Enhancing safety culture in radiology: Key practices and recommendations for sustainable excellence.

OBJECTIVES: This review aims to explore and thematically synthesize the existing literature on safety culture within the context of radiology. The primary objective is to identify key practices that effectively strengthen safety culture, highlighting the pivotal roles of leadership, effective teamwork, and interprofessional collaboration in these efforts. The review intends to showcase actionable recommendations that are particularly relevant to the radiology setting. KEY FINDINGS: The study highlights that effective leadership is fundamental in establishing and nurturing a safety-first approach within radiology departments. Key practices for promoting a safety culture include safety huddles, leadership walkarounds, quality learning boards, intentional patient rounding (frequent patient-care provider interactions), morbidity and mortality meetings, and multidisciplinary team rounds. These practices have been found to facilitate open communication and transparency, which are crucial elements in creating a sustainable safety culture. Additionally, the study underscores the significant role of radiology managers in driving these safety initiatives and acting as facilitators for a culture of safety, focused on long-term excellence and continuous improvement. CONCLUSION: The study concludes that a multifaceted and comprehensive approach is vital for fostering a safety culture in radiology departments, with a focus on sustainable excellence in patient care. The leadership role is critical in this process, with radiology managers being instrumental in implementing and maintaining effective safety practices. IMPLICATIONS FOR PRACTICE: This study provides best practices for sustainable safety culture in radiology departments. It advocates for healthcare managers to adopt and integrate these identified practices into their operational strategies. Continuous professional development, focusing on safety and quality in patient care, and fostering a collaborative environment for open discussion and learning from safety incidents are essential for the continued advancement and excellence of healthcare services.

Evaluation of the annual occupational effective doses in a SPECT/CT department.

Staff occupational radiation exposure is limited to 20 mSv annually to preclude tissue reaction and lower risk of cancer effect. Staff occupational exposure arises during the preparation, injection, and scanning of the patients. Recent studies reported that nuclear medicine personnel might exceed the annual dose limit in high workload and poor radiation protection circumstances. Therefore, an accurate estimation of the annual dose limit is recommended. The goal of this research is to calculate the cumulative external effective dose (mSv) per year for nuclear medicine physicians, technologists, and nurses at SPECT/CT department. A total of 15 staff worked in the nuclear medicine department at King Saud Medical City (KSMC), Riyadh, Saudi Arabia were evaluated for the last six years. 99mTc is used more frequently for most of the patients. The procedures include renal, cardiac scintigraphy procedures. Staff dose was quantified using calibrated thermoluminecnt dosimeters (TLD-100) with an automatic TLD reader (Harshaw 6600). Exposure to ionizing radiation was evaluated in terms of deep doses (Hp(10) were evaluated. The overall average and standard deviation of the external doses for nuclear medicine physicians, technologists' and nurses were 1.8 ± 0.7, 1.9 ± 0.6, 2.0 ± 0.9, 2.2 ± 0.8, 6.0 ± 2.8, and 3.6 ± 1.3 for the years 2015,2016,2017,2018,2019, and 2020, respectively. Technologists and nurses received higher doses of compared to the nuclear medicine physicians. Technologists and nurses involved in radionuclide preparation, patients' injection, and image acquisition. Staff annual exposure is below the annual dose limits; however, this external dose is considered high compared to the current workload.

Evaluation of potential toxicity of Steriplant©N aerosolization toward human alveolar cells A459 in vitro.

Protection of patients against hospital-acquired infections is of major importance. Disinfection of magnetic resonance imaging suites is, due to their unique properties and environment particularly, difficult to implement. We developed an OPTI-JET CS MD 2ZE aerosolizator for disinfection of a magnetic resonance imaging suite using the electrolyzed oxidizing water biocide Steriplant©N. The disinfection of the magnetic resonance imaging suite with this system reduced from the number of colony formed unit/m3 air by 87% and 96% in 6 and 15 min of disinfection, respectively. It is well known that exposure of personnel or patients to aerosols may represent risk to the respiratory system; therefore, the aim of this study was to assess potential cytotoxicity and genotoxicity of Steriplant©N aerosolization toward human alveolar cells A459 in vitro. The A459 cells were exposed to aerosol containing different concentrations (50% and 100% v/v) of Steripalnt©N for 6 min in a chamber that had been constructed to simulate the conditions in the magnetic resonance imaging suite. The cytotoxicity was evaluated by measuring iodide uptake, and the genotoxicity was determined by measuring formation of phosphorylated H2AX histones, a marker for deoxyribonucleic acid double-strand breaks, immediately after the aerosolization and after 1, 4, and 24 h postincubation. The results demonstrated that aerosolization with Steriplant©N at conditions reflecting aerosolization in a magnetic resonance imaging suite is not cytotoxic and does not exhibit genotoxic potential in vitro.

