Speeding Trauma Care with Digital Radiography
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Editor’s Note: The following is a guest blog post by Gillian Tickall, Chief Radiographer at The Alfred. The Alfred is a major tertiary referral teaching hospital that provides the most comprehensive range of specialist medical and surgical services in Victoria, Australia. Tickall kindly shares how converting to digital radiography has helped to shave off 9 to 10 minutes when working on trauma patients.
A pacesetter in Australia’s national healthcare system, The Alfred Hospital in Melbourne sees 60 percent of the traumas in Victoria. For our radiology department, this equates to about 2,400 exams per year. Like any public hospital, one of our key challenges is increasing patient throughput while also improving the patient experience and outcome. This challenge is no small feat as capital funding decreases, pushing the lifespan of our equipment from 10 to 15 years.
One way we’ve addressed this challenge and financial constraint has been to use CARESTREAM DRX detectors and mobile retrofit kits to bring our imaging technology in both the main department as well as the emergency department, into the realm of modern technology. For example, we were able to convert a conventional x-ray room, to a fully functional DR x-ray room, capable of meeting the demands of inpatient, outpatient and emergency examinations in a way that is of benefit to our patients.
In addition to inpatients from the hospital’s burns and trauma units, the room also supports a large population of outpatients, used for multiple exam types, from elderly patients in traction with broken limbs who have to be lifted onto the table to follow-up multi-trauma traffic accident victims. In these cases, it’s particularly helpful to have a wireless detector that you don’t have to reposition between projections. If the detector is positioned incorrectly, the image is accessible immediately and if anatomy is clipped, the radiographer can retake the image after slight repositioning of the detector, which is already behind the patient, thus less distress to the patient.
The benefits in intensive care are significant, through the use of Carestream’s tube and line visualization software, doctors, while by the bedside can see immediately if they have put a nasogastric tube down correctly or not. They can see the image on the monitor allowing them to make an immediate assessment and correction if required. This feature is fantastic. You don’t need another exposure, if you are not quite sure of where the nasogastric tube is going into the stomach you take a copy of the diagnostic image and then apply the software tool and it’s beautiful. The line shows up perfectly and that is a huge benefit. The ICU doctors think it’s fantastic.
Another benefit is when we go to a code blue in the ward, when the patient has just arrested and we are not sure what could have caused it, we do an x-ray. All the necessary doctors and staff are there and they can see the image straight away. They then have the ability to make a decision immediately while the patient is critical. For us to go all the way back to the department , process the image, put it on the network and bring it back to the code blue team takes time the patient doesn’t have and can result in a negative clinical outcome. We managed to shave off a good 9 to 10 minutes when working on trauma patients, which is an awful lot of time when you think about the standard golden hour with traumas.
The DRX detectors also allow us to share between the dedicated imaging rooms and ED. For the purpose of ED we have a room that has 2 wireless detectors, 1 for the vertical bucky and 1 for the table bucky, which can be taken out and used on the trauma trolleys For the odd time you need to do a mobile you can take one detector out of the room and the room will still function, the ability to maintain effective concurrent room and mobile workflows is terrific.
We also have 3 of the new cesium iodide [DRX-1C] detectors, which provide the same image quality with a lower dose as compared to detectors in the ED room and retrofit room in the main department. These are used on the mobile units for mostly in the intensive care unit and the wards. The actual exposure is minimal compared to what we used to use. We used to use the exposure settings of 85 KV on 5 or 6 MAS for a chest X-ray and [with the DRX-1C] we are using now 90 KV on 1.6 MAS. This represents a significant dose saving for the patients who may have to have 1, 2, 3 x-rays a day while they are in intensive care. Given, these images are absolutely necessary, all the more reason radiation dose exposures need to be as minimal as possible and monitored.
When it comes to evaluating the value of our conversion to DR, I look at it in terms of its ability to allow more time for my radiographers to spend with the patient, decreasing the pain effect on the patient and also having the ability to see the image instantaneously. It does mean that we can get more patients through, while still achieving a better patient experience and better outcome.