Technological advancements in computer science have started to bring artificial intelligence (AI) from the bench closer to the bedside. While there is still lots to do and improve, AI models in ...medical imaging and radiotherapy are rapidly being developed and increasingly deployed in clinical practice. At the same time, AI governance frameworks are still under development. Clinical practitioners involved with procuring, deploying, and adopting AI tools in the UK should be well-informed about these AI governance frameworks. This scoping review aimed to map out available literature on AI governance in the UK, focusing on medical imaging and radiotherapy. Searches were performed on Google Scholar, Pubmed, and the Cochrane Library, between June and July 2022. Of 4225 initially identified sources, 35 were finally included in this review. A comprehensive conceptual AI governance framework was proposed, guided by the need for rigorous AI validation and evaluation procedures, the accreditation rules and standards, and the fundamental ethical principles of AI. Fairness, transparency, trustworthiness, and explainability should be drivers of all AI models deployed in clinical practice. Appropriate staff education is also mandatory to ensure AI's safe and responsible use. Multidisciplinary teams under robust leadership will facilitate AI adoption, and it is crucial to involve patients, the public, and practitioners in decision-making. Collaborative research should be encouraged to enhance and promote innovation, while caution should be paid to the ongoing auditing of AI tools to ensure safety and clinical effectiveness.
The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the ...BI-RADS atlas of the American College of Radiology.
Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A-D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement.
Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77-0.93) to 0.89 (95% CI, 0.81-0.95) on a four-category scale (categories A-D) and from 0.89 (95% CI, 0.86-0.92) to 0.94 (95% CI, 0.89-0.97) on a two-category scale (category A-B vs category C-D). Interreader agreement ranged from substantial (κ = 0.76; 95% CI, 0.73-0.78) to almost perfect (κ = 0.87; 95% CI, 0.86-0.89) on a four-category scale, and the overall weighted kappa value was substantial (0.79; 95% CI, 0.78-0.83). Interreader agreement on a two-category scale ranged from a kappa value of 0.85 (95% CI, 0.83-0.86) to 0.91 (95% CI, 0.90-0.92), and the overall weighted kappa was 0.88 (95% CI, 0.87-0.89).
Overall, with regard to mammographic breast density classification, radiologists had substantial interreader agreement when a four-category scale was used and almost perfect interreader agreement when a dichotomous scale was used.
•Low ORN incidence 4.4% (47/1,050)•Increased risk ORN with mandibular surgery.•Complete ORN resolution in 17% of patients.•Opportunities for risk reduction identified.•Intensive lifelong dental care ...essential.
To assess osteoradionecrosis (ORN) incidence in a population of Irish Head and Neck cancer (HNC) patients, and assess precipitating factors that may contribute to ORN development to aid prevention.
Review of 1050 HNC patients attending the Dental Oncology Clinic, CUDSH between 2010 and 2021 identified 47 cases of ORN. Medical, dental and radiotherapy records of these forty-seven patients were retrospectively reviewed. Patient-, tumour-, and treatment-related variables were investigated in association with osteoradionecrosis development. Analysis conducted using SPSS, Pearson’s Chi-square test (p < 0.05), and ordinal regression model.
ORN incidence was 4.4 %. Median time from radiotherapy (RT) to ORN development was 9.5 months (range 1–98.5 months). ORN development within the mandibular surgical site was significant (p <.001), presenting at a higher Notani grade (p =.002), in mid-mandibular body region (p =.028), at radiation doses ≥ 60 Gy (p =.035), due to induced causes (p =.029), and without resolution (p =.019).
This is the first retrospective study of ORN in HNC patients in Ireland over 10-year period. ORN incidence was extremely low (4.4%). As patients reported high smoking/alcohol use and poor dental attendance pre-diagnosis, this suggests intensive dental intervention pre/post-diagnosis contributed to low ORN rates. Mandibular surgery pre-RT increased risk of developing ORN at the surgical site. Therefore, we recommend future treatment planning should contour the surgical site, designating it an organ at risk (OAR), assigning a dose constraint, where oncologically possible, with emphasis on reducing the hot-spot to this region; findings reinforce importance of life-long expert dental care to reduce ORN incidence.
The purpose of this study was to evaluate the effect of outside-field-of-view (FOV) lead shielding on the entrance surface dose (ESD) of the breast on an anthropomorphic X-ray phantom for a variety ...of axial skeleton X-ray examinations.
