Interventional Room Research Articles

The Use of Advanced Three-Dimensional Computed Tomography During Simple and Complex Endovascular Aortic Aneurysm Repairs

ObjectivesEndovascular aneurysm repair (EVAR) success depends on imaging technology both in the planning and operative phases. Endovascular repair requires intravenous contrast and radiation exposure to the patient as well as radiation exposure to the operator. Recent developments in imaging technology attempt to merge preoperative imaging with intraoperative imaging to improve the efficiency and accuracy of EVAR. The Cydar 3D imaging system combines the preoperative and intraoperative imaging during the operation. We aim to investigate the use of the Cydar 3D imaging system during EVAR compared to conventional methods. MethodRetrospective review of all patients undergoing an EVAR at a single quaternary vascular center from 2019-2023 was collected. This cohort was divided into two groups: (1) Repair using Cydar 3D imaging or (2) Repair without Cydar 3D imaging. Overall, 138 unique patients were identified with 27 operations using Cydar 3D imaging and 111 operations without Cydar 3D imaging. We performed a 1-to-1 propensity score – matched analysis using nearest-neighbor matching for variables including age, case urgency, and if the case was performed in the operative room or interventional radiology room. A match occurred when a patient in the Cydar 3D imaging group had an estimated score within 0.01 standard deviations of a patient in the control group. From this we paired 27 from each cohort for a total of 54 patients. Demographic data included length of stay (LOS) in days, contrast volume (ml), Fluoroscopy time (min), procedure length (mins), mortality, blood loss (ml). Univariate analyses were performed and a p-value less than 0.05 was considered statistically significant. ResultsA total of 54 vascular patients were analyzed: 27 without the Cydar 3D imaging and 27 with the Cydar 3D imaging. In the univariate analysis there was no statistical difference in the average length of stay (6.4 days ± 11.76 vs. 4.1 ± 6.03, p = 0.372), aneurysm size (5.9 ± 1.4 vs. 5.9 ± 1.2, p=0.88), contrast volume in mL (91.3 ± 47.0 vs. 91.1-33.49, p=9.88), fluoroscopy time in mins (20.2±17.2 vs. 19.5±19.4, p=0.89) , procedure length (299.3±177.9 vs. 353±191.98, p=0.279), blood loss in mL (513.8±791 vs. 353±191.98, p=0.594). There was an increase in reintervention for endoleaks in the group with use of Cydar 3D imaging (0 vs 6, p=0.043). A sub-analysis of patients undergoing physician modified EVARs did show a 15% reduction in the contrast volume used. ConclusionThe use of 3D imaging technology has the potential to increase the safety of EVAR to both patients and operators. In our study we did not find any difference in standard EVARs however there was a contrast use decrease in physician modified EVARs. Further studies will need to be performed to determine the realized benefit from performing EVARs using this new technology.

Fluoroscopic Procedure-Room Scatter-Dose Reduction Using a Region-of-Interest (ROI) Attenuator.

During fluoroscopically-guided interventional (FGI) procedures, dose to the patient as well as the scatter dose to staff can be high. However, a significant dose reduction can be possible by using a region-of-interest (ROI) attenuator that reduces the x-ray intensity in the peripheral x-ray field while providing full field of view imaging. In this work, we investigated the magnitude of scatter dose reduction to staff made possible by using an ROI attenuator composed of 0.7 mm Cu with a central circular hole that projected a 5.4 cm ROI onto a Kyoto anthropomorphic phantom in the head, chest, and abdomen regions. A 150-cc ionization chamber was placed on a stand at a height of 150 cm (eye level) from the floor and 25 cm and 50 cm lateral distance from the gantry isocenter in a direction perpendicular to the table centerline to measure scatter dose at different positions along the length of the table. Scatter dose per entrance air kerma (mGy/Gy) was measured with and without the ROI attenuator and the percent scatter reduction for the ROI attenuator was determined as a function of staff positions, beam energy and gantry angulation. For head imaging, the measured percent dose reduction was 50%-65% and, for chest and abdomen imaging, the scatter dose reduction was 63%-72% at 50 cm lateral distance when using this ROI attenuator with about 20% beam transmission at 80 kVp. Overall, a considerable reduction of scattered radiation in the interventional room can be realized using an ROI attenuator.

