Oral Abstracts

Contemporary models of healthcare delivery recognise that active patient involvement is now a fundamental principle of safe care. Despite this, healthcare professionals often focus on the technical and medicalised aspects of patient care, failing to provide a holistic model of care. It has been demonstrated that wide disparity can exist between perceptions of service users and those delivering services on what constitutes high quality person-centred care. Applying an interprofessional collaborative approach improves healthcare workers’ awareness of each other’s professions and skills. Interprofessional education is vital across health professions to enhance patient outcomes. Promotion of interprofessional education should therefore begin at the tertiary level. This presentation outlines an interprofessional approach to incorporating patients’ voices into the curriculum. Students are given the opportunity to learn from people’s lived experiences across diagnostic and therapeutic settings. The perspective of the consumer is presented using vignettes collaboratively designed by professionals across healthcare streams. Twelve examples of person-lived stories were obtained from students’ clinical practice reflections. Four were then selected based on clinical relevance with input from a clinical educator, a research radiation therapist, academics and a ‘patient’ in the form of a research assistant who collaborated on the project. With a growing awareness of the importance of person-centred care, empathy and compassion are core elements for healthcare professionals. This project will further prepare graduates to deliver safe personcentred care across the healthcare spectrum, providing the opportunity to develop skills, behaviours and attitudes to deliver such care.

Background: Recent findings assessing cancer patients undergoing imaging procedures indicate that 26% present with anxiety, 52% present with sub-clinical claustrophobia and 27% present with moderate to severe claustrophobia. 1 Given the burden of reported mask anxiety, management of mask anxiety is key to ensuring treatment acceptance, compliance and tolerability. 2 The advent of stereoscopic virtual reality may offer an alternative solution in such scenarios. Phase II of this study aimed to better understand maskrelated anxiety before and after the use of an immersive virtual reality patient coaching intervention in head and neck cancer patients who require a thermoplastic mask. Methods: Patients utilised the CETSOL virtual reality clinic patient experience prior to their CT simulation (see Figure). State anxiety scores were measured pre-and post-intervention using a short State Trait Anxiety Inventory questionnaire. 3 Results were converted to pro-rated scores with a lower and higher anxiety cut-off score of 41 and 55, respectively. Descriptive statistics and joint frequency distributions for the discrete variables were derived with 95% confidence intervals calculated using Ward's method. Pearson's chi-squared test of independence was used to assess the association between each set of variables. Results: Our results will compare the virtual reality intervention group mask anxiety scores to our phase 1 no virtual reality intervention cohort. Conclusion: Early anecdotal evidence indicates favourable outcomes in patient literacy and compliance.
Objectives: Radiation therapy is becoming increasingly more complex with technological advancements often demanding more active patient involvement. Providing clear communication of actions required and getting patient feedback regarding planning and treatment experiences is a priority. 1,2 This pilot study aimed to establish face validity of a developed patient reported experience survey tool. Methods: Institutional ethics was obtained to recruit left-sided breast cancer patients treated in breath-hold to pilot the survey and participate in audio-recorded cognitive interviews. Interviews were conducted using a hybrid of scripted think aloud and probing formats. Correlation of expected and participant responses were then used to confirm face validity, with additional thematic analysis using the framework method. Results: Response saturation was observed at 15 participants with 10 completing the survey and interviews at all timepoints. Face validity analysis showed minor adjustments were required to the survey, often related to interpretation of symptom terms such as fatigue/tiredness for 75% of participants. Preliminary thematic analysis revealed knowledge of own cancer diagnosis, trust in medical professionals and impact of treatment staff interactions, were themes frequently observed in the lived experience of this patient group. Discussion/Conclusion: Cognitive interviews successfully established face validity of the patient reported experience survey, with only minor adjustments required prior to testing of content validity in a randomised control trial and adaption for different patient cohorts. Preliminary thematic analysis shows interesting insights into cancer patients' interpretation of their treatment experience, providing an example of what can be achieved by engaging with consumers to shape future patient care. Australian Society for Medical Imaging and Radiation Therapy, Melbourne, Australia The first MRI linear (MR-linac) accelerator was installed in Australia in 2019. 1 With the progression of technology and the ability to facilitate online MR-guided adaptive radiotherapy, the need for further education for radiation therapists in MRI was critical. Furthermore, radiation therapists undertaking MRI are required to meet the regulatory authority's professional capabilities for medical radiation practice (Domain 1: Key capabilities 8 and 9). 2 In June 2020, the Queensland University of Technology commenced an online short course in MRI for radiation therapists. A collaboration between Queensland University of Technology and the Australian Society for Medical Imaging and Radiation Therapy (ASMIRT) was created to develop a novel certification to enhance the MRI knowledge and skills of radiation therapists. ASMIRT committee and reference group members, comprising MRI experts and educationalists, were tasked with the development of a certification syllabus that would reflect the professional skillset of a radiation therapist performing MRI. The collaboration determined a consensus of syllabus content, and the subsequent development of the certification examination questions was undertaken in partnership with the Queensland University of Technology. A pilot examination was earmarked for November 2022. Organisations that currently undertake MRI simulation and MR-linac treatments were approached to advise of the pilot, and to seek volunteers to participate. Participants comprised radiation therapist practitioners of varying clinical experience. The development of this novel certification will provide practitioners and employers with direction for study and educational programs. It presents a benchmark of industry-standard skill, and formal professional recognition of ability for the MRI radiation therapist.

Planning experience of new graduate radiation therapists in New Zealand
Kate Chadwick, 1 Peter Larsen, 1 Gay Dungey 1 1

University of Otago, Wellington, New Zealand
Objectives: This research assessed the preparedness of new graduate radiation therapists (NGRTs) for the clinical practice of planning. Methods: A senior planner from each New Zealand department and NGRTs who completed their degree in 2020 were surveyed after approximately six months of practice. Both were asked about NGRTs preparedness for practice and for feedback on the Bachelor of Radiation Therapy planning curriculum. NGRTs were asked about body sites planned, number of plans completed and planning techniques used. Senior planners were asked about their expectations of NGRTs in planning. Results: NGRTs frequently planned using 3D conformal radiation therapy (3DCRT) or virtual simulation. Commonly planned body sites were those with palliative intent, radical breast and sites more frequently planned using 3DCRT. The departmental sign-off process sometimes prevented them from generating volumetric modulated arc therapy (VMAT) plans. They suggested more VMAT teaching could be included in the Bachelor of Radiation Therapy. Senior planners expected NGRTs to be able to plan using 3DCRT and VMAT/IMRT. They suggested more clinical workflow teaching in the Bachelor of Radiation Therapy planning curriculum. The majority of NGRTs and senior planners felt the Bachelor of Radiation Therapy prepared NGRTs for clinical practice. Conclusion: The undergraduate degree is preparing NGRTs for clinical practice in planning. 3DCRT and virtual simulation planning techniques remain a core role of NGRTs and a large proportion of clinical workload. NGRTs utilised their VMAT/IMRT planning skills less often during this period of practice, despite being expected to possess these skills. This is a challenge for the undergraduate curriculum and departments as the clinical use of VMAT/IMRT continues to increase.
Online adaptive radiation therapy in-house credentialing program for the future of the radiation therapist profession Meegan Shepherd, 1,2 Alexandra Turk, 1 Leigh Ambrose, 1 Sarah Bergamin, 1  Background: Online adaptive radiotherapy (oART) is enhancing in global application, offering increased accuracy with minimal patient intervention compared to conventional techniques. 1,2 Implemented at our centre in 2020, Varian Ethos TM oART provides a personalised daily treatment plan, however it requires significant clinical resources. As an early adopter of oART, locally and globally, workflow tasks, responsibilities and radiation therapy training are less well defined. 3 We report on the development and refinement of a training and credentialing program for future radiation therapist (RT)-led oART. Methods: Training comprised of online theoretical modules guided by Ethos Super-Users, observation, emulations and clinical training for RT roles in adaptive planning and treatment. Content was decided by the multi-disciplinary team with RT proficiency for adaptive roles assessed across a range of cancer subtypes via multimodal methods and inter-professional craft groups. Results: 13 RTs have been credentialed for at least one of the new adaptive RT roles, with eight RTs fully credentialed and six adaptive support RTs in training. The Adaptive Support (RT2) theoretical module was redesigned to free up time for Ethos Super-Users. Discussion: Education and training are central components in radiation therapy to ensure quality, equity and safety. 4 Implementation challenges of oART workflows can be supported by comprehensive training and credentialing with multi-disciplinary team support. Utilisation of sound educational training methods can demonstrate effective upskilling of RTs in oART. The oART RT credentialing program serves as evidence of competence, and leverages expertise towards advanced practice for the future role of an advanced adapter in RT-led oART.
Introduction: The MRI radiographer is at the forefront of MRI safety decision-making and has the primary responsibility to provide high quality, efficient and safe patient care in the MRI environment. With the rapid advancement of MRI technology and with new safety issues emerging, where are we in the MRI safety landscape? This study aimed to provide a snapshot of the preparedness of MRI radiographers in New Zealand and Australia to practise confidently and safely. Method: An online questionnaire, consisting of a series of MRI safety knowledge questions, was distributed in 2018 via social media and relevant professional bodies. The aim of these questions was to establish participants' MRI safety knowledge and clinical decision-making competency, while simultaneously assessing their confidence levels. Results: Of the 246 completed surveys received, 61% (n = 149) were from Australia, 36% (n = 89) from New Zealand, and 3% (n = 8) from other countries. Findings indicated that current MRI education is preparing MRI radiographers in New Zealand and Australia to practise safely. However, while these radiographers were confident in their MRI safety decision-making, accuracy levels within some groups need addressing. Conclusion: To develop a consistent level of safe practice for the current workplace and into the future, it is proposed that a minimum level of MRI-specific education is defined and mandated to practise. Continuing professional development focussing on MRI safety must be encouraged and, if audited as part of registration, could also be mandated. Implementation of a supporting regulatory framework similar to New Zealand is highly recommended for consideration in other countries.
Longer term effects of distress in MRI and a void in post-procedure care Johnathan Hewis, 1 Rachel Rossiter, 2 Marguerite Bramble 2 1 Charles Sturt University, Port Macquarie, Australia 2 Charles Sturt University, Orange, Australia Background: Despite significant improvements in MRI, many individuals experience distress. 1,2 The MRI experience can result in delayed sequelae that may induce long-term claustrophobia. 3,4 Prior research examining this phenomenon has predominantly been underpinned by positivistic scientific methodologies. [4][5][6][7][8] A deep and holistic qualitative understanding of the lived experience of distress in MRI is currently lacking, particularly in the Australian context. 1,8,9 Aim: To investigate the lived experience of adults who have experienced distress during a clinical MRI examination and give a voice to their perspectives. Methods: Hermeneutic phenomenology is the philosophical framework and qualitative research methodology informing the study design. 10-12 Participants were recruited from regional New South Wales who had experienced distress during MRI scan within the past six months. Data collection was obtained through semi-structured interviews conducted via Zoom videoconference. Charles Sturt University HREC approved, No. H19498. Results: Eight participants were interviewed, providing a deep and rich insight into their lived experience of distress. Several themes of meaning emerged during data analysis to include isolation, proprioception and spatiality, distress as an existential threat, self-soothing strategies, dehumanisation and reduced agency. This oral presentation will specifically explore the interwoven themes of 'a void in post-procedure care' and 'longer term effects' after experiencing distress in MRI. Conclusions: Participants regularly described a void in their postprocedure care where their emotional and psychological needs were not met. Several participants experienced longer term effects including claustrophobic like tendencies and avoidance of confined spaces. Simple quantitative planimetric measurement of nigrosome-1 for the diagnosis of Parkinson's disease in clinical settings Minh (Shayne) Chau, 1,2,3 Marc Agzarian, 3,4 Robert A Wilcox, 1,3,4 Andrew Dwyer, 1,3,4 Eva Bezak, 1 Gabrielle Todd 5 1 University of South Australia, Adelaide, Australia 2 University of Canberra, Bruce, Australia 3 Flinders Medical Centre, Bedford Park, Australia 4 Flinders University, Bedford Park, Australia 5 South Australian Health and Medical Research Institute, Adelaide, Australia Background: There is currently no definitive diagnostic test for Parkinson's disease. A hypointense appearance of nigrosome-1 on MRI has been proposed as a biomarker for Parkinson's disease. Current clinical practice involves a subjectively rating the appearance of nigrosome-1 on susceptibility-weighted images. 1 The aim of the current study was to develop and test a simple method for quantifying nigrosome-1 in clinical settings. We hypothesised that area of nigrosome-1 hyperintense signal exhibits higher inter-rater reliability than subjective rating of nigrosome-1 appearance. Methods: Two experienced neuroradiologists measured area of hyperintense signal in nigrosome-1 (quantitative method) and rated nigrosome-1 appearance as present (normal), present but attenuated (abnormal), or absent (abnormal; subjective method) on the right and left side in two groups of patients: 21 with Parkinson's disease (likely abnormal nigrosome-1; aged 69.6 AE 8.6 years) and 21 with essential tremor (ET; likely normal nigrosome-1; aged 55.5 AE 20.9 years). Neuroradiologists were blinded to patient group, clinical notes and each other's measurements.
Conclusion: Use of this simple quantitative method may improve confidence in longitudinal clinical reporting particularly when nigrosome-1 is attenuated and for neuroradiologists who are new to nigrosome-1 MRI reporting.

HESAV, Switzerland
Introduction: MRI is a rapidly evolving modality, generally considered safe due to lack of ionising radiation. 1 While MRI technology and techniques are improving, many of the safety concerns remain the same as when first established. Patient thermal injuries are the most frequently reported adverse event, accounting for 59% of MRI incidents to the Food and Drug Administration. 2 Surveys indicate many incidents remain unreported. 3 Patient thermal injuries are preventable and various methods for their mitigation have been published. However, recommendations can be variable, fragmented and confusing. The aim of this systematic review was to synthesise the evidence base on MRI safety and skin injuries and offer comprehensive recommendations for radiographers to prevent skin thermal injuries. Methods: Six journal databases were searched for sources published January 2010 to September 2022, presenting information on MRI safety and thermal injuries. Of 23,408 articles returned, after careful screening and based on the eligibility criteria, only 36 articles and an additional 19 grey literature sources were included (n = 55). Results: Included studies were examined using thematic analysis to determine if holistic recommendations can be provided to assist radiographers in preventing thermal burns. This resulted in the three simplified recommendations supported by extensive background literature (see Figure). By implementing the above recommendations, it is estimated that 97% of skin burns could be prevented. 3 Conclusion: With thermal injuries continuing to impact MRI safety, strategies to prevent skin burns and heating are essential. Assessing individual risks, rather than blanket policies, will help prevent skin thermal injuries occurring, improving patient care. In every diagnostic imaging department and university there are a plethora or textbooks describing the standard general radiography image acquisition techniques and these have largely remained unchanged for over a century. Yet in the same timeframe the evolution of different imaging modalities has provided us greater insight into the human body, not just in a static 2D state but also in a functional sense. Alongside this the profession has developed, and is expected to utilise, evidence-based practice to optimise person-centred care. So, based on our increased educational standards and research underpinning it, is it time we critically examined the techniques that we perform every day to ensure they are really evidence-based and can be applied to every patient presentation? Variations in body habitus and disease processes together with clinician demands require adaptive practices yet our knowledge base may not be keeping up with demands. This presentation will consider whether historical acquisition techniques can be relied on or whether the profession needs to take bold steps and develop international collaborations to consider (and own) our fundamental practices.
Check before you sendcatching errors before they impact patient care Mathew Knox 1 1 Sunshine Coast University Hospital, Birtinya, Australia Background: Every year, the Sunshine Coast Hospital & Health Service Medical Imaging Department records hundreds of imaging errors that require fixing after they have gone to the picture archiving and communication system (PACS). These errors can include use of incorrect side markers, images sent under incorrect folders, imaging of incorrect anatomy or, at worst, images of the incorrect patient. The Check Before You Send (CBYS) initiative is implementing a change in attitude and workflow to reduce this number. The author seeks to achieve a higher level of patient safety by increasing imaging accuracy and efficiency, while following established diagnostic imaging accreditation scheme standards. Methods: Control data was collected from a six-month period of PACS quality control tasks and PACS call-ins. Staff were educated on the CBYS initiative via PowerPoint presentation and introduced to (a) CBYS posters and modality stickers for all sites in the Sunshine Coast Hospital & Health Service to remind everyone of the importance of checking their work, and (b) a Microsoft Forms questionnaire radiographers/sonographers must submit for all imaging errors to prompt the PACS department to amend the error. The same quality control task and PACS call-in data will be collected at three and six-month intervals and compared to the control data. The Microsoft Forms data will be collected to determine how many of the quality control tasks generated are not due to user error. Results: The initiative is ongoing and is due to conclude in March 2023. The author hypothesises that the changes will result in an overall reduction in imaging errors.
Revisiting the evidence around radiographic positioning: an examination of pelvis centring Objectives: Radiography positioning is not underpinned by evidence. With increased awareness of disease, body habitus and postural variation it is incumbent to question our historical foundation. When considering the pelvis radiograph Metzger stated, 'this region requires most careful study. . . it is imperative that the . . . work must be of a superior character'. 1 This has specific contemporary implications when considering the role of the radiograph in surgical decision making. 2 Pelvis radiography practice varies across the United Kingdom with resultant disparity in quality. 3,4 Historical textbooks described various techniques including field centring with anatomical inclusion criteria, 5,6 although radiographers also use a centring point midline between the anterior superior iliac spine and symphysis pubis. 3 This presentation will use a prospective cluster randomised research study to consider how projectional radiography can be challenged or embraced. Methods: A multi-centre prospective trial (STOPPAGE ISRCTN 77100098) compared a control and an interventional site which implemented a new standardised technique based on a femoral landmark. Patient recruitment (≥ 18 years of age, n = 289) enabled review of anatomical inclusion, repeat rate, radiation dose and structural measures, along with radiographer acceptability of the new technique. Results: Analysis is currently underway, and the research design and early findings will be shared. Discussion/Conclusion: Results will shape future practice by showing whether historical methods are suitable for today's patients, or whether further evidence is required to optimise current and future imaging. This is especially pertinent with emerging practice regarding weightbearing imaging. Objectives: Published reject analysis papers document the technical reasons for rejecting X-ray images (such as positioning errors), but there is little information surrounding other reasons for rejecting images, or for accepting poor quality images. This presentation reports on a project exploring what factors affect radiographers' decisions to accept or reject. Radiologist opinion on the radiographers' decisions will also be presented. Methods: Ethical clearance was obtained through the relevant participating metropolitan hospital. Radiographers (n = 24) submitted patient cases (n = 115) along with information about their experience, mood and gender, as well as patient age and presentation. Image reject data were also collected. Radiologist opinion on the accepted images was obtained and compared with the decisions of the radiographers. Results: The reported reject rate was 9.24%. When radiographer mood is negative, they are five times more likely to reject an image within a study. No other parameters such as radiographer experience or gender, or patient age or presentation showed significant findings. Radiologist correlation with the opinions of the radiographers was poor. Discussion/Conclusion: Radiographer decision-making is a complex issue to investigate. This exploratory research showed that radiographer mood significantly affected reject rates, which is outside of the technical factors included in traditional reject analysis publications. The opinion of radiographers showed poor correlation with the opinion of the radiologist, which requires further thought and investigation.
Re-creating the compensatory filter: honouring the past by maintaining the design into the future Adam Steward 1

