X-ray Department Research Articles

Repeat profile analysis in an x-ray department

The repeat profile of an X-ray department in a developing country was analysed monthly between July 1989 and June 1990. Results showed an average repeat rate of 3.7% for the period of study. The main causes of film repetition were: equipment fault, 33.9%; radiographer's fault, 27.4%; film fault, 19.3%; processing fault, 10.8% and patient's fault, 8.6%. The average repeat rate in the first six months of study reduced by 50% in the last six months. This was due to the effectiveness of implementation of corrective actions. The overall repeat rate was found to correlate well with both the equipment fault and radiographer's fault with correlation coefficients, r, of 0.94 and 0.91, respectively. It is expected that a further reduction in the repeat rate will be obtained after the introduction of quality assurance programmes.

Post code cracker

In reply to Michelle Nash's letter (Don't forget your post code, Nursing Standard, January 23), regarding the X-ray Department's refusal to perform X-rays on patients whose post code is unknown.

Don't forget your post code.

While doing agency nursing at a Norfolk hospital, I read a memo from the X-ray Department stating that 'no X-rays would be be carried out on patients whose X-ray forms did not state their post code'.

Risk and safety in radiography in women of childbearing ability

Ionizing radiation carries risk to the unborn child [1-12]. We know this from the deleterious effects of human exposure to the Hiroshima and Nagasaki atomic bombs, from extrapolation from the effects of high dose radiation in animal research but from very little other human data. The probability of harmful effects to the fetus from diagnostic levels of radiation must be considered even if these are sporadic and infrequent and have been difficult to prove. On the other hand it can never be proved that diagnostic radiography will not damage the fetus [13]. The medical and allied professions must therefore be aware of the nature and extent of such risks so that correct and safe decisions as to the withholding or performing of radiographs on women who are or may be pregnant can be made. Every X-ray department must have a clear local protocol which ensures that the risks to any fetus of exposure to ionizing radiation are weighed against the benefits to the mother of obtaining the radiograph. The derivation of such local protocols should be based on: (1) knowledge of the nature of the risks to the fetus from radiation exposure; (2) knowledge of the recommendations designed to safeguard the fetus from such risks;

Book reviews

Diagnostic and Interventional Radiology: A Clinical Manual is a pocket-sized book of 316 pages edited by three American radiologists with contributions from seven others. The stated aim of the authors is to provide a guide to the repertoire of the X-ray department, and how to get the best use from it, for medical students and newly qualified doctors.

The impact of the M1 air crash on the radiological services at the Queen's medical centre, Nottingham

Following the M1 air crash on 8 January 1989, 39 casualties were taken to the Queen's Medical Centre, Nottingham. A team of 31 radiographers and four radiologists used all five X-ray rooms adjacent to the Accident and Emergency Department. Patients with head and spinal injuries were further assessed in the CT suite by four radiographers and a neuroradiologist. The volume of work in the first few hours and in the subsequent days is described. All radiological examinations have been reviewed and the injuries, including those missed at initial assessment, are discussed. The role of the radiologists was to issue immediate reports, manage examinations so as to minimize any delay and assess the need for further specialized investigation. Important problems were identified, specifically: the call-out system; patient deterioration and lack of resuscitation equipment; patient flow; documentation; radiology equipment; and missed injuries. These problems are discussed and recommendations are made for X-ray Departments in dealing with disasters.

QUALITY ASSURANCE IN DIAGNOSTIC RADIOLOGY--FOR ITS OWN SAKE OR THAT OF THE PATIENT

X-Ray departments are expensive to equip and run. This paper illustrates how a quality assurance programme may help to limit the wastage of resources. The production of good quality medical X-ray images is extremely complex and can only be guaranteed by implementing some form of quality assurance programme. The exposure of patients to X-rays also entails a risk of radiation injury and a quality assurance programme is necessary in order to limit this risk to a level as low as reasonably practicable. Because of this, in countries within the CEC, legislation now requires such a programme to be implemented. The aims of a QA programme are defined, and the implications arising from these aims are discussed. The role of international organisations in helping to achieve these aims is also discussed. The pitfalls of a QA programme in radiology are also identified particularly: (1) the tendency to carry out a large programme and acquire a considerable amount of data so that the original aims are obscured; (2) the possibility of carrying out tests which are expensive to perform and are not cost effective and (3) the failure to adapt constantly the content of the QA programme to the ever changing needs of the local department and the radiological community generally. The various components of a QA programme are presented together with illustrations of their possible impact on the standard of work of the X-ray department. These include: (1) resource management through film reject analysis; (2) patient dose measurements; (3) equipment inspection programme; (4) equipment maintenance programme; (5) training and education of staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Book reviews