The Impact of Patient Education on the Nursing Care of Perioperative Patients in the Interventional Catheterization Room

Objective: To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room. Methods: We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling. The patients were divided into a control group and an observation group, with 35 cases in each group. The control group underwent basic nursing intervention, and the observation group was given precise patient education. The nursing effects of both groups were observed. Results: After the intervention, all compliance indicators of the observation group were better than those of the control group (P < 0.05). Besides, the incidence of complications in the observation group (2.86%) was lower than that of the control group (17.14%) with P < 0.05. Furthermore, the patient satisfaction of the observation group (97.14%) was higher than that of the control group (82.86%), with P < 0.05. Conclusion: A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room. Therefore, this practice should be popularized.

The characteristics of the acoustic environment and the restorative benefits of soundscape in interventional therapy rooms

Coronary heart disease (CHD) has become one of the most serious health problems in the world. As a treatment environment for CHD, the acoustic environment in the interventional therapy room is crucial to patients and healthcare workers. To investigate the characteristics of the sound environment in interventional therapy rooms and the soundscape health benefits of the soundscape for patients, acoustic measurements and noise behavior observations were conducted in various areas of an interventional therapy room, and soundscape intervention experiments were performed on patients treated there. In this study, CHD patients were used as the research object. Results show that: 1) the background noise levels for waiting area (WA) and operation area (OA) under empty field conditions were 54.5 dBA and 52.8 dBA, and 66.43 dBA and 64.2 dBA, respectively, under conditions of usual use. 2) Patients perceived the acoustic environment as noisy and uncomfortable in both areas, with OA being more severe than WA. 3) Natural sounds from composite sources has a greater potential for restorative benefits than single-source soundscape.

Place of Selective Tubal Catheterization in the Management of Female Infertility in Togo

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction. Method: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative β-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after the failure of spontaneous tubal opacification. The parameters studied related to socio-epidemiological, clinical and radiological data. Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified; 62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%. Conclusion: Selective tubal catheterization is a simple technique, without major complications with an efficiency close to natural fertility. It should be proposed as the first intention before any other procedure in the treatment of infertility by proximal tubal obstruction.

Experience of Interventional Cardiology At CHU ''Luxembourg'' In Bamako

Introduction: In the recent past, it was not possible to treat coronary disease in Mali due to a lack of technical facilities. All our coronary patients were evacuated to the Maghreb, France or the sub-region to receive adequate care. In 2019, the opening of an interventional cardiology room at the University Hospital "Luxembourg" and the training of a team has allowed the local management of a good number of Malians and foreigners suffering from coronary pathology. We report here the results of 30 months of activities. Methodology: We performed a perspective analysis of coronary angiograms and angioplasties performed in our center from September 2019 to February 2022. Clinical, paraclinical including angiographic data were collected and analyzed. Results: Between September 2019 and February 2022, 670 patients underwent coronary angiography, 262 of whom were followed by angioplasty. Male gender was predominant (72.6%), a sex ratio of 2.62. The mean age was 59 years and the 46-65 age group was the most dominant (50.24%). High blood pressure was the main cardiovascular risk factor (33.8%). Chronic coronary syndrome was the most frequent indication (59.8%) followed by coronary syndromes (38.3%). The radial route was used in 98%. Coronary angiography was pathological in 69%. Multitruncular lesions were predominant (35.5%) followed by monotruncular (32.8%). 39.10% of our patients underwent angioplasty. Complications were minimal (3%) and mortality was 2.03%. Conclusion: In our developing countries, we are witnessing an epidemiological transition with the decrease in infectious diseases and the emergence of non-communicable diseases, particularly coronary diseases. Their management requires an adequate technical platform, qualified human resources, and multidisciplinary collaboratio

Toward Robust Partial-Image Based Template Matching Techniques for MRI-Guided Interventions.

