PRINCE'S Copy ee HOSPITAL & DEPARTMENT PROCEDURES/PT CARE/CARE OF PATIENT INTRODUCTION The imaging department withi i as a standalone centre can be treated as a separate business as it is abi pai eet or os from providing routine and specialized diagnostic services with imaging technique for indoor (in patient), Out patients, it also provides therapeutic services like radiotherapy, nuclear medicine and interventional radiography, Launching a new diagnostic and therapeutic centre involves very specific requirements and roadmaps that have a direct impact on planning. Planning must focus on the strategic level of any organization, whether it is a multi-national corporation running a hospital or a fix-person radiology group. Certain common steps in the planning process are necessary to ensure the success of any construction project in a diagnostic imaging department. Determining the need for the Project, analyzing requirement for the equipments, space and personnel, and budgeting for the project are necessary steps. CATEGORIES/LEVEL OF THE RADIOLOGY DEPARTMENT: Radiology department can have diagnostic as well as therapeutic functions. Given below are the various functions that fall under each category. (A) DIAGNOSTICS 1. Routine X-Ray Studies - Plain e.g. CxR, spine etc. - Routine fluoroscopic procedures e.g. Ba studies, IVD - Special fluoroscopic procedures e.g, Angiography angiography. 2. Routine USS Studies - USS e.g Abdomen, pelvic etc Doppler studies peripheral (B/w & Color) e.g 2D echo. Vascular studies etc. Me Special Imaging Technique (Modern) - cT : MRT : DSA (Digital subtraction Angiography) (B) | THEREAPEUTIC 1. Radiotherapv e.g cobalt. contact 2. Nuclear Medicine 3. Interventional Radiography: x-rav record rooms films and chemical storage etc. (©). WHO (1998) HAS THREE CATEGORIES: 1. General angiography, general uss, general fluoroscopy conventional ‘tomography. 2. Aslevel 1, plus Doppler USS, mammography, Angiography ([Link]) CT. 3. As level 2, with more sophisticated techniques plus MRI,RADIOLOGY ROOM FEATURES i. Administration Area - Receptions seer, tolet, watting [Om SE 2. General Facility - e.g dressing rooms, drinking Wate" (ie storage Cs oc & Storage Facility - x-ray records rooms, films and che oy are, x-ray tt 4. Storage Facility - x-ray units (200mA/400mA), Centra’ Ber 5. Film processing Area -Darkroom, Automatic Processor 6. Special procedures Rooms - Ba Studies 7. Sonography roam (Routine USG) 8, Electrical Installations 9. Radiographers (imaging scientist) offices 10. Radiologist offices 11. Rooms for storage of mobile/portable units 12. Air conditions, intercom, fire safety precautions 13. Resuscitation facilities 14, Radiation protection ci SON Specific wal thickness, lead coating (depending of CAPA! Protective barrier screens, « lead apron or glov ‘Monitoring badges ty of unit) RULES FOR PLANNING AND DESIGN i new, many of Although much today's imaging equipments and health care cee, eesti the rules for planning and design remain the same. fortunately, that thinking transparency of medical imaging technology and installation. Unfortwnate ie Fm carne. allows a lack of attention to details, fundamental requirement an ‘architecture (and Archiect) may be forgiving, but technology never is. For instances ‘while MRI installation has been accomplished in a smaller room, the basic understanding of magnetic field placement or restrictions has not changed. Current CT or R/F equipment still required adequate radiation shielding and clean power, if not more so. “The role of facility engineer is often critical in the early planning stages of a project to determine what utilities may be needed, any need for plumbing or electric work, power sources, building lode requirements, the need for medical gases and suction etc. Analysis of a potential project’s equipment. space and personnel need is also critical. Gathering the necessary information from various sources within the healthcare institution is essential. “THE DESIGN OF THE MODERN MEDICAL IMAGING DEPARTMENT MUST MET SEVERAL SEEMINGLY DIVERGENT NEEDS: A) — Accommodate large, heavy, noisy technical medical lipment with i infrastructure and shielding requirements. a ee Create a safe, pleasant and efficient staff work environment. For a safe radiation environment, there are certain principl i like “Separation” of different functional areas help ao oe oe . Public areas (waiting room, chat Tooms etc. : Staff areas (offices, meeting a ma : ‘Work areas (radiation rooms, dark rooms, laboratory etc. ) AN i By 8)oO D) E) F) outside aS el area. For ground floor installation, the position of the windows. considerable extent dictate the layout of the department. ana of the department on the upper floor will require to take the rs ate ma Of the adjacent buildings into consideration, when the department. Nn the upper floor, it is important to attend to the shielding of the floor. LAYOUT: me unit should be so isolated that it is not possible to direct radiation towards loors, windows, control panels or areas of high occupancy (waiting areas). The number of doors for entry to the x-ray room should be kept minimum and preferably one only. The passage an doors leading to the x-ray installation should permit safe and easy transport of equipment and non-ambulatory patients. The dark room should be located adjacent to the x-ray room and such that primary x-ray beam cannot be directed to it. ROOM SIZE The room housing x-ray unit shall not be less than 18m? for general purpose radiography and conventional fluoroscopy equipment. The room should be much