Western Health, Footscray, Australia
The compensatory filter is used in digital imaging to even the density of an imaging field that includes non-homogeneous tissue types or thicknesses. Anecdotally, the use of the compensatory filter has declined with the advent of digital radiography, where the image can be windowed to allow visualisation in different aspects of the image. This has presented a problem in so far as the compensatory filter is still valuable to the provision of a high-quality image and that the availability of compensatory filters is now limited. This presentation details how effective the use of the compensatory filter can still be in digital radiography. It also describes the creation of a compensatory filter for use in a department, the construction of which derives from original compensatory filter design. Radiographic imaging plays an important role in disaster victim identification. The modalities used will be determined by the location and availability of resources, taking the needs of living casualties into consideration too. This presentation will provide an overview of the contribution of dental X-rays, fluoroscopy, radiography and CT to the disaster victim identification process, while applying forensic principles to avoid errors and maintain continuity of evidence.
From digital to material: how radiology is shaping the future of medical 3D printing Alex Hollingsworth, 1 Xanthe Keneally 1 1 Princess Alexandra Hospital, Brisbane, Australia You fall from a height, stumbled down the stairs or maybe you had a bit too much to drink the night before, you do not remember. All you know right now is the doctor is telling you that your ankle is injured, and traditional surgeries will not offer many options. You have heard about 3D printing. Can this technology offer a solution? Medical imaging plays an essential role in producing the models used for 3D printing within the medical field. The vision of many health researchers and professionals is to utilise this rapidly evolving technology to help improve the lives of their patients, provide clinicians with visualisation tools and educate their students and colleagues. Using CT and MRI datasets, digital models can be designed and printed to replicate a missing or damaged bone, produce a patient matched cutting guide for a difficult tumour removal or manufacture a surgical tool matched to the patient's individual anatomy. We will examine the history and how 3D printing technologies differ between the consumer and medical worlds, the applications for 3D printing within the medical space, where radiographers currently fit into the process and how we can contribute to the implementation of this technology. We will also investigate its limitations and briefly touch on the future of 3D printing in the medical field to see how it has already been implemented. Objectives: Patients risk from radiation exposure is directly related to the administered activity of a radiopharmaceutical and individual anthropomorphic parameters. Individually tailoring administered activity is one method to minimise this risk and maintain diagnostic image quality. The aim of this study was to identify ways to individually tailor administered activity to patients as a way minimise the radiation exposure while maintaining image quality. Methods: Five literature databases were searched for reports published after 2000, in English. Key search terms included "nuclear medicine", "SPECT", "PET", "radiopharmaceutical", "radiation exposure", and "image quality". Studies performed in humans from peerreviewed journals were screened and selected. Reports then underwent quality assessment using the Joanna Briggs Institute checklist tools. Relevant data were extracted from included reports. Narrative synthesis of the results was conducted due to the heterogenous nature of the articles. Results: 31 peer-reviewed papers were included. Most studies were deemed to have some level of publication bias. For general nuclear medicine procedures only myocardial perfusion reports were identified whereas a range of positron emission tomography studies were identified. To individually tailor the administered activity most reports employed a weight-based scale. Other methods included a body mass index-based scale, a reference patient weight-based formula and a weight-based quadratic formula. Conclusion: Anthropomorphic parameters are suitable to tailor the administered activity to reduce radiation exposure while achieving high quality general nuclear medicine procedures. Future research into the combination of anthropomorphic parameters to tailor the administered activity is required. Objectives: The aim of this study was to determine a methodology by which patient radiation doses can be minimised while maintaining image quality in bone scintigraphy studies. Methods: In this retrospective audit-based study, images and data for 55 patients were retrieved and resampled to simulate a series of reduced dose whole-body bone scans, coming to a total of 171 images. Images were scored against a rubric, with a subjective 10point scale on whether the image was deemed of satisfactory diagnostic quality. Results: The mean dose in current practice was found to be 817 MBq, providing a dose per weight for the average patient of 10.74 MBq.kg-1. All 171 images were reviewed, with scores, ratings and satisfaction acquired for all. Image score and image rating were found to have linear but imprecise relationships with both dose and dose per weight. Image satisfaction was demonstrated to have a close relationship with both dose and dose per weight. Using a satisfaction driven weight-based model with current data, patients less than 70 kg could receive lower doses while maintaining current image quality. Conclusion: This study demonstrates a reproducible, applicable methodology by which a given centre can use a linear, weightbased dosing regimen up until the threshold at which this produces a dose equal to current practice. This study recommends performing regular internal audits in order to more vigorously apply and maintain doses as low as reasonably achievable through regular readjustment of dosimetry practice.

Dose optimisation in bone scintigraphy
Towards a future ready nuclear medicine service: the effect of latest guidelines on nuclear medicine set-up Jin Tang Tay, 1 Tee Meng Tan, 1 Yi Wei Tan, 1 Yi Hong Chng 1   1 Woodlands Health, Singapore To safeguard patient safety, the Ministry of Health Singapore released a set of standards for the provision of nuclear medicine services in 2019. 1 Alongside the Radiation Protection Act 2007, 2 the new guideline called for a change in the nuclear medicine setup for newer hospitals. This study investigates the effect the guidelines had on the set-up of nuclear facilities in Woodlands Health, serving as a reference for future hospital planning. The new standard was compared to existing planning provisions and further evaluated through site visits to established nuclear medicine facilities and engagement with professional team members. Two significant discrepancies were observed. First, a 'hot-toilet', used exclusively by 'hot' patients, is now required to be linked to a decay sewerage management system for the storage of radioactive biological waste until safe for discharge into the public sewage system. To achieve this for Woodlands Health, a contractor specialising in the building of such facilities was consulted. Second, an exercise was initiated to re-design the nuclear medicine facility layout to fulfil the need for a segregated lead-lined waiting area. Theoretical calculation on the expected radiation exposure based on workload was performed to account for the amount of lead-lining required to protect staff working in the area. With the enforcement of guidelines by authorities in recent years, both older and new hospitals will eventually have to make changes to safeguard public and staff safety. This study records the adjustments made during the set-up of the Woodlands Health nuclear facilities and will be a good reference for other hospitals subjected to similar requirements. Objectives: Evidence shows cancer patients receiving radiation treatment have a diverse range of information needs. [1][2][3] However, there is a lack of data specific to the information needs of New Zealand patients. This cross-sectional survey captured cancer patients' preferences for radiation treatment information. Specific preferences were assessed regarding the scope of information needs and the satisfaction with which those needs were currently being met. Results will provide the largest multi-centre dataset of patient information preferences in New Zealand and aims to shape future initiatives for radiation treatment education.

References
Methods: A one-page, paper-based survey was offered to all eligible patients undergoing radiation treatment at six of 10 departments across New Zealand. The survey captured patient demographics and information preferences/satisfaction using Likert scales and one free-text question.
Results: All departments administered the survey during the same week in November 2022. Data analysis occurred during December 2022 and results will be presented. Descriptive statistics will be calculated for all questions and correlations with demographics evaluated. Free-text responses will be analysed using directed content analysis to identify common themes. Discussion/Conclusion: This survey will provide researchers and clinical departments with valuable data which current New Zealand radiation patient education practices can be evaluated against, as well as shape future initiatives. Furthermore, trends in patient information preferences maybe identified based on demographic and treatment-related characteristics. A nationwide evaluation of patient preferences is timely in the context of COVID-19 with increased utilisation of remote platforms for engagement and with the establishment of a new single New Zealand health service. 1 Princess Margaret Cancer Centre, Toronto, Canada 2 University of Toronto, Toronto, Canada Objective: To determine if a novel person-centred model of care, consisting of radiation therapist-led education and continuity of care, was more effective at reducing anxiety compared to standard care for patients with breast cancer. Methods: Patients requiring locoregional breast radiotherapy were randomised (1:1) to the intervention or standard care. The intervention was a one-on-one, in-person pre-CT education session with a radiation therapist who subsequently performed CT, planning, treatment delivery and support for the same patient. Standard care had no dedicated education and was usually delivered by many different radiation therapists. The primary outcome was change in anxiety from baseline during radiotherapy. Secondary outcomes were changes in self-efficacy, treatment concerns and health engagement levels as well as post-treatment satisfaction. Optional semistructured interviews were completed to thematically analyse patients' lived experiences with radiotherapy. Results: Patients (109 total) were randomised to the intervention (54) or standard care (55). Most received 40 Gy/15 fractions (94%) using a 4-field technique (93%) in active breath hold (57%). The magnitude of anxiety improvement during treatment was similar between arms (P = 0.682). Procedural concerns improved in the intervention arm (P = 0.001). Other secondary outcomes were similar between arms. Satisfaction significantly (P < 0.05) improved with the intervention for provision of information, members of the care team and overall care. Interview analysis (20 intervention, 21 standard care) revealed the radiation therapist-led education was broadly valued and having one consistent radiation therapist was valuable for especially vulnerable individuals. Background: The ability of patients undertaking pelvic irradiation to successfully predict bladder fullness is difficult even when utilising a well-informed protocolised bladder filling instruction. The use of an ultrasonic scanning device can significantly improve the accuracy of this prediction. The referral process for ultrasonic scanning a patient's bladder pre-treatment in the radiation oncology department has increased patient pathways and the impact of this increase to treatment timelines in this cohort of patients is the subject of this review.
Discussion: This review focussed on reducing patient timelines within the department while improving multi-disciplinary communication and procedures. Developing a baseline pelvic patient pathway through the department helped define limitations of the current practice and gave insight into interventions to improve patient outcomes. Recommendations were made to implement a new system allowing radiation therapy or nursing staff to triage the patients relative to bladder fullness before they present for treatment. It was also recommended that the hospital's electronic medical record system be utilised to record scanning results, to simplify communication, as the electronic medical record is universally utilised across disciplines. It was also recommended that an additional ultrasonic scanning device be acquired, and a training program developed to train radiation therapist staff in the use of the ultrasonic scanning device in order to share the clinical load of this intervention.
Conclusion: This radiation therapist-led initiative supports the improvement of patient experiences by streamlining an historically unpredictable and potentially stressful step in pelvic irradiation treatment. It also champions change through multi-disciplinary collaboration enabling improved patient outcomes.

Development of a paediatric radiation therapy program to allay anxiety
Xiao Wei Tan 1   1 National Cancer Centre, Singapore The management of children undergoing radiation therapy is challenging. The use of immobilisation devices and the need to remain still may cause anxiety in children, which may result in the need for sedation. 1,2 We sought to optimise our service to reduce the overall psychological burden on our patients and hopefully reduce sedation requirements.
We partnered with child life therapists and art therapists from the children's hospital. The improvements set in place include pre-treatment visits by the child life therapists in the inpatient and/or home setting, which includes playing with toy-sized models of our treatment equipment. A pre-treatment facility tour program has been introduced to allow an opportunity for caregivers and the child to familiarise themselves with the radiation therapists and treatment environment. A play therapy element is included, where the child is introduced to the immobilisation gadgets. To provide continuity, our educational booklets include a patient journey story that spans the children's hospital and our treatment unit in an adult hospital. We are developing a virtual reality facility tour environment that will be run on a headset, which includes characters from the children's educational booklets. A mask-painting program is also currently under development. Radiation therapy is an important aspect of paediatric cancer treatment, but it can cause anxiety in children, which may result in a need for sedation. We have optimised our paediatric radiotherapy program to address this and facilitate the delivery of holistic care. The 'core scope' of clinical practice for radiation therapists (RT) refers to those aspects of clinical practice that can reasonably be expected to be undertaken by all RTs. Over time, organisational needs and capabilities change, technologies progress and new services may be proposed. These factors underpin the need to routinely review and renew RTs' scope of clinical practice. Specific credentialing and determination of a specific scope of clinical practice is required where it cannot be reasonably assumed the RT's qualifications include the specific competency. 1 Stereotactic ablative body radiotherapy (SABR) adoption continues to increase and is no longer reserved solely for large centres. A high degree of accuracy is required for SABR due to the high dose per fraction and proximity of critical structures. In many departments a radiation oncologist is required to be present for each fraction to assist with and confirm the match for SABR treatments. RTled SABR image-guided radiation therapy (IGRT) can help reduce the time burden on the radiation oncologist and increase patient workflow efficiency.
Organisations are at different stages of implementing RT-led SABR IGRT. In order to credential for the specific scope of RT-led SABR IGRT, additional training, experience and ongoing proficiency all need to be considered taking into account service provision and organisation capabilities. This presentation will detail the steps undertaken by our organisation to initiate RT-led SABR IGRT and changes to credentialing over time following review. Key recommendations and lessons learnt will be shared, such that others can learn from our experience. Objective: To explore the understanding and perceptions of radiation oncology health professionals (oncologists, therapists, physicists, engineers and nurses) with respect to advanced practice radiation therapy roles, in order to define the challenges and benefits of introducing this model of care at a large tertiary cancer hospital.

Reference
Methods: A two-part mixed methods study design was employed in early 2022. The quantitative arm used a published validated survey to collect data from all radiation medicine disciplines across the service. This was followed by qualitative focus group data collection from the same cohort. Analysis utilised descriptive statistics and thematic analysis.
Results: 100 complete responses were received for the online survey. Eight focus groups and two interviews were conducted with 51 participants. Data indicated broad multi-disciplinary support for advanced practice radiation therapy (89%), and 87% believed that patients would benefit from the establishment of advanced practice radiation therapy. Concerns were identified regarding professional boundaries, understanding of the roles, and educational requirements to fulfil the role. Discussion: Advanced practice radiation therapy roles are well established internationally and have been shown to improve the quality of, and access to, care. However, implementation locally is inconsistent. Local multi-disciplinary support for this alternative model of care is strong, yet there continues to be profession-specific concerns which may inhibit broader implementation. Engaging the various professions to explore these concerns while showing sustainable improvements to care will strengthen the outcomes of these roles. Objectives: A parental cancer diagnosis has psychosocial impacts on the entire family. In 2020, a radiation therapist-led program was introduced to identify and refer patients who are parents of young persons to Canteen support services. Electronic patient-reported outcome (ePRO) surveys screened for referral candidates and radiation therapists approached them to provide Canteen information and offer referral. We report the monthly referral rates pre-and post-program introduction and results from a patient experience survey.

