Rationale: Poor cardiovascular health is associated with reduced bone strength and increased risk of fragility fracture. However, direct measurement of intraosseous vascular health is difficult due to the density and mineral content of bone. The aim of this PhD project was to investigate the feasibility of near infrared spectroscopy (NIRS) for the investigation of vascular haemodynamics in human bone in vivo. NIRS provides inexpensive, non-invasive, safe, and real time data on changes in oxygenated and deoxygenated haemoglobin concentration at superficial anatomical sites. NIRS utilises a source optode of near infrared (NIR) light and detector optode that obtains representative data of the interactions of NIR photons with tissue.

Method: a systematic review was performed identifying the current existing applications of NIRS (and similar technologies) for measuring human bone tissue in vivo. This review informed the development of an arterial occlusion protocol for obtaining haemodynamic measurements of the proximal tibia and lateral calf, including assessment of the protocol’s reliability. For thirty-six participants, NIRS results were also compared to alternative tests of bone haemodynamics involving dynamic contrast enhanced MRI (DCE-MRI), and measures of general bone health based on dual x-ray absorptiometry testing and blood markers of bone metabolism.

Results: This thesis presents novel data demonstrating NIRS can obtain acceptably reliable markers of haemodynamics at the proximal tibia in vivo, comparable with reliability assessments of alternative modalities measuring intraosseous haemodynamics, and the use of NIRS for measuring muscle. Novel associations have been demonstrated between haemodynamic markers measured with NIRS and DCE-MRI, giving confidence NIRS truly represents bone haemodynamics. Increased NIRS markers of oxygen extraction during occlusion, and greater post-ischaemic vascular response to occlusion, were both associated with greater bone mineral density.

Conclusion: As a feasibility study, this PhD project has demonstrated the potential for NIRS to contribute to research around the potential pathophysiological role of vascular dysfunction within bone tissue, but also the limitations and need for further development of NIRS technology.

© 2019 Introduction: We evaluated the reporting competency of radiographers providing preliminary clinical evaluations (PCE) for intraluminal pathology of computed tomography colonography (CTC). Method: Following validation of a suitable tool, audit was undertaken to compare radiographer PCE against radiology reports. A database was designed to capture radiographer and radiologist report data. The radiographer's PCE of intraluminal pathology was given a score, the “pathology discrepancy and significance” (PDS) score based on the pathology present, any discrepancy between the PCE and the final report, and the significance of that discrepancy on the management of the patient. Agreement was assessed using percentage agreement and Kappa coefficient. Significant discrepancies between findings were compared against endoscopy and pathology reports. Results: There was agreement or insignificant discrepancy between the radiographer PCE and the radiology report for 1736 patients, representing 97.0% of cases. There was a significant discrepancy between findings in 2.8% of cases and a major discrepancy recorded for 0.2% of cases. There was a 98.4% agreement in the 229 cases where significant pathologies were present. Conclusion: from a database of 1815 studies acquired over three years and representing work done in a clinical environment, this study indicates a potential for trained radiographers to provide a PCE of intraluminal pathology.

© 2019 Purpose: Obesity is increasing in prevalence globally, with increased demands placed on radiology departments to image obese patients to assist with diagnosis and management. The aim of this study was to determine perceived best practice techniques currently used in clinical practice for projectional radiography of the abdomen for obese patients with the aim to help elucidate areas for future research and education needs in this field. Experimental Design: a two round e-Delphi study was undertaken to establish a consensus within a reference group of expert Australian clinical educator diagnostic radiographers (CEDRs). Initially, a conceptual map of issues regarding imaging obese patients was undertaken by analysing interview transcripts of 12 CEDRs. This informed an online questionnaire design used in Delphi rounds 1 and 2. A consensus threshold was set

Objectives: to investigated the accuracy of computer-aided detection (CAD) software in musculoskeletal projection radiography via a systematic review. Key findings: Following selection screening, eligible studies were assessed for bias, and had their study characteristics extracted resulting in 22 studies being included. of these 22 three studies had tested their CAD software in a clinical setting; the first study investigated vertebral fractures, reporting a sensitivity score of 69.3% with CAD, compared to 59.8% sensitivity without CAD. The second study tested dental caries diagnosis producing a sensitivity score of 68.8% and specificity of 94.1% with CAD, compared to sensitivity of 39.3% and specificity of 96.7% without CAD. The third indicated osteoporotic cases based on CAD, resulting in 100% sensitivity and 81.3% specificity. Conclusion: the current evidence reported shows a lack of development into the clinical testing phase; however the research does show future promise in the variation of different CAD systems.