as to permit installation, use and servicing of equipment with safety and convenience for operating personnel, servicing personnel and the patient and to keep control pane at reasonable safe distance which is minimum 2m of 1.5mm lead thickness can provide adequate protection from all these consideration, size has been worked out to be minimum of 24sqm (6mx4m). The size of the room housing the geometry of the CT unit shall not be less than 25m‘. Also not more than one unit of any type shall be installed in the same room and no single dimension of any room shall be less than 4m... OPENING AND VENTILATION Unshielded opening like windows and ventilators, if provided in x-ray room must. be located above a height of 2m from the ground level of the x-ray room. ILLUMINATION CONTROL Rooms housing fluoroscopy ‘equipment shall be so designed tend adequate darkness can be achieved conveniently ‘when desired in the room during screening. CONTROL PANEL AND WAITING AREA The control panel of diagnostic x-ray ‘equipment operating at 425kvp or above should be installed in a separate room located outside but continuous to the x-ray room and provided with appropriate shielding, direct viewing (lead window) and ‘oral communication facility between the radiographer and the patient. In case of x-ray equipment operating below/125kvp, the control panel can be located in the x-ray room. between control panel and x-ray unit/chest stand shall not be less than 3m for general purpose fixed x-ray equipment. Waiting area should be provided outside X-ray room.o WARNING Lichr Suitable warn an 8 Signal s ouside the x i aay ed light shalt be provided ata appropriate as ed with t articular examen the unit sinter ‘an ning placard oe pastas examination from entering the ae ally placed. a SHIELDING a. FOR Rooms Appropriate sine ouSES EQUIPMENTS USING X-RAY Sone usin ’8, Shall be provided for walls, doors, workers ana aa housing these modalities. So that doses recetved te exceed the respective, Che Public are kept to the minimum and state competent authority (welt nual, Effective doses as prescribed by the respectively. ‘Well below 20imsr for staff and IMSR for Population) In dark iat ae foom, the radiation levels sh jould not be more than 11.3psr per ROOM HOUSING MODAL a ITIES USING NON-IONIZING MRI: Two types of shieldi Ng are required: een i. Radio Frequency (RF) shielding ii. Magnetic shielding Radio Frequency (RF) Shielding: Is done to block out specific radio waves that may distort images created the MRI. The specific radi the type of MRI installed, TA ski pasenedeen RF shielding must create a complete box with all walls, ceiling and flooring Covered with an RF shield. RF shield can be made of almost any metal but the Most common types of metals used are copper, galvanized steel and aluminum. Magnetic Shielding: is not required for every site and is often overlooked in the early planning stages. Essentially, the goal of magnetic shielding is to protect the environment from the MRI magnetic field. Other considerations in the preparation of MRI room (housing) are: ie RF FLOORING: There are 3 basic types of RF flooring as‘follows: i. Monolithic Copper ii. Modular Cell Tvoe iii, Pan Form. i wires a normal |’ depression/build up, is moisture SS i Be arrene ie underlayment as a finish. This is the for MRI application. ; ii. SE er ! Peels floor is a panel system RreoRaN ES te Te ection/buildup of 1 1/8 to 1 3/8, It is a wood core with laminated bse oth side of the core. A vapour barrier is placed on the heer ee the shield from the ground. Finished flooring may ae on top of the cell floor panels with in-fill. ee _ Pan-Fe floor is an all metal construction Ee Caer Hint ee togetner. Infill of the panel is required and ts usually nh 2 pee ST This svstem is not recommended if you concrete - V teaches within the MRI sit.. RF FILTERS AN D f ‘The RF shield ToAVEGUIDES: come into the @ complet e MRI Plete box around the MRI system. Everything that is to mounted 6 oom mie lighting of gn’ RF shield ist Pass through an RF filter or wavegutde. RF filters. are canine red oun Feate a penetration point for electrical power for : within the MRI room. RF filters also accommodate data Waveguide: S are Fo« i Penet , r an Air conditioning ons in the RF shield that allow fluid flow into the MRI equired a waveguides” “@ter and medical gas, all provide a fluid flow and ELECTROMA G electromagnetic i - INTERFERENCE; Every site should be evaluated for of EMI are: interference and vibration prior to finalization of the site sources > Nearby Elevators > , Ki pecical distribution within the building ibwas y car park, roads and path as well as electric trains and subways tes Level of EWI can be reduced with shielding; however, {s minimal and passive. The: le active solutions include magnetic active compensation system (MACS)~ s@ systems measure EMI fluctuations and generate a balancing field, so the MRI does not notice the EMI. MEDICAL EQUIPMENT PLANNING/CHOICE Advancement in healthcare technology has resulted in a quantum change in the desirable requirements of healthcare equipment. As technology continued to evolved, it has a direct impact on the overall space, it ‘occupies as well as on clinical operations. Advanced digital equipment requires integration with information ‘and other systems as well as different technologies. Equipment grading system must take into consideration the following factors for selection: ie Need assessment which decides efficient & patient load. ii. Prompt after-sale service, easy availability of spares and comprehensive warranty