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Referral to a clinical radiologist is the prime means of communication between the referrer and the radiologist. Current Australian and New Zealand government regulations do not prescribe what clinical information should be included in a referral. This work presents a qualitative compilation of clinical radiologist opinion, relevant professional recommendations, governmental regulatory positions and prior work on diagnostic error to synthesise recommendations on what clinical information should be included in a referral. Recommended requirements on what clinical information should be included in a referral to a clinical radiologist are as follows: an unambiguous referral; identity of the patient; identity of the referrer; and sufficient clinical detail to justify performance of the diagnostic imaging examination and to confirm appropriate choice of the examination and modality. Recommended guideline on the content of clinical detail clarifies when the information provided in a referral meets these requirements. High-quality information provided in a referral allows the clinical radiologist to ensure that exposure of patients to medical radiation is justified. It also minimises the incidence of perceptual and interpretational diagnostic error. Recommended requirements and guideline on the clinical detail to be provided in a referral to a clinical radiologist have been formulated for professional debate and adoption. [ABSTRACT FROM AUTHOR]

Objectives: Although ultrasound (US) is considered one of the safest imaging modalities, concerns have been raised regarding potential infection transmission risks through US procedures. A survey was undertaken by the European Society of Radiology (ESR) to establish infection prevention and control measures in US and to highlight the importance of good medical practice. Methods: An online survey was sent to all 22,000 full ESR members. Results: The response rate of completed surveys was 4.3 % (946 practitioners, 97 % of which were radiologists, mostly working in larger hospital settings). Among respondents, 29 %, 11 % and 6 % did not disinfect the US probe after every patient when performing standard surface US, endo-cavity US and interventional procedures, respectively. Eleven percent did not always use probe covers for endo-cavity US; for interventional procedures, the proportion was 23 %. A minority used sterile gel sachets in direct patient contact for endo-cavity scans (30 %), and 77.5 % used sterile gel for interventional procedures. Conclusions: The survey results highlight a wide range of practices throughout Europe and the need to raise awareness amongst practitioners regarding the importance of infection prevention and control measures. The development of European recommendations encompassing all US examinations, together with education is a priority. Main Messages : • Transmission of infection through ultrasound procedures is possible. • There is a wide range of ultrasound probe decontamination practices in Europe. • Not all practitioners use probe covers for endo-cavity or interventional ultrasound. • Not all practitioners use sterile gel for internal and invasive procedures. • Currently there are no European recommendations encompassing all US examinations. [ABSTRACT FROM AUTHOR]

Endometriosis is a common condition with significant morbidity, including pain and subfertility, which is often subject to a delay in diagnosis. Ultrasound has been successfully utilized, mostly outside North America, to preoperatively stage deep endometriosis, but in these international settings, imaging is typically performed solely by expert radiologists and gynecologists. We outline a method for detailed sonographic survey of the lower abdomen and pelvis to ensure optimum detection and communication of disease extent that is geared to radiologists practicing ultrasound in the United States, with the use of diagnostic medical sonographers. [ABSTRACT FROM AUTHOR]

The aims of the study are to identify factors contributing to preliminary interpretive discrepancies on overnight radiology resident shifts and apply this data in the context of known literature to draw parallels to attending overnight shift work schedules. Residents in one university-based training program provided preliminary interpretations of 18,488 overnight (11 pm–8 am) studies at a level 1 trauma center between July 1, 2013 and December 31, 2014. As part of their normal workflow and feedback, attendings scored the reports as major discrepancy, minor discrepancy, agree, and agree--good job. We retrospectively obtained the preliminary interpretation scores for each study. Total relative value units (RVUs) per shift were calculated as an indicator of overnight workload. The dataset was supplemented with information on trainee level, number of consecutive nights on night float, hour, modality, and per-shift RVU. The data were analyzed with proportional logistic regression and Fisher's exact test. There were 233 major discrepancies (1.26 %). Trainee level (senior vs. junior residents; 1.08 vs. 1.38 %; p < 0.05) and modality were significantly associated with performance. Increased workload affected more junior residents' performance, with R3 residents performing significantly worse on busier nights. Hour of the night was not significantly associated with performance, but there was a trend toward best performance at 2 am, with subsequent decreased accuracy throughout the remaining shift hours. Improved performance occurred after the first six night float shifts, presumably as residents acclimated to a night schedule. As overnight shift work schedules increase in popularity for residents and attendings, focused attention to factors impacting interpretative accuracy is warranted. [ABSTRACT FROM AUTHOR]