Implementation of a radiation therapist-led referral program to Canteen
Methods: An audit comparing monthly referral numbers in the year prior to program implementation and since its commencement was performed. We surveyed all ePRO-identified referral candidates (parents of 0 to 25-year-olds receiving radiotherapy). We report responses to the following 5-point Likert scale questions regarding the program: (i) acceptability, (ii) usefulness and (iii) satisfaction.
Results: Between July 2020 and October 2022, 50 patients and 93 young people were referred. Compared to 2019, the monthly referral rate in this post-implementation period was substantially increased from 0.7 to 1.9 referrals per month. The experience survey completion rate was 31% (48/153) and the responses showed 92% and 8% found the pathway acceptable or somewhat acceptable, respectively. There were no neutral or non-acceptable responses; 93% found it very useful or useful, and 90% were very satisfied or satisfied with the verbal information they received from radiation therapists. Discussion/Conclusion: A radiation therapist-led referral pathway has increased patient access to support services and is highly valued by patients.
Shaping the future of stereotactic body radiation therapy: radiation therapist-led image guided radiation therapy credentialing program for SBRT lung Princess Alexandra Hospital, Brisbane, Australia As high geometric precision is required for stereotactic body radiation therapy (SBRT) delivery, pre-treatment image guided radiation therapy (IGRT) is necessary to ensure accurate targeting of the treatment fields. Since the introduction of SBRT into the clinical setting, the radiation oncologist has standardly been required to attend every treatment fraction and approve the online IGRT match before treatment can be delivered. Following the guidelines established by the Faculty of Radiation Oncology, 1 a departmental IGRT training and credentialing program was developed for radiation therapists. The aim of the program was to enable radiation therapists to autonomously perform the online IGRT match for SBRT lung cases, removing the requirement for radiation oncologist attendance at every treatment. A multi-disciplinary team was formed to design and implement the program, with the key goal of providing radiation therapists with the knowledge to make safe and appropriate image matching decisions for a range of SBRT lung scenarios. The robust training program includes written resources, extensive offline training and testing cases that simulate the online environment. All training and testing cases are compared to a radiation oncologist gold standard match and represent broad decision-making principles. A research project is currently being conducted to assess the effectiveness of the credentialing program, including its adaptation to radiation oncology departments with differing vendor equipment and technologies. This presentation will discuss the design of the program, challenges, modifications, initial findings of the research project and future directions.  Methods: Radiographer comments were compared with the radiology report for true positive, false positive or indeterminate classifications. All radiographer errors were reviewed by two auditors and two independent radiologists and risk ratings assigned. Reporting turnaround times and clinically significant cases were collected to identify any potential harm or improved patient care. Results: All Radiographer Comment and Flag cases (n = 1019) were audited for positive predictive values. The pooled average positive predictive values across pilot sites were 0.96 (0.946-0.971, 95% CI). Radiographer error rates ranged from 2.1 to 5.0% (3.4% average). Radiology reports were incidentally found to have a 3.8% discrepancy/error rate. Reporting turnaround times ranged from three minutes to several weeks. Average report turnaround times were 10 and 15 hours at two sites, respectively. Direct benefits were noted for 179 clinically significant cases (17.3%). No significant patient risks were identified. Discussion/Conclusion: The radiographer comment error rate (3.4%) compared well with international reporting error rates (3-5%). 2 The implementation of the Radiographer Comment and Flag with a multi-disciplinary healthcare team has shown many patient benefits at 'point of care'. These benefits outweigh any potential patient risks and allows for earlier medical intervention. Objectives: This is the first study to compare and combine the radiographic interpretation performance of emergency referrers and radiographers in an emergency department.
Methods: A total of 838 radiographic examinations were analysed from 1 August to 24 August 2020. The range of examinations reviewed included both paediatric and adult presentations and included the appendicular and axial skeleton. The emergency referrer and radiographer interpretations for each examination were compared to the radiologist's report. Sensitivity, specificity and accuracy were calculated. 1 Cohen's Kappa statistic was used to assess the level of agreement between radiographers and referrers with radiologists. 2 Results: The radiographer interpretation demonstrated a mean sensitivity, specificity and accuracy of 80%, 98% and 92%, respectively. The emergency referrer interpretation demonstrated a mean sensitivity, specificity and accuracy of 82%, 95% and 89%, respectively. The highest level of agreement was between the radiographer interpretation and radiologist report (Cohen's Kappa Score = 0.81 'almost perfect') When the radiographer and emergency clinician's interpretations were combined, it yielded a mean sensitivity, specificity and accuracy of 90%, 93% and 92%, respectively.
Conclusion: This study demonstrated that with the addition of a radiographer's X-ray interpretation, an emergency referrer's interpretation can be more accurate than the emergency referrer's interpretation in isolation. This highlights the value of championing change and implementing a system that documents a radiographer's X-ray interpretation that can complement an emergency referrer's interpretation when a radiologist report is unavailable. 1 The University of Sydney, Sydney, Australia 2 Monash University, Melbourne, Australia 3 I-MED Radiology, Brisbane, Australia The Medical Radiation Practice Board of Australia professional capabilities require radiography, nuclear medicine and radiation therapy graduates to be able to practise independently in CT. 1 This involves not only the safe and effective operation of the CT system, but also the ability to assess images for diagnostic quality and evaluate them for any urgent or unexpected findings. 1 In order to provide safe and effective patient care on graduation, medical radiation students need to be educated in abnormality detection of significant and time-sensitive findings. However, according to the literature, there is a lack of accessible education interventions in image interpretation of urgent findings for medical radiation practitioners 2 and no validated educational interventions for students. To address this deficiency, an e-learning resource using a novel education platform has been developed. Learning modules each containing 10 CT chest examinations have been created with a mix of both normal and abnormal findings. For each examination, students are asked to identify if there are any abnormalities present, rate their confidence in their decision and, where an abnormality is present, assign a level of urgency. Using the test-enhanced learning strategy, after each module is completed, students are provided with immediate, individual feedback on their sensitivity and specificity scores as well as access to the pre-assigned truths. Details of the resource creation will be presented, along with plans for its evaluation and how its implementation will help shape the future of our profession.
A multi-disciplinary approach to implementing a radiographer preliminary image evaluation system at a tertiary hospital Xanthe Keneally 1

Princess Alexandra Hospital, Brisbane, Australia
The Medical Radiation Practice Board of Australia indicates that radiographers must take timely action on identifying urgent or unexpected findings to ensure appropriate patient management. 1 This must be documented to support further discussions regarding patient care, in line with the National Safety and Quality Health Service Standards. 2 It is therefore important that departments have guidelines supporting this process. There are several barriers to successful radiographer preliminary image evaluation (PIE) system implementation, including inconsistency of guideline use and presence, lack of time and radiologists' resistance, 3 the latter evidenced in the Royal Australian and New Zealand College of Radiologists' 2018 Position Statement. 4 There is evidence of Australian departments implementing a range of PIE systems, but not of a multi-disciplinary approach. 5 Implementation science reports many interventions to ensure effective guideline implementation, including stakeholder involvement, education of the intents and benefits, and having a quality improvement, performance measuring system. 6 Healthcare teams are seen as complex adaptive systems, posing further challenges when implementing change. 7 With this in mind, in 2020, radiographers at the Princess Alexandra Hospital in Brisbane worked alongside consultant radiologists, the clinical education team and team leaders to design and implement a new work unit guideline. The guideline outlines recommended practice for the documentation of significant or unexpected findings identified on X-ray by radiographers and was implemented to ensure radiographers were complying with the Medical Radiation Practice Board of Australia following removal of their list of medically urgent findings radiographers were expected to identify, as well as anecdotally poor compliance to a previous version of this departmental guideline.
The effect of clinical information on radiology reporting: a systematic review Objectives: It is common practice for radiologists to use clinical information to assist in the interpretation process. 1 This systematic review aimed to investigate the effect of clinical information communicated to the reporting radiologist, on the resultant report.
Methods: A study protocol was published in the PROSPERO register (CRD42019138509). 2 Peer-reviewed studies that investigated a relationship between clinical information and the resultant report were included. Multiple electronic databases were searched, and reference lists from included studies interrogated. Studies were screened for eligibility by two reviewers, with consensus reached by discussion. The Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental studies was used to assess the quality and risk of bias of each study. 3 Results: Following removal of duplicates, 824 abstracts were screened, 21 studies met the inclusion criteria. A range of imaging modalities was represented, including plain X-ray (n = 12), CT (n = 5) and MRI (n = 1), with three including two modalities. Study populations ranged from seven to 733. Significance testing used varied greatly and included t-test, receiver operator characteristic curve, and McNemar's test. The heterogeneity of study designs, outcomes measured and significance testing used precluded meta-analysis. A narrative synthesis was undertaken to explore the evidence for effect on outcomes.
Conclusion: Clinical information communicated to radiologists has an effect on the accuracy, confidence, timeliness and clinical relevance of the resultant report. The range of interventions described suggests clinical information is valued in the reporting process. Further investigation is needed to discover the most reliable method of communicating relevant clinical information to reporting radiologists. Objectives: Diagnostic errors in the emergency department can have major implications on patient outcomes. 1 Preliminary image evaluation (PIE) is a brief comment written by a radiographer describing an acute or traumatic pathology on a radiograph. It can be used to complement a referrers radiographic interpretation in the absence of the radiologist report. 2 Currently no studies exist that involve the analysis of false-positive errors in PIE. The purpose of this study was to investigate the anatomical regions that cause the most false-positive errors.

References
Methods: A longitudinal retrospective clinical audit was conducted to determine the diagnostic accuracy of radiographer PIEs over a five-year period from January 2016 to December 2020.
Results: A sample size of 11,090 radiographic examinations were included in the analysis. An overall PIE accuracy of 88.6% and a service accuracy of 94.6%. Foot, ankle and chest regions caused the most false-positive errors, while ankle, shoulder and elbow caused the most unsure errors. 73.3% of the unsure cases were negative for any pathology when compared to the radiologist report. The paediatric population accounted for 21.3% of false-positive cases and 33.6% of unsure cases. Discussion/Conclusion: Findings in this study should be used to improve education specific to radiographer image interpretation. Enhancing radiographer image interpretation skills can assist in improving referrer diagnostic accuracy, thus improving patient outcomes. Objectives: Graduate radiographers entering the professional healthcare setting need to orientate and familiarise themselves in a rapidly changing work environment to deliver a high standard of diagnostic imaging services. This study undertook to understand the perspectives of graduate radiographers on their work readiness on entering their new qualified positions. Methods: Ethics clearance was obtained from the university (HREC 2020-4751). A qualitative phenomenological approach was used to collect data from 14 purposively sampled graduate radiographers through individual in-depth semi-structured telephone interviews. The rich data were transcribed verbatim and then thematically analysed.
Results: New graduate radiographers had varied but shared experiences. Their past influenced their present-day practice, with many recognising increasing skills and confidence as time went on. Discussion: Participants' work readiness was largely facilitated by clinical work-integrated learning placements during their university training. These placements exposed radiography students to the realities of the job, which helped accustom them to the differing workflows, protocols, social structures and systems that exist in public and private healthcare settings. [1][2][3] Participants' support systems and coping strategies are varied, as unique personal life experiences and individual attitudes and behaviours influence a graduate's capabilities and readiness to work professionally. 4 Conclusion: As new graduates become familiar with their new role and responsibilities, the challenges they face are met with progressive confidence, skills and expertise.
Embracing complexitylessons learned from delivery of large-scale bespoke training across diverse professional groups Introduction: Professionalism emphasises humanistic aspects among other attitudes, behaviour, virtues and characteristics. 1 Professional conduct means conducting yourself responsibly, respectfully, diligently, courteously, and with competence, skill and maturity in alignment with the prescribed professional standards and capabilities as prescribed by the regulatory body. 2 This highlights the importance of integrating these concepts as early as undertaking their course at the university level. 3 Objective: This study explored undergraduate medical imaging students' experiences, perspectives and understandings of professionalism in medical imaging.
Methods: A qualitative longitudinal study was conducted between August 2020 to November 2021 using a convenient sampling technique of 40 participants that enabled acquiring rich insights into their meaning-making, knowledge and understanding of professionalism. Seven focus group interviews pre-and then post-placement were conducted followed by inductive data analysis and interpretation to thematic saturation. Results/Discussion: Students acquired their knowledge through theory units and undertaking clinical practice that shaped their meaning-making and understanding of professionalism and the possible implications it could have in practice. Examples shared among others were qualified professionals accustomed to routinised emphasis on task completion with speed. However, the novel students were vocal among others, being honest about making mistakes rather than just focussing on punctuality and physical appearance including the softer skills in terms of being empathetic and compassionate and being culturally safe and sustaining safety culture.
Conclusion: This study provided insights into undergraduate medical imaging students' awareness, knowledge and, to some extent, a holistic understanding of professionalism from a practice perspective.

University of Auckland, Auckland, New Zealand
Background: In the clinical environment, the ability to think critically is imperative for radiography students to work efficiently as part of a team in an era of rapidly advancing technology. 1 Students' ability to demonstrate critical thinking skills was studied at a comprehensive university in South Africa in order develop a more explicit curriculum to facilitate this competency.
Objectives: To present results of the study as well as guidelines to embed critical thinking skills into the medical imaging curriculum. Methods: The study employed an exploratory descriptive, mixed methods design. Third year radiography students were purposefully selected to participate in this study. The participants' responses to vignettes (in the form of clinical scenarios) were analysed using a Likert scale and action verbs developed for evaluating evidence of critical thinking skills in a radiography context and providing quantitative data. Field notes were made while analysing responses to each vignette, providing qualitative data.
Results/Discussion: The findings indicated that most participants in this study demonstrated a minimal ability to think critically in a vignette. This implies that there is a need for curriculum adjustment to embed critical thinking skills in the curriculum. It is well known that critical thinking skills can be taught to students using a range of methods. 2,3 Conclusion: Curriculum development and delivery must be adjusted to embed critical thinking for this skill to be incorporated into the program outcomes.
The self-reported knowledge, skills and attitudes of The University of Sydney, Sydney, Australia The knowledge to practice gap is well documented in diagnostic radiography. 1,2 Several older Australian and international studies have found radiographers have fewer positive attitudes towards evidence-based practice than their allied health, nursing and medical counterparts. [3][4][5][6][7] A recent Australian study found that radiographers did not routinely engage with empirical evidence and were more likely to rely on clinical experience when approaching clinical situations. 8 However, little literature exists that explores Australian radiographers' knowledge, skills and attitudes when it comes to evidence-based practice. This proposed study aims to better understand the current state of evidence-based practice among Australian radiographers. The Evidence-Based Practice Questionnaire will be used, which is a reliable and validated tool that assesses healthcare professionals' knowledge, skills and attitudes towards evidence-based practice and has been used previously in radiography populations. 2 The survey has three main sections, one that focusses on current practice, one on attitudes and the final section requires participants to selfrate their knowledge and skills. The survey was distributed in November/December 2022 and the results will be analysed in early 2023. The findings will be discussed during this presentation and will constitute a baseline to progress evidence-based practice among Australian radiographers.

Charles Sturt University, Wagga Wagga, Australia
Maintaining the integrity of assessments is an important role of higher education institutions. This is because assessments provide evidence of learner achievement and competency in qualifications conferred by higher education institutions. Due to the COVID-19 pandemic, higher education institutions rapidly transitioned to remote and online assessments which were marred with potential for increased incidence of academic dishonesty and an explosion in creative ways to do so. Absence of physical invigilation, anxiety among students, easy access to the learning content online, reduced resilience with online learning and academic inexperience in designing in assessments fit for the online environment increased opportunities for cheating, collusion and plagiarism in assessments. 1 In medical radiation science, academic dishonesty may increase the incidence of professional dishonesty, which has dire consequences for patients, regulatory bodies and higher education institutions. Patient care and safety may be compromised leading to medico-legal issues, registration of practitioners that do not meet the standards of the profession, loss of reputation for higher education institutions and a culture where academic dishonesty is normalised which then impacts healthcare delivery. 2 There is a growing need for all stakeholders to be aware of the prevalence of academic dishonesty, measures to mitigate them and potential impact on professional practice. 3 The aim of the presentation will be to increase awareness of academic dishonesty, discuss the implications on all stakeholders within the medical radiation science profession and steps to mitigate it. Objectives: The aims of this project were to analyse pilot data that had been collected using a quality assurance device (LARA) to establish extravasation rates in positron emission tomography (PET) in the Australian context and understanding the potential impact this may have on the integrity of standard uptake value measurements and patient outcomes.
Methods: A single site with a single PET/CT scanner was used to characterise injections using an autoinjector with standardised apparatus, flush volume and infusion rate using 18F-FDG, 68Ga-PSMA and 68Ga-DOTATATE; more reflective of Australian PET facilities. 296 patients with topical application of LARA sensors were retrospectively analysed.
Results: Only 1.1% of studies showed evidence of partial dose extravasation. In total, 9.1% were identified to have an injection anomaly (including venous retention). No statistically significant differences were noted across the radiopharmaceuticals for demographic data. While not demonstrating a statistically significant correlation, there were more extravasated doses associated with female patients (P = 0.334), right side (P = 0.372) and hand injections (P = 0.539). Extravasation was independent of dose administered (P = 0.495), the radiopharmaceutical (P = 0.887), who injected the dose (P = 0.343), height (P = 0.438), weight (P = 0.607) or age (P = 0.716). Extravasation was associated with higher glucose levels (P < 0.001), higher t-half (P = 0.019) and higher aUCR10, tc50, aUCR1 and c1 (all P < 0.001). Discussion/Conclusion: Calculation of the standard uptake value and image quality in PET hinges on accurate dose delivery. Extravasation or partial extravasation of the radiopharmaceutical dose can undermine standard uptake value and image quality and contribute to unnecessary imaging. Coming out ('of the closet') is the process that sexual and gender minority individuals go through as they work to accept their sexual orientation or gender identity and share that identity openly with others. Many sexual and gender minority healthcare professionals experience explicit and implicit bias at work. This may result in them carrying out significant 'identity work' to manage who they tell about their sexual orientation/gender identity and in what circumstances. For sexual and gender minority healthcare professionals (including radiation therapists) who feel comfortable enough to be 'out' at work there is evidence that they experience higher job satisfaction and are able to offer support to similarly positioned (sexual and gender minority) patients. This patient provider concordance effect has been studied more extensively in other areas 1 (e.g. race and ethnicity) but is an emerging area in the context of sexual and gender minority patients and healthcare professionals. This presentation will draw on recent qualitative research in this area and explore what it means to be 'out of the closet' for radiation therapists at work. 2,3 Saturday 29 April, 9:00 AM-10: 30  Results: A total of 225 patients met the study inclusion criteria. Primary tumours of the oral cavity were found to increase the odds of experiencing higher grade acute mucositis by four times (P = 0.0008), whereas patient age, pre-treatment ECOG status and N stage were found to increase odds of higher-grade late mucositis. The use of (intensity modulated radiation therapy) and volumetric modulated arc therapy treatment techniques increased the odds of higher acute xerostomia scores. Late xerostomia predictors included ECOG status, degree of surgery, use of intensity-modulated radiation therapy and primary tumour site. Bolus was found to increase the odds of late dermatitis by 2.5 times (P = 0.238). Conclusion: Clinical, demographic and treatment factors have been identified that increase acute and late mucositis, xerostomia and/or dermatitis in the patient cohort. Results of this retrospective analysis may allow for more specific targeting of early intervention strategies for patients more likely to experience higher grades of toxicity. Princess Alexandra Hospital, Brisbane, Australia