is ensured in any procurement. Provision for soft up graduation is also ensured as part of the service contract. Indigenous equipment is preferred over imported ones. Current contract formulation is the most important part so as to control and utilize the equipment to its optimal capacity. ve At the same time, bank guarantee and penalty clauses are carefully planned before any purchase. Radiological examination should be carried only with those machines which are intended be used for such ‘examination. Example: i ‘A mobile or portable x-ray machine with less protection should not be used for lar radiography. F poutine ae ee be used for special examinations involving. its with ordi patient table cannot le ra av ea complicated movements of patients. Similarly, ordinary x-ray oe chanel nat he used for snecific examination like mammooranhy dental x- on the necessity by deliberating on the user’s co more machiFay examination, The atric want there are doses can fermu"ing appropri for Limiting Heeclie Tequirement, of operating voltage ooces_ can be encirealyotaee eRlimnane ee soon ce aes creeper tiot sod nity ieee ths creat meet. the radiation protection The dose to the Ss Patient ares Radiation 2 eakage Radiatioy 5 hr at Im from tube. > Scattered i Public fs contributed by: mera ue Xray tube portal Of the tube housing, not >100mR (ImSv) on any one © Primary and FY and Scatts selection of kv anc ee Fadiation both can be reduced to the minimum by proper 0 Skin dose delivered ree the investigation. soft component of the x-ray spectrum can be drastically Teduced by provi ; and does ee ang filter, Softer component does not reach the screen or film eee re era ee cbeice cre, eanoms ‘information. Hence, it’s The equi s abo requires should therefore have the required filter. In order to have the beam fs determi general purpose work, asa rule, the permanent filter in the useful 1ined by the highest Kv rating of the unit. us i Units wan cues eae pone 7oky and 100kv should have total filter equipment ; . 1.5mm Al equipment 0.5mm AL for bnlonseiaeYetesar a ipment for those operating below 70kv and 0.5mm cones or adjustable collimator capable of restricting the rest should be provided to define the bear. ction of the useful beam should be Suitable devices like diaphragm, useful beam to the area off clinical inter A light beam localizer for indicating the cross se provided and should be so located that the light beam and x-ray beam fields’ concide. In case of fluoroscope machines, the x-ray tube and the screen shauld be so coupled that both move together and the axis of x-ray beam passed through the centre of the screen in all position of tube and screen. The “focal spot size” plays an important role in giving the details of the radiograph and producing penumbra. The smaller the size, the more prominent versa. Hence, depending upon the need, the size should be chosen. should be well calibrated. Wrong setting of Kv or wrong calibration of Ky itt in poor radiography and may lead to a repeat. form of the output is important, compared to half wave, full wave rectification ee energy and intensity because percentage of ‘component of higher Kv will be more. This helps in reducing skin dose. very important to ensure that: tel) x-ray machine is Tad Dak sere ot spot size and filter are as indicated on the cantral nanel the details are, with less penumbra and vice- The kv mete! meter may res¥ The beay mM an The tube an, id light fields ar % Quality assuer TEEN are align Onsruent The lit to carry oe test is aligned, ° it 7 tl ari with physicist in she fests is Ree witt PERSONNEL REQUI hospitals. ith the division of radiological Protection and The participati Pation of quatitieg ft radiology department, this ek et pre ee : aft is very tant in the safe/smooth running of ing v aaa PERSONNEL: x-ray departn Qualified and SPartment should have a radiologic: al safety employer Minespreved bY the competent authority. The 150 may Gan) parts the employer shalt ‘bed OF a consultant or a full/part time employee ae appropriate raat, delegate the responsibiity of ensuring compliance with installation, safety/regulatory equipments applicable to the xray RA 4 poets Mmaging Scientist) and RADIOLOGIST: i X-ray units performing routine/special procedures sh thes services of a qualified radiographer and radiologist. An unqualified ee eieimorktine for screening or may wrongly present the radiograph. The ‘adiographer performing special procedures have good training in radiation safety aspects and is able to adopt all the steps 0 reducing the exposure to the minimum. im) ‘SERVICE ENGINEER: The service engineer undertakes servicing of x-ray equipment should immediately report to the competent authority any equipment that s no longer safe for use, and the nature of defects that make the equipment hazardous. v RECEPTIONIST: i The receptionist registered patients for OPD imaging procedures, provide customer service and works ‘collaboratively with all the radiology area to ensure timely procedure and reporting. a v FILE CLERK: The file clerk performs daily clerical inventory department, monthly office supplies and/or as needed. He process Petrert examination charges to data processing department daily and check off the patient log for completeness. \TTENDANT(S): 5 % fe aes attendant who serve patient (female or male) during changing ag the procedure as per medical sthics ‘with a male doctors of radiographer important. duties as necessary. He maintains the PLANNING OF RADIATION THERAPY DEPART heal and the ra atin in which the source is kept atad Reset