Associate Professor Helen Warren

© 2020 The College of Radiographers Introduction: Health literacy (HL) is a universal issue in healthcare. While difficult to assess an individual's HL status, the onus is on the health provider to empower patients to seek understanding of health information provided to them. Universal HL training techniques include implementing plain language and the teach-back method. The research aims to explore the perceptions of Australian radiation therapists (RTTs) learning and implementation of these tools with patients. Methods: RTTs attended two communication and HL workshops one week apart. Participants completed three anonymous surveys (before the first workshop, immediately after the second and three months post workshops) and a workshop evaluation was administered after the second workshop. Participants had the opportunity to provide written comments on all surveys and the evaluation form. A thematic analysis was performed on the written comments by two independent researchers. Results: Five themes were revealed after the thematic analysis of the surveys. These themes were: improved patient understanding, impact on professional credibility, practice and timing of using methods, appearing to be condescending to educated patients and increased patient anxiety. The workshop evaluation assessment indicated the success of and improvement for future workshops and revealed seven themes. These were: learning from others, providing a safe environment to share experiences, to be open to learning new methods, more time for learning, role-play aversion, group sizing and thinking beyond the workshops. Conclusion: While strong evidence of using HL tools for improved patient understanding exists, this qualitative review revealed unexpected barriers with implementing both the plain language and teach-back method. Implications for practice: Barriers revealed during HL training could have patient flow on effects when checking for understanding. These challenges need further exploration, to inform all health professionals.

© 2020 Taylor & Francis Group, LLC. Background: Stroke can affect a person¿s ability to drive a motor vehicle. In Australia, there is a 4-week restriction in driving after stroke and a 2-week restriction after transient ischemic attack. Concerns exist as to whether people discharged home from the acute setting receive education about these driving restrictions. Objectives: This study sought to investigate health professionals¿ knowledge about, and responsibilities for patients return-to-driving (RTD) education after stroke and TIA. Methods: A cross-sectional online survey was designed and included questions about health professional demographic characteristics and knowledge and opinions of RTD guidelines. An open-ended question at the end of the survey enabled respondents to provide additional, free text information. Descriptive analyses were used to describe respondents¿ demography and characteristics. Chi-square analysis was used to compare responses across the different professional groups. Significance was tested using a p-value of 0.05. Data obtained from the free text question were analyzed through an inductive thematic approach. Results: A total of 455 health professionals responded to the survey, with 45% being occupational therapists. Only 22% of health professionals correctly selected the 4-week restriction period after stroke and 27% selected the 2-week restriction period for those with TIA. Occupational therapists were identified by 85% of respondents as the profession responsible for providing RTD education, followed by doctors (72%). Health professionals lack clarity in RTD guidelines and often defer the responsibility of managing RTD to others. Conclusions: Education of health professionals in RTD guidelines is recommended to improve the processes of care after stroke.

© 2019 The College of Radiographers Introduction: Informed consent for ionising radiation medical imaging examinations is currently undertaken inconsistently in Australian radiographic practice. There is no uniform informed consent process, and opinions vary about how it should be undertaken, and by whom, if indeed it needs to be undertaken at all. To ensure that patients¿ rights are maintained, the informed consent process must be consistent, proactive in the provision of information, and must empower the patient to formulate and ask questions about their care, and to make voluntary decisions. Methods: The Delphi technique utilises a group of experts whose individual responses are used to create a collective consensus on a process. This ten-expert (five radiographer, five radiologist) Delphi study examined a basic modelling of the process of informed consent for ionising radiation medical imaging examinations and made recommendations for an ideal process. Results: A series of consensus statements were developed, seeking to rectify areas of the process that were inconsistent, unclear, or ethically unsound. These statements were then considered alongside current codes of professional practice, and Australian law on the duty of disclosure. A model of the ideal process was then developed using these consensus statements and adhering to codes of practice. Conclusion: The final process model has a continuity of care and a continuity of information provision. The model eliminates the radiographer as a delegatee, and emphasises physician involvement. The referrer and the radiologist have a shared responsibility of providing risk disclosure information. Implications for Practice: For a non-pregnant adult, the ionising radiation dose from conventional radiography is considered insignificant, and does not require risk disclosure, ameliorating the time commitment needed for the process.

