THE EFFECT OF FAMILY AND WORKPLACE CHARACTERISTICS ON THE BURNOUT LEVEL OF RADIOGRAPHERS WORKING IN ONCOLOGY PATIENT CARE

Purpose: The aim of our study was to explore the burnout rate of radiographers working in oncology patient care. Materials and methods: Our cross-sectional, targeted non-random sampled research was carried out from June 2018 to September 2018. We used the Maslach Burnout Inventory supplemented with our own questionnaire for online data collection. In addition to demographic aspects, we collected data about job characteristics to examine predictors of burnout. Statistical analysis was performed using descriptive statistics, two-sampled t-test, analysis of variance, Mann-Whitney test and Kruskal-Wallis test were used at 95% confidence level (p=0.05). Results: We analyzed the data of 72 radiographers working in oncology patient care (n=72) and 332 radiographers working in other fields of patient care (n=332). Radiographers working in oncology patient care were characterized by a significantly increased value of emotional exhaustion (p=0.001). Respondents who were single, provided monthly on-call duty and held university degree showed depersonalization (p=0.001). The presence of a secondary job, working more than 40 hours of work per week and active participation in on-call duty services had a negative effect on emotional exhaustion (p=0.001). Respondents with more than one child in their household showed a significantly better value of personal accomplishment (p=0.001). The subjective assessesment of poor financial status had negative effect on all three dimensions of burnout (p=0.001). Conclusion: The mean values of the emotional exhaustion of radiograhers working in oncology patient care increased significantly. The observed elevated value of personal accomplishment shows a sign of positive feedback coming from the patients towards the radiographer.

ANODE HEEL EFFECT ATTENUATION IN LUMBAR SPINE RADIOGRAPHY: CAN THE USE OF ALUMINIUM FILTERS IMPROVE CLINICAL PRACTICE OF RADIOGRAPHERS?

Purpose: The aim of this study was to design an aluminium-based filter to reduce the anode heel effect in lumbar spine radiographs. Methods: Initially, lumbar spine examinations were observed in a public imaging department to determine the standard exposure parameters. Then, the characterization of the anode heel effect was made using the Unfors Xi R/F detector and based on the data collected, aluminium filters were designed with a wedge shape, with thicknesses ranging from 0.1 to 4.0 mm. The assessment of the entrance skin dose (ESD) reduction was performed on the anthropomorphic phantom, with and without filters, using the universal dosimeter UNIDOS E equipped with an ionization chamber. Lastly, the image quality assessment was performed with the Pehamed Phantom Digrad A+K and image quality surveys were applied to radiographers and radiologists. Results and Discussion: Uniformity of the beam was achieved, especially with the filter number 2, which presents a significant variation of 9% between cathode and anode side. This filter contributes to ESD reduction of 35% and 36% for AP and lateral projection, respectively. Also, according to the radiographers and radiologists, it improves the image quality of lumbar spine radiography. Conclusion: The use of aluminium filters can be advantageous in the clinical practice of radiographers when carrying out lumbar spine radiographs, since it allows to standardize the anode heel effect, reducing the radiation dose to the patient and without compromising the image quality.