oni ey tele bvachytherapy in which the source is kept in cont ‘on the body an Bi bentyia ‘ines can be stationary type oF rotating, ae aaa transnneted body. eletherapy machi bee are wither used manually in which case the sources arejem the storage to the patient rorage to the or mechani: oo Patient through a gue tae ty operating the mechine. no qe sources used in teleth prachytherapy they are in mace ee per ‘of thousands of curies while in ” In case of teletheray Pie wire 1 om ene ce ney meacnines the sources are located in the tempered easily. The pli brachytherapy system, the sources are loose and can be anning is done taking theses aspects into consideration. INSTALLATION a. TELETHERAPY: since i Tone Since in this case, the sources used to very high surcoml coe iS most important. The criteria of site selection a5 discussed in case of x-ray installation should be strictly followed. be considered so that all plan should also ing the number of In selecting, the site, future expansion f accelerator or increas the units can be close inclusi ie by e.g inclusion of Underground installation could be more safe and otherwise the ground floor should be preferred, space should also be provided for treatment planning, mould room, simulator etc. Construction work should not be undertaken without obtaining specific written approval from the appropriate authority. hich simulates the movement of 2 x-ray machine W mour site can be done. The simulator is essentially an the localization of tut teletherapy, with this machine; In case of basement, the parameter such as water seepage or conditioning requirement should be considered. maze wall is to reduce exposure at the door level to the ‘wooden daors can be fixed. Without maze wall, eeded. The viewing window (40mm lead) will f the wall. The thickness of wall where only of wall where The purpose of permissible limits so that ordinary the lining of doors with lead will be ne have the same shielding as the rest of scattered radiation falls is about 50cm of concrete and thickness rimary radiation falls, is above 120cm including the ceiling as well. Air conditioners should be located at a height ‘of 8 feet above the floor level. BRACHYTHERAPY: In case ‘of manual system, the layout should be so planned that the exposures are minimum and within the limits. For this, the distance 0 movement of source should be used for storing the source. ‘A minor surgery room and ‘mould room should also be planned. A full fledged brachytherapy department will have additional room for doctors, physicians examination etc. In words, there would not be an ‘open window. It should be covered with fine mesh 50 that patients may not throw the sources out. e calculations are done in a similar ways as that of For brachytherapy, th teletherapy machine and are low dose rate (LDR) and medium ose rate (MOR).my VV Quality staffs: needed for smon neers Nurses oncologist, medical physicist, radiographers etc. are oth running of radiation therapy unit. In additi nee : that en Monitoring instruments are needed in the department, so called zone monite incident can be defected. For example, a radiation detector warning signal. ‘or installed in teletherapy and brachytherapy machines can give reset the sources can get stuck up in between the “source off and source On’ Position. If the source gets stuck up, then there will be higher radiation level '¢ room. This level will trigger the zone monitor to give audio alarm. In case of manual system of brachytherapy, the monitor is fixed outside the word. If any source taken away by any body, the zone monitor will give audio alarm. The radiation Monitors are useful assessing the radiation level in and around the installation. theratation team includes a Fire protection: if is most important that the project: fire protection engineer to ensure effective detection. Electrical services: the availability of three phase power needs to be confirmed For e.g, a linear accelerator requires 250v/150A power supply, a chillor require 480v/60A and conventional simulator requires 480v/60A. Geotechnical considerations: These convey confirmed flood line, earthquak zones and ground conditions. i.e high water table and soil characteristic Geotechnical investigation includes usually surface and subsurface exploration | the site. Professional attitude of the Radiographer The Radiographer in the hospital team — ; The design & sitting of a radio-diagnostic and radiotherapy department Medico-legal aspectC) _ Restriction/eontrot a ‘ol of public access to work areas h fe work areas will normally be controlled areas, therefore, public can only access if when bein, Flow nf cat tnltnrmncael anes cae nrnae separate from po D) Consi Consideration of spaces adjacent to radiation area includes: Film processing/storage Location relative to radiation areas Chemical storage and disposal Ventilation (glutaraldehyde funs) Silver recovery ~ Bulk film storage. Natural Light in imaging rooms of all types will have the most significant impact on Patient comfort and anxiety. Evidence - based medicine and evidence - base design has spurred important research into the measurable impact of design on patient outcome, staff performance and overall efficiency. Base on research, design includes increased natural light, appropriate materials and measurable design impacts on work performance are being incorporated into new hospitals and outpatient imaging centres. This will directly impact to patients who are likely to be anxious or uncomfortable. or 2 combination of both. DETERMINATION OF DESIGN Imaging