© 2019 Objective: There is a worldwide shortage of radiographers qualified to perform mammography. One solution is the employment of male radiographers. This literature review aims to assess the scope of information available that covers the prospect of males being employed in a breast screening setting. The review specifically focuses on the incidence of males employed as mammographers, training options and client perceptions of males performing breast imaging. Key findings: Some countries employ male mammographers, though this is limited. There is contradictory information regarding the education of male radiography students in mammography. Several studies have indicated that clients of breast screening services would be open to males performing mammographic procedures, while others have reported strong opposition. The client's level of education, marital status and ethnicity affected their perception. Conclusion: The review has shown that the employment of male radiographers in mammography may work better in some countries and in some subgroup of clients than others. The review has also highlighted some of the barriers that needs to be overcome if the widespread inclusion of men in mammography were to be successfully implemented. These include the use of chaperones and providing client choice in the gender of radiographer.

© 2019 The College of Radiographers Introduction: Radiation therapy students need to demonstrate appropriate communication skills when entering the clinical environment. To assist students with preparation for their first clinical placement a clinical reasoning module comprising theory and practical sessions was developed. This paper describes the module and presents the results of student evaluations. Methods: The module consisted of lectures, observational role-play and participatory role-play. Students were ultimately tasked with providing information to a simulated patient (SP). Each student received feedback independently from the SP, peers and facilitator. At the conclusion of the module, students had the opportunity to provide feedback via an anonymous survey (8 Likert scale questions with space for written comment). Data was analysed both quantitatively and qualitatively. Results: Four hundred and thirty seven students were enrolled in the course between 2008 and 2016 and the response rate of the survey was 93%. Even though most students reported some level of anxiety before and during the role-play sessions, the majority of students perceived all aspects of the module to be extremely/very useful. The most useful aspect of the module (Likert scale assessment) was the feedback provided by the SP. The two most important themes arising from the thematic analysis were gaining an understanding of the role of the radiation therapist and the complexities of patient interactions. Conclusion: Overall, the module was deemed successful with students becoming conscious of newly acquired clinical knowledge whilst acknowledging patient feelings during interactions. Collaborative critiquing contributed to students' ability to self-reflect to improve clinical interactions.

© 2018 Introduction: Meaningfully explaining the risk of an ionising radiation examination is a challenging undertaking. Patients must contextualise the risk against the expected benefit of the imaging examination, often in a situation of heightened emotion. This systematic review seeks to explore the literature to identify what techniques are advocated for disclosing the risk to patients of ionising radiation from clinical medical imaging examinations. Methods: A systematic review of peer-reviewed literature was undertaken. Electronic databases were searched to identify peer-reviewed, full-text articles published in English from 1990. Original articles discussing techniques for disclosing ionising radiation risks in the clinical setting were included. The reference lists of the included articles were searched for unpublished articles and reports of use. Results: Sixteen papers out of 5959 unique titles met the inclusion criteria. The data was extracted independently by two researchers and assessed for quality using the Joanna Briggs Institute critical appraisal tools. Conclusion: The two most commonly cited techniques for disclosing ionising radiation risk is to compare risk to the risk of common life events, and to describe risk as an additive risk to the baseline risk of cancer. The most commonly cited communication strategy was a graphical representation of the data, but simple language is also advocated. The use of a pictograph represents a technique which satisfied the advocated techniques of most articles.

© 2019 The College of Radiographers Introduction: Informed consent for ionising radiation medical imaging examinations represents a recent change to medical imaging practice. This practice has not had a definitive and authoritative integration into clinical practice, and lack of direction has caused many health care professionals to be unsure of an appropriate consent methodology. Consent practices have been undertaken inconsistently and sometimes poorly. This research sought to investigate what barriers exist to meaningful informed consent, and what pathways are suggested to overcome these barriers. These views are then discussed in the context of practical health care consent practices. Methods: A semi-structured interview explored the views of radiographers and radiologists on the practice of disclosing the ionising radiation risk of a clinical medical imaging examination. Qualitative data was analysed using a nominal method of quantitative transformation. Responses were reviewed, and a set of definitive themes constructed. Participants considered the influences, logistics and barriers to the informed consent process. Participants were then asked what pathways might be developed that would improve the process. Results: Twenty-one (21) radiographer participants and nine (9) radiologists were interviewed. The barriers to consent identified issues of time constraints, lack of a unified message, and patient presentations. Pathways suggested included limiting the scope of the consent practice, sharing the consent responsibility, and formulation of definitive consent guidelines. Conclusion: A unified, definitive series of guidelines for informed consent for ionising radiation examinations would alleviate many of the identified barriers. Having the consent process consistently begin with the referring doctor would facilitate more meaningful consent.

