Framework for health care quality and evidence-based practice in radiology departments: A regional study on radiographer's perceptions.

INTRODUCTION: The main goals of this study were to describe, in an integrated and multidimensional way, the conditions related to the quality of care in radiology departments from Algarve (Portugal), to assess the perspective of radiographers on the use of scientific evidence in clinical practice and to validate a model that characterizes the conditions for continuous improvement. METHODS: A cross sectional study was performed in four radiology departments from public and private healthcare facilities from Algarve region (Portugal). A paper-based survey was sent to all radiographers to assess the quality systems implemented in their radiology departments and their perspective on the use of scientific evidence in clinical practice. RESULTS: In total, 62 radiographers (61.4%) completed the survey. The quality dimensions that obtained the highest degree of compliance were the existence of quality assurance and improvement activities (43.0%), existence of standards in clinical practice of radiographers (42.7%) and the existence of special provisions (37.6%). The quality dimension related to patient's involvement was the one with the lowest level of compliance. Moreover, from the radiographers perspective, positive responses were obtained related to evidence-based actions (83.0%), sources of evidence (76.0%) and the significance of research activities (74.0%). CONCLUSION: These findings suggest that a new framework based on four factors (Support for Information; Organizational Capability to Technical Quality of Care; Patient Involvement and Evidence-Based Radiology), should be considered in the establishment of strategic policies that better define the provision of diagnostic procedures and professional practices in radiology departments from Algarve region, based on quality improvement systems and better patient safety. IMPLICATIONS FOR PRACTICE: There is a need to include patients in the decision-making process, to involve radiographers in quality assurance and improvement activities and to implement quality monitoring mechanisms within radiology departments under study.

Study of scattered radiation during fluoroscopy in hip surgery.

OBJECTIVE: To measure the scattered radiation dose at different positions simulating hip surgery. MATERIALS AND METHODS: We simulated fluoroscopy-assisted hip surgery in order to study the distribution of scattered radiation in the operating room. To simulate the patient, we used a anthropomorphic whole-body phantom, and we used an X-ray-specific detector to quantify the radiation. Radiographs were obtained with a mobile C-arm X-ray system in continuous scan mode, with the tube at 0º (configuration 1) or 90º (configuration 2). The operating parameters employed (voltage, current, and exposure time) were determined by a statistical analysis based on the observation of orthopedic surgical procedures involving the hip. RESULTS: For all measurements, higher exposures were observed in configuration 2. In the measurements obtained as a function of height, the maximum dose rates observed were 1.167 (± 0.023) µSv/s and 2.278 (± 0.023) µSv/s in configurations 1 and 2, respectively, corresponding to the chest level of health care professionals within the operating room. Proximal to the patient, the maximum values were recorded in the position occupied by the surgeon. CONCLUSION: We can conclude that, in the scenario under study, health care professionals workers are exposed to low levels of radiation, and that those levels can be reduced through the use of personal protective equipment.

OBJETIVO: Medir a intensidade da dose de radiação espalhada em diferentes posições simulando uma intervenção cirúrgica no quadril. MATERIAIS E MÉTODOS: Simulou-se uma intervenção cirúrgica no quadril com apoio da fluoroscopia para estudar a distribuição da radiação espalhada no bloco operatório. Para simular o paciente foi utilizado um simulador antropomórfico de corpo inteiro e para medir a radiação utilizou-se um detector específico para medir raios X. Realizaram-se incidências com um equipamento de raios X tipo arco em C móvel, em modo de escopia contínua, com a ampola a 0º (configuração 1) e a 90º (configuração 2). Os parâmetros operacionais utilizados (voltagem, corrente, tempo de exposição) foram determinados por meio de um estudo estatístico resultante da observação de cirurgias ortopédicas de quadril. RESULTADOS: Em todas as medições observaram-se exposições mais elevadas na configuração 2. Nas medições em função da altura, observaram-se os valores máximos da taxa de dose de 1,167 (± 0,023) µSv/s e 2,278 (± 0,023) µSv/s nas configurações 1 e 2, respectivamente, correspondendo à altura do tórax dos profissionais. No estudo em torno do paciente os valores máximos registraramse na posição ocupada pelo médico cirurgião. CONCLUSÃO: Concluiu-se que a exposição à radiação dos profissionais é baixa, podendo ainda ser reduzida mediante o uso de equipamentos de proteção individual.