technology is focused toward MRI, CT and PET, more often being combined with CT in PET/CT. It is firmly to consider current design determinants: if A) SPACE: The dimensions and weight of the equipment need to be considered and support appropriate clinical patient care and staff support. B) ‘VENDOR SHOP DRAWINGS: These critical planning tools provide baseline information for guiding templates and establishing critical utilities or services, but do not provide the level of design. detail as architectural drawings. c) ESTABLISHING ROOM SIZE: Minimal Ba room size does not adequately support patient care needs, appropriate line of sight to observe the patient or critical staff support. . D) MAGNET REQUIREMENT: As MRI equipment has increased in power, magnetic field have increased, too, changes mean the increases are not directly prapositional. E) CT SPEED: Influences the room and shielding design. The greater throughout of high-: scanners can result in a more patients undergoing scan daily and planning must be done accordingly. HOSPITAL REQUIREMENT: Inpatients require more care than ambulatory care patients. This may units the number of patients’ hospital radiology department can asses daily. PET AND PET/CT: High radiation doses have a major impact on planning and shielding. Due to large exposure used for imaging, areas ‘that do not require Shielding with other imaging modalities Tequire protection. F) G)SOUND PROOFING: Sound proofing, * An essential and often overlooked ‘component of MRI suits is VIBERATION: This i S IS @ crucial is e aoe stab design’and anchorages coe, ea, ee ITAL READIN . % infomation) te Incorporating image interpretation PACS and radiology andlersch en sas ate, carefully designed for physical space demands, lighting work spaces aad ‘ing must be placed to avoid glare on the monitor. Individual ver designed to allow privacy and collaborations at the same Work surfaces and seatit i ¥ ting must consider flexibilit i L which supports work performance. a In planning a department form radi i * ae radiation safety point, the safety of all the concerned peri Scere workers, public at large, and patient has to be considered. The aim ae s to bring down the levels of radiation exposure to as low as possible but well le Dermissible units and to reduce exposure to patient as well. The various sectors which contribute to alt reduction of doses are as follows: A) Proper design of the installation Proper choice of the equipments Participation of qualified staff Installation Design: The installation includes the selection of the site of x-ray installation, layout of various facilities, and proper size of room, structural shielding and location of control panel, equipment and waiting areas. LOCATION OF X-RAY INSTALLATION The location of the department and the relative positions of the examination rooks have a considerable bearing upon the protection requirements. Aspects for planning are accessibility, convenience, privacy, traffic flow (x-ray rooms should be located as far as possible of high occupancy and general traffic crunch as maternity and pediatric wards and other department of the hospital that are not directly related to radiation and its use), etc that is, that should be well connected. Accessibility to wards, OPD and emergency is a major location with space for expansion is an added advantage. This site is generally chosen by consideration other than for protection. However. the following points are worth bearing in mind: MAIN BUILDING OR AUXILIARY ec ation to surrounding areas is a concern, the locations o' a a a separate building preferably a single story many reduce Sead problems. But this ‘could be a merely incidental advantage to the othe! disadvantage position. 2 Ground or upper floors Ground floor location can often avoid the problem of providing protection for the floor but may introduce difficulties to the irradiation of buildingsA & E RADIOGRAPHY LECTURE NOTE. Aceident and Emergency Radi ; a i sable aid to all those rs y Radiography is v tant as an indispensable 2 -by- who work in the Emergency Deceearcat ‘The com and substantial value lies in the ster Ds step analytical approaches which help you to answer this question: "These imest” normal to me, but... how can I be sure that I am not missing @ subtle but imporian abnormality?" The role of the radiography workforce in accident and emergency Globally, A & E Departments are under huge pressure as ever increasing demands are placed upon them. To deliver excellent services. the workforce needs to be highly trained and skilled with excellent levels ot knowledge and the ability to work together as a team: Radiographers are involved throughout the diverse range of emergency medicine, including services 1 minor trauma units, major trauma and resuscitation units and everything in between. Increasingly, minor trauma units are led by healthcate professionals and radiographers have a unique set of skills which allow them to triage the patient on arrival, acquire any necessary images, report the findings and discharge, trea: and/or refer the patient appropriately. In larger A & E Departments, it_is essential that radiographers work alongside other heauncare professionals _to_provide_accurate“and-timely diagnoses so! that the correct treatment can be given as quickly as possible. a Emergency department imaging includes mobile imaging where radiographers are required to obtain images of the patient while they are in the resuscitation unit and/or operating theatres These radiographers are able to work quickly and calmly under extreme