It is often assumed that the pattern of injury in children mirrors that of the adult population, but children have different anatomical proportions and the relative elasticity of their tissues results in different injury patterns. The authors of this review are members of the British Society of Paediatric Radiologists subgroup and developed the recently published 47 paediatric trauma protocols for imaging children involved in major blunt trauma. The following article has been written to bring these guidelines to the attention of the wider community of UK radiologists, and explain the rationale behind the recommendations. [ABSTRACT FROM AUTHOR]

Our purpose is to harmonise and standardise terminology in paediatric uroradiology, to provide and update recommendations for contrast-enhanced US to standardise imaging and encourage further research, and to assess the impact of the existing recommendations in paediatric urogenital imaging. Based on thorough review of literature and variable practice at several centres and after discussion within urogenital imaging groups as well as with other subspecialties, we propose a standardisation of terminology in urogenital imaging. An update with recommendations on paediatric contrast-enhanced US has been issued based on available literature and reports. Finally, a questionnaire has been used to assess the knowledge, applicability and usefulness of, and the adherence to existing recommendations of the European Society of Paediatric Radiology (ESPR) Uroradiology Task Force. In conclusion, the ESPR is working to improve patient safety and optimise paediatric urogenital imaging. Standardisation of terminology and provision of updated knowledge on contrast-enhanced US in childhood will contribute to this task, ideally reducing the need for invasive or radiating imaging. Not all existing recommendations are commonly known, which limits adherence to these recommendations and the availability of comparable data and evidence for future adaptation of imaging strategies in paediatric uroradiology. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: A national survey was conducted among the radiation oncology residents about their clinical activities and responsibilities. The aim was to evaluate the clinical workload and to assess how medical tasks are delegated and supervised. Materials and methods: A first questionnaire was administered to radiation oncology residents during a national course. A second questionnaire was mailed to 59 heads of departments. Results: The response rate was 62% for radiation oncology residents (99 questionnaires) and 51% for heads of department (30). Eighteen heads of department (64%) declared having written specifications describing the residents’ clinical tasks and roles, while only 31 radiation oncology residents (34%) knew about such a document (P =0.009). A majority of residents were satisfied with the amount of medical tasks that were delegated to them. Older residents complained about insufficient exposure to new patient's consultation, treatment planning and portal images validation. The variations observed between departments may induce heterogeneous trainings and should be addressed specifically. Conclusion: National specifications are necessary to reduce heterogeneities in training, and to insure that the residents’ training covers all the professional skills required to practice radiation oncology. A frame endorsed by academic and professional societies would also clarify the responsibilities of both residents and seniors. [Copyright &y& Elsevier]

Abstract: This paper describes manufacturing of economically affordable renal biopsy phantoms for radiology residents and practicing radiologists. We reconstructed a realistic 3-dimensional patient-specific kidney model from CT data, manufactured an organ mould and casted the kidney phantoms. Using gelatin gel materials with calibrated parameters allowed making phantoms with realistic mechanical, ultrasound and CT properties including various pathologies. The organ phantoms with cysts included were further casted into gelatin gel medium. They were validated by radiology residents in biopsy training and compared against self-made phantoms traditionally used in the curriculum of interventional radiology. The realism, durability, price and suitability for training were evaluated. The results showed that our phantoms are more realistic and easier to use than the traditional ones. Our proposed technology allows creating a low-cost (50$/kg) alternative to the pricy commercial training phantoms available today. [Copyright &y& Elsevier]

Abstract: To standardize mammographic reporting, the American College of Radiology mammography developed the Breast Imaging Reporting and Data System (BIRADS) lexicon. However, wide variability is observed in practice in the application of the BIRADS terminology and this leads to classification errors. This review analyses the reasons for variations in BIRADS mammography, describes the types of errors made by readers with illustrated examples, and details BIRADS category 3 which is the most difficult category to use in practice. [Copyright &y& Elsevier]

