JACR: Having nearby DR room cuts rate of bedside chest radiography

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patient bedside manner - 43.84 Kb

Implementing a radiography room on a patient care floor can shift chest radiography (CXR) utilization away from the bedside and allow for more useful posterior-anterior/lateral (PA/LAT) acquisitions that require a radiographic room, according to a study published in the June issue of the Journal of the American College of Radiology.

“Bedside radiography is more labor intensive and therefore more expensive to provide,” explained Cleo K. Maehara, MD, of the Center for Evidence-Based Imaging at Brigham and Women’s Hospital in Boston, and colleagues. They also pointed out that bedside CXR produces poorer quality images and poorer visualization of the basilar segments of the lungs and magnification of the heart silhouette compared with PA/LAT acquisitions. “Bedside anterior-posterior acquisitions have variability in exposure and scattered radiation effects, which can decrease image contrast.”

Despite the drawbacks, bedside CXR is often requested by physicians who don’t wish to wait for a patient to be transferred to a radiography room in a different department.

To determine whether the addition of a radiography room to a thoracic surgical ward shifted bedside CXR utilization, Maehara and colleagues retrospectively identified all patient admissions to their facility’s thoracic surgical unit between April 1, 2007, and Dec. 31, 2010. A digital radiography room had been established on the unit on Jan. 10, 2010, so the number of chest imaging tests performed was determined for the periods both before and after the implementation of the radiography room.

After identifying a total of 3,852 patient admissions, results showed a 2.61-fold increase in the number of PA/LAT CXR studies per admission after the radiography room was implemented. Additionally, there was a 1.96-fold decrease in the number of bedside CXR studies per admission. There was no significant change in the total number of CXR studies, and the utilization of other modalities—chest CT, MRI and ultrasound studies per admission—also did not significantly change.

“Establishing a radiography room physically within thoracic surgery units or in close proximity can significantly shift CXR utilization from bedside to PA/LAT acquisitions, which may enable opportunities for improvement in efficiency, quality and safety in patient care,” summed the authors.

Another benefit of performing CXR exams in a digital radiology room rather than at bedside is the reduction in radiation exposure to healthcare workers. While bedside exams expose workers to a minimal amount of radiation, it is still two to three times higher than exposure from background radiation and a shielded room can work to limit this exposure, according to Maehara et al.

The study did not assess cost-effectiveness or the impact on image quality. The authors suggested that future research focus on benefit analysis of quality, safety and efficiency of care.