treated using this template with TAD @ 54Gy in 30Rx, 16
thoracic esophagus and 9 Gastroesophageal junction tumours. The mean tumor length
was 5.9cm. The mean GTV volume was 71cc, CTV 345cc. The CTV coverage was
95%. The mean cord dose was 35.70Gy. The V20 for the right and left lungs were
9.91% and 12.05% respectively, V45 for heart was 11.0% and V35 for liver was
10.4%.
Conclusion: This planning template increased efficiency within the planning
department while also providing adequate coverage of the clinical target volume with
favourable DVH. Favourable normal tissue profiles provide a potential for dose
escalation while limiting toxicity.
120
24RT
Whole face electron beam therapy using custom-made lens block
for angiosarcoma
Chiao-Ling Liao, Ngot Swan Chong, Hsing-Yi Lee, Hui-Ju Tien, Pei-Wei Shueng
Department of Radiation Oncology, Far Eastern Memorial Hospital, Taiwan
Objectives: The purpose of this study is to analyze the dose distribution and the
transmission of the custom-made lens block. The custom-made lens block was used to
protect the lens of the eye when treating the whole face with electron beam and also
provide a uniform dose to the eyelid.
Methods: Custom-made lens block (1.5 cm x 1 cm x 2 mm lead) were placed on 10
cm solid phantom and irradiated with 6 MeV electrons. TLD and Kodak EDR-2 Film
were used to measure the transmission through the blocks. A 0.3 cm bolus was used to
simulate the thickness of the eyelid and a 0.5 cm bolus to cover the eyelid to provide
build-up during treatment. The measurements were repeated with custom-made
waxed block (1.5 cm x 1 cm x 2 mm lead) and custom-made square block (1 cm x 1
cm x 2 mm lead).
Results: Transmission of a 0.5 cm bolus through the lens block, waxed block and
square block were found to be 2.0%, 3.3% and 4.2% on the cornea. At inner surface
of the eyelid the dose were126.7%, 125.7% and 125.7%. The dose to outer surface of
the eyelid were 107.4%, 103.2% and 103.2%.
Conclusion: The dose under the custom-made lens block is attenuated by 95%. The
surface dose of the eyelid is 90% of the prescription dose after covering with a 0.5 cm
bolus. Using custom-made lens block can thus successfully protect the lens and allow
adequate radiation dose to the eyelid.
121
25RT
Analysis of accuracy and reproducibility in conformal
radiotherapy of NPC
Cheng-guang Lin, Da-yi Xiao, Zhen-yu Qi, Yu-qi Wu
Cancer Center , Sun Yat-Sen University, China
Objective: To compare and analyze the positioning error between treatment planning
and patient setup during the conformal radiotherapy for patients with nasopharyngeal
carcinoma (NPC), in order to provide a protocol for clinical treatment planning.
Methods: A total of 35 patients with NPC treated using conformal radiotherapy
techniques in our center were sampled to take simulation films. Verification films
were also taken for each NPC patient prior to the treatment. One patient was selected
to take verification films before and after the treatment during the whole period of
conformal radiotherapy. The verification film was then overlapped on the associated
simulation film by aligning anatomical landmarks. The absolute distance discrepancy
of associated reference points shifted between simulation film and verification film
was used to access the magnitude of the positioning error.
Results: The average positioning error of two lateral irregular fields for 35 NPC
patients is 0.88+1.44mm. No obvious statistical variance has been found for the
positioning error compared among different fields, various reference points and
different treatment phases (p>0.05).
Conclusion: A margin of 3mm is sufficient to compensate for the positioning error
between the treatment planning and the treatment delivery. Better immobilization and
repeated verification help improve the accuracy of patient setup. A variety of
verification such as simulation verification and treatment verification should be
widely used as a QA standard, so as to correct the error of patient setup.
122
26RT
The use of an ABC device for Ca left breast radiation treatment in
the Tuen Mun Hospital, HKSAR
Thomas Siu Ming Wong
Department of Clinical Oncology, Tsing Chung Koon Road, Tuen Mun, New
Territories, Hong Kong
Radiation treatment of cancers has been getting more precise and adaptive with
better tumour imaging, state- of- the- art treatment and portal imaging technologies,
sophisticated yet user- friendly computer planning system, more reproducible patient
immobilization and treatment setup devices and highly reliable information- based
cross- checking systems.
Determining, confining and adapting treatment setup variability has been a key
success criterion in radiation treatment delivery. While external immobilization helps
diminish the uncertainty level of treatment set-ups with reference to some external
references, it does not sufficiently restrain the possible variability due to internal
organ or tumour movement. The usual traditional method to overcome this is to use a
larger margin to account for the possible movement range. However, it may lead to a
substantial but seemingly inevitable increase of treatment volume, resulting in an
increase of unwanted side effects.
ABC, an abbreviated name for Active Breathing Control, has become an effective
tool to achieve the objective of containing the movement of internal organs or
tumours that are substantially affected by the normal breathing cycle. The device
helps patients to hold at a pre- determined breathing phase for a short period of time
so that tumours and organs nearby are more stable in their respective position during
radiation treatment.
The Tuen Mun Hospital has recently commissioned the use of an ABC device on a
patient with cancer of the Left Breast complicated with proven cardiac problem. A
case study was done to help determine whether the use of ABC could have a benefit in
her case.
123
27RT
Influence of vacuum bag on direct measurement of depth for
isocentric posterior oblique field
Jian-hua Wu, Yun-Fei Xia, Hua-Man Zhang, Qing Liu, Xing-Zhao Lian
Cancer Center, Sun Yat-Sen University, China
Objective: In order to improve quality assurance (QA) and quality control (QC) of
radiotherapy, individualized vaccum bag is used in the localization of radiation
treatment, gradually becoming one of the important steps for the QA and QC in the
many departments of radiation oncology. It is of controversy that localization with
vaccum bag under the simulator influences in the patients with thoracic and
abdominal tumors the precision of direct measurement for tumor depth in the
isocentral posterior oblique field. This study is designed to explore influence of
vacuum bag on the direct measurement
Methods: Twenty-nine patients with thoracic and abdominal carcinoma who had to
need isocentric irradiation in the supine position were immobilized using vacuum bag.
The irradiation depths of 45 posterior oblique fields were determined by CT-simulator
and regular simulator, respectively; then the absolute value for the difference of both
depths was regarded as error value.
Results: There were 37 fields (82.2 %) with error value of smaller than 5 mm ; 8
fields (17.8 %),more than 5 mm. In the latter, 5 field were belonged to be repositioned
in the phase II of radiotherapy because of light leaking air into the vacuum bag in the
phase II of radiotherapy. Conclusion: Vacuum bag has a slight influence on direct
measurement for depths of isocentric posterior oblique field.
124
28RT
Optimization of the CTV-PTV margin with reference to parotid
gland dose for intensity-modulated radiation therapy in nasopharyngeal
carcinoma
Vincent W.C. Wu, Marco, C.H. Yau, Winky W.K. Fung, Taki M.C. Lee, Grace C.K. Ng
Hong Kong Polytechnic University, Hong Kong
Introduction: Intensity-modulated radiation therapy (IMRT) provides better tumor
coverage and reduction of normal tissue complications. In IMRT of nasopharyngeal
carcinoma (NPC), a standard specification of clinical-planning target volume (CTVPTV) margin is currently not available.
Objective: By quantifying the effects of the positioning margin on parotid and CTV
doses in IMRT of NPC, this study determined the optimum CTV-PTV margin that
would provide adequate consideration of setup errors while minimizing the parotid
gland dose.
Methods: The computed tomographic data of 9 NPC patients with parapharyngeal
space involvement were collected. Margins of 0, 3, 6, 9 mm were added to each CTV
to give four PTVs for IMRT planning. The effects of added margin on the mean dose
and normal tissue complication probability of ispilateral parotid gland and the tumor
control probability of the CTV were recorded. The optimum margin was determined
based on the criterion that it should provide maximum sparing of the parotid glands
without jeopardizing the tumor control.
Results: 1 mm increase in the margin led to approximately 1.23 Gy increase in the
mean ispilateral parotid dose and approximately 2.37 % increase in NTCP. However,
there was no effect of increasing margin on the CTV dose parameters. The optimum
CTV-PTV margin was 3 mm.
Conclusion: The impact of increasing CTV-PTV margin on parotid and CTV doses
was demonstrated and 3 mm margin was selected as the optimum margin. The results
serve as a reference for oncologists during IMRT planning of NPC in future.
125
29RT
Evaluation of dose conformity in intensity-modulated and 3dimensional conformal radiotherapy
Vincent W.C.Wu, Dora L.W. Kwong, Jonathan S.T. Sham
Hong Kong Polytechnic University, Hong Kong
Introduction
Dose conformity to the planning target volume is an important criterion in
radiotherapy treatment planning, for which the conformity index (CI) is a useful
assessment tool. The purpose of this study is to compare the differences in CI for the
treatment planning of four cancers including the nasopharynx, oesophagus, lung and
prostate.
Material and Methods
Seventy patients with cancers of nasopharynx (30), oesophagus (15), lung (15) and
prostate (10) were recruited. Each of these patients was planned with three sets of
treatment plans using the FOCUS treatment planning system: the forward and inverse
3DCRT plans and the IMRT plan. The CI was generated for each treatment plan. The
mean CI from each cancer patient group was calculated and compared with the other
three cancer groups. The mean value of CI was also compared among the three
planning methods.
Results
The oesophageal and lung cancers demonstrated relatively higher overall mean CI
values (0.64 and 0.62 respectively), whereas that of the nasophaynx and prostate were
lower (0.54 and 0.50 respectively). With regards to the planning method groups, the
IMRT plans produced the highest overall mean CI (0.62), while those for the forward
and inverse 3DCRT were similar (0.57 and 0.55 respectively).
Conclusion
For the four selected cancers, oesophageal and lung cancers were easier to conform
than the nasopharyngeal and prostate cancers. The IMRT plans were more effective in
achieving better dose conformity than that of the 3DCRT.
126
30QA
Quality assurance of medical utilised X-ray units in Germany
Susanne Huber
University Hospital of Munich, Germany
Objectives: within to the radiation protection of patients during x-ray exposition it is
obligatory to test the X-ray units regularly. In Germany the way to perform both the
acceptance and constancy tests, is described in the official catalogue DIN 6868. The
different X-ray modalities have to be tested in different ways.
Methods: after the acceptance test, done once by the x-ray unit producer, constancy
tests are done monthly. The testing equipment consists of a dosemeter, different test
phantoms with integrated structures to evaluate contrast and spatial resolution and a
densitometer. The testing parameters are dose, film(or luminance)-density, field of
useful beam, high/low contrast, spatial resolution and artefacts. After the exposition
the measurement values are evaluated and documented in a special form. If a
measured value is out of the defined range, the X-ray unit has to be repaired.
Results: these quality assurance tests have to be done in Germany since 1987, which
then was added to the German "X-ray regulation" (Roentgenverordnung). Since that
time the different ways to perform the tests had to be updated to stay abreast of
changes of the X-ray units. Once a year the results of the constancy tests are
controlled by the authorities, to find out if all the X-ray units are working within the
defined ranges.
Conclusion: performing constancy tests is a very good and helpful instrument.