pressure, leading the imaging process and providing the information needed for an immediate diagnosis to ensure effective treatment. Diagnostic tests need to be fast and accurate and radiographers undertaking this work not only have highly specialist skills in imaging modalities, but are experienced in the care and techniques required for scanning acutely il patients who require urgent assessment during. a critical period of the care pathway. Radiographers’ contribution to reporting within emergency services is already extensive and allows for immediate reporting. This contribution can potentially ‘be extended significantly as more radiographers undergo ‘specialist training in reporting skills, e.g. CT in major wauma s an essential role in the rapid diagnosis of major trauma Computed al es euicasdsaiths gold standard for major vouma, CT a tae: head trauma due to its ability to demonstrate fresh and allows for ease of monitoring the patient n of head CT images have existed for ice for radiographers in many imaging e to rapidly demonstrate aortic injury, cellent for depicting spinal fractures andof major trauma MRI in major trauma Magnetic Resonance Ima; sssmment i F ging (MRI) is i d in the initial ass its use include because it not i il Se ite rs to tS 28 Widely available and has longer scan times. Other bee ‘as pacemakers) fith the very the need to screen pa n. patients (to exclude am ible ae este y MR incompat wi and the need to ensure compatibility of monitoring and anaesthetic TPM yowing high magnetic field strengths. However, MRI has an important zole im head WET por initial imagine for further ol : 4 patient Mana cross ce odomunal trawna, MRI is useful following initial assessinent trom CT fOF RATES 4, sectional imaging with increased sensitivity in depicting abdominal fluid 010" Shere haematomas. MRI does not involve the patient reeeiving # radiation dose an@ WT ay repeated imaging is required following trauma, MRI has the advantage. eens vtec trauma, MRI is useful to evaluate all the soft tissue structures surrounding the spine °° ‘ for example, damage to ligaments and to assess the spinal cord The reporting of trauma radiographs, is embedded. in the professionel field of diesnce radiography globally and is continuing to evolve. It is clear that radiographers’ contribution to trauma reporting services can potentially be extended significantly. Radiographers are pivotal to delivering fast and reliable dingnoses of disease, as well as curative and palliative treatment and care for patients with cancer. A large majority of patients will be referred for imaging during their treatment and radiographers are key to the delivery of successful clinical outcomes. thus, it is important to note. that: + Every patient must have the right diagnostic examination, at the right time, undertaken by the most appropriate person, using the right equipment to the best possible standard and with timely results to inform the outcome. « Every cancer patient must be able to be in control of decisions about their care and have access to the most effective treatment, delivered at the right time and by the most appropriate person. Bal fF— N Pies a eee omiad i ion : jon” meaning "0 A uly 1 eit "nosocomial" originates from two Gr: i A et eae t eek Words; “nasus" meant in 1), Such an care of". Nosocomial infection: Originating or taking piace ina hospital, acquired 14" gical). Si in veference to an infection, sometimes celles eres eee on, eiealed a Magh th he ee craks clinic, infection ¢ quired in hospital, Mean ee al Sees jCePital, nursing home, rehabilitation JaPiA gpl Clinical settings. ‘A nosocomial: infeetiowfiespiidncoe toa reat dine fy wopital by @ patient who -wWis-tdisitied tor a reason other thal that I er Nealthare tacliy in whom te infestion 95.21 PISE hospital le that was not val infection is-an_ occupation fection nal etc that an Sista otic Vectic eee sel ait, agaetabE. actors that promote nosocomial [Link] hospitals techniques creatine pantnity among paticnis; the inceasing varety of medical procedures and invasl ea populates ana Toutes of infection, and the triimission of drug-resistant bacteria among crowded hosp! populations, where poor infection control Practices may facilitate transmission. Regier hititd t0 the suscepiible patient in the elinical setting by various means, Health care staff such as Ecdiegrapher(s) ean spread infection, in addition to contaminated equipment, bed linens, or ait droplets. ae seu cit can originate from the outside environment, anather infected patient, staff that may be infected, or in aime cases, the source of the infection cannot be determined, In some cases the microorganism originates from baticul's own skia microbiota, becoming oppurtunistic ater surgery or her procedures that compromise the 2rotective skin barrier (though the pationt may have contracted the infection from their own skin), the infection i considered nosocomial since it develope in the healllt care setting «se/Cransmission welling catheters have recently been identified with hospital acquired in Mein réutes 2 transmission Rode Description Contact The most important und frequent mode of transinission of nosucomial infections is by direct wansmission contact. - bie gat i a. ‘ {+ Transmission ccs wisn droplesconsining microbes fom th infected person are propelled ee a short distance through the air and deposited on the patient's body; droplets are generated from transmission the source person mainly. by coughing, sneezing, and talking. and during the Performance of efore, special air-hany resnisins (ranituilted by airbory und th sand varicellaeae jssion ©! . ransmission © isk row % the 15) rn to PI Gigves: 1n addition to hand washing, gloves play an important role in Fe4¥CINE ‘hoy are Ying ood, boy mnjsroorganisms. Gloves ate wom! for three iinportant reasons in hospitals: Fi when fe Yip elihood 1 protective barvier for personnel, preventing largs scale contamination of the har oe the We thes reduce * o ids, sceretions, excretions, mucous membranes, ond new inact skia- SECON: "Turing INYEENE Ta1y, 10 microorganisms Pyesent Ba the hands of personnel will be transmitted (© a care procedures that involve touching a patient's mucous membranes OM isms. fro tne Wkelhhood thatthe hands of personne contaminated. with °*0 2TH Changed BEIMEEE 2 cor transmit these micro-organisms to another patient, in this situation, gloves ™™S" © op repla Contacts, and hands should be washed afer gloves are veinoved, Wearing gloves damage t0 trandwashing due to the possibility of contamination when gloves are replaced, OF Ty hazard. mn Doctors wearing the same glaves for multiple patient operations presents an infection es a Surface sanitation; Sanitizing surfaces is part of nosocomial infection in health car a sanitizing methods such as the use of hydrogen peroxide vapour has been clinically lst ing bacteria, such as rates and risk of acquisition. Hydrogen peroxide is effective against endospore-fOmn’te a. Clostridium difficile, where alcohol: has been shown to be ineffective. Ultraviolet cleaning, : used to disinfect the rooms of patients infected with Clostridium aifficile after discharge. ce on inanimate ‘touch? surfaces for extended Antimicrobial surfaces: Micro-organisms are known to sul vents where patients with periods of time. This can be especially troublesome. in hospital environm| immunodeficienci¢s are at enhanced risk for contracting nosocomial infections: Touch. surfaces Sem found in hospital include x-ray equipments, bed rails, all buttons, touch plates, chairs door handles, OG” switches, grab rails, intravenous poles, dispensers (alcohol gel, paper towel, soap), dressing trolleys, and counter and table tops are known to be contaminated with microbes, This is why touch surfaces in hospitals ean serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and. visitors to patients. However, a numberof compounds can decrease the risk of bacteria growing on surfaces including: copper, silver and g 8 ‘One-third of nosocomial infections are ‘considered preventable. Hospital persohnel are estimated to be responsible for 20-40% of patient-to-patient. spread of nosocomial pathogens. "Nosocomial infections are of growing concem in medical facilities, in part because many*of these infections tend to result from micro orgenism that are resistant to antimicrobials and are therefore difficult to treat". Given this concern aid that most hospital-based Radiology departments have a high turnover of both inpatient & ou tpatients, Radiographers compliance to Infection Control Guidelines & Standard Precautions could be critical in preventing canaries of such pathogsss, Basleally infection control is about preventing the transmission of infection threcch wie hospital, Health care professionals afe therefore expected to apply and or implement hence ee procedures for infection control during their practice in their various specialities. All healthcare pra meeps and expe-iod be responsible for compliance with the infection conrol precautions. According ce Ctitioners are ths &guostic imaging depariment i central within the hospital to the diagnosis ofall aie ox & Harvey, nosocomial infections add healtherelated and financial burdens on health systema, Kenn and diseases as conirl practices among Radiogrephiers i very important as future training shoud ieee : ling. used needles, the use of protective barriers, and the manocuvrability aroun ‘il : 4 curriculum and on-site training could enhance knowledge in infection reer Improved academic Contibusing factors to this included shortage of staff, Heavy workload per day, abaane eee SOME Of the towels in some diy rooms, absence of infection conral guidelines in the depareee gS aN disposable supply of materia|s by department to aid in infection control procedures. Radioerne es? e 8nd/or inadequate training in infeesipn control procedies, This could be done through woke Braphers myst b reso hers must be given perio; ie proenils, Wate robcl tnd xson mit be euines ye Mi DS et ine se of infection procedures during work, There should be an infection control offi Mane ctio practice of infecti | procedures by Radiographs, mer'who periodically monitors ne ee : eG ent eel °PANCES Cary WORK?L, r PLACE VIOLENCE INVOLVING RADIOGRAPHERS (RAD 222) a ae The term “Woe power lace vial ” . lave Violence” i ; a hese Seay ca Eaneeeaet: fl poe ey amet ‘another person or im work-related oe rhalogieal han: ae in or has a high degree of likelihood of resulting in ingUrys death SE eens eee deprivation” n Nien, met ispues re onstar Radiographers is occurring e worsening dally. Currrtly, ‘Workpts Pebtence invol¥in Se eet Teas increasingly ofen in the Nigerian medical SECO" swith namerous otessionsls ‘ist ae - becoming the ‘most dangerous oooupational pazard that jnealth eee vtond with, Perperators refers violence, Hol! the patients, claliy eee ei neon Te sarina such us verbal, non-vetbel Of ronysical invasion thet Set i hers or to their property. Thus; ee pal violence is defined as the use of usrve ox offers quae), derogatory remacks or profase B eats fe Waring Of intent to injure another person Wilh 2F = sina an object ot WORPOD © rarass and to physically intimidate. Dinysiea? assault includes slapping, pinching, pushing, shoving, SPINS oy Kicking with oF without entional use of -vao ye language Cinewusing Sexually abusive ‘and or obscene comments the use of Weapons. Workplace wiokenee did not became gatjet of eocerm until 1990, EEN the Nationa! nstiate £0 Seeupational Safety and Health respectively. Peeet (2014) indicated hey threat and violence (0 Sedical staff is common 10 &¥=1) country, BULIS Troe comsnort in CUM a evore, workplace VSIEN Tathcare setings has direcYy and fr stinued Fise in workplace vndirectly imereases ‘personnel and re ial costs Since 200, QUE continue Irsjence nie DoaHtE teva, operate costs DANE acistetly been increased 10 COST the vistapatil ety oF eaacare employees “Tis outcome was an incTeaSE employee disability. oesjgnation, and TUN ates, which Ted 0 considerable financial Tosses For example, the National Besith Serre (2008-2009) satisics ne adieated that temporary Leaves oF ADBENES by healtheare femployees afer encountering paient naialt amounted to an annual Loss of approximately p69 mittion. I addition. nee Tosses (eg, Workplace delinquency, reduced service qVality> Jow employee morale, and 4 creased patient ‘trust) pose critical thregls to ‘the Syeration of Pe jeeave fasiities amr counts have established legislatures to promote 2=Te Tirerance policies Syasding, workplace jence and actively implemented relevant organizati revention IneAstzess incidence reporting procedures, work izational : mone traising. However, large-seale and aati environment Laney areetively ceouce 2 yneidence of violence are lacking, dized assessment ost. studies qvaitable cas elated 16 workplace violence in healthear é ue settings involve personnel, Paychiawists, Radiographers an eee nave ssaeeee Peje issue related to Radiographers, Se but very. few s, 10 understand ihe current status of workplace violent © previously described analyze he effect of sitferent demographic variables on Radiogra mes on Radiographers and particule nigerian seine comes er inert, femath related workplace vi fs pasos snowed Ih ost Redlowr rs suffered from. workpl: rationale of this to} violence 4 Ta he erste about the preval slabereprete ahaa pie, Radiogseprers in Flong Kone : lence of workplace ae is 10 a consi Rs ess ence savotving Ra nsistent¢ healthcare or ganizations in op egative impact due to mj i ee Violengg MIME the averse Consequences result raphers in Hore ie vileice ven idents in 3 yen Monee 61% . Years. Algo, “eles had experies 14 had experienced workplace “toe stigating 94 Radiographers employed st Types of workplace Verbal abuse which tolence inyotyi Iving Radi has beer ' Radiographers, violence. This finding should ort’ t0 be th imssteus he sun oet ett te ateton of reas erst pt em ieee te Sou of he viene vant authorities arid prompt them to snd visitors are the inost likely ce incidents are som a patients, their family members (relativ Perpetrators in the health professions. : ee Causes of workplace viol * The easy entry and gees ‘ iness, noise of facilities, as well as healtheare staff shortages te (when Radiographe Scholars aa ee ae sore ‘and lengthy waiting times. However, ia ri - 5 Fepol ly similar results regarding the cause of workplace vilense among. Railogapes and oer etter profedouas, comity divating that lengthy waiting times and miscommunication are the primary causes. Solutions/the way forward Z Implementation of workplace violence training. In Taiwan for ¢.g, new Graduates and Younger Radioucaphers are usually assigned to the A&E Department as their initial position. They usually hind litle experience in dealing with angry patients and impatient relatives. Reports also put it het Radiographers who had been subjected to workplace violence experienced negative effets in ther aac caand subsequent job performance, such as reduced passion for work and chronic eclaches, Researchers have unanimously confirmed. that: Radiographers exit negative peeflonal espouses following incidents of workplace violence. AS 8 result, this presenis Challenges for health authorities in implementing effective preventive straegies to minimize violence in workplace. Department support: In terms of violence, the Hospital Management et Government need 10 i i i ifeagues. According 10 the Depart FE" om passive to active 10 show thir support fro Sot : saute he insuiient on-the-job violence waning oom Tea to the incapbrene of dealing Se ees ftco que Come Professional ) Development (CAD) of Radiographers should be introduce to increase the competency, courses related to workplace Radiographers st edited as formal tuning to obtsin cree forihe CPD. As forthe Government, a cates have adopted occupational Halt at safety legislation and policies. A peaceful many ; a ace will benefit at just tbe hesliheare hrs, utmost inprantySPAS Summary . the most common type of workplace violence involving Reports put it 1h ee eat ic among. the three leading: causes of such incidents. Radiographers and misconbt compulsory courses regarding imaging theories and techniques, revocational education should increase interpersonal training regarding, relationships, communication, and emotional rvedical institutions should enhance Raciographer staing *0 to patients. This strategy can reduce waiting times, enhance ‘Also, the relevant Government Authorities should establish ‘ons to increase the ratio of Radiographers to patients and should also be enacted vo improve people’s etiquette when priate punishments for perpetrators of workplace violence.