Quality and safety innovations in the Radiology Department during the COVID-19 pandemic: a Latin American experience.

Radiology departments were forced to make significant changes in their routine during the coronavirus disease 2019 pandemic, to prevent further transmission of the coronavirus and optimize medical care as well. In this article, we describe our Radiology Department's policies in a private hospital for coronavirus disease 2019 preparedness focusing on quality and safety for the patient submitted to imaging tests, the healthcare team involved in the exams, the requesting physician, and for other patients and hospital environment.

Improving patient flow in diagnostic imaging: a case report.

INTRODUCTION: This case study focuses on Erie Shores Healthcare, a small Canadian hospital with a busy emergency department (ED) who acts as the sole provider of outpatient diagnostic imaging (DI) services to the community. The hospital is experiencing bottlenecks when balancing outpatient diagnostic procedures with inpatient and urgent ED requests in the X-Ray department, creating the need for increased overtime and missed breaks, as well as frustrations amongst patients, staff and physicians. CASE AND OUTCOMES: To alleviate these issues and improve patient flow, this case study aims to identify options for increasing efficiency, improving adaptive workflow and decreasing wait times during peak hours in X-Ray. DISCUSSION: After a literature review, key components were narrowed down to include the following Lean Methods: floor plan evaluation with spaghetti diagrams, collection of benchmarking data from similar Canadian sites, and a real-time Client Flow Analysis. The potential benefits of Technologist Assistants (TA) and DI-dedicated porters are also explored. CONCLUSION: Lean methodology is an effective way to evaluate and improve patient flow in DI. Healthcare organizations should take advantage of key redevelopment projects and technological advancements to maximize their departmental efficiency.

Guidelines for Ultrasound in the Radiology Department During the COVID-19 Pandemic.

The coronavirus disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2. The virus can be spread by close person-to-person contact primarily by respiratory droplets. Given the close proximity of the sonographer or sonologist with the patient during ultrasound examinations, special precautions should be taken to limit the exposure of radiology personnel to patients with coronavirus disease 2019 while still providing optimal patient care. Methods covered in this article include modified workflow, close scrutiny and prioritization of imaging orders, and design of targeted ultrasound protocols. These guidelines summarize the personal experience and insight of multiple colleagues who lead ultrasound sections or are experts in the field.

How we provided appropriate breast imaging practices in the epicentre of the COVID-19 outbreak in Italy.

Italy has one of the highest COVID-19 clinical burdens in the world and Lombardy region accounts for more than half of the deaths of the country. Since COVID-19 is a novel disease, early impactful decisions are often based on experience of referral centres.We report the re-organisation which our institute (IEO, European Institute of Oncology), a cancer referral centre in Lombardy, went through to make our breast-imaging division pandemic-proof. Using personal-protective-equipment and innovative protocols, we provided essential breast-imaging procedures during COVID-19 pandemic without compromising cancer outcomes.The emergency management and infection-control-measures implemented in our division protected both the patients and the staff, making this experience useful for other radiology departments dealing with the pandemic.

Recommendations for nuclear neuroimaging of patients with neurological disorders in the COVID-19 era.

The novel coronavirus disease 2019 (COVID-19) pandemic has changed people's normal lives in a very short time causing extensive infections and mortality, which required the national health systems to be adapted to new situation. Changes in healthcare services included modifications of standard procedures in nuclear medicine departments in order to limit COVID-19 spreading and protect patients and personnel. Here, we recommend management of patients with neurological diseases and especially dementia and movement disorders, who are referred for neuroimaging with nuclear medicine techniques.

Determining the Need for After-Hours Diagnostic Radiological Reporting in Emergency Departments at Public Hospitals in South Africa: Perceptions of Emergency Physicians in KwaZulu-Natal.