© 2017 The College of Radiographers Introduction: Autonomy is a fundamental patient right for ethical practice, and informed consent is the mechanism by which health care professionals ensure this right has been respected. The ethical notion of informed consent has evolved alongside legal developments. Under Australian law, a provider who fails to disclose risk may be found to be in breach of a duty of disclosure, potentially facing legal consequences if the patient experiences harm that is attributable to an undisclosed risk. These consequences may include the common law tort of negligence. Ionising radiation, in the form of a medical imaging examination, has the potential to cause harm. However, stochastic effects cannot be attributable to a specific ionising radiation event. What then is the role of the Australian medical imaging service provider in disclosing ionising radiation risk? Methods: The ethical and legal principles of informed consent, and the duty of information provision to the patient are investigated. These general principles are then applied to the specific and unusual case of ionising radiation, and what responsibilities apply to the medical imaging provider. Finally, the legal, professional and ethical duties of the radiographer to disclose information to their patients are investigated. Results: Australian law is unclear as to whether a radiographer has a common law responsibility to disclose radiation risk. There is ambiguity as to whether stochastic ionising radiation risk could be considered a legal disclosure responsibility. Conclusion: While it is unlikely that not disclosing risk will have medicolegal consequences, doing so represents sound ethical practice.

© 2018 The College of Radiographers Introduction: There is a projected shortage of radiographers working in breast screening in Australia. This study aimed to examine the perceived barriers and potential incentives among current undergraduate diagnostic radiography students to train, specialise and work in mammography. Methods: A survey was undertaken to assess students' experience of six modalities during both University study and clinical practice. Students were asked to rank their priority of which they would want to specialise and if training and working in mammography was an option. Results: From 248 students invited to participate, 101 students replied to the survey. Students indicated that they had been taught all modalities, however not all students had experienced them on clinical placement. Most students had observed or performed ultrasound (US) (90%, 90%), Computed Tomography (CT) (97%, 75%) and fluoroscopy (80%, 52%), though very few had experience of mammography (55%, 8%). US, CT, and MRI were the modalities that most students would like to specialise in. Male students reported being discriminated against working in mammography as this is ¿female only¿ work. Conclusion: Students have more clinical access to the major modalities of US, CT and MRI, and this appears to be a major factor into why student wish to specialise in these modalities. Role extension and higher wages were given as possible incentives that would make specialising in Mammography more appealing. The gender divide may have to be bridged to enable crucial recruitment as male students feel discriminated against.

© 2018 The College of Radiographers Introduction: For radiographers, gaining informed consent with our patients represents a challenging undertaking. Reconciling the need to gain meaningful consent with time pressures represents one challenge, as does differing expectations of how risk communication should be undertaken. Different methods and thresholds of risk disclosure are considered, with the aim of finding a realistic best practice. Methods: A cross-sectional study of radiographers and members of the public was undertaken. Participants were asked their preferences for how they would like to receive ionising radiation risk information. This included the health care professional(s) most suited to provide the information, the media through which the information was delivered, and the technique for delivering the information. In addition, participants were asked to consider hypothetical scenarios in which they were a patient receiving an ionising radiation examination, and to give the threshold of ionising radiation cancer risk which they would consider material. These scenarios considered variations in the cancer-onset time, and the accuracy of the test. Results: One hundred and twenty-one (121) radiographer participants and one hundred and seventy two (172) members of the public met the inclusion criteria and completed the survey. There was strong agreement in the most appropriate media, and person, to disclose risk, as well as what represents a significant risk. There was considerable agreement in risk delivery technique. However, some of the agreed-upon strategies may be challenging to achieve in clinical practice. Conclusion: Radiographers and patients fundamentally agree upon risk communication strategies, but implementing some strategies may prove clinically challenging.

© 2018 The College of Radiographers Introduction: Using magnetic resonance imaging (MRI) safety as an example, this paper discusses the development of an innovative multiple-step assignment task designed to increase student engagement and learning of important concepts. The paper also summarises student feedback about the assessment as well as thematic analysis of categories thought important to students. Method: A multi-step assignment was designed. Step one was the reading of a MRI safety article, step two was the construction and submission of 5 short answer questions believed to be important concepts of understanding and step three was the answering of 15 questions compiled from all student questions by the course coordinator. The motivation to answer the course coordinator compiled questions was the knowledge that five of these questions would be in the end of course examination. At the completion of the assignment, students were asked to complete an anonymous on-line questionnaire about the assignment task. Thematic analysis was used to gather data on what students perceived to be the most and least important concepts in the article. Results: All students replying to the survey stated that they understood why MRI safety is an important topic and 79% reported this assignment was both a positive learning experience and provided understanding of the topic. Only 18% of students believed that they would have learned more through a formal lecture. Conclusion: The design of this assignment task can be used in any course, not just in medical radiation science, where student learning and understanding is critical.

