Search

A core competency for all health care professionals is evidence-based practice (EBP). An understanding of research skills are key to diagnostic radiographers adopting EBP, and should be taught and assessed in curricula leading to eligibility to register and practice. This paper focuses on the design, implementation and initial evaluation of an assessment task in the Diagnostic Radiography (DR) curriculum at an Australian university, which aimed to facilitate students' skills to identify and interpret research methods and output as a foundation for EBP by combining with EBP and DR theoretical content.An integrated assessment task was introduced across two units of study, requiring student groups to produce a single literature review incorporating learning objectives from each distinct unit of study. This approach recognised and incorporated themes of student choice, negotiation of group membership, and scholarly writing as inherent components.Student feedback showed that students valued the integration of content knowledge and research principles across two units of study to better reflect their depth and breadth of learning. Students also commented on the value of team or group work in developing their communication and cooperation skills, which are essential skills in the DR workplace.A literature review assessment task integrated across two previously separate units of study provided an innovative approach to assessment of EBP in the DR curricula.It is anticipated that DR graduates, who are prepared with knowledge and skills in EBP prior to graduation, will become leaders and drive future innovation in EBP.

Objective: One of the common modalities used in imaging COVID-19 positive patients is chest radiography (CXR), and serves as a valuable imaging method to diagnose and monitor a patients’ condition. Structured reporting templates are regularly used for the assessment of COVID-19 CXRs and are supported by international radiological societies. This review has investigated the use of structured templates for reporting COVID-19 CXRs. Methods: A scoping review was conducted on literature published between 2020 and 2022 using Medline, Embase, Scopus, Web of Science, and manual searches. An essential criterion for the inclusion of the articles was the use of reporting methods employing either a structured quantitative or qualitative reporting method. Thematic analyses of both reporting designs were then undertaken to evaluate utility and implementation. Results: Fifty articles were found with the quantitative reporting method used in 47 articles whilst 3 articles were found employing a qualitative design. Two quantitative reporting tools (Brixia and RALE) were used in 33 studies, with other studies using variations of these methods. Brixia and RALE both use a posteroanterior or supine CXR divided into sections, Brixia with six and RALE with four sections. Each section is scaled numerically depending on the level of infection. The qualitative templates relied on selecting the best descriptor of the presence of COVID-19 radiological appearances. Grey literature from 10 international professional radiology societies were also included in this review. The majority of the radiology societies recommend a qualitative template for reporting COVID-19 CXRs. Conclusion: Most studies employed quantitative reporting methods which contrasted with the structured qualitative reporting template advocated by most radiological societies. The reasons for this are not entirely clear. There is also a lack of research literature on both the implementation of the templates or comparing both template types, indicating that the use of structured radiology reporting types may be an underdeveloped clinical strategy and research methodology. Advances in knowledge: This scoping review is unique in that it has undertaken an examination of the utility of the quantitative and qualitative structured reporting templates for COVID-19 CXRs. Moreover, through this review, the material examined has allowed a comparison of both instruments, clearly showing the favoured style of structured reporting by clinicians. At the time of the database interrogation, there were no studies found had undertaken such examinations of both reporting instruments. Moreover, due to the enduring influence of COVID-19 on global health, this scoping review is timely in examining the most innovative structured reporting tools that could be used in the reporting of COVID-19 CXRs. This report could assist clinicians in decision-making regarding templated COVID-19 reports.

Diagnostic efficacy in medical imaging is ultimately a reflection of radiologist performance. This can be influenced by numerous factors, some of which are patient related, such as the physical size and density of the breast, and machine related, where some lesions are difficult to visualise on traditional imaging techniques. Other factors are human reader errors that occur during the diagnostic process, which relate to reader experience and their perceptual and cognitive oversights. Given the large-scale nature of breast cancer screening, even small increases in diagnostic performance equate to large numbers of women saved. It is important to identify the causes of diagnostic errors and how detection efficacy can be improved. This narrative review will therefore explore the various factors that influence mammographic performance and the potential solutions used in an attempt to ameliorate the errors made.

