Deploying Mobile X-ray Vehicles to COVID-19 Frontlines
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NHG Diagnostics overcomes pandemic challenges to provide timely imaging diagnosis at community care facilities.
By Chong Chun Meng, Principal Radiographer; and Damien Li, Senior Radiographer; National Healthcare Group Diagnostics.
Like other countries around the world, the COVID-19 pandemic has forced a dramatic shift in the way healthcare providers in Singapore deliver care, including X-ray chest imaging for COVID-19 detection.
Almost seven months after registering its first confirmed case on 23 January 2020, Singapore remains in the grip of the COVID-19 pandemic. From the period of January through July 1, we have had about 42,000 cases related to the coronavirus. To care for patients with milder COVID-19 symptoms outside of hospitals, the Government built several Community Care Facilities (CCFs). In addition to bringing care closer to patients in need, the CCFs eliminate the necessity for these COVID-19 patients to visit hospitals, thus reducing the risk of transmission.
As X-ray chest examinations are crucial to the clinical management of COVID-19 patients, it is essential for the CCFs to be equipped with an on-site X-ray facility to provide timely 2D radiology examinations. To achieve this, the Government enlisted National Healthcare Group Diagnostics (NHGD) for support. In early April 2020, we deployed our sole Mobile X-ray trailer to support the first CCF.
Expanding availability of mobile X-rays for COVID-19 detection
As the demand for onsite X-ray services increased, we made plans to re-purpose an additional unit into a mobile X-ray trailer. We selected our mobile Bone Mineral Densitometry (BMD) unit, which already had a lead-lined cabin. This afforded us the shortest lead time, quick deployment, and maximum flexibility should the situation evolve rapidly.
We chose the Carestream DRX-Revolution as the mobile imaging solution for our new unit for several reasons, including the fact that it has one of the simplest and cleanest user interfaces (UI) on the market. The simplicity of the UI enables users to familiarize themselves quickly, yet does not compromise the advanced functions of the system.
Our radiographers particularly appreciate the free rotating tube head of the DRX-Revolution that lets them smoothly manipulate it into the desired position. The suppression features improve the image quality significantly, and the ability to configure the grid ratio is useful as well.
Also important to us is the ability to use the DRX-Revolution for other purposes, beyond supporting chest imaging in the present fight against COVID-19. We are confident that this bedside imaging machine will continue to augment NHGD’s business-as-usual services.
At the time we requested the DRX-Revolution from Carestream, mobile X-ray units throughout the world were a hot commodity, and there were disruptions to the global supply chains and international trade. Nevertheless, Carestream was able to meet our deadlines. This allowed NHGD to provide critical, timely and cost-efficient imaging services amid the pandemic.
Within 12 days, we retrofitted our mobile X-ray unit and outfitted it with the new DRX-Revolution. In May 2020, it was deployed to support Singapore’s new CCF at Tuas South.
Adapting training amid COVID-19 restrictions
Converting our existing trailer into a mobile X-ray unit was not the only challenge we faced. We also realized we would not be able to conduct the usual face-to-face training on the new DRX-Revolution mobile unit with our radiographers because of restrictions on movement during the Circuit Breaker period. For activities like the installation and commissioning of medical imaging equipment, on-site manpower had to be kept to a minimum.
Typically, training on new imaging equipment is done in a small group, with trainer and trainees interacting in person for activities such as didactic teaching, hands-on skills development, and assessment of user competency.
To meet the new safe distancing measures implemented in Singapore, Carestream proposed an innovative remote applications training. Initially, we were concerned whether the virtual training would be effective, and if the learning experience – and in turn the user’s competency – would be compromised. But our worries turned out to be unwarranted as the training went well. The trainer was able to conduct the session smoothly and effectively through the virtual learning platform, be it verbal instruction or physical demonstration.
Partnering with the right imaging provider
NHGD values its partnership with Carestream, having worked together tirelessly to resolve many pressing issues during this challenging time. It is heartwarming to see the public and private sectors join hands to overcome the COVID-19 pandemic, which many recognize as the worst global crisis in our generation.
Chong Chun Meng is a Principal Radiographer, and Damien Li is a Senior Radiographer at the National Healthcare Group Diagnostics in Singapore.
National Healthcare Group Diagnostics (NHGD) is a leading provider of one-stop imaging and laboratory services in primary care via its extensive network in Singapore, which comprises 30 imaging centres and laboratories. NHGD’s imaging services include general X-ray, mammogram, bone mineral densitometry (BMD) and ultrasound, which are available in static centres and on board its mobile service fleet (Mammobus, Mobile X-ray, Mobile BMD and Mobile Ultrasound). NHGD also provides professional services such as teleradiology and management of radiology clinics. All its imaging centres are accredited with ISO15189; it was the first medical imaging facility to be awarded with this certification in Singapore.