Computers in Radiology

Digital Imaging and Communication in Medicine (DICOM)

• Standard for handling ,storing, printing, and transmitting information in medical imaging

• Includes file format definition and a network communications protocol

• DICOM files can be exchanged b/w two entities that are capable of receiving image and patient data in DICOM format

• Universal way of evaluating image ; has lots of tags attached with info

Picture Archiving & Communicating System (PACS) / Medical Image Management & Processing Systems (MIMPS)

• PACS changed name to MIMPS

• Computers/networks dedicated to the storage, retrieval , distribution and presentation of images

• Medical images are stored in an independent format.

• Most common format for image storage is DICOM

• You have to catch misinformation before sending it out

Computed Radiology (CR)

• Same abbreviation as Central Ray

• A radiographic technique that uses a cassette loaded w/ an imaging plate containing a photostimulable phosphor

• Take cassette to reader and uses laser to process image

• Takes 1.5 minutes longer

• If you drop it , it won’t break easily worth only $1000

Direct Radiology (DR)

• A radiographic technique that uses a flat panel of detectors or direct capture solid-state device

• majorly of where facilities are

• $40,000/plate

• have to stay in the room till you finish unlike CR

DR System

• Has a tether plate cord ; how it talks to computer

• a tripping hazard

• Always clean the cord since it touches everything including patient

DR Wireless

• Has batteries and overtime about 5 years can expand and will need to be replaced

• includes a wireless box it talks to

Radiology Informational System (RIS)

• System used by radiology departments to store manipulate and distribute patient radiological data and imagery

• System compromises of patient tracking and scheduling , result reporting and image tracking capabilities

Health Info System (HIS)

• System used by medical departments to store, manipulate and distribute patient data

Nosocomial Infection (Old term)

• Infections acquired while being in the hospital

• A hospital related disease

Health Acquired Infection (new term) (HAI)

• Infection occurring in all health care settings

• Include hospitals, clinics, and home health care

Medical Asepsis (Clean Technique)

• The use of soap ,water , degermer , friction and/or disinfectants to eliminate microorganisms

Surgical Asepsis ( Sterile Technique)

• Eliminates microorganisms and spores by heat or chemical process

Standard Precautions

• Universal precautions (old term)

• Precautions against all bodily fluids as well as mucosa membrane and non-intact skin

• Bodily fluids can come from anywhere other than mouth

• Notice patient/s door/doorknob to see any signs or information

• If you don’t know ASK!

Personal Protective Equipment (PPE)

Gloves , masks, gowns, face/eye shield

Hand Hygiene

• Single most effective method for preventing infection

• Three Methods

Three methods of Hand Hygiene

1. Hand washing

2. Use of degermer

3. Proper maintenance of hands

   • Bandaging broken skin

   • no fake nails

   • using hand approved lotion / most hospitals WILL provide don’t bring from home

Hand Hygiene : Washing hands

• Use soap and water

• use friction for 15 seconds minimum

• rinse thoroughly

• pat hand dry with paper towel

• use towel to turn off faucet and open door

Body Mechanisms

• Good body mechanisms involve three elements

  1. Balance

  2. Alignment

  3. Proper movement

Body Mechanisms : Balance

• Involves your base of support

• Broad base means that you space your feet properly

• Center of gravity is located in lower abdomen and pelvis

Body Mechanisms : Alignment

• Body alignment or posture

• When lifting , keep back straight , bend knees and avoid twisting

• Keep object close to body and balance on both feet

• work at a comfortable height

• Keep head erect

Body Mechanisms : Movement

• Use leg muscles rather than lower back muscles

• use smooth and steady movements

Transferring patients : Ambulatory

Walking or able to walk but always assess the situation and ask your patient what they can do !

Transferring patients : Wheelchair

Locks and pedals but always assess the situation and ask your patient what they can do !

