D. M. Flinton

The use of Compton scattering to differentiate between classifications of normal and diseased breast tissue.

This study describes a technique for measuring the electron density of breast tissue utilizing Compton scattered photons. The Kalpha2 line from a tungsten target industrial x-ray tube (57.97 keV) was used and the scattered x-rays collected at an angle of 30 degrees . At this angle the Compton and coherent photon peaks can be resolved using an energy dispersive detector and a peak fitting algorithm. The system was calibrated using solutions of known electron density. The results obtained from a pilot study of 22 tissues are presented. The tissue samples investigated comprise four different tissue classifications: adipose, malignancy, fibroadenoma and fibrocystic change (FCC). It is shown that there is a difference between adipose and malignant tissue, to a value of 9.0%, and between adipose and FCC, to a value of 12.7%. These figures are found to be significant by statistical analysis. The differences between adipose and fibroadenoma tissues (2.2%) and between malignancy and FCC (3.4%) are not significant. It is hypothesized that the alteration in glucose uptake within malignant cells may cause these tissues to have an elevated electron density. The fibrotic nature of tissue that has undergone FCC gives the highest measure of all tissue types.

Continuing professional development — a re-examination of the facts

This article reviews research published over the last 15 years, exploring the various components of Continuing Professional Development (CPD) and considers why it is important and whose responsibility it is. The style that CPD should take to maximize participation and effectiveness and the expected benefits and practical problems associated with CPD are issues that are raised. A modified definition of CPD is put forward which not only allows for flexibility of input but also considers the impact on clinical practice.

Preliminary findings on the Virtual Environment for Radiotherapy Training (VERT) system: simulator sickness and presence

Background: Virtual environments in medical education are becoming increasingly popular as a learning tool. However, there is a large amount of evidence linking these systems to adverse effects that mimic motion sickness. It is also proposed that the efficacy of such systems is affected by how well they engage the user, which is often referred to as presence. Purpose: This primary purpose of this study was to look at the side effects experienced and presence in the Virtual Environment for Radiotherapy Training (VERT) system which has recently been introduced. Method: A pre-VERT questionnaire was given to 84 subjects to ascertain general health of the subjects. The simulator sickness questionnaire was utilised to determine the side effects experienced, whereas the igroup presence questionnaire was used to measure presence. Both questionnaires were given immediately after use of the VERT system. Results: The majority of symptoms were minor; the two most commonly reported symptoms relating to ocular issues. No relationship was seen between simulator sickness and presence although subjects with a higher susceptibility to travel sickness had reported higher levels of disorientation and nausea. There was also a decrease in involvement with the system in subjects with a higher susceptibility to travel sickness.

Transvaginal ultrasound simulation and its effect on trainee confidence levels:a replacement for initial clinical training?

Introduction The ScanTrainer transvaginal ultrasound simulator has been developed to facilitate initial training of transvaginal ultrasound skills without patient contact. Due to the intimate nature of the examination and in some cases, limited training opportunities, the need for simulation-based education in ultrasound has gained momentum. Currently, research into the effectiveness of the ScanTrainer is limited. Methods A mixed method study was conducted in a single institution between October 2011 and January 2012. Participants were recruited using convenience sampling and allocated to the control (clinical training) or experimental (simulation training) group following a pre-test. After 10 hours of their allocated transvaginal ultrasound training method a post-test assessment was conducted and the results statistically analysed. Participants then experienced the alternative method of training and completed questionnaires. The results were used to inform semi-structured interviews for each group. Interview transcripts were interpreted using theme analysis. Results A small number of doctors completed the study, nine (82%) out of the 11 recruited. The majority of participants (89%) felt that practice on the ScanTrainer can increase confidence prior to attempting a real transvaginal ultrasound scan. Average scores showed that the simulation training group outperformed the clinical training group on overall score and each of the five post-test components. No statistically significant differences were demonstrated for overall score (U = 13, P = 0.556) or the five components (P = 0.190–1). Conclusions Transvaginal ultrasound training on the ScanTrainer has the potential to replace initial clinical training; however, further larger trials are required to evaluate. Clinically significant outcomes exist if the ScanTrainer training is proven to be more effective than initial clinical training. The ScanTrainer prepares a trainee and builds confidence to progress to clinical scanning, which has the potential to improve the patient experience.

Competency based Assessment Using a Virtual Environment for Radiotherapy

Abstract: Virtual reality in the form of VERT (Virtual Environment for Radiotherapy) has been used for radiography training since 2007. The system is a back projection system that allows the user to work within a 3D radiotherapy treatment room interacting with the room via a machine hand pendant which allows full control of the unit as in real life. With the demands within the profession and Higher Education both constantly changing we have to constantly re-evaluate our teaching and assessments in order to give the students the best learning experience whilst measuring their competencies against set professional criteria. Method: The study was a mixed methods design consisting of a randomized crossover study of 52 subjects undertaking the Radiotherapy programme at City University who were asked to undertake a simulated electron setup on both VERT and a phantom in a radiotherapy treatment unit. This was followed by focus group interviews to consider the students perspective of using VERT in this way. Subjects also completed an immersive tendencies questionnaire and presence questionnaires. Results: The results presented are from an interim analysis based on their first setup. Results indicate significantly better performance on the real treatment unit (5.23) compared to VERT (3.62) p<0.001. The focus groups also reported that they felt VERT was not suitable as a measure of competency, but felt it could be used very effectively as a training tool for setups if the final assessment was on the treatment unit

Can teaching ultrasound ergonomics to ultrasound practitioners reduce white knuckles and transducer grip force

Ergonomic training is necessary to help reduce work-related upper limb disorders (WRULD) in sonographers. This study provided an ergonomic training session for sonographers, to determine whether a teaching intervention changed the grip force used to hold a transducer. Thirteen practitioners participated and were placed into two groups (intervention group n = 7). Participants were asked to scan the same simulated transabdominal early pregnancy case. An ergometer was used, which enabled all participants to hear the effect of holding the transducer tightly. Their matched grip force was measured before and after the intervention using a dynamometer. The intervention group reviewed videos and photographs taken during the scan to see if this affected the matched grip force further. Study findings showed that the short ergonomic training session with the use of an ergometer significantly reduced the matched grip force applied to a transducer (P < .05) for all participants. The video/photo review did not result in any further significant changes.