Radiology services.pptx

Radiology department
Radiology services
Functions, layout, services

1. RADIOLOGY SERVICES By – AAYUSHI BHAWSAR

2. INTRODUCTION It is an area of medicine that enables physician to see inside the human body in order to diagnose and monitor disease. It is important department which contribute directly to the patient care. It provides, along with pathology a vital back up of the hospital which cannot practice effectively without their support. It is also an important link in the research programmes of any medical institution except only small hospital and nursing homes.

3. IMPORTANCE It helps in giving confirmed diagnosis when used along with laboratory investigation. It provides additional information as required. It also provides non-invasive techniques for better medical and surgical treatment. Documentation evidence for treatment education and research. It provides evidence in case of complaints and litigation.

4. FUNCTION The provision of radiology services of adequate quality and quantity to hospitalized patient. Routine x-ray like chest, abdomen, limbs etc. Special studies like barium studies, IVPs myelograms etc. Ultrasound work. Angiographies and interventional work. Teaching and research.

5. ACTS for Radiology services The use of radioactive materials and radiation generating equipments is governed by Atomic Energy Act, 1962. Rules issued under the Act : a. Radiation protection rules, 1971 b. Atomic energy rules (Working of the Mines, Minerals and Handling of prescribed substances), 1984

6. ACTS for Radiology services c. Atomic energy rules (Safe disposal of radioactive waste), 1987 d. Atomic energy rules (Factories), 1996 e. Atomic energy rules (Control of irradiation of food), 1996

7. LOCATION The location should be: Ground floor. Easily accessible to the OPD, casualty, and inpatient ward. There is a minimum movement and distance to travel for staff and the patient while utilizing the services. Some scope for expansion at a later date.

8. LAYOUT DESIGN RECEPTION ROOM:- Located near the entrance. Administrative function Scheduling of appointments Receiving the patient Typing and handling of forms.

9. LAYOUT DESIGN WAITING AREA:- Located at entrance of the department. Should meet the needs of patients waiting before and after registration of the service. Adequate benches and chairs should be provided. Separate area to occupy patient in wheel chair and stretcher. Should have separate cubical for ward patient who are seriously ill.

10. LAYOUT DESIGN RADIOLOGIST OFFICE:- Situated near the radiology room. Not too easily accessible to the public. Adequate space for studying films and discussing with specialists. Adequate number of viewing box.

11. LAYOUT DESIGN DOCTORS VIEWING ROOM:- Located near the radiologist office. Radiologist may be available for consultation. For diagnostic comments and discussion.

12. LAYOUT DESIGN FILM STORAGE ROOM:- Built in cupboards may be provided in charge room. Active film can be stored up to 5 years.

13. LAYOUT DESIGN DRESSING ROOM :- 3 dressing room for each x-ray room is available. Door should have locking facility to keep patient valuables. Each room should contain mirror.

14. LAYOUT DESIGN PATIENT TOILET:- Toilet should be available for patient especially patient undergoing fluoroscopy. Each toilet room should be equipped with a grab bar for use by elderly or weak patient.

15. LAYOUT DESIGN General storage:- Located near the x-ray room. Storage cabinet with sliding door and adjustable shelves. Materials such as films opaque solution, developing solution and office supplies are stored.

16. LAYOUT DESIGN X-ray room:- All x-ray equipment can be accommodated in same room or separate room. It should have adequate space for the equipment, transformer and strecher.

17. LAYOUT DESIGN Dark room:- It should be located between two x-ray room. The size of the dark room not be more than 100 sq. ft. It should be provided with- A hatch window between x-ray room and dark room. A counter for loading and standing cassettes.

18. LAYOUT DESIGN A partition to separate loading counter from the film processing area. A light lock between the dark room and the light room, equipped with interlocking door. A utility tank with a drain board should be provided for mixing chemicals solution and hand washing. A film processing area consisting of developing tank, fixing tank and washing tank placed in that order. Exhaust fans.