The purpose of this study was to introduce a continuous quality improvement (CQI) program for radiation dose optimisation during uterine artery embolisation (UAE) and assess its impact on dose reduction and image quality. The CQI program investigated the effects of optimising radiation dose parameters on the kerma-area product (KAP) and image quality when comparing a ‘CQI intervention’ group (n = 50) and ‘Control’ group (n = 50). Visual grading characteristics (VGC) analysis was used to assess image quality, using the ‘Control’ group as a reference. A significant reduction in KAP by 17% (P = 0.041, d = 0.2) and reference air kerma (Ka, r) by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.54, indicating no significant difference in image quality between the two groups (P = 0.670). The implementation of the CQI program and optimisation of radiation dose parameters improved the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.

Diverticular disease is one of the most common causes of outpatient visits and hospitalisations across Australia, North America and Europe. According to the Gastroenterological Society of Australia (GESA, 2010), approximately 33% of Australians over 45 years of age and 66% over 85 years of age have some form of colonic diverticulosis. Patients with colonic diverticulosis are known to develop subsequent complications such as acute colonic diverticulitis (ACD), and when more than one attack of diverticulitis occurs, there is a 70‐90% chance that the individual will experience ongoing problems and recurring infections throughout their lifetime. Medical imaging is fundamental in the diagnosis, treatment and ongoing management of ACD and its complications, with Computed Tomography (CT) identified as the prevailing gold standard in the last few decades. Cross‐database searching highlighted a large gap in the literature regarding the effectiveness of Magnetic Resonance Imaging (MRI) as a non‐ionising radiation alternative imaging tool for ACD imaging after the mid‐2000s, despite ongoing technological advancements in this modality. This narrative review identified 13 key publications (11 primary prospective cohort studies, 1 systematic review and 1 meta‐analysis) that evaluate MRI for ACD imaging, of which five were published within the last decade. Several existing MRI protocols are deemed suitable for ACD imaging, and it is recommended they be re‐evaluated in larger cohorts. Future studies should consider the rapidly growing technological improvements of MRI, its cost efficiency and its applicability in modern day healthcare settings when addressing ACD management. This is especially important considering the gradual rise in radiation dose among the Australian population attributable to increased CT referrals, alongside increased reporting of ACD cases in younger individuals., Diverticular disease is one of the most common causes of outpatient visits and hospitalisations. Cross‐database searching has highlighted a large gap in the literature: an absence of publications providing efficacy data on Magnetic Resonance Imaging (MRI) as a non‐ionising radiation alternative for ACD. This narrative review aims to explore available published data and provide an up‐to‐date evaluation of MRI as a tool for the diagnosis and ongoing management of ACD.

Introduction Early detection of malignant pulmonary nodules through screening has been shown to reduce lung cancer‐related mortality by 20%. However, perceptual and cognitive factors that affect nodule detection are poorly understood. This review examines the cognitive and visual processes of various observers, with a particular focus on radiologists, during lung nodule detection. Methods Four databases (Medline, Embase, Scopus and PubMed) were searched to extract studies on eye‐tracking in pulmonary nodule detection. Studies were included if they used eye‐tracking to assess the search and detection of lung nodules in computed tomography or 2D radiographic imaging. Data were charted according to identified themes and synthesised using a thematic narrative approach. Results The literature search yielded 25 articles and five themes were discovered: 1 – functional visual field and satisfaction of search, 2 – expert search patterns, 3 – error classification through dwell time, 4 – the impact of the viewing environment and 5 – the effect of prevalence expectation on search. Functional visual field reduced to 2.7° in 3D imaging compared to 5° in 2D radiographs. Although greater visual coverage improved nodule detection, incomplete search was not responsible for missed nodules. Most radiological errors during lung nodule detection were decision‐making errors (30%–45%). Dwell times associated with false‐positive (FP) decisions informed feedback systems to improve diagnosis. Interruptions did not influence diagnostic performance; however, it increased viewing time by 8% and produced a 23.1% search continuation accuracy. Comparative scanning was found to increase the detection of low contrast nodules. Prevalence expectation did not directly affect diagnostic accuracy; however, decision‐making time increased by 2.32 seconds with high prevalence expectations. Conclusion Visual and cognitive factors influence pulmonary nodule detection. Insights gained from eye‐tracking can inform advancements in lung screening. Further exploration of eye‐tracking in lung screening, particularly with low‐dose computed tomography (LDCT), will benefit the future of lung cancer screening., Early detection of malignant pulmonary nodules through screening has been shown to reduce lung cancer‐related mortality by 20%. However, perceptual and cognitive factors that affect nodule detection are poorly understood. This review examines the cognitive and visual processes during lung nodule detection.