We have developed an MRI-safe needle guidance toolkit for MRI-guided interventions intended to enable accurate positioning for needle-based procedures. The toolkit allows intuitive and accurate needle angulation and entry point positioning according to an MRI-based plan, using a flexible, patterned silicone 2D grid. The toolkit automatically matches the grid on MRI planning images with a physical silicon grid placed conformally on the patient's skin and provides the Interventional Radiologist an easy-to-use guide showing the needle entry point on the silicon grid as well as needle angle information. The radiologist can use this guide along with a 2-degree-of-freedom (rotation and angulation relative to the entry point) hand-held needle guide to place the needle into the anatomy of interest. The initial application that we are considering for this toolkit is arthrography, a diagnostic procedure to evaluate the joint space condition. However, this toolkit could be used for any needle-based and percutaneous procedures such as MRI-guided biopsy and facet joint injection. For matching the images, we adopt a transformation parameter estimation technique using the phase-only correlation method in the frequency domain. We investigated the robustness of this method against rotation, displacement, and Rician noise. The algorithm was able to successfully match all the dataset images. We also investigated the accuracy of identifying the entry point from registered template images as a prerequisite for a future targeting study. Application of the template matching algorithm to locate the needle entry points within the MRI dataset resulted in an average entry point location estimation accuracy of 0.12 ±0.2 mm. This promising result motivates a more detailed assessment of this algorithm in the future including a targeting study on a silicon phantom with embedded plastic targets to investigate the end-to-end accuracy of this automatic template matching algorithm in the interventional MRI room.

Intervention effect of encouraging mental and programmed nursing of patients in interventional operating room on their compliance and bad moods.

BACKGROUNDPatients’ lack of correct understanding of cardiovascular disease and interventional therapy is often accompanied by varying degrees of fear, depression and anxiety. Negative emotion will affect the hemodynamic fluctuation of patients undergoing interventional surgery, which is not conducive to the smooth and safe operation of interventional surgery. Therefore, it is very important to implement effective nursing intervention in the operating room.AIMTo explore the intervention effect of motivational psychological nursing combined with programmed nursing on compliance and bad mood of patients in interventional operating room. METHODSA total of 98 patients in the interventional operating room of our hospital from October 2019 to March 2021 were randomly divided into study group (n = 49) and control group (n = 49). The control group took routine nursing. However, the study group took motivational psychological nursing combined with procedural nursing on the basis of the control group. Statistics were made on rehabilitation compliance, Positive and Negative Affect Schedule of bad mood, Simplified Coping Styles Questionnaire score of coping style and satisfaction of intervention between the two groups before and after intervention.RESULTSThe rehabilitation compliance of the study group (95.92%) was higher than that of the control group (81.63%) (P < 0.05). After intervention, the scores of upset, fear, irritability, tension and fear in the study group were respectively, which were lower than those in the control group (P < 0.05). After intervention, the score of positive coping in the study group was higher than that in the control group. However, the score of negative coping in the study group was lower than that in the control group (P < 0.05). The intervention satisfaction of the study group (93.88%) was higher than that of the control group (79.59%) (P < 0.05).CONCLUSIONThe intervention of motivational psychological nursing combined with procedural nursing can improve the rehabilitation compliance, and alleviate the bad mood. In addition, it can change their coping style to the disease, and the patients are more satisfied with the nursing work.