127
31QA
DAP standard for DR and CR
YM Poon, SK Yu, TH Wong
Diagnostic Radiology Department, Tuen Mun Hospital, Hong Kong
Objectives: Diagnostic x-ray examinations are routinely performed and they are one
of the largest sources of man-made radiation for the population. The diagnostic value
of a properly conducted examination should more than outweigh the small risk to the
patient of developing cancer in later life, or of some ill-health effect being manifested
in his/her descendants as a result of the radiation he/she received. Traditionally, the
risk assessment is relied solely on some survey data from other country and it can be
affected by variations from both equipments (I.e. film/screen combination, machine
performance, etc.) and radiographic techniques. Therefore, a formal assessment of the
patient dose from diagnostic radiological examinations in local hospital is needed.
Methods: Dose Area Product (DAP) of patients undertaking Postero-Anterior (PA)
Chest using Computed Radiography (CR) or Digital Radiography (DR) is recorded
within a period of one month. The population of readings from both modalities is
around 200 and 100. Data are then analyzed for result
Result and conclusion: There are no statistical significance (Unpaired 2 tailed t-test, P
> 0.05) between the DAP results of (1) female and male; (2) DR and CR. However,
the male estimated whole body dose is larger than female by ~14% for CR and ~20%
for DR. A large variation of absorbed dose between patients is also observed (from ~3
times to ~7 times between the max. and min.).
128
32QA An experimental study on compensation of density for region with great
difference between thickness in digital radiography
Soon Yong Son, Won Hong Lee, Yong Moon Lee
Asan Medical Center, Korea
Objectives:
This experimental study is to improve the diagnostic value by
compensating density of region with great difference between patient's thickness in
digital radiography such as the defecography.
Material and Methods: We made difference of thickness with polyethylene
phantom(7cm) and acrylic step-wedge phantom for a similar situation of the
defecography. After regulating collimator(fixation with 28 x 28cm), We centered the
detector of dosimeter. And then we measured the dose to 2cm migrations the area of
phantom. To acquire the same dose, we exposed radiation with changing thickness of
compensatory filters(Cu, Al).
Results: On the basis of area exposed radiation(100%), the dose (1.1, 2.9, 14.9, 22.6,
32.0, 40.0, 48.0%) was decreased in proportion to migrating area of phantom(7.1,
14.3, 21.4, 28.6, 35.7, 42.9, 50.0%). In the test with compensatory filters(Cu, Al), the
dose to decrease of area with 28.6% was obtained similarly by using 2mm Cu. The
dose in decrease of area from 35.7 to 50.0% was obtained similarly by using 1mm,
2mm, and 4mm Al additionally on the 2mm Cu , respectively.
Conclusion: The compensatory filters are required, because dose and density are
changed according to change of radiographic region with great difference between
patient's thickness in digital radiography such as the defecography. Therefore, the
thickness of compensatory filter should be used differently according to change of
radiographic region and patient's thickness.
129
33QA
Can PACS make clinical physicians happy? An outpatient department
model
TH Wong, KK Leung
2003 is the first year where the sales of digital cameras for consumers exceeded
analogue film-based camera sales world-wide. Picture Archival and Communication
System (PACS) is no exception. The question is how to be efficient and effective in its
implementation, so that all the parties involved are happy.
From mid-2001, Diagnostic Radiology Department of Tuen Mun Hospital started a
Mini PACS in an outpatient department setting. The main customers of our PACS
internally are the orthopedics physicians. The workflow modification provokes a
series of changes applied specifically for this group of users. They include display of
digital images through the monitors with particular hanging protocol, prefetching of
historical images from archive, dedicated electronic folders for orthopedic patients,
filmless environment with paper printing, pixel matching for measurement; to name
but a few. Other areas that are workout include maintaining the speed of images put
on show, reliability of the workstations, login security and train the trainers etc.
It must be admitted that PACS implementation is always a continuous process. And
the key of success rely on the ease of adaptation and a proof of enhancing the
competence of the users.
130
34PI
Exploring individual and organisational factors that may influence
radiation therapists' participation in career management strategies
Caroline Davey
Princess Margaret Hospital, University Health Network, Toronto, Ontario Canada
Body of Background: Staff recruitment, retention and development are crucial
priorities due to healthcare professional shortage and rapid technological changes.
Human resource literature advocates the use of career management and staff
development systems for expanding employee's skills and improving their career
motivation and commitment. Data suggests that there is a link between career
motivation, skill expansion and career management strategies such as continuing
education. The literature argues that the participation in career management strategies
will expand employees' skill base to meet the demands of complex care and workload.
Also opportunities for learning and career advancement may enhance job satisfaction,
which may facilitate successful recruitment and retention.
Study objectives: The objectives are:1) to determine how radiation therapists define
career management, why and how they manage their careers and 2) to explore
environmental and personal factors perceived by therapists that may promote or deter
them from participating in career management activities. Methods: Twenty six
radiation therapists participated. Qualitative data from two focus groups and ten oneon-one semi-structured interviews were collected and analysed thematically.
Results: The findings suggest that participation in career management activities may
depend on the available job opportunities, organisational structure such as work
design and performance review systems. Personal factors such as therapists' career
desire, career stage and personal circumstances such as parenthood were some of the
emerging themes.
Conclusion: The data is preliminary and more research is warranted to gain insight
about career management strategies, job satisfaction, and skill development.
131
35PI
Establishing the higher education network for radiography in
Europe/ HENRE
Susanne Huber
University Hospital of Munich, Germany
Body Objectives: in 2002 St. Martin's College in Ambleside-UK succeeded in
receiving co-financing by the European Commission to establish a European higher
education network for Radiography. This network is a Thematic Network within the
scope of the Socrates/Erasmus project to support higher education institutions. They
shall be linked to each other to define contents and methods for radiographic
education and CPD in Europe.
Methods: Partners had to be found all over Europe. During the initial meeting in 2003
all interested participants were informed about the project and asked to work in one of
the 3 subgroups, which are education, learning- and teaching methods and continuous
professional development CPD. Since then subgroup meetings are held in different
European countries, to define the actual status of education in the countries, to look
for the learning- and teaching methods and to investigate the needs of CPD.Results:
Different forms were sent out to Radiographers of some European countries to find
out about the nature of the 3 subgroup-topics. Analyses were done, whose results are
both interesting and encouraging to review at least some of the radiographic
educations. As a result of promotion work during both national and international
events, HENRE has grown up to 17 European countries involved.Conclusion: The
establishing process of HENRE is not yet completed. It is now within the 3rd year,
which is the year of spreading and promoting. The network will be successful, if after
the establishing period as many educational institutions for Radiography in European
countries as possible will be an active member of this most useful link between them.
132
36PI
Radiography in the new South Africa
R.M Kekana
University of Johannesburg, South Africa
The changing political climate in South Africa brought many changes and this did not
exclude the provision of health care. The effects that the political changes had on the
health professionals can be seen as either positive or negative. This will depend on the
the aspects from which one views the changes.
The paper is aimed at highlighting the effects that the political changes had are are
still having on the radiography education as well as the provision of radiographic
services for the South African public. The cahllenges that the profession is facing as
well as the steps that are being taken to bring it to its current status.
133
37PI
Early pioneers of ISRRT
Niru O. Kolmannskog
ISRRT, Norway
The idea of International Society was proposed at meeting during the 1959
International Congress of Radiology in Munich where Radiographers from 24
countries were present. Our International Society was officially founded in 1962 and
first Board of ISRRT consisted of :
Miss Dien van Dijk ,NETHERLANDS- President
Miss K.C. Clark - Vice-President of Europe/Africa
Mr.Merv Allen - Vice-President of Asia/Australia
Mrs Cameron - Vice-President of Americas
Mr E.R. Hutchinson - Secretary General and Treasurer
Each of the 15 founder Member Societies present at first ISRRT meeting,nominated a
Council Member per country, thus forming first governing body of ISRRT.
Miss D.van Dijk the first elected President of ISRRT was also the Chair of Public
Relations and Editor of the first published –Newsletter ”voice?of ISRRT.
Miss Kathleen Clark distinguished pioneer and the first Vice-President of
Europe/Africa established the Education Committee leading to the start of
International Teachers Seminars.
Mr. Ernest Ray Hutchinson first elected General Secretary/treasurer
made great efforts for cooperation between all groups in x-ray field.
ISRRT honours him by ”the Hutchinson lecture?given at ISRRT World Congresses.
Main visions and aims for ISRRT were to promote and improve educational standards
and radiography practise for benefit of patient care and gain recognition for the
profession worldwide
The first pioneers of ISRRT had very few resources but they achieved great deal
towards communication between radiographers throughout the world. Due to these
few dedicated pioneers our Society is now recognised as official representative of
international radiation medicine technology worldwide.
134
38PI
An estimation of the supply and requirements of personnel resources for
medical radiological technologists in Taiwan
Jsong-wen Wei﹐Tar-liang Shen, Fu-Du Chen
Department of Radiology, Veterans General Hospital-Taipei, Taiwan, ROC
Purpose: The purpose of this study was to investigate the current medical radiological
technologist’ MRT’）manpower among major hospitals in this country, so that the
supply and need of the MRT’s manpower for the next 5 to 10 years can be accurately
predicted. In the meanwhile, we will be comparing the ratio of MRT versus general
population with foreign countries （e.g. U.S.A.）, and also to study how to enhance
the quality and quantity of MRT’s training in Taiwan.
Method & Meterials: The method of the current studies including questionnaire and
site visit. We are focusing on the investigation of MRT’s manpower supply and their
performance in the hospital. Three groups of people were included in the investigation,
including directors of Radiology department in the large hospital, directors of
radiological technology department in each university and senior radiological
technology students. This will help us to further understand the condition of MRT’s
practice in the hospital, manpower distribution and reasonable amount of MRT’s
manpower in relation to the current standard of medical system establishment as well
as to the quality evaluation system for each hospital. We will also take reference on
literature and compare with their findings.
Major findings:The growth of radiological technologists’manpower in Taiwan has
been over saturated in the recent years. However, the problem encountered was due
primarily to its distribution not quantity. So far, the ratio between radiological
technologists and general population is far behind developed countries such as Europe,
U.S.A. and Japan. The current standard of radiological technologists manpower in the
medical practice do not matched with the development of medical service, and
directly influence the quality of radiation medicine. Furthermore, lack of clinical
based teaching faculties among universities with radiological technology program is
still the major drawback in the education of radiological technologists in Taiwan.
Hence, the promotion of clinical based teaching faculties in radiological technology
become an important issue if one wish to enhance the level of radiological technology
and its quality of service.
Conclusions: The development of medicine has induced the shrinkage of global
medical resources. Medical personnels are no doubt an important resource in this
regard. We should combine all factors including medical environment, development
of service, labor force and productivity to effectively predict MRT’s manpower for the
future.
135
39MR Neuroimaging of language dominance in healthy Chinese: a structural
and functional MRI study
Suk-tak Chan (1), Kenneth K. Kwong (2)
University, Hong Kong; (2) Department of Radiology, Harvard Medical School,
Boston, MA, USA
The purpose of this pilot study was to investigate the relationship between the
handedness and the language dominance in the brain for native speakers of Chinese, a
logographic language.
10 right-handed and 3 left-handed native Chinese speakers were included. Voxelbased morphometry was used to study the anatomical difference, and fMRI with the
event-related language tasks in Chinese and English was used to study the functional
activation of language dominance.
All right-handers showed left brain dominance of Chinese language function. 2 lefthanders also showed left dominance, while one single left-hander showed right
dominance in Chinese. Subjects who were left dominant with the Chinese language
remained left dominant with the English task. However, significantly more functional
activations were observed with the English language on the right insula, inferior
frontal and inferior temporal gyri. The single left-hander who was right dominant in
Chinese showed bilateral activations in English.
