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RATIONALE: Clinical placement is an important component of any undergraduate nuclear medicine program. For first year students, it is an introduction to clinical nuclear medicine which helps them better understand the profession as well as consolidate their learning to date. At The University of Newcastle, Australia part of the clinical placement course includes radiopharmacy laboratory sessions in a simulated environment to develop necessary skills and confidence. Due to the Covid-19 pandemic, restrictions were put in place that meant that clinical placements for first year students were cancelled and time in the radiopharmacy laboratory was reduced from two hours to one hour per session. The aim of this study is to evaluate whether a clinical alternative portfolio in lieu of clinical placement was effective in increasing the students' knowledge and skills in nuclear medicine practice and if specifically developed instructional videos for preparation of the radiopharmacy laboratories compensated for the reduced time. METHODS: A paper-based survey was given to the 50 students enrolled in the first-year professional practice course. This survey containing 56 questions consisted of both open questions and closed Likert-scale questions about the changes to the radiopharmacy laboratories and the clinical alternative portfolio in two separate sections. Quantitative and qualitative analysis was performed on the resulting data. RESULTS: There was a 94% response rate to the survey. The majority of students watched the preparatory radiopharmacy videos at least once and strongly agreeing that each video adequately prepared them for the associated lab session. Just over half (51%) of the students though the reduced time in the lab was sufficient to complete the required tasks. The majority of students agreed that the modules included in the clinical alternative portfolio increased their knowledge of nuclear medicine practice. CONCLUSION: In spite of the restrictions put in place due to Covid-19, the learning outcomes of the first-year nuclear medicine professional practice course were met. The preparatory videos for the radiopharmacy laboratories and the clinical alternative portfolio was positively received and gave the students a good introduction to clinical nuclear medicine. [ABSTRACT FROM AUTHOR]

The health effects of chronic low-dose radiation exposure are a subject of worldwide debate. These effects are difficult to assess because all low-dose exposure mechanisms must be accounted for, including background exposure, personal medical examinations, and environmental exposure such as aviation, as well as lifestyle choices contributing to disease. The current literature recommends investigation of lifestyle factors to fill in these gaps. The aim of this study was to pilot-test a survey developed to assess health and lifestyle factors for Australian medical radiation workers. Methods: A cohort of nuclear medicine technologists (NMTs) was selected to test the survey. The survey consisted of 53 questions relating to demographics, employment, lifestyle, and health. Data from the 2017-2018 Australian National Health Survey were used to compare the lifestyle choices and health of the participants with those of the Australian general population. Results: In total, 101 participants pilot-tested the survey. Overall, Australian NMTs make better lifestyle choices (more exercise, more vegetable intake, lower rates of smoking and alcohol consumption) resulting in lower rates of obesity than the Australian general population. NMTs had a higher reported health status than the Australian population, with lower levels of psychologic distress. Given the low age of NMTs participating in the study, the cancer incidence rate may be higher than that reported for the Australian general population; however, a larger sample size is required to provide more definitive results. Conclusion: This pilot study demonstrated the feasibility of conducting a widespread survey to assess health and lifestyle factors for the Australian medical radiation worker cohort. Comparison of survey results with data for the entire Australian population have highlighted the potential to increase the number of lifestyle questions. [ABSTRACT FROM AUTHOR]

Current radiation protection recommendations do not provide clear guidelines or advice on pregnancy screening strategies for diagnostic nuclear medicine procedures. Previous studies have reported on variations in current practice for pregnancy screening before diagnostic nuclear medicine procedures. The development of consensus statements aims to provide a consistent approach and assist nuclear medicine personnel to confidently question patients about their pregnancy status. Methods: The Delphi technique was chosen for the research design. A panel consisting of 10 experienced nuclear medicine personnel from Australia and New Zealand was recruited. Panel members were provided with a summary of existing research. Consensus agreement was predefined as 80%. Questionnaires were developed and distributed to the panel members, with iterative analysis and feedback between survey rounds. Three survey rounds were conducted online using SurveyMonkey between December 2013 and June 2014. The round 1 questionnaire was developed from the results of a previous survey. It consisted of 30 questions designed to gather the opinions of the expert panel. After analysis of the round 1 responses, consensus statements were developed for round 2 and revised in round 3. Results: Consensus was achieved for 16 statements. The statements recommend using verbal questioning with patient signature, defining the age range for questioning as 12-55 y, providing advice on the use of pregnancy testing, and questioning potentially difficult groups such as teenagers. A flowchart was included for comment in round 3. Conclusion: This was the first Australian study to develop consensus statements and a flowchart to assist nuclear medicine personnel in consistently and confidently questioning patients about their pregnancy status before diagnostic procedures. Implementation of these statements into clinical practice guidelines should reduce the possibility of inadvertent fetal irradiation. [ABSTRACT FROM AUTHOR]

