Introduction: Medical imaging's critical role in diagnosis requires prompt and precise image interpretation. Numerous radiology departments, especially in low-resourced settings, encounter challenges such as a shortage of radiologists in their operational setup. This study explored the perceptions of radiographers and radiologists from low-resourced departments in a single country regarding operational challenges and potential solutions in image interpretation. Methods: A qualitative approach was utilised, involving heads of departments, senior radiographers, and radiologists with a minimum of 5 years of experience, from three major state referral hospitals. Face-to-face, semi-structured interviews were conducted in November 2022, using an interview guide that included questions on the challenges encountered during image interpretation and the proposed solutions. Data analysis was conducted using Atlas.ti version 9.0, following the four-step content analysis method. All participants willingly provided consent to participate in the study. Results: Ten participants, comprising two radiologists and eight radiographers participated in the study. The research identified three main themes: image interpretation pathways, image interpretation operational challenges and proposed solutions for image interpretation. In addition, a total of 10 subthemes were generated from the three main themes. Conclusion: The study revealed critical challenges and the need to explore the formal inclusion of radiographers in image interpretation, as a way to improve efficiency. However, a comprehensive assessment of the image interpretation system, encompassing radiographers' knowledge and competence, is recommended for context-specific, empirical-based modifications to enhance service provision.

INTRODUCTION:Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers. METHODS:A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9). RESULTS:Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system. CONCLUSION:Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges. IMPLICATIONS FOR PRACTICE:There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers.

A manual radiation dose management system was developed to track the radiation dose and scan parameters of patients for brain computed tomography (CT). Radiation dose in volume computed tomography dose index (CTDIvol) and dose length product (DLP) were monitored to identify procedures that may require optimisation using notification values. The data were analysed and compared with national and international diagnostic reference levels (DRLs). A total of 596 brain CTs were monitored and grouped as <1: 36, 1-<5: 38, 5-<10: 25, 10-<15: 31 and adult: 466. The CTDIvol notification value identified the following number of examinations having high CTDIvol in <1 y: 1, 1-<5: 1, 5-<10: 0, 10-<15: 0 and adult (>15): 11. Furthermore, the DLP notification values identified the following examinations with high DLP in <1 y: 1, 1-<5:1, 5-<10:1, 10-<15: 1 and adults (>15): 18. The established local paediatric DLP DRLs were 2-3 times higher than the international paediatric DLP DRLs. This calls for a total protocol review and optimisation considering the local CT practices for paediatric imaging.

Introduction Radiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging. Objective To determine radiographers’ and radiologists’ awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians. Methods Radiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval. Results The response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited. Conclusion The study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.

Introduction: Radiographers extend their roles through formal and on-the-job training to keep up with clinical practice changes. One area of role extension that is now incorporated into undergraduate programmes is image interpretation, although the training provided may vary between institutions. This study explored the experiences of graduates from one higher education institution in a low-resource context with regard to their image interpretation training.Methods: A qualitative phenomenological research design was employed to investigate the experiences of ten radiography graduates who were purposively selected from one higher education institution. Individual semi-structured interviews were conducted with each participant after obtaining their informed consent. The interview recordings were transcribed and analysed using Atlas.ti Windows (Version 9.0) software, following Colaizzi's seven-steps of data analysis.Results: From the ten interviews conducted, teaching approach, clinical education, and assessment strategy emerged as areas of experience within the teaching and learning theme, while practitioner role modelling, skill utilisation, and industry impact were sub-themes under the paradoxical reality theme. The participants' experiences indicated a theory-practice gap in image interpretation among radiographers.Conclusion: The participants' experiences reflected a misalignment in the educational process due to inadequacies in the teaching approach, clinical education, and assessment strategies. Participants encountered significant differences between their expectations and clinical realities during and after training. Image interpretation by radiographers was recognised as a relevant area for role extension in this low-resource setting. Implications for practice: While these findings are specific to the experiences of the participants, conducting similar research in comparable contexts and implementing competency-based image interpretation assessments could help identify gaps and guide interventions to address shortcomings.(c) 2023 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

A systematic literature review was carried out to explore articles that reported the use of radiation dose management systems (RDMSs) in computed tomography (CT). The preferred reporting items for systematic review and meta-analysis flow chart were used to screen articles in PubMed, EBSCOhost, Web of Science, SCOPUS and Cochrane Library. A total of 1041 articles were retrieved and screened. After evaluation against criteria, 38 articles were selected and synthesised narratively. The results revealed that several RDMSs have been used in CT. The review also indicated that the use of RDMSs has promoted the implementation of diagnostic reference levels for dose optimisation. A RDMS, such as DoseWatch, is associated with compatibility challenges and failure in data transmission, while manual RDMSs are cumbersome and prone to data entry errors. Thus, a robust automated RDMS that is compatible with the different CT systems would provide efficient CT dose management.

