Radiology department Radiology services Functions, layout, services

1. RADIOLOGY SERVICES
By – AAYUSHI BHAWSAR

2. INTRODUCTION
 It is an area of medicine that enables
physician to see inside the human body in
order to diagnose and monitor disease.
 It is important department which
contribute directly to the patient care.
 It provides, along with pathology a vital
back up of the hospital which cannot
practice effectively without their support.
 It is also an important link in the research
programmes of any medical institution
except only small hospital and nursing
homes.

3. IMPORTANCE
 It helps in giving confirmed diagnosis
when used along with laboratory
investigation.
 It provides additional information as
required.
 It also provides non-invasive techniques
for better medical and surgical treatment.
 Documentation evidence for treatment
education and research.
 It provides evidence in case of complaints
and litigation.

4. FUNCTION
 The provision of radiology services of
adequate quality and quantity to
hospitalized patient.
 Routine x-ray like chest, abdomen,
limbs etc.
 Special studies like barium studies, IVPs
myelograms etc.
 Ultrasound work.
 Angiographies and interventional work.
 Teaching and research.

5. ACTS for Radiology services
 The use of radioactive materials and
radiation generating equipments is
governed by Atomic Energy Act, 1962.
 Rules issued under the Act :
a. Radiation protection rules, 1971
b. Atomic energy rules (Working of the
Mines, Minerals and Handling of
prescribed substances), 1984

6. ACTS for Radiology services
c. Atomic energy rules (Safe disposal of
radioactive waste), 1987
d. Atomic energy rules (Factories), 1996
e. Atomic energy rules (Control of
irradiation of food), 1996

7. LOCATION
 The location should be:
 Ground floor.
 Easily accessible to the OPD, casualty,
and inpatient ward.
 There is a minimum movement and
distance to travel for staff and the patient
while utilizing the services.
 Some scope for expansion at a later date.

8. LAYOUT DESIGN
 RECEPTION ROOM:-
 Located near the entrance.
 Administrative function
 Scheduling of appointments
 Receiving the patient
 Typing and handling of forms.

9. LAYOUT DESIGN
 WAITING AREA:-
 Located at entrance of the department.
 Should meet the needs of patients waiting
before and after registration of the service.
 Adequate benches and chairs should be
provided.
 Separate area to occupy patient in wheel
chair and stretcher.
 Should have separate cubical for ward
patient who are seriously ill.

10. LAYOUT DESIGN
 RADIOLOGIST OFFICE:-
 Situated near the radiology room.
 Not too easily accessible to the public.
 Adequate space for studying films and
discussing with specialists.
 Adequate number of viewing box.

11. LAYOUT DESIGN
 DOCTORS VIEWING ROOM:-
 Located near the radiologist office.
 Radiologist may be available for
consultation.
 For diagnostic comments and discussion.

12. LAYOUT DESIGN
 FILM STORAGE ROOM:-
 Built in cupboards may be provided in
charge room.
 Active film can be stored up to 5 years.

13. LAYOUT DESIGN
 DRESSING ROOM :-
 3 dressing room for each x-ray room is
available.
 Door should have locking facility to keep
patient valuables.
 Each room should contain mirror.

14. LAYOUT DESIGN
 PATIENT TOILET:-
 Toilet should be available for patient
especially patient undergoing
fluoroscopy.
 Each toilet room should be equipped
with a grab bar for use by elderly or
weak patient.

15. LAYOUT DESIGN
 General storage:-
 Located near the x-ray room.
 Storage cabinet with sliding door and
adjustable shelves.
 Materials such as films opaque solution,
developing solution and office supplies are
stored.

16. LAYOUT DESIGN
 X-ray room:-
 All x-ray equipment can be
accommodated in same room or separate
room.
 It should have adequate space for the
equipment, transformer and strecher.

17. LAYOUT DESIGN
 Dark room:-
 It should be located between two x-ray
room.
 The size of the dark room not be more
than 100 sq. ft.
 It should be provided with-
 A hatch window between x-ray room and
dark room.
 A counter for loading and standing
cassettes.

18. LAYOUT DESIGN
 A partition to separate loading counter from
the film processing area.
 A light lock between the dark room and the
light room, equipped with interlocking door.
 A utility tank with a drain board should be
provided for mixing chemicals solution and
hand washing.
 A film processing area consisting of
developing tank, fixing tank and washing
tank placed in that order.
 Exhaust fans.

