Journal of Clinical Radiography and Radiotherapy

PEER REVIEWED ARTICLE

Authors
Eloranta Sini ^1,2 , Walta Leena ¹, Svedström Erkki ^3,4

1 Turun ammattikorkeakoulu, Terveys ja hyvinvointi
2 Turun yliopisto, Hoitotieteen laitos
3 Turun yliopistollinen keskussairaala, radiologian yksikkö
4 Turun yliopisto, Lääketieteellinen tiedekunta

Abstract

A quasi-experimental study on the experienced feelings of paediatric patients – the opportunities of augmented reality in imaging

Technology enables the utilization of augmented reality (AR) in health care. Within the study, an application for paediatric patients undergoing imaging was developed. The application guides the child during the imaging with the help of an animated figure and sound. With a quasi-experimental research design, we evaluated the impacts of the application on the feelings of paediatric patients.

The target group was paediatric patients (4–11 years old) who underwent radiographic examination at a university hospital. The experimental group (n=36) used the AR application, and the control group didn’t use it (n=40).

The questions posed to the children were targeted at what they felt before the imaging, during the imaging and afterwards. The child expressed the emotion they had felt with a smiley face in the questionnaire (positive, neutral and negative faces). The children’s pulse was also taken during the imaging. The differences between the groups were tested with cross-tabulations, Pearson Chi-Square and Mann-​Whitney U test. Part of the children who used the AR application were also interviewed (n=18) and the data was analysed inductively by examining themes.

The experienced feeling of the children during and after the imaging was more positive in children who used the AR application, even though there was no statistically significant difference between the groups. In the experimental group, the mean heart rate of the children was 96 during the imaging and in the control group the mean was 103. In the boys (experimental group 36%, n=13 and control group 45%, n=18), using the application had a statistically significant positive impact on the experienced emotion during the imaging (p= 0.034). The results indicate that utilizing augmented reality opens new kinds of opportunities for supporting the positive feeling of imaging in paediatric patients.

Keyword: radiographic examination, paediatric patients, augmented reality

Read the whole article(opens in a new window) (in Finnish) with the whole list of references

PEER REVIEWED ARTICLE

Authors
Ukkola Leila 1, Kyngäs Helvi 2, Kaakinen Pirjo 2, Oikarinen Heljä 3

1 Oulun yliopistollinen sairaala, Diagnostiikka vastuualue
2 Oulun yliopisto, Hoitotieteen ja terveyshallintotieteen tutkimusyksikkö
3 OYS, Kuvantaminen

Abstract

Introduction

The purpose was to investigate whether radiographers inform patients about radiation dose and risks.

Methods

A semi-structured questionnaire was prepared and sent to radiographers in Northern Finland. Radiographers were asked whether they informed patients about the dose and risks of radiation and the preferred ways to describe them. Radiographers were asked to estimate their preparedness to provide information.

Results

A total of 174/272 radiographers (64%) responded to the survey. Altogether 5% of the radiographers informed patients always and 36% sometimes about the dose, while 6% informed always and 41% sometimes about the risks of radiation. Dose was described by comparing it to the background radiation (48/71, 68%) or to the dose of a chest postero-anterior radiograph (31/71, 44%) and by using a verbal scale (36/71, 51%). Radiographers informed about increased risk of cancer (35/81, 43%), risk of genetic change (33/81, 41%) and risk of skin reaction (8/81, 10%). Most of the radiographers estimated their ability to inform patients about the dose and risks to be at least reasonable.

Conclusion

Radiographers inform patients insufficiently about the dose and risks of radiation, although they estimate their ability to provide information to be at least reasonable.

Keywords: communication; informed consent; patient safety; radiation

Abbreviations and acronyms
CT Computed tomography
EU European Union
OUH Oulu University Hospital

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MASTER THESIS

Author
Olga Stepanova
Master of Health Care, Master’s Degree Programme, Metropolia University of Applied Sciences
Year of publication: 2021

Breast cancer is one of the most widespread cancer types in the world. A wide variety of healthcare professionals is implicated in the breast cancer treatment. Insufficient communication and coordination of team activity leads to a poor patient information provision, high potential of treatment errors and ineffective treatment finally. European experience in breast cancer care is varied, which effects to the effectiveness of regional treatment. Importance of interprofessional interaction is growing as breast cancer is often transformed from life-threatening pathology to the chronic one that comes with treatment period prolongation and further increase the number of specialists involved. The improvement of the interprofessional communication is a challenging task in the breast cancer treatment.