Research on the Application Value of Humanistic Care in the Nursing of Interventional Operating Room

Research on the Application Value of Humanistic Care in the Nursing of Interventional Operating Room

ANALISIS PENAHAN RADIASI RUANGAN RADIOLOGI INTERVENSI CATHLAB SEBAGAI UPAYA PROTEKSI KESELAMATAN RADIASI DI RSUP. H. ADAM MALIK MEDAN

The exposure value received does not exceed the dose limit value (NBD) set by the regulation of the Nuclear Energy Supervisory Agency (BAPETEN) recommended by the National Council on Radiation Protection and Measurement (NCRP). This is the goal of radiation protection in achieving radiation safety for workers, patients and the public. To achieve this, it is necessary to evaluate the radiation-retaining structural walls of the interventional radiology room, X-ray fluoroscopy angiography, GE and Philips brands, Cathlab 1 and 2, respectively, at Adam Malik Hospital by comparing the data obtained from field calculations with the recommendations of regulators or theoretical. The results obtained are the thickness of the radiation retaining walls of the GE and Philips rooms by calculating the transmission factor and the thickness of the secondary radiation shield for each wall of the GE and Philips Cathlab rooms with a secondary air kerma value of 1 meter 3.8, the largest Xbarrier is 120.2 mm concrete, respectively. and 1.75mmPb and 81.13mmconcrete and 0.12mmPb. Using real calculations, the secondary air kerma value is 0.003 for the GE room, it is obtained that the concrete Xbarrier and Pb are minus values and the Philips air kerma value is 0.189, the Xbarrier is 22.1mm of concrete and 0.24mmPb. Meanwhile, the currently installed wall thickness is 28 cm of concrete and 0.5mmPb, with a total of 25 patients per week. On the other hand, exposure to environmental radiation, leakage of X-ray aircraft is also within safe limits. The conclusion is that the shield retaining installed both concrete and Pb on each wall of the X-ray inspection room of Cathlab 1 GE and Cathlab 2 Philips, Adam Malik General Hospital is in a safe condition for intervention, and radiation exposure measured in the environment as well as leakage of the light aircraft. -X is also within safe limits, so that the purpose of radiation shielding can be achieved, namely radiation exposure received by both officers, patients and the public does not exceed the specified dose limit value. Keywords: Radiation safety, dose limit value, radiation barrier, interventional radiology.

Percutaneous Ultrasound-Guided Release of the Lacertus Fibrosus for Median Nerve Entrapment at the Elbow.

The aim of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for pronator syndrome, i.e., entrapment of the median nerve at the elbow. Fifteen consecutive patients were included. Patients showed isolated pronator syndrome including pain plus reduced strength of specific median nerve innervated muscles. The release was performed in a non-operating interventional room under wide-awake local anesthesia no tourniquet (WALANT). It was conducted superficial to the pronator teres with in-plane ultrasound guidance. The recovery of strength was first assessed peroperatively, and then systematic visits at postoperative weeks 1 and 4 included assessments of both strength and pain. Procedures were comfortably completed with no immediate surgical or anesthetic complication. Muscle strength returned immediately and persisted at postoperative visits. Visual analog scores for pain reduced from 6.2 to 2.5 and 0.6 at weeks 1 and 4, respectively. All working patients were able to perform in their professional activities at week 1. The millimetric skin incision healed with no hypertrophic scar tissue. A small hematoma occurred at week 1 and resorbed spontaneously. No other delayed complication was observed. The procedure appeared effective with improved invasiveness compared to existing techniques. Real-time monitoring with ultrasound may improve the safety. The technique could be regarded as a new ultrasound-guided alternative to surgery. Performed superficial to the pronator teres muscle under WALANT anesthesia, the microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus may be an effective treatment of pronator syndrome.

Islamic Perspective on Eye Protection from Occupational Radiation Exposures in Interventional Fluoroscopy Procedures: A Review Article

The healthcare staff in interventional fluoroscopy room are exposed to the scattered-radiation from the patient during the procedures. Excessive occupational radiation exposures to their eyes are associated with the formation of radiation-induced cataracts. Therefore, recommendations are set-up to reduce the occupation eye exposure but are often overlooked. Thus, there is a need to incorporate additional value into the recommendations. This review is conducted to incorporate the Islamic perspectives into the recommendations on the eye protection from occupational radiation exposures. Common themes were derived from the recommendations as stated in several guidelines and articles. The relevant Islamic perspective were then identified and linked. The main themes are the responsibilities of the staff in protecting their eyes and the responsibilities of the employers to ensure that their staff are protected. There were several subthemes identified for each main theme. The relevant Islamic perspectives which are related to the identified themes, eyes and concept of radiation protection were discussed in this review. The incorporation of Islamic perspective is an effort to motivate the Muslim staff and employers to see additional values and thus follow the recommendations on the eye lens protection.