Ref 85–5 (F) This tape/slide presentation is another in the series prepared by St Bartholomew's Hospital dealing with radiation safety in the medical environment. It is the first of two programmes for domestic staff (the second one being concerned with radiation safety in laboratories). The programme covers all areas where radiation may be used in hospitals, from the diagnostic X-ray department through the radiotherapy department to the use of radioactive sealed sources on wards. No real mention is made of problems in operating theatres, although they are referred to in the text. is primarily intended for use in a radiotherapy centre.

Picture archiving and communication systems: it's not features that count but the ability to convince

The Dutch Government wants to curb the cost of Health Care. Running as high as 10% of the National Income, there is every reason for support. Imaging professionals, like radiologists, are vital for the discovery of disease in society. They need expensive equipment, not only to satisfy their professional pride but foremost to try to discover disease early and before having to put money into treatment of disease that is needlessly advanced and really beyond cure. Personal-PACS is not only cheap, it also makes X-ray departments much more efficient and gives radiologists a better image. The amazing thing, however, is that it proves to be the perfect tool to convince colleagues as well as decision makers.

Book reviews

This is an excellent book. It is small, readable and cheap, and contains a lot of simple information which will be of great interest and value to every GP who picks it up, even if he only reads part of it, which is unlikely. It is also of great interest in another way. The author has taken on the philosophy that, as every patient “belongs” to a GP, it is very important that not only GPs know what is likely to happen to their patients in hospital but also that GPs should recognize the radiologist as a front-line hospital referral specialist, whose proper use of very expensive diagnostic equipment can expedite the solving of patients' problems, and provide a much faster and better service to patients than the alternative referral to X-ray (imaging) departments only via medical or surgical outpatient departments.

Using hospital site visits for teaching occupational health.

In medical schools, the factory visit is an important ingredient of occupational health instruction at all levels. Usually the time allotted for teaching this subject in the undergraduate curriculum is limited; as a response to this constraint, the Tel Aviv University Sackler Faculty of Medicine has used its associated teaching hospitals as the "factory" since 1982. Following an introductory discussion, the students are divided into small groups and sent to various departments of the hospital--wards, kitchen, laundry, maintenance workshop, X-ray department, and surgery--to observe and evaluate the work environment. Following this activity, the students reconvene and discuss the health implications of what they have seen. This way of providing the factory visit is well accepted by the students, saves time, and contributes directly to the students' awareness of their own working environment.

An analysis of referrals for primary diagnostic abdominal ultrasound to a general X-ray department

We note with interest the findings of Drs Colquhoun, Saywell and Dewbury (1988). It is our practice to promote ultrasound as the first-line investigation of abdominal symptoms, both for hospital and GP referrals.

An analysis of referrals for primary diagnostic abdominal ultrasound to a general X-ray department

Drs Fitzgerald, Mackie and Manns are clearly as enthusiastic users of ultrasound as am I. It is the great success of ultrasound that has led to ever increasing workloads. This prompted our detailed retrospective analysis of 1861 patients, which forms only a small proportion of the 23 000 diagnostic ultrasound scans carried out in the department per year.

Diathermy hook ablation of posterior urethral valves in neonates and infants.

An insulated diathermy hook was used to destroy the posterior urethral valve in 10 boys. The technique needs no anaesthetic, no endoscopic equipment, no perineal urethrostomy and only occasional catheter drainage of the bladder. It is performed in the X-ray department, where the efficacy of the procedure can be checked immediately with a further cystogram. The results are compared with those in 7 other boys whose valves were destroyed by conventional endoscopic means.