Using an anthropomorphic phantom and radiation dosimeter, the ESD of the breast was measured with and without outside-FOV shielding in anterior-posterior (AP) abdomen, AP cervical spine, occipitomental 30° (OM30) facial bones, AP lumbar spine, and lateral lumbar spine radiography. The effect of several exposure parameters, including a low milliampere-seconds technique, grid use, automatic exposure control use, wraparound lead (WAL) use, trolley use, and X-ray table use, on the ESD of the breast with and without outside-FOV shielding was investigated. The mean ESD (μSv) and standard deviation for each radiographic protocol were calculated. A one-tailed Student's t-test was carried out to evaluate whether ESD to the breast was reduced with the use of outside-FOV shielding.
A total of 920 breast ESD measurements were recorded across the different protocol parameters. The largest decrease in mean ESD of the breast with outside-FOV shielding was 0.002 μSv (
= 0.084), recorded in the AP abdomen on the table with a grid, OM30 on the table with a grid, OM30 standard protocol on the trolley, and OM30 on the trolley with WAL protocols. This decrease was found to be statistically non-significant.
This study found no significant decrease in the ESD of the breast with the use of outside-FOV shielding for the AP abdomen, AP cervical spine, OM30 facial bones, AP lumbar spine, or lateral lumbar spine radiography across a range of protocols.
Lead contact shielding has been a crucial component of patient radiation protection since it was first introduced in the early 1900s. Concerns surrounding the hereditary effects of ionising radiation ...were a driver for using lead shielding. Recently the American Association of Physics in Medicine (AAPM) and the British Institute of Radiology (BIR) have published position papers that suggest that lead contact shielding is no longer needed due to reduced radiation doses for x-ray examinations. This work examines radiographers' opinions on these position papers.
An online survey with quantitative and qualitative elements was designed to explore knowledge and attitudes toward the BIR and AAPM position papers. The population for this survey was all qualified radiographers.
The majority (59%) of participants are aware of the AAPM guidance, and 76% are aware of the BIR guidance. Given the changes in the gonad tissue weighting factor, 66% believed additional emphasis should be placed on protecting organs and tissues with higher tissue weighting factors. The vast majority (87%) believed lead shielding is not the primary dose reduction strategy, with 82% agreeing that lead shielding may interfere with the AEC.
This study identifies a perception that lead protection may still play a role in patient protection, particularly for children and pregnant patients. However, it is not considered the primary mechanism of protection. More specific guidance and information are needed to incorporate the guidance for radiographers into working practice, improving patient care.
Lead shielding remains a tool for radiation protection in particular examinations, however, its role has diminished in clinical practice.
Additional research is required into the number of repeat x-rays associated with the use of lead shielding and the actual dose saving for shielding outside the field of view. Additional education and specific clarification on when to use and not use lead contact shielding is required.
Le blindage corporel au plomb constitue un élément essentiel de la radioprotection des patients depuis son introduction au début des années 1900. Les inquiétudes concernant les effets héréditaires des rayonnements ionisants ont été à l'origine de l'utilisation du blindage au plomb. Récemment, l'American Association of Physics in Medicine (AAPM) et le British Institute of Radiology (BIR) ont publié des documents de synthèse suggérant que le blindage corporel au plomb n'est plus nécessaire en raison de la réduction des doses de rayonnement lors des examens radiologiques. Ce travail examine les opinions des radiographes sur ces documents de synthèse.
Une enquête en ligne comportant des éléments quantitatifs et qualitatifs a été conçue pour explorer les connaissances et les attitudes à l'égard des prises de position du BIR et de l'AAPM. La population de cette enquête était composée de tous les radiographes qualifiés.
La majorité (59 %) des participants connaissent les directives de l'AAPM et 76 % celles du BIR. Compte tenu des modifications apportées au facteur de pondération des tissus gonadiques, 66 % des participants estiment qu'il convient de mettre davantage l'accent sur la protection des organes et des tissus dont les facteurs de pondération sont plus élevés. La grande majorité (87 %) pense que le blindage au plomb n'est pas la principale stratégie de réduction des doses, et 82 % conviennent que le blindage au plomb peut interférer avec le contrôle automatique de l'exposition.
Cette étude identifie une perception selon laquelle le blindage au plomb peut encore jouer un rôle dans la protection des patients, en particulier pour les enfants et les patientes enceintes. Cependant, il n'est pas considéré comme le principal mécanisme de protection. Des conseils et des renseignements plus spécifiques sont nécessaires pour intégrer les conseils destinés aux radiographes dans la pratique professionnelle, afin d'améliorer les soins prodigués aux patients.
