PATIENT CARE IN RADIOLOGY DEPARTMENT.pptx

RADIOLOGY DEPARTMENT
SAFETY
RADIATION

1. Radiologist / Mohamed Abdel Aziz Abo Shanab Consultant of Radiology, Armed Forces Hospitals & Military Medical Academy [email protected] m Patient Care in Radiology Department

2. In health care community, the patient is the most important member. The effort of every member of the team should be directed to: Safety and well being Best possible care Least discomfort possible Minimal radiation exposure To patient

3. Patients are the entire reason we are here. Radiologists are health care specialists who have little contact with patients. While physicians use medical terminology , patients use everyday words, We need to speak the language of our patients.

4. Miscommunication between radiologist or radiographer and patient, is primarily responsible for many malpractice claims . It is our professional responsibility to communicate well. Satisfied customers are return customers & will become radiology’s “ambassadors.”

5. Time for a Change “It’s time we adjust our perception of how we see ourselves and, more importantly, how we’re seen by the medical community and general public . We need to vigorously promote ourselves in order to attract referrals from primary care physicians and those patients who are self-referred. We must change the perception that we are consultants only and demonstrate our ability to provide complete patient care .”

6. Putting Patients First Minimize delays Increase communication Create a welcoming environment of caring, responsive people

7. Reception Greeter during peak volumes Manage patient arrivals Improve waiting room environment Invite patients to inquire about delays

8. Enhance Visibility of Radiologists & Radiographer Get out in front! Post photos of radiology personnel in hospitals Include radiologists’ signatures on patient reports Give patients your card (with home phone!) Call your patients – make direct referrals.

9. Role of Radiologist Meet and greet Discuss results Make the radiologist connection with your patients Give radiologists a face and a value as part of the healthcare team Contact your referring physicians

10. Ask if the instructions given for preparations were correctly carried out or not. Enquire about any premedication given before starting the examination . Radiographer should read patient prescription ensure requested exam & consult radiologist in some cases . If X-ray techniques requires “special” positioning of the patient for some time after the examination (e.g. myelography ), In this case, send the patient to the ward in the semi sitting position for 6 hours , to avoid risk of convulsions if the contrast reach the basal subarachnoid spaces.

11. The patient has the right to know steps of the examination & duration , whether there are any possible complications to be expected and whether there are any medically significant risks involved. A written informed consent has to be signed by the patient himself before subjecting the patient to certain techniques that may involve substantial risks (e.g. angiographic procedures, imaging guided biopsy or drainage procedures).

12. Confidentiality & Privacy: If the patient has to be undressed for the examination, this should not be in front of every one walking through the X-Ray department. Gowns and sheets need to be available & clean. Doors should be kept closed to ensure privacy.

13. Female examination A chaperone should stand in a location where he or she is able to assist as needed and observe the examination, therapy or procedure. A chaperone may be a health care professional or a trained unlicensed staff member or medical assistants, nurses, technicians, therapists, residents, fellows or trained student. A chaperone may assist the health professional or provide support to the patient with personal hygiene , toileting or undressing/dressing requirements if requested by the patient.

14. A pregnant woman can undergo certain radiodiagnostic, radiotherapy and nuclear medicine procedures. It is necessary to ascertain if a woman is pregnant or likely to be pregnant in each case. Additional shielding and modification of techniques may be necessary. Cessation of certain activities by the mother (e.g. B reastfeeding, T ermination of pregnancy is not justified below 100 mSv foetal dose. ) may be required of the mother.

15. Discount It’s just advertising . More and more people know their medicines and compare prices. Occasionaly , it is offered for poor people and should not be advertised

16. Introduction to Radiation Protection in Diagnostic Radiology 16 Increasing use of radiation in medical applications worldwide More machines, etc New technologies and techniques New roles Increasing complexity in the planning & delivery of the radiation Single slice CT → Multi-Detector CT Film → Computed & Digital Radiography Hybrid imaging, PET-CT Image-guided interventional procedures Virtual procedures E.g. Changes in the role of imaging: First “port of call” A move towards “screening”, in all its guises E.g. IMRT, IGRT, etc.