Anatomically, no significant difference of grey matter concentration was found in the
right- and left-handers who were left dominant in Chinese. However, grey matter
concentration at the left temporal lobe was significantly higher in the right-handers
than in the only left-hander showing right language dominance.
This study demonstrated that only a small percentage of left-handers had right
language dominance in Chinese, a finding also seen in the other alphabetical language
studies. More bilateral activations may also be needed with the processing of nonnative language. Difference in Chinese language dominance can be observed in the
grey matter concentration.
136
40MR
The feasibility of using 1.5T clinical MR-scanner to perform diffusion
tensor imaging of in-vivo rat brain
Tak-Yeung Chan, Francis Kar-Ho Lee
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital,
Hong Kong
Objective:
Magnetic resonance Diffusion Tensor Imaging (DTI) provides a non-invasive method
to investigate the neuronal fibers. Presently, most of the in-vivo DTI rodent brain
studies are being performed in small bore high field research scanners which are
expensive and limited in availability. In this study, we investigated the feasibility of
using a 1.5T clinical scanner to perfom DTI and to trace the major rodent neuronal
fibers in-vivo.
Method:
Two normal adult rats were anesthetized and imaged in a 1.5T Philips NT Intera
whole body scanner. A 4.7cm diameter microscopy coil was used as receiver coil.
Two DTI sequences were implemented with reconstructed resolution of 0.47mm x
0.47mm x 0.5 mm and b-factor of 600 mm2/sec. Neuronal fiber tracking was
performed on these data.
Results:
We have successfully traced the corticospinal cord, corpus callosum and anterior
commissure of the rats. Two anatomists were invited to verigy the traced fibers, and
the ADC values of the rats brain obtained are in good agreement wit the previous
literatures.
Conclusion:
We have demonstrated the feasibility of using 1.5T clinical MR scanner for neuronal
fiber tracking in rodent brains. Three major rodent neuronal bundles were traced. DTI
fiber tracking with a resolution of (0.47 mm x 0.47mm x 0.5mm) was obtained within
a relatively short scan time (20 minutes). DTI with a higher resolution (0.235mm x
0.235 mm x 0.5mm) was also implemented with considerable increased scan time.
The technique will be useful in rodent neuro-anatomy studies
137
41MR
Reliability study in quantitative analysis of MRI CSF flow study
P. Charnchaowanish
Mahidol University, Thailand
Objective: To identify optimal technique for quantitative analysis of MRI CSF flow
study
Methods: The retrospective study was performed by analyzing raw data of MRI
cerebrospinal fluid (CSF) flow study of the patients conducted in our radiological
department. All of them underwent 3D phase contrast imaging in transverse oblique
plane acquired perpendicular to the long axis of aqueduct of sylvius. The quantitative
analysis was performed by one radiologist and one technologist independently on
commercial software in the workstation (Easy Vision).The outline of aqueduct to be
ROI for Quantitative analysis was selected from a magnitude image after adjusted
window width and showing the biggest diameter. The stroke volume, forward flow,
backward flow, regurgitation, absolute stroke volume, flux, mean velocity, peak
velocity, maximum velocity and area were calculated. The intra-and inter-observer
agreement of these values were analyzed for intraclass correlation and F-statistics.
Results: The range of intraclass correlation of these values of inter-and intra-observer
agreement were 0.955-0.999 and 0.939-0.999 retrospectively.These agreements were
statistically significant (p<0.001).
Conclusions:Our technique for quantitative analysis of MRI CSF flow had high
reliability with very good inter-and intra-observer agreement.
138
42MR
The evaluation of MR cholangiopancreatography technique with
conventional SE protocol
Yang Chu, Chending Jing, Yafei Wang
Department of Radiology, No.1 People’s Hospital of Zhenjiang, China
This is a study on the technique of MRCP with Conventional SE Protocol. Purpose:
Preliminary technological study has been done using MRCP (magnetic resonance
cholangiopancreatography) with conventional SE (spin echo) sequence. The reports
with similar techniques have not been reported yet. Objectives and Methods: Forty
patients with suspected obstructive jaundice underwent MRCP using a 1.0T MR
imager(Siemens, Impact). Abdominal oblique coronal protone and T2 weighted
source images were obtained with conventional SE double echo protocol. Respiratory
triggering and fat saturation were also used. The T2 weighted source images were
later processed using MIP (maximun intensity projection) to get the MRCP images in
from coronal to sagittal position. The pancreatobiliary ducts system for image
analysis were divided into 6 segments: (1) left intrahepatic bile ducts, (2) right
intrahepatic bile ducts, (3) the confluence and common hepatic dust, (4) common bile
duct (CBD), (5) gallbladder and cystic duct, and (6) pancreatic duct. Overall image
quality was graded as good, fair and nondiagnostic respectively. Results: In all 40
patients conventional SE MRCP can depict 38 (95%) left and 36 (90%) right
intrahepatic bile ducts, 34 (85%) confluence area, and 33(82.5%) CBD. The showing
percentage of the proximal ducts is lower than that of distal. But the lower showing
percernage of gallbladder than that of CBD may be involved in cholecystectomy,
atrophia and bile excretion. Pancreatic ducts were depicted only in 7 of 40 cases
(17.5%). The number of good showing cases is more than that of fair in each part
respectively. Conclusion: Conventional SE MRCP is a practical technique when the
MR imager is not supplemented with hardware and software such as TSE, single shot
RARE or HASTE.
139
43MR
MRI techniques in visualisation of anterior cruciate ligament
Igor Fuèkan
Croatian Institute for Brain research, Croatia
Introduction: Magnetic Resonance Imaging (MRI) has become the most important
non-invasive method in different musculoskeletal disorders .It has possibility to
clearly distinguish anatomical structures of joints and different pathological
conditions .The aim of this study is to demonstrate the diagnostic value of MRI in
clinical suspicion on ruptured anterior cruciate ligament (ACL).
Materials and methods: During this study 60 patients with clinical suspicion on
rupture of ACL were examined by MR.Patient lies in supine position with extended
and slightly external rotated limb.The vertical course of the cruciate ligaments in
external rotation justifies their improved conspicuity in the sagittal plane.Knee joint is
positioned in the middle of circulary polarized dedicated active knee coil.All of the
patients have been examined under the same scan protocol:
-SE T1w sagittal plane
-FSE T2w+Fat Saturation sagittal,axial and coronal plane
-FSE T2w oblique plane
-IRFSE(long TE) coronal plane.
All examinations were performed on 2T Prestige high field system, made by Elscint,
Israel.
All of the patients after MRI has gone under the arthroscopic procedure.
All positive MRI findings were confirmed by arthroscopic findings.
Conclusion: MRI has changed the diagnostic imaging approach of ruptured ACL.Its
high spatial resolution and multiplanareity have provided the capability of depicting a
wide spectrum of ligaments disorders.MRI has largely replaced arthrography and
computed tomography,and can obviate the need for arthroscopy as a diagnostic tool in
ACL disorders.
140
44MR
A comparative study of MR FSEIR T1 technique and SE T1 in the
diagnosis of brain tumor
Zhi-chao Lin, Han-fang Chen, Liang-Ping Luo
Department of Radiology, The First Affiliated Hospital of Jinan University, China.
Objective: To explore the role of MR FSEIR T1 and SE T1 technique in brain tumor
diagnosis comparatively.
Methods: All forty patients with brain tumor were examined with SE T1, FSE T2,
FAIR and FSEIR T1 MR scanning. The value of every scan technique in diagnosing
brain tumor were compared.
Results: Compared with SE T1, the rate of detected lesions by the FSEIR T1
sequence were higher than that of the SE T1 sequence (SE T1:90%; FSEIR T1:95%).
Moreover, on FSEIR T1 images, the CNR and SIR which were represented the quality
of the image were higher than that on SE T1 images (CNRFSEIR T1=8.87+/-2.14,
CNRSE T1=0.4+/-1.42, P<0.001; SIRFSEIR T1=1.45+/-0.006, SIRSE T1=1.02+/0.004, P<0.001). In the post-enhanced T1 sequence, the rate of detected lesions by
the SE T1+c and FSEIR T1+C all were 100%; the CNR and SIR were higher in
FSEIR T1 than that in SE T1. (CNRFSEIR T1=71.38+/-16.30, CNRSE T1=59.97+/7.87, P<0.001; SIRFSEIR T1=0.43+/-0.003, SIRSE T1=0.41+/-0.004, P=0.004).
Conclusion: The FSEIR T1 technique was better than the SE T1in inspection of brain
tumor.
141
45MR
Experimental study on having affect on an embryo of ICR mouse
by MRI
Meung Sun Ryu, Won Hong Lee
Objectives: The utilization of magnetic resonance imaging(MRI) is on an increasing
trend rapidly under increasing interests on electromagnetic waves in society. This
study is to investigate into having affect on an embryo of ICR mouse by MRI.
Methods: The MRI-50A(0.5T Toshiba, Japan) and ICR mouse(Crj: CD-1: Swiss
Hauchka) were used for this study. For making an experiment on affect of MRI under
solid level of embryo, An eight days pregnant ICR mouse, who was raised under the
condition of temperature of 22 degrees and humidity of 60-65%, was exposed for one
hour in gauge for exposure. To investigate into skeleton deformity, her cartilage and
bone were dyed for six hours under the condition of temperature of 37 degrees after
the methods including fixation for 36 hours in ethanol solution of 80%, dehydration
for 24 hours in ethanol solution of 96%, and dehydration for 2 days in acetone
solution.
Results: The fetal death was classified into death before implantation, embryonic
death, and fetal death. The death before implantation was significant statistically in
group exposed for three hours. The embryonic death was a little significant
statistically in group exposed for three hours. The fetal death was not significant
statistically in any groups. External deformity was a little significant statistically in
group exposed by MRI. Skeleton deformity was not significant statistically in group
exposed by MRI. Fetal body weight was not significant statistically in any groups.
Conclusion: Our results showed that intensity of the magnetic field in MRI could
cause external deformity and skeleton deformity in an embryo. Therefore, it is
necessary that a counterplan on stability and protection.
142
46MR
Magnetic resonance angiography (MRA) of falling hemodialysis
fistulas
Hsiu-Chen Shih, I-Kuang Chen, Chih-Hsing Wu, Yean-Wen Ni, Tze-Wan Tang
En-Chu-Kong Hospital, Taiwan
Objectives: Early treatment of stenosis by percutaneous intervention has been shown
to increased the longevity of the dialysis shunt and TOF (Time of flight) MRA is one
of the methods that can be performed without contrast medium or ionizing radiation.
The objective of the study was to evaluate the feasibility of hemo-dialysis fistula with
MRA.
Methods: 19 patients were included in the study. All examinations were performed on
a 1.5 Tesla scanner (Picker Eclipse) and the flexible body coil was applied. MRA was
performed in the axial 2DTOF technique (2DTOF/ RF-FAST/MAST, slice
thickness=2mm). The total examination time was within 15 min.The MRA images
were retrospectively compared with fistulography or pre-angioplasty angiography as a
standard.
Result: 39 stenosis sites (29 venous arm and 10 arterial arm) were detected. About
27% over-estimation of venous arm stenosis and 57% over-estimation of arterial arm
stenosis in average found. The sensitivity and specificity of clinical important stenosis
(>50%) are 88% and 50% of the venous arm if we defined more than 80% stenosis is
true stenosis on MRA. However MRA cannot well evaluate stenosis of the arterial
arm.
Conclusion: MRA is a valid non-invasive technique to demonstrated complications of
hemodialysis fistula as pre-PTA or preoperative planning even generalized overestimation of stenosis. However, sometimes signal void in arterial arm may only due
to turbulence flow.
