ORCID Profile
0000-0001-6460-2594
Current Organisations
University of Newcastle Australia
,
CNRS en Alpes
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Publisher: American Geophysical Union (AGU)
Date: 03-2020
DOI: 10.1029/2019JC015284
Abstract: Oceanic density currents in many deep‐water channels are strongly influenced by the Coriolis force. The dynamics of the bottom boundary layer in large geostrophic flows and low Rossby number turbidity currents are very important for determining the erosion and deposition of sediment in channelized contourite currents and many large‐scale turbidity currents. However, these bottom boundary layers are notoriously difficult to resolve with oceanic field measurements or in previous small‐scale rotating laboratory experiments. We present results from a large, 13‐m diameter, rotating laboratory platform that is able to achieve both stratified and highly turbulent flows in regimes where the rotation is sufficiently rapid that the Coriolis force can potentially dominate. By resolving the dynamics of the turbulent bottom boundary in straight and sinuous channel sections, we find that the Coriolis force can overcome centrifugal force to switch the direction of near‐bed flows in channel bends. This occurs for positive Rossby numbers less than +0.8, defined as Ro R = /Rf , where is the depth and time‐averaged velocity, R is the radius of channel curvature, and f is the Coriolis parameter. Density and velocity fields decoupled in channel bends, with the densest fluid of the gravity current being deflected to the outer bend of the channel by the centrifugal force, while the location of velocity maximum shifted with the Coriolis force, leading to asymmetries between left‐ and right‐turning bends. These observations of Coriolis effects on gravity currents are synthesized into a model of how sedimentary structures might evolve in sinuous turbidity current channels at various latitudes.
Publisher: Wiley
Date: 14-03-2022
DOI: 10.1002/JMRS.574
Abstract: Adaptive communication is an essential requirement to deliver quality patient‐centred care. Determining patients’ informational needs and acting on the needs are skills radiation therapists (RTs) employ daily with patients. Learning health literacy (HL) strategies to assist with the informational delivery provides RTs with options to improve patients’ understanding of vital radiotherapy treatment information or tasks. This research investigates the lived experiences of RTs from the Illawarra and Shoalhaven Cancer Care Centres in Australia using HL strategies during patient interactions after undertaking HL training workshops. An interpretative phenomenological analysis (IPA) approach was used. Audio‐recorded semi‐structured interviews were conducted with six RTs. Two reviewers analysed each interview script separately before discussing and constructing substantive and sub‐themes. Four substantive themes were constructed: RT personal attitudes and responses to HL, HL strategies used by RTs, patient associated HL needs and barriers when addressing patient HL needs. RTs were either person‐ or process‐focussed during patient interactions. It was identified that information is provided to patients according to how RTs themselves like to learn new information. This research has allowed an opportunity to inquire into the lived experiences of RTs implementing HL strategies when providing information to patients. While RTs may be person or process‐focussed, the patient’s needs are always prioritised when providing information, which ultimately results in patient understanding and increased engagement.
Publisher: Wiley
Date: 07-02-2023
DOI: 10.1002/JMRS.651
Abstract: Magnetic resonance imaging (MRI) demonstrates superior soft tissue contrast and is increasingly being used in radiotherapy planning. This study evaluated the impact of an education workshop in minimising inter‐observer variation (IOV) for nasopharyngeal organs at risk (OAR) delineation on MRI. Ten observers delineated 14 OARs on 4 retrospective nasopharyngeal MRI data sets. Standard contouring guidelines were provided pre‐workshop. Following an education workshop on MRI OAR delineation, observers blinded to their original contours repeated the 14 OAR delineations. For comparison, reference volumes were delineated by two head and neck radiation oncologists. IOV was evaluated using dice similarity coefficient (DSC), Hausdorff distance (HD) and relative volume. Location of largest deviations was evaluated with centroid values. Observer confidence pre‐ and post‐workshop was also recorded using a 6‐point Likert scale. The workshop was deemed beneficial for an OAR if ≥50% of observers mean scores improved in any metric and ≥50% of observers' confidence improved. All OARs had ≥50% of observers improve in at least one metric. Base of tongue, larynx, spinal cord and right temporal lobe were the only OARs achieving a mean DSC score of ≥0.7. Base of tongue, left and right lacrimal glands, larynx, left optic nerve and right parotid gland all exhibited statistically significant HD improvements post‐workshop ( P 0.05). Brainstem and left and right temporal lobes all had statistically significant relative volume improvements post‐workshop ( P 0.05). Post‐workshop observer confidence improvement was observed for all OARs ( P 0.001). The educational workshop reduced IOV and improved observers' confidence when delineating nasopharyngeal OARs on MRI.