© 2017 Occupational Therapy Australia Background/aim: In Australia, all stroke survivors should not drive for four weeks and transient ischaemic attack (TIA) survivors should not drive for two weeks. This study investigates the provision of return-to-driving education in the acute hospital setting and the use of this education by a cohort of Australian patients who have experienced a mild stroke or TIA and who are discharged directly home from their acute hospital admission. Methods: A medical record audit was conducted of stroke patients discharged home from a regional hospital in Australia. All audited patients were sent a post-discharge anonymous survey of their post-stroke driving behaviours. Results: A total of 78 medical records were audited (32 women, 46 men; 15 TIA, 63 strokes). Mean age was 67.4¿years (SD¿=¿13.7, range 20¿89¿years). Only 27 (34.6%) patients had documented evidence that return-to-driving was discussed with them by a health professional, with only 10 (12.8%) having a restriction period documented. A total of 31 surveys were analysed (10 females, 21 males) and 20 participants had returned to driving. From 31 survivors of mild stroke/TIA, 21 recalled receiving advice on return-to-driving and seven resumed driving during the non-driving period of one month. Conclusions: Inconsistencies exist in the documentation of return-to-driving management after acute stroke or TIA and it is unknown whether patients who lack documentation in their medical records were provided with education or not.

© 2017 Taylor & Francis Group, LLC. Gaps exist in the knowledge of return-to-driving guidelines, and education is needed for Australian health professionals working in the field of stroke. In this paper, authors evaluate the implementation of an e-learning module. A pre- and post-module knowledge test and survey were used to assess the e-module's success in achieving its learning objectives. Initially, 204 learners completed the module, with 68% of learners scoring 100% in the post-module knowledge test. Only 12 learners completed the survey. The authors recommend that health professionals other than occupational therapists access this e-module, and a review on e-module structure is required to improve results of knowledge tests.

© 2016 Aim Breast cancer is the second most common cause of cancer-related death in Australian women, therefore early breast cancer detection is essential. Female radiographers currently conduct breast screening in Australia; however there is a projected shortage. With many women already feeling apprehensive about attending a breast examination, possible proposals to fill this shortage must be carefully considered. Training male radiographers is one proposal however, this raises some gender concerns. This study aimed to pilot an investigation into whether it would change women's willingness to attend breast screening if conducted by a male radiographer. Method A questionnaire completed by 146 women aged over 40 asked questions on attitude, initial reaction and how they would proceed if attended to by a male in three clinical situations (Mammography; Ultrasound and Breast Surgery). Results The results revealed that women would have had their mammogram (90%), ultrasound (95%) and surgery (100%) conducted by a male, though some would have preferred a female for mammography (25%), ultrasound (24%) and surgery (12%). A total of 9% of women agreed to the statement ¿If there were male radiographers I would not return for another screening appointment¿ and 9% agreed to the statement ¿if I heard there could be male radiographers it would change my opinion of Breast Screening for the worse¿. Conclusions This first Australian study investigating the perceptions of women to male radiographers in the breast screening arena suggest that a mix of male and female radiographers could be accommodated and indicates the need for a larger national survey.

© 2016 Aim There is a projected shortage of radiographers working in breast screening and this study aimed to examine comments from open response questions from a mixed methods survey of current diagnostic radiography students on their perceptions of working in mammography. Method The survey asked three open ended questions: Justification of choice of modality in which they would want to specialise, why they believed there was a shortage of radiographers working in breast screening and any other comment about mammography. Results Reasons given for specialising in any modality was interest, feature of a modality, amount of clinical exposure during the degree program, personal issues and career prospects. Few current diagnostic radiography students indicated that they would be interested in specialising in breast imaging. They considered there to be a shortage of radiographers as breast imaging was seen to be repetitive, high pressure, intimate and gender biased. Lack of education, clinical exposure, limited career prospects and low pay were also discussed. Conclusions Increasing education to the modality during the degree, allowing males to be involved in breast imaging and promoting part-time work in mammography while also working in other modalities may alter the perception that mammography offers a limited career pathway.