Background: Following implementation of Modernising Medical Careers (MMC) in the UK, potential radiology trainees must decide on their career and apply sooner than ever before. We aimed to determine whether current trainees were sufficiently informed to make an earlier career decision by comparing the early radiology experiences of Traditional and Foundation Trainees. Methods: 344 radiology trainees were appointed through MMC in 2007/08. This cohort was surveyed online. Results: Response rate was 174/344 (51%). Traditional Trainees made their career decision 2.6 years after graduation compared with 1.2 years for Foundation Trainees (57/167, 34%). Nearly half of responders (79/169, 47%) experienced no formal radiology teaching as undergraduates. Most trainees regularly attended radiology meetings, spent time in a radiology department and/or performed radiology research. Many trainees received no career advice specific to radiology (69/163, 42%) at any point prior to entering the specialty; this includes both formal and informal advice. Junior doctor experiences were more frequently cited as influencing career choice (98/164, 60%). An earlier career decision was associated with; undergraduate radiology projects (-0.72 years, p = 0.018), career advice (-0.63 years, p = 0.009) and regular attendance at radiology meetings (-0.65 years, p = 0.014). Conclusion: Early experience of radiology enables trainees to make an earlier career decision, however current radiology trainees were not always afforded relevant experiences prior to entering training. Radiologists need to be more proactive in encouraging the next generation of trainees. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to develop a phantom-based experimental calibration method to minimize the reconstruction artifacts for the geometric misalignments of the digital tomosynthesis prototype. Methods: A calibration phantom with ten fiducial markers was designed. Using this calibration phantom, the projection matrices of an experimental digital tomosynthesis prototype were acquired from each projection view under a series of misalignment conditions. The American College of Radiology mammography phantom was imaged and reconstructed with and without using the correction of the corresponding calibration projection matrices. The effectiveness of the calibration technique was then quantitatively analyzed through comparison of the calibrated and uncalibrated images. Results: As the isocenter horizontal-shift increases, the reconstruction artifacts become clearly distinguishable. Using the calibration technique, the reconstruction artifacts resulting from the isocenter horizontal-shift were effectively minimized for the prototype. Conclusions: For the specific experimental conditions utilized in this study, the phantom-based calibration method effectively reduced reconstruction artifacts for the prototype investigated in this study. The calibration method holds potential to benefit other tomosynthesis applications. [ABSTRACT FROM AUTHOR]

AbstractObjective:To report the experience of the Brazilian Program of Pediatric Teleradiology in combining teleconferencing and a virtual learning environment for services integration, collaborative research, and continuing education in pediatric radiology.Materials and Methods:We performed virtual meetings from March 2005 to October 2010 on pediatric radiology-related themes, using a combination of videoconferences and Web conferences, which were recorded and made available in an open-source software (Moodle) for reuse.Results:We performed 58 virtual sessions: 29 anatomical–clinical–radiological sessions, 28 on upgrading themes, and 1 virtual symposium. The average of connected points was 12 by videoconference and 39 by Web conference, and of 450 participants per event. At the time of this writing, 318 physicians and students are registered in the virtual learning environment, with a total of 14,678 accesses.Conclusions:Telemedicine is being included in pediatric radiology practice, as a means for distance education, training, and continuing integration between groups. [ABSTRACT FROM AUTHOR]

Abstract: In mid-2004, following a Mission nationale d’expertise et d’audits hospitaliers (MeaH) proposal, three voluntary cancer centres started setting up a safety procedure in radiotherapy. Their work made it possible to single out the need to continue elaborating a repository, aiming at a “minimal written reference”, to take into account the human factor as one of the four families of factors contributing to a systemic deviation and to build collectively, in radiotherapy departments, the experience feedback committee (comité de retour d’expérience [Crex]). Formalizing a comité de retour d’expérience is unavoidable in any safety-management system (SMM or MGS). The comité de retour d’expérience enables every active member of a department to listen to any of the events of the month (incidents and precursors), to select the event which will be under scrutiny for the next systemic analysis (Orion© method) and above all to choose the most appropriate correcting action and ensure its proper implementation. That approach has been approved and then acknowledged by the Autorité de sûreté nucléaire (ASN) before being extended to the other radiotherapy departments. The use of the comité de retour d’expérience, which is a safety management tool, should not be limited to a local circle of insiders, but shared to benefit everybody. Putting comité de retour d’expérience together – a move that was hoped for and brought up as soon as the tool was created – is now being implemented. Several initiatives have already permitted to assess its collective interest; other steps have yet to be taken to enable a true collective sharing of experience. On this basis, the definition of quality/safety practices in radiotherapy will allow the professionals to implement clinical audits in 2012. [ABSTRACT FROM AUTHOR]