Predictors of survival in the PET/CT era
The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) has been supporting members' research endeavours for many years: hosting conferences, research workshops, offering research scholarships, dissemination of members' research surveys, participant recruitment invitation circulation and social media promotion. This support can be invaluable; however, many members may be unaware of the services available.
The ASMIRT Research Committee has been working with ASMIRT to formalise and expand the research services offered to the membership and increase their promotion. This has included advocating for statistical support that members may have previously had difficulty accessing to be made available through the Society. This statistical support could include providing ASMIRT members with advice on study design, analysis and reporting of research, quality improvement and quality assurance projects. These initiatives will benefit all members of the Society by promoting the quality of medical radiation practitioner research being conducted within Australia and provide those undertaking projects with the opportunity to increase recruitment and rigour within their projects. This presentation will outline the current and new research support services ASMIRT offers its membership and how they can be accessed. By increasing the number of support services available and ensuring members are aware of what is on offer, we can increase research capacity and help empower medical radiation practitioner researchers across Australia to be the changing face of medical radiation practitioner research.
Saturday 29 April, 9:00 AM-10:30 AM Targeted Radiation Therapy -RT Quantification of motion reduction using pre-simulation assessment sessions for stereotactic ablative body radiotherapy Sophie Duncan 1   1 Liverpool Cancer Therapy Centre, Liverpool, Australia Objectives: Pre-simulation assessment sessions are utilised for the respiratory motion management of patients receiving stereotactic ablative body radiotherapy (SABR). Pre-simulation assessment sessions determine a patient's eligibility for motion management strategies prior to CT simulation, primarily expiration breath hold and abdominal compression. 1 This study aimed to determine the effectiveness of pre-simulation assessment sessions for eligible patients based on diaphragm motion in free breathing versus when using motion management strategies.
Methods: Retrospective data on diaphragm motion in FB and elected motion management strategies was collected for 71 patients. Eligible patients were treated between 2018 and 2022 using SABR for liver, kidney, pancreas, adrenal gland or lower lobe lung tumours. Patients underwent pre-simulation assessment sessions where radiation therapists recorded the diaphragm motion seen on fluoroscopy through three cycles of free breathing versus the elected motion management strategies. Results: Of the 71 patients, 28 were treated with expiration breath hold, 33 with abdominal compression, two with alternate strategies, and 10 were not suitable for motion management strategies. There was a statistically significant difference between the mean of the amplitude of the diaphragm motion when comparing free breathing and expiration breath hold (P = <0.0001) and free breathing and abdominal compression (P = 0.0133). The mean differences in diaphragm motion between free breathing and expiration breath hold/ abdominal compression was 16.9 mm (AE 8.3 mm) and 6.2 mm (AE 6.8 mm), respectively. Conclusion: Pre-simulation assessment sessions is a useful tool that can be used to shape the future of radiotherapy by selecting the best patient specific motion management strategies for the reduction of tumour motion during SABR treatments. This study will be used to further investigate the dosimetric effects of motion management strategies on target volume reductions, normal tissue sparing, radiation exposure and radiation induced toxicities. Surface guided radiation therapy (SGRT) offers accurate and quick set-up of radiotherapy patients by using real-time optical scanning with a laser system. 1À3 Within SGRT, the lasers are continually scanning the patient's position in real-time instantly and accurately by comparing it to a reference surface image and has the potential to supersede existing set-up process such as used fixed laserbased systems. With our recent acquisition of C-RAD's Catalyst+ HD treatment solution, the study aims to quantify the efficiency and stability gains of an SGRT soft implementation across palliative and radical thoracic and pelvic patients. This involves aligning patients conventionally with the fixed lasers in the transverse, sagittal and coronal plane for straightening, rotations and isocentre placement. When necessary, Catalyst+ HD's colour light projections are also used to actively guide and inform staff on how to position the patient. This is followed by fine-tuning the patient position by applying automatic couch corrections detected by Catalyst+ before using kV pre-treatment verification. All data will be stored in our secure database within the Chris O'Brien Lifehouse. The differences in patient set-up position accuracy between the two processes will be analysed using ordinary least squares linear regression. We hypothesise the magnitude of corrections required during the pre-treatment verification are reduced with a soft implementation. Recruitment is ongoing for patients into the study. Implementation of palliative adaptive radiation therapy using simulation-free diagnostic imaging: a radiation therapist perspective School of Physics, The University of Sydney, Sydney, Australia Background: The Northern Sydney Cancer Centre has developed pathways allowing palliative radiation therapy to be delivered using diagnostic imaging scans, streamlining the clinical process through a simulation-free pathway. Approximately 800 patients have been treated using this pathway, with approximately 30% of patients ineligible due to anatomical location or inappropriate diagnostic imaging. Implementation of adaptive radiation therapy began in June 2019 and has been adopted for treatment sites including bladder, rectum, gynaecological, and head and neck using Varian's Ethos. We present on the building of planning templates and protocols for Ethos driven palliative radiation therapy. Methods: Using the Ethos planning and treatment emulator, previously treated diagnostic datasets were used to retrospectively plan and treat in the offline workspace. These were evaluated to test the online reproducibility in the treatment workspace for various anatomical sites for palliative radiation therapy. Results: Since implementation we have treated 13 patients over a range of anatomical sites including bladder, rectum, abdomen and thorax. The online planning time has reduced over these 13 patients from 23 to 17 minutes, with a median of 20 minutes. Conclusion: Introduction of adaptive planning on diagnostic datasets has allowed the Northern Sydney Cancer Centre to build a range of templates for multiple anatomical sites. Progression of simulation-free adaptive radiation therapy will aim to increase the inclusion of anatomical sites that are currently being excluded, which will further streamline the palliative radiation therapy pathway.
Evaluating the impact of contour changes on reduced arc VMAT breast dosimetry

Princess Alexandra Hospital, Brisbane, Australia
Objectives: The reduced arc volumetric modulated arc therapy (VMAT) breast technique offers the ability to lower organs at risk dose while providing comparable therapeutic efficacy when compared to traditional VMAT breast techniques. 1 However, there is a need to investigate the effect of contour changes on plan quality. 2 The purpose of this study was to evaluate the effect of contour changes on planned dosimetry in breast cancer patients treated with the reduced arc VMAT technique. Methods: 20 reduced arc VMAT plans receiving 42.5 Gy in 16 fractions were assessed; 16 left-sided and four right-sided breast patients. The medial and lateral halves of the breast were defined by two clip boxes with contour expansions of 0.5 cm, 0.8 cm and 1 cm generated from the external contour to replicate possible tissue swelling. All treatment beam parameters were collected. The effect of contour change variables on tumour volume coverage and organs at risk dose were evaluated. Results: Medial breast expansions of 0.8 cm and 1 cm demonstrated the greatest effect on 95% tumour volume coverage with 65% and 30% of plans, respectively, achieving this (mean = 95.78, IQR = 94.59-97.12, mean = 93.56, IQR = 91.8-96.04) None of the contour expansions showed any clinically significant impact on the organs at risk dose. Discussion/Conclusion: The results of this study suggest that when tissue swelling exceeds 0.5 cm within the treatment area there may be an impact on planning target volume coverage. The extent of this impact may be dependent on several beam and patient related factors. Further investigation is required to determine when replanning intervention is required. Background: With advances in low-dose CT technology, it has been proposed that a CT skeletal survey could replace a skeletal survey X-ray series in the investigation of non-accidental injury. 1 Objective: The aim was to perform a phantom study using whole body CT skeletal survey to establish the threshold below which image quality became undiagnostic.

References
Methods: A paediatric non-accidental injury phantom was scanned using two different CT scanners at a range of dose levels. These datasets were screened to eliminate any undiagnostic scans as the fracture sites were known. The diagnostic data sets were then reviewed by paediatric radiologists using specific criteria in the DetectEDx software. The effective radiation doses for the diagnostic CT scans were calculated using NCI Dose software. The radiation risks were then estimated using the BEIR VII report. Theoretical investigation of the upslope of contrast curve as a predictor of optimal contrast enhancement Kelly Chu 1   1 The University of Sydney, Sydney, Australia Objectives: Current bolus tracking techniques are affected by interpatient variations that may give rise to sub-optimal contrast enhancement. This study proposes a new approach by using the upslope of the contrast curve as a predictor of CT scan delay. This study aims to investigate whether the upslope can theoretically and accurately predict the CT trigger time for optimal contrast enhancement.
Methods: A retrospective analysis of 62 CT brain perfusion scans were performed using the proposed technique. Raw patient data were fitted using a gamma variate function to simulate clinically relevant perfusion curves, 1 enabling the control of the stochastic noise, sampling frequency and injection rate. Two upslope-prediction approaches, the golden ratio and the 80/20 rule, were developed and evaluated using 10 cases with different sampling frequencies. Each sampling frequency was assessed using three statistically independent noisy realisations. The performance of the proposed protocol, in terms of prediction accuracy and prediction gain, was tested for generalisability using another 17 unseen cases.
Results: The proposed prediction technique using the golden ratio approach has higher prediction accuracy and lower prediction gain than the 80/20 rule approach. There is a substantial reduction in peak enhancement variability from 38.9% to 13.9% within the 17 test cases. The prediction gain of the proposed protocol is approxi- From its beginnings in 1913, mammography, like all radiography modalities, has undergone significant technological advancement. The gold standard for breast cancer diagnosis, mammography has transitioned from film screen acquisition to high-fidelity full-field digital mammography and digital breast tomosynthesis. Dedicated population-based screening programs using mammography have reduced morbidity and mortality from breast cancer worldwide. 1 Despite its success, mammography has inherent issues, including the need for manual handling of the breast for imaging, breast compression, which can cause pain and is a known barrier for women to undergo imaging, and the fact that neither conventional 2D nor 3D breast imaging is able to image the entire breast. 2 These issues have driven the need for the development of new technology to answer the most commonly asked question by women: "When will they invent something better?" This presentation provides an overview of the future of breast imaging using dedicated 3D cone beam breast computed tomography (CBBCT) (see Fig. 1). Commercially available and Food and Drug Administration approved, CBBCT requires no radiographer manipulation of the breast, uses no compression and, most importantly, can image all the breast. Radiation dose is comparable to conventional mammography. The spatial resolution enables the identification of 2 mm lesions and 200-lm calcification. Importantly, for women whose cultural or religious beliefs do not allow touching of the breast by others, the adoption of CBBCT will enable more inclusive imaging regimens. For all women, the removal of the need for compression can only mean more compassionate imaging and strong demand for this new technology.

Charles Sturt University, Wagga Wagga, Australia
Breast cancer affects 2.3 million women worldwide, with one in eight Australian women diagnosed annually. 1 The effectiveness of mammography in both the diagnostic and screening settings is dependent on the production of high-quality images, with image evaluation systems used to monitor positioning and radiographer performance.
Longstanding requirements in Australia for image quality analysis of the two routine breast views, the craniocaudal and mediolateral oblique, are described by BreastScreen Australia in their National Accreditation Standards, and in the Royal Australian and New Zealand College of Radiologists Mammography Quality Assurance Program manual. 2,3 Radiographers undertake prospective image quality evaluation in both settings, with the key difference being that diagnostic mammograms are determined to be acceptable or repeatable; in contrast, the PGMI (Perfect, Good, Moderate, and Inadequate) image evaluation systems used by BreastScreen Australia requires the assignment of a grade. The introduction of digital acquisition in mammography has enabled the development of benchmarked, automated image quality assessment software variably modelled on the PGMI image evaluation systems. Currently used in both the diagnostic and screening settings, this new approach to image quality evaluation has created a third tier of image quality analysis not currently captured in the standards of the accrediting bodies.
There is now an urgent need for a review of image quality evaluation in Australia and for standards to incorporate the evidence base enabled through digital analysis. Standardisation of image quality assessment is required so that all radiographers can be equally benchmarked, and all images assessed in the same way. Resilience, the ability to tolerate or recover quickly from difficulties. For medical imaging technologists, the COVID-19 pandemic has presented numerous challenges that tested the character of our workforce. In the two years prior to the pandemic the nuclear medicine profession had struggled through significant product supply disruption. Both these events have led to the prominence of resilience being used as a workforce descriptor. Survival of a series of stressful events is not resilience and caution must be exercised to ensure those at risk are identified and supported. Workforce resilience is a dynamic characteristic and needs to be nurtured. When managers support and assist their team to become resilient, organisations rebound and recover from the impacts of the difficult situation.
This presentation outlines what workforce resilience is, the rewards of workforce resilience, how workforce resilience benefits the individual worker and as a manager within a medical imaging environment what role we play in the resilience of our workforce.

Scheduled medicines in medical radiation science
Alan Malbon 1

Australian Society for Medical Imaging and Radiation Therapy, Melbourne, Australia
This presentation follows the Victorian Coronial Inquiry into the death of Peta Hickey (F/43) following a routine CT scan with an injection of contrast media. 1 The subsequent coronial recommendations will have profound ramifications for all medical radiation science practitioners. The Australian Society for Medical Imaging and Radiation Therapy (ASMIRT) has held discussions with the Medical Radiation Practice Board of Australia to discuss these recommendations to ascertain the viability of a project which supports and endorses prescribing, the supply and administration of scheduled medicines pertaining directly to medical radiation science practitioners. ASMIRT has called for a national working party to develop a body of work that encapsulates the potential prescription, supply and administration of scheduled medicines which directly pertain to medical radiation science. It should also include pharmaceutical agents to also aid in the event of an anaphylactic reaction. This will form the basis of a submission to the Australian Health Ministers Advisory Council seeking approval to endorse health practitioners under Section 94 of the National Law. ASMIRT has engaged with overseas medical radiation societies in the United Kingdom, New Zealand and Canada to gain an insight into their workplace practices and protocols in this area. This presentation will outline the coroner's report released in 2021, which recommended the Medical Radiation Practice Board of Australia review capabilities to ensure general inclusion of recognising and responding to an emergency and administering treatments as capabilities, as well as an understanding of international workplace practices and protocols. This thought-provoking presentation will engage the profession to consider key practices in their own everyday workplace. In the United States, one in eight women will be diagnosed with breast cancer in their lifetime. In Australia, one in seven women will be diagnosed with breast cancer, being the second most commonly diagnosed malignancy in both the United States and Australia. 1,2 Molecular imaging in advanced breast cancer is commonly performed using 18F-fluorodeoxyglucose positron emission tomography (PET) to evaluate patients for metastatic disease. Metabolic tumour uptake of 18F-fluorodeoxyglucose is based on the demand for increased glucose metabolism by malignant tumour cells but may have low cellular uptake predominantly in indolent, or low-glycolytic malignancies, such as invasive lobular carcinomas. 18F-fluoroestradiol is a synthetic oestrogen analogue and the first receptor-targeted radiotracer developed in the United States and approved by the Food and Drug Administration in May 2020 for the detection of oestrogen receptor positive lesions with PET imaging as an adjunct to biopsy in recurrent/metastatic breast cancer. Approximately 80% of all breast cancers in women are oestrogen receptor positive, as such these patients are often treated with endocrine therapy. Hormone receptors may, however, change over time and with treatment, therefore understanding the receptor expression particularly in the metastatic setting is vital for management of this patient population. Immunohistochemistry via biopsy is the gold standard for hormone receptor determination. However, in May 2022 the largest prospective clinical trial to date established 18F-fluoroestradiol validity compared to immunohistochemistry in detecting oestrogen receptor expression. The study found 18F-fluoroestradiol PET to be a viable alternative when biopsy is unable to be performed. 3 Saturday 29 April, 11:00 AM-12:00 PM Evidence Based Practice and Research

