RADIOLOGICAL INVESTIGATIONS OF CLIENT WITH COVID-19

1. Mrs. BHUVANESHWARI.P
M.Sc. MEDICAL PHYSICS
LECTURER
GANGA COLLEGE OF NURSING
COIMBATORE

2. RADIOLOGICAL INVESTIGATIONS OF CLIENT
WITH COVID-19

3. INTRODUCTION
During this crisis of COVID-19,here are few points to
remember by radiologic technologist while performing
radiographs for the COVID-19 affected patients.

4. Hospital Dept. Of Radiology
Protocol In Dealing With
Patients During The COVID 19
Pandemic
1) Every patient should be considered a
potential COVID positive patient and
UNIVERSAL PRECAUTIONS should be
followed.
2) Patients can be divided roughly into -
Routine and COVID suspected groups.
3) For all Routine patients,
radiographers/technologists should wear basic
PPE (Personal Protective Equipment) which
consists of cap, mask, face shield, gloves, gown
and shoe covers. Please note that Face shields
can be reused after disinfecting.

5. 4) For all COVID suspected cases, radiographers should wear a
complete PPE set. (When you are using a full PPE kit for the
first time, take the help and guidance from trained staff)
5) The scanners (CT & MRI) have to be thoroughly cleaned
with designated antiseptic solution after each and every patient
(Routine). This includes cleaning of scanning table, gantry and
other areas like door handles, knobs, key board, mouse floor,
etc.
6) It is advised to leave a gap of 20 minutes at least in between
the patients to clean the room.
7) All suspected COVID patients should be pooled and done in
the evening at 6pm followed by thorough and extensive
cleaning. It is advised not to scan any other patient for the next 3
hours, except for emergency cases.

6. 8) For all suspected patients, the staff nurse accompanying the
patient only will enter the gantry area for positioning, etc. The
radiographer wearing a total PPE is advised to minimize the entry
into the gantry room and mainly stay in the console area.
9) For all the patients (including Routine and suspected COVID),
one or two bedsheets will be used on the table to minimize the
patient contact with the table. After each patient, the bedsheets have
to be put into a designated bag and are to be sent to laundry at the
end of the day. The bed sheets should be folded from the edges and
from outside to inside avoiding the patient contact side.
10) After each patient, Radiographer should inform House keeping
on 363 or 1445 so that cleaning aspect will be taken care.

7. 11) Two sets of basic PPE kits for Radiographers and two sets for
PG students will be provided to be used for USG scanning. If the
PG doctors are doing USG in suspected patients, a full PPE kit will
be given. Use the gowns, caps and shoe covers carefully. Do not
touch the outer aspect of these.
12) When Ultrasound scans are done in the department, apart from
basic PPE usage, Please sanitise the machine, knobs, probes, room
periodically. It is advised to use one bed sheet for one patient.
Keep the room ventilated (keep the door open and use the curtain.)
13)All USG scan requests in CCU should be pooled and done at
one stretch so the PPE can be used effectively.

8. 14) AC in console areas should be
switched off especially for suspected
patients.
15) Needless to say, that all should
follow physical distance, frequent
sanitization of hands or gloves and
avoid touching your face or outer
aspect of masks. Masks should be
taken off only by holding the strings.
16) This is all for now and we will
keep adding more info as and when
required.

9. HOW TO PERFORM PORTABLE CHEST X-RAY IN
COVID PATIENTS?

10. 1. HOW MANY PEOPLE ARE NEEDED TO DO THE
CHEST X-RAY (CXR)?
 TWO PEOPLE IN IDEAL SCENARIO: Two technicians need to
work together as a team. However, only one technician needs to
enter the ICU/isolation area, while the other remains outside. This
prevents cross contamination.
 IN VIEW OF MANPOWER CONSTRAINTS, ONE TECHNICIAN
WILL SUFFICE AS WELL. Another medical staff(buddy) may be
needed at the ICU/isolation room to help wear the PPE properly
and work with the cassette/detector
 GIVE ONLY COVID DUTY TO ONE TECHNICIAN: Do not ask
your technician to multitask