Educating students to become evidence-based practitioners remains a significant challenge in health professional education. Clinical placements form a significant element of curriculum and the impact of students’ placement experiences on their ability and desire to practice in an evidence-based manner remains largely unexplored. Medical imaging students complete a variety of clinical placements and observe and participate in a range of clinical settings. This study utilised focus groups to explore students’ experiences of evidence-based practice (EBP) during clinical placements, the impact of these experiences on their education and their future tendencies within the profession. Reflexive thematic analysis was utilised to analyse data and three main overarching themes were identified. The first theme, “Education” explored participants’ understanding of the concept of EBP, the importance of sound pedagogy to enable students’ ability to practice in an evidence-based manner and explored the relationship between participants’ placement experiences and their future EBP tendencies. The second theme investigated, “Culture and responsibility” and was divided into three subthemes, professional, organisational, and individual. Focusing on where the responsibility for implementing EBP should lie and the impact of culture on individuals’ ability to implement evidence-based practice. The third theme, “Hopes, fears, and barriers” explored the participants’ sense of responsibility around implementing EBP and the barriers that they had experienced in doing so. It illuminated their fears around becoming apathetic as clinicians. Improving the teaching of EBP skills within health professional education has the potential to enhance the translation of knowledge into practice as graduates become clinicians within the profession.

Rationale and Objectives To measure the effect of visual hindsight bias on radiologists’ perception during chest radiograph pulmonary nodule detection. Materials and Methods This was a prospective multi-observer study to assess the effect of hindsight bias on radiologists’ perception. Sixteen radiologists were asked to interpret 15 postero-anterior chest images containing a solitary lung nodule each consisting of 25 incremental levels of blur. Participants were requested initially to detect the nodule by reducing the blur of the images (foresight). They were then asked to increase the blur until the identified nodule was undetectable (hindsight). Participants then repeated the experiment, after being informed of the potential effects of hindsight bias and asked to counteract these effects. Participants were divided into two groups (experienced and less experienced) and the nodules were given different conspicuity ratings to determine the effect of expertise and task difficulty. Eye tracking technology was also utilised to capture visual search. Results Wilcoxon analysis demonstrated significant differences between foresight and hindsight values of the radiologists (p = 0.02). However, after being informed of hindsight bias, these differences were no longer significant (p = 0.97). Friedman analysis also determined overall significance in the hindsight ratios between nodule conspicuities for both phases (phase 1: p = 0.02; phase 2: p = 0.02). There was no significance difference between the experienced and less experienced groups. Conclusion This study demonstrated that radiologists exhibit hindsight bias but appeared to be able to compensate for this phenomenon once its effects were considered. Also, visual hindsight bias appears to be affected by task difficulty with a greater effect occurring with less conspicuous nodules.

Mammography interpretation is challenging with high error rates. This study aims to reduce the errors in mammography reading by mapping diagnostic errors against global mammographic characteristics using a radiomics-based machine learning approach. A total of 36 radiologists from cohort A (n = 20) and cohort B (n = 16) read 60 high-density mammographic cases. Radiomic features were extracted from three regions of interest (ROIs), and random forest models were trained to predict diagnostic errors for each cohort. Performance was evaluated using sensitivity, specificity, accuracy, and AUC. The impact of ROI placement and normalization on prediction was investigated. Our approach successfully predicted both the false positive and false negative errors of both cohorts but did not consistently predict location errors. The errors produced by radiologists from cohort B were less predictable compared to those in cohort A. The performance of the models did not show significant improvement after feature normalization, despite the mammograms being produced by different vendors. Our novel radiomics-based machine learning pipeline focusing on global radiomic features could predict false positive and false negative errors. The proposed method can be used to develop group-tailored mammographic educational strategies to help improve future mammography reader performance.

