Radiographers role in population safeguarding: Non-accidental injury (NAI) / Suspected physical injury (SPI)
Bo Mussmann, Research Radiographer, Post Doc, PhD
Radiographers often work with members of society most vulnerable to experiencing physical abuse, and as such, require the knowledge and skills to identify and escalate any concerns relating to (physical) abuse.
Physical abuse is rarely seen in isolation and is considered to be only a single factor in the spectrum of abuse that extends from neglect and emotional stress through to physical and sexual abuse and death. Physical abuse is often only recognised within the emergency environment, often involving diagnostic imaging and removal of clothing to prevent image artefacts. As a result, the radiographer is often one of the first people to see the victim undressed and to identify injuries.
Despite this early patient contact, radiographers are often ignored within safeguarding procedures and are therefore uncertain of escalation processes or lack confidence to raise concerns. Where physical abuse is suspected in children, a radiographic skeletal survey, undertaken with the full knowledge and consent of parents or guardians, is often the first line of investigation. The rationale for this is that fractures are the second most common finding after bruises and contusions in physical abuse. Due to predictable fracture healing patterns in children, the skeletal survey may both reveal fractures and provide an estimate of their age. High quality image acquisition is essential as osseous signs of physical injury may be subtle and thus easily overlooked in blurred or noisy images. However, there is no consensus on threshold for acceptable noise in skeletal surveys or paediatric images and international dose reference levels are lacking.
This research program provides a unique opportunity to develop standards of education and clinical practice and identify the personal and environmental factors that prevent identification and escalation of abuse. On completion, the substantial evidence base developed will:
- Provide the underpinning framework for high quality radiographic practice with respect to NAI/SPI;
- Form the basis of a standardised international curriculum;Clarify and promote radiographer responsibilities within the safeguarding team and reporting pathway
- Clarify and promote radiographer responsibilities within the safeguarding team and reporting pathway
Clinical outcome after nephron sparing treatment of renal cancer
Louise Aarup Duus, MD, Guest Researcher
Surgery is the gold standard curable treatment of renal cancer. Minimally invasive nephron sparing treatments such as ablation (destruction of cancer cells with heat or cold) were developed approximately 15 years ago as a treatment option for comorbid patients that could not undergo surgery. Cryoablation has proved to be a good alternative to surgery.
Today, cryoablation is also offered patients that are otherwise healthy.
In this project we investigate clinical, oncological and kidney functional outcome in patients with renal cancer treated with partial nephrectomy or cryoablation.
The project includes four studies:
- A retrospective study of oncological outcome and complications after CT-guided cryoablation of renal cancer performed in 2012-2017 at Odense University Hospital
- A retrospective study of renal functional outcome after CT-guided cryoablation of renal tumors performed in 2014-2018 at Odense University Hospital
- Systematic literature review of renal functional outcome after minimally invasive partial nephrectomy or CT-guided cryoablation of renal cancer
A prospective cohort study of renal functional outcome in patients with renal cancer treated with minimally invasive partial nephrectomy or cryoablation. Renal function is investigated with DTPA clearance and renography before and 6 months after treatment.
Distal radius fractures and accuracy of measurements - does positioning influence clinician decision-making?
Janni Jensen, Radiographer, PhD student
A wrist fracture is one of the most common injuries seen in emergency rooms worldwide, accounting for approximately 15% of all fractures in the adult population. A wrist fracture is of significant socioeconomic concern particularly because of the high incidence and the possible long-term disability caused by post-traumatic osteoarthrosis. Treatment of a wrist fracture is mainly decided based on radiographic characterization of the fracture. Measurements of tilt of the distal radius, radial inclination (RI), and ulnar variance (UV), are often used to decide between operative and non-operative treatment.
Study A – Systematic review (doi: 10.1177/0284185119834687)
Prior to using radiographs in the treatment decision an assessment of measurement accuracy is essential. To summarize existing evidence on accuracy of the radiographic measurements we made a systematic literature review. Five studies addressed this, all indicating a lack of radiographic stringency and perhaps, therefore, differing results. We were not able to draw any conclusions on accuracy and must conclude that there appears to be a lack of evidence on accuracy of abovementioned measurements.
Study B – laboratory study
This is a diagnostic accuracy study using donor-arms in which radiostereometric analyses (RSA) Tantalum beads are injected and artificially created wrist fractures are made. The overall purpose of this study is, in a laboratory setting, to assess:
- Accuracy of the radiographic measured values of UV, RI and tilt and,
- the influence of forearm supination/pronation on reproducibility of the radiographic measured values of UV, RI and tilt
RSA is a validated and highly precise research tool originally developed to measure micromotion of joint implant in relation to bone. In this study RSA is used to give a precise measure of supination and pronation of the forearm between alternating exams. RSA is also used for highly accurate values of UV, RI and tilt in the fractured arms.
The goal in the long run is to improve outcome for patients with wrist fractures by ensuring that characterization of fracture and decision to treat is based on evidence based measurements. Hypothesizing that long-term complication such as post-traumatic osteoarthrosis can be minimized.
Nephspare PRO - Patient reported outcome after nephron sparing treatment of small renal tumors
Theresa Junker, RN, PhD student
Surgery in the form of partial nephrectomy (PN) has traditionally been the preferred treatment of small renal tumours. Cryoablation (Cryo) is another nephron sparing treatment introduced 20 years ago as a treatment option of comorbid renal cancer patients with high surgical risk.
The purpose is to assess and compare clinical outcome and quality of life after PN and Cryo, respectively.
The project is designed as a prospective comparative cohort study, including a literature study. We include patients from Region Zealand and the Region of region of Southern Denmark in a two-year time period. We only include patients with biopsy verified renal cell carcinoma.
Investigation of image quality, radiation exposure to the patients and diagnostic performance of micro dose 2D/3D slot scanner X-ray imaging system compared with conventional Direct Radiography (DR) X-ray imaging system
Ahmed Abdi Abdel, MSc, PhD student
The study aims are:
- To evaluate the image quality of the micro dose 2D/3D slot scanner compared with the conventional DR X-ray imaging system using different evaluation methods
- To evaluate the use of the micro dose2D/3D slot scanner system for clinical diagnostics, particularly in the determination of bone fractures and assessment of bone structures and chest examinations
- To compare the radiation exposure to the patient between the micro dose 2D/3D slot scanner and conventional DR X-ray imaging system