A Longitudinal Evaluation of Computed Tomography Radiation Incidents Within a Multisite NHS Trust.

OBJECTIVES: This single-center review explores trends in computed tomography "radiation incidents" and suggests strategies for improvement. METHOD: A retrospective mixed-methods approach was used in this longitudinal evaluation of radiation incidents within a multisite NHS Trust in northern England. DATIX was interrogated at the Trust level to identify all records linked to radiation incident in computed tomography departments between January 1, 2015, and December 31, 2018. RESULTS: During the 4-year review period, 159,596 exams were performed at the Trust and a total of 133 incidents were recorded. This comprised 42.1% (n = 56) of radiation incidents, 43.6% (n = 58) of near-miss incidents, and 14.3% (n = 19) of repeat scans due to extravasation of contrast. The reported radiation incident rate was 0.08%. These data suggest an approximation of 1 incident per thousand cases. Most incidents were investigated using a "system approach," and the reports highlighted the relevant action that had been taken to try and prevent recurrence of the incident. Qualitative data collected from the root cause analysis minutes demonstrated themes related to the contributory factors, incident analysis performed, and overall learning. CONCLUSIONS: Computed tomography departments need to focus on a system approach instead of the "person approach" to identify areas where efficiencies can be implemented. Staff should feel open to discuss system inefficiencies that they experience and may highlight problems the management is unaware of. The reporting of all types of incidents, including near misses, should be encouraged, to foster an open culture and to expand learning.

Computed tomography during the COVID-19 pandemic: A survey of changes to service delivery, working practices and decision-making role of radiographers.

INTRODUCTION: During the COVID-19 pandemic, Computed Tomography (CT) departments have established additional acute capacity whilst maintaining essential services. The purpose of this study was to investigate the changes in service delivery, working practices and decision-making role of diagnostic radiographers during the pandemic. METHODS: We conducted an electronic cross-sectional survey of diagnostic radiographers working in CT during the COVID-19 pandemic. The survey was open for 6-weeks, with radiographers from all geographical regions encouraged to respond. The questionnaire explored social distancing, patient scheduling and departmental organisation; PPE usage; recognition and escalation of COVID-19 changes, patient management pathways and any training. Additionally, we sought the personal perspectives of radiographers through free text comments. RESULTS: Following exclusions, 180 responses were analysed. Service delivery changes included social distancing (59.4%; n= 107), restriction of referrals to those considered time-critical (63.3%; n=114) and dedicated COVID-19 scanners (66.1%; n=119). Working practices were impacted by a need to implement PPE, although variation in PPE worn for different scenarios was seen. Half of the radiographers were routinely reviewing asymptomatic outpatient images for common COVID-19 signs, despite 63.5% of respondents not receiving formal training. Ad hoc patient pathways were in place in 90.5% of cases with 35% indicating that this was radiographer-led. CT staff had experienced anxiety, fatigue, and low morale, but praised teamwork. CONCLUSIONS: Radiographers were able to reduce the risk of transmission through social distancing, designated scanners, and PPE. This study has demonstrated that despite variance in practice, radiographers play a key role in identifying and triaging high-risk patients.