Radiology Administration Quiz

Administration, Leadership, and Entrepreneurship in Radiological Facilities (Module 4)

• Learning Objectives: Discuss Radiology Administrator functions, location and design of radiological facilities, government requirements, staff types, and financial considerations.

Radiology Administrator

• Role: Plan, direct, and coordinate administrative activities for imaging departments (hospitals, medical centers, imaging centers, multi-specialty physician offices, clinics).
• Responsibilities: Conduct studies, implement changes to improve internal operations, advise staff and supervisors on administrative changes, and coordinate personnel activities.
• Additional Duties: Assist facility administration in preparing department budgets, conduct classes and provide training materials for student programs, recommend cost-saving processes and hospital supply changes, interpret, prepare, and distribute statistical data on department operations.
• Areas of Responsibility: Oversee technologists, supervisors, film librarians, etc., Radiology Information Systems (RIS), Asset Management (equipment, services, products), business side of radiology (budgeting, revenue projection, billing, compliance), film library (accessibility, maintenance, adherence to state/federal laws), and Project Management.

Radiology Department

• Focal Point: A key component of any hospital or medical center, requiring careful planning and a vision for the future.
• Scope: Includes imaging studies and a therapeutic role, often with minimal invasive interventional radiology.

Strategic Planning

• Initial Step: Feasibility of establishing an imaging center in a specific area, considering need, presence of other centers, acceptability of referring physicians, and the presence of larger hospitals.
• Further Planning: Undertaken after it's clear a need exists for such a center.

Types of Radiology Centers

• Hospital Setting: Radiology departments within established hospitals.
• Dedicated Centers: Centers focusing on referrals from other facilities.
• Difference: Patient referrals are central.

Location

• Ground Floor: Preferred location, especially for sophisticated equipment like CT and MRI, to accommodate emergency/walk-in patients.
• Accessibility: Easily accessible to OPD, inpatients, and the emergency department.

Equipments

• Digital X-rays, Fluoroscopy Units, Mammography Units, Dual Energy X-ray absorptiometry (DEXA) units, Ultrasound Units, Multislice CT, 1.5/3T MRI, Digital subtraction angiography units, Positron emission tomography (PET) computed tomography (CT) units.

Layout

• Reception Area: Well-lit, sufficient space for sitting, trolleys, wheel chairs, person-in-charge with expertise in scheduling.
• Preprocedural and Changing Rooms: Necessary for patient preparation.
• Investigation Rooms: Minimum of one digital X-ray unit, one fluoroscopic unit, one mammographic unit, one sonographic unit, one CT scan, and one MRI unit.
• Reporting Room: Dedicated workstations for efficient reporting, potentially filmless, with space for radiologists, and easy communication.

Preprocedure and Changing Rooms

• Preparation: Nearly every radiological investigation requires preparation.
• Removal Policy: Metallic clips/rings need removal before X-rays.
• Standard Practices: Hospital gown and screening for metadata.

Investigation Rooms

• Minimum Requirements for modern setup:
• One digital X-ray unit, one fluoroscopic unit, one mammographic unit, one sonographic unit, one CT scan, one MRI unit.
• Radiation Protection: X-ray, fluoroscopic, and CT scan rooms require special care due to potential ionising radiation.

X-Ray Installation

• Location: Ideal distance from high-traffic areas (maternity, pediatrics, etc.) is essential.
• Residential Complexes: X-ray installations in residential complexes need walls with specific thickness to reduce scattered radiation and shielding of doors and windows (brick thickness and lead shielding).
• Room Size and Shielding: Sufficient area (≥18m²) and appropriate structural shielding.

Dark Room

• Location: Placement to ensure no significant (primary or secondary) X-rays reach it.
• Features: Completely dark, with separate and appropriate systems for removing X-ray film after procedures.
• Equipment: Processing tanks, cassettes, safelight, hangers, automatic processors.

Cassette Transfer Cabinet

• Purpose: Facilitates transferring cassettes from/to the darkroom without light or radiation issues.
• Design: Extra heavy duty constructions with double radiation traps, welded doors.

Mobile Equipment

• Movement Restrictions: Within the registered institution.
• Distance: Minimum 2 meters between the operator and mobile equipment.
• Protection Devices: Use of protective aprons.

