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.

The worldwide coronavirus disease 2019 outbreak: Advice and recommendation on radiology management and infection control from makeshift hospitals in Wuhan.

ABSTRACT: To describe and advise on management protocols and infection-protection experience of the radiology department in makeshift hospitals in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.Based on the literature review and the experience in the frontline, we retrospectively reviewed the configuration of the radiology department, human resource, personal protection, examination procedures for patients confirmed with COVID-19 in Wuhan fangcang shelter hospital.From February 11, 2020 to March 10, 2020, 2730 and 510 CT examinations were performed in the Hanjiang shelter hospital and Hanyang Sports School shelter hospital, respectively, including initial examinations and re-examinations. The maximum number of daily CT examinations reached 289. The CT scanned a patient approximately once every 13 mins.Fangcang shelter radiology department could be powerful components of both global and national responses to the COVID-19 pandemic.

Management and infection control practices in a Taiwanese radiology department during the COVID-19 outbreak.

The radiology department was categorized as a "high risk area" during the severe acute respiratory syndrome (SARS) outbreak in 2003 and is similarly considered a "high risk area" during the current coronavirus (COVID-19) pandemic. The purpose of infection control is to isolate patients with suspected or confirmed COVID-19 from uninfected people by utilizing separate equipment, spaces, and healthcare workers. Infection control measures should be prioritized to prevent the nosocomial spread of infection. We established a COVID-19 infection control team in our radiology department. The team's responsibilities include triaging patients with confirmed or suspected COVID-19, performing imaging and reporting, using dedicated equipment, disinfecting the equipment and the immediate environment, and staff scheduling.

Accelerated implementation of remote reporting during the COVID-19 pandemic.

AIM: To assess, via a survey of UK radiological departments, if the COVID-19 pandemic led to a change in radiological reporting undertaken in a home environment with appropriate IT support. MATERIALS AND METHODS: All imaging departments in the UK were contacted and asked about the provision of home reporting and IT support before and after the first wave of the pandemic. RESULTS: One hundred and thirty-seven of the 217 departments contacted replied, producing a response rate of 61%. There was a 147% increase in the provision of remote access viewing and reporting platforms during the pandemic. Although 578 consultants had access to a viewing platform pre-pandemic, this had increased to 1,431 during the course of the first wave. CONCLUSION: This survey represents work undertaken by UK NHS Trusts in co-ordinating and providing increased home-reporting facilities to UK radiologists during the first wave of this global pandemic. The impact of these facilities has been shown to allow more than just the provision of reporting of both elective and emergency imaging and provides additional flexibility in how UK radiologists can help support and provide services. This is a good start, but there are potential problems that now need to be overcome.

Covid-19 infection in cancer patients: the management in a diagnostic unit.

BACKGROUND: COVID-19 infection is particularly aggressive in frail patients, as cancer patients. Therefore, the more suitable management of the oncological patient requires a multidisciplinary assessment, to identify which patients should be treated, as inpatients or outpatients, and which treatments can be procrastinated. CONCLUSIONS: The role of radiologist is crucial, and, all cancer patients who need an imaging evaluation will need to be studied, using the most appropriate imaging tools related to the clinical question and paying a special attention to preserve public health. Guidelines are necessary in the correct organization of a radiology unit to manage patients with suspected or confirmed COVID-19 infection, and whenever possible, a satellite radiography center with dedicated equipment should be used to decrease the transmission risk.

Special Report of the RSNA COVID-19 Task Force: Crisis Leadership of Major Health System Radiology Departments during COVID-19.

Severe acute respiratory syndrome coronavirus 2 has spread across the world since December 2019, infecting 100 million and killing millions. The impact on health care institutions during the coronavirus disease 2019 pandemic has been considerable, with exhaustion of institutional and personal protective equipment resources during local outbreaks and crushing financial consequences for many institutions. Establishing adaptive principles of leadership is necessary during crises, fostering quick decision-making and workflow modifications, while a rapid review of data must determine necessary course corrections. This report describes concepts of crisis leadership teams that can help maximize their effectiveness during the current and future pandemics.

