Projection radiography of the ankle; the views used for different indications vary between medical imaging departments

Plain radiographs are used for initial evaluation of many conditions of the ankle. Many different radiographic views are described in positioning textbooks but evidence on which views to use, in which case, is scarce. The aim of this study was to map imaging procedures related to four indications for ankle projection radiography. A questionnaire was sent to all medical imaging departments in Iceland with questions about acquisition technique for ankle radiography views and which views were used for selected indications. Answer was received from 14 of the 28 departments. All departments gave very similar descriptions of the four most common views. In the case of trauma, all but one department used four views but for control of trauma or operation, four different combinations of views were found using from two to four images. For detrition and osteomyelitis, four views were more common in the larger departments but there was not a statistically significant difference. Eight different combinations of the number of views for the four indications were found. The study indicates that there is a need for standardization in image acquisition protocols. More studies are needed to support decisions about how many views are necessary for the most common ankle radiography indications.

Radiographer-led Discharge for Emergency Care Patients, Requiring Projection Radiography of Minor Musculoskeletal Injuries: a Scoping Review

BackgroundPressure on emergency departments (ED) from increased attendance for minor injuries has been recognised in the United Kingdom. Radiographer-led discharge (RLD) has potential for improving efficiency, through radiographers trained to discharge patients or refer them for treatment at the point of image assessment. This review aims to scope all RLD literature and identify research assessing the merits of RLD and requirements to enable implementation.MethodsWe conducted a scoping review of studies relating to RLD of emergency care patients requiring projection radiography of minor musculoskeletal injuries. MEDLINE, Embase and CINAHL, relevant radiography journals and grey literature were searched. Articles were reviewed and the full texts of selected studies were screened against eligibility criteria. The data were extracted, collated and a narrative synthesis completed. ResultsNine studies with varying study designs were included in the review. The small number of studies was possibly due to a generally low research uptake in radiography. The main outcome for five studies was reduced length of stay in ED, with recall and re-attendance to ED a primary outcome in one study and secondary outcome for three other studies. The potential for increased capacity for ED staff was recognised. Radiographers identified a concern regarding the risk of litigation and incentive of increased salary when considering RLD. The studies were broadly radiographer focussed, despite RLD spanning ED and Radiology.ConclusionThere were a low number of RLD active radiographers, likely to be motivated individuals. However, RLD has potential for generalisability with protocol variations evident, all producing similar positive outcomes. Understanding radiography and ED culture could clarify facilitators for RLD to be utilised more sustainably into the future. Cost effectiveness studies, action research within ED, and cluster randomised controlled trial with process evaluation are needed to fully understand the potential for RLD. The cost effectiveness of RLD may provide financial support for training radiographers and increasing their salary, with potential future benefit of reduction in workload within ED. RLD implementation would require an inter-professional approach achieved by understanding ED staff and patient perspectives and ensuring these views are central to RLD implementation.

Geometric validation of a computer simulator used in radiography education

Objectives: The radiographical process of projection of a complex human form onto a two-dimensional image plane gives rise to distortions and magnifications. It is important that any simulation used for educational purposes should correctly reproduce these. Images generated using a commercially available computer simulation widely used in radiography education (ProjectionVRTM) were tested for geometric accuracy of projection in all planes. Methods: An anthropomorphic skull phantom was imaged using standard projection radiography techniques and also scanned using axial CT acquisition. The data from the CT was then loaded into the simulator and the same projection radiography techniques simulated. Bony points were identified on both the real radiographs and the digitally reconstructed radiographs (DRRs). Measurements sensitive to rotation and magnification were chosen to check for rotation and distortion errors. Results: The real radiographs and the DRRs were compared by four experienced observers and measurements taken between the identified bony points on each of the images obtained. Analysis of the mean observations shows that the measurement from the DRR matches the real radiograph +1.5 mm/−1.5 mm. The Bland Altman bias was 0.55 (1.26 STD), with 95% limits of agreement 3.01 to −1.91. Conclusions: Agreement between the empirical measurements is within the reported error of cephalometric analysis in all three anatomical planes. The image appearances of both the real radiographs and DRRs compared favourably. Advances in knowledge: The commercial computer simulator under test (ProjectionVRTM) was able to faithfully recreate the image appearances of real radiography techniques, including magnification and distortion. Students using this simulation for training will obtain feedback likely to be useful when lessons are applied to real-world situations.

Image Calibration Based on Dynamic No-Load Data for the 60Co Gantry-Movable Dual-Projection Radiography Inspection System

The 60Co gantry-movable dual-projection radiography inspection system is newly developed, aiming to the inspection of vehicles entering and exiting the nuclear facilities. It adopts two Co-60 radioactive sources and two arrays of gas ionization chambers corresponding to the two sources, respectively. They can move synchronously with the gantry driven by the mechanical and control subsystem. So, dual projections could be obtained through one scan from two different directions. Compared to a single projection, the dual projections make it easier to found hidden objects and distinguish whether a dark area is due to overlapping objects or because there are well-shielded prohibited items such as nuclear materials. Therefore, it is helpful to found well-shielded nuclear materials and prevent them from being stolen. However, problems also come due to the using of two radioactive sources and the moving gantry. For the former one, it will bring about scattering effect between two sources, while for the latter one, the signals of the detectors would fluctuate as the gantry moves, owing to the vibration of collimator and gantry as well as the non-synchronous movement of sources and detectors. So, the radiography projections are needed to be corrected. In response to the second question, the no-load data is repeatedly measured when the gantry is in different positions, then a method of image calibration based on the dynamic no-load data is proposed for this inspection system to replace the correction with average no-load data. Result shows that the corrected no-load image turns smoother, meaning that the method of dynamic correction could effectively improve the radiation image.