Objectives: Radiographers are key patient-facing healthcare professionals involved in many aspects of patient care. The working patterns and professional practice of the radiography workforce (RW) has been altered during the COVID-19 pandemic. This survey aimed to assess the impact of the pandemic on radiography practice in the United Kingdom (UK). Methods: An online cross-sectional survey of the UK RW was performed (March 25th to April 26th, 2020). The survey sought information regarding 1. Demographics 2. Impact of the pandemic on professional practice 3. Infection prevention/control and 4. COVID-19 related stress. Data collected was analysed using the Statistical Package for Social Sciences (v.26). Results: A total of 522 responses were received, comprising n = 412 (78.9%) diagnostic and n = 110 (21.1%) therapeutic RW categories from across the UK. 12.5% (65/522) of the respondents were redeployed. Redeployment did not appear to contribute (p = 0.31) to work-related stress. However, fear of contracting the infection and perceived inadequate personal protective equipment (PPE) were identified as key contributors to stress during the study period. Compared to the therapeutic RW, a significantly higher proportion of the diagnostic RW identified fear of being infected as a major stressor (166/412 (40.3%) vs 30/110 (27.3%), p = 0.01). Conclusion: This survey has demonstrated changes to clinical practice, in particular to working patterns, service delivery and infection prevention and control were key contributors to workplace-related stress during the pandemic. Advances in knowledge: Timely and adequate staff training and availability of PPE as well as psychosocial support during future pandemics would enhance quality patient and staff safety.

The objectives of this study were to quantify the ionizing radiation exposure to patient and operator during radiofrequency (RF) catheter ablation and to estimate the risks associated with this exposure. The study consisted of 50 RF ablation procedures, all performed in the same electrophysiology laboratory. Occupational dose to two cardiologists who performed the procedures was measured using film badges and extremity thermoluminescent dosemeters (TLDs). Absorbed dose to the patients' skin was measured using TLDs. Dose-area product (DAP) was also measured. The effective dose to the cardiologists was less than 0.15 mSv per month. The mean equivalent dose to the cardiologists' left hand and forehead was 0.24 mSv and 0.05 mSv, respectively, per RF ablation procedure, which was more than twice the mean dose for the other cardiology procedures carried out in the centre. Yearly occupational dose to the cardiologists was much lower than the relevant statutory dose limits. The mean skin dose, fluoroscopy time and DAP to patients were 0.81 Gy, 67 min and 123 Gycm(2), respectively, with a maximum of 3.2 Gy, 164 minutes and 430 Gycm(2), respectively. Mean effective dose to patients was 17 mSv, from which the excess risk of developing fatal cancer is 0.1%. Six of the patients (12%) received a skin dose above the threshold dose for radiation skin injury (2 Gy), but no skin injuries were reported. Patient skin dose and DAP were closely correlated and this allows DAP to be used to monitor patient skin dose in real-time. DAP levels were locally adopted as diagnostic reference levels (DRLs) that provide an indication during a procedure that a patient is at risk of suffering deterministic skin injury.

Introduction: The use of artificial intelligence (AI) in medical imaging and radiotherapy has been met with both scepticism and excitement. However, clinical integration of AI is already well-underway. Many authors have recently reported on the AI knowledge and perceptions of radiologists/medical staff and students however there is a paucity of information regarding radiographers. Published literature agrees that AI is likely to have significant impact on radiology practice. As radiographers are at the forefront of radiology service delivery, an awareness of the current level of their perceived knowledge, skills, and confidence in AI is essential to identify any educational needs necessary for successful adoption into practice.Aim: The aim of this survey was to determine the perceived knowledge, skills, and confidence in AI amongst UK radiographers and highlight priorities for educational provisions to support a digital healthcare ecosystem.Methods: A survey was created on Qualtrics® and promoted via social media (Twitter®/LinkedIn®). This survey was open to all UK radiographers, including students and retired radiographers. Participants were recruited by convenience, snowball sampling. Demographic information was gathered as well as data on the perceived, self-reported, knowledge, skills, and confidence in AI of respondents. Insight into what the participants understand by the term “AI” was gained by means of a free text response. Quantitative analysis was performed using SPSS® and qualitative thematic analysis was performed on NVivo®.Results: Four hundred and eleven responses were collected (80% from diagnostic radiography and 20% from a radiotherapy background), broadly representative of the workforce distribution in the UK. Although many respondents stated that they understood the concept of AI in general (78.7% for diagnostic and 52.1% for therapeutic radiography respondents, respectively) there was a notable lack of sufficient knowledge of AI principles, understanding of AI terminology, skills, and confidence in the use of AI technology. Many participants, 57% of diagnostic and 49% radiotherapy respondents, do not feel adequately trained to implement AI in the clinical setting. Furthermore 52% and 64%, respectively, said they have not developed any skill in AI whilst 62% and 55%, respectively, stated that there is not enough AI training for radiographers. The majority of the respondents indicate that there is an urgent need for further education (77.4% of diagnostic and 73.9% of therapeutic radiographers feeling they have not had adequate training in AI), with many respondents stating that they had to educate themselves to gain some basic AI skills. Notable correlations between confidence in working with AI and gender, age, and highest qualification were reported.Conclusion: Knowledge of AI terminology, principles, and applications by healthcare practitioners is necessary for adoption and integration of AI applications. The results of this survey highlight the perceived lack of knowledge, skills, and confidence for radiographers in applying AI solutions but also underline the need for formalised education on AI to prepare the current and prospective workforce for the upcoming clinical integration of AI in healthcare, to safely and efficiently navigate a digital future. Focus should be given on different needs of learners depending on age, gender, and highest qualification to ensure optimal integration.