19. LAYOUT DESIGN Control booth:- It should be located to right side of the machine so that patient may be observed when table is inclined. Film drying area:- Steel cupboard with heating elements at top and exhaust fan at bottom. Film dryer units are also available.

20. LAYOUT DESIGN Barium mixing facilities:- Small room of 10 sq. ft. to 12 sq. ft. each may be provided for the preparation of barium meal and for injection in large hospital.

21. SPACE REQUIREMENT In 1969,Mc Gibony advocated that 2000 sq. ft were required for a 200 bedded hospital. WHO has suggested the standard size of X-Ray room at 20 m2. Size of the Hospital Space in Radiology 100 Beds 65 Sq mts 200 Beds 175 Sq mts 300 Beds 370 Sq mts 500 Beds 650 Sq mts 750 Beds 800 Sq mts

22. SPACE REQUIREMENT Waiting area : 30.30 sq. mt. Reception area :10.10 sq. mt. Radiologist office : 20.20 sq. mt. X-ray room : 25.00 sq. mt. Control booth : 40.00 sq. mt. Dark room :10.00 sq. mt.

23. STAFFING Recommended staff for a 500 bedded teaching hospital Radiologist : Consultant/professor -1 Senior specialist/ Associate professor - 2 Junior specialist/ Lecture - 3 X-ray technician - 8 (for 3 shifts & leave reserves). Dark room asst. - 4 (for 3 shifts)

24. STAFFING Staff nurse - 1 Attendant - 4 (3 shift) Record clerk - 1 Receptionist - 1 [ Note:- Henry Garland estimated that one radiologist is necessary for the every 25 patient/day. Approx. 2-3 x-ray technician are required for every 30-35 patient /day. 2-clerk or secretaries per 30 patient].

25. ELIGIBILITY OF STAFF Radiologist:-MD in radiology. X-Ray technicians:-minimum diploma in radiography or preferably B.Sc. Radiography (3 yrs.) Staff Nurse : Registered nurse GNM or B.Sc (N)

26. Types of radiology Diagnostic radiology:- Routine x-ray for limbs, chest, spine, abdomen etc. Sonography. Computed axial tomography. (CT scan) Magnetic resonance imaging. (MRI) Digital subtractions angiography.

27. Dental X-ray Equipment

28. X-ray Equipment

29. Ultra Sonography It is useful in detecting abnormalities, stones, space occupying lesions etc. It is also useful in diagnosis of solid, air filled and fluid filled organ. It is a non-invasive procedure.

30. Computed Tomography (CT scan) CT (Computed tomography) scanning is a type of x-ray used to depict anatomy at different levels within the body. The CT scan is able to rotate the x-ray source around the patient allowing the physician to capture the necessary image from many different angles. Each rotation of the x-ray beam produces a single cross-sectional "slice" of anatomy, like the slices in a loaf of bread.

31. CT scanning Uses of CT scanning:- To examine the head for bleeding, tumors, blood clots, or signs of stroke. To distinguish whether a growth is solid or fluid-filled. To detect ruptured disks in the spine. To determine an organ's size and shape. To evaluate many types of disease processes. Help to determine the stage of certain cancers.

32. Magnetic Resonance Imaging MRI is a non- invasive technique that does not use any ionizing radiation. MRI uses powerful magnetic fields and radio frequency pulses to produce images. Magnet of the scanner is 30000 times more powerful than earths magnetic field.

33. Magnetic Resonance Imaging MRI used in – Region of abdomen Pelvis Chest Orbit Musculoskeletal systems Joints Staging of cancer

34. Digital Subtraction Angiography It is a computer- based facility for x-ray examination of arteries. It is useful in detecting high blood pressure, preventing strokes and monitors post operative progress and studying heart condition.