Publisher: Wiley
Date: 07-12-2021
DOI: 10.1002/JMRS.453
Abstract: Conventionally computed tomography (CT) has been used to delineate target volumes in radiotherapy however, magnetic resonance imaging (MRI) is being continually integrated into clinical practice therefore, the investigation into targets derived from MRI is warranted. The purpose of this study was to evaluate the impact of imaging modality (MRI vs. CT) and patient positioning (supine vs. prone) on planning target volumes (PTVs) and organs at risk (OARs) for partial breast irradiation (PBI). A retrospective data set, of 35 patients, was accessed where each patient had undergone MRI and CT imaging for tangential whole breast radiotherapy in both the supine and prone position. PTVs were defined from seroma cavity (SC) volumes delineated on each respective image, resulting in 4 PTVs per patient. PBI plans were generated with 6MV external beam radiotherapy (EBRT) using the TROG 06.02 protocol guidelines. A prescription of 38.5Gy in 10 fractions was used for all cases. The impact analysis of imaging modality and patient positioning included dose to PTVs, and OARs based on agreed criteria. Statistical analysis was conducted though Mann–Whitey U, Fisher’s exact and chi‐squared testing ( P 0.005). Twenty‐four patients were eligible for imaging analysis. However, positioning analysis could only be investigated on 19 of these data sets. No statistically significant difference was found in OAR doses based on imaging modality. Supine patient position resulted in lower contralateral breast dose (0.10Gy ± 0.35 vs. 0.33Gy ± 0.78, p = 0.011). Prone positioning resulted in a lower dose to ipsilateral lung volumes (10.85Gy ± 11.37 vs. 3.41Gy ± 3.93, P = .001). PBI plans with PTVs derived from MRI exhibited no clinically significant differences when compared to plans created from CT in relation to plan compliance and OAR dose. Patient position requires careful consideration regardless of imaging modality chosen. Although there was no proven superiority of MRI derived target volumes, it indicates that MRI could be considered for PBI target delineation.
Publisher: Wiley
Date: 20-07-2021
DOI: 10.1002/JMRS.531
Abstract: Gastrointestinal (GI) toxicities are common in patients receiving radiotherapy (RT) to the pelvis. This systematic review aims to evaluate the effectiveness of nutritional interventions involving dietary counselling (DC) on GI toxicities in patients receiving pelvic RT. The search method entailed two phases to retrieve studies. Articles from a previous Cochrane review by Lawrie et al. 2018 were assessed for inclusion. An updated systematic search was then conducted to retrieve articles published between 2013 and 2020 from five electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL and Scopus). The inclusion criteria entailed randomised controlled trials involving adults ≥18 years, undergoing curative pelvic RT, receiving a nutritional intervention involving DC with or without supplements. DC was defined as written or face-to-face dietary advice provided before or during RT. Outcomes included GI toxicities reported by validated assessment tools. The Academy of Nutrition and Dietetics Quality Criteria Checklist was utilised to assess quality and risk of bias. Of 1922 studies retrieved, 12 articles encompassing 11 in idual RCTs were included. Seven studies included a supplement in addition to DC. Supplements included probiotics, prebiotics, probiotic + soluble fibre, high protein liquid supplement and fat emulsion. Of the 11 studies, one involved in idualised DC, and the remaining studies prescribed consumption or avoidance of fats, fibre, lactose, protein and FODMAP. The most common toxicities reported were diarrhoea (n = 11), pain/cr ing (n = 9) and bloating/flatulence (n = 5). Three studies stated an improvement in diarrhoea incidence. Results varied between studies. Further quality studies are required to assess the effectiveness of DC, in particular in idualised DC on GI toxicities in patients receiving pelvic RT.