University of Alberta, Edmonton, Canada
Quality criteria for qualitative research are an important, but debated, topic. As in quantitative work, broad concepts of validity and relevance can be used but the concepts and processes vary according to the different underpinning goals of qualitative research. The term 'trustworthiness' has been widely recognised as a way to discuss quality since first being conceptualised by Lincoln and Guba. 1 This presentation will focus on how to design and carry out trustworthy qualitative research using an eight-point framework developed by Tracy that consists of: a worthy topic, rich rigor, sincerity, credibility, resonance, significant contribution, ethics and meaningful coherence. 2 Bridging the gap between haphazard care and evidence-based care in cancer Geoff Delaney 1

Liverpool Hospital, Liverpool, Australia
Introduction: Deviation from evidence-based care can occur for many reasons. Some valid reasons are where patient co-morbidities preclude the planned therapy or patients decline advice about evidence-based care after being adequately informed by their clinicians. We also know that there are situations where treatment is not delivered with a valid reason -this is referred to as unwarranted variation in care.
Results: We have shown that although an evidence-based model suggests that 48% of the Australian population should receive radiotherapy at least once, only 28% currently do so. 1 We have also shown that reductions in local control and survival for cancer patients will occur if evidence-based care is not received. 2,3 Factors that impact on radiotherapy utilisation include lower socioeconomic status and geographic distance from a treatment facility. 4 This has led to initiatives to improve access to radiotherapy including reducing waiting times, reducing fractionation schedules and funding of smaller radiotherapy facilities in rural centres to reduce travel time. However, using retrospective data to reduce variations in care based on individual clinician decision-making has been largely unsuccessful due to slowness of the analytical process; so, when data are reported back to clinicians the response is usually that the data are old and not in keeping with changes in practice. This presentation will review the evidence to date on unwarranted variation in cancer care and propose a near-real time decision support system as a possible contribution to improving the link between evidence-based care and patient decision making. 5 Introduction: There has been increasing interest in online adaptive radiation therapy (oART), whereby the patient contours and plan can be reshaped at the time of daily treatment, providing increased accuracy and superior treatment plans to patients. 1 It is widely accepted that oART delivery is limited due to radiation oncologist (RO) availability. 2 This study sought to explore perceptions of confidence, accuracy and attitudes of Northern Sydney Cancer Centre ROs and radiation therapists (RTs) on pelvic organ contouring and training that will ultimately up-skill RTs to lead oART. Objectives: Traditional treatment planning workflows allow for radiation therapists (RTs) and radiation oncologists (ROs) to contour pelvic organs under minimal time pressure. 1 Recent implementation of online adaptive radiation therapy (oART) at our facility requires RTs to contour organs normally contoured by ROs, decreasing the likely need for ROs at the treatment console, 2 while helping facilitate increased delivery, efficiency and oART benefits to patients. 3 We investigate if a RO virtual workshop improves RT contouring accuracy in pelvis organs.
Method: Baseline assessments of contouring accuracy on five pelvis organs were undertaken by RTs using Proknow contour accuracy. RTs initial contours were assessed against RO gold standard contours using Dice similarity coefficient (DSC). RTs then completed virtual RO workshops for each organ, supplemented with organ anatomy guidelines. RTs then completed second round contours on new image datasets. Assessments between initial DSC and post-training DSC were evaluated. Results: 33 RTs participated in baseline assessments of bladder, rectum, bowel bag, sigmoid and uterus contouring. Initial results indicate excellent DSC scores for bladder, rectum and sigmoid. Bowel bag contours showed most variation and worst overlap DSC. Uterus contours were excluded from initial analysis due to incorrect gold standard. Second phase contour analysis is currently in progress and results available 2023. Conclusion: Presently, RT initial contouring of some pelvic organs shows excellent agreement against a single gold standard contour on CT images, relative to the DSC less than 0.7 recommended in the literature for RT/RO contour agreement. The RO virtual training intervention and supplementary information is currently under evaluation.
The impact of patient positioning lasers on setup accuracy for MR-linac radiotherapy Objective: Traditionally, the first step in patient alignment has relied on lasers to reduce set-up errors. The introduction of online adaptive treatment on the MR-linac may see the lasers as redundant. This study aimed to compare differences in set-up errors measured with and without the use of lasers in patients treated on the MRlinac.
Methods: 20 patients received stereotactic ablative body radiotherapy in five fractions to the abdominal region on the MR-linac at two different centres were retrospectively selected. 10 patients were positioned using laser and 10 patients without lasers. Daily MR-linac scans were registered to the reference CT plan or previous adapted MR plan, with the 3D isocentre shifts recorded for analysis. Differences in daily positioning errors were examined using paired student's t-tests. The mean (M) and standard deviation (SD) of the set-up errors were calculated. The SD of population M expressed the systematic error (Σ), and the root mean square of the SD describes the random error (r). Results: Differences in daily errors between the two groups were statistically significant in the superior-inferior direction (P = 0.0001) but not in the left-right (P = 0.8) or anterior-posterior (P = 0.08) directions. In the superior-inferior direction, the systematic and random errors were higher in the group without laser by 0.74 cm and 0.41 cm, respectively (see Table 1). Conclusion: Significant large variation was noted in the superiorinferior direction for patients positioned without laser. While these offsets can be corrected using the MR-linac adaptive workflow, minimising the errors with laser for patient positioning may reduce the overall treatment time.
A collaborative approach to developing an advanced practice curriculum in adaptive radiation therapy The implementation of adaptive radiation therapy (ART) technologies is changing the paradigm of treatment delivery, whereby it is possible to modify the intended radiation therapy plan to best suit the patient anatomy of the day. 1 It is essential that the radiation therapist has the advanced skills, knowledge and aptitude to be an active and safe contributor to ART treatment delivery, where responsibility for timely and accurate clinical decision making and daily plan approval adds complexity to usual procedures. 2 A flexible and responsive advanced education program is required to enable the radiation therapist to lead ART procedures, in the context of continually evolving ART technology and practice applications. Subsequently, a collaboration was established between Monash University, Northern Sydney Cancer Centre, and Olivia Newton-John Cancer Wellness and Research Centre in late 2020 to develop and implement an advanced practice curriculum for ART.
The key objectives of the collaboration were to: • Identify the advanced capabilities required of an ART-radiation therapist beyond current practice expectations.
• Map content delivery and assessment strategies to allow demonstration of the advanced capabilities.
• Establish a postgraduate course pathway and flexible clinical training framework to enable achievement of the advanced capabilities.
The Master of Advanced Radiation Therapy Practice ART pathway was implemented in March 2022. The curriculum was designed to meet the needs of academic and inter-professional clinical stakeholders and includes advanced learning content and a clinical school. This outcome demonstrates that sustained active collaboration between universities and clinical centres can enable a proactive educative response to new technology implementation. Objective: Standard radiotherapy delivering 40-60 Gy (1.8-2 Gy per fraction) add minimal to no survival benefit for patients with unresectable locally advanced pancreatic cancer. 1 Magnetic resonance-guided adaptive radiotherapy (MRgART) allows delivery of stereotactic ablative body radiotherapy (SABR) effectively with improved overall survival. 2 We present our early experience of dose escalated SABR of pancreas treated with MRgART. Methods: 10 patients with locally advanced pancreatic cancer were treated with MRgART on the Unity MR-Linac (December 2021 to August 2022). The clinical target volume was defined as gross tumour volume and para-aortic nodal regions covering coeliac axis to superior mesenteric artery and was uniformly expanded by 3 mm to create the planning target volume. Planning risk volume involved a 3-5 mm expansion of organs at risk. Any overlapping portion of the planning target volume by the planning risk volumes was constrained to 33 Gy to meet organs at risk constraints, and the remainder (planning target volume high) was dose-escalated to 50 Gy. Results: The median age was 65 years (range = 50-80 years), and six patients were male. The clinical target volume D99 coverage was ideal/acceptable in 88% of total fractions, while the planning target volume D99 coverage was ideal/acceptable in 72% fractions. Ablative dose was delivered to most target volumes as demonstrated by the median planning target volume high D90 dose of 43.4 Gy (see Table 1). The median time from patient set-up to treatment delivery completion was 50 minutes (range = 29-67 minutes). Conclusion: Dose escalated SABR treated with MRgART is dosimetrically feasible and tolerable. Analysis of larger patient cohort with follow-up including toxicity and patient reported outcomes is planned. Aim: Liver stereotactic ablative body radiotherapy (SABR) is challenging given the motion and deformation of critical anatomy that is poorly visualised on standard cone-beam CT. To overcome this, the aim is to describe a liver SABR workflow using online adaptive SABR with an MR-linac. Methods: Patients were imaged under 2D fluoroscopy on a C-arm linac to quantify motion under active breath-hold or an abdominal compression belt. Those with motion less than 15 mm using compression underwent 1.5T MR-linac simulation to determine tolerance and suitability of non-contrast 3D MR and 2D cine-MR. Triphasic CT-sim and 3T MR-sim aided in gross tumour volume delineation. MR-based planning applied 5 mm planning target volume around internal target volume and used 8-12 IMRT fields. Daily online treatment involved plan re-contouring and re-optimisation (i.e. 'adapt-to-shape' workflow) by a team of two therapists (one dual-certified in MR), one physicist and one oncologist. Results: Thirty-five patients underwent MR-linac simulation, and 12 did not proceed due to motion (five), imaging (two), patient tolerance (one), technical fault (one) or clinical reasons (three).

Logan Hospital, Meadowbrook, Australia
Objectives: There is an urgent need for more focus on mental health and wellbeing among healthcare workers in allied health; particularly radiography departments involved in trauma and intensive care unit imaging. The challenges of the pandemic have highlighted the inadequacies in mental health support and training in hospitals and the lack of literature regarding this topic, particularly in radiography departments, suggests there is a gap. This review aimed to explore the prevalence and necessity of debriefing tools in radiography departments associated with trauma and intensive care unit imaging.
Methods: A search of terms associated with radiography, critical incidents, trauma and debriefs was conducted using Google Scholar and PubMed.
Results: There were no articles pertaining specifically to radiography departments. Five articles were deemed eligible for inclusion as they targeted debriefing tools in emergency and intensive care unit settings. The literature suggests debriefing tools are an asset to healthcare workers as it benefits quality improvement and improves staff morale and support, which directly impacts the delivery of quality patient care. [1][2][3][4] Differences between the types of debriefing were analysed. Discussion/Conclusion: This review of the literature highlighted a gap in evidence pertaining to debriefs in radiography departments following a critical incident and suggests that early intervention tools such as hot debriefs and mental health training have the potential to provide greater support in radiography departments and thus, improve secondary outcomes to deliver imaging services safely and efficiently. Future research is warranted to explore the misconception of the impact of trauma on radiographers.
The value-adding radiographer of the future Value-based health care was first proposed by Porter in 2010. 1 The concept involves optimising all health inputs to maximise quality, long term, sustainable outcomes for patients and enhance their experiences. Value-based health care maximises value within the healthcare system by analysing each element of the value chain to increase efficiency, minimise waste and eliminate activity that does not improve patient outcomes or enhance their experience. 2 Several Australian health jurisdictions, such as NSW Health, have begun focussing more on value-based models of care rather than more traditional activity-based models. 3 Due to their unique position in the health care value chain, radiographers are ideally placed to influence patient outcomes. Through receiving communication from referrers and patients, caring for and communicating directly with patients, optimising imaging and passing vital information on to radiologists, radiographers who adopt a value-adding mindset can significantly improve outcomes for their patients. Radiographic practice in Australia is regulated by the Medical Radiation Practice Board of Australia (MRPBA). The MRPBA professional practice capabilities guide radiographers in various domains of their practice, including professionalism, interprofessional collaboration, the use of best-practice evidence and patient care. The overall goal of these capabilities is to ensure radiographers practise safely and competently. 4 This presentation will: • Outline the principles of value-based health care as it pertains to medical imaging • Explain the medical imaging value chain and radiographers' role as a key component • Describe specifically how radiographers can add value to their patients and shape the future of the healthcare system, with respect to various MRPBA professional practice domains.
Seeing the bigger picture: embracing modern pain science to enhance care in the imaging department Scientific understandings of pain have changed dramatically in recent years, 1,2 yet it seems radiographers are being left out of these conversations, despite frequently encountering patients experiencing pain. 3 Embracing modern pain science offers an opportunity to enhance current and future practice, and facilitate optimal patient care.
Pain is a complex phenomenon arising from the interplay of biological, psychological and social factors. 2 It is now known that pain can occur in the absence of tissue pathology, 1 the degree of tissue pathology cannot reliably predict pain, 1,4 and that 'pathological' imaging findings are highly prevalent in pain-free cohorts. 5,6 Clearly, pain is more complicated than once thought. This is important knowledge for radiographers, as patients may experience severe acute or chronic pain even in cases with no evidence of injury. Patients with chronic pain, particularly those without a clear pathoanatomical cause, have reported feeling stigmatised by health professionals, even accused of 'faking' or 'drug-seeking'. 7 Clinical encounters themselves have potential to increase distress, or promote trust and safety, both of which may directly influence pain. 1,8 Indeed, pain severity experienced during mammograms has been linked to radiographer attitudes, opinions and communication. 9 This presentation will provide a summary of modern pain science, before discussing potential implications and applications within radiography practice to achieve optimal person-centred care. Avenues for future research will be highlighted, including exploration of radiographers' current understanding of pain, and the impact of enhanced pain knowledge on clinical outcomes and patient experiences in the imaging department. Introduction: In the delivery of patient care, we each have roles to play. Understanding other's roles is vital to minimising communication failures and ensuring positive patient care is delivered. 1 Procedures across imaging modalities within one department can be complex and diverse. Communicating our requirements of these procedures to ward staff is essential to delivering universal care. Method: We surveyed ward nursing and medical staff to determine their level of understanding of medical imaging procedures, allowing them to express any concerns that they had with the associated modalities. We simultaneously surveyed imaging staff to identify communication and patient preparation issues of ward patients. Following the surveys, the intent was to provide education to ward staff specific to each modality addressing the concerns and providing a consistent, communicative approach.
Results: In line with literature, a lack of understanding of patient requirements for imaging procedures, who to contact in imaging and nursing handover were among the major issues identified by both ward and imaging staff. 1,2 A series of educational modules for each modality was created, including clinical information specific to the modality, contact details and operational workflow. This was made available to all staff involved in patient clinical care via the internal learning management system. Conclusion: Module availability is currently in its infancy with future plans to evaluate their effectiveness. It is hypothesised that these modules will improve the understanding of imaging procedures and workflow, thereby bridging the communication gap across the multiple specialties involved in patient care and improving workflow efficiency.  3 Health providers should endeavour to better understand the needs and concerns of Aboriginal and Torres Strait Islander peoples, communicate in a culturally respectful manner, and provide a more holistic approach to treatment to improve outcomes of health care. 2 Conclusion: Aboriginal and Torres Strait Islander peoples experience poorer access to, and outcomes of care as their concept of health transcends beyond physical wellbeing. Cultural incompetence in health care correlates with compromise in quality of health outcomes. 2 The education of medical radiation professionals to deliver culturally responsive care is imperative to providing equitable care in Australia.
Is radiomics a promising direction for the future of radiation oncology?

RMIT University, Bundoora, Australia
Given the rapid rate of change in radiation oncology, it is important for practitioners, specifically radiation therapists, to understand future directions of practice to ensure that they can adopt the latest developments in their own routine clinical practice. This presentation aims to holistically evaluate radiomics, a future direction of radiation oncology practice, identifying the implications, benefits and limitations to both patients, the radiation oncology workforce and the community at large, that the implementation of this technology would have on the industry. Medical images serve an integral role in the clinical management of radiation oncology patients. Despite this crucial role, the analysis of an image is based on a visual interpretation that is subject to intraand inter-physician variability. An advanced medical image processing paradigm, radiomics is an evolving medical field attempting to overcome this limitation to current practice. Through extracting quantitative image features, radiomics facilitates the identification of an infinite supply of imaging biomarkers that can be used for cancer detection, diagnosis, prognosis and predicting response to treatment, ultimately improving the accuracy with which radiotherapy treatment is prescribed and delivered. The implications of this technology on practice are significant, with the potential to prescribe personalised treatment to identified areas of high-risk disease, predict the onset of toxicities, in addition to treatment outcomes, radiomics offers a clear benefit to patients. However, there are also challenges to this technology, notably the limited prospective, multi-centric research within this field, and the additional technical considerations associated with implementing a novel technique into an established clinical workflow. Objectives: This study aimed to establish treatment times for patients receiving stereotactic body radiation therapy for liver, lung or spine cancer. The magnitude of intrafraction motion exhibited by these sites as time elapses during the treatment session was also determined.

An evaluation of treatment time and intrafraction motion in stereotactic body radiation therapy
Methods: Retrospective image-guided radiation therapy data for 20 patients was collected. This included imaging times and shifts made from each pre-, during and post-treatment cone beam computed tomography (CBCT) scan. Total treatment time, time between online image matching completion and 3D vector displacements were calculated. Descriptive statistical analysis was performed.
Results: The image-guided radiation therapy data associated with 332 CBCT images was evaluated. All liver patients and 6/7 lung patients utilised breath hold techniques, while all spine patients were free breathing. The average treatment time was highest in the liver (19.3 minutes), followed by lung (14.9 minutes) and spine (14.2 minutes). Liver patients had the largest mean 3D vector displacement (0.1 cm), with 7.8% of shifts more than 3 mm. Lung patients had a mean 3D vector of 0.1 cm with 3.8% more than 3 mm, and spine patients had a mean vector of 0.02 cm with 0% more than 3 mm. Clinical tolerances were exceeded at multiple imaging timepoints (range = 4.9 to 24.4 minutes).

