Development,implementation, and associated challenges of a new HDR brachytherapy program

Developing any new radiation oncology program requires planning and analysis of the current state of the facility and its capacity to take on another program. Staff must consider a large number of factors to establish a feasible, safe, and sustainable program. We present a simple and generic outline that lays out the process for developing and implementing a new HDR brachytherapy program in any setting, but with particular emphasis on challenges associated with starting the program in a limited resource setting. The sections include feasibility of a program, starting cases, machine and equipment selection, and quality and safety.     

Residents’ Perceptions of Usage of the Current Alumni and Attending Network for a Formal Mentorship Program in an Academic Affiliated Community Hospital Radiology Residency

Mentor-mentee relationships within radiology residencies can add significant value to a resident’s overall experience. Studies demonstrate that mentorship programs can increase satisfaction for residents and faculty alike by reducing stress, easing career related decisions, increasing involvement with research, improving teaching and communication skills, and finally increasing leadership roles. In a survey of radiology program directors, 85% of program directors find such a program beneficial but only 57% have a formal program in place. Totally, 42% of program directors believe a structured mentorship program is necessary. Studies have also shown that female residents prefer female mentors. Alumni serve as an ideal group for resident mentorship as they do not face the pressures of internal faculty. No study to date in diagnostic radiology literature uses an alumni network in establishing a formal mentorship program. The objective of this study is to implement a formal mentorship program within an academic affiliated radiology residency by using program alumni and internal attending physicians for potentially increasing faculty engagement, improving resident morale, research opportunities, and networking for fellowship and job opportunities.     

Strength Training Guidelines for Cardiac Patients

In brief: Many cardiac patients would like to improve their muscle fitness through a program of strength training. Evidence now indicates that such a program, if conducted within a medically supervised rehabilitation program, is both safe and beneficial. This article provides practical guidelines for a strength training program, which may be modified to fit a particular program. The recommendations include criteria for admission, procedures for orientation and instruction, and techniques for supervision.     

Gynecological intrauterine brachytherapy training for radiation therapists: The development and implementation of a training program

PURPOSEGynecological brachytherapy (GynBT) is an important part of gynecological cancer management. At Olivia Newton-John Cancer Wellness & Research Centre (ONJCWRC), Melbourne, Australia, radiation therapists (RTs) are integral to the MRI adaptive GynBT program workflow. However, there is limited GynBT training available for RTs in Australia. A GynBT training program has been developed at ONJCWRC to meet this need and support RTs in becoming competent, proficient and confident in the various roles in GynBT. This is a preliminary report on the development and implementation of a credentialing program, providing a structured approach to GynBT training of RTs.METHODS AND MATERIALSA credentialing program was designed with modules and competency assessments to ensure efficiency and proficiency of RTs in the GynBT workflow. The program includes theoretical modules in anatomy, international GynBT guidelines, radiation safety and local protocols; and practical modules in equipment, ultrasound for GynBT, operating theatre procedures, MRI, contouring, applicator reconstruction, planning, quality assurance and treatment delivery. Learning strategies include self-directed learning, tutorials, practical sessions, and third-party courses. The program concludes with an exit examination assessing major competencies.RESULTSThe program was implemented in April 2018 with three RTs completing the program and passing the exit examination on first attempt. On post-program survey, the RTs felt the program was comprehensive, helping to build their confidence, and proficiency in GynBT.CONCLUSIONSA GynBT RT credentialing program was successfully developed and implemented to improve the quality of training at ONJCWRC. This program is mandatory for RTs joining the GynBT team. This program can provide a framework for implementation of GynBT training in other centers.     

Basic science and clinical application in the athlete's shoulder. A preventative program focusing on the glenohumeral joint

This program can be implemented as either a preventative program or a rehabilitative program for the upper extremity in the throwing athlete or in nonthrowing athletes involved in overhead activities. The authors have found this program to be easily employed in a university setting. The keystone to its effectiveness is the participating individual. For optimal results, it should be performed as specifically outlined. The likelihood that shoulder symptomatology will develop is higher now that more people are participating in recreational and team sports for cardiovascular fitness. It is, therefore, imperative that a preventative program be developed in both the recreational and professional athletic population.     

A new graduate education program in radiation therapy

PurposeThe evaluation of the Radiation Oncology Network's (RON) in house professional development year (PDY) support program was implemented to determine the appropriate teaching, learning and transfer of learning strategies that assist the newly practicing radiation therapists' transition into the busy working environment. As the AIR program saw little clinical support offered to participating new graduates and thus a need for further educational support was felt.The RON support program was initially introduced as the clinical education support component of the NSW PDY program that was introduced in 1995 by the Australian Institute of Radiography.MethodFollowing the facilitation of the RON PDY program over a twelve month period, qualitative feedback was obtained using a focus group consisting of new graduates from the program. Two moderators facilitated the focus group: one moderator facilitated the discussion while the second moderator transcribed it. The graduate practitioners were asked a number of questions related to the teaching and learning strategies employed by the program as well as the structure of the program.Results/discussionThe responses were analysed into the following themes: teaching and learning strategies, transfer of learning, facilitation and future learning needs. Overall the graduate practitioners found the program nurtured their skill, knowledge and attitudes appropriately at such a critical stage in their career.     

