S. L. McFadden

Potential Irish dose reference levels for cardiac interventional examinations

Collective dose for cardio-angiography studies is the highest of all non-CT radiological investigations. Deterministic effects such as erythema, epilation and ulceration being reported on patients who have undergone these procedures emphasise the importance of optimising radiation dose, whilst not compromising diagnostic efficacy. This study investigated radiation doses delivered to patients for four common types of cardiac radiological examinations: coronary angiography (CA), percutaneous coronary intervention (PCI), coronary angiograms (which were followed by an interventional procedure (CA-PCI)) and permanent pacemaker insertions (PPIs). 21 cardiac imaging suites participated in the study in 14 hospitals, representing 90% of relevant centres within Ireland. Radiation dose was monitored for 1804 adult patients using dose-area product meters. Operational and examination details, such as cardiologist grade, patient details, examination complexity and exposure factors, were recorded for each examination. Variation factors in dose between centres ranged from 2.7 to 11.1, but these factors were not higher than intrahospital variations previously recorded for other examinations within Ireland, such as chest X-ray. High-dose centres were often associated with long screening times, a high patient body mass index and complexity of the procedure. Preliminary dose reference levels (DRLs) were established using rounded third quartile values at 4200 cGy cm(2), 8400 cGy cm(2), 10,700 cGy cm(2) and 2100 cGy cm(2) for CA, PCI, CA-PCI and PPI, respectively. With these commonly performed relatively high-dose procedures, it is important that some guideline values are available to encourage optimised strategies. These proposed DRLs offer such guidance.

Digital training platform for interpreting radiographic images of the chest

INTRODUCTION Time delays and errors exist which lead to delays in patient care and misdiagnosis. Reporting clinicians follow guidance to form their own search strategy. However, little research has tested these training guides. With the use of eye tracking technology and expert input we developed a digital training platform to be used in chest image interpretation learning. METHODS Two sections of a digital training platform were planned and developed; A) a search strategy training tool to assist reporters during their interpretation of images, and B) an educational tool to communicate the search strategies of expert viewers to trainees by using eye tracking technology. RESULTS A digital training platform for use in chest image interpretation was created based on evidence within the literature, expert input and two search strategies previously used in clinical practice. Images and diagrams, aiding translation of the platform content, were incorporated where possible. The platform is structured to allow the chest image interpretation process to be clear, concise and methodical. CONCLUSION A search strategy was incorporated within the tool to investigate its use, with the possibility that it could be recommended as an evidence based approach for use by reporting clinicians. Eye tracking, a checklist and voice recordings have been combined to form a multi-dimensional learning tool, which has never been used in chest image interpretation learning before. The training platform for use in chest image interpretation learning has been designed, created and digitised. Future work will establish the efficacy of the developed approaches.