Publisher: Wiley
Date: 16-06-2021
DOI: 10.1002/JMRS.520
Abstract: Radiation therapist (RT) communication plays an essential part of patient‐centred care in achieving better patient outcomes within radiation oncology. Patients present from a range of social circumstances, education levels and cultural backgrounds, all of which may significantly impact their level of health literacy (HL). Using literature sourced from databases such as EMCare Nursing & Allied Health Database, MEDLINE(R) and APA PsycInfo, this narrative review explores HL definitions, international comparison rates and indications of in idual low HL. It also reviews HL assessments as well as exploring enablers and barriers to HL from the RT perspective. Strategies from both the in idual or organisational perspective are provided for RTs to begin or continue their HL interest. By educating the radiation therapy profession about health literacy and making small changes in interpersonal interactions, there is the opportunity to impact patients’ experiences and outcomes significantly.
Publisher: Elsevier BV
Date: 08-2011
Publisher: Elsevier BV
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 26-02-2020
Publisher: Wiley
Date: 10-08-2023
DOI: 10.1002/JMRS.713
Abstract: Radiation therapy treatment for breast cancer may negatively impact patients' health‐related quality of life. Evidence suggests exercise and nutrition interventions may be beneficial to patients experiencing compromised health‐related quality of life. This study investigates whether radiation oncology practitioners support the implementation of a tailored exercise and nutrition intervention for patients and explores their interest in participating in training for exercise and nutrition as interventions. Data were collected by an online survey, deployed to public and private radiation oncology departments, across three Australian states (Australian Capital Territory, New South Wales, Queensland). The survey was completed between June and August 2020. Radiation oncologists, radiation oncology registrars, radiation therapists and radiation oncology nurses completed the survey. The survey included demographics, patient assessment and questions regarding the radiation oncology practitioners' use of exercise and nutrition as interventions. Of 192 practitioners targeted, 76 completed the survey, for a response rate of 40%. Of 76 respondents, 42% ‘sometimes’ recommended exercise and 41% ‘sometimes’ recommended nutrition as health‐related quality of life interventions to their patients. The majority indicated they would benefit from more training in these subjects, with 58% for exercise and 55% for nutrition. 47 per cent of respondents thought patients would benefit from a tailored exercise and nutrition programme and 62% agreed they would refer patients to a programme if it were available. Radiation oncology practitioners reported they need training in exercise and nutrition to better understand how this can benefit the health‐related quality of life of breast cancer patients. Also, the findings indicate that if such an exercise and nutrition intervention were readily available, practitioners would refer patients who may benefit from this intervention.
Publisher: Wiley
Date: 18-06-2022
DOI: 10.1002/JMRS.602
Abstract: The magnitude and impact of rotational error is unclear in rectal cancer radiation therapy. This study evaluates rotational errors in rectal cancer patients, and investigates the feasibility of planning target volume (PTV) margin reduction to decrease organs at risk (OAR) irradiation. In this study, 10 patients with rectal cancer were retrospectively selected. Rotational errors were assessed through image registration of daily cone beam computed tomography (CBCT) and planning CT scans. Two reference treatment plans (TP R ) with PTV margins of 5 mm and 10 mm were generated for each patient. Pre‐determined rotational errors (±1°, ±3°, ±5°) were simulated to produce six manipulated treatment plans (TP M ) from each TP R . Differences in evaluated dose‐volume metrics between TP R and TP M of each rotation were compared using Wilcoxon Signed‐Rank Test. Clinical compliance was investigated for statistically significant dose‐volume metrics. Mean rotational errors in pitch, roll and yaw were −0.72 ± 1.81°, −0.04 ± 1.36° and 0.38 ± 0.96° respectively. Pitch resulted in the largest potential circumferential displacement of clinical target volume (CTV) at 1.42 ± 1.06 mm. Pre‐determined rotational errors resulted in statistically significant differences in CTV, small bowel, femoral heads and iliac crests ( P 0.05). Only small bowel and iliac crests failed clinical compliance, with majority in the PTV 10 mm margin group. Rotational errors affected clinical compliance for OAR dose but exerted minimal impact on CTV coverage even with reduced PTV margins. Both PTV margin reduction and rotational correction decreased irradiated volume of OAR. PTV margin reduction to 5 mm is feasible, and rotational corrections are recommended in rectal patients to further minimise OAR irradiation.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 28-06-2022
DOI: 10.1002/JMRS.605
Abstract: Head and neck cancer (HNC) patients are at risk of weight change, due to inadequate nutrition intake or dehydration, when receiving radiotherapy (RT). This study aimed to develop methodology to measure water content changes on magnetic resonance imaging (MRI) scans of the head and neck region over the course of RT. Retrospective datasets of 54 patients were analysed. Eligible patients had been treated for HNC with cisplatin chemoradiation (CRT) or RT alone and underwent a minimum of 2 MRI scans from weeks 0, 3 and 6 of their treatment. Anatomical regions consisting of ≥90% water, on T2‐weighted DIXON MRI sequences, were contoured. Water volume changes of all patients were evaluated, within an anatomically standardised external volume, by comparing the absolute water fraction volume (cc) (VEx90WF) and relative water fraction volume (%) (RelVEx90WF) at weeks 0 and 6 of RT. There was a statistically significant difference between the RelVEx90WF at weeks 0 and 6 ( P = 0.005). However, no statistically significant difference was identified between weeks 0 and 6 VEx90WF ( P = 0.064). There were no statistically significant differences identified between patients who received CRT versus RT alone. This study developed a novel method for measuring changes in water fraction volumes over time, using T2‐weighted DIXON MRIs. The methodology created in this study requires further validation through phantom imaging, with known fat and water values.
