9 3.6. Computed Tomography (CT) as the most optimal medical imaging method for patients with Ventricular Assist Devices – a retrospective review Presenter: Ingrid Jolley, Alfred Health (Melbourne), Australia Author: Ingrid Jolley Introduction: The insertion of Ventricular Assist Devices (VADs) is one of the treatments applied for patients with chronic heart failure. These devises temporally or permanently support the blood circulation at the volume and rate adequate for normal function of body systems. The insertion of the VADs may cause complications and adverse events, such as device dislodgement and/or malfunction, bleed, cardiac tamponade, infection, fluid accumulations, thrombosis and thromboembolism Medical imaging plays a major role in clinical monitoring and management of patients with inserted Ventricular Assist Devices. The imaging modalities employed in these examinations include conventional radiography (incl. mobile and fluoroscopy), Computed tomography (CT), Nuclear Medicine (NM), Ultrasound (US) and Digital Subtraction Angiography (DSA). The purpose of this retrospective showcase is to review the benefits of imaging modalities that are applied for examinations of patients who are treated with the VADs and to demonstrate that Computed Tomography is the most optimal imaging method in these investigations. Methods: A retrospective review of clinical cases (2009-2013) in Alfred Health involving the insertion of VADs and relevant literature (1997–2013) has been performed. 21 selected images represent conventional radiography, CT, NM, US and DSA modalities. Conclusions: The imaging modalities that are employed for examinations of patients with inserted VADs encompass conventional radiography, CT, NM, US and DSA. Their employment is correlated to the ability of delivering diagnostic information. According to the retrospective review, the Computed Tomography is considered the most optimal imaging method as it provides high contrast and spatial differentiation within the images and allows evaluation of areas not well visualized with other imaging modalities. 3.7. Radiographer´s Competence in Computed Tomography – defining competence dimensions in order to develop selfassessment instrument Presenter: Marjut Pawsey, HUS Medical Imaging Center, Radiology department in Haartman Hospital, Finland Author: Marjut Pawsey Introduction: Radiographer´s work has developed to respond to the increased demands placed on radiology services. Radiographer´s role has changed significantly from 2000 onwards. Digital imaging and the transfer to the picture archiving and communication system (PACS) have influenced the radiographer´s role change and the increased demands on competence. This creates challenges for both radiography education and the preceptorship period. A preceptorship period that is well organized and of high quality is important as it influences the employee’s competence, the quality of work and work load. Computed Tomography (CT) is a central part of the radiographer´s work in many Radiology departments. Radiographer´s competence in CT practice includes many fields, from ensuring the examination’s justification and indications, to the patient´s exit from the radiology department and radiologist and physicians receiving diagnostic images. The European Qualification Framework (EQF) competence levels are based on learning outcomes which are described as knowledge, skills and competence. Competence is defined by European radiographer´s competence descriptions as a dynamic concept that integrates knowledge, skills, abilities, values and attitudes. The European radiographer´s competence descriptions were used as theoretical framework in the study. The study reported here is part of a project developing an instrument to measure radiographer´s competence in CT after the preceptorship. The aim was to develop competence criteria for radiographer´s in CT after the preceptorship. Methods: The data was collected from a systematic literature search and from theme interviews with participants (n=6) having expertise in CT. It was analyzed by theory driven content analysis by using abductive reasoning. Results: Three main categories were formed; competence in performing the CT-examination, competence in safety and competence in the work environment. From these, radiographer´s competence criteria in CT after preceptorship were created. Criteria can be used for forming preceptorship programs for CT-units and for evaluating and monitoring the preceptorship. They can help to identify the need for individual competence development and accordingly guide the radiographer´s competence development in CT-imaging. 3.8. Post mortem imaging at Tampere University Hospital Presenter: Mia Mustalahti, Medical Imaging Center and Hospital Pharmacy Tampere University Hospital, Finland Author: Mia Mustalahti Introduction: I work as an X-ray nurse at Tampere University Hospital. A year ago, Forensic Medicine received new facilities on our campus, and forensic post mortems in Western Finland, Central Finland and Ostrobothnia were centralised in Tampere. Previously, we had mainly taken plain X-rays of the deceased, but in the new facilities, we also have room for a CT device. However, we have not received the device yet. However, the goal is to introduce Obduction's CT device during 2014. We have now performed the necessary imaging using first aid's device, a Ge 64 Lightspeed. Methods: The imaging request is always submitted by the forensic pathologist. The imaging indications are affected by the site where the deceased person was found, the circumstances, and the statement by the police. Routine tasks are to perform imaging of gunshot wounds, deceased children, suspected cases of homicide, industrial accidents and traffic accidents. Imaging is always performed before the autopsy. With CT, we first take a long scout picture(from head to toe). After that, with one deck, we perform imaging of the skull area, and with another deck from above the outer auditory canal as far as is allowed by the 3,000 slice maximum, usually below the knees. The imaging is performed with thin 0,6mm slices. The images are transferred to a workstation. The radiologist issues statements and builds the necessary 2D and 3D reformats. The forensic pathologist always has access to the statement and the images when he or she is drawing up the final autopsy document. We currently perform about 25 imaging sessions per month, but the number is on the rise. The images are archived in our own Pacs system. For identifying the deceased we also performed some Optg imaging sessions last year. The specialised dentist issues statements on the Optg images. Results: Since 2013, the number of imaging sessions has been rising. The need is becoming more extensive as more and more forensic pathologists realize the benefits of the imaging. In CT images, it is easy to see foreign objects, air embolisms and fractures which are difficult to see in an autopsy. We are hoping to soon receive the CT device in Obduction's facilities and thus get more resources to meet the increasing demand. With first aid's device, we can no longer increase the number of imaging session. 4. Dose Wise Radiographer of the Year 2014 Dose Optimisation in Paediatric Interventional Cardiology Presenter: Sonyia Mc Fadden, University of Ulster, Belfast, UK Author: Sonyia Mc Fadden Introduction: The use of interventional cardiology (IC) has risen dramatically in recent years due to advances in technology, medical devices and increased reliability. Many IC procedures have eradicated the need for open heart surgery in patients with congenital heart defects (CHD) yet these procedures are also responsible for some of the highest radiation exposures in medical departments. Studies have indicated that the radiation risk is 4-8 times higher for infants than for adults in IC and that ionising radiation during childhood may result in a 2-3 fold increase of certain detrimental effects compared to adults. There is a lack of robust evidence in the literature as current studies differ in their risk estimation for paediatric patients, however all published data concur that paediatric patients are highly radiosensitive and are at a higher risk than adults. At present there is limited research on dose guidelines or DRLs for paediatric IC and imaging protocols are usually determined in the clinical department at a local level. Aims and Objectives: This study aimed to investigate radiation doses in paediatric IC in the UK and Ireland with a view to establishing Local Diagnostic Reference Levels (LDRLs). The research also sought to determine the IC protocols currently in use in the clinical departments and highlight any variation in practice which might impact upon the radiation
ISRRT | Book Of Abstracts
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