Patients with intellectual disabilities often fail to follow traditional tongue position instructions for panoramic radiographs resulting in missed pathology or unnecessary further radiation. This simple breathing technique is a new clinical instruction method for panoramic radiography developed to reduce the most common patient position error: patient failure to hold the tongue to the roof of the mouth. The technique is suitable for all patients including young patients and those with intellectual disabilities. The simple breathing technique uses 'tell-show-do' communication methods and does not mention the tongue but utilises the known tongue positions that occur during breathing and swallowing. This simple breathing technique instruction for panoramic radiography uses a demonstration of 'breathe-in, breathe-out, swallow, lips closed and hold still' to reduce the intensity of both the palatoglossal and pharyngeal airspaces on panoramic radiographs. This method, referred in this article as the simple breathing technique, can improve the diagnostic potential of panoramic radiographs and can be used with young children and patients with intellectual disabilities, and this slow breathing technique can help them further relax.

Uterine artery embolisation (UAE) is an interventional angiography procedure for the treatment of symptomatic fibroids and/or adenomyosis in women. UAE is a less invasive and non‐surgical alternative to hysterectomy or myomectomy. However, ionising radiation is used for both fluoroscopic and angiographic image guidance to visualise and access the uterine arteries for embolisation and treatment of these benign conditions. Identifying the contributors and implementing dose reduction techniques are particularly important as UAE patients are usually of child‐bearing age. The purpose of this review was to examine the progression of literature on radiation exposure measurements and identifying the factors contributing to the total radiation exposure of female patients undergoing UAE. A Medline, ProQuest Central, ScienceDirect and Scopus database search from 2000 to 2018 was performed and forty articles were deemed acceptable for review following the inclusion and exclusion criteria set. UAE is a viable alternative to hysterectomy and myomectomy, as the reviewed literature demonstrated that the reported radiation exposure doses appear to be below the threshold for any deterministic radiation risks. The total radiation exposure of UAE patients is affected independently by multiple patient, operator expertise and technique, angiographic imaging and x‐ray unit variables. Uterus preservation can be attained post‐UAE with dose reduction and optimisation, however, a longitudinal study on UAE patients and their risk of radiation‐induced deterministic and/or stochastic effects is recommended.

Trauma to the facial area accounts for a significant number of admissions to the emergency department. Diagnostic imaging is almost always required, and is critical in determining patient management. Multi‐detector computed tomography (MDCT) appears consistently in the literature as the gold‐standard imaging modality for facial bones, but results in a high radiation dose to the patient. This makes the application and advancement of dose reduction and dose optimisation methods vital. This narrative review presents a critical analysis of the literature concerning diagnostic imaging of facial bone trauma, with an emphasis on dose reduction methods for MDCT. Databases including Pubmed, Medline, Web of Science and Scopus were used to investigate this topic, with the key words: facial bone trauma, computed tomography (CT) imaging and dose reduction. Exclusion criteria included studies on nasal bone fracturing, dental imaging, elective surgeries and paediatric imaging. The literature shows overwhelming support for MDCT, given its accuracy, efficiency and ease of operation. Noise reducing reconstruction algorithms show promise as a successful method of dose reduction in facial bone imaging. Investigations of more innovative techniques also appear within the literature, including diagnostic cone‐beam CT (CBCT), intraoperative CBCT and dual‐source CT (DSCT), but further research is required to confirm their clinical value.