19. LAYOUT DESIGN
 Control booth:-
 It should be located to right side of the
machine so that patient may be observed
when table is inclined.
 Film drying area:-
 Steel cupboard with heating elements at
top and exhaust fan at bottom.
 Film dryer units are also available.

20. LAYOUT DESIGN
 Barium mixing facilities:-
 Small room of 10 sq. ft. to 12 sq. ft. each
may be provided for the preparation of
barium meal and for injection in large
hospital.

21. SPACE REQUIREMENT
 In 1969,Mc Gibony advocated that 2000 sq. ft were required for
a 200 bedded hospital.
 WHO has suggested the standard size of X-Ray room at 20 m2.
Size of the Hospital Space in Radiology
100 Beds 65 Sq mts
200 Beds 175 Sq mts
300 Beds 370 Sq mts
500 Beds 650 Sq mts
750 Beds 800 Sq mts

22. SPACE REQUIREMENT
 Waiting area : 30.30 sq. mt.
 Reception area :10.10 sq. mt.
 Radiologist office : 20.20 sq. mt.
 X-ray room : 25.00 sq. mt.
 Control booth : 40.00 sq. mt.
 Dark room :10.00 sq. mt.

23. STAFFING
 Recommended staff for a 500 bedded
teaching hospital
 Radiologist :
• Consultant/professor -1
• Senior specialist/ Associate professor - 2
• Junior specialist/ Lecture - 3
 X-ray technician - 8 (for 3 shifts & leave
reserves).
 Dark room asst. - 4 (for 3 shifts)

24. STAFFING
 Staff nurse - 1
 Attendant - 4 (3 shift)
 Record clerk - 1
 Receptionist - 1
[Note:- Henry Garland estimated that one radiologist is
necessary for the every 25 patient/day. Approx. 2-3 x-ray
technician are required for every 30-35 patient /day. 2-clerk or
secretaries per 30 patient].

25. ELIGIBILITY OF STAFF
 Radiologist:-MD in radiology.
 X-Ray technicians:-minimum diploma in
radiography or preferably B.Sc.
Radiography (3 yrs.)
 Staff Nurse : Registered nurse GNM or
B.Sc (N)

26. Types of radiology
 Diagnostic radiology:-
 Routine x-ray for limbs, chest, spine,
abdomen etc.
 Sonography.
 Computed axial tomography. (CT scan)
 Magnetic resonance imaging. (MRI)
 Digital subtractions angiography.

27. Dental X-ray Equipment

28. X-ray Equipment

29. Ultra Sonography
It is useful in detecting abnormalities, stones, space
occupying lesions etc.
It is also useful in diagnosis of solid, air filled and
fluid filled organ.
It is a non-invasive procedure.

30. Computed Tomography
(CT scan)
 CT (Computed tomography)
scanning is a type of x-ray used
to depict anatomy at different
levels within the body. The CT
scan is able to rotate the x-ray
source around the patient
allowing the physician to
capture the necessary image
from many different angles.
Each rotation of the x-ray beam
produces a single cross-
sectional "slice" of anatomy, like
the slices in a loaf of bread.

31. CT scanning
 Uses of CT scanning:-
 To examine the head for bleeding, tumors,
blood clots, or signs of stroke.
 To distinguish whether a growth is solid or
fluid-filled.
 To detect ruptured disks in the spine.
 To determine an organ's size and shape.
 To evaluate many types of disease
processes.
 Help to determine the stage of certain
cancers.

32. Magnetic Resonance Imaging
 MRI is a non- invasive
technique that does not
use any ionizing
radiation.
 MRI uses powerful
magnetic fields and
radio frequency pulses
to produce images.
 Magnet of the scanner
is 30000 times more
powerful than earths
magnetic field.

33. Magnetic Resonance Imaging
 MRI used in –
 Region of abdomen
 Pelvis
 Chest
 Orbit
 Musculoskeletal systems
 Joints
 Staging of cancer

34. Digital Subtraction Angiography
 It is a computer- based facility for x-ray
examination of arteries.
 It is useful in detecting high blood
pressure, preventing strokes and monitors
post operative progress and studying
heart condition.

35. Types of radiology
 Interventional radiology:-
 It carries out certain procedures under
radiology control like angioplasty,
introduction of silver clips for treatment of
aneurysm.
 It should be situated near diagnostic
radiology.
 In case of complication backup medical and
surgical services must be available.
 2-3 beds for recovery should be available.