BACKGROUND: Emergency departments in South African public hospitals have a high patient load after hours, with inadequate numbers of health care professionals available to satisfy patient influx. In addition, there is often no provision of after-hours diagnostic reporting services in public hospitals, to an extent that the emergency physician is responsible for interpreting all radiographic images requested themseves. Emergency physicians, in this study, can be described as any medical doctor registered with the Health Professions Council of South Africa and working in the emergency department as a registrar or consultant physician because there were no physicians specialized in emergency medicine working at the hospitals selected for this study. AIM: The aim of this study was to determine the views of emergency physicians on whether there is a need for an after-hours diagnostic radiological reporting service in selected public hospitals in KwaZulu-Natal Province, South Africa. METHODS: A descriptive cross-sectional quantitative research design was utilized, through means of a survey, to assess the emergency physicians' perceptions regarding the need for after-hours diagnostic radiological reporting. In addition, the study used a descriptive quantitative research design to record the number of conventional diagnostic radiographic examinations performed at the selected hospitals, after hours, and the proportional number of these radiographic examinations that were reported on by radiologists during office hours, the following day. The distribution of questionnaires and data collection, with regard to the number of examinations reported on, and those not reported on, were carried out simultaneously during the execution of this study. The study was conducted over a three-month period in 2017, at four public hospitals in KwaZulu-Natal-one of the nine provinces of South Africa. RESULTS: This study found that, during the study period, between 0.1% and 0.6% of the conventional diagnostic radiographic examinations performed, after hours, were reported on by radiologists during office hours, the following day. The surveyed emergency physicians felt that the interpretation of diagnostic images took up valuable time that could be spent on patient management, and there was near-total agreement, whereby 92% (n = 36) of the physicians would have preferred after-hours reporting to be performed by a radiologist. Physicians agreed that having a radiologist or reporting radiographer to provide radiological reports would allow for more effective and efficient patient management. CONCLUSION: The results of this study indicated that there is a need for after-hours radiographic reporting at the selected public hospitals and for the further training of emergency physicians in radiographic image interpretation. Based on the findings of this study, it is recommended that after-hours radiological reporting services be considered for public hospitals and that courses be offered to emergency physicians on the interpretation of diagnostic radiographic images. A hospital policy review may therefore be needed to adjust the focus of hospitals toward reducing the workload of emergency physicians, wherever possible, such as by incorporating support services like radiographic reporting and by providing further training on the interpretation of diagnostic radiographic images, which will both act to reduce the potential risk of misdiagnosis.

Technique, radiation safety and image quality for chest X-ray imaging through glass and in mobile settings during the COVID-19 pandemic.

The COVID-19 pandemic in 2020 has led to preparations within our hospital for an expected surge of patients. This included developing a technique to perform mobile chest X-ray imaging through glass, allowing the X-ray unit to remain outside of the patient's room, effectively reducing the cleaning time associated with disinfecting equipment. The technique also reduced the infection risk of radiographers. We assessed the attenuation of different types of glass in the hospital and the technique parameters required to account for the glass filtration and additional source to image distance (SID). Radiation measurements were undertaken in a simulated set-up to determine the appropriate position for staff inside and outside the room to ensure occupational doses were kept as low as reasonably achievable. Image quality was scored and technical parameter information collated. The alternative to imaging through glass is the standard portable chest X-ray within the room. The radiation safety requirements for this standard technique were also assessed. Image quality was found to be acceptable or borderline in 90% of the images taken through glass and the average patient dose was 0.02 millisieverts (mSv) per image. The majority (67%) of images were acquired at 110 kV, with an average 5.5 mAs and with SID ranging from 180 to 300 cm. With staff positioned at greater than 1 m from the patient and at more than 1 m laterally from the tube head outside the room to minimise scatter exposure, air kerma values did not exceed 0.5 microgray (µGy) per image. This method has been implemented successfully.

Optimising after-hours workflow of computed tomography orders in the emergency department.

Ordering and protocolling CT scans after-hours from the emergency department (ED) at our institution previously required discussion between the ED physician and radiology resident, which led to workflow inefficiency. Our intervention consisted of creating an electronic list of CT requests that radiology residents would monitor. Radiology protocolled straightforward requests and contacted the ordering physician for more details when required. We aimed to improve workflow efficiency, increase provider satisfaction and reduce CT turnaround time without significantly affecting CT utilisation. Plan-do-study-act cycles were used to plan and evaluate the intervention. The intervention was initiated on weekday evenings and then expanded to weekend hours after an interim analysis. Qualitative outcomes were measured via electronic survey, and quantitative outcomes were collected from administrative data and analysed via control charts and other statistical methods. Survey response was high from ED physicians (76%, n=82/108) and radiology residents (79%, n=30/38). After the intervention, the majority of ED staff and radiology residents perceived improved workflow efficiency (96.3%, 73.3%), radiology residents noted a subjective decrease in disruptions (83.3%) and most ED staff felt that scans were performed more quickly (84.1%). Radiology residents received fewer pages per shift, adjusted for scan volume. There was a reduction in time from order entry to protocol on weekday shifts only, with no statistically significant effect on time from order entry to scan. Segmented regression analysis demonstrated a background increase in utilisation over time (0.7-2.0 CT/100 ED visits/year, p<0.0005), but the intervention itself did not contribute to an overall increase in CT utilisation. In conclusion, our intervention led to improved perceived workflow efficiency and reduced pages. Scans were protocoled more quickly on weekdays, but turnaround times were otherwise not significantly affected by the intervention. Background CT utilisation increased over time, but this increase was not attributable to our intervention.