Background: The radioguided occult lesion localisation (ROLL) technique was introduced at Groote Schuur Hospital in 2003 replacing the wire-guided localisation (WGL) technique. In the case of preoperative histologically proven impalpable breast cancers, a sentinel lymph node (SLN) biopsy was done simultaneously (sentinel node [SN] with occult lesion localisation or SNOLL). Aim: To assess the efficacy of the ROLL and SNOLL techniques for diagnostic and therapeutic excisions. Setting: A retrospective record analysis of 190 patients who underwent a ROLL procedure for diagnostic or therapeutic excision of occult breast lesions was performed at a large tertiary hospital in the Western Cape. Methods: Data were collected on patient and tumour characteristics, successful localisation rates, the volume of tissue removed, complete tumour resection rates, the number of re-operations performed and the proportion of SLN detection. The Pearson’s chi-squared test was used to test for significance between variables at α = 0.05. Results: Correct radiopharmaceutical placement was achieved in 177/190 (93.2%) lesions. Histologic examination of excised specimens confirmed 115/190 (61.0%) malignant and 75/190 (39.0%) benign lesions. Involved margins were found in 37/115 (32.2%). Complete excision with adequate margins occurred in 50/70 (71.4%) of cases of invasive cancer and in 11/45 (24.4%) of ductal carcinoma in situ (DCIS). The SN was successfully identified in 30/37 (81.1%) of SNOLL cases. Conclusion: Radioguided occult lesion localisation is an effective tool in the preoperative localisation of occult lesions for surgical biopsy as well as the removal of impalpable breast cancers. A single intratumoural injection with 99m Tc nanocolloid combined with lymphoscintigraphy is a reliable method of localising the SN.

Introduction: In health professions education (HPE), focus is placed on developing clinically competent practitioners who can function within their professional scope in a broad range of health care contexts. In this study, the authors investigated diagnostic radiography lecturers' understanding of how students become socially responsive. The concept of 'critical consciousness' was explored as an intervention of being a transformer in the local environment. This places focus on learning and teaching that aims to develop radiography graduates who are critically conscious, such that they can take up the challenges of healthcare in their environment, in addition to being clinically competent in their field. The study under discussion therefore sought to find out how radiography lecturers understand a socially responsive curriculum at a University of Technology in the South African context. Method: A qualitative, exploratory design was used where curriculum documents were reviewed and from which stimulus points were identified for a semi-structured focus group interview with radiography lecturers followed by five individual interviews. All interviews were audio-recorded, transcribed, coded and analysed through a process of thematic analysis. Results: Four dominant themes emerged from the analysis, namely i) diverse understandings of critical consciousness, ii) becoming a reflective practitioner, iii) a need for curriculum transformation and iv) emerging pedagogies. Conclusion: Critical reflection by both the radiography students and lecturers is key to developing social awareness and critical consciousness which could drive critical motivation and critical action to effect social change. It is recommended that the current curriculum should be reviewed and transformed to include constructive reflective practice. Implications for practice: Dedicated time should be scheduled, in the curriculum, to allow students and lecturers to engage in meaningful constructive reflection to enhance socially responsive practice. (C) 2022 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Introduction: Measures of adiposity are related to cardiovascular disease risk, but this relationship is inconsistent in disease states, such as chronic kidney disease (CKD). This study investigated the relationship between adiposity and blood pressure (BP) by CKD status. Materials and Methods: South Africans of mixed-ancestry (n=1,621) were included. Estimated glomerular filtration rate (eGFR) was based on the modification of diet in renal disease (MDRD) equation, and CKD defined as eGFR <60mL/min/1.73m(2). Body fat distribution was assessed using anthropometry [body mass index (BMI) and waist circumference (WC)] and dual-energy x-ray absorptiometry (DXA) (n=152). Pulse pressure (PP) and mean arterial pressure (MAP) were calculated from systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: In participants without CKD, anthropometric and DXA-derived measures positively correlated with SBP, DBP, MAP and PP (p<0.02 for all), except for leg fat mass (LFM), which was not associated with BP indices (p>0.100 for all). Contrary, in prevalent CKD (6%, n=96), only BMI was inversely associated with PP (p=0.0349). In multivariable analysis, only BMI and WC remained independently associated with SBP, DBP and MAP in the overall sample. Notably, the association between BMI, WC and LFM with SBP and PP, differed by CKD status (interaction: p<0.100 for all), such that only BMI and WC were associated with SBP in those without CKD and inversely associated with PP in those with CKD. LFM was inversely associated with SBP and PP in those with CKD. Conclusion: In people without CKD, BP generally increases with increasing measures of adiposity. However, excess body fat has a seemingly protective or neutral effect on BP in people with CKD.