143
47MR
Basics of fMRI
Andrej Sirnik
Klinical Center, Klinical Institut of Radiology, Slovenia
Functional MRI is based on the increase in blood flow to the local vasculature that
accompanies neural activity in the brain. This results in a corresponding local
reduction in deoxyhemoglobin because the increase in blood flow occurs without an
increase of similar magnitude in oxygen extraction. Since deoxyhemoglobin is
paramagnetic, it alters the T2* weighted magnetic resonance image signal. Thus,
deoxyhemoglobin is sometimes referred to as an endogenous contrast enhancing agent,
and serves as the source of the signal for fMRI. Using an appropriate imaging
sequence, human cortical functions can be observed without the use of exogenous
contrast enhancing agents on a clinical strength (1.5 T) scanner. Functional activity of
the brain determined from the magnetic resonance signal has confirmed known
anatomically distinct processing areas in the visual cortex, the motor cortex and Broca
144
48MR
Evaluation of MR imaging technique on prostate
Zhang Chen, Chen Min, Li Saying
Department of Radiology, Beijing Hospital, China
Objectives To evaluate different imaging techniques and to obtain high quality of
prostate images, so that to improving diagnoses of prostate.
Methods 212 patients were performed on MRI examination and 3DMR Spectroscopy
examination.
Results 206 patients were well done on MRI examination.2 patients weren not done
on MRI examination because of coil failure and 4 patients were not done on MRS
examination because of they did not put up with examination.
Conclusion The use of combing phased-array coil with endorectal coil may obtain
good image quality in prostate MR examination; It is helpful that explaining for
acierate diagnosis of prostate disease.
145
49MR
Comparison of the Brain MRI with 8Hrbrain phased-array coil
and with Head coil
Zhang Chen, Chen Min, Yin Jing-jing
Objective To compare the image quality of brain MRI by using head 8-channel
phased-array coil and conventional head coil respectively .
Methods MRI studies of the head were performed in 14 patients with 8-channel head
phased array head coil and conventional head coil respectively. The quality of images
obtained with above two kind of coils was compared.
Results The mean signal to noise ratio(S/N) of images obtained with 8-channel head
phased array coils was significant higher than that of images obtain with conventional
head coil (P<0.05).
Conclusion To compare the quality of images obtained with above two kind of coils,
8-channel head phased array coils can provide much better MR image quality of the
brain.
146
50MR
Application of 3D-FIESTA sequence of MR imaging in the inner
ear and internal auditory canal
Zhang Chen, Cai Kui, Yin Jingjing
Purpose: The aim of this study was to evaluate the fast 3D-FIESTA acquisition pulse
sequence for MR imaging of the inner ear and internal auditory canal (IAC).
Methods 3D volume scans of temporal bone was performed in 86 patients (172ears)
using 3D-FIESTA sequence. The post-procession analysis with maximum intensity
projection (MIP) was carried out with high imaging quality of 3D-FIESTA sequence
to show anatomic structures and lesions of the inner ear and IAC.
Results Scans combined with post-procession using 3D-FIESTA sequence could
precisely shows cochlear, labyrinth, semicircular canals of the inner ear, and the facial,
superior vestibular nerve and vessels of the IAC.
Conclusion 3D- FIESTA sequence can be provided very good resolution of water
structures of the cochlea and lesions in the inner ear and IAC; therefore it allows for
the diagnosis of the clinical application in the inner ear, IAC, and cerebellopontine
angle (CPA).
147
51GR
Dry versus wet laser imager: Image quality and stability
S.C. Bansal, L.K Gupta, R. Bapuraj, M. Gulati, N. Khandelwaland, S. Suri
Pgimer, Chandigarh, India
Objective: Laser cameras whether dry or wet have become indispensable tools for
recording Images from the newer imaging modalities like computed tomography,
magnetic resonance imaging, ultrasonography or digital radiographic systems.
Different users give different opinions about the performance of these cameras. This
study too, has been done with the aim to compare the image quality and stability of
films using both dry laser and conventional wet laser imager.
Method: Hard copies of 68 CT studies randomly selected (comprising of abdomen
23 nos., brain 22 nos., chest 15 nos., PNS 5 nos. and neck 3 nos.) done on both single
slice (High speed Dxi GE) and multislice (Light speed plus GE) CT scanners were
compared. In total 188 films and 4482 images exposed on Agfa’s Scopix LR 3300 and
Kodak’s Dry View 8100 laser imager were analysed for gray scale distribution, image
quality and temperature stability. Both subjective & objective criteria were used. In
subjective criteria three senior radiologist independently studied (on the same viewing
station) the same images exposed on both the dry & wet laser camera with the same
window settings etc. on the basis of brightness, contrast, detail detection, diagnostic
information and general information and rated these by grading A (excellent) , B
( satisfactory) and C ( not acceptable). In the objective criteria step wedge test pattern
was printed on both the dry & wet imager films which were then developed and
stored at seven specific temperatures (ranging from 400 C to 1000C) for 12 minutes
each to evaluate observable changes and to plot a sensitiometric curve separately for
each of these.
Result: In case of dry Imager films 90.8% copies were graded A and 9.2% copies
were grade B. Whereas, in case of wet laser imager films 47.1% copies were graded A,
51.9% were graded B and 1.0% were graded as C. Further Image degradation took
place in case of dry imager films when these were stored at a temperature higher than
800 C.
Conclusion: Dry laser imager demonstrate overall superior diagnostic information
than the wet laser imager apart from the added advantage of elimination of wet
chemistry and waste disposable.
148
52GR
Computed radiography in the Ugandan perspective
Stephen A. Bule
In response to the rapidly advancing technology, Computed Radiography (CR)
knowledge and acceptability survey was carried out amongst the medical radiology
practitioners. These updates are important in a profession in which knowledge and
skill domains continuously evolve.A prospective study was carried in the national,
referral, and teaching hospital of 50 medical and support staff to assess their
knowledge and response to the introduction of computed radiography in the
department.
The majority (38/50=76%) were not well informed and could not differentiate
between computed radiography and digital radiography (DR). The majority in
addition, felt it would take over their jobs and even still a very expensive venture
(Project) to undertake.Inadequate sources of information were some of the hindering
factors prevailing. From available sources, Hong Kong has progressed well in both
CR and DR application, therefore a good place to get the other side of the story.
149
53GR
The angiographic projections for distal left circumflex of leftdominant circulation in coronary arteriography
Kuang-Hua Chu (1,3), Chung-Li Huang (2), Lung-Kwang Pan (1), Ying-Tsung Chen
(3), Chih-Tai Ting.(3)
(1) Graduate School of Radiological Technology, Chungtai Institute of Health
Sciences and Technology, (2) Division of Cardiology, Changhua Christian Hospital,
(3) Division of Cardiology, Taichung Veterans General Hospital,Taiwan.
Coronary Artery Disease (CAD) is the leading cause of death and disability
worldwide. Coronary arteriography can visualize coronary artery stenosis directly and
proceed with angioplasty and stent implantation. However, accurate coronary artery
diagnosis requires coronary injections in multiple views. The coronary circulation is
left dominant in 8% of patients. The purpose of this study is to assess which
projection angle has the better image quality in delineating the distal left circumflex
(LCX) of left-dominant circulation during coronary arteriography.
From 2002 to 2003, twelve patients with stenosis in distal LCX of left-dominant
circulation were enrolled in this study. They all received four different projection
angles. The angulations were RAO 30 plus caudal (Ca) 20, PA plus cranial (Cr) 40,
LAT 90 Ca 20 and LAT 90 Cr 20. The image quality of coronary arteriography for
distal LCX was divided into three grades in the each projection. The imaging quality
was given score 1 (poor), if the stenosis was overlapped; score 2 (fair), the stenosis
appeared in the image partially; score 3 (good), the stenosis could be clearly
visualized. The distribution of the score of the study patients in the four groups was
compared by Wilcoxon Signed Rank Test.
In RAO 30 Ca 20 group, 8 patients had score 1; 2 patients had score 2 and 2 patients
had score 3. In PA Cr 40 group, 0 patient had score 1; 1 patients had score 2 and 11
patients had score 3. In LAT 90 Ca 20 group, 6 patient had score 1; 0 patients had
score 2 and 6 patients had score 3. In LAT 90 Cr 20 group, 4 patient had score 1; 0
patients had score 2 and 8 patients had score 3. The image quality of the PA Cr 40
compared with the others was significantly better (p = 0.003).
In conclusion, the projection angle, PA Cr 40, in delineating distal LCX stenosis of
left-dominant circulation during coronary arteriography has much better image quality
than others.
150
54GR The use of barium reflux study in patients with gastroesophageal reflux
disease and presentation of a new classification of gastroesophageal reflux
Hyuk Jang Dong, Soon Park Young
Department of Diagnostic Radiology, Sohae College, Korea
Objectives : This study presents a new classification of gastroesophageal reflux to
evaluate the patients with Gastroesophageal reflux disease after barium contrast reflux
exam to help making the correct diagnosis and treatment according to the symptoms
and states of the patients.
Materials & Methods : We enrolled 64 patients with laryngopharyngeal symptoms, 26
patients with heartburn and epigastric pain, 30 patients having medical checkups, and
20 participants as a control group for the project at our institution during the period
from March 2002 to July 2002. The peristaltic contractions of esophagus and
gastroesophageal reflux were observed using barium and water. The reflux was
classified into 5 Grades : Grade 0 (Normal) which has no reflux, Grade 1 which has
minor reflux but the peristaltic contraction of esophagus pushes them back to the
stomach, Grade 2 which a minor reflux lasts more than 10 seconds but does not reach
major reflux, Grade 3 which has major reflux but remains as minor state by the
peristaltic contraction of esophagus, Grade 4 which major reflux lasts more than 10
seconds.
Results : Of the 64 patients with laryngopharyngeal symptoms, 8(12.5%) were Grade
0(normal), 5(7.8%) were Grade 1, 19(19.7%) were Grade 2, 23(35.9%) were Grade 3,
9(14%) were Grade 4, and 27(42.2%) had decrease in peristaltic contraction of
esophagus. Among 26 patients with heartburn and epigastric pain, 3(11.5%) were
Grade 0, 3(11.5%) were Grade 1, 10(38.5%) were Grade 2, 7(26.9%) were Grade 3,
3(11.5%) were Grade 4, and 10(38.5%) had decrease in peristaltic contraction of
esophagus. Among 30 patients having medical checkups, 9(30%) were Grade 0,
10(33.3%) were Grade 1, 8(26.7%) were Grade 2, 3(10%) were Grade 3, none were
Grade 4, and 11(36.7%) had decrease in peristaltic contraction of esophagus. Among
normal persons without symptoms, 11(55%) were Grade 0, 4(20%) were grade 1,
5(25%) were grade 2, none were grade 3 and 4, and 6(30%) had decrease in peristaltic
contraction of esophagus.
Conclusion : Gastroesophageal reflux exams ought to be required for those having
medical checkups, considering increase of reflux diseases due to westernization of our
eating habits and changes of lifestyle, and barium reflux study the most useful method
in observing peristaltic contractions of esophagus and the gastroesophageal reflux. We
recommend applying the new classification provided in this study to diagnose and
plan the appropriate treatment for the patients with gastroesophageal reflux diseases.