Abstract: Positron emission tomography can be used in radiation oncology for the delineation of target volumes in the treatment planning stage. Numerous publications deal with this topic and the scientific community has investigated many methodologies, ranging from simple uptake thresholding to very elaborate probabilistic models. Nevertheless, no consensus seems to emerge. This paper reviews delineation techniques that are popular in the literature. Special attention is paid to threshold-based techniques and the caveats of this methodology are pointed out by formal analysis. Next, a simple model of positron emission tomography is suggested in order to shed some light on the difficulties of target delineation and how they might be eventually overcome. Validation aspects are considered as well. Finally, a few recommendations are gathered in the conclusion. [ABSTRACT FROM AUTHOR]

Abstract: PET/CT imaging modalities have been shown to be useful in the diagnosis, staging, and monitoring of malignant diseases. Its inclusion into the treatment planning process is now central to modern radiotherapy practice. However, it is essential to be cognisant of the factors that are necessary in order to ensure that the acquired images are consistent with the requirements for both treatment planning and treatment delivery. Essential parameters required in image acquisition for radiotherapy planning and treatment include consistencies of table tops and the use of laser light for patient set-up. But they also include the accurate definition of the patient’s initial positioning and the use of proper immobilization devices in the radiotherapy department. While determining this optimum set-up, patient psychological factors and limitations that may be due to the subsequent use of PET/CT for planning purposes need to be taken into account. Furthermore, patient set-up data need to be properly recorded and transmitted to the imaging departments. To ensure the consistency of patient set-up, the radiation therapist should ideally be directly involved in informing and positioning the patient on the PET/CT. However, a proper exchange of patient-related information can also be achieved by a close liaison between the two departments and by the use of clear detailed protocols per type of patient set-up and/or per localization of tumour site. [ABSTRACT FROM AUTHOR]

El artículo presenta una evaluación de los procedimientos de exploración ginecológica. Se incluyen los exámenes bacteriológicos, los métodos endoscópicos y la radiología ginecológica como procedimientos utilizados frecuentemente. También se discurre sobre la exploración de varias enfermedades ginecológicas, incluyendo la infección tuberculosa, las infecciones gonocócicas y el sífilis, con información sobre los tratamientos comunes para cada infección.

Abstract: Introduction: The radiation oncology process along with its unique therapeutic properties is also potentially dangerous for the patient, and thus it should be delivered under a systematic risk control. To this aim incident reporting and analysis are not sufficient for assuring patient safety and proactive risk assessment should also be implemented. The paper accounts for some methodological solutions, lessons learned and opportunities for improvement, starting from the systematic application of the failure mode effects and criticality analysis (FMECA) technique to the radiotherapy process of an Italian hospital. Materials and methods: The analysis, performed by a working group made of experts of the radiotherapy unit, was organised into the following steps: (1) complete and detailed analysis of the process (integration definition for function modelling); (2) identification of possible failure modes (FM) of the process, representing sources of adverse events for the patient; (3) qualitative risk assessment of FMs, aimed at identifying priorities of intervention; (4) identification and planning of corrective actions. Results: Organisational and procedural corrective measures were implemented; a set of safety indexes for the process was integrated within the traditional quality assurance indicators measured by the unit. A strong commitment of all the professionals involved was observed and the study revealed to be a powerful “tool” for dissemination of patient safety culture. Conclusion: The feasibility of FMECA in fostering radiotherapy safety was proven; nevertheless, some lessons learned as well as weaknesses of current practices in risk management open to future research for the integration of retrospective methods (e.g. incident reporting or root cause analysis) and risk assessment. [Copyright &y& Elsevier]

Abstract: This paper describes a novel teleradiology solution, its services and graphical user interfaces (GUIs), and the strategic decisions taken in the development of the services. The novel services are embedded in a radiology information infrastructure in Västra Götalandsregionen (VGR), Sweden. The application is fully integrated with all different RIS and PACS systems in the region and interconnected through the radiology information infrastructure. In practice, the solution offers new ways of collaborating through information sharing within a region. Knowledge can be used collectively to improve the radiology workflow and its outcomes for clinicians and patients. The new shared approach marks the beginning of a change from local to enterprise workflow. The challenges are to develop useful and secure services for different groups related to the radiological information infrastructure. It involves continuous negotiation with people concerning how they should collaborate within the region. The need for teleradiology as a service provided “by somebody” has disappeared in VGR; today it is a shared service embedded in the innovative radiology information infrastructure. This infrastructure is just a starting point for a novel and limitless telemedicine service including limitless healthcare actors and activities. The method applied for this study was action research. The study was carried out in collaboration between practitioners and researchers. [Copyright &y& Elsevier]

The article provides information on interventional radiology (IR) and its role in modern medical practice. IR is considered a sub-specialty in diagnostic radiology that involves minimally-invasive targeted treatment options to handle different medical conditions under imaging guidance. One of the available IR procedures and applications is balloon angioplasty and stenting which involves balloon use to dilate areas of stenosis in veins and arteries. One of the applications of image-guided drainage is breast cysts.

