The Department has the following ongoing Research Projects:
Ms Karen Borg Grima – Assistant Lecturer
This research is being held as part of Ms Grima’s Ph.D. studies at University College Dublin (UCD) under the supervision of Dr
Louise Rainford (UCD), Dr Desiree O’Leary (UCD) and Dr Paul Bezzina (UM).
Overall research question:
To investigate whether a set of researched clinical criteria can aid to determine the type of stress testing, that would give the best diagnostic results for patients requested to perform a Technetium-99m MIBI SPECT stress scan.
Underlying research aims:
Background to the area of study:
An article in the newspaper ‘Malta Independent’, based on the most recent annual mortality report, highlighted the fact that 40% of the total number of registered deaths in 2008 in Malta, were due to diseases of the circulatory system, such as ischaemic heart disease, stroke and heart failure. Apart from this, local statistics indicate that at least 1069 new angiographic procedures are done yearly within the main general hospital, the majority of which cases would be sent at a later stage for a Tc-99m MIBI SPECT stress scan, in order for the cardiologist to evaluate the overall perfusion state of the myocardium and to determine patient prognosis.
Due to the urgent nature of their condition these cardiac cases, should ideally be given priority appointments, yet busy units, such as the Nuclear Medicine section, have a considerable throughput of patients daily other then cardiac cases. Therefore any system, protocol or technique proven to target better patient prognosis and reduce appointment periods would be of critical importance and welcome within the clinical setting.
Currently cardiac patients requested for a scintigraphy SPECT stress test, may either undergo the pharmacological stress test or the treadmill E.C.G stress test. The decision on which of these two tests to perform is purely on the basis of whether the patient is mobile or not, and if he or she is suffering from asthma or severe bronchitis, in which cases pharmacological stress testing is contraindicated. There appears to be no protocol on how patients should be selected for either of these two stress tests based on their clinical situation and previous medical results. This may indicate that patients who are not managing to reach peak activity during the treadmill stress tests may in reality not be undergoing the ideal test for the best prognostic results.
In contrast to the above debate, literature has suggested for many years that the results of myocardial perfusion scintigraphy may be unsatisfactory if the level of exercise achieved by the patient is insufficient (2). Thus although 99mTc-Sestamibi stress SPECT MPS provides incremental information for prognostic evaluation of patients with suspected or diagnosed CAD, future research should focus on identifying high risk subsets within this group, with a set of clinical criteria such as maybe blood test results (3 ; 4). Categorising such cardiac patients prior to their scintigraphy stress test may ensure that each risk group of patients undergoes the best stress test for their clinical scenario whilst for each case aggressive secondary preventive measures can be instituted to prevent future hard cardiac events (3).
Mr Pierre Demicoli – Teaching Assistant
Ultrasound is routinely done during pregnancy and is useful in monitoring foetal development and maternal well-being. In addition, visualization of the foetus during the ultrasound examination may enhance the parental-foetal bonding process. Parental-foetal bonding refers to the connection parents feel towards their foetus and is an important predictor of the relationship that the parents would eventually have with their child later on in
life. Nowadays this process is said to be facilitated with 4D ultrasound. However, further studies are required to investigate and establish this relationship. 4D ultrasound examinations are not routinely performed at the only general state hospital in Malta, but are only performed in cases of suspected foetal malformations. On the other hand, parents who can afford to pay for such an examination may decide to undergo this examination at a private hospital or clinic. If it is proven that 4D ultrasound is helping parents to establish a stronger bond with their foetus, then, those who may not afford to pay end up being at a disadvantage.
This is what mainly inspired the researcher to perform this research study and, unlike many other performed studies in the field, the researcher opted to explore the paternal aspect as well.
The research design used in this study is mainly qualitative in nature but some elements of quantification are also included. Fifty (50) couples having a singleton pregnancy with unremarkable medical histories were included in the sample. Half of the sample (group 1) consisted of parents performing only a 2D foetal ultrasound examination, while the other half (group 2) were couples who had both the routine 2D and 4D ultrasound scan done.
Results showed that ultrasound in general activated emotions on the parents towards the foetus and triggered the parental-foetal bonding process irrespective of gender and ultrasound technique used. However, this seemed to be more apparent on the parents in group 2 and hence, it seemed that 4D ultrasound enhanced the parental-foetal bond further. In conclusion, the results obtained in this study were based on such a small sample that they may only be interpreted as providing a picture of the effect that 2D and 4D ultrasound had on parental-foetal bonding in the investigated parents. Hence, for more definite conclusions, further research in the field is required and recommendations in this sense are therefore put forward.
Ms Connie Falzon – Assistant Lecturer
Mammography is the standard procedure that is used in the diagnosis of breast cancer. Despite its beneficial effects, it has also been associated with psychological distress in women attending for a mammogram. Maltese women are very conscious of breast cancer and almost everyone knows someone who was diagnosed with the disease. Consequently a vast number of women are referred for a mammogram for reassurance. Whether these women are anxious or not is not known. This unknown factor motivated the author to undertake the study to ascertain whether or not Maltese women were psychologically anxious when they attend for a mammogram.