Le blindage au plomb reste un outil de radioprotection pour certains examens. Cependant, son rôle a diminué dans la pratique clinique.
Des recherches supplémentaires sont nécessaires pour déterminer le nombre de radiographies répétées associées à l'utilisation du blindage au plomb et la réduction réelle de la dose pour le blindage en dehors du champ de vision. Une formation supplémentaire et une clarification spécifique sur le moment où il faut utiliser ou non le plomb sont nécessaires.
•AI implementation in medical imaging/radiotherapy is impeded by lack of training.•There is a distinct lack of knowledge of AI governance frameworks.•Different professionals identify different ...priorities for AI adoption.•Customised training and governance frameworks can accelerate AI implementation.
Medical Imaging and radiotherapy (MIRT) are at the forefront of artificial intelligence applications. The exponential increase of these applications has made governance frameworks necessary to uphold safe and effective clinical adoption. There is little information about how healthcare practitioners in MIRT in the UK use AI tools, their governance and associated challenges, opportunities and priorities for the future.
This cross-sectional survey was open from November to December 2022 to MIRT professionals who had knowledge or made use of AI tools, as an attempt to map out current policy and practice and to identify future needs. The survey was electronically distributed to the participants. Statistical analysis included descriptive statistics and inferential statistics on the SPSS statistical software. Content analysis was employed for the open-ended questions.
Among the 245 responses, the following were emphasised as central to AI adoption: governance frameworks, practitioner training, leadership, and teamwork within the AI ecosystem. Prior training was strongly correlated with increased knowledge about AI tools and frameworks. However, knowledge of related frameworks remained low, with different professionals showing different affinity to certain frameworks related to their respective roles. Common challenges and opportunities of AI adoption were also highlighted, with recommendations for future practice.
Abstract
This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen–pelvis examinations using automatic tube current modulation to ...protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 μSv without ODM (1.92–1.91 μSv, p = 0.49) and increased by 0.03 μSv with ODM (1.53–1.56 μSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 μSv with shielding (1.91–1.56 μSv, p = 0.24) and by 0.39 μSv without shielding (1.92–1.53 μSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen–pelvis.
Background
Chest radiography after peripherally inserted central catheter insertion in infants is the reference standard method for verifying catheter tip position. The utilisation of ultrasound (US) ...for catheter placement confirmation in the neonatal and paediatric population has been the focus of many recent studies.
Objective
In this systematic review we investigated the diagnostic accuracy of US for peripherally inserted central catheter tip confirmation in infants in the neonatal intensive care unit (NICU)
Materials and methods
We conducted a systematic literature search of multiple databases. The study selection yielded eight articles, all of which had acceptable quality and homogeneity for inclusion in the meta-analysis. Sensitivity and specificity values were reported together with their respective 95% confidence intervals (CI).
Results
After synthesising the eligible studies, we found that US had a sensitivity of 95.2% (95% CI 91.9–97.4%) and specificity of 71.4% (95% CI 59.4–81.6%) for confirming catheter tip position.
Conclusion
Analyses indicated that US is an excellent imaging test for localising catheter tip position in the NICU when compared to radiography. Ultrasonography is a sensitive, specific and timely imaging modality for confirming PICC tip position. In cases where US is unable to locate malpositioned PICC tips, a chest or combined chest–abdominal radiograph should be performed.
Children with congenital heart disease are exposed to repeated medical imaging throughout their lifetime. Although the imaging contributes to their care and treatment, exposure to ionising radiation ...is known to increase one's lifetime attributable risk of malignancy. A systematic search of multiple databases was performed. Inclusion and exclusion criteria were applied to all relevant papers and seven were deemed acceptable for quality assessment and risk of bias assessment. The cumulative effective dose (CED) varied widely across the patient cohorts, ranging from 0.96 mSv to 53.5 mSv. However, it was evident across many of the included studies that a significant number of patients were exposed to a CED >20 mSv, the current annual occupational exposure limit. Many factors affected the dose which patients received, including age and clinical demographics. The imaging modality which contributed the most radiation dose to patients was cardiology interventional procedures. Paediatric patients with congenital heart disease are at an increased risk of receiving an elevated cumulative radiation dose across their lifetime. Further research should focus on identifying risk factors for receiving higher radiation doses, keeping track of doses, and dose optimisation where possible.