Reconfiguring the radiology leadership team for crisis management during the COVID-19 pandemic in a large tertiary hospital in Singapore.

The coronavirus 2019 (COVID-19) outbreak poses a serious public health risk. To date, the disease has affected almost all countries in the world. The enormous scale of the outbreak and the relative lack of knowledge and information regarding a new virus, as well as the unpredictability of events, make it challenging for leadership teams to respond. This paper shares how we have reconfigured our radiology leadership team into a smaller disease outbreak task force (DOTF) to respond and coordinate all related efforts during this ongoing COVID-19 pandemic. The DOTF format is modelled after the military with domain groups looking at manpower, intelligence, operations, and logistics matters on a daily basis so that timely decisions can be made and action plans executed promptly. In managing the DOTF, discipline, flexibility, and teamwork are key principles, and these are built upon a strong foundation of focus on infection prevention and control, and patient and staff safety as well as staff well-being. The DOTF has positioned us well to confront the many challenges to date. We believe it will also help us navigate the complex issues that will arise with future surges in cases and in formulating strategies to manage exit from the present and future lockdowns. KEY POINTS: • In a pandemic, regular and directed meetings by a smaller leadership core group are required, for prompt decision making and execution of action plans. • The military format, with domain groups to look at manpower, intelligence, operations, and logistics matters, is useful in managing a pandemic. • Discipline, flexibility, and teamwork with strong focus on infection prevention and control, and patient and staff safety as well as staff well-being are key principles for leadership teams managing a pandemic.

Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time in an Emergency and Trauma Radiology Department.

OBJECTIVE: To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department. PATIENTS AND METHODS: This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to September 30, 2013, and (2) January 1, 2017, to January 30, 2018, and whose reports were read by an attending emergency and trauma radiologist was noted. RESULTS: The 24/7/365 radiology coverage was associated with a significant reduction in TAT of computed tomography reports, and the time reduction was comparable between trauma and nontrauma cases. In adjusted models, the extension of radiology coverage was associated with an average of 7.83 hours reduction in overall TAT (95% confidence interval [CI]: 7.44-8.22) for reports related to trauma, in which 2.73 hours were due to reduction in completion to transcription time (TC; 95% CI: 2.53-2.93), and 5.10 hours were due to reduction in transcription to finalization time (TF; 95% CI: 4.75-5.44). For reports related to nontrauma cases, 24/7/365 coverage was associated with an average of 6.07 hours reduction in overall TAT (95% CI: 3.54-8.59), 2.91 hours reduction in TC (95% CI: 1.55-4.26), and 3.16 hours reduction in TF (95% CI: 0.90-5.42). CONCLUSION: Our pilot study demonstrates that the implementation of on-site 24/7/365 attending emergency radiology coverage at a tertiary care center was associated with a reduced TAT for trauma and nontrauma patients imaging studies. Although the magnitude and precision of estimates were slightly higher for trauma cases as compared to nontrauma cases. Trauma examinations stand to benefit the most from 24/7/365 attending level radiology coverage.

Initial data from an experiment to implement a safe procedure to perform PA erect chest radiographs for COVID-19 patients with a mobile radiographic system in a "clean" zone of the hospital ward.