As radiation therapy transitions from intensity modulated radiation therapy ( IMRT) to volumetric modulated arc therapy ( VMAT) it is important to consider the quality assurance ( QA) of VMAT plans in light of what has previously been learned and developed in IMRT QA. This technical note assesses if IMRT based plan QA software, which has reduced the need in IMRT for phantom dose measurements on the linear accelerator, can be incorporated into VMAT QA processes. Twenty prostate cases were retrospectively planned using VMAT with one arc to deliver a prescription of 74 Gy in 37 fractions. A plan QA was performed using both IMSure (version 3.3), a software-based IMRT QA program, and ArcCHECK (version 6.2.3.5713), a phantom-based VMAT QA tool. Outcomes assessed included the time needed to perform the QA of both the IMSure and ArcCHECK QA methods, and agreement between planned dose and QA measured dose. On average per case, the ArcCHECK technique needed 31.5 min to perform the VMAT plan QA, while IMSure required 3.5 min to perform the same QA. All 20 cases passed dosimetric QA using Arc CHECK. However, using IMSure, three cases failed dosimetric QA using the departments existing IMRT QA criteria. This research has demonstrated that the IMRT QA software IMSure may be incorporated into the QA of VMAT plans, however the criteria to assess the dosimetry of the VMAT plans may need to be different to that for IMRT cases. The implication of this research for radiation therapists is to be critically aware of the differences between the plan QA requirements and methods for IMRT and those required for VMAT. [ABSTRACT FROM AUTHOR]

Introduction This study compared four different volumetric modulated arc therapy ( VMAT) beam arrangements for the treatment of early-stage prostate cancer examining plan quality and the impact on a radiotherapy department's resources. Methods Twenty prostate cases were retrospectively planned using four VMAT beam arrangements (1) a partial arc ( PA), (2) one arc (1A), (3) one arc plus a partial arc (1A + PA) and (4) two arcs (2A). The quality of the dose distributions generated were compared by examining the overall plan quality, the homogeneity and conformity to the planning target volume ( PTV), the number of monitor units and the dose delivered to the organs at risk. Departmental resources were considered by recording the planning time and beam delivery time. Results Each technique produced a plan of similar quality that was considered adequate for treatment; though some differences were noted. The 1A, 1A + PA and 2A plans demonstrated a better conformity to the PTV which correlated to improved sparing of the rectum in the 60-70 Gy range for the 1A + PA and 2A techniques. The time needed to generate the plans was different for each technique ranging from 13.1 min for 1A + PA to 17.8 min for 1A. The PA beam delivery time was fastest with a mean time of 0.9 min. Beam-on times then increased with an increase in the number of arcs up to an average of 2.2 min for the 2A technique. Conclusion Which VMAT technique is best suited for clinical implementation for the treatment of prostate cancer may be dictated by the individual patient and the availability of departmental resources. [ABSTRACT FROM AUTHOR]

PurposeStudent experience on clinical placement is not well captured with traditional program evaluation tools. This study aims to complete a qualitative analysis of the reflective clinical journals completed during professional placement by radiation therapy (RT) students in order to uncover the issues that affect students on placement and how these change as the student's progress through the program.Materials and methodsA qualitative descriptive analysis (QDA) was undertaken on the descriptive content of student journals completed by 97 students over 3 consecutive years while undertaking professional placement in Radiation Oncology Treatment Centres within Australia. Two coders used a QDA sourcebook specifically designed for the research to independently analyse the descriptive content of the reflective journals for four main categories and 18 subcategories.ResultsThe result revealed a statistically significant increased tendency to discuss clinical environment and a decreased tendency to discuss the patient, 92·9–12·5% (coder 1) and 85·7–18·8% (coder 2), as they progressed through the program.ConclusionsThe results of this study showed some similarities with studies completed in other health professions; however, the breadth of issues explored within the content of these RT student journals demonstrates the true diversity of the RT student experience on professional placement. [ABSTRACT FROM AUTHOR]

PurposeStudent experience on clinical placement is not well captured with traditional program evaluation tools. This study aims to complete a qualitative analysis of the reflective clinical journals completed during professional placement by radiation therapy (RT) students in order to uncover the issues that affect students on placement and how these change as the student's progress through the program.Materials and methodsA qualitative descriptive analysis (QDA) was undertaken on the descriptive content of student journals completed by 97 students over 3 consecutive years while undertaking professional placement in Radiation Oncology Treatment Centres within Australia. Two coders used a QDA sourcebook specifically designed for the research to independently analyse the descriptive content of the reflective journals for four main categories and 18 subcategories.ResultsThe result revealed a statistically significant increased tendency to discuss clinical environment and a decreased tendency to discuss the patient, 92·9–12·5% (coder 1) and 85·7–18·8% (coder 2), as they progressed through the program.ConclusionsThe results of this study showed some similarities with studies completed in other health professions; however, the breadth of issues explored within the content of these RT student journals demonstrates the true diversity of the RT student experience on professional placement. [ABSTRACT FROM PUBLISHER]