© 2015 . Introduction: Globally, the role of the radiographer is changing; some countries have developed advanced roles with specific scopes of practice. Other countries, like Australia, are in the process of this change. The aim of this research is to assess the diagnostic outcomes reported by the radiographers and compare them to those reported by current screen readers. Method: Six experienced radiographers were invited to participate in a prospective study conducted between 2010 and 2011. They were required to read 2000 mammograms each. Their results were compared with those of the radiologists. Statistical analysis of the results included overall cancer detection rates, recall rates, levels of agreement, kappa, sensitivity, specificity, accuracy, positive predictive value and negative predictive value. Results: A total of 9348 women were included in the study. The percentage of cancers detected by the radiographers ranged from 53% to 100% of the cancers detected by the radiologists. Radiologist recall rate ranged between 3.4% and 5.5% and the radiographers' range was 2.9%-9.8%. Level of agreement of the radiographers with the radiologists ranged from 90 to 96%. Conclusion: The potential for accuracy in screen reading by Australian radiographers is supported by the results of this study. Implementation of formal training is likely to result in an increase in the diagnostic accuracy of radiographers.

© 2016 Occupational Therapy Australia Background/aim: Technology is becoming increasingly integral to the practice of occupational therapists and part of the everyday lives of clients. ¿Generation Y¿ are purported to be naturally technologically skilled as they have grown up in the digital age. The aim of this study was to explore one cohort of ¿Generation Y¿ occupational therapy students¿ skills and confidence in the use of technologies relevant to contemporary practice. Methods: A cross-sectional survey design was used to collect data from a cohort of 274 students enrolled in an Australian undergraduate occupational therapy programme. Results: A total of 173 (63%) students returned the survey. Those born prior to 1982 were removed from the data. This left 155 (56%) ¿Generation Y¿ participants. Not all participants reported to be skilled in everyday technologies although most reported to be skilled in word, Internet and mobile technologies. Many reported a lack of skills in Web 2.0 (collaboration and sharing) technologies, creating and using media and gaming, as well as a lack of confidence in technologies relevant to practice, including assistive technology, specialist devices, specialist software and gaming. Conclusions: Overall, the results suggested that this group of ¿Generation Y¿ students were not universally skilled in all areas of technology relevant to practice but appear to be skilled in technologies they use regularly. Recommendations are therefore made with view to integrating social networking, gaming, media sharing and assistive technology into undergraduate programmes to ensure that graduates have the requisite skills and confidence required for current and future practice.

© 2016 The College of Radiographers Background Practice education is a compulsory component of health programs with practice educators playing a critical role in the education of students. Practice educator characteristics may positively or negatively affect student learning in practice settings. This study aimed to identify characteristics of the ideal practice educator that lead to successful practical experiences as perceived by current practice educators working in the Australian context of diagnostic radiography, nuclear medicine, nutrition and dietetics, occupational therapy, physiotherapy and radiation therapy. Methods All practice educators (n = 1063) on the University of Newcastle Practice Educator Database were invited to participate in this prospective, cross-sectional, descriptive study via online link or paper format. Results There was a 52% response rate. The five most valued characteristics were feedback skills, non-judgemental, professionalism, clarity and listening skills. The five least valued characteristics were scholarly activity, respect for students' autonomy, well-prepared, availability and being a role model. Comparisons between disciplines, genders, ages, years in practice and levels of supervisory experience indicated some statistically significant differences, though actual differences were small. Discussion Overall there was a high degree of agreement within and between disciplines on the characteristics of the ideal practice educator. The top five skills could be classed as generic skills and not specific clinical and practice skills, thus formal training and certification schemes may enhance practice educator competence.

© 2015 . This systematic review aims to evaluate the literature on the performance of radiographers in assessment of screening mammograms compared with radiologists. Measurable performance criteria were essential as well as a gold standard with which to compare both performance, and outcomes by means of biopsy reports or consequent negative screenings. The level of training of the radiographers in mammogram assessment was also documented. The majority of the literature demonstrated that the performance statistics of radiographers are equivalent to that of radiologist readers. Although formal training of radiographers demonstrates improved sensitivity, results of all performance data suggest no statistical difference at the 95% level between trained or untrained radiographers and radiologists.

© 2016 Introduction Globally, the role of the radiographer is changing; some countries have developed advanced roles with specific scopes of practice. Other countries, like Australia, are in the process of this change. This paper demonstrates the abilities of Australian radiographers in mammogram screen reading, highlighting some of their specific difficulties with different lesion types. Method Six experienced radiographers participated in a prospective study, screen reading 2000 mammograms each between 2010 and 2011. This paper looks at the results of those same women at biennial re-screen. Analysis of the results included validation of normal results by negative follow-up screens and new cancers at biennial review; there is also analysis on the types of lesions detected and missed. Results After biennial review, three cancers in 2013/2014 had been marked as abnormal by one radiographer two years prior, which increased her sensitivity from 64% to 85%. Sensitivity for the radiologists decreased from the assumed 100% to 95%. Radiographers appeared to be skilled in detection of calcifications and architectural distortions but had difficulty with non-specific densities. Conclusion This study demonstrates the potential for Australian radiographers to enhance the accuracy of screen reading programs.

