移动方舱CT用于新型冠状病毒肺炎检查的工作流程与实践

建立方舱医院可有效缓解新型冠状病毒肺炎(COVID-19)疫情期间医院的压力,利于及时收治轻型和普通型病人。CT检查在COVID-19病人的发现、病情监测及出院评估上起到重要作用,而移动方舱CT有其特殊的优越性,其投放使用在避免院内交叉感染、快速解决相关病人大流量影像检查方面发挥了巨大作用。就疫情期间关于方舱CT的检查流程及防控策略做一简单介绍,以资参考。     

新型冠状病毒肺炎放射诊断检查场所的感染控制与辐射安全监测和分析

目的 对新型冠状病毒肺炎放射诊断场所存在的感染控制和辐射安全风险进行调查和监测，为放射技师及相关工作人员的安全防护提供数据支持。方法 根据国家标准（WS 519-2019和GBZ 130-2013）对湖北省4所未启用的应急医院（"小汤山式"甲、乙医院及方舱医院、砖混模式医院）中新安装的8台CT及其场所进行成像性能和放射防护检测并评价。对机房布局等感染控制安全的因素实施了监测与调查。选择定点医院2所（综合医院和传染病专科医院），通过现场调查和对4个CT机房环境生物样本进行新型冠状病毒核酸检测，对放射场所的布局、感染防控和核酸检测结果的分布进行分析，评价其生物安全的可靠性和风险点。结果 应急医院的8台CT设备的成像性能和放射防护指标均能满足国家标准的要求。甲、乙医院各有3个CT机房，面积均为38.8 m²和4 mm Pb当量的屏蔽防护；方舱医院和砖混建筑医院的CT机房面积和屏蔽防护分别为20.0 m²、4 mm Pb当量和35.8 m²、3 mm Pb当量。8个放射诊断场所符合感染防控"三区两通道"的设计要求。新型冠状病毒核酸检测结果显示，CT机房内患者触碰到的多个位点如检查床、机架内侧、地面等多处发现核酸阳性。放射技师通过手部、足底沾染造成操作间内操作台和地面的病毒污染风险。此外，机房内患者未触及的区域如观察窗和排风口等处也出现类似阳性。结论 4所应急医院的8台CT设备和机房基本满足成像性能和放射防护要求。新型冠状病毒肺炎放射诊断检查场所需加强消毒的规范化。     

新型冠状病毒肺炎CT方舱剂量检测与防护分析

目的 调查新型冠状病毒肺炎防控期间武汉地区方舱医院使用的CT方舱放射诊疗安全与放射防护水平。方法 现场调查CT方舱的总体布局、放射防护设施及个人防护用品,并对CT方舱放射防护水平、CT剂量指数进行检测,按照国家相关标准进行分析与评价。结果 CT方舱总体布局基本合理,设置的放射防护设施较齐全。检测23套CT方舱放射防护水平,合格20套,合格率87.0%,3套不合格CT方舱各存在1个超标检测点,经整改后均符合要求;检测7台方舱CT的体部剂量指数,加权CT剂量指数（CTDI_W）变化幅度均在±7.5%内。结论 CT方舱放射防护效果总体较好,可满足新型冠状病毒肺炎防控期间放射诊疗辐射安全与放射防护的要求。     

方舱CT技术进展与临床应急使用现状

在新型冠状病毒肺炎(COVID-19)的诊疗方案中,CT检查被确定为该疾病诊断和疗效判定的关键方法。在方舱医院建立后,方舱CT更是成为复杂条件下应急救治的必备工具。梳理方舱CT的发展历程、设备配置及扫描参数、临床应用,综述方舱CT在临床应急使用中的相关进展。     

野战心理防护方舱开进新兵营

春节前夕,济南军区联勤部抽调战时心理防护专家和野战心理防护方舱,赴新兵营开展心理教育、心理疏导和咨询服务,受到普遍欢迎。这台由第89医院研制的野战心理防护新装备,分为指挥控制、接诊咨询、综合干预等6个区域,配有先进的心理干预仪器设备和多套军人心理干预系统,具备     