INTRODUCTION: With the current Covid-19 pandemic, general wards have been converted into cohort wards for Covid-19 patients who are stable and ambulant. A 2-radiographer mobile radiography team is required to perform bedside Chest X-rays (CXR) for these patients. Hospital guidelines require both radiographers to be in full Personal Protective Equipment (PPE) throughout the image acquisition process and the mobile radiographic unit needs to be disinfected twice after each case. This affects the efficiency of the procedure and an increase usage of limited PPE resources. This study aims to explore the feasibility of performing mobile chest radiography with the mobile radiographic unit in a "clean" zone of the hospital ward. METHODS: An anthropomorphic body phantom was used during the test. With the mobile radiographic unit placed in a "clean" zone, the phantom and the mobile radiographic unit was segregated by the room door with a clear glass panel. The test was carried out with the room door open and closed. Integrated radiation level and patient dose were measured. A consultant radiologist was invited to review and score all the images acquired using a Barco Medical Grade workstation. The Absolute Visual Grading Analysis (VGA) scoring system was used to score these images. RESULTS: A VGA score of 4 was given to all the 40 test images, suggesting that there is no significant differences in the image quality of the images acquired using the 2 different methods. Radiation exposure received by the patient at the highest kV setting through the glass is comparable to the regular CXR on patient without glass panel at 90 kV, suggesting that there is no significant increase in patient dose. CONCLUSION: The result suggests that acquiring CXR with the X-ray beam attenuating through a glass panel is a safe and feasible way of performing CXR for COVID-19 patients in the newly converted COVID wards. This will allow the mobile radiographic unit as well as one radiographer to be completely segregated from the patient. IMPLICATIONS FOR PRACTICE: This new method of acquiring CXR in an isolation facility set up requires a 2-Radiographer mobile radiography team, and is applicable only for patients who are generally well and not presented with any mobility issues. It is also important to note that a clear glass panel must be present in the barriers set up for segregation between the "clean" zone and patient zone in order to use this new method of acquiring CXR.

Modifications to mobile chest radiography technique during the COVID-19 pandemic - implications of X-raying through side room windows.

INTRODUCTION: Modifications to common radiographic techniques have resulted from the challenges presented by the COVID-19 pandemic. Reports exist regarding the potential benefits of undertaking mobile radiography through side room windows. The aim of this study was to evaluate the impact on image quality and exposure factors when undertaking such examinations. METHODS: A phantom based study was undertaken using a digital X-ray room. Control acquisitions, using a commercially available image quality test tool, were performed using standard mobile chest radiography acquisition factors. Image quality (physical and visual), incidence surface air kerma (ISAK), Exposure Index (EI) and Deviation Index (DI) were recorded. Image quality and radiation dose were further assessed for two additional (experimental) scenarios, where a side room window was located immediately adjacent to the exit port of the light beam diaphragm. The goal of experimental scenario one was to modify exposure factors to maintain the control ISAK. The goal of experimental scenario two was to modify exposure factors to maintain the control EI and DI. Dose and image quality data were compared between the three scenarios. RESULTS: To maintain the pre-window (control) ISAK (76 µGy), tube output needed a three-fold increase (90 kV/4 mAs versus 90 kV/11.25 mAs). To maintain EI/DI a more modest increase in tube output was required (90 kV/8 mAs/ISAK 54 µGy). Physical and visual assessments of spatial resolution and signal-to-noise ratio were indifferent between the three scenarios. There was a slight statistically significant reduction in contrast-to-noise ratio when imaging through the glass window (2.3 versus 1.4 and 1.2; P = 0.005). CONCLUSION: Undertaking mobile X-ray examinations through side room windows is potentially feasible but does require an increase in tube output and is likely to be limited by minor reductions in image quality. IMPLICATIONS FOR PRACTICE: Mobile examinations performed through side room windows should only be used in limited circumstances and future clinical evaluation of this technique is warranted.

COVID-19 radiology CT personnel management.

A new coronavirus outbreak called COVID-19 started in December 2019. In Turkey, the first case was reported on 10 March 2020. In this article, information will be given about the patient and staff management and organization that we have implemented in the Radiology Department of our hospital during the COVID-19 pandemic. The rules we followed were: 1- Performing the examinations of COVID-19 patients and suspects with a CT device isolated from other patients; 2- Reducing the unnecessary workload in imaging modalities other than CT, emergency radiography, and emergency ultrasonography; 3- Directing and managing patients and their relatives in accordance with the mask and distancing rules; 4- Disinfecting the device with an appropriate disinfectant after each patient in order to prevent cross-contamination; 5- Protecting the entire technician team from infection by employing one week work, two weeks off shifts of fixed teams; 6- Ensuring adequate ventilation of the gantry room. Adhering to the above rules, no infection spread was reported from the Radiology department and especially the COVID-19 CT unit.

Role of diagnostic imaging technologists during the COVID-19 pandemic: the importance of organization and planning in the first line. / Papel del personal técnico superior en imagen para el diagnóstico durante la pandemia COVID-19: importancia de la organización y planificación en la primera línea.