35. Types of radiology Interventional radiology:- It carries out certain procedures under radiology control like angioplasty, introduction of silver clips for treatment of aneurysm. It should be situated near diagnostic radiology. In case of complication backup medical and surgical services must be available. 2-3 beds for recovery should be available.

36. Types of radiology Nuclear medicine:- Use of radioactive isotopes and scanning of organs is done. The dept. can be independent, can be a part of radiology or medicine dept.

37. Nuclear Medicine Equipment

38. Types of radiology Radiotherapy:- All hospital need not have this service. It requires initial budget, requiring expenditure, availability of trained staff, work load, and affordability of patient. Compliance with conditions laid down by Bhabha Automic Research Center. It should be located on ground floor or basement.

39. Types of radiology Adequate arrangement for dissemination of radiology. Therapy room. Chemotherapy rooms. Standardization facility. Quality control laboratory. Storage facility.

40. Utilities Power requirement: Mains:- 220 volts AC, three phase. 50-60 cycles. 25 Amps. Main impedence should not be greater than 0.5 ohms.

41. Utilities For a steady current with least impedence, a separate power lines exclusively for the radiology dept is necessary. Current voltage fluctuations give unsatisfactory results. Voltage stabiliser is necessary for each machine. Actual power consumption will be determined by the machine’s power (mA) and number of exposure per day.

42. Utilities Walls: According to BARC, Mumbai the walls of the radiography room should be: 9 inches thick concrete walls or 14 inches thick brick masonry walls which are sufficient for primary as well as scattered radiation. Lead shielding is recommended where the walls are thin or where there are doors. The places which needs special protection are: Walls behind the chest stand in radiology room. Walls between radiology room and adjoining room.

43. Utilities Air Conditioning Administrative areas and waiting areas: A temperature of 72 F with a relative humidity of 50% and a ventilation rate 1-1 ½ air changes per hour. Patients and technicians corridors: A temperature of 75 F to 80 F with relative humidity of 50% and 2 air changes per hour.

44. Utilities Fluoroscopic and x-ray room: A temperature of 75 F TO 80 F with RH 50% and 6 air changes per hour. Dark room: A temperature of 72 F with RH 50% and 10 air changes per hour.

45. RISK X-ray or gamma rays - 0.3 r per week Local radiation rays - 4.5 r per week Exposure beyond these limits can lead to- Blood cancer Skin cancer Cataract Leukemia Infertility

46. PRECAUTION & SAFETY According to International commission on radiology protection in 1995 – Personal test:- All new staff in radiological dept. should undergo pre-employment blood exam like blood count, Hb, total and differential blood count. Protection:- X-ray dept before starting starting its function should be monitored by recognized specialist.

47. PRECAUTIONS & SAFETY Each equipment should be shock proof provided with insulation and earthening. Personal monitoring of exposure by photographic devices like ‘film badge’. In case where isotopes are used for exposure is monitored by using ionizing devices like ‘dosimeter’. The film batch/dosimeter provided by BARC changed every quarterly. Lead thyroid guard should be used by the technicians.

48. PRECAUTIONS & SAFETY Lead aprons and gloves should be used by the technician. Exposure of workers to radiation should not exceed 20 SV/Annum. Maximum permissible limit for an individual is 300 rem/month. Maximum range of exposure must not exceed 5 secs. Cable length recommended from the control panel is 3 meters.

49. RECORDS Reporting:- All the radiological examination should be reported by radiologist only. Diagnostic examination should be reported as soon as possible. Therapeutic procedures can be reported at the end of the course.

50. RECORDS Film identification:- X-ray films (exposed) should be permit identification of patient, date, orientation. Lead alphabets and numbers can be used. Adhesive labels after processing.

51. RECORD Film filing:- Both exposed and unexpected films should be stored in fire resisting metal container. Old exposed films and surplus stock of films should be stored in a vault Vault should be outside building Adequate ventilation Light with vapour proof globes and ceiling fixtures. Automatic sprinklers in adequate number.