151
55GR
A survey of patient dose variation for common general X-ray
examinations in Hong Kong radiology centers
K.K.L.Fung, S.K.Chong, S.Y.Mok, M.C.Ho, Y.T. Wong
Dept. of Optometry and Radiography, The Hong Kong Polytechnic University
Introduction: The wide variation of patient dose for the same type of X-ray
examination from several international dose surveys suggests that significant dose
reduction is possible to reduce the variability. The National Radiation Protection
Board (U.K.) has implemented the concept of reference dose levels (RDLs) as
thresholds for indication of potentially poor practices and aid to optimize radiation
protection.
The aims of this study were to establish the RDLs in Hong Kong for some common
X-ray examinations, including the chest, abdomen and lumbar spine and investigate
the reasons leading to the variation and possible methods to reduce the dose levels.
Method: The entrance skin doses (ESDs) were measured using thermoluminescent
dosemeters (TLDs) attached to a tissue-equivalent phantom. These dose
measurements were carried out in 13 radiological centres.
Results: Results showed a wide variation of measured ESDs for each examination,
from a factor of 1.62 for the AP Lumbosacral joint projection to a factor of 9 for the
Chest projection with low kVp technique. Low tube potential, high mAs, inadequate
filtration and slower film-screen speed were shown to have association with high dose
practices. Survey results were also compared to those reported in the U.K., Malaysia
and Ireland, which demonstrated a significant lower RDL up to 75% except for the
chest projection using low kVp technique. The lower dose levels achieved were
generally due to faster film-screen speed used in Hong Kong and the lower patient
body weight.
Conclusion: The study achieved the establishment of a RDLs database for some
common general X-ray examinations in Hong Kong and investigated the possible
causes which lead to the dose variation.
152
56GR
Key question search in PACS : Digital imaging display quality
assessment
Hong Guo, Qi Wu, Tong Qi, Fengtan Li
Dept. of Radiology, Tianjin Medical University General Hospital , China
The development of IT industry has promoted the revolution of radiologic technique.
The application of PACS not only increased the level of medical diagnosis and
efficiency but also decreased the cost. Imaging quality assessment, especially the
aspects to insure the coherence and stability of image display, has been one of the
most important questions about PACS. The capability of monitor and adapter had
effect on image quality directly, so a series of quality assessment and control process
was used in image display just like hardcopy to acquire excellent images. Most of
standards of imaging quality assessment is compatible with DICOM3.0. The standard
contrast curve, Grayscale Standard Display Function (GSDF) , has been widely used
in assessment, check, acceptance and quality control of medical electric display
equipment. But the standard for color and dynamic image display has not been
established completely. With the application of teleradiology and mobile equipment,
image display methods and quality assessment must become a new research subject in
the early future.
153
57GR
A study of advanced transorbital technique using a magnification
function in PACS system
Sang Hyun Kim, Ho Nam Koong, Hyung Ki Kim, Ki Tae Cho, Young Woo Lee
The Korean Radiological Technologists Association, Korea
Introductions: A transorbital technique is a useful technique for observing an internal
acoustic canal by projecting a petrosa into the orbit. However, the transorbital
technique can also deteriorate the sharpness of image as the penumbra increases
according to the distance between the object and film. We clinically compared the
traditional transorbital technique, which only uses double magnification against the
advanced transorbital technique using the CR and PACS systems magnification
function.
Subject Recruitment Criteria & Methods: The case subjects of this study consisted of
a total of 16 patients (10 males, 6 females, mean age of 38.2 and years at the range of
9 ~ 56) from April to June 2004. All patients underwent the traditional transorbital
technique with radiographic magnification and the advanced transorbital technique.
Among these, 6 patients (5 males, 1 females, mean age of 22.4 and years at the range
of 15 ~ 38) had undergone a multi-channel cochlear implant insertion surgery. Two
radiological technologists and one ENT specialist conducted the comparative
evaluations. The images of the multi-channel cochlear implant insertion were
conducted on the electrode array path and were used to compare between the
traditional and advanced transorbital techniques. In the advanced transorbital
technique, the images were magnified in the PACS system after exposure.
Results: The images in the traditional transorbital technique came out excellent in 4
(25%) cases, good in 8 (50%), and poor in 4 (25%). In the advanced transorbital
technique, it showed that the images were excellent in 10 (63%) cases, good in 4
(25%), and poor in 2 (12%). In the evaluation of the multi-channel cochlear implant
insertion surgery, the advanced transorbital technique demonstrated to be definitely
superior in the sharpness of the electrode arrays in all 6 results.
Discussions: The application of the advanced transorbital technique was attributed
due to the magnification function of PACS. This advanced technology made it
possible to improve the image sharpness by removing the scatter ray with the moving
bucky and freely control the contrast and density of images, resulting in a more
effective evaluation. The advanced transorbital technique proved to be a useful test to
improve the traditional transorbital technique without any deterioration of the image
quality in the clinics.
154
58GR
Patient's selection for extracorporeal shock wave lithotripsy for
treatment of common bile duct stones resistant to endoscopic extraction
Won-Hong Lee, Soon Yong Son, Cheon Kyoo Park, Cheong Chan Cho, Yong Moon Lee
Objectives: Common bile duct(CBD) stones may cause jaundice, cholangitis, or
pancreatitis. Extracorporeal shock wave lithotripsy(ESWL) may be needed whenever
endoscopic procedure are failed to extract common bile duct stones. The aim of this
study is to define criteria for better patient's selection for ESWL for treatment of CBD
stones resistant to endoscopic extraction.
Material and Methods: Fourty-six patients failed to endoscopic stone extraction
including mechanical lithotripsy were treated by ESWL. In all patients, endoscopic
sphincterotomy and nasobiliary drainage tube was done before ESWL using the
ultrasonography for stone localization with a spark-gap type lithotriptor. Patients were
sedated with an intravenous injection of 50mg of Demerol. None were treated under
general anesthesia.
Results: Overall complete clearance rate of CBD stone was 89.1% (41/46). In 82.6%
of the patients, the stones were extracted endoscopically after ESWL, and
spontaneous passage was observed in 6.5%. In the clearance rate after ESWL, there
were no high differences with regard to number(single: 82.8%, two or three: 100%,
more than three: 100%) and size of the stone(less than 33mm: 92.9%, 33mm or larger:
83.3%), whereas there were significant differences with regard to the ratio of sum of
long-axis length of the all stones to sum of long-axis length of the CBD in part not
containing stone(1:1.4, 1:1.1) and diameter of the largest stone to diameter of CBD in
part not containing stone(1:0.9, 1:0.4) for patients with complete clearance compared
with those without.
Conclusion: We propose that stones without the fragments are travelable space in
CBD regardless of stone size and number should be treated by other technique to
prevent time and cost consuming, such as percutaneous transhepatic cholangioscopylithotomy.
155
59GR
An experimental comparison of imaging quality for CR/DR and
screen/film systems with oblique X-ray projection
Chuan-ya Liu, Chuan-you Lu, Shao-juan Song
Shandong Medical Image Research Institute, China
Objective: To study on the imaging quality of CR and DR with oblique X-ray
projection.
Methods: For screen/film, CR, a-Si DR, and a-Se DR system, test chart of square
wave was exposed with oblique X-ray projection angle of 0, 15, 30, and 45 degrees
respectively.
Results: Limiting resolution of screen/film system decreased obviously, while that of
CR, a-Si DR, and a-Se DR hardly decreased.
Conclusion: There is oblique effect that makes unsharpness in screen/film system,
while there is hardly oblique effect in CR, a-Si DR, and a-Se DR.
156
60GR
A comparative study of energy responses of CR system and screenfilm system
Yantao Niu
Beijing Tongren Hospital, China
Objectives: To investigate the relationships between CR image pixel values and
exposure factors (kVp,mAs), thickness of exposed subject, and the relationships
between conventional screen-film optical density and exposure factors (kVp,mAs),
thickness of exposed subject. These two kinds of energy response relationships were
compared. The feasibility of using CR image pixel values and measure values of IP
mean incident exposure as parameters for setting up phototimer was studied.
Method: Homogeneous acrylic phantoms 10, 15 and 20cm thick were imaged with a
traditional X-ray system and a CR system at 50~90, 70~120, 90~140kVp and AEC
density grade -2. Automatic exposure responses of the two systems at various tube
voltages, same exposed subject thickness and grade selection were compared.
Phantoms of 15 cm thickness were imaged with two systems at 70~120kVp and
various density grades. Automatic exposure responses of two systems at same
exposed subject thickness, different tube voltages and grade selection were also
compared.
Results: Tube voltage vs pixel value curves were similar to those of tube voltage vs
exposure curves in CR system. When the projected subject thickness remained 10cm,
screen- film density defference in 50~90kVp was 1.21, and pixel value defference was
270. When 20cm thick 90~130kVp, they were 0.30 and 100. When 15cm thick, they
were 0.62 and 160 seperately. When the projected subject thickness 15cm remained
and AEC grades -3~+1 selected, exposure on receptor increased with the tube voltage
increasing in 70~120kVp, and the increasing trend of exposure remained invariable at
each AEC grade. The increasing trend of film density was similar basically, and
density defferences were all 0.75 in 70~120kVp at each grade. Pixel values increased
with the tube voltage increasing at each. The higher AEC grades, the smaller
increasing trend of pixel values. The difference of pixel value was 190 in 70~120kVp
when grade -3 selected, and 110 when +1 selected.
Conclusion: Exposure index value in flat field image and IP mean incident exposure
could be used as factors to setup phototimer of AEC. At the investigation institute,
400 speed screen-film system was used for general radiography and chest radiography
before. According to the theory of X-ray absorption efficiency, when EI>1500 for
general radiography(50~90kV) and EI>1800 for chest radiography(125kV),the CR
image quality could be acceptable.
157
61GR
Direct digital imaging in the hospital for children and adolescents
E.Ornmark, P. Palmumaa, R. Rantala
Helsinki University Central Hospital, Finland
A direct digital imager with a single mobile detector was installed, in May 2003, in
our radiology department, that performs 25 000 x-ray studies per year. We had been
using computed radiography and digital archiving for 6 months. The aim was to
increase the pace and flexibility of image acquisition, to decrease the patient dose, to
preserve the high image quality, and to take into account the special features of the
pediatric patients. The equipment was situated so as to retain the view of the patient
in any imaging position. A web server next to the imager allowed checking of
previous images of the patient. Two radiographers were trained to set the positioning
and protocols, and to coach the 12 other radiographers. They tailored protocols for the
0 to 18 years age groups, based on the values of the computed radiography, and the
adult values provided by the manufacturer. The sensitivity values, use of grid, and
filtering, were based on the dose and imaging values displayed after each exposure.
Images were archived without modifying the raw data. We developed a new way of
positioning the detector and the tube, and to secure the baby for upright chest x-rays.
Direct digital imaging is most appropriate for pediatric patients because it is fast, the
dose is low, and the image quality is excellent, which can be observed immediately
after image acquisition. The young patients find the motion of the device entertaining,
interesting, and exiting, but never frightening.
158
62GR
Imaging technique and radiation doses to neonates treated in
PICU in Finland
Minna Tikkanen, Anja Kettunen, Antti Servomaa
Oulu University Hospital, Department of Radiology, Finland
Purpose: According to the Med.Dir ( 97/43/Euratom) special protection requirements
are needed in childhood. This study was focused on finding out the imaging technique
and radiation doses to newborns treated in a pediatric intensive care unit.
Material and Methods: The technique and Dose-Area Product of 118 chest
examinations of newborns in paediatric intensive care units were measured by DAP.
Entrance surface doses and effective doses were calculated separately to each
newborn. Based on the patient records, the number of all x-ray examinations during
the study was calculated and the effective doses were estimated retrospectively to
each child.
