Initial data from an experiment to implement a safe procedure to perform PA erect chest radiographs for COVID-19 patients with a mobile radiographic system in a “clean” zone of the hospital ward

Abstract

Introduction: With the current Covid-19 pandemic, general wards have been converted into cohort wards for Covid-19 patients who are stable and ambulant. A 2-radiographer mobile radiography team is required to perform bedside Chest X-rays (CXR) for these patients. Hospital guidelines require both radiographers to be in full Personal Protective Equipment (PPE) throughout the image acquisition process and the mobile radiographic unit needs to be disinfected twice after each case. This affects the efficiency of the procedure and an increase usage of limited PPE resources. This study aims to explore the feasibility of performing mobile chest radiography with the mobile radiographic unit in a "clean" zone of the hospital ward. Methods: An anthropomorphic body phantom was used during the test. With the mobile radiographic unit placed in a "clean" zone, the phantom and the mobile radiographic unit was segregated by the room door with a clear glass panel. The test was carried out with the room door open and closed. Integrated radiation level and patient dose were measured. A consultant radiologist was invited to review and score all the images acquired using a Barco Medical Grade workstation. The Absolute Visual Grading Analysis (VGA) scoring system was used to score these images. Results: A VGA score of 4 was given to all the 40 test images, suggesting that there is no significant differences in the image quality of the images acquired using the 2 different methods. Radiation exposure received by the patient at the highest kV setting through the glass is comparable to the regular CXR on patient without glass panel at 90 kV, suggesting that there is no significant increase in patient dose. Conclusion:The result suggests that acquiring CXR with the X-ray beam attenuating through a glass panel is a safe and feasible way of performing CXR for COVID-19 patients in the newly converted COVID wards. This will allow the mobile radiographic unit as well as one radiographer to be completely segregated from the patient. Implications for practice: This new method of acquiring CXR in an isolation facility set up requires a 2-Radiographer mobile radiography team, and is applicable only for patients who are generally well and not presented with any mobility issues. It is also important to note that a clear glass panel must be present in the barriers set up for segregation between the "clean" zone and patient zone in order to use this new method of acquiring CXR.

Performance of a Severity Score on Admission Chest Radiograph in Predicting Clinical Outcomes in Hospitalized Patients with Coronavirus Disease (COVID-19)

“…Thus, studies that use CT for grading include a disproportionate number of patients that undergo imaging due to either clinical deterioration or to exclude other reasons for hypoxia, such as pulmonary embolism. As such, CT is not as applicable for COVID-19 prognostication at the time of admission as CXR, which is widely available, inexpensive, and, in the case of portable CXR, more easily decontaminated (31)(32)(33). Lung ultrasound has also been explored as a method for diagnosing COVID-19 pneumonia, with at least one study demonstrating a higher specificity and sensitivity for lung ultrasound than for CXR (34).…”

Implementing a Novel Through-Glass Chest Radiography Technique for COVID-19 Patients: Image Quality, Radiation Dose Optimization, and Practical Considerations

“…One study showed that the image quality was rated as uniformly excellent when the technique was used on a phantom but did not evaluate this imaging technique on patients. 10 Brady and colleagues reported that 30 through-glass radiographs were assessed by 2 readers: one scored 70% of them as acceptable quality while the other scored 90% of them acceptable. 11 However, they did not compare these images to conventionally obtained radiographs.…”

Analysis Exposure Index as an Optimization Effort on Examination Chest Posterior Anterior

“…Radiografer telah mengupayakan optimisasi: kualitas citra dan dosis radiasi citra dengan pemilihan faktor eksposi yang disesuaikan dengan kondisi pasien dan memaksimalkan post processing untuk meningkat kualitas. Kesimpulan: Dalam melakukan upaya optimisasi pada sistem pencitraan CR perlu pemahaman tentang EI, hal ini berkaitan tentang kategori underexposed, optimal dan overexposed, selain itu radiografer dapat memanfaatkan post PENDAHULUAN Pada saat pandemi COVID-19, pencitraan radiografi menjadi salah satu diagnosa screening pada pasien suspect COVID-19, untuk pasien dewasa dan anak-anak yang kooperatif dapat dilakukan dengan pemeriksaan Posterior Anterior (PA) (Sng et al, 2020) (Woznitza et al, 2020). Pencitraan radiografi dada (CXR) memiliki peran penting dalam membantu diagnosis dan perkembangan perawatan pada pasien COVID-19.…”