Introduction Radiologists utilise mammography test sets to bench mark their performance against recognised standards. Using a validated test set, this study compares the performance of radiographer readers against previous test results for radiologists. Methods Under similar test conditions radiographer readers were given an established test set of 60 mammograms and tasked to identify breast cancer, they were measured against their ability to identify, locate and give a confidence level for cancer being present on a standard set of mammographic images. The results were then compared to previously published results for radiologists for similar or the same test sets. Results The 10 radiographer readers demonstrated similar results to radiologists and for lesion sensitivity were the highest scoring group. The study group score a sensitivity of 83; a specificity of 69.3 and lesion sensitivity of 74.8 with ROC and JAFROC scores of 0.86 and 0.74 respectively. Conclusion Under test conditions radiographers are able to identify and accurately locate breast cancer in a range of complex mammographic backgrounds. Implications for practice The study was performed under experimental conditions with results comparable to breast radiologists under similar conditions, translation of these findings into clinical practice will help address access and capacity issues in the timely identification and diagnosis of breast cancer.

Objectives This narrative review examines the current status of evidence-based practice and knowledge translation in diagnostic radiography. It explores knowledge translation efforts in the allied health professions aimed at systematically implementing evidence-based practice and suggests ways that these may be applied within diagnostic radiography. Key findings Knowledge translation in diagnostic radiography is in its infancy with numerous examples of key findings of rigorous studies not implemented in practice. Utilising frameworks, models and theories to systematically translate knowledge into evidence-based practice has been shown to be effective in other allied health professions. Whilst few studies in diagnostic radiography report utilising these systematic approaches to implementing evidence-based practice, those that do, show promising results. Attitudes towards evidence-based practice within diagnostic radiography are becoming more positive and it is important to use this positive shift in attitudes to create real evidence-based change in the profession. Conclusion The potential benefits of systematically translating knowledge into evidence-based practice in diagnostic radiography are wide reaching with positive implications for our patients, the profession and wider community. Leaders at all levels of radiography must work towards implementing evidence-based practice in their daily work. Implications for practice Systematic approaches to knowledge translation should be adopted and reported in diagnostic radiography in order to more effectively translate knowledge into evidence-based practice.

Rationale and objectives: Target recall rates are often used as a performance indicator in mammography screening programs with the intention of reducing false positive decisions, over diagnosis and anxiety for participants. However, the relationship between target recall rates and cancer detection is unclear, especially when readers are directed to adhere to a predetermined rate. The purpose of this study was to explore the effect of setting different recall rates on radiologist’s performance. Materials and Methods: Institutional ethics approval was granted and informed consent was obtained from each participating radiologist. Five experienced breast imaging radiologists read a single test set of 200 mammographic cases (20 abnormal and 180 normal). The radiologists were asked to identify each case that they required to be recalled in three different recall conditions; free recall, 15% and 10% and mark the location of any suspicious lesions. Results: Wide variability in recall rates was observed when reading at free recall, ranging from 18.5% to 34.0%. Readers demonstrated significantly reduced performance when reading at prescribed recall rates, with lower sensitivity (H=12.891, P=0.002), case location sensitivity (H=12.512, P=0.002) and ROC AUC (H=11.601, P=0.003) albeit with an increased specificity (H=12.704, P=0.002). However, no significant changes were evident in lesion location sensitivity (H=1.982, P=0.371) and JAFROC FOM (H=1.820, P=0.403). Conclusion: In this laboratory study, reducing the number of recalled cases to 10% significantly reduced radiologists’ performance with lower detection sensitivity, although a significant improvement in specificity was observed.

