Thread by @CroakeyNews

#ASMIRT2023 is gearing up for a high-level closing session tomorrow on 'the future of medical radiation sciences (MRS)' - key speakers shared their thoughts with us ahead of the session on what excites/worries them & much more croakey.org/what-does-the-…

We heard insights on #AI, scope of practice, education, research, patient-centred care and more from @CMalamateniou @AmandaBoldersto
@DrKEHawk @DrGeoffCurrie @hilderbillies, Assoc Prof Andrew Kilgour & Alan Malbon - a big read that maps out many challenges/opps in MRS

Here are the opening sessions at #ASMIRT2023 today - we'll be tweeting on presentations/interviews through the course of the day, follow @AlisonSBarrett too, as well as @WePublicHealth & an array of excellent MRS tweeps twitter.com/i/lists/164427…

Among the key speakers in this session is @DrEMRohren #ASMIRT2023

#ASMIRT2023 has opened with address from Dr Nigel Anderson, winner of the 2022 Varian award for outstanding achievement in radiation therapy - with a big picture view on the profession

Before we get into the thick of presentations: sharing some of the fabulous official photos via Patrick Hamilton/ @ASMIRTorg, including both unflappable and indefatigable conference convenor @johnhewis

#ASMIRT2023

#ASMIRT2023 credit: Patrick Hamilton/ASMIRT 2023

Yesterday's #ASMIRT2023 Women in Leadership panel discussion (Patrick Hamilton/ASMIRT)

Timely presentation at #ASMIRT2023 from Alli Tonks & Caitlin Tu, on the practice of radiographer 'commenting' (or reporting) to alert clinical staff of
significant findings on both X-ray and CT images at the time of acquisition ... part of scope of practice issues for MRS

Tonks & Tu say such practice aligns with legal minimum practice standards articulated by Aust's Medical Radiation Practice Board & addresses key professional standards #ASMIRT2023

But they say, while a few clinical sites have radiographer commenting systems in place for general X-ray exams, its use in CT is still emerging. Their study was conducted at a hospital using commenting to alert referrers to significant findings in X-ray, CT and MRI studies.

In the first nine months of data collection, 38 comments were made on CT examinations, representing 18% of all comments. Positive predictive value for CT comments was 0.97 - Tonks & Tu #ASMIRT2023

On average, comments were available within 5 minutes of study completion, and an average of 2 days and 2 hours prior to comprehensive, 'gold-standard' radiologist reports. The most alerted exam types
were CT brain, CT pulmonary angiogram and CT abdomen - Tonks & Tu #ASMIRT2023

Tonks & Tu conclude that, overall, radiographer comments are used to "alert clinically urgent conditions demonstrated on CT, which enables referrers to prioritise care, follow-up with radiologists, expedite treatment to improve patient safety".
#ASMIRT2023

Croakey spoke to @ASMIRTorg president Carolyn Heyes ahead of #ASMIRT2023, she said she's always keen at national conferences to see the student papers .... "they always come up with interesting papers and topics". She pointed to a couple of interest this year.....

'The cost of perfection: an investigation into unnecessary rejection of clinically acceptable imaging (lateral wrist)' by Kathryn Currie, Sarah Semsem, and Adam Steward #ASMIRT2023

They highlight that the transition from film screen to digital radiography should have brought reduced repeat rates due to reduced exposure-related error. But literature suggests that this is not necessarily the case with increased positioning-related repeats #ASMIRT2023

The results of their study found reject rates "alarmingly higher than averages accepted in literature and a concerning trend among junior radiographers to over repeat imaging" (as in the costs of perfection’) #ASMIRT2023

Carolyn Heyes also highlighted this study: Radiological bone age assessments: should they determine whether individuals are prosecuted as children or adults, by Josephine Awwad @UniversitySA #ASMIRT2023

Awwad notes that a posterior–anterior X-ray of the non-dominant hand/wrist are used in radiographic bone age assessments, which Aust Govt performed from 2008-2012 to determine whether Indonesian immigrants were children as they said, or people smugglers.....#ASMIRT2023

The images were assessed under the Greulich and Pyle method, and if proven to be adults, individuals were sent to jail for five years - Awwad #ASMIRT2023

As well as raising accuracy issues, Awwad notes that using ionising radiation for immigration purposes, rather than for diagnostic or therapeutic reasons is a "blatant violation of the ‘as low as reasonably achievable’ (ALARA) principle". #ASMIRT2023

Awwad's conclusion: "Subjecting children to ionising radiation is hard to justify when the biological or ethical risks do not outweigh the benefit of conducting this examination within a non-clinical setting." #ASMIRT2023

Catching up on earlier presentation -- important, fascinating (and - beware – gruesome/distressing) work from Edel Doyle who is Disaster Victim Identification coordinator for the Aust/NZ branch of @IAFRorg (global body for forensic radiographers) #ASMIRT

Edel Doyle sets the scene on imperatives in disaster victim identification #ASMIRT2023 @IAFRorg

Doyle says radiography has important role in mass disasters: to determine the extent of injuries but also, as it is a non-invasive technique, ideal for imaging of those who have died (vs in earlier times having to remove hands to get fingerprints!) #ASMIRT2023

Doyle said the @IAFRorg has, for example, provided radiographers for victim identification in the 2004 Asian tsunami, London bombings, Grenfell Tower fire in London, crash of Malaysia Airlines Flight 17 over Ukraine #ASMIRT2023

Radiographic imaging has 3 main roles in the emergency mortuary - one is safety: detection & location of hazardous material, sharp objects, munitions, explosive devices – to protect the health and safety of the mortuary team including the
forensic pathologist - Doyle #ASMIRT2023

Other roles in mass disasters are establishing cause of death and victim identification. Doyle stressed to Croakey the imperative to "use technology to confirm who has been involved in a mass disaster, so that we can return (victim's bodies) to their families ASAP". #ASMIRT2023

The @IAFRorg's disaster victim identification team trains radiographers on what to do and how to ensure that any evidence or images produced can be admissible in court, whether that's in a Coroner's Court or criminal court - Doyle #ASMIRT2023

Should this be standard training? "No," says Doyle, stressing that DVI is not for everyone: can be very traumatic & distressing also, eg, such as in the London 7/7 bombings, for those who are x-raying perpetrators, "because you have to remain impartial" #ASMIRT2023

More to come later from Edel Doyle, on efforts to improve screening for young children who have been subject to or suspected to have experienced child abuse. #ASMIRT2023