36. Types of radiology
 Nuclear medicine:-
 Use of radioactive isotopes and scanning
of organs is done.
 The dept. can be independent, can be a
part of radiology or medicine dept.

37. Nuclear Medicine Equipment

38. Types of radiology
 Radiotherapy:-
 All hospital need not have this service.
 It requires initial budget, requiring
expenditure, availability of trained staff,
work load, and affordability of patient.
 Compliance with conditions laid down
by Bhabha Automic Research Center.
 It should be located on ground floor or
basement.

39. Types of radiology
 Adequate arrangement for dissemination
of radiology.
 Therapy room.
 Chemotherapy rooms.
 Standardization facility.
 Quality control laboratory.
 Storage facility.

40. Utilities
 Power requirement:
 Mains:-
 220 volts AC, three phase.
 50-60 cycles.
 25 Amps.
 Main impedence should not be greater than
0.5 ohms.

41. Utilities
 For a steady current with least impedence,
a separate power lines exclusively for the
radiology dept is necessary.
 Current voltage fluctuations give
unsatisfactory results. Voltage stabiliser is
necessary for each machine.
 Actual power consumption will be
determined by the machine’s power (mA)
and number of exposure per day.

42. Utilities
 Walls:
According to BARC, Mumbai the walls of the
radiography room should be:
 9 inches thick concrete walls or 14 inches thick
brick masonry walls which are sufficient for
primary as well as scattered radiation.
 Lead shielding is recommended where the walls are
thin or where there are doors.
 The places which needs special protection are:
• Walls behind the chest stand in radiology room.
• Walls between radiology room and adjoining room.

43. Utilities
 Air Conditioning
 Administrative areas and waiting areas: A
temperature of 720 F with a relative
humidity of 50% and a ventilation rate 1-1
½ air changes per hour.
 Patients and technicians corridors: A
temperature of 750 F to 800 F with relative
humidity of 50% and 2 air changes per
hour.

44. Utilities
 Fluoroscopic and x-ray room: A
temperature of 750 F TO 800 F with RH
50% and 6 air changes per hour.
 Dark room: A temperature of 720 F with
RH 50% and 10 air changes per hour.

45. RISK
 X-ray or gamma rays - 0.3 r per week
 Local radiation rays - 4.5 r per week
 Exposure beyond these limits can lead to-
 Blood cancer
 Skin cancer
 Cataract
 Leukemia
 Infertility

46. PRECAUTION & SAFETY
 According to International commission on
radiology protection in 1995 –
 Personal test:-
 All new staff in radiological dept. should
undergo pre-employment blood exam like
blood count, Hb, total and differential blood
count.
Protection:-
 X-ray dept before starting starting its
function should be monitored by
recognized specialist.

47. PRECAUTIONS & SAFETY
 Each equipment should be shock proof
provided with insulation and earthening.
 Personal monitoring of exposure by
photographic devices like ‘film badge’.
 In case where isotopes are used for
exposure is monitored by using ionizing
devices like ‘dosimeter’.
 The film batch/dosimeter provided by
BARC changed every quarterly.
 Lead thyroid guard should be used by the
technicians.

48. PRECAUTIONS & SAFETY
 Lead aprons and gloves should be used by
the technician.
 Exposure of workers to radiation should
not exceed 20 SV/Annum.
 Maximum permissible limit for an
individual is 300 rem/month.
 Maximum range of exposure must not
exceed 5 secs.
 Cable length recommended from the
control panel is 3 meters.

49. RECORDS
 Reporting:-
 All the radiological examination should be
reported by radiologist only.
 Diagnostic examination should be
reported as soon as possible.
 Therapeutic procedures can be reported
at the end of the course.

50. RECORDS
 Film identification:-
 X-ray films (exposed) should be permit
identification of patient, date,
orientation.
 Lead alphabets and numbers can be
used.
 Adhesive labels after processing.

51. RECORD
 Film filing:-
 Both exposed and unexpected films should
be stored in fire resisting metal container.
 Old exposed films and surplus stock of films
should be stored in a vault
 Vault should be outside building
 Adequate ventilation
 Light with vapour proof globes and ceiling
fixtures.
 Automatic sprinklers in adequate number.