Stretcher or gurney

• locks

• hand rails ( ALWAYS UP)

• transfer with sheets or sliding board

• watch for IV, O2 , and catheters ( Look where they are always)

• Ask patient to cross arms and hold head up

• Patients with hand rails up with blankets taped to them have seizures

Patient assessment: Vital Signs

• Establish baseline

• Temp

Patient assessment: Temperature

• Avg adult is 98.6 degrees

• 0.5-1.0 degree up or down is normal

• Methods of reading :

  → Rectal

  → Oral

  → Axillary (armpit)

  → Tympanic (ear/forehead)

• Reading may vary due to site

• Hyperthermia → Hot

• Hypothermia → Cold

Vital Signs: Pulse

Adult = 60-90 beats/min

Child = 90-100 beats/min

Infant = 120 beats/min

Tachycardia

• Rapid greater than 100 beats/min

Bradycardia

• Slow less than 60 beats/min

Locations of Pulse

• Carotid - neck

• Brachial- elbow

• Radial - wrist

• Femoral - groin

• Tibial - inner ankle

Respiratory rate

• Adult is 15-20 breaths/min

• Infant is 30-60 breaths/min

Tachypnea

Rapid shallow breathing

Bradypnea

Abnormally slow breathing

Apnea

Stopped breathing

Blood pressure unit and definition

• Is force exerted by the blood against vessel wall

• Measured in mmHG ( millimeters of mercury)

Systole

• Contraction phase

• heart muscle contracts to pump blood out, specifically when the ventricles contract to eject blood into the arteries

Diastolic

• Rest phase

• Ventricles filling with blood

Blood pressure

• Brachial artery

• 120/80 avg

• Systole/Diastole

Hypertension

• Fast

• a condition where the force of blood against your artery walls is consistently too high

• Systolic above 140 / Diastolic above 90

Hypotension

• Slower

• condition where blood pressure is abnormally low

Sphygmomanometer (blood) (Pressure)

• Blood pressure cuff

• Device for measuring pressure ,cuff.

Sethoscope

• Devcie used to detect sounds

  • ear piece

  • Binaurals (metal tubes with earbuds)

  • Tubing

  • Chest piece

    1. Bell

    2. Diaphragm

When figuring out blood pressure

Write down numbers at the first and last sound

How many times does a patient need to be screened for the scanner room

they should be screened by two separate individuals

Who should be screened when entering the scanner room

All personnel

What studies should be used to confirm the absence of metal fragments in critical parts of the body

Radiographic studies

Most clinical scanners are how strong ?

1.5-3 Telsa scanners

3 Telsa = ?

30,000 Gauss

How strong is the earth’s magnetic field?

~0.5 Gauss

Magnetic strength definition

A measure of the intensity of the magnetic field

Gauss definition

Unit of measure of magnetic induction

Fringe Field definition

Stray magnetic field outside the bore (opening) of the scanner , Room is shielded to confine the fringe field to the scanner room

Most MRI magnets are

Superconducting

Liquid Helium is used

To keep the magnet ultra-cold

Because of Superconducting system

The magnetic field is present 24 hours a day ; whether MRI machine is used or not. ALWAYS ON

Ferromagnetic

• Object attracted to the magnet

• example: metal

• NOT all metal is ferrous

Potential safety issues : Biological effects if high-strength magnets

• screening

• pregnancy

Potential safety issues: Magnetic object safety

• Ferrous objects can become projectiles

Potential safety issues: Cryogenic (ultra-cold ) gases

• Liquid helium

• Quench ( shuts down magnetic field with helium gas )

Potential safety issues: Acoustic noise

• can be at a level where hearing lost can happen

• All personnel are required to wear hearing protection in the magnet room while the canning procedure is being performed

Potential safety issues: Patient burns

• do not let patient’s cross arms or legs as they complete a circuit that causes internal burning

Is there any chance of evidence indicating side effects from magnetic fields of an MRI scan ?

No

Do MRI machines use ionizing radiation?