Abstract: In February 2007, the radiation therapy department of the Jean Monnet Hospital in Épinal (France) has stopped the radiotherapy treatments after the discovery of a radiotherapy accident and bad practices leading to overexposure of patients between 1987 and 2006. The Regional Cancer Center “Centre Alexis Vautrin” in Nancy (France) was given the task of the new start of treatment activity. From February 2007 to January 2008, actions of training, updates of equipments and practices have been performed in the Épinal Hospital, guided by the quality approach, allowing the treatment of new patients in February 2008, with the radiation oncologists and the medical physicists of the Centre Alexis Vautrin, with the highest conditions of security and confidence. [Copyright &y& Elsevier]

Abstract: Although it may be argued that single fraction (SF) radiotherapy (RT) should be regarded as the standard palliative treatment for pain due to uncomplicated bone metastases, its widespread clinical use is still underexploited. In this chapter, the authors discuss a number of surveys investigating doctors and patients'' preferences for palliative RT schedules, discuss the possible reasons for this phenomenon, and suggest potential strategies to increase the use of SF. [Copyright &y& Elsevier]

Commissioning radiotherapy is becoming increasingly challenging. Technical developments may result in better clinical outcomes but come at a cost. Radiotherapy services in the UK are often operating at or near capacity with no slack in the system. A balance between technical perfection and reasonable cost of service provision has to be struck. Eighty per cent of UK radiotherapy departments are now equipped to deliver precision treatments which conform precisely to the shape of the tumour in the individual patient. The benefits are an increase in the cure rate and a reduction in long-term side effects due to the unnecessary irradiation of normal tissues. The delivery of intensity-modulated radiotherapy (IMRT) with image guidance (IGRT) takes more staff time and is therefore more costly than conventional radiotherapy. Such precision is normal practice in Europe and North America but has only been partially implemented in the UK. This paper provides commissioners with a guide to the technology and its implementation together with an appreciation of its likely benefit. [ABSTRACT FROM AUTHOR]

Abstract: There is still debate about the appropriateness of taking postoperative radiographs in the management of maxillofacial fractures. We did a prospective, multicentre study with predefined inclusion and exclusion criteria involving seven centres with a minimum sample size of 50 patients from each (total n =431). A standard data sheet was given to operators to record clinical and radiological variables before and after operation. The information obtained was analysed to evaluate the need for routine postoperative radiographs in the management of maxillofacial fractures. Patients were followed up for one month postoperatively. The parasymphyseal (n =240) was the most commonly encountered fracture site. The orthopantograph was the most commonly used radiograph, being recorded in 421 cases (98%) before, and all 305 cases in which it was recommended after, the operation. Assessment of the reduction after fixation was the most common reason (n =237, 78%)) for advising postoperative radiographs. Intraoperative reduction and immediate postoperative occlusion were better indicators (p =0.02 and 0.01) of reduction, fixation, and clinical outcome than immediate postoperative radiographs. The practice of advising postoperative radiographs routinely should be discouraged as it has no significant role in the management of maxillofacial fractures. [Copyright &y& Elsevier]

Abstract: Radiotherapy is one of the basic methods of radical treatment of prostate cancer. Because of that getting to know all factors of post-radiation complications, and in consequence the possibility to limit them, is one of the challenges of contemporary radiotherapy. One of the potential complications associated with radiation treatment is radiation-induced cancer. Despite a whole range of epidemiological analyses there is still lacking a fully credible model that would allow one to estimate the magnitude of risk of inducing such cancers. The last decades have seen the entry into clinical practice of technologically advanced methods of radiation therapy, such as the 3DCRT and IMRT. As the previous epidemiological analyses refer mainly to older radiation techniques, there is still a lack of credible data estimating the risk of inducing secondary cancers for new techniques, and in particular IMRT. It should be emphasized that IMRT allows one to escalate the dose, which may contribute to the improvement of radiotherapy effectiveness. From this there follows a new problem to be solved in future, i.e. how the escalation of the dose may influence the magnitude of risk of radiation carcinogenesis. The problem of carcinogenesis may concern the group of younger patients for whom long survival is very likely, and the competitive edge of RT relative to surgery, in particular in the aspect of late complications, has to be thoroughly justified. [Copyright &y& Elsevier]