Parental awareness and engagement in the Active Kids program across socioeconomic groups

ObjectivesIn 2018, the New South Wales (NSW) Government implemented a State-wide program to reduce the cost barrier to organised sport and physical activity participation. We explored parent/carer’s awareness and children’s engagement in the Active Kids program across socioeconomic groups and used the NSW Population Health Survey (PHS) to validate engagement in the program.DesignCross-sectional.MethodsData were obtained from the 2018 NSW PHS and the Active Kids program registration database. We compared demographic characteristics of children who had registered for the program in the registration database with children in the weighted NSW PHS. Multinomial regression models were used to determine whether socioeconomic status was associated with parent/carer awareness and children’s engagement in the program.ResultsParent/carer’s in the most disadvantaged quartile were twice as likely to have never heard of the Active Kids program (OR: 2.04, 95% CIs 1.31, 3.16) or to have heard or the program but not registered (OR: 1.94, 95% CIs 1.26, 3.00), and more than twice as likely to have registered for a voucher, but not followed through and redeemed the voucher (OR: 2.68, 95% CIs 1.27, 5.63) compared with the least disadvantaged quartile.ConclusionsThe Active Kids program has provided financial support for organised sport and physical activity to a large number of children. However, there are still a substantial proportion of socially disadvantaged groups who are unaware or have not engaged in the program. Further targeted work is required to increase the awareness and engagement in the program for socially disadvantaged groups.     

Computerized search of chest radiographs for nodules

A computer program that recognizes potential pulmonary nodules in PA chest radiographs has been developed. This program produces a display of candidate nodules that require interpretation by a radiologist. Some false positives are rejected by a program, the Nodule Expert. Detection performance with and without Nodule Expert has been evaluated. Using the untrained program (no Nodule Expert), and after inspecting 45 candidate nodules, a radiologist may be confident that a nodule was inspected, if one was located by the program. When pattern recognition techniques are incorporated, the number of false positives presented for inspection is reduced. The radiologist must inspect, at most, 10 candidate nodules to be confident of having inspected a nodule, if one was located by the program. Concomitant with this decrease in the candidate nodule false-positive rate is a decrease in sensitivity (film true-positive rate) from 92 to 86%. This program was trained on candidate nodules from 37 radiographs and also tested on these 37. Some of the features used by the pattern classifier to classify candidate nodules are comparable to those used by human observers.     

Importance of the radiology program coordinator

The ACGME requires adequate lengths of appointment for both the program director and faculty as being essential to maintaining an appropriate continuity of leadership (1). Although this requirement does not apply to the program coordinator, the ACGME does require that a program have a dedicated coordinator. Any list of coordinator duties is long, but underestimates the true volume of the coordinator’s responsibilities. Although the program director is accountable for all aspects of the program, much of the director’s work is delegated to the coordinator. The training period for a new coordinator is from months to years, and coordinator turnover can be very disruptive to the program. The coordinator must possess skills in communication, problem solving, decision making, administration, organization, and supervision. He or she must have a broad knowledge of academic medicine and radiology training. The coordinator is generally the first and last person to interact with resident candidates, visiting speakers, and ACGME site reviewers. His or her professional and administrative skills are a reflection of the quality of the program and effectiveness of the program director. The work of a coordinator involves managing many complex tasks at once, while maintaining the flexibility to accommodate changes in work priorities in the face of unexpected events. He or she should be seen as an advocate of both faculty and residents. The coordinator needs to work independently within prescribed guidelines, engage in continuous professional development and suggest initiatives to improve the quality of the program. When done well, the coordinator’s work is accomplished effortlessly in the eyes of the program director, faculty, and residents. A highly skilled and experienced coordinator is a valuable asset to the program. Providing the coordinator with adequate support (i.e., clerical assistance, materials, training, and workspace) is a smart investment, the return on which can be substantial.     