Background Visceral adipose tissue (VAT) accumulation is a known risk factor for cardiometabolic diseases. Efficient imaging modalities are necessary to quantify VAT. The study assessed the agreement between dual-energy x-ray absorptiometry (DXA) and single-slice computed tomography (CT) for abdominal fat quantification in mixed-ancestry South African women, and determined if this differed by body mass index (BMI) categories. Methods VAT and abdominal subcutaneous adipose tissue (SAT) were measured using single-slice CT and DXA in 132 women aged 55 (45–64) years. Participants were categorised as normal weight (BMI < 25 kg/m 2 ), overweight (BMI: 25–29.9 kg/m 2 ) and obese (BMI ≥ 30 kg/m 2 ). Pearson correlation coefficients and Bland–Altman analysis were used to determine agreement between the two measurements. Results Two thirds of the participants were obese. DXA and CT-derived measurements of abdominal VAT and SAT were significantly correlated in the overall sample ( r = 0.872 and r = 0.966, both p < 0.001, respectively) and within BMI categories. DXA overestimated VAT and SAT in the overall sample and across BMI categories. In the overall sample, the mean difference (DXA–CT estimates) was 75.3 cm 2 (95% CI: 68.8–81.8 cm 2 , p ≤ 0.0001) for VAT and 54.7 cm 2 (47.1–62.3 cm 2 , p ≤ 0.0001) for SAT. Within increasing BMI categories, the variance between the two modalities was fixed for VAT ( p = 0.359 for obese), whereas the variance for SAT was heteroscedastic ( p ≤ 0.0001). Conclusions DXA overestimated VAT and abdominal SAT in a sample of middle-aged mixed-ancestry South African women. VAT variance was fixed in the obesity category, an indication that DXA may be valid in measuring VAT in obese people.

Background A number of studies have shown central adiposity, in particular visceral adipose tissue (VAT) accumulation to be a hallmark of metabolic syndrome (MetS). In clinical practice, waist circumference (WC) is used as a proxy for VAT. Aim To compare the ability of dual energy x-ray absorptiometry (DXA)-derived VAT area and anthropometric measures of adiposity for diagnosing MetS in a sample of high risk South African women. Methods MetS was quantified using the Joint Interim Statement (JIS) criteria. Fasting glucose, insulin and lipid profile were measured in 204 post-menopausal women. Anthropometry measures included body mass index (BMI), WC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index (ABSI). The area under the curve (AUC) was used to assess their performance in detecting any two components of MetS (excluding WC). Optimal WC and VAT area cut-points were derived to compare their performance for diagnosing MetS and to compare to internationally recognised cut-points. Results The highest AUC for the prediction of MetS was recorded for VAT, followed by WHtR and WC (AUC, 0.767, 0.747 and 0.738 respectively), but these did not differ significantly (all p ≥ 0.192). In contrast, VAT was significantly better than BMI (p = 0.028), hip (p = 0.0004) and ABSI (p < 0.0001). The optimal WC (94.4 cm) and VAT area (174 cm 2 based on the Youden’s index method and 175.50 cm 2 based on the CTL approach) cut-points performed similarly in detecting MetS. Conclusion DXA-derived VAT and WC had the same overall performance in discriminating the presence of any 2 MetS components in high risk South African women. These findings support the current recommendations of using WC rather than VAT for MetS risk screening, as it is cheap, accessible and easy to measure.