Background: A clinical audit is a systematic, independent, and documented process to improve the quality of radiological processes and radiation safety for patients. Purpose: To evaluate the effect of an audit process by comparing the results of two consecutive audits at the same units. Material and Methods: Audits were carried out twice at each imaging unit in the southwest hospital district of Finland: first, at the end of 2003, and again in November 2007. Both evaluations were carried out in a similar way: by interviewing personnel and examining documents, independent experts from other hospital districts ensured that diagnostic medical imaging processes at each unit were carried out according to generally accepted standards for good medical radiological procedures. The results of the consecutive audits were compared in order to analyze the effects of the clinical audits. Results: The use of radiation was in accordance with the requirements and standards of good medical procedures at every audited unit during both evaluations. The list of audit criteria was fulfilled satisfactorily on both occasions at all of the audited units, and clearly better during the second run. In the first audit, the auditors made 80 recommendations for improving diagnostic procedures and, in the second audit, 53 recommendations. During the first audit, most of the recommendations (22/80) concerned instructions in the fundamental practice of examining a patient. During the second audit, most recommendations were in the category of radiation doses. Conclusion: The clinical audit had a positive impact on the practice of work procedures in radiological departments. Most of the recommendations made after the first audit had been taken into consideration by the time of the second audit. [ABSTRACT FROM AUTHOR]

Abstract: The radiotherapy community has in the past few decades witnessed dramatic shift in the treatment modalities from conventional 2-D radiotherapy to the now widely practiced 3-DCRT, IMRT and evolving IGRT. IMRT has generated so much interest because of its unique dosimetric modulation to concentrate doses to the targets of interests while also being able to relatively spare neighboring normal tissue. However IMRT is not the all in one solution for radiotherapeutic management of solid malignancies. The current enthusiasm in IMRT most be tempered with an understanding of the complexities of IMRT planning, treatment delivery, quality assurance, monitoring and clinical limitations. The widespread implementation of this technological innovation may have been a bit premature considering that clinical information regarding the same is still being generated. This article tries to give an overview of the potential advantages/disadvantages of IMRT in the clinical set up and the few controversies (Grey Zone) that are still being resolved. There is evidence to indicate that indiscriminately used IMRT may even harm the patient or have an inferior therapeutic index to 3DCRT. This and other pertinent issues will be covered by the authors in this short review of IMRT in clinical practice. [Copyright &y& Elsevier]

Summary: Background: Concurrent use of chemotherapy and twice-a-day hyperfractionated radiotherapy is an efficacious scheme to control limited disease (LD) small-cell lung cancer (SCLC). Aim: Our main objective was to estimate initial results in overall survival for patients with LD-SCLC treated with concomitant chemotherapy and hyperfractionated thoracic radiotherapy in routine practice. Response to treatment and toxicity were also assessed. Material and Methods: Forty-nine patients with confirmed LD-SCLC were treated at the Department of Radiotherapy of the Hospital General de Catalonia (Spain) from December 1999 to February 2007. The chemotherapy regimen was cisplatin (80 mg/m2) on day 1 and etoposide (100 mg/m2) on days 1, 2, and 3, every 21 day. The target dose to the tumor volume was 45 Gy. Prophylactic cranial irradiation (PCI), consisting of 30 Gy delivered in 15 fractions, was prescribed for all patients with a response rate >75% (23 of 30 patients). Results: Median follow-up was 12 months (range, 6–58 months) and median overall survival was 28.9 months. Two-year and 4-year survival rates were 56.4% and 30.1%, respectively. At 2 years, specific survival, local control, and systemic control were 64.2%, 88.8%, and 46.8%, respectively. Myelotoxicity and oesophagitis were the most severe toxicities. Conclusions: The combined schedule – hyperfractionated irradiation plus concurrent chemotherapy – can be applied in routine practice in the context of early radiotherapy, which is considered standard treatment, with acceptable toxicity and similar results to those described in the literature. [Copyright &y& Elsevier]