Application of Key Link Safety Management in Interventional Operating Room

Application of Key Link Safety Management in Interventional Operating Room

Study on the Hidden Danger and Countermeasures of Nursing Safety in Interventional Operating Room

Study on the Hidden Danger and Countermeasures of Nursing Safety in Interventional Operating Room

Application of comprehensive unit-based safety program model in the inter-hospital transfer of patients with critical diseases: a retrospective controlled study

BackgroundTo explore the effect of applying a comprehensive unit-based safety program (CUSP) in the intrahospital transfer of patients with critical diseases.MethodsA total of 426 critically ill patients in the first affiliated Hospital of Anhui Medical University from August 2018 to February 2019 were divided into two groups according to the time of admission. Overall, 202 patients in the control group were treated with the routine transfer method, and 224 patients in the observational group were treated with the transfer method based on the CUSP model. The safety culture assessment data of medical staff, the occurrence rate of adverse events and related causes, the time of transfer, and the satisfaction of patients’ relatives to the transfer process were compared before and after implementation of the transfer model between the two groups.ResultsBefore and after the implementation of the CUSP mode transfer program, there were significant differences in the scores of all dimensions of the safety culture assessment of medical staff (P < 0.05), and the occurrence rate of adverse events and the causes in the observational group were significantly lower than those in the control group (disease-related, staff-related, equipment-related, environment-related) (P < 0.05). The transfer time for Computed Tomography (CT), Magnetic Resonance Imaging (MRI), operating room, and the interventional room was significantly shorter in the observational group than that in the control group (P < 0.05), while the satisfaction of relatives to the transfer process was significantly higher than those in the control group (P < 0.05).ConclusionThe implementation of CUSP model for the intrahospital transfer of critically ill patients can significantly shorten the in-hospital transfer time, improve the attitude of medical staff towards safety, reduce the occurrence rate of adverse events, and improve the satisfaction of patients’ relatives to the transfer process.

Clinical Application of Medical Imaging in Neurointerventional Treatment of Brain Diseases

The incidence rate of cerebral infarction is high, and the risk of death is also grown significantly with age. Atherosclerotic stenosis is a part of the main causes of cerebral infarction. The effect of drug conservative therapy is not ideal. Interventional therapy is tantamount to send the guidewire, catheter and so on to the lesion site using imaging means, and operates the local area to achieve the purpose of a precise treatment. Therefore, it is important to explore the characteristics and high-risk factors of complications for clinical prevention and guidance of treatment righteousness. This study was to investigate the clinical effect of digital subtraction angiography (DSA) in the treatment of ischemic cerebrovascular disease. Also, this paper discusses the clinical effect of digital subtraction angiography (DSA) in the treatment of cerebral infarction. It has been proved that the application of flat detector CT in the interventional room can not only obtain high-quality 3D angiography (3D rotational angiography), but also display the vessels and high-density structures (skeleton, vascular clamp, coil, stent, and ingenious plaque). Fd-ct has also been proved to be able to perform 3D reconstruction on the stent placed in the patient’s heart and the stent of the external carotid artery. Compared with multi-slice spiral CT, the stent is much clearer and can be used to evaluate the soil and stent placement in the treatment of aneurysms.

Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

Background. Splenic artery pseudoaneurysm is a rare complication of acute and chronic pancreatitis caused by an arterial wall lesion with aggressive pancreatic enzymes and followed by arrosive bleeding into pseudocyst lumen and the formation of a dense fibrous capsule prone to growth.Clinical Case Description. Patient M., 61 yo, was emergently admitted to Territorial Clinical Hospital No. 2 with a preliminary diagnosis: Chronic pancreatitis, incomplete remission. Pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting. Gastrointestinal haemorrhage. The patient complained of moderate persistent belting upper abdominal and left subcostal pain, nausea, general weakness, black liquid stool over last five days. Pancreonecrosis in history. Pseudocyst formation in two months, endoscopic papillosphincterotomy and pancreatic stenting in hospital, the aforementioned complaints appeared past three months. Moderate anaemia (haemoglobin 73 g/L, erythrocyte count 2.8 x 1012), hyperamylasaemia (amylase 170 U/L), no other pathology in general and biochemic blood panels. The patient was rendered urgent oesophagogastroduodenoscopy for large duodenal papilla, with no evident bleeding detected. Abdominal CT angiography revealed a haemorrhagic mass connected with splenic artery lumen in the projection of pancreatic tail. The patient was transferred to an interventional radiology room for coil embolisation of splenic artery. The postoperative period was benign, and the patient discharged on day 3 after surgery for outpatient surgical patronage. Definite clinical diagnosis: Chronic pancreatitis, incomplete remission. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting.Conclusion. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst is reluctant to early diagnosis due to a lacking definite clinical picture and tractable only at an interdisciplinary institution disposing with a rich diagnostic toolkit and sufficiently qualified medical personnel. Endovascular treatment is overall most effective and enables a reliable aneurysm isolation from the splenic artery basin.

Abstract No. 562 Process interventions for improving interventional radiology room turnover efficiency: effect of radiology transporters and dedicated clinical nurse coordinator in a tertiary care hospital practice

Inefficiencies in procedure room management can delay patient care and waste resources. Rapid room turnaround time (RTT) requires multiple tasks be completed in a brief window of opportunity. We examine the effect of dedicated radiology transporters and a clinical nurse coordinator on room utilization metrics in the interventional radiology (IR) department. A prospective database of event times related to room workflow was created for all cases performed in a 4-angiosuite IR department at a 900-bed tertiary care hospital. Cases with incomplete data were excluded. Log-linear gamma regression models were used to assess the impact of radiology-specific transporters and, 11 weeks later, charge nurse implementation, on RTT and case start delay. Covariates were included in each model to control for possible patient-level and procedure-level effects. All analyses were performed in SAS 9.4 (SAS Institute, Inc., Cary NC). In total, 5837 and 1018 cases were included in the RTT and case start delay analyses, respectively, from October 2017 to March 2020. The mean RTT and case delay times were 67.3 and 25.8 minutes, respectively. The effect of radiology transporters were not independently significant using a 5% confidence interval, associated with an estimated 5.2% (-0.5%,11.2%) increase in RTT (P = 0.062) and a 2.0% (-22.5%,21.6%) reduction in case start delay (P = 0.861) on average. Subsequent IR charge nurse implementation was associated with an estimated 7.6% (3.1%,11.8%,) reduction in RTT (P < 0.001) and 22.0% (8.3%,33.7%) reduction in case start delay (P = 0.003) on average. Increase in transporters alone did not independently improve room utilization metrics. Addition of a clinical coordinator role yielded significantly improved RTT and case start delay times.

Evaluations for New Healthcare Environment Commissioning and Operational Decision Making Using Simulation and Human Factors: A Case Study of an Interventional Trauma Operating Room

The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning. Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada. A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations. The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.

Radiation Exposure and the Neuroanesthesiologist

I have done it many times, I have stood there unprotected while I cared for a patient having a quick postoperative computerized tomography (CT) scan of the head. I have walked into an interventional radiology room during a procedure, without wearing a lead apron, to quickly ask the radiologist a question about the next patient. Most would easily agree that I would be putting myself at unnecessary risk from radiation exposure in these two situations. I have also stood there many times, wearing a lead apron and thyroid shield, at the head of the bed, talking to a patient to try to comfort them during a cerebral angiogram. Am I really completely protected from radiation risk in this latter scenario?