11. 2. WHICH MACHINE TO USE FOR THE X-RAY?
 Prefer portable DR over portable CR for COVID patients (less
handling of cassette needed)
 Use separate machines for COVID and non-COVID patients
 Scenario 1: Many portable machines available –use one for
ICU, one for isolation ward, and one for rest of the patients
 Scenario 2: Two portable machines available –use one for ICU
and isolation ward, and one for rest of the patients
 Scenario 3: One portable machine available –Use across all
patients after careful sanitization; try to acquire another
portable machine! Do Covid patients last -clean as per protocol
(discussed later)

12. 3. WHAT IS PERSONAL PROTECTIVE EQUIPMENT (PPE)?
PPE may include
 Mask (N95 respirator or surgical mask); NOT CLOTH
MASK
 Gloves
 Eye protection/ Face shield
 Hood
 High neck Gown
 Shoe covers and disposable
knee length boots
 (no skin is exposed)
Details on how to wear it ahead

13. 4. WHAT TO DO IN PREPARATION?
 Hold a mock drill to prepare the technicians, doctors, and
hospital staff with all SOPs
 Discuss with COVID team and cluster all X-rays into one or two
(morning and evening) slots to prevent excess use of PPE
 Do suspect patients first and proven patients last
 Sanities machine and detector between each suspected but not
proven patient; not required between each proven COVID-19
patient
 X-ray machine should be kept just outside or at the entrance of
the ICU/isolation ward
 REMEMBER TO NOT TOUCH YOUR FACE (MOUTH EAR
NOSE) AND TO NOT TOUCH ANY UNNCESSARY
SURFACES AND MAINTAIN HAND HYGIENE

14. 5. HOW TO PREPARE THE MACHINE BEFORE
ENTERING THE ICU/WARD?
 Sanitize your hands and change into scrubs
 Wear lead apron and wear non-sterile gloves
 Wipe the portable machine and the cassette/detector with alcohol
rub. Be careful to rub the parts you will touch first.
 Sanitize gloves. Enter the data of all patients who need to be
imaged together outside patient room
 Cover the cassette with 3 layers of plastic (could use garbage bin
bags for example)
 Cover the x-ray detector with 2 layers of plastic.
 Discard gloves. Next step is to don the PPE.

15. 6. HOW TO WEAR (DON) THE PPE?
 Remember to wear lead apron first. Sanitize your hands
again.
 See exact steps of donning PPR in next slide
 Check N95 mask fit by blowing into it; you should not feel
air escaping from the sides. Do this before wearing face/eye
protection
 No part of the body should be openly exposed

16. STEPS OF DONNING PPE (IN DESIGNATED ARE
ONLY
 Remove home clothes, jewelry,watches etc. and wear scrubs
 Wash hand with soap and water.
 Wear shoe covers.
 Wear first pair of gloves
 Wear clean disposable non-permeable gown(+/-neck cover if
hood doesn’t cover neck)
 Wear N95 mask (there should be minimal leak)
 Wear eye cover (goggle/face shield)
 Wear hood
 Wear 2 nd pair of gloves (should cover free end of gown
sleeves)
 Gown fitness check

17. CORRECT WAY TO WEAR MASK/ N95
Surgical Mask N95 Respirator
Chin covered
Nose covered
No facial hair
Nose covered
Over ear
Chin covered
At nape of neck
(and not under ears)

18. 7. WHAT TO WEAR IF FULL PPE NOT THERE?
 At least 2 triple layer surgical mask/one N95 + 2 gloves + cap
should be there
 Wear spectacles if you have (these need to be sanitized with
alcohol /soap water later)
 Use OT gowns and shoe covers if available
 Many do-it-yourself face covers can be made by the dept using
plastic sheets etc. think of ‘jugaads ’and ways to circumvent the
shortage
 Follow institutional reuse policies for masks