Results: Two projections of chest and abdomen are produced during the prenatal
period: either as a single exposure usually taken at the first exposure time (anterior
posterior supine chest and abdomen and lateral chest and abdomen) or as two separate
exposures from chest and abdomen ap and lateral. The image receptor- focus distance
was 1m, total filtration 3 mmAl and there was no grid in use. The tube voltage varied
in chest ap from 66kV to 80kV (mean 69,2kV) and in chest lateral between 70kV and
74kV (mean 71kV). The effective dose from one chest radiograph varied from 7.5μ
Sv to 54.8μSv. Retrospectively, the total number of radiation examinations to these
43 newborns totalled 399 during the study; the mean was 9.3 (range 1-40). 98% of the
examinations were produced during the first treatment period after birth.
Conclusions: The variation in field size with in the same size group of newborns and
in all data was noticeable as in all other studies. That shows how difficult it is with
small newborns to identify the real exposure area and limit the exposure area to the
optimal size. The wide range of doses in the PICU needs the continual assessment of
radiation dose in the neonatal nursery.
159
63GR
Informational teaching and radiologic education
Qi Wu, Hong Guo
Dept. of Radiology, Tianjin Medical University General Hospital, China
As one of the most advanced technology in the medical field, radiologic education has
moved quickly to embrace by using information technology to perform new teaching
modalities. Clinic medicine has important improvement to predict the future of
radiological education development by using informational teaching assist education
also. By mean of such IT tools as computer and the internet, the traditional training
for radiologists and technologists like reliance on text books and an apprenticeship
model of one on-one interaction could be changed. It is possible to develop more
abundance, more effective, and efficient means of teaching radiological.
160
64GR
The correlation between temperature and conserving time of laser
films printed by dry way and wet way
Yaping Yu, Qi Yang, Guoxiang Deng
Department of Radiology, Shanxi Medical University, Taiyuan, Shanxi, China
We design tests to investigate the correlation between conserving time and
temperature for films printed by dry way and wet way, so as to conserve the films
better.
Method: According to the standard methods suggested by ANSI, the films have been
conserved under 6 different grades of temperature, which are normal atmospheric
temperatures, 32°C, 42°C, 52°C, 62°C, 72°C respectively for 5040h,during which time,
humidity is 14%~25%, space is 30X28X35cm3 and each group includes 12 dry and 12
wet laser films of every part of the body. Read the image in double blind and record
the time when yellow spot has been seen (the area of yellow spot > 1cm2). Having
yellow spot is 1 and not is 0. Measure the density between 1 and 0, then analyze the
results statistically (SPSS).
Results: It has a high difference in density between 1 and 0. Under such 6
temperature points, films printed by wet way don't become yellow. But films printed
by dry way retained Ag, which is no sensitized, will continue to form the image -be
accelerated - develop again - turn yellow. The higher the temperature is, the shorter
the catalytic course and the conserving time are. Thus, we draw a characteristic curve
about the correlation between conserving time and temperature.
Conclusion: 52°C is the most important temperature point, upper that point, films have
more highly possibility of becoming yellow. So it's reliable to conserve them under 32
°C.
161
65GR
Median arcuate ligament syndrome : The contribution of
combined imaging modalities to diagnosis and treatment in a patient post liver
transplantation. A case report
M.Zelicovich, Sh.Shklar
Tel Aviv Sourasky Medical Center, Israel
We present a case in which the median arcuate ligament syndrome was a causative
factor of hepatic artery thrombosis in a young patient after liver transplantation. The
diagnosis and treatment were performed by Doppler ultrasound (US) and angiography.
The Median Arcuate Ligament syndrome (MALS) is due to an uncommon anatomical
variant in which a tendonous band that unites the medial margins of the two crura
causes compression of the celiac and/or the SMA. The clinical features are varied and
can range from asymptomactic to postprandial pain and weight loss. The symptoms
are aggravated on expiration. In this case we present a young patient 5 weeks post
liver transplantation who was sent for US-Doppler evaluation due to rising liver
function tests the working diagnosis was Steriod resistant rejection. On the USDoppler examination there was no flow in the hepatic artery and the patient was sent
to an emergency angiography. On angiography, hepatic artery thrombosis was
established and the additional finding of MALS causing reduced flow in the celiac
axis and hepatic artery contributing to the thrombosis. The hepatic artery was
recanalized and the patient recovered. On repeat US-Doppler evaluation the hepatic
artery was patent and hepatofugal flow was seen in the hepatic artery at the celiac
origin consistent with the MALS. In this case we discuss the MALS, present the
imaging studies of this unique case and emphasize the importance of awareness to this
incommon condition especially in patients post liver transplantation.
162
66GR
The radiology department role in mass casualty events
M.Zelicovich, Sh.Shklar, A. Blank
Tel Aviv Sourasky Medical Center, Israel
A mass casualty event is considered a medical system task. Unfortunately countries
all over the world have suffered at times such events, including terrorist bombing.
Such events challenge medical systems since simultaneous diagnosis and treatment
are required for a large number of patients in an extremely short time interval. In a
hospital setting, imaging has a major role in the immediate evaluation, diagnosis and
sometimes treatment of the victims. Our institution has had a relatively large
experience with such events and in our work we will show the participation of the
radiology department (including various units within it) in the chain of events after a
mass casualty event. We will review our institution statistics of the number of staff
(radiographers and radiologists) the number of X-rays, CT scans, FAST ultrasound
and angiography procedures needed to cover an event of 60 victims. We will show the
additional work load increase when such events happen during weekends or evening
hours. We will demonstrate some special aspects of the injuries such as nails added to
the bomb and the importance of their recognition. Conclusion: Imaging and the
radiology department play an important role in the first steps of evaluation and
diagnosis of victims of mass casualty events. Familiarity with previous experience can
optimize activity in terms of personnel and equipment for the best readiness and
service.
163
67ER
Radiography education in Uganda
Stephen A. Bule
Radiography as a profession in Uganda evolved well back in the early 1950s from
basic radiography to the present multi-disciplinary radiological profession.The
curriculum kept shifting to incorporate the modern and new innovative modalities to
keep brace with the ever-advancing radiological technology. Particularly in ultrasound,
computed tomography, magnetic resonance imaging, nuclear medicine and
radiotherapy. Although ultrasound was first introduced in the mid 1980s initial
training commenced in 1994-1996. Attended by participant from several African
countries sponsored by Nuff foundation over that period. Through the World
Federation of Ultrasound in Medicine and Biology (WFUMB), world health
organization has recognized Uganda as a center of excellence.The training institution
is now challenged with the practical aspect of clinical radiography and not to forget
introducing pattern recognition for graduates.To overcome the challenges, the task
now is to build human resource capacity by offering scholarships to study in foreign
universities. 3 have trained in Japan under Japan medical technology foundation and 6
in South African university on private/self sponsorship.
164
68ER
A free radiology dictionary made from abstract corpus of the
"radiology" and "radiographics"
Mei-Yen Chang, Ying-Chou Sun, Chen-Fa Chang, Ping-Yi Ko, Michael M Teng,
Cheng-Yen Chang
Radiology Department, Taipei Veterans General Hospital, Taipei, Taiwan
Purpose:
Spell-checkers are useful not only in daily electronic communication, but also in
professional fields. For radiologists/radio-technologists, off-the-shelf electronic
dictionaries have some drawbacks.
Method & Meterals:
1. They are made for general medical usage, not customized for radiology. Many
radiology terms are not in the vocabulary.
2. Many general medical terms are rarely been used in radiology. Those terms pose a
problem: a typo may turn out to be some kind of bacteria in Antarctica and never be
detected.
3. The update of the dictionary is usually biannually or longer. 4. Each license costs
about $30-$100.
Result：
We downloaded all the abstracts of Radiology and Radiographics before March 2003
from National Library of Medicine, and made a dictionary from the abstract corpus.
Our process is entirely computerized---there is no need of human interpretation. The
dictionary can be integrated to a reporting system or other application.
Conclusions:
A supplemental edition is also made for Microsoft Word, in which all existing terms
in MS-Word are removed. We will present each step of the process in detail. The
dictionary will also be available on the Internet during the conference period and the
following week, for free.
165
69ER
Determination of the best radiation dose using 188Re-MAG3-filled
balloon dilation on granulation tissue formation following stent placement in a
canine urethral model
Won-Chan Choi., Ji Hoon Shin, Tae-Hyung Kim, Eun Young Kim, Chul-Woong Woo,
Ho-Young Song
Korean Radiological Technologist Association, Korea
Formation of granulation tissue following expandable metallic stent placement into
the urethra has been problematic with occasional restenosis. The purpose of this
exhibit is to determine the best radiation dose among various radiation doses using
188Re-MAG3-filled balloon dilation to reduce granulation tissue following stent
placement in a canine urethral model. We placed polyurethane-covered stents in the
proximal urethra in 24 dogs and applied b-irradiation at both ends of the placed stents.
Radiation dose was 0Gy, 20Gy, and 40Gy at a distance 1 mm away from the balloon
surface. Gross and histologic findings were obtained after sacrificing all dogs 12
weeks later and compared according to the radiation dose. The numerical mean values
of each histologic finding were the lowest in the group receiving 20Gy, followed by
40Gy, and 0Gy. The mechanism of radiation effect according to various radiation
doses on granulation tissue will be discussed with literature review.
166
70ER
Practice of objective structured clinical examination
Ohtani Hiroki, Senoo Atsushi, Sekine Norio, Fukushi Masahiro
Tokyo Metropolitan University of Health Sciences, Japan
Objectives:
Improvement on education method and radiation technology ability of the
Radiological Technologist student is desired. By trying Objective Structured Clinical
Examination (OSCE) in a student before a clinical practice and knowledge,
technology and the attitude suitable to complete a clinical practice, and we'd like to
use it for improvement of the estimate method and lecture of the future.
Methods:
A clinical practice was performed in three fields of the radio diagnosis, the nuclear
medicine and the radiation treatment, but OSCE was tried about each territory of a
radiation diagnosis by this research. The student before a clinical practice was made
an examinee and a critical person was made a teacher with licenses of the
Radiological Technologist as a member. The patient role was selected optionally.
Result:
The viewpoint of the OSCE evaluation was made patient treatment, the grade of the
photography technology and the picture for checks and a reply to an oral examination.
As a result, an outcome of a lecture showed for knowledge of photography technology,
however the student who can't get the behavior of which they thinks existed by a
practical affair of positioning and imitation photography.
Conclusion:
The validity of the lecture was indicated in acquisition of knowledge of photography
technology, but by trying OSCE for the first time, and the lack of the practice ability
was made clear. Necessity of OSCE was suggested to knowledge, technology and the
humanity in education of radiation technology territory.
167
71ER
The radiographer's professional career model
M Hirvonen-Kari, A Erkkilä ,R Järvenpää , T Koskimaa, M Mannila
Helsinki University Hospital, Finland
The radiographer has a responsibility to one's own professional skills, self
development and to keep the knowledge and skills learned up to date. The
radiographer's professional career model (RAURA) has been created in Helsinki
University Hospital (in Finland) and it supports the radiographer's professional
development. The professional career model describes qualifications that the
radiographer's clinical work demands from the radiographer's professional
competence. Qualifications are technical competence, patient care, customer service
and process development.
The radiographer's professional progress is accomplished from an introductory stage,
through a stage of basic capabilities to become the competent radiographer. All the
radiographers in Medical Imaging Center have to achieve a competent level and
maintain it through out the career. The progress from the practised stage to an expert
is accomplished voluntarily. There has been created criteria for each stage.