Abstract: The objective was the drafting of a practical document intended for radiotherapists and radiophysicists, describing the technique of irradiation of a non small cell bronchial cancer. The good practices concern the care of patients affected by bronchial cancer localized in the thorax and inoperable or patients who must undergo postoperative irradiation. The document has been developed according to a methodology aiming to join the current scientific data from an analysis of the literature on the subject and the assessment of radiotherapists, radiophysicists, lung specialists and methodologists from Rhône-Alpes area. From the stages necessary for the good progress of a radiotherapy, the writers of this document proposed common definitions concerning the centering and the location of the zone to be treated, the calculation of the dose distribution, the preparation of the patient for the treatment, the treatment and the surveillance during the treatment. The recommendations of this guide took into account the peculiarities bound to the nature of the treated region and more particularly the lung heterogeneity, respiratory movements and the radiosensibility of healthy lung tissue. Even if the technical aspect of the radiotherapy was particularly developed, the interest accorded to patient information takes on all its importance for a therapeutic coverage of quality. The authors of the document wished that this Guide of Good Practices, which will be regularly updated, helps the radiotherapists and allows them to harmonize their practices. [Copyright &y& Elsevier]

Abstract: Radiotherapy for bone metastases represents an important part of daily practice in our departments of radiotherapy. Majority of treatments deliver either one fraction (6 to 10Gy) or multifractions mainly using 30Gy in ten fractions. In the past decade, several randomized trials aimed to determine the optimal scheme of radiotherapy in this setting. In the present review, the efficacy of radiotherapy on bone metastases will be evaluated using the following parameters: the partial or complete responses on pain, the reduction of antalgic intake, bone recalcification, and need for reirradiation. Other parameters must also be considered, such as the primary site, number of metastasis, performance status, overall prognosis and side effects of radiotherapy. [Copyright &y& Elsevier]

Abstract: In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Épinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Société française de radiothérapie oncologique is a requirement. [Copyright &y& Elsevier]

Summary: Aim: The aim of this study was to provide a parameter for treatment plan comparisons in clinical practice. Materials and Methods: 21 patients with brain tumours were selected for analysis. Two alternative treatment plans were calculated for each patient. One of the alternative plans was approved while the second one was rejected by the physician. Alternative plans were compared with the parameter RPI. The computer program RPIWin® was prepared to facilitate the calculation process. Results: Calculations showed that 80% of approved treatment plans had higher RPI than rejected ones. Only 4 cases of approved treatment plans were characterized by lower RPI values than rejected ones. Conclusion: The experiment demonstrated that the Radiation Planning Index formula takes into account the relation between dose distributions calculated for planning treatment volumes and organs at risk and is a convenient tool for treatment plan comparisons in routine clinical practice. [Copyright &y& Elsevier]

The article presents a study on the adoption of healthcare information system in a radiology practice in Australia. The study applies the social actor theory to provide a more-refined analysis on the relationships among radiology practitioners, healthcare information system and the social milieu surrounding its use. The ability of the radiologists to adopt healthcare information system in radiology practice is affected by their identity, interactions and affiliations. The study also shows the active role of organizational policy, mandates and practice culture in enabling human agency in the use of an information communication technology.

The article focuses on the inconsistencies of the 2005 radiation protection recommendations which was released by the International Commission on Radiological Protection at the 11th International Radiation Protection Association's congress held in Madrid on May 2004. It touches mainly on its sections that deal with exclusion levels particularly on the exclusion of sources from the scope of the recommendations. It indicates that the International Atomic Energy Agency's approach is more balanced where each nuclide receives its own exclusion level rather than incomplete and arbitrary categories proposed by the commission. The author suggests to resolve the problem by adopting values and referring the recommendation to the association's safety series 115.

Abstract: Aims: To audit current practice related to treatment verification undertaken in radiotherapy departments throughout the UK. Materials and methods: A questionnaire was circulated to the radiotherapy service managers of 62 radiotherapy centres in the UK. This looked in detail at the department demographics, imaging equipment, site-specific verification protocols, and training and competency assessment of staff responsible for verification. Results: The response rate was 48% (30/62). All departments were using megavoltage imaging equipment in routine clinical practice. Twenty-four out of 29 (83%) departments that had electronic portal imaging capability were using image analysis software for verification. Twenty-nine out of 30 (97%) departments had site-specific written verification protocols. Twenty out of 30 (67%) treatment centres audited set-up errors within their department. Forty-three per cent of centres were using simulator image as the reference image of choice across all sites. Electronic portal imaging, alone or in combination with portal film, was being used for verification in 75% of the centres. Fifty-three per cent of centres used off-line correction strategies for measuring set-up errors across all sites. Radiographer-led interventions were primarily in the pelvis. Conclusion: Presently in the UK, verification strategies vary widely at individual treatment sites and between departments. Dedicated departmental verification teams, with input from radiographers, physicists and clinicians, may assist in the effective implementation of evidence-based verification. The inclusion of comprehensive verification protocols within multicentre radiotherapy trials encourages standardisation across treatment centres. [Copyright &y& Elsevier]