方舱医院车载CT在新型冠状病毒肺炎检查中的防护问题及对策

自2020年2月9日以来,江汉方舱医院车载CT开始陆续接诊新型冠状病毒肺炎患者,车载CT在临床诊断方面凭借其独特的优势,发挥了不可替代的作用。在CT检查中,一线放射技师既要保证患者接受尽可能低的辐射剂量,同时要注重放射技师和患者的感染防控,并及时关注放射技师有无心理健康问题,并采取相关措施予以干预。     

野战方舱医院设立“五官”方舱模块的探讨

在野战方舱医院中设立＂五官＂方舱模块,有利于提高口腔、耳鼻喉和眼科疾病的救治能力。本文探讨了设立野战方舱医院＂五官＂方舱模块的意义,介绍了＂五官＂方舱模块在灾害救援中的实际应用经验与装备改进的思路。     

COVID-19疫情下非新冠肺炎患者CT检查流程及感染防控

【摘要】随着2019新型冠状病毒肺炎（COVID-19）疫情的好转,群众基本就医需求增加,普通门诊、急诊和住院部开始连续恢复非新冠肺炎患者的救治工作,但无症状或不以发热为首发症状的新冠肺炎感染者将成为重要的传播源,CT检查作为临床上常用的辅助诊断手段,尤其是对新型冠状病毒肺炎的排查,使CT室成为感染防控的重点科室。通过阅读相关政策文件、规范标准及文献资料,结合自己的工作体会,从规范CT检查流程、建立疫情防控小组、环境、人员和流程防控五个方面,提出非新冠肺炎患者CT检查流程及感染防控策略,供大家参考。     

新冠肺炎疫情常态化防控下行急诊经皮冠状动脉介入治疗护理管理专家共识（2022年版）

鉴于当前新冠疫情形势仍严峻复杂,特制定疫情常态化防控下行急诊经皮冠状动脉介入治疗的护理管理专家共识,内容主要包括应急预案、患者接诊与转运、术前准备、术中防控、术后处置等五个方面。旨在为全国各级医院运用急诊经皮冠状动脉介入治疗（PCI）ST段抬高型心肌梗死（STEMI）患者提供规范化的流程管理和标准防控指导,在保证患者得到快速、高效救治的同时,杜绝院内感染并实现医务人员零感染;同时避免过度防护,提供可靠依据。     

COVID-19患者CT增强检查流程及防护管理体会

【摘要】自2019年12月以来，新型冠状病毒肺炎（COVID-19）确诊人数与日俱增，形势十分严峻。我院作为COVID-19患者定点收治医院之一，在承担收治COVID-19患者工作的同时，还要保证其他疾病的医疗救治。与此同时，由于疫情爆发期正值冬春季节，也是主动脉夹层等疾病的高发时期，而该类疾病属于急诊范畴，需快速诊断及治疗，目前诊断主动脉夹层的首选方法是多层螺旋CT血管成像（CTA）。因此，为了避免院内交叉感染，在保证正常医疗救治工作的前提下，对于那些急需行CT增强检查的COVID-19患者，既要建立起高效的急诊患者“绿色通道”，又要做好COVID-19患者CT增强检查的流程及防护管理。本文结合国家卫生健康委员会颁布的COVID-19相关防控法规及我院实际情况，以1例在我院行急诊CTA检查的COVID-19患者为例，介绍COVID-19患者的CT增强检查流程及防护管理体会。     

新型冠状病毒肺炎患者影像学检查防控措施

目的探讨如何确立一套防控措施,适用于新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疑似患者和确诊患者的影像学检查。方法启动应急预案,在隔离病房放置一台移动DR摄影机,给COVID-19患者进行胸部X线摄影,来初步评估治疗效果;指定专用CT检查室,关闭通风系统,划分三区(清洁区、半污染区和污染区),开辟医患专用通道。结果目前我院放射科已经进行了468例次床旁胸部X线摄影检查,270例次胸部CT检查,无1例院内交叉感染事件发生。结论建立一个适用COVID-19患者影像学检查的防控措施,可避免医务人员感染和院内感染。     

Cost-effectiveness of trauma CT in the trauma room versus the radiology department: the REACT trial

Objective

To determine the cost-effectiveness of trauma room CT compared with CT performed at the radiology department.