AIM To measure the level of radiologists' performance in lung cancer detection, and to explore radiologists' performance in cancer specialised and non-specialised centres. MATERIALS AND METHODS Thirty radiologists read 60 chest computed tomography (CT) examinations. Thirty cases had surgically or biopsy-proven lung cancer and 30 were cancer-free cases. The cancer cases were validated by four expert radiologists who located the malignant lung nodules. Reader performance was evaluated by calculating sensitivity, location sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC). In addition, sensitivity at fixed specificity (0.794) was computed from each reader's estimated ROC curve. RESULTS The radiologists had a mean sensitivity of 0.749, sensitivity at fixed specificity of 0.744, location sensitivity of 0.666, specificity of 0.81 and AUC of 0.846. Radiologists in the specialised and non-specialised cancer centres had the following (specialised, non-specialised) pairs of values: sensitivity=(0.80, 0.719); sensitivity for fixed 0.794 specificity=(0.752, 0.740); location sensitivity=(0.712, 0.637); specificity=(0.794, 0.82) and AUC=(0.846, 0.846). CONCLUSION The efficacy of radiologists was comparable to other studies. Furthermore, AUC outcomes were similar for specialised and non-specialised cancer centre radiologists, suggesting they have similar discriminatory ability and that the higher sensitivity and lower specificity for specialised-centre radiologists can be attributed to them being less conservative in interpreting case images.

Purpose The purpose of this study was to investigate the effect of increasing iterative reconstruction (IR) algorithm strength at different tube voltages in coronary computed tomography angiography (CCTA) protocols using a three‐dimensional (3D)‐printed and Catphan® 500 phantoms. Methods A 3D‐printed cardiac insert and Catphan 500 phantoms were scanned using CCTA protocols at 120 and 100 kVp tube voltages. All CT acquisitions were reconstructed using filtered back projection (FBP) and Adaptive Statistical Iterative Reconstruction (ASIR) algorithm at 40% and 60% strengths. Image quality characteristics such as image noise, signal–noise ratio (SNR), contrast–noise ratio (CNR), high spatial resolution, and low contrast resolution were analyzed. Results There was no significant difference (P > 0.05) between 120 and 100 kVp measures for image noise for FBP vs ASIR 60% (16.6 ± 3.8 vs 16.7 ± 4.8), SNR of ASIR 40% vs ASIR 60% (27.3 ± 5.4 vs 26.4 ± 4.8), and CNR of FBP vs ASIR 40% (31.3 ± 3.9 vs 30.1 ± 4.3), respectively. Based on the Modulation Transfer Function (MTF) analysis, there was a minimal change of image quality for each tube voltage but increases when higher strengths of ASIR were used. The best measure of low contrast detectability was observed at ASIR 60% at 120 kVp. Conclusions Changing the IR strength has yielded different image quality noise characteristics. In this study, the use of 100 kVp and ASIR 60% yielded comparable image quality noise characteristics to the standard CCTA protocols using 120 kVp of ASIR 40%. A combination of 3D‐printed and Catphan® 500 phantoms could be used to perform CT dose optimization protocols.

Introduction An ideal organ‐specific insert phantom should be able to simulate the anatomical features with appropriate appearances in the resultant computed tomography (CT) images. This study investigated a 3D printing technology to develop a novel and cost‐effective cardiac insert phantom derived from volumetric CT image datasets of anthropomorphic chest phantom. Methods Cardiac insert volumes were segmented from CT image datasets, derived from an anthropomorphic chest phantom of Lungman N‐01 (Kyoto Kagaku, Japan). These segmented datasets were converted to a virtual 3D‐isosurface of heart‐shaped shell, while two other removable inserts were included using computer‐aided design (CAD) software program. This newly designed cardiac insert phantom was later printed by using a fused deposition modelling (FDM) process via a Creatbot DM Plus 3D printer. Then, several selected filling materials, such as contrast media, oil, water and jelly, were loaded into designated spaces in the 3D‐printed phantom. The 3D‐printed cardiac insert phantom was positioned within the anthropomorphic chest phantom and 30 repeated CT acquisitions performed using a multi‐detector scanner at 120‐kVp tube potential. Attenuation (Hounsfield Unit, HU) values were measured and compared to the image datasets of real‐patient and Catphan® 500 phantom. Results The output of the 3D‐printed cardiac insert phantom was a solid acrylic plastic material, which was strong, light in weight and cost‐effective. HU values of the filling materials were comparable to the image datasets of real‐patient and Catphan® 500 phantom. Conclusions A novel and cost‐effective cardiac insert phantom for anthropomorphic chest phantom was developed using volumetric CT image datasets with a 3D printer. Hence, this suggested the printing methodology could be applied to generate other phantoms for CT imaging studies.