© 2016 The College of Radiographers Background Practice education is a core component of undergraduate health programs, with the characteristics of the practice educator reported to have an influence on student experience during practical. This study analyses Australian student perceptions from six allied health professional undergraduate programs, to identify the characteristics of the ideal practice educator leading to successful placement experiences. Methods An existing survey developed for medical students was modified to incorporate both quantitative and qualitative responses. Participants included all students enrolled in six undergraduate health professions in the School of Health Sciences at the University of Newcastle, Australia (n = 1485). Students were invited to complete the survey via hard copy or online. Results There was a 54% response rate. The most valued characteristics were non-judgemental, clarity and feedback. The three least valued characteristics were scholarly activity, role model and practices evidence base practice. Students identified the importance of their relationship (respectful, inspirational and supportive) with the practice educator as being fundamental to a productive placement. Conclusion The characteristics identified by respondents were common to all six professions, with little differences between gender, year of program or number of placements completed. This study suggests that the attitude of the practice educator towards the student is one of the key factors that underpin the success of practice experience across allied health professions.

© 2016 MA Healthcare Ltd. Background/Aims: Practice education is integral to health professional curricula. There is emerging evidence that student generational attributes may be impacting on practice education. Students born between 1982 and 2000, termed ¿Generation Y¿, are said to have a different outlook on learning to those students from other generational groups. However, there is little research from student perspectives to investigate these claims. This study aimed to identify ¿Generation Y¿ occupational therapy students¿ preferred teaching and learning approaches in practice education. Methods: Using a qualitative descriptive approach and purposive sampling, 22 semi-structured interviews were undertaken with third and fourth year ¿Generation Y¿ occupational therapy students from one Australian university. Interview transcripts were analysed thematically. Findings: Four themes emerged from the data: developing practice skills and confidence; essential communication; valued educational approaches; and the supervisory relationship and the team. Conclusion: Findings relate to ¿Generation Y¿ characteristics. Practice educators may need to consider that these students have unique learning preferences. Students prefer ¿doing¿ to observing, they want to be given clear expectations and responsibility for their own work tasks, they want to work in a team, they prefer to self-evaluate prior to feedback and access to the internet is essential for their learning.

© 2014 The College of Radiographers. Objective: To examine current knowledge and the level of compliance of radiation safety principles in equine veterinary clinics within Australia. Method: Surveys were sent to equine veterinary surgeons working in Australia. The survey was delivered both online and in hardcopy format; it comprised 49 questions, 15 of these directly related to radiation safety. The participants were asked about their current and previous use of radiation-producing equipment. Information regarding their level of knowledge and application of radiation safety principles and practice standards was collected and analysed. Results: The use of radiation-producing equipment was evident in 94% of responding clinics (a combination of X-ray, CT and/or Nuclear Medicine Cameras). Of those with radiation-producing equipment, 94% indicated that they hold a radiation licence, 78% had never completed a certified radiation safety course and 19% of participants did not use a personal radiation monitor. In 14% of cases, radiation safety manuals or protocols were not available within clinics. Conclusions: The study has shown that knowledge and application of guidelines as provided by the Code of Practice for Radiation Protection in Veterinary Medicine (2009) is poorly adhered to. The importance of compliance with regulatory requirements is pivotal in minimising occupational exposure to ionising radiation in veterinary medicine, thus there is a need for increased education and training in the area.

© The Author(s) 2015. Introduction: This systematic review aimed to determine whether stroke survivors routinely received return-to-driving education in the acute hospital setting prior to discharge home; and if education was provided, were the restrictions in driving guidelines adhered to. Method: A systematic search was conducted of PubMed, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Web of Science, Scopus, Pedro and OTseeker databases for original research reporting findings on the adherence to return-to-driving legislation and clinical guidelines after stroke, and return-to-driving behaviours in stroke survivors up to 1 month post stroke. Results: Three studies met the inclusion criteria and reported on a combined total of 252 stroke survivors living in the United Kingdom. Forty-eight per cent of stroke survivors received education on the 1 month driving restriction. A total of 61.4% of participants waited 1 month prior to returning to driving. Conclusion: This review found that there is limited literature available on the management of return to driving following acute stroke but there is evidence that education may not be routinely provided in the acute hospital setting and that many stroke survivors could be returning to driving within the 1 month restriction.