Methods

In this randomised controlled trial, adult patients requiring evaluation in a level 1 trauma centre were included. In the intervention hospital the CT system was located within the trauma room and in the control hospital within the radiology department. Direct and indirect medical costs of the institutionalised stay and diagnostic and therapeutic procedures were calculated.

Results

A total of 1,124 patients were randomised with comparable demographic characteristics. Mean number of non-institutionalised days alive was 322.5 in the intervention group (95?% CI 314?C331) and 320.7 in the control group (95?% CI 312.1?C329.2). Mean costs of diagnostic and therapeutic procedures per hospital inpatient day were ?554 for the intervention group and ?468 for the control group. Total mean costs in the intervention group were ?16,002 (95?% CI 13,075?C18,929) and ?16,635 (95?% CI 13,528?C19,743) for the control group (P?=?0.77).

Conclusion

The present study showed that in trauma patients the setting with a CT system located in the trauma room did not provide any advantages or disadvantages from a health economics perspective over a CT system located in the radiology department.

Key Points

? Computed tomography has become increasingly important in patients who have suffered trauma. ? Emergency departments either use embedded CT facilities or CT machines in the radiology department. ? The cost-effectiveness of CT was not influenced by the location of CT. ? The number of non-institutionalised days alive was not influenced by the location. ? Further assessment of optimal location of CT units is required.     

MSCT对肝包虫囊肿及并发症的诊断价值

目的:探讨MSCT在肝包虫囊肿及其并发症诊断中的应用价值。方法:回顾性分析我院经手术确诊的46例肝包虫囊肿的CT表现。结果:46例共61个包虫囊肿。单房性包虫囊肿14例,多房性包虫囊肿32例;有钙化16例,无钙化30例。其中有并发症19例。单房性包虫囊肿并发症中内在性破裂4例;多房性包虫囊肿并发症中13例为交通性破裂,直接破裂2例,合并感染2例。误诊1例,46例术前CT诊断正确率为97.8%。结论:螺旋CT可为肝包虫囊肿及并发症诊断、治疗提供可靠的影像依据,具有较大的临床应用价值。     

Workload of an imaging department in 1978 vs. 1982: changes, reasons, and resolutions

The diagnostic radiology workload in a university-affiliated general hospital (primarily for inpatients) was recorded and analyzed as to number of examinations and room occupancy time of three different representative months in both 1978 and 1982. Examinations of conventional radiology decreased in number in all fields, markedly in the biliary system and GU tract and minimally in the chest and skeletal system, whereas ultrasound as well as CT rapidly increased in number and/or time. Special procedures (invasive/interventional) also increased in number and time with the exception of lymphography. Future planning of imaging rooms as well as training programs should be instituted based on these data.     

Workload in a roentgenologic department 1978 and 1982. Changes--causes--consequences

This is an analysis of the workload in the imaging department (number of exams and room time) from 1978-1982. The different changes are listed and explained. During the 4 years there has been a significant increase in Ultrasound, CT, and special procedures (invasive/interventional), whereas in conventional radiology the workload decreased. The origin of requests for diagnostic work-up was found to be not only due to the total number of hospital beds. It depends mainly on the type of clinical specialty making use of the beds. The consequences of these findings are discussed briefly.     

