the lower limb radiograph is an extremely common request with trauma and the practising radiographer requires familiarity with normal and abnormal appearances. normal variations in anatomy and the variable ossification centres often lead to some confusion. recognition of a haemarthrosis at the knee is clinically very useful and especially with tibial plateau fractures. suggestions for recognition of calcaneal fractures (boehler's angle) and midfoot/forefoot dislocations are illustrated.

This paper will explore the radiographer's role within the chain of evidence when imaging children suspected of having received non-accidental injuries (NAI). Although other authors have addressed technical issues in relation to NAI, no one has specifically focused on the radiographer's unique role in relation to their contribution to the chain of evidence or on the fact that radiographers may be required to attend Court proceedings at a later date.

ultrasound serves as an essential adjunct to mammography and clinical examination in symptomatic breast evaluation and is the initial imaging modality of choice in some patient groups.

in this review the role of ultrasound in the assessment of the symptomatic breast is discussed and examples of a variety of breast pathologies illustrated.

the aim of this study was to establish whether hydration prior to radiopharmaceutical injection, in addition to post injection hydration, contributed any value to image quality during bone scintigraphy. two hundred patients referred for bone imaging over a four month period were randomised into two groups. group a was issued with instructions to hydrate pre and post injection, and group b was only advised to hydrate between injection and scan. equal regions of interest (roi) were then drawn on each image: firstly over the femoral diaphysis, and secondly over the contra-lateral adductor area. the total number of gamma counts from the bone roi and the soft tissue roi was then expressed as a ratio, and a mean value for each group was established.

the mean ratio for group a was found to be 2.25, and for group b 2.30. a t test of variance confirmed that there was no statistical difference between the ratios of the groups (t = 50.272, n = 5100, p = 50.618). it was concluded that hydration levels prior to bone scintigraphy injection, where it is preserved post injection, have no significant effect on the bone-soft tissue (b:st) ratio in the image.

the nature of professional expertise has been widely debated in the literature. however it has been examined primarily from a dichotomy of perspectives – either from an experiential or a cognitive focus, without the attempt to integrate these, and other aspects of expertise into an integrated and coherent model. this article series explicates the nature of professional expertise specifically in the field of medical imaging. it represents a section of the outcomes of a larger study which formulated and illustrated an integrated model of professional expertise also applicable to other professions. it has been written in two parts, part i of which overviews the study and presents two of the five aspects of expertise identified. part ii presents the other three aspects.

the study used data gathered from interviews and critical incident recording from expert medical imaging practitioners in auckland, new zealand, over an extended time frame.

findings showed that while expertise is situated in the context of practice, it incorporates several dimensions working together in an integrated, seamless fashion through the medium of the individual practitioner. the participants identified and illustrated that expertise in medical imaging is a synthesis of a particular knowledge base, the cognitive processes, personality and internal processes of the practitioner. it manifests through, and builds on, interpersonal relationships with patients and other professionals, and is expressed through the actual doing of professional practice. it is through the reflexive examination of practice and management of change that professionals may transform these integrated aspects into the qualitative state of expertise.

There is an increasing trend in higher education for institutions to view themselves as competitors. This has led to mounting pressures for each college and university to provide high quality courses in order to obtain a continuous supply of able students seeking entry. Quality in academic terms is a controversial concept, with different stakeholders each having their own view on what constitutes quality.

This study's primary objective was to design and implement a way of measuring the quality of the courses offered by a university department, in order to highlight areas in which additional funds need to be allocated to improve performance.

Following a review of literature on the subject, it was apparent that measurement of customer perceptions of quality is important in any service organisation. A questionnaire was therefore designed, based on Zeithaml et al's SERVQUAL instrument, to measure the difference between student expectations and perceptions of quality of service delivery.

The results indicate areas where the university is failing to meet student expectations and provide a framework for managers to use and redirect resources. In addition, measurement of customer perceptions of service quality can be used over a period of time to monitor the impact of quality improvement activities initiated through an organisation's strategic planning process.

Aim: This paper discusses the design, implementation and evaluation of an electronic version of an Objective Structured Clinical Examination (e-OSCE) for student assessment in undergraduate and postgraduate programmes in diagnostic imaging.

Assessment design: Web-authoring software and multimedia manipulation tools were used to design interactive web pages. The use of this software, in addition to the authors' experience of assessment, permitted the development of a dynamic environment rather than cross-application switching between various software packages.

Method and data collection: Over a 6 month period, the researchers participated as facilitators in six action research cycles of problem solving, involving 33 students. The students were either undergraduate diagnostic radiographers, or practitioners studying for a postgraduate qualification in medical ultrasound. Data was collected using the following sources inter alia; reflective diaries, invigilators' notes and observations during the assessment process and student evaluation forms.

Results: Each of the action research cycles resulted in the authors developing and further enhancing the overall design of the web e-OSCE, in terms of user-friendliness, interactivity and navigation facilities. Although students expressed initial anxieties, they rated their overall experience positively.