© 2015 Cambridge University Press. Aim This study compared the acute toxicities reported during radiotherapy treatment using either intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) to deliver a moderate hypo-fractionated treatment for early-stage prostate cancer. Material and methods Acute toxicities are routinely reported at the clinical site for all patients using the Common Terminology Criteria for Adverse Events. Toxicity assessment is performed on day 1 of treatment, then once weekly thereafter. The recorded toxicities of 40 cases treated with five-field IMRT, and 32 cases treated using VMAT were retrospectively compared. All cases were prescribed 73·68 Gy in 28 fractions. Eight symptoms were assessed; diarrhoea, proctitis, fatigue, pain, dermatitis, urinary frequency, urinary retention and urinary tract pain. Results In terms of the overall toxicity recorded, VMAT was shown to reduce the toxicities of dermatitis, fatigue, pain and urinary frequency (p<0·05). Using IMRT, grade 2 toxicities were reported for proctitis, pain, urinary frequency, urinary retention and urinary tract pain. Using VMAT, grade 2 toxicities were reported for urinary frequency and urinary retention. Findings The research reported here is one of the first publications to demonstrate that VMAT is associated with decreased toxicities compared with IMRT for the treatment of early-stage prostate cancer.

This review examines the most commonly reported treatment options for ocular squamous cell carcinoma (OSCC) and periocular squamous cell carcinoma (POSCC) in horses and proposes to conclude on the most viable method based on available published studies in terms of treatment outcome, known side effects, advantages, disadvantages, and reliability of available evidence. After a literature search for peer-reviewed published articles, seven most commonly reported on treatments for OSCC and/or POSCC were identified: surgery, photodynamic therapy, carbon dioxide (CO 2 ) laser ablation, radiofrequency hyperthermia, cryotherapy, chemotherapy, and radiation therapy. Combination therapies were supported as a most successful recommendation; however, when considering site-specific outcomes, the following conclusions may be drawn: limbal squamous cell carcinoma (SCC) was most effectively treated with surgery and adjunctive therapy including CO 2 laser ablation, mitomycin C, and brachytherapy; third eyelid SCC reported good outcomes when treated with surgery alone (clear margins) and in combination with brachytherapy for unclear margins; eyelid SCC, surgical resection was usually limited and most reports supported the use of adjunctive brachytherapy, although photodynamic therapy appeared to be a promising new treatment. It was deemed unreasonable to conclude on the best treatment for cornea, conjunctivae (palpebral and bulbar), and medial canthi in isolation because of lack of evidence. A consistently favored treatment for OSCC and/or POSCC in horses does not currently exist. The presentation of data in the literature and its lack of consistency make it impossible to statistically analyze and make comparative conclusions on treatment outcomes. This review provides a basis for further research to establish a best-practice protocol. © 2014 Elsevier Inc. All rights reserved.

A Medical Radiation Science (diagnostic radiography) instrumentation course historically taught face-to-face was taught fully online. The purpose of this study was to assess differences in academic achievement as well as gather feedback on student experiences. An anonymous online survey relating to student engagement and directions for future course development was distributed to all students who completed the course. The results clearly supports online delivery as students appreciated the ability to pause and rewind (94%) course content and work at their own pace (88%) whilst maintaining almost identical course results (p=0.96). Future improvements would see the inclusion of interactive on-line modules and the re-introduction of face-face tutorials, appealing to students' desire for more support and human contact (27%) therefore reflecting the flipped classroom approach.

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 SurveyMonkey 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. © 2013 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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. © 2013 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

The usage of diagnostic ultrasound equipment has expanded into physiotherapy. The aim of this paper is to deliver to both the ultrasound and physiotherapy professions an understanding of the use of diagnostic ultrasound for biofeedback in physiotherapy of the female pelvic floor and the issues related to competent and safe practice, including accessing suitable training. This has been evaluated using a qualitative research paradigm with data gathered via focus groups of Australian physiotherapists. The target group were pelvic floor physiotherapists as this is one of the main uses of diagnostic ultrasound within physiotherapy and the main area physiotherapists would like to be trained in. Two focus groups were run with a total of sixteen physiotherapists. Focus group participants reported their training in diagnostic ultrasound to be largely self directed. They also reported they were learning on their patients. Despite very limited training, participants demonstrated some familiarity with images and equipment settings. Participants felt the modality had a role within physiotherapy as an adjunct to their current practices. The main need raised by participants during the focus groups was related to patient expectations and the fact that the physiotherapist may miss evidence of pathology. © 2013 The College of Radiographers.