三级医院介入放射防护能力及个人防护现状调查

目的 调查三级医院介入放射防护能力及个人防护现状.方法 2014年6月至2015年11月于广东省某三级医院对108名在介入室、CT/MR室、介入导管室、放疗科、放射科的在岗的医师、技术人员及护理人员进行问卷调查.采用自行设计的问卷,调查医务人员的一般人口学资料、个人辐射接触及防护资料,自制医院介入放射防护能力问卷(I-CVI、S-CVI均为0.9)调查医院的介入放射防护能力.结果 广东省某三级医院在屏蔽设施、操作时间及距离防护方面的防护能力较强,但仍缺乏完善保健休假制度,职业危害检测不足,存在对防护及培训制度执行力不足等现象.个人防护方面,介入手术过程中铅围裙的使用率仅为72.2％,不佩戴放射检测仪高达4.6％,表示不确定放射检测仪佩戴位置的医务人员高达9.3％.结论 医疗机构对放射介入医务人员个人防护、职业健康重视不足;部分医务人员防护意识淡薄,防护知识缺乏,对职业防护缺乏足够重视,有待进一步加强.     

Early clinical management after polytrauma with 1 and 4 slice spiral CT

In the early clinical phase the comprehensive imaging of patients with multiple trauma using helical CT is already established. Aim of this study was to assess whether MSCT may improve the patient management and the diagnostic results. The procedure is designed as follows: after life-thretening treatment x-ray of chest and ultrasound are carried out in the emergency room. Then the patient is moved to CT. From 1998 to december 2000 241 patients were examined using a single slice helical CT (Somatom plus 4), in 2001 79 patients using a 4-slice helical CT (Somatom VZ, Siemens Med.Sol.). After CT selected radiograms of the extremities were taken. 359 of 360 procedures were carried out successfully. Excluding 1 case (death during 1-sl.h CT) all relevant lesions of head, neck, and body were diagnosed. Although the patients had an injury severity score of approximately 30. The change from 1 slice-helical CT to 4 slice-helical CT allowed us to reduce the stay in the CT room from 28 to 16 min. The total lethality decreased by approximately 4%. Advantages for the patient arose from the standardized examination protocol using multislice CT. If integrated in an interdisciplinary management concept, it is a good compromise between examination time, comprehensive diagnostic imaging, life-saving therapeutic procedures, and therapy planning.     

Improved Utilization Following Conversion of a Fluoroscopy Suite to Hybrid CT/Angiography System

PurposeTo assess changes in operational utilization following conversion of a single IR suite to a hybrid CT/angiography (Angio-CT) system at an academic tertiary care center.Materials and MethodsThe total number of interventional procedures and diagnostic CT examinations performed in 29 rooms (20 diagnostic radiology, 7 IR, 2 shared between divisions) was calculated in the 24 months before conversion of an IR suite to Angio-CT and 12 months after conversion. The total number of IR procedures (global IR/month) and diagnostic CT scans per month (global CT/month) in both before and after conversion periods was calculated and defined as baseline institutional growth. This was compared against the change in the number of IR procedures performed in the before and after periods in the converted room (Angio-CT/month) as well as the number of diagnostic CT scans performed in the shared rooms (shared CT/month).ResultsThe percent change in global CT and global IR from the before to the after periods was 39.2% and 3.1%, respectively. Shared CT per month and Angio-CT per month increased by 46.7% and 12.0% across the same time periods, respectively. The ratio of the percent increase in Angio-CT per month to percent increase in global IR per month was 3.87. The ratio of the percent increase in shared CT per month to percent increase in global CT per month was 1.19.ConclusionsOperational utilization improved in both diagnostic radiology and IR sections following conversion of a conventional fluoroscopic IR suite to an Angio-CT room.     

Iatrogenic venous air embolism caused by CT injector--from a risk management point of view

An iatrogenic venous air embolism caused by computed tomography (CT) injector occurred in a 74-year-old man undergoing abdominal-pelvic CT for evaluation of an abdominal aortic aneurysm (AAA). During the initial inspection scan of the thoracic part, a large amount of air was detected in the right ventricle, but no contrast medium was noted in the aorta. Surface oxygen was given immediately, and the patient was placed in the left lateral decubitus position on the CT bed. During that time he had no symptoms except coughing. CT revealed no air in the brain or pulmonary vein, and he was returned to his room 55 minutes after the incident. There were no complications during a six-month follow-up period. The importance of daily risk management and immediate proper after care to prevent such accidents was reconfirmed.