Life Is Short, the Art Long, Opportunity Fleeting, Experience Treacherous, Judgment Difficult

To the Editor. —I wonder if it is only coincidence that the article by Drs Elliot and Hickam1about the evaluation of physical examination skills appeared inTHE JOURNALso soon after the A PIECE OF MY MIND2by the disillusioned student was published. Certainly the student had ample reason to be discouraged. If his story is anywhere near the truth, he was mortally ill, probably thought he was dying, and the only parts of the modern hospital complex that paid any attention to him, the central character in this little drama, were the hospital laboratory, the x-ray department, and other sophisticated and expensive specialty aids. I am an old and retired general practitioner. From 1939 to the late 1960s, it was my (often frightening) experience to serve my patients in whatever ways I could, without these machines and with precious little specialty help. This entailed a good

An analysis of referrals for primary diagnostic abdominal ultrasound to a general X-ray department.

Abnormalities were found in 30% of examinations. Comparison of outpatient and family practitioner referrals in cases of suspected gallstones (24%:27%) indicated the value of GP access. There was also evidence, in the absence of a dilated common bile duct, that there was little value in extending the examination of the gallbladder. In post-cholecystectomy syndrome, endoscopic retrograde cholangiography is shown to be the investigation of choice. Abnormalities revealed in lower abdomen examinations were related only to pelvic organs and in this group examination should therefore be confined to this area. Pick-up rates of 15% were found in patients with left upper quadrant pain and a number of miscellaneous conditions. There is a marked increase in positive findings in the presence of a palpable mass.

A Guide to the X-Ray Department, 2nd editionA Guide to the X-Ray Department, 2nd edition Goldman M Wright 94pp £5.95 0-7236-0765-6

A Guide to the X-Ray Department, 2nd editionA Guide to the X-Ray Department, 2nd edition Goldman M Wright 94pp £5.95 0-7236-0765-6

Lead thickness in shielding in the protection of radiodiagnostic staff.

We indicate the principles which can be used to apply cost-benefit analysis to radiation protection of staff in an X-ray department. The cost of saving radiation exposure to staff by varying the lead equivalence of lead gowns and lead protective screens is calculated. The cost is compared with the financial values of the detriment as assessed by the National Radiological Protection Board. The expenditure required to avoid a man-Sv for staff protection in diagnostic departments is suggested. In the examples we take, it is found that the larger staff dose reductions, and often the cheaper reductions, can be obtained by reducing the radiation dose to the patient. There are, of course, major additional advantages to the patient in reducing this dose.

Measurement of X-ray image intensifier sharpness in the X-ray department

A method is presented for determining the modulation transfer function (MTF) of an image intensifier as it is found in the X-ray department. The image of an edge input into the image intensifier tube is photographed at the television camera port with a high quality camera and the photographic image scanned with a microdensitometer. Sensitometric conversion enables the determination of the edge spread function and further calculation produces the line spread function and the MTF. A correction is made for the camera/lens/film/developer response function. Results from the use of the technique on over 25 X-ray image intensifiers in New Zealand hospital X-ray departments are presented and discussed. Most of the image intensifiers had been in use for more than 7 years. The low-frequency drop values were similar to reported values with an average value of 22%, but modulation values at 1 cycle/mm (the average value was 29%) were generally lower than values previously reported, indicating that the sharpness performance in the clinical environment is inferior to claims for new or state-of-the-art intensifiers.

Diagnostic radiology in disaster medicine: implications for design, planning and organization of X-ray departments

Diagnostic radiology plays an important role in the evaluation of disaster casualties; these are referred to X-ray departments, shortly after their arrival at hospital, in large numbers, frequently overwhelming facilities and resources of the department. The study of relevant literature and the experience of the authors suggest that there are implications for design, planning and organization of X-ray departments to be considered in disaster-prone areas. Departments should be sited as near as possible to triage areas, on the same floor, with broad, unobstructed passages. There should be provision for easy passage of equipment and trolleys through doors and corridors and large circulation areas, working rooms and waiting spaces with plugs, for electricity, piped oxygen and suction and devices for hanging infusion sets. Two entrances to the department would enable one-way flow through the department. All work should be done in the department and examinations performed with mobile units avoided. A radiologist at the entrance to the department and a control post at the exit ensure adequate processing of casualties. Interpretation and reporting should be done by assigned radiologists dictating directly to typists; films and reports should accompany casualties.