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Radiology Article
Review Article
Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence
Corresponding author: Dr Richard E Pow, Faculty of Health Sciences, The University of Sydney, NSW
Diagnostic error in radiology is not uncommon, with rates of clinically significant error reported to be as high as 20%. Radiological errors are often multi-factorial,
however, perceptual factors are thought to be mainly responsible. One way of reducing perceptual error is that of double reporting, which refers to the interpretation of
radiological investigations by two observers, with strategies of arbitration and consensus available to settle discordant reports. Independent double reporting, where
observers have no knowledge of each other’s reports, is generally considered to be the most effective form. The impact of double reporting on diagnostic efficacy has been
primarily explored in screening mammography, where it has consistently been shown to improve sensitivity, cancer detection rate and depending on local policy, have a
positive influence on recall rates. Subsequently, the adoption of double reporting is reported as standard practice in many national and regional breast cancer-screening
programmes. To a lesser extent, the impact of double reporting has also been investigated for neuroradiology, thoracic and gastrointestinal imaging, with small-scale
studies in these fields showing promising results. With the widespread implementation of digitisation and the ease of access to images, the efficacy and cost-effectiveness
of double reporting for other common radiological investigations requires attention. The review will evaluate the evidence regarding the effect of double interpretation of
diagnostic imaging studies on test accuracy.
Radiology Article
Pictorial Essay
Imaging of tarsal navicular stress injury with a focus on MRI: A pictorial essay
Corresponding author: Dr Guy Harris, Radiology Department, Concord Hospital, NSW
Predominantly diagnosed in athletes, stress fracture of the tarsal navicular is becoming increasingly recognised by clinicians as a cause of midfoot pain. Delayed diagnosis
can increase the significant morbidity associated with this condition. Consequently the role of MRI is increasing, given the potential to identify a stress reaction in the
navicular prior to the development of a discrete stress fracture. It is necessary for radiologists to be familiar with the typical and atypical appearances of this important
condition.
Radiation Oncology Article
Original Article
Definitive intensity-modulated radiotherapy concurrent with systemic therapy for oropharyngeal
squamous cell carcinoma: Outcomes from an integrated regional Australian cancer centre
Corresponding author: Dr Reza Masoud Rahbari, North Coast Cancer Institute Lismore, Radiation Oncology, NSW
Introduction: Oropharyngeal squamous cell carcinoma (OPSCC) incidence has increased over the past two decades largely because of an increase in human papilloma virus
(HPV)-related OPSCC. We report here outcomes of definitive radiation therapy for OPSCC with simultaneous integrated boost intensity-modulated radiotherapy (IMRT)
in a regional Australian cancer centre.
Methods: We retrospectively reviewed electronic medical records (EMR) of all patients treated with IMRT for head and neck cancer. We included patients who received a
curative intent IMRT for OPSCC (2010–2014).
Results: Of 61 patients, 80% were men, and the median age was 57 years. Ninety percent of our patients received concurrent systemic therapy, and 68% were p16 positive.
The median radiotherapy dose received was 70Gy in 35 fractions. The median follow up for surviving patients was 22 months. Twenty-four month actuarial data show that
the loco-regional recurrence free, metastasis-free MFS, cancer-specific (CaSS) and overall survival percentages were 98.3%, 92.6%, 91% and 90.3%, respectively. We did
not observe grades 4 or 5 acute or late toxicities, and 10 patients (16.2%) exhibited persistent grade 3 toxicity 6 months after completing the treatment.
Conclusion: The results from curative IMRTs for OPSCC delivered in a regional cancer centre are comparable with results published by tertiary referral centres. A long-term
follow up of this patient cohort will continue for further analyses and comparisons with tertiary centres.
Radiation Oncology Article
Original Article
What is the viva experience of phase 2 Radiation Oncology examination candidates? Survey and advice for future candidates
Corresponding author: Dr Hilde M Kleiven, The Canberra Hospital, Garran, ACT
Introduction: Medical speciality examination is a very stressful event in medical careers. We aimed to determine the subjective experience of Radiation Oncology Royal
Australian and New Zealand College of Radiologists (RANZCR) oral examination candidates. It was hoped the results would provide reassurance and advice for future
candidates.
Methods: We distributed an anonymous online survey through the RANZCR membership database to Radiation Oncology Trainees and fellows who may have sat their oral
examination within the last 3 years.
Results: There were 21 responses, yielding a response rate of 21%. Nineteen percent of respondents were moderately or very surprised during their viva and the most
frequently noted cause was the demeanour of the examiners. The clinical cases and clinical examination station were rated very fair by over 80% of responders while the
planning cases were rated very fair by 57%. During the viva, 33% thought they passed and 71% of these candidates were successful. Forty-three percent felt they were
borderline, and all of these respondents passed. Five participants (24%) failed in the first attempt and four described being unable to convey their actual knowledge.
Candidates found mock examinations to be the most useful examination preparation activity. The most frequently given advice was to focus on the planning examination.
Conclusions: The majority of this select group of candidates indicated that the oral examination cases were very fair. Candidates rated the planning exam as least fair,
indicating this may be the area that would benefit most from better preparation.
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