Because of the ionizing radiation used in diagnostic nuclear medicine procedures, it is recommended that all female patients of childbearing age be questioned about their pregnancy status before the procedure begins. Several patient groups have been identified as potentially difficult to question: teenagers, unconscious or sedated patients, patients with language or cultural barriers, and patients with mental disability. Our aim was to capture the thoughts and opinions of nuclear medicine personnel in Australia and New Zealand regarding pregnancy screening strategies before diagnostic imaging procedures. Methods: Members of the Australian and New Zealand Society of Nuclear Medicine were invited to complete an online survey. Section 4 consisted of open-response questions asking participants to describe the strategies they use to question a patient about pregnancy status in 4 potentially difficult clinical scenarios. The content of the responses was analyzed. Results: For each question, 232 responses were recorded. The most commonly used strategies included questioning teenage girls away from their parents, referring to medical notes for unconscious patients, using an interpreter and visual aids for patients with language barriers, and asking a caregiver or relative of mentally disabled patients. Pregnancy testing was used when there was doubt about the patient's pregnancy status. Personal questions about menstrual and sexual history were often asked to determine the risk of pregnancy. Conclusion: The study revealed that a variety of strategies are used by nuclear medicine personnel in Australia and New Zealand to determine the pregnancy status of patients. A standardized practice guideline may be useful to ensure a consistent approach to questioning that would optimize the accuracy of pregnancy assessment and reduce the possibility of fetal irradiation. [ABSTRACT FROM AUTHOR]

The ionizing radiation used in diagnostic nuclear medicine procedures has the potential to cause biologic harm to a fetus. Although the risks are relatively small, it is recommended that all female patients of childbearing age be questioned regarding their pregnancy status before administration of the radiopharmaceutical. This can be a sensitive situation especially for certain types of patients, such as teenagers. Currently, there are no guidelines that detail how to question the patient. Previous studies have revealed the lack of a consistent approach in this area. The aim of this study was to investigate current practice for pregnancy screening before diagnostic nuclear medicine procedures in Australia and New Zealand and to determine whether a standardized practice guideline is required. Methods: An online survey was administered via Survey Monkey from October to December 2011. Members of the Australian and New Zealand Society of Nuclear Medicine were invited to participate. The survey consisted of 30 questions divided into 4 sections: demographics, policy and regulations, current practice, and open-ended clinical scenarios. Results: Three hundred thirty-five responses were recorded from participants in all states and territories of Australia and New Zealand; 90% were nuclear medicine technologists. Participants reported a low awareness of radiation policy and regulations but demonstrated good knowledge of the relative risk to the fetus from commonly performed procedures. The most common minimum and maximum age to question patients was 12 y (32%) and 55 y (42%), respectively, although the range was from 10 to 60 y. Verbal questioning (44%) was the most commonly used approach. Pregnancy testing was used by 72%, usually if the patient indicated she was unsure of her pregnancy status. Responses to clinical scenarios were varied, and these will be discussed in a subsequent paper. Conclusion: The survey revealed a lack of awareness of government regulations and departmental policy regarding radiation protection. The study demonstrated wide variety in pregnancy screening strategies used to determine the pregnancy status of patients before diagnostic nuclear medicine procedures, indicating that a standardized practice guideline is required for Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Objective: Freeform reflective writing is one way that radiation therapists can document their development. Barriers to this form of writing include the fact that some radiation therapists do not know what to write or how to begin this writing process. This paper outlines the development and validation of guided inventories called the Newcastle Reflective Inventories and the validation of the Newcastle Reflective Analysis Tool as an effective tool for assessing short-form guided reflective writing. Method: The Newcastle Reflective Inventories consist of a series of questions that guides the user through the reflective writing process. Validation of the Newcastle Reflective Inventories involved comparing the evidence of reflection in 14 freeform journals to that of 14 inventories completed on the same topic. Validation of the Newcastle Reflective Analysis Tool included the assessment of 30 Newcastle Reflective Inventories. Results: There was a highly statistically significant difference (p < 0.001) in the high levels of reflection evident in the inventories when compared to the lower levels of reflection in the freeform journals. Good levels of agreement were achieved between the coders. Discussion: These results show that the Newcastle Reflective Inventories are effective tools in promoting reflective writing when compared with freeform journaling. [ABSTRACT FROM AUTHOR]