Profile of the institution
Each year,
the Hospital attends 2,800,000 consultations,
manages 46,500 discharges and performs 52,000 surgical procedures in its 41 operating theaters.
It has a capacity of 785 beds,
of which 200 are for critical care,
and 800 beds of home medicine.
Its work team is made up of 9237 people: 3400 medical doctors,
3337 members of the health staff and 2,500 people from the administrative sectors.
Global political actions
1.- From the Head of the Imaging Department arose the idea for applying to become an EuroSafe Imaging Star institution.
2.- This idea was submitted as a major improvement in health care safety and quality to the main authorities of the Hospital (Medical Director,
Dean,
CEO,
etc).
3.- Approval of the hospital directory was obtained.
A task force was constituted (Head of the Imaging Department,
a radiologist specialized in quality and safety (Q&S) and two medical physicists and started working on the first steps to proceed with the accreditation of the Hospital in the EuroSafe Imaging Stars program.
4.-A strategic decision of creating a Radioprotection Committee (RP) was decided institutionally,
which included the members of the aforementioned taskforce.
5.- The RPC integrated a multidisciplinary team of auditors (composed by medical experts in the use of ionizing radiation,
radiation physics,
radiation oncology,
nuclear medicine,
interventional radiologists,
etc.-) as well as experts in other safety and quality aspects of health care (clinical engineering,
occupational health ,
etc.) to perform an audit program.
A team leader was designated and responsible for organizing the tasks and preparing the final report making sure that no conflict of interest existed between the auditors and the areas to be audited.
Operative actions
1.- The quality manual was written.
One of the main tasks was radiation protection on children.
2.- The protocols of fluoroscopic studies were included in the items to be audited.
In this way,
the most frequently requested studies were identified: the barium swallow (sometimes combined with small bowel transit),
voiding cystourethrography and contrast Enema.
The main indications of these three studies are summarized in Table 1.
3.- In joint work with medical physicists,
it was determined the use of:
-
Leaded apron,
thyroid protector,
eye protector,
and gloves (if the child is immobilized during the shooting) both the medical personnel and the companion (Figure 1).
-
Gonadal,
thyroid and/or mammary protection by the patient,
in case the study focuses on another region of the body.
-
Fixation/immobilization elements that facilitate study and reduce fluoroscopy times,
always trying to make the patient and his family feel comfortable.
-
Use of equipment light for patient placement,
rather than fluoroscopy.
It was defined that the position must be correct before beginning fluoroscopy,
to decrease the time of exposure to radiation (Figure 2).
4.- The following technical parameters were also specified:
-
Inclusion in the visual field of all the elements to be evaluated,
with correct collimation of the area of interest in order to avoid irradiating unnecessary areas .
-
Positioning of the patient as close as possible to the intensifier (less than 5 cm).
-
Positioning of the X-ray tube as far as possible.
-
Use of pulsed fluoroscopy,
not continuous,
with a frequency of 3.5-7.5 pulses /sec and pulses of 2-10 mS duration; and carrying out frozen image registers,
that is,
not using additional registers.
-
Avoid using magnification and use digital zoom whenever possible.
-
Activate the grid in children over 8 years old.
Do not use it in younger children or in children of small size for their age.
-
Use copper filtration.
-
Be aware of fluoroscopy time alerts during the procedure.
-
Record of the fluoroscopy time and the dose administered,
once the study is finished.
-
Adequacy of the technical parameters according to age and weight,
as it appears in the table 2.
5.- Exposure parameters are defined in table 3,
4 and 5 for contrast enema,
voiding cystourethrography and barium swallow.