May. 2, 2018
Jessica Shell, A.A.S., R.T.(R)(CT)(MR), was a recent recipient of a 2018 RAD-AID/ASRT Foundation Outreach Fellow grant. She currently works as a traveling technologist with Aureus Medical Group. Her recent fellowship experience in Tanzania is an inspiration of how one technologist can touch lives on a global scale while helping to improve the quality of patient care. Visit the Foundation website to learn how you can receive a RAD-AID/ASRT Foundation Outreach Fellowship grant.
I’m so thankful for the time I spent with the talented team of technologists at Aga Khan Hospital in Dar es Salaam, Tanzania, and proud that we accomplished so much in such a short time. Working side by side during my four-week visit, the team and I implemented changes that honed their skills, improved their department standards and protocols, and provided better patient care. They were so receptive to working together, to learning about new methods and techniques, and to doing whatever was needed to elevate the department and patient care. Their eagerness and expertise made my job easy and a joy.
Fly On the Wall
During my first week at the hospital, I observed the daily routines in the magnetic resonance imaging and computed tomography departments to get to know their workflow, to determine areas for potential improvement, and to gather information about the concerns the technologists had. During the final three weeks, I split my time among the CT, MR and diagnostic imaging departments, serving as a consultant and teacher.
Reducing Dose in CT
After reviewing the CT department’s workflow practices, patient dose documentation and equipment protocol settings, I realized that my main concern was the dose patients were receiving during CT scans, and I identified several changes that would reduce it. These changes included adjusting the automatic exposure control settings on the equipment, which were higher than needed for the patient population, and explaining the new levels to the technologists who operate the equipment and showing them how to set them.
I also saw a need to create standardized protocols for various clinical indications. The typical workflow in the department was to perform a CT scan of the abdomen and pelvis with a noncontrast-enhanced series then repeat the scan — potentially several more times — in different phases of contrast enhancement. The radiation dose to the patients who were undergoing these multiple scans was much higher than desired or required.
Per the lead radiologist’s request, I gave a presentation to the team that addressed my concerns and recommendations for change. My assessment was well received, and I worked with the team to put these changes in place. We also created protocols for various diagnoses seen on CT orders and a guideline that ordering physicians could use to select appropriate imaging based on various clinical indications. In addition, I made recommendations for improving the department’s imaging practices, such as a slight increase in contrast dose and injection flow rate for CT angiography exams.
The combination of patient dose education, standardized protocols implementation and imaging practice modifications reduced patient dose and improved the overall quality of images.
Tweaking Improves Image Quality in MR
After a thorough review of the MR department’s protocols, I found they were in pretty good shape. However, I did suggest minor changes that would enhance the image quality of the scans from various exams. For example, I changed the MRA neck protocol to make it diagnostic for radiologists and to make it available for implementation into stroke workup for compatible patients. I also shared various techniques for improving image quality, such as creation of subtraction images and bolus tracking for angiography studies.
Technique Charts Make a Difference in Diagnostic Imaging
After reviewing the diagnostic imaging department’s radiographic positioning techniques, I developed a technique chart technologists could reference in selecting the proper technique. In addition, I showed them how to use the system’s dose index feature more effectively, which also will help ensure proper technique selection for each body part they image.
Creating Resources
During my weeks at Aga Khan Hospital, I created numerous handy references for the technologists, such as sets of protocols from other institutions, technique charts, protocols and ordering guidelines. Since returning home, I have connected with the team several times via phone, text and email in an effort to remain an ongoing resource to them.
Memorable Experience for All
Working with the wonderful people at Aga Khan Hospital is an experience I’ll cherish for a long time. The ability to exchange ideas and elevate methods of care made my outreach visit there a success. In addition, I came home a stronger person and an even more dedicated technologist.
I’m so honored to have been part of RAD-AID’s important movement to improve radiology service throughout the world, and I thank ASRT for the amazing opportunity. I was moved by the realization that although the world is different in so many ways, the passion for our profession and for quality patient care is a universal language that deserves to be cherished and celebrated.