52. REGISTERS
 X-ray register.
 Deep x-ray treatment register.
 Cobalt treatment register.
 Inventory of non exposed store & equipment.
 Film account.
 Radium needles account.
 Expendable store account.
 Indent book.
 Instruction manual for all the technical staff
are to be developed depending on the local
working condition.

53. PACS
 A PACS (Picture Archiving and
Communication System) consists of four
major components:
 The imaging modalities such as CT and
MRI.
 A secured network for the transmission of
patient information.
 Workstations for interpreting and
reviewing images.
 Long and short term archives for storage
and retrieval of images and reports.

54. PACS
 Benefits of PACS:
 PACS provides near instant access to
images and reports from multiple
locations.
 The health care achieved significant cost
and benefits through the advanced
approach to PACS.

55. PACS
 Cost related to film, storage and radiology
coverage were all significantly reduced, as
well as need to dedicate physical space to
film processing, storage and management.
 Patient and staff benefited from the
improved workflow.
 New technologies are characterized by film
cost that are increasing dramatically .

56. PACS
 E.g. multi-slice CTs that can manage
700to 800 slices in five minutes. This
technology evidences both economical
problems and the practical difficulty for
the radiologist to view this amount of
images in hard copy form, which can be
solved only with a PACS.
 Reduced time in transferring of images
from one hospital to another hospital. the
automatic transfer of images reduces the
work of manpower.

57. Radiation Protection
 As per recommendation of radiation
protection division of BARC, Mumbai the
wall of the radiology room have to be
9inches thick concrete walls or 14
inches thick brick masonry wall.

58. WASTE DISPOSAL
 The disposal of radioactive waste is in
accordance with Atomic Energy rules 1987.
 The radioactive waste can be classified into
a. High level wastes
b. Intermediate level wastes
c. Low level wastes
 Collection of radioactive waste
• Foot operated waste bins
• Disposable polythene lining for solid waste
• Polythene carboys for liquid wastes

59. WASTE DISPOSAL
 Basic guidelines for disposal of waste :
 Dilute and disperse the low level
radioactive waste.
 Delay and decay the short lived isotopes
 Concentrate and contain for
intermediate and high level waste.

60. POLICY
 Dept. should provide round clock service.
 OPD and routine patient should be
scheduled through appointment.
 Requisition form should be of standard
size and should have colour coding for
urgent, serious or routine type of
requisition.
 Requisition should be accompanied by
doctors order.

61. POLICY
 Instruction should be followed by the
patient should be written in local
language in the department.
 Radiologist should study the film, prepare
the report and sign it before dispatching.
 Issuing of x-ray to the patient depends on
the requsing unit. Also issuing of x-ray to
the patient on discharge has to be decided
by the hospital mgmt.
 In MLC x-ray should not be handed over
to the patient or relative.

62. POLICY
 Dept. should maintain a checklist
regarding working condition of the
equipment.
 Scheduled maintenance should be done.
 Regular in service training to all the
technician.
 All used and unused films should be kept
safety.
 All instruction on radiation should be
followed.

63. PROBLEMS
 Problems of scheduling the investigations
Educational and research activities.
 Pilferage/ theft of-
 Used films to extract silver.
 Consumable items.
 Patient belongings.

64. PROBLEMS
 Shortage of x-ray films due to inadequate
inventory or wastage of films.
 Machines breakdown due to-
 Rough handling.
 Overuse
 Misuse
 Unfair practices.
 No proper maintenance.

65. PROBLEMS
 Radiation overdose due to-
 Improper precautions.
 Non use of lead aprons and gloves.
 Non use of film badge.
 Difficulties to control the working and
movement of portable x-ray equipment.
 Staff absentism.

66. RECOMMENDATIONS
 During scheduling of investigation priority
should be as follows :
1. Emergency cases both IPD and Casualty.
2. ICU patient.
3. Routine indoor patient.
4. Routine outdoor patient.
 Pilferage/ theft of can be avoided by proper
security arrangements.

67. RECOMMENDATIONS
 Patient relatives should be asked to take
care of their patient’s belongings.
 Proper inventory should be maintained to
avoid shortage of films.
 Regular maintenance (concurrent) should
be carried out to avoid break down of
equipments.
 Policy and procedures for taking
precautions like lead aprons, film badges,
lead gloves etc

68. REFERENCES
 Effective hospital management by
Pragna Pai.
 Principles of hospital administration by
BM Sakharkar.

69. THANK YOU