The study involved the participation of 150 Maltese women aged 35 years and over who attended for a mammogram at the main NHS hospital on the Islands. The women were equally divided into two groups. Each individual group consisted of 75 women either without family history or with a family history of breast cancer. Anxiety levels immediately before and immediately after the mammogram were measured using the State and Trait Inventory for Adults developed by C.D. Spielberger. A quantitative cross-sectional non-experimental design was used to analyse the State (S-anxiety) anxiety of the women. The Paired Sample Test, the one way ANOVA and the Pearson Correlation were used to analyse the data collated.
Statistical analysis showed that Maltese women in both groups were significantly more anxious before than after the procedure. A positive correlation existed between their pre and post mean S-anxiety levels. When the two groups were compared between each other it resulted in no significant difference between their mean S-anxiety levels. A negative relationship existed between the women’s age and their S-anxiety levels. Based on the data obtained the researcher concluded that Maltese women were anxious because of the procedure, irrespective of whether they had a family history or not. There was no difference in the anxiety levels of the two groups when compared to each other. It was also concluded that if the women were anxious before the procedure they remained anxious after the procedure. From the correlation analysis it transpired that the younger the women were, the more anxious they felt.
Mr Jonathan Portelli – Assistant Lecturer
Despite the great benefits pertaining to the early diagnosis and treatment of various conditions, the increased use of higher radiation dose examinations in children has also raised many concerns about the associated cancer risks that may be involved. This matter is not aided by the fact that research evidence is suggesting that health professionals generally underestimate or lack knowledge of radiation doses and risks associated with medical imaging examinations they request and/or perform. This is of concern, particularly since prescribers and practitioners are bound by National and European regulations to 'justify' every single medical exposure, meaning that they should weigh the benefits and risks of the examination in order to decide as to whether performing the examination would be in the best interest of the patient. Consequently, prescribers and practitioners should also provide the patient with an explanation of the benefits and risks associated with any medical exposure while obtaining consent to perform such an examination, but research evidence suggests that this does not always happen in practice as health professionals do not always convey risk-related information or they prefer to be ‘economical with the truth' in order not to cause the patient undue anxiety.
This proposed research study will adopt a mixed methodology research approach to provide a foundation for a body of knowledge to be built with regards to the estimated radiation doses and associated risks in children undergoing higher dose medical imaging examinations in Malta. This study will seek to assess the level of awareness amongst local health professionals with regards to radiation doses and associated risks of higher dose medical imaging examinations performed on paediatrics locally. In addition, the study will seek to obtain a comprehensive understanding of practices, procedures and experiences of risk communication and consent, which can serve as a resource to recommend a practical and patient-centred framework for consenting procedures related to paediatric patients undergoing higher radiation dose procedures.
This research is being held as part of Mr Portelli’s Ph.D. studies at University College Dublin (UCD) under the supervision of: Dr Louise Rainford (UCD), Mr Jonathan McNulty (UCD) and Dr Paul Bezzina (UM).
Mr Francis Zarb – Assistant Lecturer
This research is being held as part of Mr Zarb’s Ph.D. studies at University College Dublin (UCD) under the supervision of: Dr Louise Rainford (UCD), Dr Mark Mc Entee (University of Sydney) and Dr Paul Bezzina (UM).
The rapid technological advancements and new imaging techniques in CT focused on the quest for increased image quality and increased diagnostic accuracy. Concerns on radiation dose might have been underrated in the process. Further research into the complex relationship between radiation dose, image quality and diagnostic accuracy has been recommended in several publications. Such research is needed to establish scientifically the minimum radiation dose necessary to provide adequate diagnosis in answer to the posed clinical question.
The 97/43/Euratom Directive highlights the 3 basic processes of radiation protection: Justification, Optimization and Diagnostic Reference Levels (DRLs) which have to be applied to the various CT units throughout the country. The establishment of local DRLs in CT is important as DRLs provide a simple means of identifying situations where the levels of patient dose is unusually high and hence indicate when consideration of dose reducing measures (optimization) should be made with the impact of dose optimization being shown with changes in DRLs. However, the focus should not be on just minimizing the radiation dose but to which level can dose optimization be achieved without compromising diagnostic efficacy.
Studies performed to investigate the effect of measures in reducing the radiation dose and their effect on image quality have either tackled specific CT scan parameters individually or measured the effect on image quality by using phantoms. However phantom studies alone may not necessarily reflect the true quality characteristics of the CT image in representing anatomical structures.
This study aims to first identify current DRL values for Malta and then investigate optimization potential by evaluating the effects of optimized CT scan protocols based on combined changes of CT scan parameters. The effect of the combined changes of scan parameters on image quality and dose are gauged from phantom studies followed by animal studies before being implemented and evaluated in clinical practice.