This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre’s practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura, n = 95) and Group II (Azurion, n = 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm2 vs 52.9 Gy cm2; P < 0.001, d = 0.8) and 67% (0.6 Gy vs 0.2 Gy; P < 0.001, d = 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm2 and the limits of agreement were +28.49 and −27.71 Gy cm2, and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system’s features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.

Three‐dimensional (3D) printing technology has demonstrated a huge potential for the future of medicine. Since its introduction, it has been used in various areas, for example building anatomical models, personalising medical devices and implants, aiding in precision medical interventions and the latest development, 3D bioprinting. This commentary is provided to outline the current use of 3D printing in medical imaging and its future directions for advancing the healthcare services.

Background: Lung cancer, the leading cause of cancer death worldwide, can be survived if early detection through screening programs occurs. However if a large scale lung cancer screening program needs to be implemented, it may require a substantial increase in qualified readers’ numbers. To investigate whether senior radiology residents may potentially increase the pool of available readers in screening for lung cancer, by comparing their performance with that of board-certified radiologists. Methodology: Twenty board-certified radiologists and ten senior residents read sixty chest CT scans. Thirty cases had surgically or biopsy-proven lung cancer and the remaining thirty were cancer-free cases. The cancer cases were validated by four expert radiologists who located the malignant lung nodules. Reader performance was evaluated by calculating sensitivity, location sensitivity, specificity, area under the receiver-operating-characteristic curve (AUC) and sensitivity at fixed specificity = 0.8. Results: Readers had the following (radiologists, residents) pairs of values: sensitivity = (0.782, 0.687); location sensitivity = (0.702, 0.597); specificity = (0.8, 0.83); AUC = (0.844, 0.85) and sensitivity for fixed 0.8 specificity = (0.74, 0.73). Conclusion: Initial findings suggest that senior residents compare favorably with board-certified radiologists based on the similarity of the AUCs and the summary ROC curves in terms of the ability to discriminate between diseased and non-diseased patients. However, they have demonstrated significantly lower detection sensitivity than board-certified radiologists and may require additional training, considering the importance of having high sensitivity when screening for cancer.

This experiment investigated whether there might be an effect on the visual search strategy of radiologists during image interpretation of the same adult chest radiographs when given different clinical information. Each of 17 experienced radiologists was asked to interpret a set of 57 (10 abnormal) posteroanterior chest images to identify the presence of pulmonary lesions using differing clinical information (leading to unknown, low and high expectations of prevalence). Eye position metrics (search time, dwell time and time to first fixation) were compared for normal and abnormal images, as well as between conditions. For all images, there was a significantly longer search time at high prevalence expectation compared to low prevalence expectation (W = 75.19, P =

Rationale and Objectives This research investigates whether an expectation of abnormality and prior knowledge might potentially influence the decision-making of radiologists, and discusses the implications for radiological expert witness testimony. Materials and Methods This study was a web-based perception experiment. A total of 12 board-certified radiologists were asked to interpret 40 adult chest images (20 abnormal) twice and decide if pulmonary lesions were present. Before the first viewing, a general clinical history was given for all images: cough for 3 + weeks . This was called the “defendants read.” Two weeks later, the radiologists were asked to view the same dataset (unaware that the dataset was unchanged). For this reading, the radiologists were given the following information for all images: “ These images were reported normal but all of these patients have a lung tumour diagnosed on a subsequent radiograph 6 months later. ” They were also given the lobar location of the newly diagnosed tumor. This was called the “expert witness read.” Results There was a significant difference in location-based sensitivity (W = −45, P = 0.02) between the two conditions with nodule detection increasing under the second condition. Specificity increased outside the lobe of interest (W = 727, P = P = 0.03) significantly in the “expert witness” read. Case-based sensitivity and case-based specificity were unaffected. Conclusions This study showed evidence that increased clinical information affects the performance of radiologists. This effect may bias expert witnesses in radiological malpractice litigation.