Abstract: Aims: To document UK practice in radiotherapy fractionation. Methods: All radiotherapy centres in the UK participated in a 1-week audit from 29 September 2003. Fractionation data were collected for all patients starting external beam radiotherapy. This included 2498 patients who were prescribed 32 547 fractions. Results: For the radical treatment of non-skin malignancy (n =708), the prescribed dose ranged from a single fraction of 8Gy for total-body irradiation to 75Gy in 43 fractions for prostate cancer. Postoperative treatment for breast cancer was dominated by three regimens: 40Gy in 15 fractions; 45Gy in 20 fractions; and 50Gy in 25 fractions. Palliative treatment was given in a single fraction to 393 patients (36%) with doses of up to 15Gy. Three hundred and ninety patients (36%) received four to seven fractions delivering 20–25Gy. Only 89 patients (8%) received more than 10 fractions with palliative intent but used 29% of such fractions. In the treatment of bone metastases, the most common prescriptions were 8–10Gy in a single fraction and 20Gy in five fractions. Conclusion: UK radiotherapy practice has become more uniform and moved closer to practice in North America and Europe over the past 15 years. For radical radiotherapy, 54% of prescriptions were for a fraction size of 1.8–2.0Gy but the distribution was bi-modal and 20% of patients were prescribed fraction sizes of 2.7–3.0Gy. Evidence-based practice now supports hypo-fractionated palliative treatment favouring single fractions for bone metastases and one or two fractions for many patients with advanced lung cancer. Two fractions are advised for some patients with brain metastasis. If these guidelines had been applied uniformly, then the number of treatments prescribed for palliation could have fallen by 36% from 5197 to 3313. This would have represented a 6% reduction in the overall radiotherapy workload. Not all patients are suitable for such hypo-fractionated treatments, but this is an area in which resource use can be improved. In the postoperative management of breast cancer, a change in practice to use 15 fractions uniformly would reduce overall radiotherapy workload by 4%. By contrast, a change to 25 fractions would increase overall workload by 7%. [Copyright &y& Elsevier]

The article presents information on the importance of medical imaging informatics for clinical practice. As reported, if data is used properly and prospectively, it can serve as a valuable tool to improve clinical practice. It is further reported that it can also elevate the quality of medical care, and differentiate service providers based on objective performance measures. The article also presents information on evidence-based medicine (EBM) and evidence-based radiology (EBR).

The article discusses problems with prompt communication of radiology diagnostics. All parties involved have their own dissatisfactions, including anxious patients, frustrated primary-care physicians, and radiologists, for whom lawsuits are an increasing concern. Conall Garvey and Sylvia Connolly, from Liverpool, Great Britain, observe legal and industry standards being set up to ensure the timely communication of crucial information to the patient and consumer. The American College of Radiology sets out guidelines for radiologist responsibility regarding the communication of abnormal findings to the patient.

The article discusses the Liver Imaging Reporting and Data System (LI-RADS), a radiology system which aims to standardizing liver diagnostic imaging in patients at risk for hepatocellular carcinoma (HCC). It mentions the integration of LI-RADS into HCC clinical practice guidance by the professional organization American Association for the Study of Liver Diseases. Topics include the role of radiologists in multidisciplinary procedure, and the changes to the clinical algorithm of LI-RADS.

The article focuses on the changes in technologist continuing education (CE) in medical radiology practice. Topics discussed include an overview of technologist CE, the quality of CE based on skills and knowledge, the value of earned credits for minimal learning, and the significance of CE in the achievement of technologists' career and operational objectives.

A letter to the editor is presented in response to the article "Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions" by T. Smith and colleagues, in 2015 issue.

A letter to the editor is presented in response to the article "Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions" by T. Smith and colleagues, in 2015 issue.

The author addresses developments in the U.S. radiology sector in 2015 and their impact on healthcare. Topics discussed include regulation issues on radiation dose association with the proposed ICD-10 coding standards, the plan for deployment of a Clinical Decision Support System to decide on affordable radiology solutions, and his personal experience in radiology management.

The article discusses the legal aspects of radiology practice in India. One of the rules and regulations framed by the government for doctors of all disciplines are mandatory registration of medical professionals with the Medical Council of India (MCI) or with state medical councils. It advises the practice doctor to be prudent and manage patient records with sincerity to prevent litigation. Also stressed is the need for radiologists to establish rapport with the patients and their attendants.