Safety Personnel

• Radiological Safety Officer (RSO): Required for all X-ray departments, proficient and approved by relevant authorities, ensuring safety/regulatory compliance.

Radiologist, X-ray Technologists, and Engineers

• Radiologist: Expertise for image interpretation and reporting.
• X-ray Technologist: Expertise for operating X-ray equipment.
• Service Engineers: Maintain and repair X-ray equipment.

Radiation Standards

• Equipment Types, Applied Voltages, Applied Currents, Exposure Times, Workloads: Details for various radiological equipment, reflecting safety guidelines.

Computed Tomography (CT) Room

• Room Size: Minimum 25 square meters (25m²).
• Control Panel: In a separate room, adjacent to the CT room; proper shielding and communication features (direct viewing, oral communication).

Interventional Radiology Installation

• Components: C-Arm, examination table, viewing glass (lead equivalent shielding), control unit, and dedicated space for the equipment.

Ultrasound Room

• Building Design Guidelines: Rooms do not require specialized shielded construction, as ultrasound machines do not utilize ionizing radiation. The design is general, with ambient lighting, examination trolley/bed, changing room, and washroom.

MRI Room

• Shielding Necessity : The strong magnetic field of MRI machines demands appropriate shielding (active shielding, passive cladding, room shielding); devices sensitive to magnetic fields (steel pipes, structural steel, etc.) cannot be placed near the unit as they can be affected negatively by stray magnetic fields, or become dangerous to personnel and equipment.
• RF Shielding : Shielding from radio frequency (RF) waves, such as from electronic device to prevent inference.

Reporting Room

• Workstations: Dedicated workstations for efficient reporting.
• Filmless Setup Benefits: Cheaper, environmentally friendly, easier maintenance, separate workstations for reporting by radiologists, facilitating interpersonal communication.

PACS and HIS (Hospital Information System)

• System Goal: For achieving rapid reporting, image transfer, and storage.
• PACS Features : Linked to central server for image storage and reporting, providing individual workstations for radiologists.
• Data Transfer: Images made available to referring physicians and radiologists with access to clinical and lab details shortly after acquisition.

Governmental Requirements

• Notification: Operators of therapeutic X-ray facilities must notify the relevant authority (CDRRHR) in writing.
• Authorizations: Entities must secure appropriate authorizations (two-stage process).
• Protection Surveys: The facility must undergo radiation protection surveys and evaluations (RPSE) conducted by authorized representatives of regulatory bodies.
• Personnel Qualification: Personnel in the facility whose work involves patient safety needs appropriate training and qualification regarding radiation protection.
• Regulatory Requirements: Policy to justify procedures, limit doses (optimization of protection), and use dose constraints.
• Responsibility of Management: To establish a comprehensive policy regarding protection and safety, and demonstrate active support of radiation protection staff and procedures. Ensure that design, equipment, and procedures for the X-ray facility complies as per set standards.
• Monitoring Devices: Radiation monitoring devices must be provided to all occupationally exposed individuals, and measures to limit radiation levels (exposure to radiation) for personnel and the public.
• Quality Assurance: Comprehensive and developed quality assurance programs in compliance with regulations.

Operating Room Procedures

• Technologist Role: Presence in the OR suite is required (operates and maintains C-arm and portable equipment), and portable equipment must be returned to the storage area immediately after use; the technologist must be present to operate and maintain relevant equipment during surgery.

Outpatient Services Procedures

• General Policies for X-ray Requests:
• Patient calls or visits for x-ray scheduling and instructions.
• Special procedures are scheduled via appointment.
• Portable X-rays in ICU/other specialized areas.
• X-ray request forms should be properly filled and submitted as per patient's diagnosis and scheduling requirements.

Ultrasound/CT Scan Procedures

• Scheduling and Bowel Preparation: Bowel prep policies, special scheduling prioritization, on-call procedures when necessary.
• Patient Numbers: Unique case numbers are created for patients and relevant medical data is updated, so related prior cases can be easily retrieved.

Billing and Recordkeeping

• Billing: Patient billing, including both inpatients and outpatients.
• Recordkeeping: Maintaining comprehensive and reliable patient records, including information, type, time of procedure.
• Results Release Methods to issue results including outsourcing (teleradiology).