Publisher: Elsevier BV
Date: 08-2015
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.RADI.2021.10.002
Abstract: Radiation therapists must possess adaptable communication skills to manage patient-centred care and provide required technical information. Adaptive communication is also an expectation of undergraduate students to gain registration in Australia. The University Of Newcastle's Clinical Reasoning Module (CRM) prepares first-year radiation therapy students for clinical interactions. This research aims to reveal the lived experience of students after completing their first clinical placement. An interpretative phenomenological analysis (IPA) approach was the chosen methodology. Audio-recorded semi-structured interviews were conducted with first-year students who had completed the CRM and attended their first placement. Two independent reviewers analysed each data set separately before discussing and agreeing on, and arranging themes into clusters to reveal substantive and sub-themes. Four students were interviewed. Five substantive themes were revealed 'making sense of the CRM', 'the inner self',' the art of communication', 'the student as a learner' and 'clinical work'. Students' varied clinical experiences were evident, and the interviews allowed a de-brief mechanism. Students related the CRM to the clinical environment and revealed unexpected reactions and emotional responses during their placement. Ex les include disclosing the reluctance of patients to interact and talking about dying, which became their new normal. This review allowed an opportunity to inquire into the lived experiences of radiation therapy students navigating their way through the clinical environment. Differences between student's emotional intelligence and level of communication reflected their ability to make sense of their experiences in the clinical setting. While students appeared satisfied with the CRM in preparing them for clinical placement, providing regular de-brief sessions and reviewing clinical practice guidelines to better prepare for psycho-social issues encountered is recommended for overall student well-being.
Publisher: Elsevier BV
Date: 11-2016
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.RADI.2019.02.012
Abstract: Radiation therapy students need to demonstrate appropriate communication skills when entering the clinical environment. To assist students with preparation for their first clinical placement a clinical reasoning module comprising theory and practical sessions was developed. This paper describes the module and presents the results of student evaluations. The module consisted of lectures, observational role-play and participatory role-play. Students were ultimately tasked with providing information to a simulated patient (SP). Each student received feedback independently from the SP, peers and facilitator. At the conclusion of the module, students had the opportunity to provide feedback via an anonymous survey (8 Likert scale questions with space for written comment). Data was analysed both quantitatively and qualitatively. Four hundred and thirty seven students were enrolled in the course between 2008 and 2016 and the response rate of the survey was 93%. Even though most students reported some level of anxiety before and during the role-play sessions, the majority of students perceived all aspects of the module to be extremely/very useful. The most useful aspect of the module (Likert scale assessment) was the feedback provided by the SP. The two most important themes arising from the thematic analysis were gaining an understanding of the role of the radiation therapist and the complexities of patient interactions. Overall, the module was deemed successful with students becoming conscious of newly acquired clinical knowledge whilst acknowledging patient feelings during interactions. Collaborative critiquing contributed to students' ability to self-reflect to improve clinical interactions.
Publisher: Elsevier BV
Date: 11-2016
No related grants have been discovered for YOLANDA SURJAN.