April 02, 2020

ACR Information on Field Radiology Care During the COVID-19 Pandemic

The resources below are not intended to be — nor offered as — comprehensive medical guidelines, but may be of help as the radiological community works to protect patients and health care providers from this virus.

The diagnostic capabilities of radiology have been utilized in the field environment for more than 100 years, and there are many resources and precedents that can help inform its implementation in the current crisis created by the COVID-19 pandemic.1-4

The standard of care and regulatory requirements familiar to all radiology leaders will be the same, and this should serve as the starting point for all new field radiology projects. Major considerations fall into the categories of radiation protection, infection control, technical support and “lessons learned.”

Radiation Protection

Maintain a 6’ radius from the X-ray tube, patient and projection path.

For a fixed X-ray device, mark a standoff distance of 50’ from the tent structure housing radiology facilities. This will affect the location of the radiology workspace when planning the layout of the field hospital.

Ensure the radiology workspace has controlled access to limit exposure to non-radiology staff, patients and the public.

Maximize the use of collimation to reduce scatter radiation.

Radiology personnel should wear lead aprons, if possible, and conform to established dosimetry protocols.

Infection Control

The same infection control procedures recommended for a fixed facility will apply to the field hospital. Please refer to the Centers for Disease Control for the most up-to-date guidelines.

To maximize patient throughput while conforming to IC guidelines, consider the following:

Separate the X-ray tube from the patient with plexiglass in order to simplify terminal cleaning. Avoid glass when possible to minimize beam attenuation.

Remove unnecessary equipment from the radiography room to simplify terminal cleaning.

Utilize portable HEPA filters that vent externally to increase the rate of air circulation, to reduce the possibility of airborne transmission.

Consider a dedicated portable unit for use on intubated patients.

Technical Support

Power:

  • 10kW and 20-35kW generators are deemed enough to power up a portable radiography unit
  • A 20,000–35,000 kW generator is deemed enough to power the entire field hospital
  • Consider a dedicated power source for radiology
  • Placement of the generator should be done in consultation with radiology personnel

Networking:

Connections to the Electronic Health Record, the Radiology Information System and the Picture Archiving and Communication System should be established by experienced radiology personnel according to local standard.

Wired or WiFi networks and VSAT are preferable to CD transmission of images
Networks should be secured to protect patient data and to prevent data breaches

Lessons Learned

The best-laid plans may be undermined by overlooking small items that are often obvious to end users.5

 The planning and implementation team should be multidisciplinary and include subject matter experts from every step in the radiology value chain. Teams should include a radiology technologist, medical physicist(s), medical maintenance officer, network and PACS specialists, power and facilities staff, infection control and a staff radiologist.

References

  1. Thomas AM. The first 50 years of military radiology 1895-1945. Eur J Radiol. 63, 214-9 (2007).
  2. Department of the Army. (2002). Management and control of diagnostic, therapeutic, and medical research x-ray systems and facilities (TB MED 521).
  3. Department of the Army. (1994). Employment of the combat support hospital tactics, techniques, and procedures (FM 8-10-14).
  4. Interagency Working Group on Medical Radiation. (2014). Federal Guidance Report No. 14: Radiation Protection Guidance for Diagnostic and Interventional X-Ray Procedures.
  5. Bess DW, Roberge EA. Battlefield Teleradiology. Curr Trauma Rep 2, 173-80 (2016).