Of course, CT everything! Why didn't we all think of that!
1) There won't be any delay at all getting resus patients full CT, it sits there doing nothing all the time; and the staff (that can do everything, not just a simple CT head protocol) are never asleep in bed at home.
2) The CT scanner is right there in the next cubicle, so no problems with transferring the acutely ill patient
3) Once a patient is nice and snug in the 70cm wide gantry opening, they will just nod off, and you can relax. They couldn't possibly need any intervention during the scan.
4) CT scanners emit these really cool x-rays that go through the patient, but are completely harmless. Your patient can have loads of them with no ill effects at all. The really cool 3D ones are the best, they do a scan every mm - not like those old CT head protocols where you needed 1 every cm with a big gap in between.
5) All the Resus staff can happily stand in the CT room while the scan is going on, keeping an eye on the patient at all times, just pop your sunglasses on and enjoy the rays.
6) CT scanners don't have any problem with artefacts from ECG leads, and other metal structures like normal x-rays do.
(Please note a slight hint of sarcasm)
Just to be serious for a moment - What is wrong with the diamond miner's scanner? I thought this would really take off in resus, but no advocates so far. What's the problem with it? http://www.umm.edu/news/releases/statscan.htm
I don’t really need to ask - it will be cost. But it is a low dose option, and it is fast.
Philip Cosson ● Senior Lecturer ● Medical Imaging
University of Teesside ● Borough Road ● Middlesbrough
Tees Valley● TS1 3BA
LEARNING TECHNOLOGIST OF THE YEAR 2007
http://www.alt.ac.uk/docs/learning_technologist_of_the_year_award_2007.pdf
t: 01642 384175 ● f: 01642 384105 ● m: 07817 362823
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-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 05 February 2008 15:15
To: [log in to unmask]
Subject: Re: Resus gantries / DR
Don't waste money on gantries. When I built a resuscitation room everyone assumed I would specify en suite radiography. It was £400,000 (8 years ago) for each two bays. And for what? Three low-quality radiographs per patient max. The comments about electric delays are entirely spurious when the radiographers and plates aren't in position. You should have chest and pelvic plates in place before the spine board/scooped patient is even put on the trolley so that the films can be shot immediately on arrival. Incidentally, you will hear lots of spurious pseudo-physics from puzzled radiographers about this practice. The first is that the spineboards are not radiolucent. That can be cured with one test shot. The second is a claim that there is scatter between the films. Again, that's wrong and can easily be disproved. However, my favourite excuse of all time was that the radiologist would have more difficulty interpreting the films! A touch of the Catherine Tates soon sorted that.
I am in full agreement with Tom Treasure's recent view that we should be moving to whole-body CT for multiple trauma.
Forget gantries, go with rapidly acquired portable CR images for the holy trinity and CT the rest.
Best Wishes,
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Cosson, Philip
Sent: 05 February 2008 14:48
To: [log in to unmask]
Subject: Re: Resus gantries / DR
Paul,
Firstly - one of the biggest delays is often getting the image linked to the patient details. Raising an examination on the various systems, and then linking the image to this record depends on different local situations. If you have Electronic requesting, this will be done in your department, otherwise it will be done in radiology. If it is the latter - the radiographer will still have a problem when trying to examine a patient that does not exist on the system. With a dDR system - this all has to be done before the button can be pressed; examining them as "a.n.other" is a risk.
Secondly - The concept does look attractive, but the receptor is larger than a cassette and one fixed size. The radiographers lose the flexibility of different film sizes. Cassettes have been around for a long time, and they work because they are so flexible.
The linkage adds another level of inflexibility - it can be infuriating when drip stands and the like are in the way. You may have to purchase special radiolucent trolleys etc because the receptor won't fit in the cassette tray on your old trolleys. These things are quite big - so you would need a large clear space in the room and high ceilings to store it away most of the time.
I would guess a CR plate reader in resus and a PACS work station would be cheaper - and provide you with a similar solution. This has the advantage of many different cassette sizes available, and familiarity for the radiographers (useful for agency staff/new starters). Image review is likely to be sub 90 seconds with such a system (if you can crack the patient registration time)
The half way alternative is a mobile machine that has a digital detector connected via a cable. These are capable of sub 10 second image display (but the cable can be a pain). In a year or two a wireless detector will be available.
Regards
Philip
Philip Cosson ● Senior Lecturer ● Medical Imaging
University of Teesside ● Borough Road ● Middlesbrough
Tees Valley● TS1 3BA
LEARNING TECHNOLOGIST OF THE YEAR 2007 http://www.alt.ac.uk/docs/learning_technologist_of_the_year_award_2007.pdf
t: 01642 384175 ● f: 01642 384105 ● m: 07817 362823
e: [log in to unmask] ● AIM: philipcosson
web: http://radiography.tees.ac.uk/soh_research/
short c.v: http://myprofile.cos.com/philipcosson
-----Original Message-----
From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Redman Paul (Frimley Park Hospital NHS Foundation Trust)
Sent: 05 February 2008 11:27
To: [log in to unmask]
Subject: Resus gantries / DR
We are in the process of redeveloping our majors / resus area and will have to expand and replace our xray gantry that we currently have in resus.
I've come across the concept of 'dDR' (Digital direct radiography) where a portable Xray machine is connected to a digital 'receiver' that will show you the xray instantly on the monitor attached to the xray machine and then download the film into pacs later on- ideal (i would have thought) in trauma situations, otherwise we currently have to wait for the films to be processed, archived and then transferred to pacs.
Has anyone had experience of this or has comments on gantries compared to portable xray machines in resus?
Thanks
Paul Redman
Frimley Park
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