OBJECTIVE:To investigate the relationship between body fat distribution and cardiometabolic risk in mixed-ancestry South African (SA) men and women, and to explore the effect of menopausal status on these relationships in women. METHODS:In a cross-sectional study, 207 mixed-ancestry SA women and 46 men underwent measurement of body composition using dual-energy X-ray absorptiometry, blood pressure, oral glucose tolerance, lipid profile and high-sensitivity C-reactive protein determination. The associations between different body fat compartments and associated cardiometabolic risk factors were explored. RESULTS:Men had less percentage fat mass ( %FM) [26.5% (25-75th percentiles: 19.9-32.5) vs 44.0%(39.8-48.6), p ≤ 0.001], but more central and less peripheral fat (both p <0.001) than women. Post-menopausal women had greater %FM, waist and visceral adipose tissue (VAT), and less gynoid %FM than pre-menopausal women (all p ≤ 0.004). After adjusting for age and gender, VAT accounted for the greatest variance in insulin resistance (R2 = 0.27), while trunk %FM and leg %FM accounted for the greatest variance in triglyceride (R2 = 0.13) and high-density lipoprotein cholesterol concentrations (R2 = 0.14). The association between fat mass and regional subcutaneous adipose tissue and cardiometabolic risk factors differed by gender and menopausal status. CONCLUSIONS:Central fat was the most significant correlate of cardiometabolic risk and lower body fat was associated with reduced risk. These relationships were influenced by gender and menopausal status.

Background/Objective: Mild Head Injury (MHI) is the most commontype of head trauma, and forms a majority of the injuries seen in the traumaunit (65-85%).1 This study was aimed at using previously identifiedclinical risk factors to determine which category of patients with MHIwould not need to undergo Computed Tomography (CT). This may serveas cost saving measure to patients and hospitals likewise reduce collectiveradiation dose to the population.Methodology: A retrospective study conducted at the trauma unit of ateaching hospital situated in the Cape Metropole. CT scan images of 50patients aged 14 years and above who had MHI and undergone CTexamination were retrieved from the archive. Patients’ information, clinicalhistory and resultant CT findings were collated. Clinical risk factors werecorrelated with abnormal and normal CT scan findings. Data wereanalyzed using chi-square statistic at 95% confidence interval.Results: Twenty three (46%) of the patients had abnormal CT findings,and all presented with one or more of these risk factors; severe headache(10%), skull fracture (20%), scalp injury (6%), loss of consciousness(LOC)(8%) and intoxication(2%). The results were not statisticallysignificant when compared with the normal CT scans group. Four patients(8%) with no risk factors had normal CT scans. All the patients presentingwith the clinical risk factors, of nausea and vomiting 6% (n=50), seizures4% (n=50) had normal CT scan findings.Conclusion: Certain clinical risk factors can be used to suggest theprobability of abnormal CT scan in patients with MHI. Patients with norisk factors such as patients with confusion and disorientation are morelikely to have normal CT findings and may therefore be exempted from CTexamination. Further studies with larger sample size may be helpful invalidating these findings.

Computed tomography dose index w and dose length product were recorded for the purpose of developing diagnostic reference levels (DRLs) for radiation dose optimisation. The study was conducted in three radiology departments with CT centres in Northern Nigeria. Data were collected from 54 consenting adult participants (weighing 70 kg ± 3) that had head CT scans. Analysis was done using SPSS version statistical software. A combined dose for the three centres was calculated and compared with the reported data from the international communities where there are established DRLs. Third quartile values of CTDIw and DLP were determined as 77 mGy and 985 mGy cm, respectively. Local DRLs that are significantly higher than most of the reported data in the literature have been established.

This study investigated the radiation dose received by patients referred for barium meal (BaM) examinations at three state hospitals in the Western Cape, South Africa (SA). Twenty-five participants (male and female patients) aged between 18 and 85 years and weighing 50 to 85 kilograms (kgs) were included in the study. The radiation dose to the participants was measured using a Dose-Area-Product (DAP) meter permanently fitted to the fluoroscopy equipment at the selected health facility sites. Measurements were done on digital fluoroscopy (DF) and conventional fluoroscopy (CF) units. The third quartile and median DAP values were 20.1 Gycm2 and 13.6 Gycm2 respectively. The median DAP value (13.6 Gycm2) is recommended as the diagnostic reference level (DRL) for BaM examinations because this value is less affected by outlying values of under or overweight [1]. The relationship between DAP and patient weight, fluoroscopy time (FT), the number of images recorded, and the employment of DF or CF units, are discussed.