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Report: U.S. Radiology Departments Prepare for Ebola

Experts issue guidelines

Radiologists at the National Institutes of Health (NIH) and the Emory University School of Medicine have issued a special report on radiology preparedness for handling cases of Ebola virus infection. The report, outlining their protocols and recommendations, was published online in Radiology.

According to the authors, health care administrators are placing a major emphasis on Ebola preparedness training at medical facilities throughout the U.S. Failure to have proper procedures in place to diagnose and treat patients with Ebola virus was cited as a major reason for infection of medical personnel in Dallas.

In the U.S., there are currently four biocontainment facilities with specialized isolation rooms and staff trained to treat patients with Ebola virus: Emory University Hospital in Atlanta; NIH Clinical Center in Bethesda, Maryland; St. Patrick Hospital in Missoula, Montana; and Nebraska Medical Center in Omaha. Additional tertiary care institutions have been preparing staff and facilities to handle patients with Ebola virus.

At present, the role of medical imaging in Ebola care is to exclude other diagnoses or to assess complications of the virus. For the radiology team to provide the best possible medical care for the patient while maintaining full protection of the medical staff, medical imaging exams of patients with Ebola virus should be performed within a specialized isolation unit, the report says.

Portable X-ray units and bedside ultrasound imaging have been used in biocontainment units. At the NIH, training sessions for the radiology staff directly involved in Ebola patient care involves in-depth information on the background and spread of the virus, as well as on isolation unit procedures.

Radiology departments must develop standard operating procedures for performing imaging procedures in an isolation unit, the report notes. Details of the standard operating procedure will vary, depending on the type of equipment available, on whether the facility is equipped for wired or wireless image transmission, and on the complexity of the examination.

Currently, two different imaging strategies exist. In the first, radiologic technologists do not enter the patient’s room, known as the “hot room.” In this approach, the technologists instead stay in the anteroom (or “warm room”) and provide verbal instructions for use of the equipment to nurses or physicians in the “hot room.”

In the second approach, radiologic technologists enter the “hot room” to assist in the operation of the imaging equipment. This approach is needed when the equipment may be more complex.

The authors emphasize that every effort should be made to perform general x-ray procedures in the isolation room rather than transporting the patient to the radiology department.

Preparations for procedures in the “hot room” include ensuring that all supplies are in place (including lead aprons, equipment disinfectant/wipes, and equipment covers) and that batteries in the portable equipment are fully charged. The x-ray detector is then double-bagged, and each bag is separately zip-locked before entering the patient’s room.

During the imaging procedure, close cooperation between the isolation-unit nurse and the radiologic technologist is necessary.

Transporting a patient with Ebola virus to the radiology department for a medical imaging procedure is not advisable and requires additional precautions, the report says. For example, the patient transportation route must be coordinated with the hospital’s infection- control team.

In addition, the disinfection of radiology-procedure rooms requires many hours and may prohibit diagnostic treatment of other patients in the facility. Computed tomography (CT) and magnetic resonance imaging (MRI) equipment are not designed to image patients with Ebola or other highly contagious diseases. Small crevices in the gantry table and moving parts are difficult to protect with plastic covers, and bodily fluids can accumulate in narrow recesses that are inaccessible to surface cleaning.

“Radiology staff directly involved in the care of patients with Ebola virus disease need to be identified and educated regarding procedures of the isolation unit and regarding appropriate donning and doffing of correctly sized personal protective equipment,” said co-author David A. Bluemke, MD, PhD, of the NIH Clinical Center. “Open and frequent communications are essential.”

Sources: RSNA; November 18, 2014; and Radiology; November 18, 2014.

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