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To maintain normal cellular and physiological function, sufficient oxygen is required. Recently, evidence has suggested that hypoxia, either pathological or environmental, may influence bone health. It appears that bone cells are distinctly responsive to hypoxic stimuli; for better or worse, this is still yet to be elucidated. Hypoxia has been shown to offer potentially therapeutic effects for bone by inducing an osteogenic-angiogenic response, although, others have noted excessive osteoclastic bone resorption instead. Much evidence suggests that the hypoxic-inducible pathway is integral in mediating the changes in bone metabolism. Furthermore, many factors associated with hypoxia including changes in energy metabolism, acid-base balance and the increased generation of reactive oxygen species, are known to influence bone metabolism. This review aims to examine some of the putative mechanisms responsible for hypoxic-induced alterations of bone metabolism, with regard to osteoclasts and osteoblasts, both positive and negative.

Paediatric cardiac catheterizations may result in the administration of substantial amounts of iodinated contrast media and ionizing radiation. The aim of this work was to investigate the effect of iodinated contrast media in combination with in vitro and in vivo X-ray radiation on lymphocyte DNA. Six concentrations of iodine (15, 17.5, 30, 35, 45, and 52.5 mg of iodine per mL blood) represented volumes of iodinated contrast media used in the clinical setting. Blood obtained from healthy volunteers was mixed with iodinated contrast media and exposed to radiation doses commonly used in paediatric cardiac catheterizations (0 mGy, 70 mGy, 140 mGy, 250 mGy and 450 mGy). Control samples contained no iodine. For in vivo experimentation, pre and post blood samples were collected from children undergoing cardiac catheterization, receiving iodine concentrations of up to 51 mg of iodine per mL blood and radiation doses of up to 400 mGy. Fluorescence microscopy was performed to assess γH2AX-foci induction, which corresponded to the number of DNA double-strand breaks. The presence of iodine in vitro resulted in significant increases of DNA double-strand breaks beyond that induced by radiation for ≥ 17.5 mg/mL iodine to blood. The in vivo effects of contrast media on children undergoing cardiac catheterization resulted in a 19% increase in DNA double-strand breaks in children receiving an average concentration of 19 mg/mL iodine to blood. A larger investigation is required to provide further information of the potential benefit of lowering the amount of iodinated contrast media received during X-ray radiation investigations.

Collective dose for cardio-angiography studies is the highest of all non-CT radiological investigations. Deterministic effects such as erythema, epilation and ulceration being reported on patients who have undergone these procedures emphasise the importance of optimising radiation dose, whilst not compromising diagnostic efficacy. This study investigated radiation doses delivered to patients for four common types of cardiac radiological examinations: coronary angiography (CA), percutaneous coronary intervention (PCI), coronary angiograms (which were followed by an interventional procedure (CA-PCI)) and permanent pacemaker insertions (PPIs). 21 cardiac imaging suites participated in the study in 14 hospitals, representing 90% of relevant centres within Ireland. Radiation dose was monitored for 1804 adult patients using dose-area product meters. Operational and examination details, such as cardiologist grade, patient details, examination complexity and exposure factors, were recorded for each examination. Variation factors in dose between centres ranged from 2.7 to 11.1, but these factors were not higher than intrahospital variations previously recorded for other examinations within Ireland, such as chest X-ray. High-dose centres were often associated with long screening times, a high patient body mass index and complexity of the procedure. Preliminary dose reference levels (DRLs) were established using rounded third quartile values at 4200 cGy cm(2), 8400 cGy cm(2), 10,700 cGy cm(2) and 2100 cGy cm(2) for CA, PCI, CA-PCI and PPI, respectively. With these commonly performed relatively high-dose procedures, it is important that some guideline values are available to encourage optimised strategies. These proposed DRLs offer such guidance.

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