How to set up a mobile X-ray unit in the community - Implementation initiatives for patient-centred care

The effect to dose and diagnostic quality of limiting source-to-image distance on anterior-posterior semi-erect adult chest X-rays

INTRODUCTION

Mobile chest X-rays (CXR) examinations are requested for clinically unstable inpatients who cannot be transported to the radiology department. These examinations often have limitations, such as reduced source-to-image distance (SID) in anterior-posterior (AP) position due to limited space in ward environments. This study aimed to investigate the effect of entrance skin dose (ESD) and the diagnostic image quality of reduced SID from the standard 180cm to 150cm and 100cm on semi-erect AP CXRs.

METHOD

A human tissue equivalent Alderson Rando phantom was positioned in a hospital bed at an AP semi-erect 45-degree angle. Three exposures were taken for each SID; the dose was recorded with an Ion Chamber attached to the anterior chest wall to record the ESD and the dose area product (DAP). The mean dose from the three SID positions was compared using a t-test. Image quality was assessed using Image Quality Score (IQS) and RadLex criteria for diagnostic quality using Analysis of Variance (ANOVA).

RESULTS

A linear response of decreasing the SID resulted in a 40.1 % increase in ESD (53.7 μGy; p = < 0.001) from 180 cm to 150 cm SID and a 121.5 % increase (329.9 μGy; p = < 0.001) from 180 cm to 100 cm SID. There was also a decrease in image quality from 180 cm to 100 cm SID (IQS p = 0.03), with 100 cm scoring poor against lower lung field visual reproduction and limited diagnostic quality on RadLex.

CONCLUSION

The findings demonstrate that in controlled X-ray settings, the ESD is increased when the SID is reduced from 180cm to 150cm SID (40.1 %) and to 100cm SID (121.5 %), which furthermore decreases image quality (p = 0.03) and the diagnostic value of the image. It is recommended that radiographers maintain the standard 180 cm SID during adult inpatient semi-erect AP CXR examinations to maintain as low as reasonably practicable (ALARP) diagnostic X-ray examinations.

A service evaluation of the clinical and cost effectiveness of a home-deployed mobile x-ray imaging service in a regional setting

INTRODUCTION

Falls in older adults are common, leading to high rates of emergency admissions, extended hospital stays, and unnecessary use of healthcare resources. This service evaluation reports on a home-deployed imaging service using mobile X-ray equipment to explore the potential cost-effectiveness and patient benefits of facilitating imaging at the patient's place of residence.

METHODS

A six-month pilot program was established involving transporting portable imaging equipment to patients' homes or care facilities in Cornwall as required. Referrals were made by community clinicians via phone, and imaging results were integrated with existing hospital systems. Cost-benefit analysis was performed based on reduced ambulance usage and avoided hospital admissions. Patient satisfaction was assessed using a survey.

RESULTS

305 patient referrals were made, resulting in 294 imaging visits. Most referrals (64.5 %) were to patients at home, with the remainder in care facilities. The majority of imaging involved hip (41.3 %) and lower limb (23.5 %) examinations. 87.4 % of patients were discharged at the scene, with the remaining 12.6 % requiring ambulance transport. Ambulance callouts were avoided in 257 cases, potentially saving over 19 total days of ambulance handover time. Patient feedback was predominately positive. The average age of patients imaged was 83 and the average frailty score was 6 (moderately frail).

CONCLUSIONS

The home-deployed imaging service was effective in reducing need for ambulance conveyance, number of emergency department admissions, and hospital stays, with high patient satisfaction.

IMPLICATIONS FOR PRACTICE

This pilot demonstrates the potential for mobile X-ray services to enhance patient care and reduce healthcare costs. Future implementation should focus on reducing repeat imaging rates and addressing logistical challenges to optimize the service's effectiveness in different settings. Ongoing monitoring and staff training will be essential for sustainable service delivery.

Beyond the Clinic Walls: Examining Radiology Technicians' Experiences in Home-Based Radiography

In recent years, the landscape of diagnostic imaging has undergone a significant transformation with the emergence of home radiology, challenging the traditional paradigm. This shift, bringing diagnostic imaging directly to patients, has gained momentum and has been further accelerated by the global COVID-19 pandemic, highlighting the increasing importance and convenience of decentralized healthcare services. This study aims to offer a nuanced understanding of the attitudes and experiences influencing the integration of in-home radiography into contemporary healthcare practices. The research methodology involves a survey administered through Computer-Aided Web Interviewing (CAWI) tools, enabling real-time engagement with a diverse cohort of medical radiology technicians in the health domain. A second CAWI tool is submitted to experts to assess their feedback on the methodology. The survey explores key themes, including perceived advantages and challenges associated with domiciliary imaging, its impact on patient care, and the technological intricacies specific to conducting radiologic procedures outside the conventional clinical environment. Findings from a sample of 26 medical radiology technicians (drawn from a larger pool of 186 respondents) highlight a spectrum of opinions and constructive feedback. Enthusiasm is evident for the potential of domiciliary imaging to enhance patient convenience and provide a more patient-centric approach to healthcare. Simultaneously, this study suggests areas of intervention to improve the diffusion of home-based radiology. The methodology based on CAWI tools proves instrumental in the efficiency and depth of data collection, as evaluated by 16 experts from diverse professional backgrounds. The dynamic and responsive nature of this approach allows for a more allocated exploration of technicians' opinions, contributing to a comprehensive understanding of the evolving landscape of medical imaging services. Emphasis is placed on the need for national and international initiatives in the field, supported by scientific societies, to further explore the evolving landscape of teleradiology and the integration of artificial intelligence in radiology. This study encourages expansion involving other key figures in this practice, including, naturally, medical radiologists, general practitioners, medical physicists, and other stakeholders.

Reimagining Radiology: A Comprehensive Overview of Reviews at the Intersection of Mobile and Domiciliary Radiology over the Last Five Years

(Background) Domiciliary radiology, which originated in pioneering studies in 1958, has transformed healthcare, particularly during the COVID-19 pandemic, through advancements such as miniaturization and digitization. This evolution, driven by the synergy of advanced technologies and robust data networks, reshapes the intersection of domiciliary radiology and mobile technology in healthcare delivery. (Objective) The objective of this study is to overview the reviews in this field with reference to the last five years to face the state of development and integration of this practice in the health domain. (Methods) A review was conducted on PubMed and Scopus, applying a standard checklist and a qualification process. The outcome detected 21 studies. (Key Content and Findings) The exploration of mobile and domiciliary radiology unveils a compelling and optimistic perspective. Notable strides in this dynamic field include the integration of Artificial Intelligence (AI), revolutionary applications in telemedicine, and the educational potential of mobile devices. Post-COVID-19, telemedicine advances and the influential role of AI in pediatric radiology signify significant progress. Mobile mammography units emerge as a solution for underserved women, highlighting the crucial importance of early breast cancer detection. The investigation into domiciliary radiology, especially with mobile X-ray equipment, points toward a promising frontier, prompting in-depth research for comprehensive insights into its potential benefits for diverse populations. The study also identifies limitations and suggests future exploration in various domains of mobile and domiciliary radiology. A key recommendation stresses the strategic prioritization of multi-domain technology assessment initiatives, with scientific societies' endorsement, emphasizing regulatory considerations for responsible and ethical technology integration in healthcare practices. The broader landscape of technology assessment should aim to be innovative, ethical, and aligned with societal needs and regulatory standards. (Conclusions) The dynamic state of the field is evident, with active exploration of new frontiers. This overview also provides a roadmap, urging scholars, industry players, and regulators to collectively contribute to the further integration of this technology in the health domain.