Advanced practice in screening mammography has become widespread in the United Kingdom over the last 20 years, and Australian radiographers working in BreastScreen programs have shown interest in similar developments. Radiographers working in BreastScreen Australia were surveyed in order to capture their thoughts and perceptions on role extension.Questionnaires were circulated to radiographers working in BreastScreen Australia programs. Thematic analysis was used to analyze the open response questions to explore the advantages and disadvantages identified by the participants with respect to role expansion in screening mammography as well as any changes to their duties over the last decade.There were 253 responses to the survey and of those responses, 70% of radiographers shared their thoughts on role extension and 49% provided comments on changes in the workplace. The majority (61%) radiographers responding to the role extension question were concerned about potential problems associated with role extension; the biggest issues were that role extension should not be mandatory and that selection criteria for advanced practitioners should be stringent, with adequate time made available for training and study. The major change in the role of the radiographer has been the increased time dedicated to quality assurance tasks and administrative duties as well as more training required due to technological changes from film-screen to digital mammography.There is high interest in role extension by radiographers working in BreastScreen programs, provided that it is voluntary. The role of the radiographer within breast imaging in Australia is still evolving. © 2013 The College of Radiographers.

Purpose: This study aims to compare intensity-modulated radiation therapy (IMRT) to volumetric-modulated arc therapy (VMAT) for the treatment of prostate cancer. Particular focus was placed on the impact IMRT and VMAT have on departmental planning and treatment resources. Materials and Methods: Twenty prostate cancer cases were retrospectively planned to compare 5-field IMRT to VMAT using a single arc (VMAT-1A) and 2 arcs (VMAT-2A). The impact on departmental resources was assessed by comparing the time needed to generate the dose distributions and to deliver the treatment plan. A comparison of plan quality was also performed by comparing homogeneity, conformity, the number of monitor units (MUs), and dose to the organs at risk. Results: IMRT and VMAT-2A were able to produce adequate plans for all cases. Using VMAT-1A, planning guidelines were achieved in 8 of the 20 cases. IMRT provided an improved dose distribution and the best homogeneity to the planning target volume. Also, the IMRT plans were generated significantly faster than both VMAT techniques. VMAT planning provided significantly improved conformity and used significantly fewer monitor units than IMRT. VMAT-1A treatments were significantly faster than both IMRT and VMAT-2A. VMAT plans delivered lower dose to the bladder and heads of femur, and an increased dose to the rectum in the low dose region. Conclusion: IMRT may have an advantage over VMAT for the treatment of prostate cancers. This is primarily due to the uncertainty of achieving planning guidelines using VMAT and the extended time needed to generate the VMAT plans. © 2013 Elsevier Inc. All rights reserved.

Background: This study aimed to describe eating behaviors, food tolerance, and dietary intake after laparoscopic adjustable gastric banding (LAGB); explore associations between these variables; and examine the relationship between diet-related factors and percentage weight loss and quality of life after surgery. Methods: A cross-sectional survey was mailed to subjects who had previously undergone LAGB in Newcastle, Australia. Results: Sixty-seven subjects responded (55 females; mean age 49±11.5 years; postoperative body mass index [BMI] 34.5±5.4 kg/m2). Reported average weight loss since surgery was 20.5±9.2% (26.6±13.0 kg). Restraint (including flexible and rigid control) and disinhibition were higher than community norms and hunger trended toward being lower. The majority of respondents rated their eating ability as good (n=27, 40.3%) or excellent (n=15, 22.4%). Median reported energy intake was 4,833 kJ (3,823-5,961) per day. Protein and fat intake as a percentage of daily energy intake was within acceptable distribution ranges, although saturated fat intake exceeded recommendations. Fiber and several micronutrients were below estimated average requirements. BMI at time of surgery and satisfaction with eating ability were significantly associated with reported weight loss after surgery (adjusted R2=0.32, p<0.001), and satisfaction with eating ability and rigid control were significantly associated with physical well-being (adjusted R2=0.19, p=0.001). Conclusions: This study highlights that potential remains to improve aspects of eating behavior, food tolerance, and diet quality in some individuals who have undergone LAGB, and endorses the need for further development of multifactorial interventions to help optimize a range of diet-related factors after LAGB. © 2013 Mary Ann Liebert, Inc.