Conclusion:
The results demonstrated that stereotactic body radiation therapy liver patients exhibited the greatest treatment times and 3D vector displacements, followed by lung and spine. Intrafraction imaging is required in liver and lung stereotactic body radiation therapy treatments to identify instances where clinical tolerances are exceeded.
An evaluation of the utilisation of a six degree of freedom couch in radiation therapy Objectives: This study evaluated the use of a six degree of freedom (6DoF) couch at a single radiation therapy centre to determine which patient sites required shift corrections and to analyse the patient demographic trends. Methods: Patients who had received treatment with cone beam computed tomography within a period of four years were retrospectively analysed, categorised by treatment site. The sample was stratified to include patients with rotational shift applied. Descriptive and comparative statistics were used to analyse rotational and translational trends. Objectives: In this pilot study, we tested a newly developed AI software for detecting osteoporotic vertebra fractures (OVFs) on chest X-ray not indicated for spinal disorders based on a single centre experience. Our purpose was to determine the feasibility of the AI tool for automated detection of OVFs on lateral chest X-ray to lay the foundation for robust studies.
Methods: Lateral chest X-ray of 94 elderly women (mean age = 80 years, range = 55-97 years) were retrieved from a tertiary hospital database in Perth, Western Australia, over 12 months. All chest X-ray images were processed with the AI tool, Ofeye 1.0 which allows automated recognition of suspected fractures on lateral chest radiographs. Output metrics were analysed to determine the consistency of detecting OVFs by AI in comparison with radiological reports (by radiologists). It takes about three minutes to process 100 images with the AI software, with abnormalities such as OVFs highlighted on the chest X-ray images.
Results: Of the 94 cases, AI detected seven cases of OVF that radiologists did not, thus representing 10.4% of cases that should be reported with presence of OVFs. This is clinically significant as these fractures may progress or result in significant adverse outcomes. Discussion/Conclusion: For women with osteoporosis referred for chest radiographs not for spinal disorders, around 10% of vertebral fractures were missed by the radiologists. AI serves as a valuable tool to detect these missed fractures with high efficiency. Further research with inclusion of more cases is warranted to validate the clinical value of this newly developed algorithm.
An investigation into using eye-gaze metrics to assist chest radiograph interpretation performance: a pilot study Elizabeth Arthur 1

Curtin University, Perth, Australia
Aim: To investigate the performance of health professionals in interpreting chest radiographs using eye-tracking technology.
Methods: Health professionals were invited to participate in the study by interpreting five chest radiographs comprising common lung pathologies. Thirty-two participants varied in background, including medical and radiography students (n = 7, respectively), radiographers (n = 6), radiologists (n = 5) and other specialist physicians (n = 7). Total data set collection totalled 160 interpretations with a variation in chest pathologies. Outcome measures: The primary aim of this study investigated the relationships between expertise level and outcome factors. The secondary aim investigated the relationships between diagnostic accuracy and outcome factors. Accuracy and confidence measurements were collected via audio recording, with speed and eye-metric data collected through the Tobii Pro Spectrum system. Results: Results showed that expert groups were more diagnostically accurate than student populations (P = 0.015) irrespective of the radiograph presentation (P = 0.919). There was, however, no significant correlation between participant experience and fixation duration (P = 0.987), with image presentation significantly influencing the result (P = 0.008). Additional analysis found significant relationships between accuracy and image presentation (P = 0.002), accuracy and confidence (P = 0.001), and accuracy and fixation duration metrics (P = 0.006). Non-significant findings were established for relationships between diagnostic accuracy with time to first fixation and interpretation speed, respectively. Conclusion: This study is one of the first studies of its kind to utilise eye tracking to explore radiological impacts with objective, quantitative data and though analysis of eye gaze during chest radiograph interpretation. This study provides additional context to the discussions surrounding expertise in radiographic interpretation. Introduction: The transition from film screen to digital radiography should have brought with it a reduction in repeat rates due to a reduction in exposure-related error. Literature suggests that this is not necessarily the case with increased positioning-related repeats. This study aimed to assess the unnecessary reject rate of digital imaging for the five most commonly repeated projections described in literature: the lateral wrist, the lateral horizontal beam knee, shoot across horizontal beam hip, lateral lumbar spine, and antero-posterior pelvis. This presentation describes the outcome of the first study completed in the project, the lateral wrist projection. Methods: The investigation involves a reject analysis of all lateral wrist projections performed over a three-month period at a single site. All de-identified rejected images plus 50% of non-rejected images were blind reviewed by a radiologist, used as the gold standard, two expert radiographers who were trained on plain film, and six junior radiographers with less than two years of digital radiography experience. The rejected images were assessed for the clinical appropriateness of the repeat to ascertain the rate of unnecessarily rejected images. Results: The reject rate for adult lateral wrists over the three-month period was 38.66%. The blinded survey results indicated junior radiographers would repeat projections almost twice as often as senior radiographers and the gold standard of the radiologist. Conclusion: Our results found reject rates alarmingly higher than averages accepted in literature and a concerning trend among junior radiographers to over repeat imaging.
Optimising horizontal beam lateral hip radiographs: analysis of radiation dose, image quality and efficiency

Redcliffe Hospital, Brisbane, Australia
Objectives: There is a disparity existing within medical imaging departments regarding the performance of the horizontal beam lateral hip radiograph, a prevalent X-ray contributing to a large proportion of departmental workflow. 1,2 This study aims to assess current methods of obtaining the horizontal beam lateral hip projection in an experimental setting; to find the optimal technique that considers radiation dose, image quality and efficiency holistically.
Methods: An experimental study took place within the Queensland University of Technology Medical Imaging Simulation Laboratory using Shimadzu RADspeed pro digital radiography equipment and a full body RS-501 anthropomorphic phantom. Eight methods of projection were tested with varying parameters of erect bucky and free detector, with grid and airgap and the use of an aluminium wedge filter. Radiation dose assessment involved dose area product in Gy.m and absorbed dose in mGy. Timing of each method in seconds assessed efficiency. Image quality was quantified by range and standard deviation of grey values to assess image contrast and noise over a specified region of interest.
Results: Airgap techniques produced the least radiation dose with the use of a filter also significantly reducing radiation dose. Erect bucky techniques were most efficient. There was no clinical difference between techniques in terms of image quality, thus image quality was maintained. Overall, optimal parameters align with the erect bucky airgap with filter technique. Conclusion: The recommended optimal method is the erect bucky airgap technique with filter. This finding can provide direction to help create a standardised approach and implement evidencebased practice, improving workflow and patient outcomes. Assessment of patient data with a variety of radiographers and correlation with a subjective image analysis tool are future recommendations.
Radiological bone age assessments: should they determine whether individuals are prosecuted as children or adults?

University of South Australia, Adelaide, Australia
Background: A posterior-anterior X-ray of the non-dominant hand and wrist are used in radiographic bone age assessments. The plain-film image traditionally can be assessed under one of two standardised tests: the Greulich and Pyle method or Tanner-Whitehouse method. Between 2008 and 2012, the Australian Government performed radiographic bone age assessments to determine whether Indonesian immigrants were children as they said they were, or people smugglers. The images were assessed under the GP method, and if proven to be adults, individuals were sent to jail for five years. Aim: To investigate the limitations of radiological bone age assessments in non-clinical settings and ensure that radiographers are participating in ethical practices. Discussion: When assessing the age threshold of 18 years using the Greulich and Pyle method, radiologists look for the epiphyseal fusion of the radius. This has an accuracy of only 54.44%, as the complete fusion of the radius may not occur in males until 19 years of age. Normal variance can occur as various factors influence skeletal development. Diagnostic radiographers should limit the radiation dose, and obtain informed consent for all individuals, in keeping with practices from the Medical Radiation Practice Board of Australia. 1 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. 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.

University of Canberra, Bruce, Australia
Objectives: Of the nursing home residents visiting an emergency department, approximately 85% will need a general radiographic examination and 35% will require a CT scan. 1 Patient-centred care is an integral component that cannot be treated in isolation from the overall medical imaging encounter. Few studies have explored a patient-centred approach during ageing population medical imaging encounters. The aim of this study was to explore radiographers' experiences and perspectives of ageing population medical imaging encounters within a person-centred context. Methods: A qualitative explorative approach with a purposive sampling technique was used.
Data collection using open-ended interviews with radiographers practising in Australian public and private clinical settings occurred from July 2022 to October 2022. Data interpretation and analysis will be concurrent to establish preliminary categories, followed by themes and sub-themes.
Results: This is a work in progress, so preliminary analysis of the data will be discussed drawing on the relevant literature. Prominent categories related to the ageing population that have emerged so far include the following: adapting to unique circumstances, communication styles, and the technicalities involved in producing a diagnostic radiograph. Discussion/Conclusion: This study could inform on the development of best practice principles for person-centred medical imaging for the ageing population. It could provide a baseline study for similar research of this nature. Objectives: Globally, there is increasing emphasis on ensuring health care is personalised, coordinated and enabling, and that individuals are treated with dignity and respect. Key to this is putting the person at the centre of the episode of care (rather than the clinician/process/system) to deliver person-centred care. However, there is currently limited research that considers the different perspectives on what constitutes 'good' person-centred care between the Global North and the Global South. The aim of this research was to identify the effect of socio-economic status, different healthcare models, rural communities and cultural beliefs on both patient and professionals' perspectives of what 'good' person-centred care looks like in medical imaging.
Methods: A two-stage mixed methods study to define informed measures of patient-centred care in diagnostic radiography, previously carried out in the United Kingdom, was replicated in South Africa, New Zealand and Australia. Data collection was carried out using an online survey and focus groups/semi-structured interviews. Quantitative data was analysed statistically and quantitative data was analysed using thematic analysis.
Results: Data collection is currently ongoing. Early results from the project will be shared at the ASMIRT 2023 Conference. Similarities and differences between research participants' perspectives from each country will be compared.
Conclusion: This is the first study to compare perspectives on 'good' person-centred care in medical imaging between the Global North and Global South. We hope to be able to share recommendations for 'good' person-centred care which are applicable in all settings, as well as highlighting considerations specific to each country.
Person-centred radiation therapy models of care and services Michael Velec 1

Princess Margaret Cancer Centre, Toronto, Canada
The radiation therapy pathway is at risk of delivering care that is impersonal, fragmented and non-responsive to individual patient needs. Examples of efforts to re-design radiation therapist (RT) practice using a person-centred care approach are highlighted. For standard practice RTs, a new model of care is being developed and evaluated to re-organise RT staff around patients in need of more personal care. Here they are partnered with one RT who provides support in addition to all technical procedures (imaging, planning, delivery) to maximise continuity of care, resulting in better preparation for treatment and overall satisfaction. More recently, in an effort to provide earlier access to RTs and tailored education, the use of virtual care was piloted. Patients opted to remotely meet their treating RT (one-on-one using video-conferencing) in advance of on-site appointments. Patients overwhelmingly endorsed this modality over both tele-and in-person consultations. Using advanced practice models, RTs have even been embedded in medical consultations in an effort to offer same day breast irradiation and one-step sim-plan-treat for palliation. These expansions rapid access clinics have been coupled with technology advances in (e.g. automated planning) to balance resources and maximise efficiency. Finally, the recent clinical implementation of online adaptive radiation therapy has required the daily presence of a multi-disciplinary team for technical delivery. This has offered new patient access to their care team for support. In summary, re-designing services and models of care around patients, supported through a range of technologies from low-tech to advanced, can enable RT practice to be more person-centred.
Dementia patient care in the medical imaging The Global Centre for Research and Training in Radiation Oncology (GC-RTRO), supported by the University of Newcastle, Australia, commenced operations in January of 2022 and rang the bell for the first time to mark the opening on 2 November. The Centre is the true definition of collaboration with support from leading global and national radiation oncology cancer care companies, philanthropic contributors and community advocacy groups. The GC-RTRO is the first of its kind to bring radiation oncology research and training activities together to support medical technology industry and clinician needs; and train the next generation of radiation therapists. The Centre is focussed on elevating the standard of cancer care globally through research, training and collaboration, and developing curriculum for radiation therapy. This presentation is an opportunity to discuss the very complex and yet interconnected world in which we live, and that the idea that engagement and collaboration, the interdependency on one another is really what ensures progress. This Centre is a part of that interdependent ecosystem with an ultimate focus on patient care. Working with industry and community drives progress, to answer difficult clinical questions and ultimately, to respond to the commitment that we, as clinicians have made which is to serve our patients' needs. This presentation is an opportunity to discuss collaboration and advocacy for radiation oncology.  Objectives: The concerns regarding radiation safety from CT examinations underscore the need to identify factors associated with high doses to inform optimisation strategies. Although the relationship between various CT factors and dose is well known and there are current well established dose optimisation strategies implemented in CT practice, there is a lack of understanding of the CT factors that influence dose data gathered from abdomino-pelvic examinations. The purpose of this study is to investigate the CT factors influencing radiation dose. Methods: The study utilised a secondary dataset gathered from Australian facilities, with information about the scanning parameters, patient factors and dose metrics, volume CT dose index (CTDIvol) and dose-length product for abdomino-pelvic examinations. Univariate analysis was performed to identify which factors were associated with CTDIvol and dose-length product. Multiple linear regression analysis was then performed to assess the contribution of these statistically significant factors on CTDIvol and doselength product. Results: The univariate analysis showed that patient gender, iterative reconstruction, contrast media, phases, tube voltage, starting or reference current-time product, pitch, detector width and number of detectors were associated with both CTDIvol and dose-length product. The multiple linear regression model showed that iterative reconstruction was the most significant determinant of CTDIvol and dose-length product followed by whether the scan was single or multiple phases. Discussion/Conclusion: Several system, acquisition and patient factors influence radiation dose in abdomino-pelvic CT scans. Medical imaging providers should consider reviewing their iterative reconstruction algorithms, reduce the application of multi-phase scanning by utilising dual-energy CT and update CT scanners according to government legislations.

Evaluation of two modified clinical prediction models
for optimising the use of CT pulmonary angiography

Royal Brisbane and Women's Hospital & STARS, Herston, Australia
Objectives: The purpose of this retrospective study was to determine the overall discriminatory ability of two clinical prediction model scores for the diagnosis of pulmonary embolus on CT pulmonary angiography (CTPA). The interim analysis results are presented here. Methods: Institutional ethics board approval was obtained. The imaging request forms and radiology reports for all CTPAs performed at a major city hospital over a four-year period were reviewed. Revised Geneva (rGeneva) score and modified Wells' (mWells') score (in which clinical gestalt score was excluded) were calculated from the clinical notes for the first 250 participants who met the inclusion criteria for interim analysis. Receiver operator curve analysis was performed for the two clinical prediction models. Optimal cut-offs for each model were established, both prioritising specificity at levels of 90% and 95%, and using the Youden index which maximises both sensitivity and specificity. Results: Pulmonary embolus was diagnosed on 24 of the 250 CTPAs. The areas under the curves were 0.65 and 0.69 for the rGeneva and mWells' scores, respectively. The Youden, 90% specificity and 95% specificity scores for the two clinical prediction models are presented in Table 1. Discussion/Conclusion: This interim analysis suggests the two clinical predication models tested are not useful for optimising the use of CTPA for patients presenting to our hospital with any type of pulmonary embolus. Sub-group analysis of the full dataset for lobar, segmental and subsegmental pulmonary embolus is warranted. Objectives: To investigate the impact of patient off-centring, tube voltage and localiser direction on dose and CT number accuracy. Correlations between CT number and dose change were also explored. Methods: A discovery CT750 HD-128 slice (GE Healthcare) scanner was used to scan the trunk of a PBU-60 anthropomorphic phantom. Using the system's automatic tube current modulation, images were acquired by employing 0°and 180°localisers for different combinations of tube voltage (80, 120 and 140 kVp) and vertical off-centring (AE 30, AE 60 and AE 100 mm). The displayed volume CT dose index (CTDIvol) and CT number were recorded. Results: The maximum change in dose (191% to 196%) was observed when there was closer proximity of the phantom to the Xray tube (AE 100 mm) above and below the gantry iso-centre. The maximum change in CT number (180°localiser and 80 kVp) as a function of vertical off-centring was 43 HU. A strong positive correlation was reported between the variation in dose and CT number (r = 0.969, P < 0.001, 95% CI 0.93-0.99). Conclusion: As the literature reports that a considerably large percentage of CT patients are off-centred vertically, and more likely below the gantry iso-centre, this study recommends employing the 0°localiser and applying lower tube voltage where applicable. It is also crucial for those involved in CT imaging to have an in-depth understanding of the limitation of CT systems to avoid potential pitfalls in clinical decision-making when using CT numbers as an absolute value for tissue lesion characterisation.
CT venography for cerebral venous thrombosis: are we imaging wisely?