© 2015 the College of Radiographers. Background: Peer to peer support programmes involve students supporting each other in either an educational, social and/or pastoral way. This is now common place in higher education institutes and has been proven to decrease student attrition and improve grades. Aim: to evaluate a peer assisted learning scheme (PALS) within the University of Exeter undergraduate programme, where final year (stage 3) students held extra-curricular teaching sessions in an on-campus X-ray room throughout the academic term to support a first year (stage 1) module introducing basic projectional radiographic examinations, radiation safety, patient care and radiographic equipment. PALS sessions were unstructured and as such could involve roleplaying radiographic examinations, revisiting lecture material and/or discussing hospital placement or pastoral issues. Methods: Brookfield's four lenses of critical reflection were used. 16 of 63 stage 1 students and 9 of 29 stage 3 students were electronically surveyed upon completion of the PALS sessions. Relevant colleagues and educational specialists were also informally interviewed. These were put in context with autobiographical reflections and the existing literature base on PALS. Results: all agreed that the sessions provided a good environment for stage 1 students to improve their practical skills, revise lecture content, and gain confidence for upcoming clinical placements. Stage 3 students gained experience teaching students, an essential role of a graduate radiographer's job. Improvements around recruiting stage 3 peer leaders, sustainability, timetabling and session structure were explored. Conclusion: the PALS proved to be a successful initiative within the undergraduate programme and will be continued into the future.

The primary association of both type 2 diabetes mellitus (T2DM) and fragility fractures with age has become cause for concern in the developed world, with T2DM now considered an independent risk factor for an increased risk of fragility fracture. The increased susceptibility to fragility fracture associated with T2DM has wide ranging and increasing socioeconomic, morbidity and mortality effects. As the incidence of T2DM increases, understanding the mechanisms behind why T2DM is a causative risk factor to decreased bone health is an important step. These may be split into two broad categories: those that involve an increased risk of falling, and those mechanisms that make fragility fracture after falling more likely due to detrimental changes to bone strength. The latter is not definitively understood making diagnosis in T2DM populations difficult. Current diagnostic methods do not sufficiently account for the unique endocrinological effects of T2DM on bone. New markers for identifying fragility fracture risk in patients with T2DM are required to overcome the paradoxical increase in bone mineral density (BMD) in these populations, and the shortcomings of predictive algorithms and dual energy X-ray absorptiometry (DXA) in identifying fracture risk in T2DM populations. Earlier identification of patients with T2DM who are at risk of fragility fracture is important, as these patients are not as responsive to current preventative medical interventions as those without T2DM, although there are also adoptive lifestyle changes that can help.

Accuracy of radiographer primary clinical evaluation of intraluminal pathology at computed tomography colonography. Liverpool 29 June – 1 July 2015. UKRC conference proceedings. P113: P152

Survey of current clinical practice of radiographers performing computed tomography colonography. Liverpool 29 June – 1 July 2015. UKRC conference proceedings. P53-54.

© 2015 the College of Radiographers. Objective: to design and test an audit tool to measure the reporting accuracy of radiographers using radiologist reports as the gold standard. Design: a database was designed to capture radiographer and radiologist report data. The radiographer preliminary evaluation of intraluminal pathology was given a score (PDS score) by the reporting radiologist based on the pathology present, the discrepancy between the preliminary evaluation and the final report and the significance of that discrepancy on the clinical management of the patient. To test the reliability of this scoring system, 30 randomly selected cases (n=1815) were retrospectively compared and assessed for accuracy using the PDS score by 3 independent practitioners. Inter rater reliability was assessed using percentage agreement and kappa scores. Results: There was 100% agreement between participants for all significant pathologies. Inter rater agreement was 80-93% for normal studies and insignificant pathologies. Conclusion: Results indicate that the tool provides a practical, easy to use and reliable method to record, monitor and evaluate a preliminary evaluation of the colon by radiographers.