An evaluation of a sexual assault prevention and advocacy program for U.S. Navy personnel

To address the needs of Navy personnel (and dependents), the Navy implemented the Sexual Assault Victim Intervention (SAVI) program. The SAVI program has two components, namely, a presentation/training component and an advocacy component. The presentation/training component involves education designed to increase awareness and prevention of sexual victimization, delivered to all military and civilian personnel through presentations, and training of SAVI advocates. The advocacy component provides victims with professionally trained advocates who provide information and emotional support and help guide victims through various medical, legal, and investigative processes. Data are presented on (1) satisfaction with program quality, (2) how well the SAVI program met its primary objectives (e.g., helps program users cope with sexual trauma), (3) how well the SAVI program met its primary program objectives or reasons for being (e.g., helps service members concentrate on their jobs), and (4) program effects on mission-related outcomes (i.e., quality of life, readiness, and intended retention).     

Voluntary and Mandatory Fitness Programs for Fire Fighters

Physiological studies were done on 50 fire fighters before and after they participated in successive year-long voluntary and mandatory physical fitness programs. Although neither program produced impressive fitness changes or was more cost-effective, mean aerobic capacity increased by 13% following the mandatory program, compared with a 3% increase after the voluntary program, suggesting that a mandatory program could more effectively improve fitness levels. It is recommended that fire fighters maintaining acceptable fitness standards be rewarded in some manner.     

Teen obesity addressed in the military

OBJECTIVE: The purpose of this study was to trial a teen weight loss program at the largest U.S. Air Force Medical Center to find its effect in reducing the serious problem of teen obesity in San Antonio, Texas, at Lackland Air Force Base. A successful program, developed by physicians, was examined. The program, SHAPEDOWN, selected because it was the first program for teen obesity ever developed and has been successful for over 20 years, used a behavioral modification approach, which required parental involvement. The five students and five parents graduating from the program did reduce their body mass index but not to the program specifications of 1/2 to 1 lb/week. As recommended for success, the program was supposed to include weekly consecutive meetings, pretesting families to note specific family problem areas, and purchasing the training video for the teacher. However, financial and other constraints limited following the program design, and these steps were not taken. Nurturing skills for the parents were taught successfully, and parents expressed future application of these skills for both future weight loss efforts with their teens and for their improved parent/teen relationship.     

A Guide to the Interventional Radiology Residency Program Requirements

The program requirements for the new Interventional Radiology (IR) Residency were approved by the ACGME in September 2014. Soon, training institutions will be able to apply for accreditation and begin enrolling residents. The IR program requirements are long (44 pages) and a bit complex. In addition, some concepts in the program requirements, such as options for integrated or independent formats, may be unfamiliar to the radiology community. In this article, we summarize key concepts and explain important provisions in the IR program requirements. We hope to provide the reader with a firm foundation for understanding the full program requirement document and the application process.     

Designing a flexible user interface for both users and programmers

The design of a user interface for computers is examined from both the end user's and the programmer's point of view. Different methods of menu selection and user feedback are discussed. A graphics interface using pull down menus and dialog boxes is ideal for simplifying user interaction and program organization. This style of interface also provides for a modular program development environment, reduced program development time, program portability, and reduced maintenance. Software tools for programming the user interface are explored and pseudo-code examples are given.     

航天型号非嵌入式软件调试验证可视化技术研究

目的针对航天型号非嵌入式软件在调试验证中的设计问题,研究其可视化技术。方法参考GraphML和ATML标准,使用XML模式定义测试描述语言,用于将可视化的测试设计保存为测试描述文件;定义测试程序模板,封装通用硬件接口的操作并定义了测试程序的基本框架;设计翻译程序,逐步解析测试描述文件并根据测试程序模板,生成测试程序。结果设计了具有通用接口和可视化设计界面的通用测试平台。该平台不仅可用于设计测试程序,对目标系统进行测试,而且可用于构建一个模拟程序,与其他系统进行协同测试。结论可视化测试平台可以简化航天型号软件的测试设计,并能提高测试效率。     

Proposed program guidelines for pregnant radiology residents: a project supported by the American Association for Women Radiologists and the Association of Program Directors in Radiology

RATIONALE AND OBJECTIVES: Written institutional policies governing radiation exposure and work responsibilities for pregnant radiology residents are not uniform and often are nonexistent. Standardized program guidelines would allow residents and program directors alike to prepare for a resident pregnancy with objectivity and consistency. MATERIALS AND METHODS: The American Association for Women Radiologists (AAWR) launched a task force to revisit guidelines for the protection of pregnant residents from radiation exposure during training. We conducted two surveys of the Association of Program Directors in Radiology (APDR) membership. Survey 1 was designed to learn about existing program and institutional policies and to assess the need for and interest in standardized guidelines that would address radiation exposure and work responsibilities for pregnant radiology residents. Based on those responses, we drafted a set of program guidelines incorporating policies contributed by responding program directors. Our follow-up APDR survey, survey 2, was conducted to determine opinions and acceptance of the drafted program guidelines. Each survey was analyzed by using a proportion of means test. RESULTS: Fifty-five of 156 program director APDR members (35%) responded to survey 1. Only half the respondents had formal written policies at their respective institutions. Review of submitted policies showed widely divergent opinions about appropriate policies for pregnant radiology residents. Most (34/52; 75%) supported the development of standardized guidelines. In survey 2, 38/73 responding APDR members (53%) offered their opinions and comments on our drafted guidelines. Approximately 90% agreement was catalogued on 13 of 18 items (72%); a majority (>60%) agreed on all points, even the most controversial points concerning fluoroscopy. CONCLUSION: A minority of radiology residency programs have written policies addressing pregnancy during training. With expressed support from a majority of responding program directors, we have developed and present here proposed program guidelines for pregnant radiology residents to serve as a framework for radiology residents and program directors alike.     