COMPARISON OF DIAGNOSTIC AND RADIOTHERAPY PLANNING PROTOCOLS IN LUNG CANCER TREATMENT

Purpose: The purpose of the study was to compare a standard diagnostic protocol for computed tomography imaging on a positron emission tomography scanner at the Department of Nuclear Medicine, and a radiotherapy imaging protocol for pre-planning needs in radiotherapy for lung cancer treatment, to determine the differences between these two protocols and to propose possible improvements in the dose optimisation for computed tomography imaging in a radiotherapy protocol. Methods: In this retrospective study, data were collected via the SyngoVia program and statistically analysed according to the patient dose load in computed tomography imaging in standard and radiotherapy protocols. The analysis encompassed data on a total of 56 patients in the period from 1 January 2017 to 1 December 2018. We compared data on patient dose load in computed tomography imaging in a standard protocol before and after the introduction of the improved sinogram-affirmed iterative reconstruction method (SAFIRE). Results and discussion: It was established that there are statistically significant differences in dose per patient (p<) in computed tomography imaging in standard and radiotherapy protocols. Statistically significant differences were also established in computed tomography imaging in the standard protocol before and after the introduction of the improved iterative reconstruction method (p=0,001). Dose load on the lung in computed tomography imaging was 67.5% lower in the standard protocol with the iterative reconstruction in image space (IRIS) method than in the radiotherapy protocol. The introduction of the improved SAFIRE method additionally lowered the dose per patient by 34.2% compared to the IRIS method. Conclusion: In the future, the introduction of the improved iterative reconstruction method is possible for the reconstruction of tomographic images, including for radiotherapy imaging protocol that takes into account the impact of the indirect reduction in the dose on the accuracy of the identification of tumour target volumes when planning radiation treatment for the patient. Key words: positron emission tomography with computed tomography, iterative reconstruction, dose optimization, lung cancer, radiation treatment planning

IDENTIFICATION OF OCCUPATIONAL STRESSORS AMONGST RADIOGRAPHERS

Purpose: The aim of this research is to defi ne stress and correlated factors and identify which stressors are present among radiographers in relation to their workplace. Methods: A total of 450 radiographers received a questionnaire that covers a variety of workplace stressors, which conditions aff ect stress, how frequently radiographers notice stress and to what extent they use coping mechanisms. The online survey was available on the website 1ka and the results were analysed using the IBM SPSS program. Results: A total of 236 radiographers completed the survey (52.4% response rate). Interpersonal relations and management staff cause the highest level of stress, while the most important stressor is a conflict with a supervisor (3.38). Radiographers who work in a field of radiotherapy perceive the most stress. There is no difference between a healthcare activity in relation to levels of perceived stress. We could not identify any statistically significant differences in perceived stress in relation to gender or age (p?0.05). Radiographers who asses their relationship with co-workers and supervisors as good perceive lower levels of stress. Additionally, the same results are present with radiographers who are satisfied because they work in a multidisciplinary team (p?0.05). Teaching new staff has a positive correlation with occupational stress development. Unnecessary radiological procedures, along with unclear roles, have no effect on the development of stress behaviour (p>0.05). However, a conflict between roles has a major association (p?0.05) with stress occurrence. The most frequent methods for reducing symptoms of stress are caring for one’s health and physical appearance (3.77). It proved that communication with patients and duty work (p<0.05) represent significant elements of the workload. Most radiographers think that physical conditions in the workplace could be improved. Discussion and conclusion: The results show that radiographers notice a variety of stressors in their workplace. The most important are related to interpersonal relations. Further research should include analysis of stress within particular fields of radiography that would help to explain occupational stress.

HOW DOES THE REDUCTION OF GLANDULAR TISSUE EFFECT THE FORCE AND BREAST THICKNESS IN MAMMOGRAPHY?

Purpose: To determine whether breast thickness decreases with menopause after the reduction of glandular tissue. We also wanted to know how the decrease in breast thickness affects the compression force and the average glandular dose. Methods: In this project, we collected data regarding the compression force, breast thickness and mean glandular dose of 300 patients who had mammographic imaging in two views: CC (craniocaudal) and MLO (mediolateral oblique) view. The data were divided into three age groups: 100 patients aged 50 to 55, 100 patients aged 60 to 65 and 100 patients aged 70 to 75 years. We used basic statistical tests for measurement purposes, while we used the Shapiro–Wilk test to check normality and the Kruskal–Wallis test to compare the differences. Results and discussion: We presented the results and comparisons in the tables and box plot graphs for CC and MLO views of the left and right breast for compression force, breast thickness and MGD. In the CC view of the both breasts, we found that there were statistically signifi cant differences in thickness between groups 1 and 3, and differences in MGD between groups 1 and 2, and 1 and 3. In the MLO view of both breasts we found that compression force does not increase with the age of patients, which can be attributed to the different size and density of breasts, and different compression force. Higher compression force results in lower MGD and breast thickness. Conclusion: In the CC view of left and right breast, there is no statistically signifi cant differences in compression force, but thickness and MGD changed between some groups. In the MLO view, only MGD changed. For further research, we recommend taking measurements on a larger sample, and concurrently considering and examining other factors that may affect breast thickness, compression force and MGD.