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.

Improved Utilization Following Conversion of a Fluoroscopy Suite to Hybrid CT/Angiography System.

PURPOSE: To assess changes in operational utilization following conversion of a single IR suite to a hybrid CT/angiography (Angio-CT) system at an academic tertiary care center. MATERIALS AND METHODS: The total number of interventional procedures and diagnostic CT examinations performed in 29 rooms (20 diagnostic radiology, 7 IR, 2 shared between divisions) was calculated in the 24 months before conversion of an IR suite to Angio-CT and 12 months after conversion. The total number of IR procedures (global IR/month) and diagnostic CT scans per month (global CT/month) in both before and after conversion periods was calculated and defined as baseline institutional growth. This was compared against the change in the number of IR procedures performed in the before and after periods in the converted room (Angio-CT/month) as well as the number of diagnostic CT scans performed in the shared rooms (shared CT/month). RESULTS: The percent change in global CT and global IR from the before to the after periods was 39.2% and 3.1%, respectively. Shared CT per month and Angio-CT per month increased by 46.7% and 12.0% across the same time periods, respectively. The ratio of the percent increase in Angio-CT per month to percent increase in global IR per month was 3.87. The ratio of the percent increase in shared CT per month to percent increase in global CT per month was 1.19. CONCLUSIONS: Operational utilization improved in both diagnostic radiology and IR sections following conversion of a conventional fluoroscopic IR suite to an Angio-CT room.

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.

Managing patient flows in radiation oncology during the COVID-19 pandemic : Reworking existing treatment designs to prevent infections at a German hot spot area University Hospital.

PURPOSE: The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV­2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS: The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS: Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV­2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION: In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.

The use of a patient advocate to improve the experience in pediatric radiology.

There is increasing emphasis on improving the patient experience with a shift to patient- and family-centered care throughout all areas of health care. In 2013, the American College of Radiology launched Imaging 3.0, an initiative aimed at encouraging and enabling radiologists to work on culture change to increase focus on appropriateness, efficiency, quality, safety and patient satisfaction. Many groups have subsequently used these and other tools to improve the overall patient experience, focusing on the entire imaging journey to include initial order placement, registration in the department, image acquisition, departure from the department, and how and when the patient and family receive the imaging results. In our department we have used multiple strategies and have applied quality-improvement methods and patient/family-centered care models to improve quality, safety and the patient experience. Most of these efforts have included team members across the department, including radiologists, technologists, quality-improvement personnel, managers and nurses. In addition, for the last 12 years, a key member of these teams has been our patient and family advocate (PFA). We describe the important role that a PFA can play in improving the patient and family experience in pediatric radiology.

The role of child life in pediatric radiology.

Pediatric radiology departments rely heavily on a dedicated, efficient and collaborative multi-disciplinary health care team to provide efficient service and quality care to patients and families. Certified child life specialists are an essential part of this multi-disciplinary team. The main goal of the child life specialists is to improve the overall experience for patients and families. In addition, child life specialists, working in collaboration with the medical care team, help decrease the need for general anesthesia by providing patient pain management, distraction and coping techniques. These interventions result in improved patient safety, increased departmental efficiency and increased revenue. The role of child life specialists extends into the exam room, where their interventions help decrease procedure times and improve imaging quality. In this article, the authors discuss the key role of child life specialists in a pediatric radiology department and provide examples of how child life can impact patient safety, patient and family satisfaction, and operational efficiency.

Using informatics to engage patients.

As a specialty, radiology has spent much of the last two decades implementing information systems that improve departmental efficiency and the ordering provider's access to information. While our patients have realized benefits such as improved access to care and reduced turnaround times, there has been little focus on using these information systems to improve patient engagement. In the last decade, society has shifted. Now, consumers in every industry expect to be able to use technology to help them accomplish different tasks from scheduling to communicating. Medicine, in general, has been slow to respond to the concept of the patient as a consumer. In this manuscript we describe some of the informatics efforts we have employed in our department to improve patient engagement. We present these initiatives, corresponding to each aspect of the radiology value stream, from the patient's point of view.