The aim of the study was to describe the responsibilities of the professionals involved in the breast cancer treatment and the ways of interprofessional communication, as well as to identify gaps and barriers in the interprofessional communication in European countries.

Scoping review method was used to produce comprehensive description of the field. The following databases were used: PubMed, EBSCO Host (including CINAHL complete, eBook collection, Medline, Open Dissertation). A web search in Google Scholar and Google was conducted for gray literature. Publications in English, published between January 2015 and February 2021, were included. The most acceptable publications were used after study quality assessment using Critical appraisal tool by J. Briggs institute.

Forty three articles were finally selected for scoping review. Physician, nurse, surgical oncologist, laboratory diagnostic staff, radiographer and cardio-oncologist were identified as mandatory members of treatment team. Involvement of additional specialists (neurosurgeon, plastic surgeon) is optional. Supportive specialists (psycho-oncologist, rehabilitation professionals) provide various services for improving the quality of life of breast cancer survivors. Nurse’s involvement in treatment decision-making, radiographer and surgeon’s interaction, cancer and plastic surgeon’s interaction, connection of treatment team with psycho-oncology and rehabilitation services are often interrupted. Underlying conditions of professional’s exclusion are administrative barriers, arrogant attitude of some professionals to other, mistrust to other specialists and professional interest’s conflicts. Effective multiprofessional collaboration can be promoted with regular collaborative meetings, patient consultations carried out simultaneously by several specialists, clinical reports, schedule’s’ harmonization and other data exchange intensification. Digital tool’s implementation is helpful in informational exchange intensification.

Multiprofessional collaboration depends significantly on local regulation of health care, national context and department’s structural organization. Common gap for European countries’ breast cancer treatment strategy is insufficient interprofessional educational interventions and joint practices, low standardization of education and treatment procedures. Separation of breast cancer as independent discipline together with organizational structure unification across Europe is expected to stimulate significantly breast cancer treatment efficiency.

Link to the original publication https://www.theseus.fi/handle/10024/504695(opens in a new window, you will be forwarded to another service)

Contact
Olga Stepanova
alzass123@gmail.com(opens in a new window)

MASTER THESIS

Author
Eero Vilppula
Master of Health Care, Master’s Degree Programme in Clinical Expertise and Development, Tampere University of Applied Sciences
Year of publication: 2021

Introduction and methods
Computer tomography (CT) examinations use contrast media (CM) to enhance different tissues and ensure diagnosis. Iodine containing CM is a renal toxic compound that can cause immediate and delayed side effects. The frequency of adverse reactions can be influenced by selecting an iso- or low- osmolal CM, but also by the amount of CM. The amount of CM used is linked to the radiation dose received by the patient. Technologies that modulate tube voltage, such as low-kV and double energy imaging, can reduce the patient’s radiation dose. Iodine radiation absorbing feature increases up to 33.2 keV. With lower tube voltage the CM produces more contrast to the images.

The study was carried out as a systematic literature review of international sources in the field. The aim was to determine the effect of the tube voltage on the required amount of CM in the CT examinations. The purpose of the work was to provide guidance on the amount of the administration of CM in CT examinations to Kanta-Häme Central Hospital and to respond to how kV modulation affects the diagnostic amount of CM in the CT study. The study was completed during 2021 at Tampere University of Applied Sciences. The data retrieval was carried out in the Medline database. The inclusion criteria were that the article is no more than five years old, peer reviewed and the entire text can be found. The exclusion criteria were that the article does not deal with iodine, does not deal with CT studies and does not answer the research question. After the inclusion and exclusion criteria, there were 15 articles to be included in the review. All articles were read by the study author and compiled by means of synthesis content analysis. The articles were divided into four main categories, according to anatomy. These categories were abdomen, pulmonary arteries, angiography and coronary angiographies.

Results
Based on the review, tube voltage modulation has a significant impact on the required amount of CM in CT studies. By using less tube voltage, less CM is required in CT studies. In the abdominal area, determining the diagnostic amount of CM by patient size of 1.5ml/kg, the amount of CM can be reduced by 10 % for each 10 kV tube voltage reduction from standard 120 kV. Angiography and pulmonary artery studies can be performed with 50 % less CM using 80kV instead of 120 kV. Coronary angiography studies can be performed lowering CM dose by 20 % with a Tube voltage of 100 kV and 30 % Tube voltage of 80kV. When using a smaller amount of CM, the duration of the injection can be compensated by using a lower concentration of CM, a double injection technique or slowing down the injection rate.