Practical Issues in Employee Fitness Programming

In brief: Data suggest that an employee fitness program in a large corporation is not only an attractive fringe benefit but a profitable investment as well. Fitness programs have resulted in decreased absenteeism, reduced health care costs, and increased productivity. Developing and marketing a fitness program requires months of well-planned activity that includes forming a fitness committee, hiring a program coordinator, planning and equipping the proposed exercise facility, getting the support of top management, and generating publicity. Cost is a big consideration, but the savings seem to outweigh the expense of a successful corporate employee fitness program.     

Muscular strength changes in hospitalized anorexic patients after an eight week resistance training program

We investigated whether an eight week, light resistance program could increase the muscular strength of the knee and elbow extensors and flexors in a group of hospitalized anorexic patients compared to anorexic controls (AC) who did not participate in the training program, but received the same caloric intake, and non-anorexic exercisers (NAE) who undertook the resistance training program. After the resistance training program, the seven anorexic exercisers (AE) significantly increased the peak torque (PT) of their knee extensors (p < 0.001), flexors (p < 0.0001) and elbow flexors (p < 0.01). In comparison, the seven anorexic non-exercisers (anorexic controls, AC) and seven non-anorexic exercisers (NAE), who performed the same program, showed no significant increase in peak torque after the program (p > 0.05). The study has demonstrated that an eight week, light resistance program increases the knee and elbow strength of the hospitalized anorexic patients.     

An approach to fractures of the midface: An interactive tutorial

Purpose: To describe an educational computer aided instruction program dealing with diagnosis and classification of facial fractures. Methods: A program was created for use on Macintosh computers using a graphic presentation package. This program allows for the display of high resolution digitized radiographic images and illustrations, along with integrated voice and text information. Users can interact with the program to review complex concepts or study additional cases. Case material was obtained from selected high quality plain radiographs and computed tomography (CT) scans obtained in the trauma center of one institution, and was scanned on a high resolution digital scanner with image parameters optimized for viewing on the Macintosh high resolution color monitor. Results: The program has been installed in the computer aided instructional laboratories or trauma centers at The University of Texas Health Science Center, Houston; The University of Alabama, Birmingham; Emory University School of Medicine, Atlanta, Georgia; and The University of North Carolina, Chapel Hill. The program is available to radiology residents and medical students rotating on the trauma radiology services at these institutions. Completion of the program requires 30–45 minutes. Conclusion: Based on our initial experience, the program has been used by residents in the training programs of all institutions with favorable results.     

Coverage of emergency after-hours ultrasound cases: survey of practices at U.S. Teaching hospitals

RATIONALE AND OBJECTIVES: Diagnostic ultrasound examinations may be performed after-hours by physicians if technologists are not available or cases are complex. Our experience suggested there is wide variability in how ultrasound coverage is provided after-hours, which motivated us to conduct a formal survey of teaching programs around the country. METHODS: Four hundred five members of the Association of Program Directors in Radiology were contacted by e-mail and sent a link to a five-part questionnaire posted on the Web. Respondents were asked whether ultrasound cases after-hours are performed in their institutions by radiology residents, technologists on the premises after-hours, technologists on-call, or some combination. Data on the type of program, number of beds in the primary hospital, number of residents in the program, and geographic location of the program were recorded. Responses were automatically written to a data file stored on a Web server and the imported into an Excel spreadsheet for data analysis. A chi(2) analysis was performed to assess associations among the variables and statistical significance. RESULTS: A total of 79 programs responded to the survey. Of those, 32% provided coverage with ultrasound technologists on call, 24% by ultrasound technologists on the premises, 13% provided combination coverage, and 10% provided coverage solely with residents on call. There was no association among number of residents in the program, location of the program, or type of program (university, community, or affiliated) and type of coverage provided. CONCLUSION: There is wide variability in methods for providing coverage of after-hours ultrasound cases. However, on-site or on-call coverage of emergency cases by technologists did not appear to depend significantly on program location, program type, or program size.