17. 17 Natural background
3.1 mSv Medical exposure
3.0 mSv NCRP160 2009 U.S. annual per caput effective dose Increasing medical exposure

18. Principles of radiation protection Justification Optimization, Diagnostic reference levels (DRLs ), Dose (ALARA) Dose limitation The aim is to prevent harmful tissue reactions and to limit the probability of stochastic effects to acceptable levels In Practice: Unjustified examinations are ≈ 20-50% Optimization can bring down patient doses by about 50 % Radiographers have a key role to play

19. Radiation protection in Medical practice X-ray & Fluroscopy Careful selection of x-ray beam quality (tube voltage [kV]) and magnitude (tube current [ mA ] and exposure time [s]) enables good diagnostic images to be obtained whilst minimising patient dose This is optimisation Decreasing kV – less photons in beam and reduces mean photon energy (‘softens’ the beam) Decreasing mA – less photons in beam Reducing the x-ray field of view and the number of ‘shots’ will also reduce patient dose

20. Introduction to Radiation Protection in Diagnostic Radiology 20 Patient effective doses Depends on the radiological procedure, e.g . Radiography A few μSv to a few mSv CT A few mSv to tens of mSv Image-guided interventional procedures A few mSv to tens of mSv Skin doses up to several 1000 mSv NBR, 2.4 mSv LD 50 3000 - 5000 mSv Whole body dose X ray exams

21. In radiographic practice, does it happen? Unjustified exposures - Yes Wrong patient - Yes Wrong body part - Yes Lack of optimization - Yes Lack of calibration – Yes Lack of QA – Yes DRLs not used - Yes

22. Protective measures in Radiography Rooms Awareness & Training : All persons who operate or use x-ray equipment must receive adequate training in the safe procedures and the hazards Dose optimization and use of filters and shields: Use of suitable filtration - removes ‘soft’ radiation, use of lead aprons, lead goggles...etc Beam collimation : Limit the beam size to the minimum necessary by the provision of shielding and having collimators built into the set Visible & audible warnings: that the X-ray set is operating or about to operate Effectiveness of personal (Dosimeters) and area monitoring (No scattered radiation) Depending on the application, an interlock circuit may be used to prevent operation of the equipment whilst the door is open.

23. 1- Inadequate clinical data (history & examination) 2 - Unavailable previous studies. 3 -False choice of imaging modality or technique 4 - Delayed date of examination without reviewing recent clinical data 5 - Improper preparation - bowel over distension - improper fasting - improper U.B filling Pre examination mistakes in medical imaging :

24. A useful investigation is one in which the results positive or negative will alter management or add confidence to the clinician diagnosis. Choice depends upon: Clinical data. Availability of imaging modality Availability of technique Availability of personnel Dependable personnel Emergency cases

25. Causes of the wasteful use of radiology are : 1-Repeating investigations which have already been done 2-Investigation when results are unlikely to affect patient management 3-Investigating too often 4-Doing the wrong investigation. 5-Failing to provide appropriate clinical information and questions that the imaging investigation should answer

26. Contrast Media If the patient has a history of allergy to x-ray contrast material, the radiologist may advise that he takes special medication for 24 hours before CT with contrast to lessen the risk of allergic reaction. Another option is to undergo a different exam that does not call for contrast material injection . If a large amount of x-ray contrast material leaks out from the vessel being injected and spreads under the skin where the IV is placed, skin damage or damage to blood vessels and nerves, though unlikely, can result.

27. MRI SAFETY Claustrophobia: ( Fear of closed spaces) is a common reason for patient related cancelation (relative contraindication ) of MR exams . MRI-Absolute Contraindications Cardiac Pacemakers Electronic stimulators Metallic foreign bodies Cardiac valves Aneurysm clips N.B ; Titanium plates are accepted

28. Thank you