52. REGISTERS X-ray register. Deep x-ray treatment register. Cobalt treatment register. Inventory of non exposed store & equipment. Film account. Radium needles account. Expendable store account. Indent book. Instruction manual for all the technical staff are to be developed depending on the local working condition.

53. PACS A PACS (Picture Archiving and Communication System) consists of four major components: The imaging modalities such as CT and MRI. A secured network for the transmission of patient information. Workstations for interpreting and reviewing images. Long and short term archives for storage and retrieval of images and reports.

54. PACS Benefits of PACS: PACS provides near instant access to images and reports from multiple locations. The health care achieved significant cost and benefits through the advanced approach to PACS.

55. PACS Cost related to film, storage and radiology coverage were all significantly reduced, as well as need to dedicate physical space to film processing, storage and management. Patient and staff benefited from the improved workflow. New technologies are characterized by film cost that are increasing dramatically .

56. PACS E.g. multi-slice CTs that can manage 700to 800 slices in five minutes. This technology evidences both economical problems and the practical difficulty for the radiologist to view this amount of images in hard copy form, which can be solved only with a PACS. Reduced time in transferring of images from one hospital to another hospital. the automatic transfer of images reduces the work of manpower.

57. Radiation Protection As per recommendation of radiation protection division of BARC, Mumbai the wall of the radiology room have to be 9inches thick concrete walls or 14 inches thick brick masonry wall.

58. WASTE DISPOSAL The disposal of radioactive waste is in accordance with Atomic Energy rules 1987. The radioactive waste can be classified into High level wastes Intermediate level wastes Low level wastes Collection of radioactive waste Foot operated waste bins Disposable polythene lining for solid waste Polythene carboys for liquid wastes

59. WASTE DISPOSAL Basic guidelines for disposal of waste : Dilute and disperse the low level radioactive waste. Delay and decay the short lived isotopes Concentrate and contain for intermediate and high level waste.

60. POLICY Dept. should provide round clock service. OPD and routine patient should be scheduled through appointment. Requisition form should be of standard size and should have colour coding for urgent, serious or routine type of requisition. Requisition should be accompanied by doctors order.

61. POLICY Instruction should be followed by the patient should be written in local language in the department. Radiologist should study the film, prepare the report and sign it before dispatching. Issuing of x-ray to the patient depends on the requsing unit. Also issuing of x-ray to the patient on discharge has to be decided by the hospital mgmt. In MLC x-ray should not be handed over to the patient or relative.

62. POLICY Dept. should maintain a checklist regarding working condition of the equipment. Scheduled maintenance should be done. Regular in service training to all the technician. All used and unused films should be kept safety. All instruction on radiation should be followed.

63. PROBLEMS Problems of scheduling the investigations Educational and research activities. Pilferage/ theft of- Used films to extract silver. Consumable items. Patient belongings.

64. PROBLEMS Shortage of x-ray films due to inadequate inventory or wastage of films. Machines breakdown due to- Rough handling. Overuse Misuse Unfair practices. No proper maintenance.

65. PROBLEMS Radiation overdose due to- Improper precautions. Non use of lead aprons and gloves. Non use of film badge. Difficulties to control the working and movement of portable x-ray equipment. Staff absentism.

66. RECOMMENDATIONS During scheduling of investigation priority should be as follows : 1. Emergency cases both IPD and Casualty. 2. ICU patient. 3. Routine indoor patient. 4. Routine outdoor patient. Pilferage/ theft of can be avoided by proper security arrangements.

67. RECOMMENDATIONS Patient relatives should be asked to take care of their patient’s belongings. Proper inventory should be maintained to avoid shortage of films. Regular maintenance (concurrent) should be carried out to avoid break down of equipments. Policy and procedures for taking precautions like lead aprons, film badges, lead gloves etc

68. REFERENCES Effective hospital management by Pragna Pai. Principles of hospital administration by BM Sakharkar.

69. THANK YOU