The professional competence is assessed by agreed methods. Self assessment and the
portfolio are used at every stage of the professional career. The development
discussion is based on the criteria of the professional career model. The peer
assessment is performed by a colleague.
The radiographer's professional development is based on the idea of a lifetime of
learning where learning is accomplished by learning at work, virtual studies and
education. The demands of the working life are changing constantly. The Medical
Imaging Center responds to these demands by supporting individual development.
The organisation receives from professional development more competencies and that
enables constant process development. This is acknowledged in the radiographer's pay.
168
72ER
A newly designed pulsatile flow model for the evaluation of aortic
stent-grafts
Tae-Hyung Kim, Won-Chan Choi, Jin-Oh Lim, Chul-Woong Woo, Hyoung Jin Lee,
Young-Ran Kim, Yong-Moon Lee
Korean Radiological Technologist Association, Korea
It is known that endovascular stent-graft implantation is an alternative to conventional
open surgery for the treatment of aortic aneurysm. Newly development stent-graft
evaluated in the in-vitro test before animal experiment or clinical study. However,
have some limitation in the in-vitro test because of different of the actual human
aortic size and condition. To overcome the limitation of the in-vitro test, we designed
an abdominal aortic aneurysm flow model. The aim of this exhibit is to show the
effectiveness, function of an abdominal aortic aneurysm model for in-vitro test of
graft-stent. A model consists of the heart and aneurysm parts. A peristaltic pump and a
solenoid valve were used to simulate a pulsatile flow from the heart. The pressures at
the thoracic aorta, aneurysm, and both iliac artery were measured with the outlet valve
opening at 25, 50 and 100% before and after graft-stent placement.
169
73ER
Discussion of quality criterion of big high densitylesionon the
frontal chest film
Zhi-chao Lin, Zhong-yan Liu, Liang-pin Luo, Jin-chen Chen
Department of Radiology, The First Affiliated Hospital of Jinan University, China
Objective: To evaluate the quality criterion of the big high density lesion on the high
kv frontal chest film and the clinic values of the chest CR (computed radiography).
Materials and methods The big high density lesions of 130 cases on high kv frontal
chest films and that lesions of 60 cases on CR900 frontal chest films were reviewed
retrospectively. The technique group weight the quality of the chest film according to
the traditional criterion and expressed it as the first film percentage, the diagnostic
group weight the quality of the chest films according to the satisfactory degree about
the vision of the big lesion and vision of the anatomy structure, they expressed it as
usefulness percentage.
Result (1) It was significant difference between the first film percentage and the
usefulness percentage in the 130 cases (the first film percentage was usefulness
percentage of 80 cases with the lesions
170
74ER
The expertise of the radiographer
M Pawsey, M Hirvonen-Kari
Helsinki Medical Imaging Center, University Hospital, Hospital District of Helsinki
and Uusimaa, Finland
The Helsinki Medical Imaging Center promotes professional development by use of
the radiographer professional career model. The radiographer progresses through
levels: introductory, basic capability, competent, practiced and expert.
The radiographer's competence was assessed in research carried out in 2003. Criteria
were taken in four competence areas for self assessment and assessment by superiors.
The research method was quantitative and the data was analysed by statistical method
and open questions by content analysis. 196 of 230 self assessment questionnaires
were returned and 223 questionnaires of superiors. The radiographers themselves
rated technical competence and customer service highest (average 3,7) followed by
patient care (3.4) and process development (3,3). Customer service (3,8) and technical
competence (3.5) received the highest average in assessments by superiors followed
by process development (3.4) and patient care (3.3). The criteria were: self assessment
and assessment by the superior for the competent stage; self assessment, peer
assessment (2), assessment by the superior, portfolio and post graduate studies (600 h)
for the practiced stage. 23 radiographers applied for the practiced stage. Six practiced
radiographers were chosen after interviews.
Practiced radiographers act as modality experts and develop the processes in their
own responsibility areas. There is a network of practiced radiographers and they
assemble regularly to develop the criteria of selecting practiced radiographers. There
is a goal in the Helsinki Medical Imaging Center to obtain, for the year 2005, two
vacancies for expert radiographers. A Master of Health Science Degree is required for
an expert radiographer.
171
75ER
Improvement of knowledge of radiological technicians
Xian-hui Run
Xiangfan Vocational and Technical College, China
With the rapid development of modern technology, radiography has changed greatly.
The development of modern technology provides medical technicians with more
modern equipment, and at the same time, the technicians need to have more new
knowledge about the equipments. In order to improve the working ability, the
technicians have to improve his related knowledge. The ways to get the new
knowledge are to use the information resources of technical magazines, library,
technical net, internet; to study in the university, to attend academic meeting; and to
join in particular scientific research, etc. This paper describes the different ways that
technicians in China do to 'improve their knowledge and their working ability.
172
76ER
Modelling a living subject liver using Rapid Prototyping technique
under PACS environment
Fuk Hay Tang; Lawrence WC Chan; Martin Wong, Thomas YH Lau
Optometry and Radiography, The Hong Kong Polytechnic University, Hong Kong
Objective: to produce a computed-generated rapid prototyping liver model from
DICOM liver images to facilitate diagnosis and treatment planning for liver diseases.
Method: Selected DICOM CT images of liver at 5mm slice thickness in the PACS
were retrieved to the computer-aided design (CAD) application server (AS). To
produce volume image of liver, manual segmentation of liver on each slice was
produced. After CAD processing, the 3D CAD files, in STL format, were produced
and transferred to the rapid prototyping (RP) machine to build the physical models.
The RP system was developed based on the Three Dimensional Printing (3DP)
process. The digital data were processed to control a printer head to print binder onto
a bed of plaster powders. Layer by layer, the cross-sections were printed and the
binder fused the powder particles to form a solid mass.
Result: The liver model made of plaster powders has a one-to one scale of a human
liver and fabricated by the 3D RP technology was produced. The production time was
about 12 hours.
Conclusion: The 3D liver model was obtained with precision of slice separation of
5mm, despite that a RP processes could build models of layer thickness up to 0.1mm.
The liver model was still not smooth enough on its surface due to limitation of RP
machine. However, the structure produced was comparable with real liver. The
establishment of such model would facilitate various areas of diagnosis and treatment
planning for liver diseases without exposing the real liver.
173
77ER
Concept analysis of radiography
Sorppanen S., Tikkanen M.
University Hospital of Oulu, Finland
Objectives: In radiography, theoretical research related to concepts has been rare.
Nevertheless, radiography needs systematic conceptual clarification and development.
In this study, the concept of radiography was examined using concept analysis, a
theoretical process to examine the structure and use of concepts. The purpose of this
master’s thesis study was to clarify the content and uses of the concept of radiography
in health sciences, and to compare it to the concept of radiography in physics and
technology. The study was conducted at the University of Oulu, Finland, within the
degree programme of radiography, which has provided academic studies for
radiographers since 1999.
Methods: So-called evolutionary method of concept analysis was used. The concept
of radiography was examined by determining its essential characteristics and
observing these characteristics in interdisciplinary comparison. The data consisted of
scientific and popular literature and Internet pages, and were analysed using
deductive-inductive content analysis.
Results: The concept of radiography in health sciences can be determined as dual,
dynamic, social and situation-related expertise of radiographers in the use of radiation,
which is based on versatile synthesis. The antecedents of radiography identified were
resources, operation, justifiability and expertise, and the consequences were health
and well-being, and the strengthened position of radiographers. The concept of
radiography in health sciences appeared to be softer, larger, much more humane and
more abstract than in other fields, and clearly radiographer-centered.
Conclusion: The content and the use of the concept of radiography appears to vary
according to the discipline.
174
78ER
A study on teaching approach of radiographic simulation system
with medical imaging
C. S. Tsai(1), J. S. Lin(1,2), Y. C. Lin(1), K. H. Liu(1), Y. C. Huang(1), Y. C. Lin (1),
H. H. Lin(3), C. C. Lee(4), K. H. Chung(4)
(1) Dept of Radiological Technology, Tzu-Chi College of Technology; (2) Polymath
Enterprise Co., Ltd. Taipei; (3) Dept of Electrical Engineering, National Taiwan
Ocean Univ; (4) Dept of Radiology, Buddhist Tzu-Chi General Hospital, Taiwan
Objectives:
In this study, a radiographic simulation system which combined medical imaging was
designed and performed for teaching and clinical training purposes.
Materials and methods:
The radiographic parameters and procedures containing positioning skills and x-ray
medical images were chosen to be as the input unit of system. The operating pulses
are converted by analog to digital signal converter (ACDs). The signals from x-ray
device simulator are accepted and processed by 8051 microprocessor unit, and then,
the processed data are sent to the server through RS-232C serial port. The server
receives the medical image databases of the corresponding addresses that come from
the 8051 microprocessor unit, and displays the medical image on monitor. In this
system, the 8051 microprocessor unit and the server are driven by the use of assembly
language and basic language, respectively.
Results and Conclusion:
The results from radiographic images on skull, chest, abdomen, extremity bone,
confirm the applicability of the study and meet the requirement of clinical digital
medical image processes. The advantanges of radiographic simulation system include
easy portable operation, no radiation risk and no high voltage. In addition, it can be
also used as the auxiliary tools for teaching image interpretation and radiographic
skill, as well as for clinical training.
175
79ER
Influence of entrances terms on study of radiology
Nevenka Volavek
College of Health Studies, University of Ljubljana , Slovenia
Objective:The study of Radiology Engineering in Republic of Slovenia is organised
within the College of Health Studies, University of Ljubljana.The system of entering
on whichever study on Univesities of Slovenija, gives an opportunity to candidates
(graduate students of four year secondary education programme)to compete for three
different university studies of their own chooses.The candidates generally put the
most favorite study on the first place.On which study the candidate will be arranged,
depending on his or her result on matura examination and of disposable places on
University.
Methods: Quality and quantitative analysis have been performed including the
questionnarie among freshmen on this subject.We were looking for the correlation
between the place on which they had put the study of radiology on the beginning and
the result they achieved during the studdy of radiology.
Results: Between 2000 and 2003, 120 students took part in the questionnare.The
results are:30 students (25%) put the radiology study on first place,55 students (54,1%)
on second,35 students (29,1%) on third place.Avarage pass rate from 1st to 2nd year
is 70%. And from 2nd to 3rd 95%.The average duration of study is 4 years.
Conclusion: The results of the research shows that the place on which the students put
radiology study has no big influence on succes during the study.
176
80ER
A web-based library of digital radiography
TH Wong, YM Poon, CM Kung
With the increasing role that digital imaging and picture archiving and communication
systems (PACS) plays in the radiology department, it is apparent that teaching files
and reference images will need to move in a similar manner. However most PACS
vendors have either not added this functionality or the implementation is complicated.
We have developed a web-based library of digital radiography which can be assessed
through the hospital intranet or even through the internet. Users can take advantage of
web-based reference library of digital images at any time, choosing the site which
works best for them.
The system is easy to use, secure and efficient. Thanks to the utilization of free
software from the Internet, the cost of the implementation is relatively low. We will
demonstrate the details and tips for establishing such a system.
177
81ER
Evaluation of In vivo dosimetry for TBI using diode
Pei-Chieh Yu (1), Hank Chen (2), Ching-Jung Wu (1)
(1) Yu,Pei-Chieh Cathay General hospital, Taipei Taiwan;
(2) University of Pittsburgh Medical Center
Methods and Materials: 1. Different SDDs measurements: The SCD we have been
measured were 90cm, 100cm, 110cm, 120cm, and 150cm. In this SDDs experiment,
diodes were placed at every depth just 2cm away from the edge of Markus chamber.