Clarifying radiology's role in safety events: a 5-year retrospective common cause analysis of safety events at a pediatric hospital.

BACKGROUND: Common cause analysis of hospital safety events that involve radiology can identify opportunities to improve quality of care and patient safety. OBJECTIVE: To study the most frequent system failures as well as key activities and processes identified in safety events in an academic children's hospital that underwent root cause analysis and in which radiology was determined to play a contributing role. MATERIALS AND METHODS: All safety events involving diagnostic or interventional radiology from April 2013 to November 2018, for which the hospital patient safety department conducted root cause analysis, were retrospectively analyzed. Pareto charts were constructed to identify the most frequent modalities, system failure modes, key processes and key activities. RESULTS: In 19 safety events, 64 sequential interactions were attributed to the radiology department by the patient safety department. Five of these safety events were secondary to diagnostic errors. Interventional radiology, radiography and diagnostic fluoroscopy accounted for 89.5% of the modalities in these safety events. Culture and process accounted for 55% of the system failure modes. The three most common key processes involved in these sequential interactions were diagnostic (39.1%) and procedural services (25%), followed by coordinating care and services (18.8%). The two most common key activities were interpreting/analyzing (21.9%) and coordinating activities (15.6%). CONCLUSION: Proposing and implementing solutions based on the analysis of a single safety event may not be a robust strategy for process improvement. Common cause analyses of safety events allow for a more robust understanding of system failures and have the potential to generate more specific process improvement strategies to prevent the reoccurrence of similar errors. Our analysis demonstrated that the most common system failure modes in safety events attributed to radiology were culture and process. However, the generalizability of these findings is limited given our small sample size. Aligning with other children's hospitals to use standard safety event terminology and shared databases will likely lead to greater clarity on radiology's direct and indirect contributions to patient harm.

Radiologist Reporting and Operational Management for Patients With Suspected COVID-19.

PURPOSE: The aim of this study was to evaluate the adoption and outcomes of locally designed reporting guidelines for patients with possible coronavirus disease 2019 (COVID-19). METHODS: A departmental guideline was developed for radiologists that specified reporting terminology and required communication for patients with imaging findings suggestive of COVID-19, on the basis of patient test status and imaging indication. In this retrospective study, radiology reports completed from March 1, 2020, to May 3, 2020, that mentioned COVID-19 were reviewed. Reports were divided into patients with known COVID-19, patients with "suspected" COVID-19 (having an order indication of respiratory or infectious signs or symptoms), and "unsuspected patients" (other order indications, eg, trauma or non-chest pain). The primary outcome was the percentage of COVID-19 reports using recommended terminology; the secondary outcome was percentages of suspected and unsuspected patients diagnosed with COVID-19. Relationships between categorical variables were assessed using the Fisher exact test. RESULTS: Among 77,400 total reports, 1,083 suggested COVID-19 on the basis of imaging findings; 774 of COVID-19 reports (71%) used recommended terminology. Of 574 patients without known COVID-19 at the time of interpretation, 345 (60%) were eventually diagnosed with COVID-19, including 61% (315 of 516) of suspected and 52% (30 of 58) of unsuspected patients. Nearly all unsuspected patients (46 of 58) were identified on CT. CONCLUSIONS: Radiologists rapidly adopted recommended reporting terminology for patients with suspected COVID-19. The majority of patients for whom radiologists raised concern for COVID-19 were subsequently diagnosed with the disease, including the majority of clinically unsuspected patients. Using unambiguous terminology and timely notification about previously unsuspected patients will become increasingly critical to facilitate COVID-19 testing and contact tracing as states begin to lift restrictions.

Strategies for radiology departments in handling the COVID-19 pandemic.

The world is facing an unprecedented global pandemic in the form of the coronavirus disease 2019 (COVID-19) which has ravaged all aspects of life, especially health systems. Radiology services, in particular, are under threat of being overwhelmed by the sheer number of patients affected, unless drastic efforts are taken to contain and mitigate the spread of the virus. Proactive measures, therefore, must be taken to ensure the continuation of diagnostic and interventional support to clinicians, while minimizing the risk of nosocomial transmission among staff and other patients. This article aims to highlight several strategies to improve preparedness, readiness and response towards this pandemic, specific to the radiology department.