Significance of results for radiography
Combining low-kV technology to change the amount of CM according to tube voltage is a useful tool to reduce the amount of CM. This particularly benefits patients at risk of acute kidney injury. A smaller amount increases the tolerability of the CM in other patient groups as well, causing fewer adverse effects. Compensating the injection duration by slowing injection rate reduces the risk of CM extravasation. Reducing the CM and low-kV technology can reduce the patient’s radiation dose.

Guidance for Kanta-Häme will replace their guidance for required amount of CM. This will lower the amount of injected CM per patient, lowering the risk of acute kidney injury and adverse reactions.

Link to the original publication https://urn.fi/URN:NBN:fi:amk-2021112521752(opens in a new window, you will be forwarded to another service)

Contact
Eero Vilppula
eero.vilppula@gmail.com(opens in a new window)

PhD DISSERTATION

Leila Ukkola
röntgenhoitaja (YAMK), TtT
Oulun yliopiston tutkijakoulu; Oulun yliopisto, Lääketieteellinen tiedekunta; Oulun yliopistollinen sairaala

Tutkimuksen tarkoitus ja luonne:
Tutkimuksen tarkoituksena oli kuvailla aikuispotilaiden ja lasten huoltajien informointia ionisoivalle säteilylle altistavien kuvantamistutkimusten yhteydessä sekä heidän toiveitaan informoinnista. Lisäksi tarkoituksena oli kuvata ja selittää röntgenhoitajien toimintaa säteilyannosten ja – riskien informoinnissa sekä mahdollisia informointiin liittyviä esteitä.

Menetelmät:
Tutkimus koostui kahdesta osatutkimuksesta. Ensimmäisessä osatutkimuksessa kuvailtiin aikuispotilaiden (osajulkaisu I) ja lasten huoltajien (osajulkaisu III) informointia ionisoivalle säteilylle altistavien tutkimusten yhteydessä sekä heidän toiveitaan asian suhteen (osajulkaisut II ja III). Toisessa osatutkimuksessa kuvailtiin ja selitettiin röntgenhoitajien toimintaa informoinnissa ja siihen liittyviä esteitä (osajulkaisut IV ja V). Aineisto kerättiin tätä tutkimusta varten kehitetyillä puolistrukturoiduilla mittareilla aikuispotilailta (n=147) ja lasten huoltajilta (n=41) sekä röntgen-hoitajilta (n=174). Kahdessa tutkimuksessa käytettiin sopivuuteen perustuvaa otantaa ja Pohjois-Suomessa toimivat röntgenhoitajat pyydettiin mukaan tutkimukseen. Aineisto analysoitiin tilastomenetelmin. Avointen kysymys-ten vastaukset luokiteltiin sisällön analyysin periaatteella

Keskeiset tulokset:
Säteilytutkimukseen tulevat aikuispotilaat ja huoltajat, joiden lapset tulivat tavanomaiseen röntgentutkimukseen, eivät saaneet riittävästi informaatiota. Informointi oli vähäistä etenkin säteilyannoksista ja -riskeistä sekä vaihtoehtoisista tutkimuksista. Tutkittavat saivat informaatiota useammin säteilytutkimuksen tarkoituksesta. Aikuispotilaat ja lasten huoltajat toivoivat saavansa monipuolista informaatiota tutkimuksesta etenkin lähettävältä lääkäriltä ja röntgenhoitajalta. Lisäksi toivottiin tietoa kirjallisesti.
Informaatiota toivottiin erityisesti säteilytutki-muksen tarkoituksesta sekä säteilyannoksesta ja -riskeistä. Röntgenhoitajista vain harvat informoivat potilaita säteilyannoksista ja -riskeistä, koska he olettivat aiheuttavansa potilaille turhaa pelkoa tai eivät kokeneet sitä tarpeelliseksi. He olettivat myös lähettävän lääkärin jo kertoneen asiasta.

Tulosten merkitys radiografian tieteenalalla:
Tutkimuksen tuottamaa tietoa voidaan hyödyntää säteilytutkimuksiin liittyvän informoinnin kehittämisessä osana potilaan korkeatasoista kokonaishoitoa. Tuotetun tiedon avulla voidaan myös selkeyttää röntgenhoitajan roolia osana oikeutusarvioinnin varmistamista. Tavoitteena on edelleen kehittää lain ja suositusten edellyttämä informoinnin toimintamalli Oulun yliopistolliseen sairaalaan. Jatkossa tuloksia voitaneen hyödyntää kansallisestikin.

Yhteystiedot:
Leila Ukkola
leila.ukkola@ppshp.fi(opens in a new window)