We put 4 diodes around the Markus chamber. To avoid diode readings being perturbed,
we changed positions of diodes. 2. Off-axis measurements: The calibration condition
is set up at the field center, but the feet and head of TBI patient are off-axis. If we
measured the off-axis ratio of diode in advance, we will get more accurate dose. We
put the phantom away from the field center about 30cm to observe whether the offaxis response of diode needs to be considerable or not.
Result: 1. Different SDDs measurements: The performances of diode and Markus
chamber are so different. We thought that diode is source-detector distance dependent.
So, if the clinical condition is different to calibration condition, a correction factor
needs to be added into dosimetry system. But between source-detector distance at
90cm and source-detector distance at 110cm, the correction factor will be less than
1.5%. According to fig.4, we consider that TBI in vivo measurements need a special
calibration condition. 2. TBI Off-axis measurements: Off-axis ratio at 30cm is around
1.06 in clinical TBI calculation sheet. This number is the same as our Markus
chamber measurement data (fig.6), but off-axis ratio for diode is a little bit lower than
1.06(fig.6).
Discussion: 1. Different SDDs measurements: Diode sensitivity increases with the
instantaneous dose rate (dose per pulse). The dose per pulse is higher at smaller SDD.
Two factors also contribute to the diode response. First, the diodes and ion chambers
have different energy responses, and second, when the SSD decreases, the number of
contamination electrons and head scattered low energy photons able to reach the
sensitive part of the diode detector is larger. 2. TBI Off-axis measurements: Diodes
were not at phantom center and they were also placed on phantom surface not the
same depth of Markus chamber (dmax). Off-axis ratio of diode was 0.9% different
from ionization chamber. I thought these values were reasonable. We have already
calibrated diodes, and measured the center dose and off-axis dose. The next step we
will do is measuring TBI in vivo dose. In clinical situation, we used TLD to measure
the in vivo dose, but we could not get the dose immediately. If we can get the dose
immediately, we could adjust the dose for next treatment.
178
82PC
Communication enchancement project (CEP)
Tat-Man Law
The purpose of the study is: 1) to evaluate the effectiveness of present communication
channels in the Department of Radiology, Tuen Mun Hospital; 2) to set a baseline on
the level of satisfaction of communication among staff in the department, 3) to
investigate any difference on the perception of departmental communication between
various disciplines in the department. Hopefully, we can obtain useful information
from the study so as to make improvement on communication within the department.
In order to proceed the study, we must first conceptualise the term communication.
Definition: Process of sharing information using a set of common rules.
It was assumed that human communication is a two-ways ongoing, continuous,
dynamic ever-changing process, and many variable continuously affecting the process;
is transactional, both individual affect each other and that human communication is
multidimensional , human communication. It occurs at two levels, 1.content
dimension; 2. Relationship dimension. These two dimensions are inextricably bound
together. The relationships affect the interpretation of the content. To ensure effective
communication, we must make sure that the organization have effective collegial
relationship.
Based on the above definition and assumptions on communication, we carried out a
survey by randomly selecting samples of the target groups: radiologist, radiographer,
nurse, clerical staff to answer the questionnaire. Data were then analyzed to give
insight on communication enhancement proposal.
179
83PC
Study and Utility of Tourniquets for the Femoral Artery Puncture
Jianping Li
Department of Radiography, Affiliated hospital of Binzhou Medical College, China
Objective: To avoid blood vessel complication in the femoral artery puncture.
Methods: The study was done using the traditional operating procedure of the
entrapment hemostasis and the pressure pack for the femoral artery puncture, and the
cross shape entrapment tourniquet was designed, applied in 1504 cases and compared
with the traditional methods.
Results: The rate of the blood vessel complication for the traditional methods was
19.9% in 252 cases and for the cross shape entrapment tourniquet was 3.7%. The
optimal pressure of the entrapment hemostasis and the pressure pack was 28.3kPa and
14.3kPa, respectively. The experiment group relatively has a significant difference
with contrasting the group (p<0.01)
Conclusion: The cross shape tourniquet is a convenient and effective method to avoid
bleeding and hematoma in the femoral artery puncture.
180
84PC
A protective study on asymmetric scan in chest CT examination
Jianping Li
Department of Radiography, Affiliated hospital of Binzhou Medical College, China
Objective To avoid accepting much radiation dose in chest CT scanning．Methods
332 cases were performed chest CT examination with the auto-mA asymmetric scan
in 15months and the radiation dose of the asymmetric scan was compared with one of
the routing CT scan．Results There were 171 cases chest diseases including lung
cancer．Per capita CTD I100 was lowered to 10.17mGy by 26.9mGy and the DLP
was lowered to 198.32mGy by 524.55mGy．The whole reduced dose was5554.3mGy
in this group．Conclusion It can improve the positive rate and reduce the radiation
dose by using the asymmetric CT scan
181
85PC
Study on the effect exposure level has on adjacent organs during
mammography
Yun-park Jae, Hwa-baek Il, Suk-moon Hee, Soo-cho Nam
Samsung Medical Center, Korea
We measured exposure level of the adjacent sensitive organs such as thyroid, eyeball,
ovary and the opposite breast using ion chamber to reduce patient dose in conducting
mammography. According to the distribution and the thickness of breast tissue,
average effective and glandular dose were calculated and analyzed in terms of
exposure parameter such as kVp, mAs, SID. Total of 598 cases were tested for
craniocaudal view using compression paddle in the period between January and June,
2004. We obtained effective dose of 3.56μSv for thyroid, 1.03μSv for eyeball, 0.12
μSv for ovary, and 1.67μSv for the opposite breast in relative to 1.28 mGy AGD for
the exposed breast. Also, we analyzed and demonstrated the distributions of 4
different groups of breast composition, 10 different groups of breast thickness and
accordingly their averaged AGDs for the tested patient. We discussed and concluded
from the data and reached to some valuable points: (1) in the case of the thyroid,
exposure level increases after radiation of thyroid cancer which occurs at the follicular
epithelium, (2) in the case of the ovary, there was found a surprisingly low level of
exposure, (3) the breast tissue of Korean women are rapidly changing, whose fat
layers are getting thicker and more susceptible to exposure as a result, (4) the average
thickness of the breast increases from about 3cm to 4.1 ~4.5cm, and (5) the amount of
exposure to the breast and adjacent organs will increase considerably in near future.
182
86PC
The examination of the Japanese women's psychology regarding to
mammography
Nobutaka Kasuya, Morikazu Amano
Kakegawa City General Hospital, Japan
Introduction: The Japanese women have reserved manner regarding to take off the
upper cloth and to touch their breasts when performing mammography examination.
The present study, we investigated various questionnaires of patient’s psychology
regarding to examine by the different sex technicians.
Method: During April to September in 2003, 256 patients undergoing mammography
were investigated using questionnaires. Before the mammography examination, the
patient had read the directions of how to examination, and to comprehend regarding
the contents of examination. After the mammography examination, the patient had
done the below questionnaires:
1: How do you feel the abhorrence to take off your cloth?
2: Who do you want to examine the mammography next time?
“Male technician or Female technician？”.
Result: Among 251 patients, those who felt to take pictures by upper half of the body
undressing to have resistance were 137 (54%) patients from the result of the
questionnaire. 127 (50%) patients answered that pictures wanted to be taken by a
woman technician next time. But, 124(68%) patients that 183 patients insides were
examined by a man engineer answered that a photography engineer didn't care about
the man, the woman which.
Conclusion: The Japanese women are known as a race whose sense of shame to be
strong. But, it found that it was not necessarily so from last result. It can think that the
understanding of contents of inspection and the considerate correspondence of the
radiological technologists were connected with last result.
183
87NM
Creation of FDG-PET normal database for easy Z-score imaging
system (eZIS)
Seisuke Fukuyama, Naoya Yamamoto, Seiya Hiyama
Kizawa Memorial Hospital, Japan
Purpose: To improve the diagnostic performance of 18-F-fluorodeoxyglucose PET
(FDG-PET) and compare with SPECT data statistically, we created normal database
for FDG-PET.
Material and Method: We collected 73 healthy volunteer of various age generation.
Each volunteer had a routine neurological examination, MRI and blood glucose
measurement on the day of PET. PET was carried out with Advance, which provides
35 images with 4.5 mm intervals. Volunteer was placed in the PET scanner so that
slices parallel to the canthomeatal line after 4 hours fasting. Dose of 0.12 mCi/kg
FDG was administered intravenously. A set of transaxial images was obtained for 7
minutes starting at 40 minutes following the injection. And following transmission
scan for 3 minutes was obtained. Images were reconstructed using OSEM method.
Results: We found 4 volunteer of focal cerebral abnormalities by MRI and 1
hyperglycemia, who were excluded. Finally, we selected 68 volunteer for normal
database. Distibutions of age were 20~29 (age):10(n), 30~39:10, 40~49:11, 50~59:10,
60~69:18 and 70~79:9, respectively.
Discussion: We created site-specific normal databases for FDG-PET, which would be
used statistically to evaluate dementia, brain injury and cerebrovascular disease with
eZIS. After this, we will validate FDG-PET eZIS analysis with this normal database
to compare with SPECT data.
184
88NM
The evaluation of factors which influence binding efficiency of modified
in vivo erythrocyte labeling technique
Han Kyung Seo
Department of Radiotechnology, Seo Hae college, Korea
Purpose: We underwent this study to evaluate the factors which influence labelling
efficiency when modified in vivo erythrocyte labeling technique was used.
Materials and methods: Thirty healthy volunteers (M:F=19:11, age: 25 yrs) were
enrolled in this study. Totally, two hundred ten samples were obtained from them. The
1 mg of stannous pyrophosphate was injected intravenously at the beginning of
labeling. After suitable tinning time (5 min, 20 min, 35 min) passed by, blood (5 mL,
3 mL or 1 mL) was withdrawn into 10 mL syringe previously containing Tc-99m (740
MBq) and anticoagulant (heparin, ACD or CPDA) through 19-gauged scalp needle.
The generator ingrowth time of Tc-99m was within 24 hrs in each case. The blood
samples were placed on rotating invertor during incubation (10 min, 25 min, 40 min)
but some of them were not. Immediately after the conclusion of incubation, the
labeled blood specimens to analyze were centrifuged. And then %Unbound Tc-99m
was calculated. Statical analysis was used paired T-test and one way ANOVA with
SPSS 10.0.
Results: The binding efficiency at 1 mL of blood volume was 73%, 91% at 3 mL and
96% at 5 mL (p<0.01). The binding efficiency at 5 min of tinning time was 45%, 98%
at 20 min and 97% at 35 min (p<0.001). The binding efficiency at 10 min of
incubation time was 96%, 95% at 25 min and 98% at 40 min (p>0.05). The binding
efficiency in case of using rotating invertor was 96% and the binding efficiency in
case of not using it was 87% (p>0.05). There was no significant difference between
them. In binding efficiency according to kinds of anticoagulants, ACD was 98%,
CPDA was 97% and heparin was 89??20% (p<0.001).
Conclusion: When modified in vivo erythrocyte labeling technique is used with Tc99m, the methods to obtain the highest labeling efficiency are as follow. The
withdrawing blood volume should be over 3 mL, tinning time should be kept between
20 min and 35 min, and incubation time should be kept between 10 min and 40 min.
ACD or CPDA have to be used as a anticoagulant except heparin and the blood
samples should be placed on rotating invertor during incubation.
185
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