IMPACT OF ACQUISITION PARAMETERS ON THE QUANTITATIVE ASSESSMENT OF PET IMAGING – ANALYSIS OF THE NEMA PHANTOM

Aim: The aim of the research was to analyse the most common factors that influence SUV values. Material and methods: In the study, I used a NEMA body phantom filled with a mixture of water and 18F-FDG in a ratio 1:4 (background/spheres), and analysed the most common factors that influence SUV values. The most common factors include the impact of the patient's body weight, the impact of time between application and PET/CT imaging, and the impact of differently prepared and administered RP activities. Results: Different values of patient body weight, time between application and PET/CT imaging, and differently prepared and administered RF activities have a statistically significant effect on the quantitative assessment of SUVmax (p < 0.001) and SUVmean (p < 0.001). Conclusion: The results showed that all factors can significantly influence the quantitative assessment of SUVmax and SUVmean.

TWO CASES OF MRI-INDUCED SKIN BURNS

Materials and methods: Both cases were imaged using a GE Optima™ MR450w 1.5T scanner. A combination of anterior and posterior arrays were used. In both cases, patients were placed in the headfi rst prone position. Results and discussion: In the fi rst case, there was a red area on the skin and a white blister appeared after 15 minutes. A closed conducting loop was created in the patient’s body, which caused increased local temperature at the junction of her thighs. We could prevent this by using insulation, such as foam pads, which is one of eight steps for preventing MRI-induced skin burns. In the second case, there were red spots on the skin of the left and right thighs at the contact of the scrotum where a white blister appeared after 15 minutes. This could not have been prevented, even if we considered all the steps for preventing MRI-induced skin burns. Conclusion: I reported a case of burns on a small area of skin at the junction of the patient’s thighs, which we could have prevented by using insulation pads, and a case of burns on the skin at the contact of the scrotum, which we could not have prevented, even if we considered all the steps for preventing MRI-induced skin burns. However, we could have stopped the increase in the degree of the burn by recognising early signs.

MAGNIFICATION ERROR IN RADIOGRAPHS OF CERVICAL SPINE IN LATERAL PROJECTION

Purpose: The main purpose of this study was to determine how the distance between the cervical spine and the image receptor on the one hand and the distance between the source and the image receptor on the other aff ects the image size of the cervical vertebrae. Moreover, it was important to understand how the entrance skin dose varies when the distance between the object to image receptor and the distance source to image receptor changes. Methods: The theoretical part of this study was carried out based on an analysis of the readings, the practical part was carried out on a head, neck and trunk phantom at the radiological laboratory of the Faculty of Health Sciences (University of Ljubljana). Results: When the object to image receptor distance (OID) was increased from 24 to 39 cm, the image size of the vertebra increased by 23% at a source to image receptor distance (SID) of 115 cm. At an SID of 150 cm, it increased by 17% and by 11% at an SID of 180 cm. When SID was decreased from 150 to 115 cm at an OID of between of 24 and 29 cm, the entrance skin dose increased by 26%. As the OID was increased further, the entrance skin dose (ESD) was even higher. Similarly, the ESD decreased with an increase in SID. For example, when SID was increased from 150 to 180 cm at an OID of between 24 and 29 cm, the ESD decreases by 8.5%. Discussion and conclusion: The results indicate that the lateral radiography of the cervical spine should be performed at a SID of 150 cm. By doing so, it is assured that a proper image size is obtained, and the entrance skin dose is not harmful to the patient.