19. 8. HOW TO PERFORM THE X-RAY?
 As much as possible, keep 6-feet distance from the patient
 Place the cassette/detector in correct position quickly, move 6
feet away, give breath-hold instructions, and press trigger
 Check image; if good quality remove the cassette/detector and
move on to next patient
 Complete all patients in a single round with the same PPE for
both COVID-19 ICU and isolation wards (assuming that they
are next to each other)

20. 9. CAN ANOTHER MEDICAL STAFF PUT THE
CASSETTE/DETECTOR IN POSITION?
 YES; particularly if you do not have adequate PPE while
the medical staff does
 Explain to them how to position the cassette, or request
someone senior in the dept to make this request
 The medical staff can place the cassette, while you can
shoot from a distance

21. 10. ARE THERE OTHER POSSIBLE TECHNIQUES?
 If the patients are each in separate ICU cubicles,
you could take the x-ray staying out of the cubicle
 Position the x-ray tube outside the open door of the
cubicle, while the medical staff with PPE positions
the patient upright and places the cassette/detector
based on your directions
 Provide breathing instructions. The tube will be at
about 15-17 feet. Try using 125 kVp at this
distance. If the exposure time is too long, you may
need to move the patient closer.

22. 11. HOW TO SAFELY
REMOVE THE CASSETTE?
 Scenario 1 (2 technicians): Take the
cassette to the 2ndtechnician,
who will remove the cassette
with the inner cover without
touching the outer cover or the
1sttechnician. Discard the outer
cover and sterilize inner cover.
 2ndtechnician will remove
cassette from inner cover and
sterilize the cassette properly
 1st technician can continue taking
more x-rays similarly. Change
the outer pair of gloves between
two x-rays.
Mollura DJ et al. Radiology preparedness in
Ebola virus disease. Radiology. 2015

23. 11. HOW TO SAFELY
REMOVE THE CASSETTE?
 Scenario 2 (1 technician): Remove the
outside cover of the cassette and discard it
Remove outer pair of gloves Remove
cassette and clean it with disinfectant
Place the cassette in a separate space away
from the x-ray machine Wear another pair
of gloves Continue taking further x-rays.
 Scenario 1 (2 technicians): Take the cassette
to the 2ndtechnician, who will remove the
cassette with the inner cover without
touching the outer cover or the
1sttechnician. Discard the outer cover.
 2ndtechnician will remove cassette from
inner cover and sterilize the cassette
properly, while 1sttechnician can continue
taking more x-rays similarly. Change the
outer pair of gloves between two x-rays.
Mollura DJ et al. Radiology
preparedness in Ebola virus disease.
Radiology. 2015

24. 12. HOW TO SAFELY REMOVE (DOFF) THE PPE?
 Once all patient x-rays are over, wear fresh pair of
gloves and sanitize the entire x-ray machine completely
including the detector, handles, buttons etc
 Order of removing PPE: See next slide (the donning and
doffing instructions should be put up in the ICU as
well). Ensure you do not touch any part of routine
clothing while removing PPE.
 Take the cassettes back to the dept. Leave the x-ray
machine in its designated location.
 Do not shift machine to non-COVID patient areas/ non
COVID ICUs.

26. 13. WHAT TO DO IF WE DO A ROUTINE
RADIOGRAPH ON A PATIENT WHO LATER TESTS
POSITIVE FOR COVID-19?
 Disinfect the entire machine and room with 1% freshly made
sodium hypochlorite.
 Hydrogen peroxide vapor decontamination (fumigation) can also
be performed subsequently for 30-60 minutes.
 Lysol (commercially available) 2% is a suitable alternative for
machine surface.
 Disinfect keyboard and mouse with alcohol wipe at start of work-
end of work-whenever possible and in doubt.
 Leave room unused for 1hr; open ventilation-doors/ windows.

27. CT SCAN PROVIDES A BEST DIAGNOSTIC
INFORMATION FOR NOVEL CORONA VIRUSES

29. CT CHEST IMAGES OF COVID-19 LUNG INVOLVEMENT

30. COVID -19 PRESENTED IN LUNGS

31. THANK YOU
STAY SAFE