• No they do not

• no damage to cells or DNA

Magnetic object safety : Main potential danger from MRI machines

From the interaction of the magnetic field with metallic objects or particles

Prevent what items in scanner room?

Ferromagnetic metals into the MRI room

Can there be any metal in the patient’s body ( such as shrapnel or medical devices?)

No since it can cause severe injuries

Translational Force

• Causes a ferrous object to be pulled towards the magnet isocenter ( middle )

• May also affect implanted foreign objects ( piercings or shrapnel)

• May properly prescreen individuals

Rotational force ( Torque)

• Causes a ferrous object to turn and align with the direction of the main magnetic field

• Strongest at the isocenter of magnet

• Implanted devices such as stent or surgical clips

Potential projectiles

• pens

• glasses

• coins

• clipboards

• steel toe shoes

• etc.

Quench

• Liquid helium surrounding the magnet causing it to lose it’s magnetic field

• it cools the superconducting magnet

What can a Quench do to the room?

• Can cause a life-threatening oxygen shortage in the MRI room

• Must take everyone out of the room

Static Magnetic field Zones

Zone 1 : General public area

Zone 2: Screening interview area ( verify any metals, forms etc.)

Zone 3: Control area ; Access restricted with key locks , passkey systems etc.

Zone 4: MRI scanner room; MR personnel must have safety training . Access restricted

Classification of personnel

• Non-MRI personnel

• Level I MR personnel

• Level II MR personnel

• MRMD

Non-MRI personnel

• Any individual who has not within 12 months have successfully undergo formal MR safety education defined by MRMD

Level I MR personnel

Individuals who have passed the facility’s MR safety education as defined by MRMD to ensure they are not a danger to themselves or others in the MR environment

Level II MR personnel

• Individuals who have been extensively trained and educated in the broader aspects of MR safety issues.

• Issues can include RF-related thermal loading ,burns and direct neuromuscular excitation from rapidly changing gradients

MRMD

MR Medical Director

FDA labeling for MR

MR SAFE

MR UNSAFE

MRCONDITIONAL

MR SAFE

• An item which poses no known hazard in all MR environments

• Non-magnetic , nonmetallic , non-conducting objects

MR UNSAFE

• An item that is known to pose hazards in all MR environments

• Primarily ferromagnetic objects

MR CONDITIONAL

• Object may or may not be safe for the patient undergoing MR procedure or an individual in the MR environment

• Depending on the specific conditions that are present

ex: MR conditionals has been tested to be safe at 3T at gradient strengths of 400 G/cm or less and normal operating mode

Hospital organization : Mission Statement

• The driving force that outlines the organization’s reason for existence

• Defines what should be done and how

• Visit website for information

Organizational chart: Board of Directors or Governing Board

• Where governance begins

• The board is authorized by law to operate a hospital

• Board employs CEO or President

• CEO/President sets up formal reporting structure for the organization

Radiology Organization: Medical Director

Responsibilities include

• Oversees the quality or patient care and safety

• Approving department policies and procedures

• Equipment and technology acquisition

Joint Commission on Accreditation of Health Care Organizations

• independent not-for profit organization

• Accredits and certifies more than 20,000 health care organizations and programs in US

• Accreditation and certification nationwide is a symbol of quality that reflects an organization’s commitment to standards.

Joint Commission on Accreditation of Health Care Organization’s Mission

To continuously improve health care for the public by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality.

Joint Commission on Accreditation of Health Care Organization’s Vision

All people always experience the safest , highest quality , best-value healthcare across all settings

HIPAA

Health insurance Portability and Accountability Act

HIPPA what is it

• Law governs access and usage of patient-identifiable information

• Students must follow the mandates

• Failure of the students to abide by HIPAA mandates may result in disciplinary procedures

HIPAA when did it pass

1996 , Federal legislation was passed to improve the efficiency and effectiveness of the health care system by mandating confidentiality of health information

Telsa

SI unit of magnetic influx 1T= 10,000 G

Static magnetic field

Main magnetic field of the scanner. Always on