Royal Brisbane and Women's Hospital & STARS, Herston, Australia
Objectives: This audit was performed to determine if optimisation of the requesting practices and/or imaging protocol for CT venography to exclude cerebral venous thrombosis (CVT) is warranted to reduce the radiation and healthcare costs of this examination. Methods: Institutional ethics board approval was obtained. The referral indications, radiological diagnosis and CT protocol (number of phases and dose length protocol) for all CT venograms performed to diagnose/exclude CVT at a major city hospital between 24 August 2018 and 17 June 2022 were documented. Descriptive statistics were calculated for CVT diagnoses, alternate diagnoses, normal studies, scan phases performed and radiation dose. Results: 530 relevant CT venography scans were performed during the audit period. Of these, CVT was diagnosed on five (1.0%), excluded on 523 (98.6%) and unable to be confirmed or excluded on two (0.4%). A radiologist report of 'normal study' was made on 376 (70.9%) studies in which CVT was excluded. 446 (84.0%) patients underwent two scan phases (non-contrast and venogram), four (0.8%) had three phases (non-contrast, venogram, post-contrast). The remaining 81 (15.2%) had a single venogram phase scan. Of these, 30 (37.0%) had undergone a non-contrast scan within the prior 24 hours. The average dose length product was 1716 mGy.cm, which equates to an approximate effective dose of 3.6 mSv. Discussion/Conclusion: The prevalence of CVT on CT venogram at the study site is extremely low, and most examinations are normal. In the interests of reducing unnecessary CVTs, investigation into the use of virtual non-contrast reconstructions +/À a clinical assessment tool is warranted. Cone beam computed tomography (CBCT) has an accepted role in image-guided radiotherapy. However, in diagnostic imaging the hybrid technology is yet to become a frontline imaging resource beyond the dental sector. Based on digital technology, new applications in musculoskeletal practice as a result of different manufacturer's approaches are enabling 3D imaging with lower dose and cost. These now include weightbearing peripheral and spinopelvic imaging. As a relatively low dose application with some of the positioning challenges of general radiography there remains a question as to how, and where, this becomes integrated into mainstream practice. This presentation will consider the emerging application of cone beam CBCT in diagnostic imaging and review the role medical radiation practitioners must take to develop the evidence base to effectively implement such technology. Objectives: The scope of podcasts in health and medicine has grown rapidly over the past few years. Podcast content and delivery style can be versatile, and hence podcasts offer a unique learning environment for university students. The aim of this presentation is to describe the use of cognitive theory of multi-media learning and adult learning theory as frameworks for podcast development. 1,2 Methods: Following a pilot study, insights into radiography students' perceptions and learning needs that could be supported by podcast content were identified. The cognitive theory of multi-media learning and adult learning theory were used to provide structure to 10 newly developed podcasts. Each podcast focussed on one topic within the field of radiography. Results: Five academic-led and five student-led podcasts were developed on a range of topics including non-accidental injury, patients who self-harm, and students' personal experiences in the radiography course. Three main considerations applied from cognitive theory of multi-media learning were to reduce extraneous stimuli, segmenting podcasts into key points, and using social cues to motivate the listener to understand the content. From the adult learning theory, key assumptions were made about intended podcast audience, namely that radiography students have self-concept, personal and professional experiences, readiness to learn, orientation to learning and motivation to learn. Discussion/Conclusion: The cognitive theory of multi-media learning and adult learning theory were practical frameworks for podcast development, in that they provided a structure for presentation of content within the podcasts, as well as a theoretical foundation underlining podcasts for future evaluation.
Getting to know you: interprofessional learning workshops with radiation therapy students and radiation oncology registrars

University of South Australia, Adelaide, Australia
Background: Radiation therapy is a multi-disciplinary field, and graduates must be able to collaborate with other healthcare practitioners. 1 Skills in teamwork and interprofessional communication are key to these collaborations and must be incorporated into radiation therapy training. 2,3 Interprofessional learning workshops between radiation therapy students and radiation oncology registrars can improve participants' teamwork and technical skills, as well as improving their understanding of each other's professional roles, 3 and were piloted in the training programs for these groups in South Australia for the first time in 2022. Content: An interprofessional learning workshop series for finalyear radiation therapy students and radiation oncology registrars was held. Three sessions were held over one year, with a focus on radiation therapy dosimetry. Sessions increased in complexity, with time initially for participants to get to know each other and talk through their roles. In the final session, participants worked in small groups to complete a palliative planning case from volume delineation to plan evaluation. Conclusion: The pilot interprofessional learning workshop series between radiation therapy students and radiation oncology registrars was successful, based on informal evaluation feedback from both cohorts. Future series will involve formal research into the immediate benefits for the trainees, as well as how improved collaboration skills may carry on to our future professionals.

MRI in radiation therapy: educational opportunities
shaping the future for current and future practitioners Julie Burbery, 1,2 Crispen Chamunyonga 1,2 1 Queensland University of Technology, Brisbane, Australia 2 Centre for Biomedical Technologies, Brisbane, Australia The utilisation of magnetic resonance (MR) technology in radiation therapy through dedicated MR simulation and MR-linac technology is increasing. The greatest challenge is the training and education of radiation therapists to ensure the safe and effective operation of MR technology. [1][2][3] In 2019, professionals including radiation therapists, radiographers, medical physicists and a radiologist were involved in the development of a comprehensive continuing professional education program that commenced in June 2020. The successful implementation of the continuing professional education program provides an avenue for upskilling radiation therapy practitioners nationally and internationally. Under phase 1, eight modules were developed to address MR physics, safety, quality assurance, imaging protocols, image interpretation, multi-modality image registration and the use of contrast in MR imaging with an opportunity to undertake a practical module. Developments in the undergraduate radiation therapy program include the incorporation of both didactic elements with practical consolidation. This is aimed at ensuring that graduates have ample opportunities to meet the needs of a changing clinical environment, practice standards and professional requirements. The program is providing opportunities for radiation therapy students to develop knowledge which can be applied in many areas such as multi-modality image registration for planning, adaptive therapy and image-guided radiation therapy. The provision of educational opportunities for the current and future radiation therapy workforce in the use of MR technology is paramount. However, ongoing development is necessary, requiring collaborative initiatives and support from industry, clinical departments, vendors, MR experts and professional bodies. Delivering continuing professional development events has been the role of our committee for several decades. Our usual event schedule has been three seminars throughout each year, held at centrally located venue in Brisbane city. Like all face-to-face events, the COVID-19 pandemic presented significant challenges, and as a committee we needed to band together with the support of our head office to become 'champions of change'. After a tumultuous 2020, 2021 saw us return to some semblance of our previous annual schedule, with our committee offering a virtual seminar experience. This saw us reach a larger audience, not just within eastern Queensland, but also inclusive of rural Queensland, other states and territories and even a small overseas attendance. Behind the scenes however, there was significant anxiety and challenges to overcome as well as the fear of the unknown. Many issues we experience as a committee did not present themselves until the day of the seminar, and the main challenge for us was for the show to go on. Many abilities and skill sets were utilised, and this only served to highlight that you do not know what skill sets you have until you need them (often under pressure!). With 2023 seeing a more reliable return to face-to-face seminars, our presentation will take you through our hurdles, reflections, and the importance of strong communication between stakeholders to improve infrastructure and capacity for the future.
Translating research in medical radiation practice: shaping the future of patient care Christopher Hicks 1 1 West Moreton Health, Ipswich, Australia Introduction: This paper explores the concept of research translation and its application in the medical radiation practice professions. A concept of research translation that extends beyond the familiar 'bench to bedside' or translation of pure scientific research into clinical practice, to a consideration of processes that ensure clinicians practise in an evidence-informed manner and that health systems are organised and co-ordinated for improved access and outcomes for patients. 1 Methods: A range of research translation frameworks are explored, including Glasziou and Haynes' work, which focusses on the individual practitioner's attempt to bridge the divide between the volumes of research literature produced and the clinician's uptake of evidence into practice; Matus et al's systematic review of research pertaining to allied health professions research capability building; and Harvey and Kitson's iPARIHS framework, which takes account of the clinical practice environment where research is adopted into practice. [2][3][4] Discussion: The merits of the various research translation frameworks applied to a medical radiation practice context is explored. The extension of the professional responsibility to undertake research to include research translation provides opportunities for medical radiation practitioners to practise in an evidence-informed way, implement improvements in practice and thereby shape a future characterised by improved patient experience and outcomes. Evidence-based practice and, more specifically, evidence-based radiography, is widely acknowledged as fundamental to good practice. [1][2][3][4] Students in Australian universities undertake a range of clinical placements to qualify for national registration as radiographers, this places them in the unique position of observing varied practice at a wide range of clinical centres. The purpose of this study was to explore students' experiences of evidence-based practice during clinical placements, the impact of these experiences on their education, and their perspective of evidence-based practice tendencies in the profession. Students who had completed a minimum of three clinical placements at different sites were invited to participate in focus group discussions that explored their experiences of evidence-based practice in clinical settings. The data were then analysed utilising reflexive thematic analysis. Three themes were identified: education; culture and responsibility; and hopes, fears and barriers. The theme, culture and responsibility was further broken down into three sub-themes: professional, organisational and individual. A wide variety of students' experiences of evidence-based practice on placement contributed to varied perceptions of the concept. Although participants had a clear and strong desire to implement evidence-based practice while on clinical placement, they felt limited by poor educational preparation and disempowered by workplace cultures and barriers. These findings have implications for radiography educators, managers and leaders, and those interested in advancing the profession. The ability to convey complex information about radiation therapy in a clear, concise and consistent manner to non-English speaking patients often requires the use of dedicated education resources and/or interpreter services that at times can be difficult to obtain. For patients who require interactive radiation therapy techniques such as deep inspiration breath hold (DIBH) or end expiration breath hold (EEBH) using the Elekta Active Breathing Coordination System, the capacity to communicate in a common language is a factor that may influence whether these treatments can be successfully applied. To ensure equity in the provision of these radiation therapy techniques for non-English speaking patients, the Princess Alexandra Hospital Radiation Oncology Department has developed several app-based resources that assist staff to educate, set-up and deliver DIBH and EEBH treatments to patients in their native language. In this presentation we will discuss the cultural considerations made in developing the Mandarin language module for our DIBH and EEBH voice command application and the thought process behind its linguistic architecture. We will also showcase how our app-based resources are utilised in a clinical environment and examine the advantages and disadvantages in providing education and instruction to non-English speaking patients via this software platform.
The experience of CALD patients in radiation therapyhow can we improve patient-centred care?

University of South Australia, Adelaide, Australia
Introduction: This presentation will consider the complexities of working with patients of culturally and linguistically diverse (CALD) backgrounds and highlight factors that impact the care they receive through a unique patient case. Studies show CALD patients tend to have increased complications and difficulties with the management of side-effects ensuing a greater level of dissatisfaction with healthcare services. 1 The challenges for clinicians when interacting with CALD patients will also be addressed. Case Presentation: The patient was a 57-year-old female refugee, originally diagnosed with early-stage breast cancer in 2019 and received treatment for it overseas. Due to her refugee status and lack of health insurance she received no further follow up and then presented in Australia with a more advanced recurrence. Management/Outcome: Given her advanced staging, her initial treatment was hormone therapy followed by a course of palliative radiation therapy, which she unfortunately did not complete. Due to the language barrier present, the patient found it difficult to adhere to the recommended skincare regimen, resulting in her experiencing a severe skin reaction and difficulty maintaining the treatment position. Discussion: Clinicians adopt a range of strategies to reduce communication barriers, however there are concerns about the quality and extent of information provided. Language barriers also affect the level of support and the treatment techniques available to CALD patients, creating a disparity of care. 2 This case illustrates that further investigation into supporting CALD patients receiving radiation therapy is necessary for the best patient-centred care to be delivered. Introduction: In southwest Sydney, 45% of the population speak a language other than English. 1 Clinical trials participation from culturally and linguistically diverse (CALD) populations is low, with communication and health literacy concerns identified as factors affecting participation. 2 The objective of this study is to test the effect of an educational intervention that aims to increase CALD participation rates in already recruiting MRI-based clinical trials. Method: A multi-modal educational intervention was developed that highlighted the value of clinical trial participation and introduced MRI and radiotherapy concepts. A cross-sectional pre-and post-intervention survey was developed to assess the impact of the educational intervention. Survey questions assess participants' inclination to participate in MRI-based clinical trials pre-and posteducational intervention. The educational materials and survey were translated into the two most common languages (other than English). Anticipated sample size will be 100 participants. Results: In this interim analysis, 23 participants have been recruited. Most participants (64%) indicated they had not seen any information regarding clinical trial participation in their language, and that their English proficiency impacts their willingness to participate in a clinical trial (57%), with 76% of responders indicating that having information pertaining to MRI and clinical trials in their preferred language would increase their willingness to participate in these trials. The number of responders unlikely to participate in an MRI clinical trial decreased after the educational intervention (24% vs. 5%). Conclusion: Interim results indicate that the educational resource could positively impact CALD recruitment rates.

Increasing recruitment of CALD populations to MRI clinical trials in radiation oncology
A modern approach to treating stereotactic ablative body radiotherapy/stereotactic radiosurgery in regional communities Marissa Morey 1 1 Dubbo Cancer Care Centre, Dubbo, Australia Statistics show that people living in rural and remote Australia have reduced access to health services and treatment while also experiencing poorer health outcomes than those living in metropolitan areas. 1 These communities experience lower life expectancy and are more likely to die younger, especially from potentially avoidable deaths, than their counterparts living in major cities. 1 Traditionally, a radiation oncologist would be present during stereotactic ablative body radiotherapy and stereotactic radiosurgery treatments. Unfortunately, in regional Australia many facilities do not have the luxury of having an oncologist on site. To overcome this, a relationship was built with our metropolitan radiation oncologists to allow us to utilise stereotactic body radiation therapy and stereotactic radiosurgery techniques. Radiation therapists video call the oncologist during the imaging scan and use this technology to communicate thoughts around image matching. Providing these treatment options means patients do not have to travel to a major city to receive high quality care. This is especially beneficial for patients that travel long distances for treatment, often leaving their work, country and families behind. Providing patients with high quality treatment course options enables them to return home much sooner. We are forging a path to a new, modern way of treating and helping to reduce the gap in health outcomes for people dealing with cancer in rural and remote communities. Objectives: Wide variation exists globally in the treatment and outcomes of stage III non-small cell lung cancer (NSCLC) patients. We conducted an up-to-date patterns of care analysis in the state of Victoria, Australia, with a particular focus on the proportion of patients receiving treatment with radical intent, treatment trends over time and survival. Methods: Stage III NSCLC patients were identified in the Victorian Lung Cancer Registry and categorised by treatment received and treatment intent. Logistic regression was used to explore factors predictive of receipt of radical treatment and the treatment trends over time. Cox regression was used to explore variables associated with overall survival. Co-variates evaluated included age, gender, ECOG performance status, smoking status, year of diagnosis, Australian born, Aboriginal or Torres Strait Islander status, socioeconomic status, rurality, public/private status of notifying institution and multi-disciplinary meeting discussion. Results: A total of 1396 patients were diagnosed between 2012 and 2019 and received treatment with radical intent 67%, palliative intent 23%, unknown intent 5% and no treatment 5% (see Table). Radical intent treatment was less likely if patients were more than 75 years of age, ECOG ≥1, had T3-4 or N3 disease or resided rurally. Surgery use decreased over time, while concurrent chemoradiotherapy and immunotherapy use increased. Median overall survival was 38.0 months, 11.1 months and 4.4 months following radical treatment, palliative treatment or no treatment, respectively (P < 0.001). Conclusion: Almost a third of stage III NSCLC patients still do not receive radical treatment. Strategies to facilitate radical treatment and better support decision-making between increasing multimodality options are required.
A preliminary review of the issues associated with treating patients with a larger body habitus

University of Alberta, Edmonton, Canada
Objectives: Obesity is generally reported as having a significant impact on health care practice and systems, although there is also growing recognition that pervasive weight stigma can affect access to health care and/or cause negative health effects. 1,2 This scoping review sought to answer the question: How has imaging and treating patients with a larger body habitus been defined, classified, and understood in the medical radiation sciences literature? Methods: A scoping review of English language peer-reviewed papers published from 2011 to 2021 was performed using the PRISMA framework. Three independent reviewers selected papers with the inclusion criteria: English language, human subjects, obese, bariatric, fat, medical imaging, medical radiation technology, radiation therapy and radiography. Results: The initial search identified 8809 articles; 8463 studies were screened and 347 full text studies assessed for eligibility. 80 studies were included for final data extraction. Of the articles included, preliminary qualitative content analysis revealed three major themes. The majority of papers looked at imaging and/or dose issues as well as equipment and environment. Fewer papers discussed patient care. There were specific radiation therapy considerations related to technique, dosimetry and acute side effects. Many of the radiography and radiation therapy specific papers were reviews and commentaries rather than research studies. Analysis is ongoing. Conclusion: A growing number of studies in this area have been published with both practical and patient care implications. Preliminary qualitative analysis revealed that major themes in the medical radiation sciences literature consist of equipment and technical considerations. Positive responses (strongly agree and agree) decreased from 89% to 74% between academic and clinical environments when identifying abnormalities, and 89% to 73% when describing findings. This highlights the challenges students face when in the clinical environment; also identified in the qualitative data where three recurring themes were identified among responses. Wilcoxon signed ranked test analysed a statistically significant relation between the two environments (P < 0.05). However, the relationship between identifying and describing skills was not statistically significant (P > 0.05). Discussion/Conclusion: ePortfolios assist in improving confidence in the identification and description of abnormalities, particularly in an academic setting. The clinical environment presents unique challenges which may limit student clinical performance however, this requires further investigation. Background: Western Australia's Medical Imaging Replacement Program is replacing its existing AGFA picture archiving and communication system and radiation information system with the Enterprise Medical Imaging Platform (EMIP) solution. The EMIP is a consortium of more than 15 applications. Considering the impact of COVID-19 on face-to-face training delivery, e-learning was the primary method of staff training for the EMIP applications. A team of radiographers, who were internal staff, were responsible for the design and development of the e-learning courses, using Articulate Rise and Articulate Storyline software. Discussion: The creation and management of e-learning by internal radiographers resulted in numerous benefits, compared to outsourcing this task to an external learning and development team. The insider expertise from radiographers ensured that e-learning content was targeted to the audience and responsive to changes in working practices. As the EMIP applications frequently evolved, the e-learning could be regularly and directly updated by radiographers to maintain content accuracy. These updates were efficiently deployed, by eliminating the need for repeated engagement with an external developer. Considering the time investment required in creating bespoke, continually updated courses, radiographer-designed learning was more cost-effective than procuring e-learning from an external team. Conclusion: Radiographer-designed e-learning was effective and responsive to successfully train staff in using the EMIP applications.