Conclusion: Ultimately, this form of assessment is considered to be cost effective in terms of staff and equipment resources, as well as student preference. The researchers would recommend the use of e-OSCEs as an effective means of assessing various learning outcomes, at differing academic levels, in both undergraduate and postgraduate imaging programmes.

this qualitative study investigated multiple sclerosis (ms) patients' holistic experience of magnetic resonance imaging (mri). with support from the ms society, eight individuals with ms were interviewed using unstructured, tape-recorded interviews.

the holistic experience was overall a negative one. the most negative aspects being cited as the lack of support and information around the time of diagnosis. the loss of control felt by individuals was also an import ant issue, which led patients to pursue self-empowerment by actively seeking out information and support.

the study suggests improvement in information to patients attending for mri is essential, along with adequate support (including details about the ms society) being offered at the time of receiving confirmed diagnosis and results. the study shows that for some patients, there is a long lasting negative effect from the scan, which impacts on other activities, as well as affecting the patients' willingness to undergo future imaging.

a rare case of axillary artery injury following a displaced surgical neck of humerus fracture is presented. the epidemiology and pathoanatomy of the condition are described. a literature review is presented emphasising the need for prompt diagnosis and treatment.

this article describes a system for reviewing reporting discrepancies encountered in our department. this system has been in operation for two years and its aim was to learn from errors being encountered. it was introduced as part of our department's approach to clinical governance.

within the health care sector there is a renewed emphasis on the satisfaction of patients and their involvement in its' evaluation. there is also some evidence to suggest that the expectations of patients play a fundamental part in forming this satisfaction. this study aimed to establish the expectations of bone scan patients who attended a nuclear medicine department and consequently measured their satisfaction after the visit. a possible link between the two was assessed. a questionnaire survey was undertaken to assess the patients' expectations prior to their visit and subsequently their satisfaction after their scan. the questionnaires included comment sections to encourage the addition of free text to the questionnaires by the patients. a total of 181 patients were included in the analysis which provided a range of expectations, with most patients expressing high importance to those expectations. generally satisfaction was found to be high. statistical analysis of the results showed a significant positive correlation between the expectations of patients and their satisfaction. the expectations of patients may therefore be targeted by health professionals in their attempts to provide the care patients need and deserve.

Medical Imaging students work under the close supervision of qualified Medical Radiation Technologists (MRTs), or Radiographers. In the New Zealand setting, some MRTs are formally appointed as clinical tutors by an educational institution providing medical imaging education, while others are senior staff who have supervision and some aspects of assessment incorporated within their job role. This article proposes a model of clinical supervision that supports and extends medical imaging students at their clinical placement.

The model includes discussion relating to modes, scope, boundaries and relationships within clinical supervision, and also outlines important aspects within the actual process of supervision. This includes teaching, assessment and feedback.

The model maintains the importance of critical analysis, clinical reasoning and reflection within the supervision relationship. It focuses on a form of professional practice and teaching which encourages the development of professional, adaptable MRTs, who have the ability to incorporate principles and theories into their practice.

Background: Approximately one in seven of the British population has some degree of hearing loss. Studies have found that the deaf or hard of hearing often find communication in a health setting unsatisfactory. The aim of this study was to investigate the experiences of deaf people in the diagnostic imaging department.

Methods: A semi-structured interview technique was used with small numbers of radiographers and deaf patients. Transcripts were analysed using thematic content analysis.

Results: Deaf patients experienced difficulties at reception and with the system for calling patients. Examinations that required the patient to follow verbal instructions caused communication problems for both patients and radiographers. A high proportion of the deaf subjects had had an MRI scan, and nearly all of them found this a distressing experience. Radiographers had some awareness of communicating with the deaf, although nearly all significantly overestimated the percentage of words understood by patients who lip-read.

Conclusion: Patients experienced problems with communication. In some cases these were such that informed consent may not have been given. Recommendations made for future practice include deaf awareness training for all staff, the installation of equipment that gives visual signals for breath holding, and extra time allowed for explanation to deaf patients before imaging procedures.

the challenge of making life better for the paediatric oncology patient by correctly identifying the specific psychosocial needs of the individual patient is dealt with in this paper. among the topics discussed are the inclusion of the patient's parents in this process, the role of therapeutic play, and the use of a pain scale as a successful intervention. stein's understanding of empathy is dealt with in some detail.

aims: 1. compare memory ability between ct and mri radiographers using the rey auditory verbal learning test (ravlt) and between mri radiographers working with 1 and 1.5tesla (t) scanners. 2. investigate the change in memory ability (as measured by ravlt) with increasing time worked in mri.

subjects: 11 ct and mri radiographers from four hospital sites were included. each worked exclusively in their modality. ravlt was administered once to each subject. results show no significant difference between mri and ct groups' scores. there were significantly lower scores in subjects who worked more than 5 years in mri and subjects who worked with 1.5t scanners.

the results indicate that static magnetic fields may have a detrimental effect on memory ability. these results indicate the need for further research into the neuropsychological effects of the mri environment on occupationally exposed staff.

this paper describes some radiological features of osteogenesis imperfecta and temporary brittle bone disease. both conditions cause fractures in early childhood that the parents cannot explain. they can underlie the finding of unsuspected fractures when x-rays are done for other reasons, including fractures of different ages. both can readily be confused with non-accidental injury.

in these disorders any type of fracture can occur; no fracture pattern makes bone disease more or less likely. metaphyseal fractures, often regarded as specific for non-accidental injury, also have a wide range of other causes including several bone diseases. osteopenia cannot be reliably used in diagnosis, not least because it can be absent in some bone diseases such as osteogenesis imperfecta. wormian bones, if present in excess, are a valuable pointer to osteogenesis imperfecta but their absence does not eliminate this diagnosis.

there is growing evidence for the identification of temporary brittle bone disease as a distinctive disorder with its own characteristic clinical and radiological findings.