Garbutt
Opportunities for radiographer-designed e-learning could be further explored for ongoing medical imaging staff education, including professional development and modality training.
Burnout or lean inis professional supervision the answer?
Sarah Thomson 1   1 Christchurch Oncology, Christchurch, New Zealand In a career crisis? Would you choose contacting workplace support and taking stress leave or would you proactively invest in your career with professional supervision? I believe professional supervision will ensure radiation therapists have sustainable fulfilling careers and are confident and reflective in their practice. This is our goal at Christchurch Oncology with a professional supervision pilot study, where we are conducting monthly sessions with nine radiation therapists over a 12-month period. The aims of our sessions are for the radiation therapists to walk away seeing them as a learning experience and having a richer capacity on how to handle the same situation in the future. The other key emphasis is the basis of the relationship. If the relationship is structured well, this will reflect in the radiation therapist's professional relationships with patients and other professionals. Supervision can also provide opportunity to support the radiation therapist's self-care, build resilience and develop strategies that improve wellbeing.  Australia 5 Barwon Medical Imaging, Geelong, Australia 6 The University of Melbourne, Parkville, Australia Introduction: Clinical education is crucial to develop the skills of future medical radiation science (MRS) practitioners. Thus, the impact of COVID-19 on clinical education warrants further investigation to assess the extent of any underdeveloped skills of students. [1][2][3] The perspective of academics and students has been well documented globally. 3 This paper reports on MRS clinical educators' perspectives within Australia. Methods: MRS clinical educators across Australia were invited to complete an ethics approved survey between 17 June to 17 July 2022. Survey questions related to students' competency, wellbeing and safety using the Medical Radiation Practice Board of Australia's professional capability standards. Results: 55 clinical educators replied to the survey with 26 from medical imaging and 29 from radiation therapy. Respondents reported that first-and second-year students had the greatest lost placement time, with 65% and 61% of students losing more than a quarter of their clinical placements, respectively. Domain 1 (Medical radiation practitioner) and Domain 3 (Communicator and collaborator) of the Medical Radiation Practice Board of Australia's standards demonstrated the greatest negative impact from reduced placement time.
Prior to the pandemic, students were receiving adequate opportunities according to respondents (95%) but did not gain the required experience during the pandemic (14%); 58% reported that students were underprepared to enter the workforce. Conclusion: Ongoing concerns remain among MRS clinical educators around the quality and preparedness of students due to pandemic related loss of placement time and learning opportunities. A greater understanding of this impact allows educators to better support the transition to practice of MRS practitioners. It has been well established that childhood maltreatment or abuse, has detrimental effects on mental health and is a major risk factor for most psychiatric disorders. Maltreatment can also lead to a range of behavioural problems and can alter the structure and function of the developing brain. It is also associated with impairments to IQ, academic achievement, working memory, emotional regulation and inhibitory control. 1 Modern neuroimaging techniques, such as functional MRI, positron emission tomography and diffusion tensor imaging have the ability to visualise the structural changes that occur in the brain due to child maltreatment. Examples include the ability of functional MRI to visualise the altered facial perception of adults in people with a history childhood emotional maltreatment and diffusion tensor imaging to detect abnormalities of white matter microstructure in the brains of maltreated children. 2 This presentation reviews the chronic stress response to childhood maltreatment and the subsequent effects on the developing brain. This presentation also explores current neuroimaging techniques for child abuse and how medical imaging is changing the way child abuse and its resultant behaviours is understood by researchers. Forensic imaging is 'the application of the science of diagnostic imaging to questions of law'. 1 A skeletal survey X-ray series in the investigation of non-accidental injury is performed for medicolegal purposes, rather than clinical reasons. Therefore, the medicolegal aspects of providing an imaging service should be considered by the radiographers involved in the skeletal survey X-ray series. These include continuity of evidence, appropriate witness and documentation of the examination. This presentation will review the recently published Royal Australian and New Zealand College of Radiologists Guideline for Imaging of Suspected Non-Accidental Injury, in conjunction with the International Association of Forensic Radiographers best practice guidelines for the provision of forensic imaging. 1 The Medical Radiation Practice Council (MRPC) of New South Wales manages complaints about the conduct, performance and health of registered medical radiation practitioners and students in New South Wales with the key objective of protecting the public. 1 The MRPC is made up of six council members (four practitioner, one community and one legal member) and is supported by staff at the Health Professional Councils Authority. The MRPC receive complaints from the Health Care Complaints Commission and the Australian Health Practitioner Regulation Agency (Ahpra) for practitioners and students based in New South Wales. Complaints are managed by the MRPC across three key pathways: performance, health and conduct. This presentation will outline the responsibilities of the MRPC and provide insight into the types of complaints managed over the past few years, with some anonymised case study examples from all three key pathways, including examples of complaints that require immediate action under Section 150 of the National Law (NSW). 1 The presentation will also include what happens to a practitioner when conditions on their registration are required to ensure safe practice. This presentation will be helpful for all practitioners and students as they will be able to learn from the experience of others and understand the present complaints management process in New South Wales to better shape their future. This presentation will provide attendees with a firm understanding about what kinds of complaints are received and how the MRPC manages these complaints to champion change: supporting practitioners to improve public safety.

Medico-legal aspects of non-accidental injury imaging
Maximising all that hot air: DIBH vs non-DIBH in adolescent young adult patients Danielle Duff 1 1 Te Whatu Ora Waitaha: Canterbury Regional Cancer & Haematology Service, New Zealand Introduction: Should deep inspiration breath hold (DIBH) be used in adolescent young adult patients? This case study reviews the use of DIBH verses free breathing to improve patient outcomes for a 13-year-old patient with a chest wall sarcoma. Case Presentation: This presentation will provide a brief review of the literature, including international recommendations, and how we were able to adapt clinical protocols to achieve the best outcome for a young person during their treatment. It will assess the educational requirements needed to achieve DIBH compliance in a 13year-old as well as the additional dosimetric considerations required to facilitate treatment in breath hold. Discussion: Discussions will include a plan comparison between DIBH and free breathing and the clinical considerations made to determine the best plan for this young person.
Assessment of workplace learning in MRS: Why? What?

RMIT University, Bundoora, Australia
Objectives: Proving capability in workplace learning requires an assessment approach which considers the contextual variability of professional practice. The aim of this research was to develop an approach to assess undergraduate radiography students' workplace learning capability. 1 Methods: This study is located in the interpretive paradigm, within which a deconstruction-reconstruction method was employed. The overarching research question was: What is an optimal method for assessing the clinical capability of radiography students? To answer this question three research sub-questions were posed: • Why do we asses? • What do we assess? • How do we assess it? Results: This study clearly pointed to different assessment strategies being necessary for assessing professional practice. Because professional practice does not occur in isolation, but rather forms part of a complex whole, it was determined that the different assessment strategies should occur in parallel, producing a multi-dimensional assessment approach. 2 This approach assesses student capability in professional practice utilising professional judgement of workplace assessors, structured reflective journals assessed by university academics, and assessment of technical competence by workplace assessors. Discussion: The deconstruction process examined the nature of professional practice in the literature; it was deemed to be interactional, dynamic and contextual in nature. These aspects of professional practice were found to be integral to assessment of radiography workplace learning capability, but not to the neglect of the technical aspects of radiography practice currently assessed. Therefore, the assessment approach developed needed to adequately assess all these aspects of practice. 3 Professional certificationembrace the present to shape your future Min Ku 1 1 Australian Society for Medical Imaging and Radiation Therapy, Melbourne, Australia The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) is the peak body representing medical radiation practitioners in Australia. Currently ASMIRT offers a broad range of certification options available to all medical radiation practitioners in Australia and internationally. These certifications have been available for at least two decades. The certification pathway varies between the certification types, however, includes a theoretical component and a practical component. Medical radiation practitioners are required to meet a minimum regulatory standard to practise their specific modality. 1 For practitioners to demonstrate additional skills, knowledge and expertise in their chosen modality, there is a choice of further postgraduate education, or alternatively continuing professional development through an industry recognised professional certification. The certification program is designed to assist medical radiation practitioners with their career pathways. It enables a smaller manageable form of study in a specific modality to support that scope of practice. Investing time, energy and resources demonstrates to employers a commitment to self-improvement and excellence in your profession. 2 This presentation will detail the benefits of the ASMIRT professional certification pathway, the opportunities available for medical radiation practitioners and the benefits of obtaining and retaining this formal professional recognition. 1 Sydney West Radiation Oncology Network, Westmead, Australia 2 The University of Sydney, Westmead, Australia Acute haematological toxicity is a known side effect of chemo-radiotherapy with an incidence of 30-45% when fields encompass active bone marrow (ABM). However, bone marrow is not routinely defined as an organ at risk during planning. In 2019, one cervical cancer patient receiving extended field chemo-radiotherapy (EFC-RT) experienced grade 3 anaemia and thrombocytopaenia, alongside grade 4 leukopaenia, neutropaenia and lymphopaenia. This required more than 20 blood product transfusions, a month-long hospital admission and multiple treatment breaks. This highlighted a quality improvement need to reduce haematological toxicity for future EFC-RT patients. Bone marrow contouring definitions and dose constraints were determined from a literature review. A planning study utilised three previous patient datasets, with CT-based bone marrow surrogate and PET-based ABM contoured. Plans were optimised with bone marrow and ABM constraints then compared with the original. Bone marrow optimised plans reduced bone marrow V10, V20, V30 and V40 by 13%, 10%, 3% and 1%, respectively, and ABM by 10%, 11%, 5% and 3%, respectively, while maintaining coverage of target volumes. ABM optimised plans reduced ABM doses by 13%, 17%, 18% and 15%, respectively, however target coverage was compromised. CT-based bone marrow sparing was selected for expedited implementation. Gynaecological planning guidelines were updated to include the bone marrow objectives, and a progressive implementation followed over a 24-month period as follows: (i) EFC-RT patients, (ii) concurrent chemotherapy patients, (iii) all gynaecological patients. Retrospective data collection of full blood count and blood product transfusion is ongoing. Future quality improvement includes reassessing PET-based ABM sparing, investigating MRIbased ABM delineation, and identifying biological predictors for haematological toxicity. Objective: Cardiac radioablation is a promising non-invasive modality for the treatment of cardiac arrhythmias, but accurate dose delivery can be affected by heart motion. For this reason, real-time ultrasound guidance can be a solution. A typical ultrasound-guided cardiac radioablation workflow includes simultaneous ultrasound and planning CT acquisitions, which can result in ultrasound transducer-induced metal artefacts on the planning CT scans. To reduce the impact of these artefacts, a metal artefact reduction algorithm has been developed based on a deep learning Generative Adversarial Network (CycleGAN), and it has been compared with metal deletion technique (MDT) and combined clustered scan-based metal artefact reduction (CCS-MAR) algorithms. 1,2 Methods: COVID-19-CT dataset was used in this study. 3 The CycleGAN network was trained using CT scans from 70 patients consisting of paired CT slices with and without simulated ultrasound transducer-induced metal artefacts. Then, CT scans with simulated artefacts from 14 patients were used to create the artefact-corrected CT scans after MDT, CCS-MAR and CycleGAN applications. The HU value improvement percentage for the heart, lungs and bone regions in the artefact-corrected CT scans was calculated. Results: In Figure 1 an example of the effect of the application of these algorithms is shown. The proposed CycleGAN network effectively reduces the negative impact of metal artefacts. For example, the calculated HU value improvement percentage for the heart in the artefact-corrected CT scans was 59.58%, 62.22% and 72.84% after MDT, CCS-MAR and CycleGAN applications, respectively. Discussion/Conclusion: In comparison to MDT and CCS-MAR, the developed CycleGAN application on CT scans performs better or comparably in reducing these artefacts.
Histology classification based on radiomics for nonsmall cell lung cancer patients using an artificial neural network Eva YW Cheung, 1 Wing Yan Wong, 1 Ricky Wu, 2 Ellie Chu 1 1 Tung Wah College, Hong Kong 2 Glasgow Caledonian University, Glasgow, Scotland Background: Lung cancer is the most common cancer in Hong Kong, with 85% of lung cancers being non-small cell lung cancer (NSCLC). Within NSCLC, there are large cell carcinoma, squamous cell carcinoma, adenocarcinoma and other types, which can be confirmed through pathological analysis only. In this study, we aimed to classify the above histology types based on radiomics retrieved from CT images. Method: Planning CT images and RT structures of 293 NSCLC patients were downloaded from the cancer imaging archive database. 107 radiomics were retrieved from the planning CT using slicer version 4.11.20210226, based on gross tumour volume delineated by clinical oncologists. An artificial neural network model was built on Matlab neural network toolbox to classify large cell carcinoma, squamous cell carcinoma and adenocarcinoma from others for NSCLC patients. The model performance was analysed by its sensitivity, specificity, area under the ROC curve and overall accuracy. Results: The proposed neural network model showed good performance in predicting different types of histology, with overall accuracy of 74.2% and area under the ROC curve of 78%. The sensitivity and specificity of large cell carcinoma are 67% and 83.1%, squamous cell carcinoma 79% and 79.8%, adenocarcinoma 72.4% and 67.7%, and others 78.7% and 587%, respectively. Conclusion: CT radiomics had good performance in classifying different types of histology in NSCLC patients using a neural network model. External cohort of patients can be included to validate the model for further studies. Objectives: At a Queensland tertiary hospital, a child aged less than 12 years who presents with an acute wrist injury will receive a full forearm X-ray as per paediatric X-ray protocols. With no known origin of this protocol, the evidence has revealed that doctors fear missing concurrent injuries at the elbow, however, existing literature states it is an unnecessary use of radiation. 1 This audit aimed to find the prevalence of proximal forearm fractures in children with wrist pain. Method: A retrospective study of 536 forearm X-rays over a sixmonth period (January to June 2022) were reviewed and included if a child was aged less than 12 years, with an acute wrist injury, presenting to emergency. Data was collected from radiology reports and clinical notes to identify prevalence. Results: Out of 278 eligible participants, 154 children had confirmed distal forearm fractures and six (2.16%) had mid-proximal forearm fractures. Out of those six children, four had obvious visual deformities of the forearm, that likely would not have been missed by a clinician. Which lowers the prevalence of proximal fractures (without visual deformity) to 0.7%. Conclusion: The prevalence of proximal forearm fractures in children aged less than 12 years with wrist pain presenting to the emergency department is very low. Undertaking forearm radiographs for wrist pain is an unnecessary additional use of radiation on our most radiosensitive population. It is recommended the protocol is abolished and suggested if a visual deformity is present, then a forearm X-ray is appropriate.

Development of an online clinical placement assessment for medical imaging students
Susan Said, 1 Frances Gray, 1 Laura di Michele, 1 Yobelli Jimenez, 1 Amanda Punch 1   1 The University of Sydney, Camperdown, Australia Objectives: The professional capabilities of medical radiation practice are well established as the standard of practice that all practitioners must meet to be registered with the Medical Radiation Practice Board of Australia (MRPBA), part of The Australian Health Practitioner Regulation Agency (Ahpra). 1 The aim of this presentation is to report on the development and initial evaluation of the new clinical assessment tool (NCAT) developed for students at an Australian university based on the MRPBA capabilities. Method: The NCAT was developed with the intention to align students' clinical performance with the MRPBA capabilities, and to ensure straightforward access and ease of use on a digital platform. A first draft of the NCAT was developed by matching the criteria under each MRPBA domain with each work integrated learning unit of study's learning objectives. This was followed by an iterative process of trialling the tool in four clinical sites and making adjustments to wording and rating scale grading scales based on clinical educators' feedback. Following implementation of the final version of the NCAT, an online survey was used to explore clinical educators' perceptions of using the NCAT to evaluate students' skills. Results: The NCAT consists of five sections which align to the MRPBA domains. A manual was developed with observational descriptors on each rating. Data from online survey is currently being analysed and will be presented at the conference. Discussion/Conclusion: The NCAT provided an opportunity to consult and engage with clinical supervisors as partners in student education. Development of the NCAT provides strong evidence for course accreditation purposes.